November 2012

Hurricane sandy

Hurricane Sandy has passed and we hope everyone is able to get back to normal as soon as possible.  Fortunately, CPB did not experience any service interruption.  If anyone needs assistance, please let us know. 

CHANGING MEDICAL environment – We are here for You!

As you are aware, the medical environment is changing rapidly – EHR’s, ICD-10, etc.  CPB is well prepared to help guide and support you thru all of these changes.  Most of the preparation for ICD-10 change will be handled by CPB, our software vendor, our coders, and the insurance companies.  ICD-10 is not effective until October 1, 2014 and we have already performed our Risk Analysis. 

The growing corporatization of medicine has forced many physicians to consider giving up the independence of private practice to merge with a larger practice or hospital. Unfortunately, this not only takes away from the physician’s ability to provide individualized, quality care but will not avoid problems that arise from the inevitable changes caused by ICD-10.

If you are beginning to wonder what effect the whole process will have on your practice, be comfortable knowing that CPB will be working with you well in advance to ensure your cash flow is not interrupted. Our success is tied to your success and we are partners in this challenging transformation.

We appreciate the opportunity to serve you and look forward to helping you through the upcoming 2 years of ICD-10 changes.

HOME INR TESTING & PAYMENT

Medicare covers 2 INR codes:

• G0248:  “Demonstration, prior to initiation of home INR monitoring, for patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets Medicare coverage criteria, under the direction of a physician; includes: face-to-face demonstration of use and care of the INR monitor, obtaining at least one blood sample, provision of instructions for reporting home INR test results, and documentation of patient's ability to perform testing and report results.  Medicare’s Allowed Amount for southern NJ is $140.25.

• G0250:   “Physician review, interpretation, and patient management of home INR testing for patient with either mechanical heart valves(s), chronic atrial fib, or venous thromboembolism who meets Medicare coverage criteria; testing not occurring more frequently than once a week, billing units of service include 4 tests per unit.”  Medicare’s Allowed Amount for southern NJ is $9.68 and is billable every 4 weeks.

For both codes be sure to include a Diagnosis for the medical condition that requires the INR monitoring (A Fib, etc.), as well as V58.83 & V58.61.  We can update your Healthpac Charge form if it does not already have the necessary codes.

October 2012

HORIZON NJ HEALTH – NOW REQUIRING CO-PAY’S

As you may know, Horizon NJ Health is now requiring a co-pay.  We strongly recommend that it be collected on the date of service. 

Refunds

1. We reviewed the cause of refunds for the past few months – well over half are due to collecting co-pays for Well visits (99381-99397) when that was the only reason the pt was seen.  It is not necessary to collect the co-pay when the pt was only seen for a Well Visit. 

            If the pt had both a Well visit and a “sick” visit, then the co-pay should be collected for the          sick visit. 

2. Another smaller but significant # of refunds are for patients only seen and billed for a procedure (echo, surgery, injection, etc.) – no office visit was billed.  No co-pay is usually necessary then either.

Both of the above are separate from a patient’s deductible – which, if not met, still needs to be collected.

Of course, please do not pay any refund request from an insurer that has not been reviewed and confirmed by CPB as an overpayment.  For Medicare and other insurers who will do offsets, we will notify the insurer (if we agree) to do that offset.  If you send a check, they often still take the $ back and then also have your check. 

CHECKING PATIENT ELIGIBILITY & STATUS OF CO-PAY & DEDUCTIBLES

For clients using the Appointment Scheduler, we will have the ability to check patient eligibility and status of co-payments & deductibles in the near future.  If you are interested in this service, please let Rich know.

BENEFITS of patient portals

For office-based specialties, physician and non-physician, the current “best practices” emphasizes collecting the known patient balances on the date of service.  Web-based programs now offer convenience to both the offices and patients that were not available in the past.  The following is an example of the benefits:

“Boca Raton Regional Medical Center has significantly boosted collections from its patients by placing a payment portal on the hospital's website.

The 400-bed facility in Southeast Florida added the payment portal to its website in the spring of 2011 with the intent of increasing cash flow and reducing its accounts receivable days, Veronica Small, Boca Raton's patient finance services director, said at the Healthcare Finance Management Association's annual national institute in Las Vegas on Monday.

Although web-based portals for paying bills have proven immensely popular for consumers, healthcare has been slow to adapt such methods. Less than 10 percent of patient payments were made online in 2010, reported American Medical News. However, some software companies are moving toward that arena, even offering smart phone apps to process patient payments, according to Tech Crunch.

Boca Raton had performed a little more than 77,000 patient payment transactions between April 2010 and March 2011, the one-year period just prior to installing the payment portal. After its installation in April 2011, transactions increased more than 10 percent, to 84,463 during the following one-year period. Overall collections increased from $13.8 million to $14.7 million. Accounts receivable over 180 days--considered the write-off point by the hospital--dropped more than 6 percent.” 

If you want to read the full article, you can find it at:

http://www.fiercehealthfinance.com/story/hospital-boosts-patient-payments-online-portal/2012-06-26?utm_medium=nl&utm_source=internal

Medicare Influenza Vaccine Fees – 2012-13

 Payment Allowances Effective for Dates of Service between October 1, 2012 and September 30, 2013 are:

