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Mary Pat and Dr. Peter Polack Discuss (Approximately) 101 Ideas to Increase Revenue and Decrease Costs in a Two Part Podcast

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Mary Pat recently sat down with Peter Polack, MD of Medical Practice Trends for another podcast to talk about one of the most important parts of any practice: The Bottom Line. In this two-part podcast series, Dr. Polack and MP discuss ideas for cutting costs and raising revenue to strengthen any group’s financial position.

Click here to listen to part 1

Click here to listen to part 2




News from Medicare & Other Payers for the Week of January 23, 2012: 5010 National Provider Call This Week; Most Insurances Will Be Required to Cover Birth Control Without Co-Pays

Français : Différents types de pilule contrace...

 

e-RX: Medicare e-prescribing hardship exemptions under review (jump to story)

 

EFT: suppliers and providers who are not currently receiving Medicare EFT payments are required to submit the CMS-588 EFT form (jump to story)

 

SNFs: Allowing Physician Assistants to Perform Skilled Nursing Facility (SNF) Level of Care Certifications and Recertifications (jump to story)

 

ACA: the final rule on preventive health services will ensure that women with health insurance coverage will have access to the full range of the Institute of Medicine’s recommended preventive services, including all FDA -approved forms of contraception. (jump to story)

 

EHR Incentive Program: what can still be completed in 2012 in order to receive an incentive payment for CY2011 (jump to story)

 

5010: National Provider Call:  Medicare FFS Implementation of HIPAA Version 5010 and D.0 Transactions (jump to story)

 

Claims Crossovers: Greater instances of Medicare correspondence letters that make reference to error N22226 as the basis for patient claims not crossing over(jump to story)

 

ICD-10: What’s Your Plan, Man?(jump to story)

 

MLN: Medicare Learning Network Announcements, Updates and Revisions (jump to story)
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Medicare e-prescribing hardship exemptions under review

Last fall, physicians had the opportunity to seek hardship exemptions and avoid penalties for failing to successfully participate in Medicare’s e-prescribing program. The Centers for Medicare & Medicaid Services (CMS) is reviewing each hardship exemption request on an individual basis and has not yet completed its analysis. Therefore, it is possible that some physicians will be subjected to a 1 percent Medicare payment penalty inappropriately until the backlog of exemption requests is reviewed. Ultimately, CMS will reprocess the claims.

Read information regarding remittance advice and information on the impact to physician reimbursement and patient copays. More information on the penalty program can be found here.

Find additional electronic prescribing information and resources on the AMA website.

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The ACA (Affordable Care Act) Mandates Federal Payment to Providers and Suppliers Only by Electronic Means

Existing regulations at 42 CFR 424.510(e)(1)(2) require that at the time of enrollment, enrollment change request, or revalidation, providers and suppliers that expect to receive payment from Medicare for services provided must also agree to receive Medicare payments through electronic funds transfer (EFT).  Section 1104 of the Affordable Care Act further expands Section 1862(a) of the Social Security Act by mandating federal payments to providers and suppliers only by electronic means.  As part of CMS’s revalidation efforts, all suppliers and providers who are not currently receiving EFT payments are required to submit the CMS-588 EFT form with the Provider Enrollment Revalidation application, or at the time any change is being made to the provider enrollment record by the provider or supplier, or delegated official.

For more information about provider enrollment revalidation, review the Medicare Learning Network’s Special Edition Article #SE1126, titled “Further Details on the Revalidation of Provider Enrollment Information.”

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Allowing Physician Assistants to Perform Skilled Nursing Facility (SNF) Level of Care Certifications and Recertifications

http://www.cms.gov/MLNMattersArticles/Downloads/MM7701.pdf

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A Statement by U.S. Department of Health and Human Services Secretary Kathleen Sebelius

In August 2011, the Department of Health and Human Services issued an interim final rule that will require most health insurance plans to cover preventive services for women including recommended contraceptive services without charging a co-pay, co-insurance or a deductible.  The rule allows certain non-profit religious employers that offer insurance to their employees the choice of whether or not to cover contraceptive services. Today the department is announcing that the final rule on preventive health services will ensure that women with health insurance coverage will have access to the full range of the Institute of Medicine’s recommended preventive services, including all FDA -approved forms of contraception.  Women will not have to forego these services because of expensive co-pays or deductibles, or because an insurance plan doesn’t include contraceptive services. This rule is consistent with the laws in a majority of states which already require contraception coverage in health plans, and includes the exemption in the interim final rule allowing certain religious organizations not to provide contraception coverage. Beginning August 1, 2012, most new and renewed health plans will be required to cover these services without cost sharing for women across the country.

