April 2013

SEQUESTRATION

Now that sequestration has taken effect, unless Congress & the President can get their collective acts together, Medicare payments will be cut by 2% for dates of service April 1 and after.  So, what does that mean financially? 

The reduction applies to the amount Medicare will actually pay to the provider - AFTER - the appropriate deductible or copayment has been calculated.  So, if the allowable is $100.00, the co-payment is 20% or $20.  Medicare's payment was - pre-sequestration supposed to be $80.00 (80% of the allowable).

NOW, post-sequestration, the $80.00 will be reduced by 2% ($1.60). So instead of the Medicare payment being $80.00, it will be $78.40.  Unfortunately, providers are not authorized to collect the sequester related reduction from the patient.  The patient will still owe the full $20.00 (20%) co-insurance amount.  If the pt has no 2’ insurance, it can be collected during the office visit. 

If anyone needs to know the monthly average amount of Medicare payments or has any questions, contact Rich.  Lots of partisan politics going on for the benefit of some BIG congressional egos. 

Medicare REVALIDATION

Be sure to watch for a letter from Medicare requiring you to revalidate your information with them.  You have a very limited time period to do this.  Failure to do so results in de-activation of your provider # - and a stoppage of all payments – until the revalidation has been completed. 

The Monthly list can be found at:   http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/MedicareProviderSupEnroll/Revalidations.html

MEANINGFUL USE

As you may know, Medicare providers who do not achieve 90 days of Meaningful Use by 12/31/2013 will lose $15,000 in Medicare EHR Incentive Funds.  This means you need to START using your EHR no later than 10/1/2013. Allowing 6-8 weeks to implement and train, you need to purchase by July.  Plus, it is expected many others will delay getting started also, thereby creating a backlog.  CPB can offer some suggested vendors. 

Transitional care management codes 99495 & 99496

So far, only Medicare & Horizon will pay.  Aetna does not.  Horizon & Medicare are allowing the same amount:  99495 = $176.73 & 99496 = $249.06.

Only one physician may bill Medicare for the TCM for any one patient’s discharge from the hospital, and the physician must wait until 30 days after the discharge to bill for the service.  The first physician who submits a claim will be paid.  

Can we bill any services during the 30-day post discharge period?   Yes. Second and subsequent E/M services after the initial bundled E/M service may be reported. Other diagnostic or therapeutic services may be billed.

Anything else we can’t report with these codes?   Yes. Some of the codes that may not be billed with the TCM codes during the time period covered by the TCM codes (29 days post discharge), are:

·         Care Plan Oversight (99339, 99340, 99474-99380)

·         Prolonged services without patient contact (99358, 99359) (with patient contact is allowed)

·         Anticoagulant management (99363, 99364)

·         End stage renal disease services (90951-90970)

Medicare & REFERRING PROVIDERS

Effective May 1, 2013, the long delay in requiring only currently validated providers to be able to refer will end.  On that date, if your referring provider is not in PECOS or in the carrier’s system, you will not be paid for any services (Radiology, Lab, etc.) or equipment, that were referred to you. 

Medicare & ICD-10

Good news, sort of.  On January 18, 2013 CMS instructed its contractors to start the process to update CPT code National Coverage Determinations to ICD-10 codes (now ICD-9).  Medicare uses that list to determine medical necessity for many CPT & HCPCS payments. 

PQRS

Just a reminder that Medicare is requiring providers to participate in the PQRS program to avoid a loss of Medicare payments.  If you need assistance with that, please let me know ASAP as the measures require more participation than in past years.

Medicare AnnuAl wellness visits required documentation

 If you need to know what Medicare requires to be documented for each of the 3 AWV codes, you can use this link:  http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/AWV_chart_ICN905706.pdf

March 2013

SEQUESTRATION

When Congress enacted the sequestration process in 2011, they specifically linked the Medicare Part A and Part B sequestration cuts to commence in a manner according to a process outlined in Section 256 of legislation enacted in 2010 called the “Pay As You Go Act.”

In that legislation, it states that any cuts mandated by the Office of Management and Budget are to take effect for Part A and Part B of Medicare, one month after the date that OMB issues the mandatory order.  Therefore, if, as expected, OMB issues the sequestration order tomorrow, the cuts will not take effect for Part A and Part B of Medicare until April 1.  So providers have a 30 day grace period before we begin to see the actual cuts. 

