March 2010

RED FLAGS PROGRAM

The Red Flags statute is scheduled to go into effect on June 1, 2010. On Tuesday, March 23 at 8:00 am (prior to office hours) CPB is sponsoring a program at our office in conjunction with MSNJ on implementing the Red Flags program. The program includes handouts that will put you about 90% of the way to compliance.

If you are interested in attending, please RSVP no later than noon on Monday, March 15th. A light breakfast will be provided.

SOFTWARE UPDATES

One of the concerns we are hearing recently is patients who forget their appointments. Our software vendor has just released an “Auto-Dialer” product that can be used with our appointment system to automatically call pts a day or 2 prior to their appt as a reminder.

They also released another new product called a “Digital Pen” which also is used with our appointment system. If you chose to use this product, CPB would cover the cost.

Both of these products would improve the efficiency of your office and cash flow (patients who show up create $$!). Please give Rich a call if you are interested.

HITECH ACT

As everyone knows from our email or other sources, the HITECH Act went into effect Wednesday February 17th. This information was also emailed to all CPB clients (if we had an email address).

While it covers a number of issues, the one that relates directly to billing is the ability of a patient to require you to “not to disclose an item or service paid for entirely out-of-pocket by an individual to a Health Plan for payment or health care operations purposes, unless such disclosure is required by law.” In other words, you cannot bill insurance for that service.

We do not expect this to occur very often, but a few things are important when it does.
· Your financial policy needs to be revised to clearly indicate that you will comply with their request but it requires payment on the date of service. Each pt needs to sign the new financial policy. If you have the CPB version, let me know and we’ll send the latest version to you.
· It may be helpful to add a sign to your office waiting room “Patients who do not want their insurance billed, the office requires notice prior to being seen and payment in full is required today.”
· Be sure to collect full payment that day and record it on the Charge form.
· On your Charge Form, it is critical that you clearly indicate in big, bold letters “Do Not Bill Insurance.” We will then enter the charge and patient payment, then remove the insurance so it does not get billed.

If there are any questions, please call me.

February 2010

PROVIDER MEDICAL RECORD SIGNATURES - UPDATE

Highmark Medicare has now agreed that “Electronically Signed” signatures are now acceptable.

Medicare 2010 eRx Program

The 2010 program has some small changes from the 2009 program making it easier to participate.
· Only 1 code is now used: G8553: “At least 1 Rx created during the encounter was generated and transmitted electronically using the eRx system.”
· Only 25 or more unique visits (reporting the code 25 times) are required, with a minimum of “10% of an eligible professional’s Medicare Part B charges”. The codes counted include all of the office visit codes (99201-99215), plus Home, Rest Home, and Nursing Home visits.
· Still requires a “qualified electronic prescribing (eRx) system.”
· The G8553 MUST be submitted with the E&M code at the time it is billed for claims reporting. The G8553 cannot be sent at a later date and still count.
· Payment will be 2% of “allowed charges for professional services covered by Medicare Part B.” If you are also performing other testing in your office and billing globally (meaning both the technical & professional components), then we read this to mean that the 2% will not include the technical component portion of payments.

If you decide to participate, CPB (i.e., Rich) will need to know in advance so we can add the G8553 to your charge master and make sure the data entry staff are also aware. Clients for whom we maintain their charge form, we will add the code for you.

Please call with any questions.

2010 MEDICARE PHYSICAL, OCCUPATIONAL & SPEECH THERAPY CAP

The Therapy Cap for 2009 is $1,860 through December 31, 2010. However, as of January 28th, the Medicare Cap Exceptions process for independently practicing physical, speech and occupational therapists has not been extended beyond December 31, 2009. Our software is tracking each patient’s progress. Patients who near the Cap have the option of transferring their care to an outpatient hospital setting or signing an Advanced Beneficiary Notice and accepting responsibility for the balance.