Q2035	Afluria vacc	$11.54
Q2036	Flulaval vacc	$9.83
Q2037	Fluvirin vacc	$14.05
Q2038	Fluzone vacc	$12.05
Q2039	Not otherwise specified flu vacc	Individual Consideration
90654	INFLUENZA VIRUS VACCINE	$18.98
90655	INFLUENZA VIRUS VACCINE	$16.46
90656	INFLUENZA VIRUS VACCINE	$12.40
90657	INFLUENZA VIRUS VACCINE	$6.02
90660	INFLUENZA VIRUS VACCINE	$23.46
90662	INFLUENZA VIRUS VACCINE	$30.92
90669	PNEUMOCOCCAL CONJUGATE VACCINE	$95.48
90670	PNEUMOCOCCAL CONJUGATE VACCINE	$137.03
90732	PNEUMOCOCCAL POLYSACCHARIDE VACCINES (PPV)	$65.77
90740	HEPATITIS B VACCINE (HBV)	$119.42
90743	HEPATITIS B VACCINE (HBV)	$24.22
90744	HEPATITIS B VACCINE (HBV)	$24.22
90746	HEPATITIS B VACCINE (HBV)	$59.71
90747	HEPATITIS B VACCINE, DIALYSIS	$119.42

Vaccine Administration Codes:

• G0008 - ADMINISTRATION OF INFLUENZA VIRUS VACCINE
• G0009 - ADMINISTRATION OF PNEUMOCOCCAL VACCINE
• G0010 - ADMINISTRATION OF HEPATITIS B VACCINE
• G9141 - INFLUENZA A (H1N1) IMMUNIZATION ADMINISTRATION

In NJ the Vaccine Administration Codes Allowed amount is $26.58 for southern Jersey and $27.79 for Central & northern Jersey.

September 2012

MEDICARE ANNUAL WELLNESS VISITS AND EKG’S

G0402 Initial Preventive Physical Exam (IPPE) First 12 months of Medicare eligibility

G0403 Used only with G0402 to obtain a baseline EKG

G0438 First Annual Wellness Visit after 12 months of eligibility.

G0439 Subsequent years Annual Wellness visits. Must be 12 months since the previous year’s G0438 or G0439.

Medicare does not have a separate CPT code to bill an EKG on the same day as a Medicare Annual Wellness Visit (G0438 & G0439) like they do for an IPPE (G0402). Thus, to bill for an EKG - and get paid- with either a G0438 or G0439 you will need one of the pathologic diagnosis indications.

COLLECTING CO-PAYS

Reminder – only collect copays for office visits – not for Well Visits (99381-99397) or if the patient only received a procedure (no office visit). They almost always are overpayments resulting in refunds.

BILLING DRUGS

Some drugs are covered by insurers. Please not the following requirements:

• The NDC #, found on the product packaging, is required by NJ Medicaid and a few other insurers. Please be sure to send a copy of the label – large enough to be readable. Be sure to provide the unit measure given (Grams, mg, ml, etc.)

• The HCPCS (J”) code description specifies how it is to be billed – which often is very different than the way it is packaged. If it says “per mg” – and there are 10 mg/ml – then if you give 1 ml you will need to indicate 10 units (mg’s) on the charge form. Then you will get paid the correct amount. If you give 1 for “1 ml” – then you will not get paid in full.

Examples:

• 1 - description of drug is per 6 mg. 6 mg administered. Therefore - 1 unit is billed.

• 2 - description of drug is per 50 mg. 200 mg administered. Therefore - ◦ 4 units are billed.

• 3 - description of drug is per 1 mg. 10 mg vial of drug administered. Therefore - 10 units are billed

For Medicare, it is specifically stated that they will not cover an injection (96372) “if the provider is paid for any other physician fee schedule service (includes any office visit) furnished at the same time.” (August 29, 2012 Novitas Webinar.

Drug Waste:

• If the remainder of a vial must be discarded after being administered, the program covers the amount discarded as well as the amount administered.

• The amount ordered, administered, and the amount discarded must be documented in the

medical record.

• Coverage of discarded drugs applies only to single use vials. (CMS 100-02, Chapter 17, Section 40)

Let me know if we need to change your charge form.

RAPID STREP REIMBURSEMENT (2012)

Insurance Allowed Amount

Horizon $ 13.17

AmeriHealth $ 15.00

Aetna $ 9.29

CIGNA $ 10.94

Out-of-State Blue Shield $ 13.94

United Healthcare $ 7.70

In all cases, insurance paid the lab fee in full. Be sure the Dx code shows medical necessity.

EHR & PQRI Penalties

EHR penalties begin in 2015 at 1% based on 2013 performance for those that have successfully attested in a prior year and must use an EHR for a full year to comply. For those that are in their first year, they can use an EHR for 3 months in 2014 to avoid the 2015 penalty as long as they attest by July 2014.

The EHR penalties increase by 1% per year between 2015 and 2019 maxing out at 5%. By 2016 the PQRS penalties max out at 2%.

The total penalty assessment beginning in 2019 will be 7% of Medicare revenue.

AMBULANCE

Dizziness

Dizziness is covered if the patient has

• a Glasgow score of 15, or

• Transient symptoms of dizziness associated with neurologic or cardiovascular symptoms and/or signs, or abnormal vital signs (e.g., hypotension)

Be sure to document the additional signs & symptoms in order for dizziness to be covered.

Medicare Policy:

“Complaint or Symptom: Altered level of consciousness (non-traumatic)

Condition Requirement: Neurologic dysfunction in addition to any baseline abnormality


Examples of Systems and Findings Necessary for Coverage (and Documentation):  Acute condition with Glasgow Coma Scale <15 abnormal="abnormal" and="and" associated="associated" cardiovascular="cardiovascular" dizziness="dizziness" nbsp="nbsp" neurologic="neurologic" of="of" or="or" p="p" signs="signs" symptoms="symptoms" transient="transient" vital="vital" with="with">

Complaint or Symptom: Neurologic dysfunction

Condition Requirement: Acute or unexplained neurologic dysfunction in addition to any baseline abnormality.

Examples of Systems and Findings Necessary for Coverage (and Documentation): Signs include facial drooping, loss of vision without ophthalmologic explanation, aphasia, dysphasia, difficulty swallowing, numbness, tingling extremity, stupor, delirium, confusion, hallucinations, paralysis, paresis (focal weakness), abnormal movements, vertigo, unsteady gait/balance.”