After evaluating comments, we have decided to add an additional element to the final rule. Nonprofit employers who, based on religious beliefs, do not currently provide contraceptive coverage in their insurance plan, will be provided an additional year, until August 1, 2013, to comply with the new law. Employers wishing to take advantage of the additional year must certify that they qualify for the delayed implementation. This additional year will allow these organizations more time and flexibility to adapt to this new rule.  We intend to require employers that do not offer coverage of contraceptive services to provide notice to employees, which will also state that contraceptive services are available at sites such as community health centers, public clinics, and hospitals with income-based support.  We will continue to work closely with religious groups during this transitional period to discuss their concerns.

Scientists have abundant evidence that birth control has significant health benefits for women and their families, it is documented to significantly reduce health costs, and is the most commonly taken drug in America by young and middle-aged women. This rule will provide women with greater access to contraception by requiring coverage and by prohibiting cost sharing.

This decision was made after very careful consideration, including the important concerns some have raised about religious liberty. I believe this proposal strikes the appropriate balance between respecting religious freedom and increasing access to important preventive services. The administration remains fully committed to its partnerships with faith-based organizations, which promote healthy communities and serve the common good.  And this final rule will have no impact on the protections that existing conscience laws and regulations give to health care providers.

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Receiving an EHR Incentive Program Payment for CY2011

As 2012 begins, CMS wants to remind eligible professionals (EPs) participating in the Medicare Electronic Health Record (EHR) Incentive Program of important deadlines approaching and what can still be completed in 2012 in order to receive an incentive payment for CY2011.

Important Medicare EHR Incentive Program Dates

On Saturday, December 31, 2011, the reporting year ended for EPs who participated in the Medicare EHR Incentive Program in 2011.  What does this mean?  For participating EPs, they must have completed their 90-day reporting period by the end of 2011.

However, EPs have until Wednesday, February 29, 2012 to actually register and attest to meeting meaningful use to receive an incentive payment for CY2011 through the Medicare & Medicaid EHR Incentive Program Registration and Attestation System.

Payment Threshold Information
Wednesday, February 29, 2012 is also the deadline for EPs to submit any pending Medicare Part B claims from CY2011, as CMS allows 60 days after Saturday, December 31, 2011 for all pending claims to be processed.  This means that EPs have 60 days in 2012 to submit claims for allowed charges incurred in 2011.

Medicare EHR incentive payments to EPs are based on 75% of the Part B allowed charges for covered professional services furnished by the EP during the entire payment year.  If the EP did not meet the $24,000 threshold in Part B allowed charges by the end of CY2011, CMS expects to issue an incentive payment for the EP in April 2012 for 75% of the EP’s Part B charges from 2011.

Note for Medicaid Participants:  Medicaid incentives will be paid by the states, but the timing will vary according to state.  Please contact your State Medicaid Agency for more details about payment.

Want more information about the EHR Incentive Programs?  Visit the EHR Incentive Programs website for the latest news and updates on the EHR Incentive Programs.

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National Provider Call:  Medicare FFS Implementation of HIPAA Version 5010 and D.0 Transactions – Register Now

Wednesday, January 25, 2012, 2-3:30pm ET

CMS will host a special National Provider Call regarding the Medicare FFS implementation of HIPAA Version 5010 and D.0 transaction standards.

Target Audience:  Vendors, clearinghouses, and providers who need to make Medicare FFS-specific changes in compliance with HIPAA Version 5010 requirements.

Agenda (there will be no slide presentation for this call):

  • HIPAA Version 5010 implementation update
  • Question & answer session

If you would like to submit a question related to this topic in advance of, during, or following the call, please email your inquiry to the 5010 FFS Information resource mailbox at 5010FFSinfo@CMS.hhs.gov.  Note that this resource box will only accept emails the day before, the day of, and the day after this call; your emailed questions will be answered as soon as possible, and may not be answered during the call.

