MEDICARE DEDUCTIBLES = DECREASE CASH FLOW
The 2008 Medicare Part B deductible increased to $135 further slowing cash flow over the previous year. Cash flow will be down as usual in January & February since Medicare deductibles hit - until secondary insurance & patient payments are received in February & March.
Just a reminder that historically for all providers it takes until the end of March before cash flow catches up to normal levels due to the new insurance deductibles (Medicare and other insurances). This means that Days-in-Accounts Receivable and AR will go up in January & February then begin to decrease to normal levels in March when cash flow catches up.
NPI # Information From Medicare
We are pleased to report that CPB has been sending only the NPI # to Medicare for several weeks without any problems getting paid. At least for Medicare patients, it appears we are in good shape for May 23rd.
MORE POTENTIAL CASH FLOW ISSUES
Once we get past the annual deductibles in March, there is still potential for cash flow interruption when the NPI # becomes mandatory for all insurers on May 23rd. Our concern now is that other insurers (including Blue Shields, Medicaids, etc.) do not seem to be doing much testing.
We recommend taking this into consideration if you plan to make any significant purchases until we see how well the national system (Medicaid, Horizon, other Blue Shields, CIGNA, AETNA, etc.) handles the NPI # only.
Horizon, as of 2/28/08, still is not ready to test! We will continue to test claims as insurers indicate they are ready.
Thursday, January 14, 2010
February 2008
MEDICARE DEDUCTIBLES = DECREASE CASH FLOW
The 2008 Medicare Part B deductible increased to $135 further slowing cash flow over the previous year. Cash flow will be down as usual in January & February since Medicare deductibles hit - until secondary insurance & patient payments are received in February & March. Just a reminder that historically for all providers it takes until the end of March before cash flow catches up to normal levels due to the new insurance deductibles (Medicare and other insurances). This means that Days-in-Accounts Receivable and AR will go up in January & February then begin to decrease to normal levels in March when cash flow catches up.
NPI # Information From Medicare
(MLN Matters 2007-12, December 2007, pp. 72-73).
· Effective May 23, 2008, providers who have not obtained an NPI # are not permitted to refer or order services or items for Medicare beneficiaries.
· Physicians (MD & DO) and the following provider types are the only ones allowed to refer or order services or items for beneficiaries: Nurse Practitioners (NP), Physician Assistants (PA), Clinical Nurse Specialists (CNS), and Certified Nurse Midwives (CNM).
· Effective May 3, 2008, Medicare will begin requiring an NPI number for all ordering & referring providers regardless of whether that referring or ordering provider participates in the Medicare program.
CPB has finished updating nearly 3,000 referring physician’s NPI numbers in its database so we are ready for these changes.
We are currently testing sending only the Rendering Provider’s NPI #’s with Medicare. All providers have been tested and only one was required by Medicare to complete an 855I application.
Horizon, as of yesterday, still is not ready to test! We will continue to test claims as insurers indicate they are ready.
Uniformed Services Family Health Plan Bankruptcy
You may recall that CPB filed the necessary paperwork to obtain payment for our clients. All payments have now been received.
The 2008 Medicare Part B deductible increased to $135 further slowing cash flow over the previous year. Cash flow will be down as usual in January & February since Medicare deductibles hit - until secondary insurance & patient payments are received in February & March. Just a reminder that historically for all providers it takes until the end of March before cash flow catches up to normal levels due to the new insurance deductibles (Medicare and other insurances). This means that Days-in-Accounts Receivable and AR will go up in January & February then begin to decrease to normal levels in March when cash flow catches up.
NPI # Information From Medicare
(MLN Matters 2007-12, December 2007, pp. 72-73).
· Effective May 23, 2008, providers who have not obtained an NPI # are not permitted to refer or order services or items for Medicare beneficiaries.
· Physicians (MD & DO) and the following provider types are the only ones allowed to refer or order services or items for beneficiaries: Nurse Practitioners (NP), Physician Assistants (PA), Clinical Nurse Specialists (CNS), and Certified Nurse Midwives (CNM).
· Effective May 3, 2008, Medicare will begin requiring an NPI number for all ordering & referring providers regardless of whether that referring or ordering provider participates in the Medicare program.
CPB has finished updating nearly 3,000 referring physician’s NPI numbers in its database so we are ready for these changes.