The scale comprises three tests: eye, verbal and motor responses. The three values separately as well as their sum are considered. The lowest possible GCS (the sum) is 3 (deep coma or death), while the highest is 15 (fully awake person).

Best eye response (E)

There are four grades starting with the most severe:

1. No eye opening
2. Eye opening in response to pain. (Patient responds to pressure on the patient’s fingernail bed; if this does not elicit a response, supraorbital and sternal pressure or rub may be used.)
3. Eye opening to speech. (Not to be confused with the awakening of a sleeping person; such patients receive a score of 4, not 3.)
4. Eyes opening spontaneously

Best verbal response (V)

There are five grades starting with the most severe:

1. No verbal response
2. Incomprehensible sounds. (Moaning but no words.)
3. Inappropriate words. (Random or exclamatory articulated speech, but no conversational exchange)
4. Confused. (The patient responds to questions coherently but there is some disorientation and confusion.)
5. Oriented. (Patient responds coherently and appropriately to questions such as the patient’s name and age, where they are and why, the year, month, etc.)

Best motor response (M)

There are six grades starting with the most severe:

1. No motor response
2. Extension to pain (abduction of arm, external rotation of shoulder, supination of forearm, extension of wrist, decerebrate response)
3. Abnormal flexion to pain (adduction of arm, internal rotation of shoulder, pronation of forearm, flexion of wrist, decorticate response)
4. Flexion/Withdrawal to pain (flexion of elbow, supination of forearm, flexion of wrist when supra-orbital pressure applied ; pulls part of body away when nailbed pinched)
5. Localizes to pain. (Purposeful movements towards painful stimuli; e.g., hand crosses mid-line and gets above clavicle when supra-orbital pressure applied.)
6. Obeys commands. (The patient does simple things as asked.)

August 2012

CPB BACKUP GENERATOR
I am pleased to announce that the office backup generator installation was completed on July 17th ! This is a substantial commitment to our clients and staff to ensure that our ability to service clients and perform our daily work will not be interrupted by a loss of electric. Very few billing services have gone to this level of backup.
In the event of a power outage, the individual hardware battery backups will carry the equipment for the 10 second delay until the generator starts. Since it is fueled by natural gas, it should never run out. We also protect your data with both an automatic onsite and offsite data backup every 2 hours.
We thank all of you for allowing us to serve you!
OBAMACARE
There has been speculation & discussion about the real effects of the Patient Protection and Affordable Care Act (aka Obamacare) now that the Supreme Court has upheld most of that law.
First, no one can say for certain what will happen with physician or other payments over the next few years. Much depends on whether people actually will purchase the insurance since there are essentially no penalties if they do not (withholding tax return money can easily be avoided by not having as much withheld).
Second, what might happen to physician payments in one specialty may not be what is realized by physicians in other specialties. With increased emphasis on "primary care" it is entirely conceivable that payments for primary care services and primary care providers will increase over the next few years whereas payments for certain specialists could go down.
Finally, there is strong pressure both from government and employers to get healthcare costs under control and that appears to be translating into changing how healthcare is delivered & paid for.
Any time there is change, there will be winners and losers and healthcare is no different. Some specialties (physician and non-physician) may see improved revenues and others see reduced revenues.
ERX – TWO NEW EXEMPTIONS
CMS announced 2 New Exemptions to Avoid the 2013 eRx Payment Adjustment

CMS has created two additional hardship exemptions to avoid the 2013 Medicare e-Prescribing Payment Adjustment. The new exemptions are:

• Eligible Professionals (EPs) that have achieved or are planning on attesting to Meaningful Use on or before October 14, 2012.

• Eligible Professionals that show intent to be part of the EHR incentive program through registration and adoption of a certified EHR.

The deadline for these new exemption categories is October 15, 2012. To request a significant hardship exemption, EPs and group practices must submit their hardship exemption requests through

https://www.qualitynet.org/portal/server.pt/community/communications_support_system/234
OIG PROBES PHYSICIAN MEDICARE BILLING FOR OFFICE VISITS
“Physicians are billing Medicare for far more intensive evaluation and management services than they did a decade ago, according to a Dept. of Health and Human Services Office of Inspector General report released in May.
Use of the two highest-level codes for established patient office visits has increased by 17%, as doctors have billed Medicare for fewer low- and mid-level codes from 2001 to 2010, the OIG said. Utilization of the high-level code for billing an emergency department visit also has risen 21%, while the top code for subsequent inpatient hospital care has increased 9%.
The OIG concludes in the report that several factors have led to these increases, including a boost in the overall number of services provided to patients and the average payment for evaluation and management services. “However, changes in physicians’ billing of E&M codes also contributed to this increase,” the report states.
The inspector general did make note of aberrant billing patterns during its review and sent the Centers for Medicare & Medicaid Services a list of 1,669 physicians who billed many more complex and expensive codes than their peers. The Medicare agency will forward the list to its contractors and direct them to focus on the top 10 billers in each jurisdiction for further review, according to a March 28 memo from acting CMS Administrator Marilyn Tavenner.
The health professionals singled out in the report had billed high-level codes at least 95% of the time and could find themselves in trouble with the government, Nicoletti said. The three specialties with the largest percentage of physicians using high-level codes were Internal Medicine, Family Practice and Emergency Medicine.
Medicare plans to publish its own report targeting 5,000 physicians who billed high-level evaluation and management services consistently. The report is not intended to be an indication of fraud. “The intent is to be proactive and provide statements that will support helpful insights into physician coding and billing practices,” Tavenner said. That report was scheduled for release in June.”
Ambulance Clients
Obtaining insurance information is key to getting paid. Hospitals provide information (tho often a week or more later). Patients often ignore both phone calls and statements which often results in them going to collections – and no or less money for the municipality. It is harder for patients to ignore when you are face-to-face.
We recognize that patient care is your first priority, as it should be.
But when you are obtaining other information from the patients, if you could get insurance information it would greatly help the municipality and avoid collections for some patients.
Just a reminder to please get not only the Name of the insurance company, but also the policy and Group #’s.
Many insurers, including MVA & W/C, service claims out of multiple offices. In those cases, getting the address of the correct office is critical to billing the claim – we can then call the adjuster and get the required Claim #’s.
We appreciate your assistance.
Medicare Billing Issues
The information below is intended to assist EMTs with the nuances of the new Medicare ambulance payment policy. It is not intended to suggest documenting signs or symptoms that are not present. It is intended to encourage:

