October 2010

HUMANA CHANGES

On August 6th Humana announced they will be making a number of changes in billing and payment policies and procedures effective November 6, 2010. The most notable that we saw pertains to our PCP’s: Humana will include E&M services with the removal of impacted cerumen (69210). It is not clear from their letter whether they will allow modifiers to show when the 69210 was separate and distinct from E&M services.

HIghmark Medicare – 99204 & 99205 prepayment review

On September 20, Highmark Medicare announced that all 99204 & 99205 CPT codes will undergo prepayment review:

A recent widespread post payment audit performed by Highmark Medicare Services’ Medical Review Department revealed that 73% of new patient office or outpatient visits, procedure codes 99204 and 99205, were billed incorrectly. While the number one error was incorrectly coding the level of service, other issues were identified. The issues included:

· The lack of an accepted form of provider signature,
· The documentation did not support incident to guidelines as there was no evidence of the physician initiating the plan of care, and
· No documentation was received to support the services billed.

In order to bill a new patient office or outpatient visit, the patient must not have received any professional service from any physician in the group of the same specialty within the last three years.

As a result of these review findings, a prepayment edit will be implemented on procedure codes 99204 and 99205 for physicians and non-physician practitioners (NPP) of all specialties.

You can read the full article:
https://www.highmarkmedicareservices.com/bulletins/partb/news09202010.html

If you are asked for any medical records, you are welcome to ask us to review them for anything non-clinical. We strongly urge you not to respond without making sure that the signature is in an acceptable format. There are legitimate ways to make it acceptable. Be sure to respond within the required time frame and please notify us (faxing the letter is fine) so we know why payment is being delayed.

It is important that your medical records substantiate your services to avoid being placed on prepayment review for other services as well. Failure to respond at all may lead Medicare to review even more charges or cease paying entirely.

If you have any questions, please contact me.

September 2010

CMB APPOINTMENT SYSTEM

Several office-based clients are now using our appointment system and enjoying the numerous benefits it offers. And it is free! Setup takes only a few minutes (which we do) and simply requires a computer and high-speed internet.

The system also offers an add-on auto-dialer option that works off the appointment system to remind your patients they have an appointment – thus cutting down on Missed appointments. After making the calls, it creates a report that lists who was called, what the status of the call was (appointment confirmed, no answer, busy, etc.), etc.

We also have 2 clients using the new digital pen technology which sends your charges to us within minutes or hours of treating the patients! This requires a color laser printer to print the specially engineered charge form. This is real “cutting-edge” technology!

If you are interested in the appointment system and/or the digital pen, please feel free to call.

ElectRonic PATIENT STATMENTS

Patient statements are moving into the 21st century! Patients can now access their monthly statement online via a secure hyperlink - much like many other bills. Providers that have this service, report a 20% - 30% increase in patient payments in addition to lower statement costs due to zero postage. To do so, we need to begin capturing the email addresses so patients can be notified via email. That saves postage (and trees!) and provides more timely payment. Patients without an email address can continue to receive paper statements. If the email bounces or is not opened within X days (7, for example), the statement software will recycle and print a paper statement. Clients using our free Appointment System can enter the email address in the first Demographics screen. Other clients can simply add it to any Charge form for us to enter – but please be sure it is written clearly.

EMR’s

In our continuing series to provide information, some additional considerations to ensure vendors meet the “meaningful use” criteria:

• If you look at an EMR program that does not have the CCHIT 2011 (yep, 2011) certification, we suggest you ask them to provide you a written guarantee that they will receive 2011 certification by December 31, 2010. Otherwise, you could be losing out on the initial Medicare payments. The top EHR vendors are all providing written guarantees including penalties if they do not meet 2011 through 2015 certification by the posted certification date.
• You can start with an EMR as late as 2012 and still receive the full Medicare Incentive bonus. See graph below.
• A Physician gets 75% of Medicare Allowable Charges up to the maximum each year (see chart below) if they have a certified EHR and can meet 15 of the 25 quality Meaningful Use criteria. For example, annual payments are calculated based on Medicare processed allowable charges for Year 1:

$40,000 x 75% = $37,500 = Max of $18,000
$24,000 x 75% = $18,000 = Max of $18,000
$20,000 x 75% = $15,000 = Max of $15,000

eRx & PQRI PAYMENTS

Per CMS, the 2009 eRx incentive payments will be distributed first, from late September through late October, and the 2009 PQRI incentive payments will be distributed from late October through mid-November.
The 2010 incentive payments will be distributed sometime in the fall of 2011.