We are currently testing sending only the Rendering Provider’s NPI #’s with Medicare. All providers have been tested and only one was required by Medicare to complete an 855I application.
Horizon, as of yesterday, still is not ready to test! We will continue to test claims as insurers indicate they are ready.
Uniformed Services Family Health Plan Bankruptcy
You may recall that CPB filed the necessary paperwork to obtain payment for our clients. All payments have now been received.
January 2008
2008 PART B DEDUCTIBLE
The Centers for Medicare & Medicaid Services (CMS) announced the Part B annual deductible for 2008 is $135.00 (up from $131 for 2007). If the patient has no secondary insurance, we strongly recommend collecting the deductible and co-insurance on the day of service. Be sure to ask if the patient has paid all or part of their deductible to any other providers, of course.
The annual co-insurance form that we prepare will be sent as soon as we receive the 2008 fees from Medicare.
2008 MEDICARE PHYSICAL, OCCUPATIONAL & SPEECH THERAPY CAP
The Therapy Cap for 2008 is $1,810. However, the moratorium on the Medicare Cap Exceptions process for independently practicing physical, speech and occupational therapists was extended only to June 30, 2008 by Congress with President Bush expected to sign that bill by December 31st. The cap will be $1,810 after that for the remainder of 2008 unless Congress acts later to extend it.
That Cap applies for Physical Therapy & Speech-language pathology combined and for Occupational Therapy services alone. Thus, a patient will have $1,810 for PT/ST and another $1,810 for OT. When a patient exceeds the $1,810 (total of Allowed Amounts) the patient is responsible for the Allowed Amount in excess of the $1,810. If a Medigap policy is secondary then there will be no coverage. If a supplemental plan is secondary then there may be coverage and that plan should be contacted before treating to determine benefits.
There is a requirement for the provider to give the patient at the first encounter an NEMB (with specific language) that they will be responsible for allowed amounts when they exceed the Cap (subject to their secondary policies) if no valid Exception applies. The Cap is per year for all outpatient rehab services except outpatient hospital.
ANNUAL CHARGE FORM CHANGES
This is a good time to review your Charge forms for new CPT, ICD-9 and HCPCS codes and to decide whether to add your new NPI # before you re-order. The Charge form is a key part of any insurance audit so ensuring it is current is important. CPB will be glad to review all codes on the form for you and provide any necessary corrections at no cost. Many clients also have their Tax ID#, Medicare # or other numbers on their Charge form but they are not required unless the patient does their own billing.
Medicare Preventive Services Quick Reference
Enclosed this month for our PCP’s is a copy of the Medicare Preventive Services Quick Reference form indicating what is required to bill for the Initial Preventive Physical Examination (IPPE). If you would like these CPT codes added to your charge form, please let Rich know. Medicare’s 2007 Allowed amount is $99.46 for the IPPE and $26.99 for the EKG. The updated 2008 Fee Schedule has not yet been released.
DME Supplier Accreditation Requirement
On December 19, CMS held an Open Door Forum and announced that all DME suppliers must be accredited was September 30, 2009 in order to be paid for products. CMS specifically stated they had no exemptions to announce.
CMS Online Internet Applications
The Centers for Medicare & Medicaid Services (CMS) has announced new online enterprise applications that will allow Medicare fee-for-service providers to access, update, and submit information over the Internet. Details of these provider applications will be announced as they become available. Even though these new internet applications are not yet available, CMS recommends that providers take the time now to set up their online account so they can access these applications as soon as they are available. The first step is for the provider or appropriate staff to register for access through a new CMS security system known as the Individuals Authorized Access to CMS Computer Services - Provider Community (IACS-PC). This does NOT apply to DMEPOS suppliers at this time. This is the first step in the PECOS On-Line Provider Enrollment process which is expected to begin in about 60 days. Please let Rich know when you have done this.
A recent MLN Matters article, the first in a new series on IACS-PC, addresses key questions and answers about the registration process and can be found at
http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0747.pdf on the CMS website.
What is particularly important is that a provider can designate an authorized representative to access the system on their behalf. This will allow physicians and other providers to designate the billing company as a designated representative. As the designated representative, the billing company will be able to complete the on-line enrollment, as well as update information as necessary.