1. Documenting all signs or symptoms that are found.

2. Asking more probing questions to support the patient’s condition as found and include those answers in the Run Report.
The codes selected are based on what is written in the Run Reports.
“Weakness and Dizziness”
For weakness to be covered, the patient must not be able to walk or stand – which needs to be documented in the Run Report. Dizziness is not considered clinically to be the same as altered mental status
Page 26 of the Medicare Ambulance Policy:

“Statements such as the following, absent supporting information, are insufficient to justify Medicare payment for ambulance services:
■ Patient complained of shortness of breath.

■ History of stroke.

■ Past history of knee replacement.

■ Hypertension.

■ Chest pain.

■ Generalized weakness.

■ Is bed-confined.”
If possible, try to determine what might be causing the weakness.
Shortness of Breath vs. Respiratory Distress

Shortness of breath (786.05) is not covered. Respiratory “insufficiency/distress” (786.09) is covered. Be sure to differentiate. Providing oxygen is covered.

July 2012

CPB BACKUP GENERATOR
In response to the changing weather elements, and to support all clients with the highest level of service possible, CPB will be installing a back-up generator by Sunday, July 15th to ensure that we will not be without power. Many CPB clients use our scheduler, or connect with our billing software, so this will add another layer of security to ensure our daily operations are not interrupted.
If you have any questions, please feel free to contact me.
COMBATING HIGH DEDUCTIBLE HEALTH PLANS
When patient’s have a high deductible, it is worth considering requiring the patient to sign an agreement to use their credit card to pay any deductible or co-insurance balance not covered by insurance. Your credit card company vendor should have a document that can be signed by the patient permitting this. Then if they fail to pay their patient statements, the credit card would be a next option.
If anyone else is interested in Patient Payment Portals and/ or Credit Cards, please contact Rich.
OUT-OF-NETWORK PATIENTS
As the Summer approaches, we occasionally get calls asking how to handle patients who are tourists and far from their home network physician. We STRONGLY recommend that such patients be seen on a CASH basis (or debit/credit card if you accept those) only. Collecting payment ($125?) PRIOR to seeing the provider assures that you will at least be paid something. The patient can be told that you will bill their insurance and refund any overpayment. It is a lot easier to refund than to collect from a patient who has returned home. If they do not want to pay when they need a service, it is not likely they will pay later. And, no need to wait for payment.
MEDICARE TIMELY FILING EXCEPTIONS
The time limit for filing all Medicare fee-for-service claims (Part A and Part B claims) is 12 months, or 1 calendar year from the date services were furnished. Exceptions to the 1 calendar year time limit for filing Medicare claims are as follows:

(1) Error or misrepresentation by an employee, Medicare contractor, or agent of the Department of HHS that was performing Medicare functions and acting within the scope of its authority;

(2) Retroactive Medicare entitlement to or before the date of the furnished service;

(3) Retroactive Medicare entitlement where a State Medicaid Agency recoups money from a provider or supplier 6 months or more after the service was furnished;

(4) A Medicare Advantage plan or Program of All-inclusive Care for the Elderly (PACE) provider organization recoups money from a provider or supplier 6 months or more after the service was furnished to a beneficiary who was retroactively disenrolled to or before the date of the furnished service.
NJMVA FEE SCHEDULE
Please be advised that the NJ MVA Fee Schedule has a $99.00 per day limit for all providers. You are STRONGLY urged to ask patients if they were seen by any other provider each day or will be seeing another provider the day they see you. The Code states:
“NJ Administrative Code 11.3-29.4

(m) The daily maximum allowable fee shall be $99.00 for the Physical Medicine and Rehabilitation CPT codes listed in subchapter Appendix, Exhibit 6, incorporated herein by reference, that are commonly provided together. The daily maximum applies when such services are performed for the same patient on the same date. The daily maximum applies to all providers, including dentists. However, when the provider can demonstrate that the severity or extent of the injury is such that extraordinary time and effort is needed for effective treatment, the insurer shall reimburse in excess of the daily maximum. Such injuries could include, but are not limited to, severe brain injury and non-soft-tissue injuries to more than one part of the body. Such injuries would not include diagnoses for which there are care paths in N.J.A.C. 11:3-4.. Unless already provided to the insurer as part of a decision point review or precertification request, the billing shall be accompanied by documentation of why the extraordinary time and effort for treatment was needed.”
If you have an MVA pt, you may want to make sure to verify they have not seen another provider on the same day of service. If they have, send us their billing information (including any required reports) so we can get their billing sent ASAP.