Government agencies do have flexibility in their spending so all of the “doom & gloom” is not accurate.  And, even at the Program level, they have discretion.  Layoffs are not a necessity.

Also on this point, the Administration and Congress are in agreement that there is $33 Billion in unnecessary farm subsidy money sitting at the Department of Agriculture that is no longer needed.  If the Administration would allow for reprogramming, that money could be taken from Ag and applied against the $85 billion for sequestration and reduce sequestration by more than 1/3.

Earlier today the Washington Post, no less, called out the Secretary of Education on one of his statements.  He said more than 30,000 teachers were going to be laid off due to the sequester.  When asked for specifics, he gave them the name of a school in West Virginia.  However, when the Post Reporter contacted the Superintendent of schools, they said no.  No layoffs.  Maybe next year, but none due to sequestration this year and probably not next year.  They would just reprogram money to avoid teacher layoffs. 

When the Post went back to the Secretary of Education to see what was up, they said that they just took the total amount of money that would have to be cut from a program account, divided it by the average teacher salary ($70,000) for that program and used that number as an example but could not actually produce any teachers who were being laid or nor did they know how local school districts might apply the cuts at a community level.

Lots of partisan politics going on for the benefit of some BIG congressional egos. 

Preventing Lost Insurance Checks

Occasionally insurance checks somehow get lost in the mail resulting in delayed payment to the provider.  The best way to avoid this is direct deposit (also known as EFT – Electronic Fund Transfer) and is the same as save way that Social Security, AARP and others require.

We STRONGLY suggest you consider Direct Deposit/ EFT for as many payments as possible since it avoids delay due to nearly all external factors, including bad weather, theft, misplacing checks, etc.  And no one needs to go to the bank to deposit those checks – just check your bank account online.

PQRI

A reminder that CMS will use 2013 as the reporting year for Medicare cuts beginning in 2015 if providers do not participate in PQRS in 2013.  Thus, if you want to insure that you do not get the 1.5% reduction in Medicare payments beginning in 2015, followed by a 2% reduction beginning in 2016 you MUST participate in 2013.

EHR’s – BY THE NUMBERS

Software Advice, a vendor neutral software research company, released the following statistics about Health IT:

• 115,918 - The number of Eligible Professionals that have successfully attested for Meaningful Use.
• 623 - The number of vendors listed on the Office of the National Coordinator's Certified Health IT Product List.

These numbers strongly support the case that the implementation of Health IT is growing quickly and is changing the way the medical community delivers quality healthcare.  But implementation of an EHR system is only the beginning.  Meaningful Use of an EHR system is the foundation upon which the growth of Health Information Exchanges (HIEs) and the movement toward Patient-Centered Medical Homes will be built upon.  NJ-HITEC urges providers throughout the Garden State to get on board before they fall too far behind.  

Medicare payment for G0444 – Annual depression screening

Medicare pays when this code is billed with an office visit, but not when billed with an Annual Wellness Visit.  Consider doing the Depression Screening during a separate visit. 

More EHR – DISCONTINUED EHR’s

 

Allscripts recently announced they were discontinuing support of Medinotes and MyWay. Why are EHRs discontinued? How can a buyer keep from purchasing an EHR that might be discontinued?

Some products that have been discontinued:

• Misys will not be certified for MU – Customers encouraged to move to Allscripts
• GE discontinued Advance EHR (Jan 2012)
• Medinotes is discontinued by Allscripts effective 12/31/2012
• Epocrates announced EHR was discontinued (May 2012)
• Allscripts MyWay will not be upgraded for Meaningful Use Stage 2 (announced Oct 2012)

Are there any common themes?

1. When a company owns several EHRs and in particular EHRs that serve the same practices sizes, they are likely to discontinue the “duplicate” EHRs.
2. Expensive EHRs are not as marketable to smaller practices and thus more likely to be shuttered and/or replaced.
3. Companies may have difficulty maintaining products that they did not build.
4. EHR is competitive – newer products that do not have full competitive functionality and/or insufficient market share to be profitable may be closed. These companies may close or other vendors may purchase them for their customers/market share and not the technology.

