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.
Tuesday, July 10, 2012
Tuesday, June 5, 2012
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.
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.
Monday, May 14, 2012
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.
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.
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