June 2012

COMBATING HIGH DEDUCTIBLE HEALTH PLANS
As mentioned a few weeks ago, we are seeing a significant increase in the # of HIGH deductible insurance plans – as high as $5,000 per year – with the resulting higher patient balances. Patients are taking longer to pay and even refusing to pay their deductible. Finding a way to avoid sending them to collections is important for your cash flow.
We have now looked at 6 vendors and have finished doing the formal comparison. We are now in the process of negotiating prices with 2 of the vendors. Should have a recommendation by the end of June.
OUT-OF-NETWORK PATIENTS
As the Summer approaches, we occasionally get calls asking how to handle patients who are tourists and far from their home network physician. We STRONGLY recommend that such patients be seen on a CASH basis (or debit/credit card if you accept those) only. Collecting payment ($125?) PRIOR to seeing the provider assures that you will at least be paid something. The patient can be told that you will bill their insurance and refund any overpayment. It is a lot easier to refund than to collect from a patient who has returned home. If they do not want to pay when they need a service, it is not likely they will pay later. And, no need to wait for payment.
THERAPY CAPS – MAJOR CHANGE EFFECTIVE OCTOBER 1, 2012
The therapy cap amounts for 2012 are $1880 for occupational therapy services, and $1880 for the combined services for physical therapy and speech-language pathology. Suppliers and providers will continue to use the KX modifier to request an exception to the therapy caps on claims that are over these amounts. The use of the KX modifier indicates that the services are reasonable and necessary, and there is documentation of medical necessity in the patient’s medical record.
For services provided on or after October 1, 2012 and before January 1, 2013, there will be two new therapy services thresholds of $3700 per year: one annual threshold each for 1) Occupational Therapy (OT) services, and 2) Physical Therapy (PT) services and Speech-Language Pathology (SLP) services combined. Per-beneficiary services above these thresholds will require mandatory medical review .
We have attached a copy of the MLN Matters article for our PT/OT clients.
MEDICARE ANNUAL WELLNESS VISITS
Just a reminder that the Initial Preventive Physical Exam (IPPE) for Medicare, G0402, is only valid within the first 12 months of the patient reaching Medicare eligibility (age 65). So a patient who is age 66 or older usually will not qualify unless they did not start their Part B coverage right away.
So an older patient who has been on Medicare Part B for more than 1 year would start with the G0438 AWV code. Also, each of the codes (G0402, G0438 & G0439) have different H&P requirements for billing.
HEALTHPAC’S APPOINTMENT SCHEDULER
For clients using Healthpac’s Appointment Scheduler, it has had a nice feature update to allow a card reader to scan insurance cards, driver’s licenses, etc. direct to a PDF and automatically attaches to the correct pt account - rather than make a paper copy which then still needs to be scanned and manually attached. One product that has been tested is the ScanShell 800DXN Duplex Color Scanner:

http://www.scanshell-store.com/scanshell_800dxn_a6_duplex_card_scanner.htm
It is 8 inches by 3 inches so is quite compact and connects to your front desk PC via USB port. Online cost is $339 at Amazon and the link above.
If you decide to purchase a different product, the scheduler should work with any TWAIN compatible scanner. We do recommend one that can 1. duplex (scan both sides at the same time – which saves time) and 2. Scan in color so that the Driver’s License pictures will have color.
eRx

“Last call” – to avoid a 1.5% reduction in all Medicare reimbursement for 2013, be sure to use a qualified eRx program for at least 10 Medicare prescriptions between now and June 30, 2012 with a total of 100 by 12/31/12. This can be part of a certified EHR program or a standalone. For perspective, if you receive $120,000 in Medicare Allowed amounts, the 1.5% reduction would be $1,800 in lost revenue in 2013. The reimbursement loss increases to 2.0% in 2014.
The only alternative is to qualify for an exemption, which can be difficult.
EHR
If you miss qualifying for the 2012 EHR funding, you will lose $5,000 per provider from the total amount available over the 5 years. Providers include physicians, Podiatrists, Physician Assistants, Nurse Practitioners, etc. You must have at least 90 days of Meaningful Use (MU) before you can attest – this requires time to install the product, train everyone, & begin using it up to the point that it meets MU guidelines. Then the 90 days begins.

May 2012

COMBATING HIGH DEDUCTIBLE HEALTH PLANS
As mentioned a few weeks ago, we are seeing a significant increase in the # of HIGH deductible insurance plans – as high as $5,000 per year – with the resulting higher patient balances. Patients are taking longer to pay and even refusing to pay their deductible. Finding a way to avoid sending them to collections is important for your cash flow.
We have now looked at 6 vendors and are in the process of getting prices and doing the formal comparison. Should have a recommendation by the end of May. Sorry for the delay.
Healthpac’s Appointment Scheduler
For clients using Healthpac’s Appointment Scheduler, it has had a nice feature update to allow a card reader to scan insurance cards, driver’s licenses, etc. direct to a PDF and automatically attaches to the correct pt account - rather than make a paper copy which then still needs to be scanned and manually attached. One product that has been tested is the ScanShell 800DXN Duplex Color Scanner:

http://www.scanshell-store.com/scanshell_800dxn_a6_duplex_card_scanner.htm
It is 8 inches by 3 inches so is quite compact and connects to your front desk PC via USB port. Online cost is $339 at Amazon and the link above.
If you decide to purchase a different product, the scheduler should work with any TWAIN compatible scanner. We do recommend one that can 1. duplex (scan both sides at the same time – which saves time) and 2. Scan in color so that the Driver’s License pictures will have color.
eRx

“Last call” – to avoid a 1.5% reduction in all Medicare reimbursement for 2013, be sure to use a qualified eRx program for at least 10 Medicare prescriptions between now and June 30, 2012 with a total of 100 by 12/31/12. This can be part of a certified EHR program or a standalone. For perspective, if you receive $120,000 in Medicare Allowed amounts, the 1.5% reduction would be $1,800 in lost revenue in 2013.
The only alternative is to qualify for an exemption, which can be difficult.
ICD-10
The Department of Health and Human Services (HHS) announced on April 9, 2012 a proposed rule that would delay the compliance date until October 1, 2014 for ICD-10. It has not been finalized but this would push it back 1 year.