How can you avoid getting stuck? Some things to look for:

• How many customers do they currently have?
• Ownership. Public companies may have very high growth and profit motives vs. customer service orientation. Companies funded by venture capital generally have very high growth expectations with the goal of being purchased by another company.
• How long has the company been in business?
• When was the last version of the software released?
• Does the vendor charge extra for new releases?
• Is there a Meaningful Use guarantee for Stage 2 and 3?
• Does it feel right? For example a “free” or really low cost EHR has to cover their costs somehow – are they just looking to hook you so they can raise their rates later or sell their company to another one looking to buy market share and then switch you to another EHR?
• How old is the technology? If the system still looks and operates much as it did 5 years ago the company may not be investing for the future.

No one has a crystal ball so no matter what you do make sure that your EHR contract gives you your data in the event you cancel or otherwise need to move to another EHR down the road.

February 2013

Slow Medicare Payments

Just a reminder that that Medicare patients must meet their annual deductible in January which causes a slowdown in cash flow.  But due to Congress’ delay in approving the Conversion factor until January 2^nd, it is even slower paying than usual.  The reason is that all of the Medicare contractors (MAC’s) could not process any claims until the fee schedules were updated.  CMS gave the MAC’s until January 23^rd to get that done.  Novitas released their fee schedule on 1/22.  So, instead of being able to process a charge to deductible and releasing it to the 2’ early in the month, all of those charges were delayed nearly 3 weeks.  Cash flow should start to pick up by mid-February and improve from then on. 

FREE Eligibility Checking for CPB Appointment System Users!

Patient eligibility is now offered to all clients using the CPB Scheduler.  If you are interested in using it, please call Rich.  At least for the next few months, CPB will cover the cost.

EHR’s – CHOOSE WISELY THE FIRST TIME

According to Medscape.com (August 13, 2012 edition) half of EHRs sold are replacements!  “Use of electronic health records (EHRs) is snowballing, and so is the number of unhappy users. Half of EHR systems sold to physician practices are now replacements, up from 30% last year, according to a recent study by research firm KLAS. The leading reason for switching systems, cited by 44% of practices, is product issues. Service issues (15%) and group consolidation (14%) - such as when a hospital converts newly hired physicians to a new EHR - are a distant second and third.

Morale of the Story:  Choose carefully and thoroughly evaluate your choice before purchasing.  It is disruptive enough to move from paper to electronic.  Switching to another EHR is a 2^nd major impact to your practice.

TherAPy Cap 2013 update

CMS announced that the Therapy Cap will be $1,900 for 2013.  Once the total gets to $3,700, then Medicare is required to perform a mandatory review the same as late in 2012. 

The other new items are the new “G” codes, Proper Modifier Reporting, and Multiple Procedure Payment Reduction (MPPR) process.

 

ICd-10

ICD-10 is still about 20 months away, but after attending an ICD-10 coding class earlier this month, thought you might enjoy some statistics.  Someone took the time to count the # of ICD-9 codes commonly used by several specialties and compare them to the same ICD-10 codes. 

Specialty	ICD-9	ICD-10	Increase
Cardiology	178	430	2.4
Family Practice	229	829	3.6
OB/GYN	220	777	3.5
Pediatrics	165	836	5.1
Orthopedics	143	5843	40.9

Aetna Medicare Advantage (MA) plans

Per Aetna, “Aetna Medicare Advantage (MA) plans now cover an annual wellness visit; no longer cover annual physicals.   Effective January 1, 2013, Aetna MA plans include coverage for an annual wellness visit. The CPT codes for a wellness visit are G0438 and G0439.

Aetna MA plans no longer cover annual physical exams. The CPT codes for the annual physical exam are 99381-99397, 99401-99404, 99201-99205 and 99211-99215 with primary diagnosis of preventive. The preventive diagnosis codes that are not covered are:  V03.0-V03.9, V04.0-V04.89, V05.0-V05.9, V06.0-V06.9, V20.0-V20.2, V70.0, V70.3, & V70.5.

 This change was made as a result of a change in coverage made by the Centers for Medicare and Medicaid Services (CMS).”

PATIENT BALANCES

According to a recent article in MGMA Connexion, $1 of every $4 owed is now paid by the patient.  That is 25% of the average practice’s revenue. 