Registration Information:  In order to receive the call-in information, you must register for the call.  Registration will close at 12pm on the day of the call or when available space has been filled; no exceptions will be made, so please register early.  For more details, including instructions on registering for the call, please visit http://www.eventsvc.com/blhtechnologies.

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Greater instances of Medicare correspondence letters that make reference to error N22226 as the basis for patient claims not crossing over

On Monday, December 5, 2011, CMS issued a Special Edition MLN Matters Article (SE1137) entitled “Additional Health Insurance Portability and Accountability Act (HIPAA) 837 5010 Transitional Changes and Further Modifications to the Coordination of Benefits Agreement (COBA) National Crossover Process.”  CMS issued this guidance for the benefit of physicians/practitioners, providers, and suppliers to help them understand why they were seeing greater instances of Medicare correspondence letters that made reference to error N22226 as the basis for why their patients’ claims could not be crossed over.

CMS has since learned that concern exists in the provider community concerning whether billing of hardcopy CMS 1500 or UB04 claims or HIPAA version 4010A1 or National Council for Prescription Drug Programs (NCPDP) version 5.1 batch claims will result in Medicare being unable to cross those claims over to COBA supplemental payers that have cut-over to exclusive receipt of crossover claims in the version 5010 837 claim formats or NCPDP D.0 batch claim formats.  This is not true.

During the 90-day Version 5010 non-enforcement period (Sunday, January 1, 2012 through Saturday, March 31, 2012), Medicare will have the systematic capability to perform up- or down-version conversion of incoming claim formats (ie. convert incoming hardcopy formats to HIPAA equivalent claim formats and convert incoming version 4010A1 claim formats to 5010 formats and vice-a-versa), in accordance with external supplemental payer specifications concerning production claims format.  This practice will discontinue, however, at the conclusion of the 90-day non-enforcement period, with the exception below.  (This action is controlled by information that the Common Working File receives concerning individual supplemental payers’ ability to accept HIPAA 5010 or NCPDP D.0 claim formats in “production” mode.)

Note that physicians/practitioners, providers, and suppliers that have authorization under the Administrative Simplification Compliance Act (ASCA) to submit claims using a hardcopy format should know that Medicare has the systematic capability to convert keyed claims into outbound-compliant HIPAA 837 claim formats for crossover claim transmission purposes.  This is true at all times, not just during the 90-day non-enforcement period.

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What’s Your Plan, Man?

Is your organization preparing for a smooth transition to ICD-10 on Tuesday, October 1, 2013?  ICD-10 National Provider Calls, hosted by the CMS Provider Communications Group, can help you prepare for the US healthcare industry’s change from ICD-9 to ICD-10 for diagnosis and inpatient procedure coding.

Video slideshow presentations from the following National Provider Calls are available on the CMS YouTube Channel.  These video slideshows include the call slide presentation and audio with captions; each call includes presentations by CMS subject matter experts, followed by a question and answer session.

The ICD-9-CM and ICD-10 Cooperating Parties – CMS, the American Hospital Association (AHA), the American Health Information Management Association (AHIMA), and the Centers for Disease Control and Prevention (CDC) – discuss ICD-10 implementation strategies and planning, and the CMS Provider Billing Group discuss the Medicare FFS claims processing guidance issued in August 2011.

CMS subject matter experts discuss how physician offices can prepare for the change to ICD-10 for medical diagnosis and inpatient procedure coding and provide updates on national ICD-10 implementation issues affecting all providers.

CMS subject matter experts discuss the ICD-10 conversion process currently taking place within CMS, including a case study from the Coverage and Analysis Group on their transition to ICD-10 for the lab national coverage determinations (NCDs).

Podcasts, complete audio files, and complete written transcripts for these ICD-10 National Provider Calls are also available on the CMS ICD-10 webpage at http://www.CMS.gov/ICD10/Tel10/list.asp.

Available 24/7, YouTube video presentations and podcasts make learning about the ICD-10 transition easy and convenient. Check them out today.