CAPEBANK OPTION
We have been set up with Cape Bank to perform Remote Deposit. This means that if you use Cape Bank we can deposit checks sent to us for you remotely instead of mailing the checks to you. This service decreases the need to travel to your bank to make the deposit & also offers an extended deposit time of 8:00 PM instead of the standard bank time of 3:00 PM. It also means you will have access to your money the next day and can log on to your account to see your deposits each day. You could also have this service in your office.

April 2012

COMBATING HIGH DEDUCTIBLE HEALTH PLANS

As mentioned a few weeks ago, we are seeing a significant increase in the # of HIGH deductible insurance plans – as high as $5,000 per year – with the resulting higher patient balances. Patients are taking longer to pay and even refusing to pay their deductible. Finding a way to avoid sending them to collections is important for your cash flow.

We are looking at various products to help you address this before it becomes a cash flow crisis. We think it may be better for you to receive 97-98% of your payment on the day of service, than 100% of nothing – or a long delay in getting paid. Practices are essentially becoming a bank/ loan officer for these patients!

Just wanted to keep you appraised of progress. When we attended our billing software’s Users Meeting last month, I met with several vendors. I am looking for something that is beyond simple credit cards, so that the increasing #’s of high deductible plans can be addressed in a more effective way with broader options – credit cards, electronic checks, HAS cards, and the occasional first born child!

So far several vendors meet the above criteria and offer:
*For those using our Appointment system, integration into the Hpac Appt. System to avoid double entry and ease of use to check eligibility and storage of that data.
*Credit cards (deposit direct to the client, and a report to CPB). Also sets up payment plans to automatically pay each month.
*Eligibility, including co-pay amount, deductible, amount of deductible already met. This
*Electronic patient statements – which can also direct patients to the patient portal for electronic payment.
*Patient portal (numerous benefits)

So far I have looked at 3 vendors with pretty good products & will look at one more.

We are still on track to select 1-2 to recommend to you by the end of April, tho hopefully a little sooner. You would have a great deal of flexibility as the vendors all seem to have an ala carte approach, as well as options within what you choose use. Or you could not use it at all.

Feel free to call with any questions.

THERAPY CAP AUDITS

As part of the Middle Class Tax Relief and Job Creation Act of 2012 (Job Creation Act) signed into law by President Obama on Wednesday, February 22, 2012, Section 3005 also mandates that Medicare perform manual medical review of therapy services furnished beginning on October 1, 2012, for which an exception was requested when the beneficiary has reached a dollar aggregate threshold amount of $3,700 for therapy services, including OPD therapy services, for a year. There are two separate $3,700 aggregate annual thresholds: (1) physical therapy and speech-language pathology services, and (2) occupational therapy services. These audits will be for charges being processed today so please be certain that these patients properly meet the Exception requirements.

ICD-10

CMS announced that they are delaying implementation of ICD-10 from the October 1, 2013 date. When the new date is announced, we will again begin to address it.


CHECKING MEDICARE PATIENTS FOR PREVIOUS ANNUAL WELL VISITS (AWV)

We have called Medicare to ask how a provider would know if a new patient had received other AWV services from another provider previously. We were told you can call Medicare and ask if patient received AWV services before. We have found some reps are more helpful than others.

INDUSTRY STATISTICS

One-sixth of the US economy is devoted to Healthcare Industry Statistics healthcare spending
• $2.6 trillion spent each year on healthcare in the US.
• $800 billion a year goes to care that is wasteful, redundant, or inefficient.
• On the current course, health expenditures will increase 6.1 percent per year on average over the next decade.
• Over $160 billion is spent on administration that does not go toward paying for health care.
• One of every seven claims is denied initially -- about 200 million claims out of the 1.4 billion submitted yearly.
• On average, national health insurers paid physicians in 33 days and denied 9.2 percent of claims.
• Administrative costs stemming from interactions between providers and insurers are estimated to total $31 billion a year.
• On average, a full 60% of a provider’s practice revenues is overhead.
• Commercial insurance companies have an error rate of almost 20% due to errors in claims processing, wasting almost $17 billion annually.
• 1 in 5 claims are not sent electronically.
• Almost 25% of all claims received no payment at all.
• The top reason claims are denied is patient eligibility. Other top reasons are missing information and services not covered.
• A 20% error rate in processing claims represents $3.6 million in erroneous claims payments, and an added $1.5 billion in unnecessary administrative costs.

March 2012

COMBATING HIGH DEDUCTIBLE HEALTH PLANS

If you haven’t already noticed, high deductible health plans are here - estimated at 16% in 2011 !

And the news is generally not good. Horizon has at least 1 plan that does not even allow providers to collect payment for the co-pay or deductible on the date of service (DOS)! Some insurers have also applied Well Visits to the deductible. Of course many patients are slow to pay out of their own pocket, don’t pay at all, or want payment plans spaced out over many months – all of which adversely affect your cash flow.

Important components of a strong office financial policy:

1. When making the appointment for new patients obtain their demographics and insurance information (including subscriber name & DOB, policy & group #’s). If it is an existing patient, ask if the insurance has changed.
2. Check eligibility & benefits at least 1 day before the pt will be seen. Verify their co-pay, annual deductible, and the amount of the deductible met.
3. Contact each patient 1-2 days prior to remind them of their appointment.
4. Always collect money at check-in and never at check-out. Make that your policy.
5. If a high dollar procedure for a patient with a high deductible plan is to be performed in the office, determine patient responsibility. Document all of this in the CPB appointment system so money can be collected at check-in. The minimum collected should be the patient’s copay. It is better to refund overpayments than not get paid.
6. Clients using the CPB appointment system can run a report showing all patients with patient balances. That amount also prints on the Charge Form when you print it.
7. Each practice must have a clear policy on collecting co-pays and previous balances on the account at each visit. If the balance is large, how much is an acceptable payment if it cannot be paid in full? The key to this policy is to reschedule the appointment, even when the patient showed up for the visit, if appropriate payment is not made so long as it is medically, ethically and legally permissible.
8. If the practice is not using the CPB Appointment System, it is available at no cost. Even if you do not want to use it for appointments, you can still check patient balances.
9. As part of our Month-end Reports, we include the amount collected on the date of service. We track this each month for each client.