Ways to collect these balances:

• Verify patient eligibility when the appointment is made.  At the latest, verify it a day before the appointment so you can have the appropriate discussion on the date of service. 
• Be sure patients know when the appointment is made that payment is due on the date of service.
• Collect all co-pays before the patient is seen.
• Accept credit & debit cards

Current state-of-the-art software provides features to establish and create payment plans using credit & debit cards, automatic scheduling of those payments (with patient / guarantor approval, of course), store the credit card data in a fully compliant PCI format, etc.  CPB has access to such programs.  If you are interested, please contact Rich.

January 2013

CONGRESS - & the fiscal cliff

If Congress is unable to do what they were sent to Washington to do, we will again recommend that you ask us to hold your 2013 Medicare charges until agreement has been reached.  Otherwise, Medicare will pay the charges at the approximately 26% decrease – then have to go thru reprocessing.  That works “ok” for Medicare, but the 2’ insurances often have difficulty handling that.

FREE Eligibility Checking for CPB Appointment System Users!

Patient eligibility is now offered to all clients using the CPB Scheduler.  If you are interested in using it, please call Rich.  At least for the next few months, CPB will cover the cost.

Medicare Part B Deductible for 2013

The Medicare Part B Deductible for 2013 is $147. 

TherAPy Cap 2013 update

CMS announced that the Therapy Cap will be $1,900 for 2013.  The only catch is that the Therapy Caps were only authorized thru 2012 so we’ll have to see if they are extended.

 

Refunds – Please do not send refunds until cpb verifies

Just a reminder to not accept any insurance company’s request for a refund until CPB verifies it is correct.  Many of the insurances which providers participate with (Medicare, Medicaid, Horizon, Aetna, CIGNA, United healthcare, etc.) will do an automatic offset upon request – which we can initiate for you once we confirm the refund is due.  Be sure to send us a timely copy of the refund request. 

If you pay and they do an offset, we may not be aware of your payment and you could end up short! 

MEDICARE HOME HEALTH VISITS CERTIFICATION COVERAGE

The G0180 Home Health Certification Code is only covered once per 60 days. If it is billed more frequently, patients may not be billed unless a properly completed ABN is received.

QUALCARE WILL NOT OVER AN OFFICE VISIT & WELL VISIT

QualCare will not cover both an office visit and a Well visit on the same day.  They will pay the higher of the two, but even with the usual modifier, only one of the two services is covered. We suggest in these cases that the patient be brought back for a separate visit for the Well service.

PATIENT BALANCES

According to a recent article in MGMA Connexion, $1 of every $4 owed is now paid by the patient.  That is 25% of the average practice’s revenue. 

Ways to collect these balances:

• Verify patient eligibility when the appointment is made.  At the latest, verify it a day before the appointment so you can have the appropriate discussion on the date of service. 
• Be sure patients know when the appointment is made that payment is due on the date of service.
• Collect all co-pays before the patient is seen.
• Accept credit & debit cards

 Medicare CERT Audits

Medicare continues to perform their CERT (Comprehensive Error Rate Testing) Audits.  If a provider does not respond, the money in question is automatically recouped.  The envelope containing the request letter is very distinctive:

If no response is received within 30 days, they will send three more reminders with 15 days for each.  If still no response then the claim will be denied and a demand letter sent.

December 2012

CPB Holiday closings

CPB will be closing a few hours early on Thursday, December 6^th at 1:30 for our Annual Staff Appreciation event.   CPB will be closed on December 24 & 25 for Christmas.

 

Congress and the “fiscal cliff”

Current “wisdom” is to save as much cash as you can before the end of the year.  In the Atlantic City Press last week there was discussion that the Democrats may not cut a deal until January as a way to force the Republicans to make more concessions.  Of course the Republicans & Democrats have both been unwilling to make concessions previously – thus the “fiscal cliff.”  So, better to save now to pay bills in January than to run out of cash while Congress plays games. 

CPT CODE CHANGES IN 2013

CPT Code changes for our clients affect Nerve Conduction Studies, Psychotherapy, and a couple of deleted vaccine codes (90701 & 90718).  Each client has been contacted and the new codes added to their dataset and Charge form.  Deleted codes have been indicated in Healthpac to avoid using when they are no longer valid.