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Medicare Learning Network Announcements, Updates and Revisions

From the MLN:  “Health Professional Shortage Area Bonus Payment Policy Reminders” MLN Matters Article Released – A new MLN Matters® Special Edition Article #SE1202, “Health Professional Shortage Area (HPSA) Bonus Payment Policy Reminders,” has been released in downloadable format.  This article is designed to provide education on the HPSA Bonus Payment Program, and provides information about the program and resources that providers can use to determine whether they are eligible to receive the bonus payment.

From the MLN:  New “Medicare Coverage of Radiology and Other Diagnostic Services” Fact Sheet Released – A new “Medicare Coverage of Radiology and Other Diagnostic Services” fact sheet (ICN 907164) has been released in downloadable format.  This fact sheet is designed to provide education on Medicare coverage and billing information for radiology and other diagnostic services, and includes specific information concerning billing and coding requirements and an overview of coverage guidelines.

From the MLN:  New Fast Fact on MLN Provider Compliance Webpage – A new fast fact is now available on the MLN Provider Compliance webpage.  This page provides the latest educational products designed to help Medicare Fee-For-Service providers understand – and avoid – common billing errors and other improper activities.  Please bookmark this page and check back often as a new fast fact is added each month!

From the MLN:  “Acute Care Hospital Inpatient Prospective Payment System” Fact Sheet Revised – The “Acute Care Hospital Inpatient Prospective Payment System” fact sheet (ICN 006815) has been revised and is available in downloadable format.  This fact sheet includes information on payment background, the basis for the Acute Care Hospital Inpatient Prospective Payment System payment, payment rates, and how payment rates are set.

From the MLN:  “Items and Services That Are Not Covered Under the Medicare Program” Booklet and “Medicare Claim Submission Guidelines” Fact Sheet Now Available in Hardcopy – The “Items and Services That Are Not Covered Under the Medicare Program” booklet (ICN 906765), available now in hardcopy, includes information about the four categories of items and services that are not covered under the Medicare program and applicable exceptions to exclusions and the Advance Beneficiary Notice of Noncoverage.

The “Medicare Claim Submission Guidelines” fact sheet (ICN 906764), available now in hardcopy as well, includes information about applying for a National Provider Identifier and enrolling in the Medicare program, filing Medicare claims, and private contracts with Medicare beneficiaries.

From the MLN:  “Medicare Claim Review Programs” Booklet Revised – The revised “Medicare Claim Review Programs: MR, NCCI Edits, MUEs, CERT, and RAC” booklet (ICN 006973) is designed to provide education on the different CMS claim review programs and assist providers in reducing payment errors, including, in particular, coverage and coding errors.  It includes frequently asked questions, resources, and an overview of the various programs, including Medical Review, Recovery Audit Contractor, and the Comprehensive Error Rate Testing Program.

From the MLN:  “Substance (Other Than Tobacco) Abuse Structured Assessment and Brief Intervention (SBIRT)” Fact Sheet Revised – This revised “Substance (Other Than Tobacco) Abuse Structured Assessment and Brief Intervention (SBIRT)” fact sheet (ICN 904084) is designed to provide education on SBIRT, an early intervention approach that targets those with nondependent substance use to provide effective strategies for intervention prior to the need for more extensive or specialized treatment.

From the MLN:  “Non-Specific Procedure Code Description Requirement for HIPAA Version 5010 Claims” MLN Matters Article Released – The new “Non-Specific Procedure Code Description Requirement for HIPAA Version 5010 Claims” MLN Matters Special Edition Article (#SE1138) is designed to provide education on the requirements for non-specific procedure codes for HIPAA 5010 claims, as established in Change Request 7392.  It includes guidance to help providers comply with the requirements and submit HIPPA-compliant claims for all non-specific procedure codes.

From the MLN:  “Federally Qualified Health Center” Fact Sheet Revised – The revised “Federally Qualified Health Center” fact sheet (ICN 006397) includes the following information: background; FQHC designation; covered FQHC services; FQHC preventive primary services that are not covered; FQHC Prospective Payment System; FQHC payments; and Medicare Prescription Drug, Improvement, and Modernization Act of 2003 provisions that impact FQHCs.