With this increase in high deductible plans, we are searching for a tool that will allow the patient to authorize automatic withdrawals from their checking account each month or from their credit card. This way the patient is committed to payment.

Steps to avoid losing money:• Accept credit & debit cards. Paying 2% to the credit card company is better than losing the other 98%.

We are also working some other options and hope to report a comprehensive solution within 2-3 months.

A FEW HELPFUL HINTS TO GET PAID

It is very important for offices to check each patient’s insurance each time they are seen. Insurance plans are written with anniversary dates of either the 1st or 15th – so insurance can change or be lost – on those dates. Clients using the CPB appointment system and who scan insurance cards into it can simply view the insurance card from the last visit, & scan the new card into the software, if needed. Without correct insurance information, you will not be paid.
NJ Medicaid benefits are month-to-month & should be verified with Medicaid on EVERY visit before the patient is seen. The card they carry is not an insurance card and does not insure benefits. Coverage needs to be verified before seeing the provider. If the Medicaid system says they are not covered, you should seriously consider collecting payment (Cash) before the patient is seen. You may want to begin collecting patient email addresses! Current technology allows patient statements to be handled via secure email and costs about half of the cost to mail a paper statement.

MEDICARE REFUNDS

On Tue Feb 14, CMS proposed that providers and suppliers must report and return self-identified overpayments within 60 days of the incorrect payment being identified.

EHR’s

Good news! If you have not implemented a Complete Certified EHR yet:• 2012 is the last year to receive full funding under the Medicare program. To do so, you must implement soon so you can achieve 90 days of “Meaningful Use” by the end of the year.• If you implement this year, you can also use the current Stage 1 guidelines for 2013 and will not have to meet Stage 2 requirements until 2014Final Stage 2 guidelines are expected to be released later this year.

ICD-10

CMS has now announced that the October 1, 2013 date will be postponed but have not indicated for how long.

Now that 5010 is safely behind us, we will begin focusing on the transition to and implementation of ICD-10 coding which is effective on October 1, 2013. While that sounds like a far off date, the ICD-10 codes are very different – yet also similar – than ICD-9. For all of our clients that only affects diagnosis codes – not CPT codes. Over the next 20 months we will include a brief paragraph each month to help bring you up to speed so we have another smooth transition.

CHECKING MEDICARE PATIENTS FOR PREVIOUS ANNUAL WELL VISITS

I just called Medicare & asked how a provider would know if a new patient had received G0438 services from another provider previously. I was told we can call Medicare’s Representative Dept and ask if patient received G0438 before.

Note -They can only answer yes or no and cannot give any details as to when G0438 was rendered or by which provider.

Medicare’s new phone system was a bit confusing. The prompts are as follows:
Part BClaim-related QuestionsClaim StatusSay “Operator” after listening to claim status
It seems kind of silly to listen to claim status messages such as “claim currently in process” or “no record of claim” before you can opt out to an operator. However, per another rep, this is the only way.

February 2012

CHECKING INSURANCE CARDS EVERY VISIT

It is very important for offices to check each patient’s insurance each time they are seen. Insurance plans are written with anniversary dates of either the 1st or 15th – so insurance can change or be lost – on those dates. Clients using the appointment system and who scan insurance cards into it can simply view the insurance card from the last visit & scan the new card into the software, if needed. Without correct insurance information, you will not be paid.
NJ Medicaid benefits are month-to-month & should be verified with Medicaid on EVERY visit before the patient is seen. The card they carry is not an insurance card and does not insure benefits. If the Medicaid system says they are not covered, you should seriously consider collecting payment before the patient is seen.

MEDICARE ELECTRONIC HEALTH RECORD (EHR) INCENTIVE PROGRAM

If you plan to participate in the Medicare EHR Incentive program, you must start in 2012 in order to be able to collect the full $44,000. Not starting until 2013 decreases the total amount to $39,000 and not starting until 2014 decreases it to $24,000. We strongly recommend getting started ASAP as it can take time to install the program, learn to use it “meaningfully,” & begin billing with the proper code to document the use with Medicare (has to be done at the same time charges are billed – cannot be done later). Billing the special code is how Medicare tracks the eligible charges. You need a minimum of 90 days plus $24,000 of Allowed charges in order to qualify for the $18,000 first year payment. “Ramp up” for an EMR is usually 60-90 days once you “go live” plus 4-8 weeks from contract signature to ‘go live” depending on the EHR vendor’s backlog.

If you have questions, feel free to call Rich.

GARDASIL

United Healthcare/Oxford Will Start Covering Gardasil for Males Age 9-26 On February 1, 2012.

NEW MEDICARE ABN FORM

In March 2011, CMS revised the Advanced Beneficiary Notice of Noncoverage (ABN) form used by healthcare professionals, including physicians, when they expect Medicare will deny payment. The mandatory date to use this revised form is January 1, 2012. Old forms used on or after January 1, 2012, are considered invalid. As mentioned in Client Bulletins earlier this year, if you are using a form prepared by CPB please let us know so it can be updated to the new form. Using the old form means it will not be considered valid.

ELECTRONIC CLAIMS AND PAYMENTS – 5010 FORMAT

On January 1, 2012 the medical billing industry must begin submitting claims and applying payments using the 5010 version. CPB has been submitting all electronic claims in the 5010 format since mid-December and have not seen any significant problems. However, Medicare has had problems returning complete payment information & we are working thru those issues.