A key point is when someone should register as an “individual” versus an “organization”. If the provider registers as an “individual” ONLY he or she is authorized to enter or change information. If the provider wishes to allow someone else access (an employee, billing company, etc.), then he/she must register as an “organization” - even if it is a solo practicing physician.
CPB will be glad to do this on your behalf at no cost – just fax a request to Rich.
The Centers for Medicare & Medicaid Services (CMS) announced the Part B annual deductible for 2008 is $135.00 (up from $131 for 2007). If the patient has no secondary insurance, we strongly recommend collecting the deductible and co-insurance on the day of service. Be sure to ask if the patient has paid all or part of their deductible to any other providers, of course.
The annual co-insurance form that we prepare will be sent as soon as we receive the 2008 fees from Medicare.
2008 MEDICARE PHYSICAL, OCCUPATIONAL & SPEECH THERAPY CAP
The Therapy Cap for 2008 is $1,810. However, the moratorium on the Medicare Cap Exceptions process for independently practicing physical, speech and occupational therapists was extended only to June 30, 2008 by Congress with President Bush expected to sign that bill by December 31st. The cap will be $1,810 after that for the remainder of 2008 unless Congress acts later to extend it.
That Cap applies for Physical Therapy & Speech-language pathology combined and for Occupational Therapy services alone. Thus, a patient will have $1,810 for PT/ST and another $1,810 for OT. When a patient exceeds the $1,810 (total of Allowed Amounts) the patient is responsible for the Allowed Amount in excess of the $1,810. If a Medigap policy is secondary then there will be no coverage. If a supplemental plan is secondary then there may be coverage and that plan should be contacted before treating to determine benefits.
There is a requirement for the provider to give the patient at the first encounter an NEMB (with specific language) that they will be responsible for allowed amounts when they exceed the Cap (subject to their secondary policies) if no valid Exception applies. The Cap is per year for all outpatient rehab services except outpatient hospital.
ANNUAL CHARGE FORM CHANGES
This is a good time to review your Charge forms for new CPT, ICD-9 and HCPCS codes and to decide whether to add your new NPI # before you re-order. The Charge form is a key part of any insurance audit so ensuring it is current is important. CPB will be glad to review all codes on the form for you and provide any necessary corrections at no cost. Many clients also have their Tax ID#, Medicare # or other numbers on their Charge form but they are not required unless the patient does their own billing.
Medicare Preventive Services Quick Reference
Enclosed this month for our PCP’s is a copy of the Medicare Preventive Services Quick Reference form indicating what is required to bill for the Initial Preventive Physical Examination (IPPE). If you would like these CPT codes added to your charge form, please let Rich know. Medicare’s 2007 Allowed amount is $99.46 for the IPPE and $26.99 for the EKG. The updated 2008 Fee Schedule has not yet been released.
DME Supplier Accreditation Requirement
On December 19, CMS held an Open Door Forum and announced that all DME suppliers must be accredited was September 30, 2009 in order to be paid for products. CMS specifically stated they had no exemptions to announce.
CMS Online Internet Applications
The Centers for Medicare & Medicaid Services (CMS) has announced new online enterprise applications that will allow Medicare fee-for-service providers to access, update, and submit information over the Internet. Details of these provider applications will be announced as they become available. Even though these new internet applications are not yet available, CMS recommends that providers take the time now to set up their online account so they can access these applications as soon as they are available. The first step is for the provider or appropriate staff to register for access through a new CMS security system known as the Individuals Authorized Access to CMS Computer Services - Provider Community (IACS-PC). This does NOT apply to DMEPOS suppliers at this time. This is the first step in the PECOS On-Line Provider Enrollment process which is expected to begin in about 60 days. Please let Rich know when you have done this.
A recent MLN Matters article, the first in a new series on IACS-PC, addresses key questions and answers about the registration process and can be found at
http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0747.pdf on the CMS website.
What is particularly important is that a provider can designate an authorized representative to access the system on their behalf. This will allow physicians and other providers to designate the billing company as a designated representative. As the designated representative, the billing company will be able to complete the on-line enrollment, as well as update information as necessary.
A key point is when someone should register as an “individual” versus an “organization”. If the provider registers as an “individual” ONLY he or she is authorized to enter or change information. If the provider wishes to allow someone else access (an employee, billing company, etc.), then he/she must register as an “organization” - even if it is a solo practicing physician.
CPB will be glad to do this on your behalf at no cost – just fax a request to Rich.
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