From the MLN:  Medicare Preventive Services Series: Part 2, Web-Based-Training Course (WBT) Revised – This WBT is designed to provide education on Medicare Preventive Services.  It includes information on Medicare’s coverage for the initial preventive physical exam (IPPE), ultrasound screening for abdominal aortic aneurysm (AAA), screening electrocardiogram (EKG), Annual Wellness Visit (AWV), cardiovascular screening blood tests, diabetes-related services, human immunodeficiency virus (HIV) screening and smoking and tobacco-use cessation counseling services. To access the WBT, visit the MLN Products page, scroll to the “Related Links Inside CMS,” and select the “Web-Based Training (WBT) Courses.”

From the MLN:  MLN Guided Pathways (Basic, A, and B) Provider-specific Resource Booklets Revised – The revised MLN Guided Pathways curriculum is designed to allow learners to easily identify and select resources by clicking on topics of interest.  The curriculum begins with basic knowledge for all providers and then branches to information for either those enrolling on the 855B, I, and S forms or on the 855A form (or Internet-based PECOS equivalents).  The resource booklets are:

From the MLN:  “MLN Guided Pathways Provider-specific” Resource Booklet Revised – The Revised MLN Guided Pathways to Medicare Resources provider-specific resource booklet provides various specialties of healthcare professionals, (physicians, chiropractors, optometrists, podiatrists), nurses (APN, RNCNS, NP, Midwife) PAs, social workers, psychologists, therapists (OT, PT, SLP), dietitians, nutritionists, suppliers (ambulance, ASC, DMEPOS, FQHC, RHC, Labs, mammography, radiation therapy, portable x-ray), and providers (CMHC, CORF, ESRD, HHA, hospice, OPT, pathology and SNF) with resources specific to their specialty including Internet-Only Manuals (IOMs), Medicare Learning Network® publications, CMS webpages, and more.  This version includes the addition of pathways for Anesthesiology Assistant/Certified Registered Nurse Anesthetist, Anesthesiologist, Ophthalmologist, and Optometrist, along with a fully developed pathway for Mass Immunization Roster Biller.

All of the MLN Guided Pathways booklets above are available at http://www.CMS.gov/MLNEdWebGuide/30_Guided_Pathways.asp.

From the MLN: “Preventive Services Educational Resources for Health Care Professionals” MLN Matters® Article Released – The new “Preventive Services Educational Resources for Health Care Professionals” MLN Matters® Special Edition Article (#SE1142) is designed to provide education on available educational resources related to Medicare-covered preventive services.  It includes a list of MLN products that can help Medicare FFS providers understand coverage, coding, reimbursement, and billing requirements related to these services.

From the MLN:  “Advanced Payment Accountable Care Organization Model” Fact Sheet Available – The new “Advanced Payment Accountable Care Organization Model” fact sheet (ICN 907403) is designed to provide education on the advance payment model for Accountable Care Organizations (ACOs).  It includes a summary of the Advance Payment ACO Model, background, and information on the structure of payments, recoupment of advance payments, eligibility, and the application process.

From the MLN:  “Summary of Final Rule Provisions for Accountable Care Organizations Under the Medicare Shared Savings Program” Fact Sheet Available – The new “Summary of Final Rule Provisions for Accountable Care Organizations Under the Medicare Shared Savings Program” fact sheet (ICN 907404) is designed to provide education on the provisions of the final rule that implements the Medicare Shared Savings Program with ACOs.  It includes background, information on how ACOs impact beneficiaries, eligibility requirements to form an ACO, and information on monitoring and tying payment to improved care at lower costs.

From the MLN:  “Improving Quality of Care for Medicare Patients: Accountable Care Organizations” Fact Sheet Available – The new “Improving Quality of Care for Medicare Patients: Accountable Care Organizations” fact sheet (ICN 907407) is designed to provide education on improving quality of care under ACOs. It includes a table of quality measures under the program.

From the MLN:  “Medicare Shared Savings Program and Rural Providers” Fact Sheet Available – The new “Medicare Shared Savings Program and Rural Providers” fact sheet (ICN 907408) is designed to provide education on how the Medicare Shared Savings Program impacts rural providers.  It includes information on federally qualified health centers, rural health clinics, critical access hospitals, and how this program impacts them.

