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.  

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.