OFFICE-BASED PROVIDERS (PHYSICIAN AND NON-PHYSICIAN) COMBATING HIGH DEDUCTIBLE HEALTH PLANS

Important components of a strong office financial policy:

1. Always collect money at check-in and never at check-out.

2. Be sure to verify insurance before the visit. Be sure to identify either the co-pay amount or a co-insurance/deductible status. If a high dollar procedure for a patient with a high deductible plan is to be performed in the office, determine patient responsibility. Document all of this in the system so money can be collected at check-in. The minimum collected should be your cost

3. Clients using the CPB Appointment system can run a report showing all patients with patient balances. That amount also prints on the Charge Form when you print it.

4. Each practice must have a clear policy on collecting co-pays and balances on the account at each visit. If the balance is large, how much is an acceptable payment if it cannot be paid in full? The key to this policy is to reschedule the appointment, even when the patient showed up for the visit, if appropriate payment is not made so long as it is medically, ethically and legally permissible.

5. If the practice is not using the CPB Appointment System, it is available at no cost. Even if you do not want to use it for appointments, you can still check patient balances.

6. As part of our Month-end Reports, we include the amount collected on the date of service. We track this each month for each client.

7. With the increase in high deductible plans (estimated at 16% in 2011), we are searching for a tool that will allow the patient to authorize automatic withdrawals from their checking account each month or from their credit card. This way the patient is committed to payment.

ICD-10

Now that 5010 is safely behind us, we will begin focusing on the transition to and implementation of ICD-10 coding which is effective on October 1, 2013. While that sounds like a far off date, the ICD-10 codes are very different – yet also similar – than ICD-9. For all of our clients that only affects diagnosis codes – not CPT codes. Over the next 20 months we will include a brief paragraph each month to help bring you up to speed so we have another smooth transition.

eRx for 2012

In order to avoid a penalty in 2013, you must report code G8553 at least 10 times on eligible visits prior to June 30, 2012 and 25 times prior to 12/31/12. An eligible visit is 1) a visit by a patient who has Medicare Part B, 2) an encounter billed as an E/M code, and 3) one that a prescription was submitted electronically (and was associated with the visit).

January 2012

OFFICE CLIENTS

Just a reminder to our office clients that it is important to send a list of patients seen each day so we can verify all patient charges have been received. Ideally it would be the first page after the Batch Cover Sheet.

ATLANTICARE INSURANCE CHANGES

AtlantiCare notified all employees and area providers on December 13th that their insurance will be changing effective January 1, 2012 to 1 of 2 unique Horizon plans – Engaged and PPO. They are also “transitioning to an Accountable Care type model” differentiating providers who are in and out of network. AtlantiCare Tier Network physicians (medical & specialists) have a $10 copay except for preventive care, which is $0 (zero). Non-network physicians have a $35 copay.

PATIENT STATEMENTS

Due to phenomenal growth, CMB has now reached the point that we began to send patient statements twice a month in order to spread patient calls out and further improve your cash flow.

PRIMARY CARE PROVIDERS

January & February are usually the time of year when patients are meeting their annual deductibles. These have increased significantly in the past few years as more policies are being purchased with $1,500 - $5,000 deductibles. As you know, we strongly recommend collecting these balances on the date of service if the patient has no other coverage.
One way to avoid this loss of cash flow early in the year is to include a Well Visit for Medicare patients (and HMO/PPO patients, if they have such coverage). The services are separate and distinct from a non-well visit and can be provided on the same day. The medical record needs to clearly reflect the 2 types of visits and the appropriate co-pay collected.

ELECTRONIC CLAIMS AND PAYMENTS – 5010 FORMAT

On January 1, 2012 the medical billing industry must begin submitting claims and applying payments using the 5010 version. CPB has been submitting all electronic claims in the 5010 format since mid-December and have not seen any significant problems.
Providers should be aware by now from CPB Monthly Client Bulletins that on January 1, 2012 new data requirements go into effect for the submission of electronic claims. The primary affect on providers is that certain additional data is now required in order to be paid. Some of this we have already taken care of on your behalf, such as adding the “Pay To” field which allows payments to be sent to PO Boxes instead of street addresses, and 9 digit zip codes for the location of services.

OFFICE-BASED PROVIDERS (PHYSICIAN AND NON-PHYSICIAN)

For those who see Workers Comp cases, 5010 now requires the name and address of the employer. Failure to provide it will mean the claim will be rejected.
If your office uses the New Patient Form or the Established Patient Form which CPB created, they may need to be updated to capture this information. Please notify me if you need that done.

For those offices which use your own form, you will need to either switch to ours or make provision to capture this information from patients while they are in the office. Let me know ASAP if you need us to prepare one for you.

AMBULANCE

For our ambulance clients, the same requirement pertains. If you are able to capture this information, along with the other information you are already capturing, it will facilitate payment. Failure to obtain it will mean a delay in being able to submit the claim until the patient provides it.

As mentioned above, don’t shoot the messenger. We aren’t excited about it either since it creates additional data entry for us and 1 more reason for W/C carriers to deny claims – resulting in follow-up work. Please call Rich with any questions.

MAKING COPIES OF MEDICAL RECORDS

HIPAA did away with "minimum" charges for copying medical records - or any other method of charging that exceeds the ACTUAL costs of making the copies. HIPAA provides that, in states where the patient may be charged for copies of the chart, the charge may not exceed the actual cost, including labor and postage, of making and sending out the copies.

Note also that if you keep your records in electronic form, the patient can request that that the records be provided in electronic form. In that case the charge would be the cost of labor to make the e-copy, along with the cost of the CD-ROM or other medium used. Remember, if you produce these records in electronic format you should at a minimum password protect them and ideally encrypt them. Only give the password to the patient or legal representative.