MED RISK UPDATE

Effective 8/18/10, Med Risk asks that providers start using their new fax numbers. To fax New patient (PIF) or Submit Initial Evaluations and Rx’s: 877-389-7197 or 877-805-4173.

August 2010

MEDICARE - PECOS

Medicare is reminding all physicians regarding the PECOS requirements for providers who have not re-enrolled or updated their enrollment within the past 6 years. Providers will need an approved enrollment record in PECOS to continue to order or refer items or services for Medicare beneficiaries and to receive incentive payments made by Medicare and Medicaid. If you, or a colleague, need assistance using the internet-based PECOS, please call us.

EMR’s

The final Meaningful Use (MU) criteria came out on July 13th. CMS has lowered the # of standards that must be met in order to qualify for MU and meet the certification standard so providers can receive the incentive bonuses.

Mark Anderson, CEO of the AC Group, said they have conducted a review of 114 EHR vendors, and, as of July 15, believe that 83 of them can meet Stage 1 MU requirements. Although CCHIT is NOT an approved 2011 MU certification body yet, almost everyone assumes they will become one of the certifying bodies. Right now 28 EHR vendors have already received CCHIT 2011 certification and the CCHIT certification process requires more than just the Stage 1 MU requirements. CCHIT has opened up certification again and 48 additional EHR vendors have said they are in the process of getting CCHIT certified.

Primary Care Bonus Payments

Beginning in 2011 and effective until 2016, all primary care physicians, PA’s, NP’s, and CNS’s will be eligible for a 10% bonus in Medicare payments. To qualify, at least 60% of a physician’s total Medicare charges must be comprised of office, nursing home, and home care visits." We will forward details when they are released by CMS.

AETNA EFT

From Aetna: Electronic Funds Transfer (EFT) is available to all providers treating Aetna members for all benefits plans. If you choose free online electronic delivery of your claims payments via EFT, you:

• Get payments transmitted directly into your bank account(s) up to one week faster than with paper EOBs and checks
• Reduce mail, and eliminate trips to the bank, while providing a convenient audit trail.
  
  If you are interested, we can give you the contact information.
  
  MEDICAL IDENTITY THEFT
  
  Recently I was speaking with the Receptionist for one of our clients and reminding her how important it is to verify insurance each visit, plus copy and verify the photo ID for new patients. Her response was that she sometimes was too busy to do that. That was not a surprise since we had noticed a higher # of denials for wrong insurance at that office, which prompted the visit.
  
  Patients are not the only victims of medical identity theft - physicians and other healthcare providers are also victims. If a physician treats a patient who has provided fraudulent information, one of two bad outcomes are likely:
  · If the insurer has already caught the identity theft, the provider will not be paid for the services rendered.
  · If the provider already got paid by the insurance company, they will be required to return those funds when the identity theft is caught. The laws always exempt fraud when an insurer wants money back, so that does not prevent take-backs.
  
  The above can be prevented by carefully checking the photo ID. CPB’s appointment system allows copies of both driver’s licenses and insurance cards to be kept and viewed.
  
  In case you didn't know…
  IRS-CMS & Delinquent Tax Bills
  
  Legislation recently signed by President Obama that delays Medicare cuts until December 1 also establishes a data match program between the Centers for Medicare and Medicaid Services and the Internal Revenue Service. Under the new law, the IRS has the authority to disclose to CMS any information on delinquent tax debts for a provider who has applied to enroll or re-enroll in Medicare. CMS can use information obtained from the IRS in determining whether to deny a provider application for participation in Medicare or to apply enhanced oversight to the provider. Text of the enrolled version of the bill, H.R. 3962, is available at congress.gov.
  
  Cape Medical Billing
  1-888-633-2457