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A Manage My Practice Classic: 101 Ideas for Increasing Revenue and Decreasing Expenses in Your Medical Practice

Mary Pat’s Note: This post has always been popular because it answers one of the most burning questions in Healthcare: “How can I improve my bottom line?” If you have used any of these ideas in your practice- or have some of your own to share- let us know in the comments below!

 

BUILD ON WHAT YOU’RE CURRENTLY DOING:

1. Add physician hours – add evening or weekend hours; start your office hours earlier and end hours later.

2. Reduce physician time off – decrease vacation or change weekly days off to 1/2 days off.

3. Set a minimum number of providers to be in the office seeing patients at all times the office is open.

4. Have each provider add one new patient visit to his/her schedule weekly.

5. Add ePrescribing to recoup additional Medicare revenue and streamline prescribing (there are free ePrescribing software packages available, but evaluate them carefully so they don’t add more complexity to the system instead of less.)

6. Report PQRI measures to recoup additional Medicare revenue.

7. Charge patients an out-of-pocket fee for completing patient forms – disability forms, etc. and reserve office visits for treating patients.

8. Choose an EMR that qualifies your practice for the ARRA money (although it has been widely promoted that in a larger practice, an EMR and its associated work will cost more than you will get from the government.)

9. If you are in an underserved or rural area, check to see if there might be grants or funds available locally, in the state or federally, for adding a service to your practice.

10. If your practice does Independent Medical Exams (IMEs), reviews records or depositions, make sure that your fee schedule for such services is current and that the fees are collected before the physician provides the service.


ADD TO YOUR CURRENT SERVICES:

11. Allergy testing & treatment

12. Dispensing pharmaceuticals

13. Dispensing nutriceuticals

14. Dispensing Durable Medical Equipment

15. Group patient visits

16. Coumadin Clinic

17. Heart Failure Clinic

18. Diabetes Education Classes

19. Add primary care to specialty care practices

20. Add specialty care to primary care practices

21. Research

22. Joint Ventures with other practices or hospital

23. Lease space to other entities

24. eVisits (virtual visits or email visits)

25. Elective procedures or services

26. Mid-level providers

27. Walk-in clinic

28. Occupational medicine: drug screens, employment physicals, etc.

29. Hospitalists

30. Medical Director of local nursing homes

31. Complementary & alternative medicine (CAM)

32. Aging in Place services

33. Social worker

34. Concierge practice

35. School team physician

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EVALUATE YOUR REVENUE CYCLE MANAGEMENT:

36. Are you renegotiating payer contracts regularly?

37. Do your scheduling staff know how to educate patients about what payers you have contracts with and are in network with and what the patient’s financial responsibility will be?

38. Do staff know what typical new patient charges are to tell the patient?

39. Do you check every patient’s eligibility for insurance benefits immediately prior to every service?

40. Do you have patients sign a financial policy to acknowledge what they are responsible for based on their payer type?

41. Do you copy the patient’s insurance cards at every visit, or at least compare their current card to the card you have on file? Are you able to scan patient insurance cards and driver’s licenses into your practice management (PM) system?

42. Is your PM system able to download the information from the scan into the patient registration screen? If not, do you have a way to confirm that demographic and insurance information has been entered correctly from the cards?

43. Are your charges being posted daily?

44. Does the person who provides the service, or a documentation coding specialist, choose the CPT and ICD9 code?

45. Is the documentation for the charges being completed within 24 hours of the service?

46. Is your encounter form up-to-date with current CPT and ICD9 codes; do you order smaller batches of them so you can change the codes as new services are added in the practice?

47. Do you check the CPT and ICDD9 matching to make sure the codes are valid for the year, the codes adhere to NCCI and LCD edits before you finalize the charges?

48. Do you regularly audit medical records for coding and documentation and give providers feedback on where coding could be improved?

49. Are you using ABNs for Medicare patients who want services that Medicare might not pay for?

50. Do you file claims daily?

51. Do you correct claims daily when they are rejected at the practice management, claims clearinghouse or payer level?

52. Do you correct claims daily when they are rejected at the claim level and are not paid for for reasons that can be corrected?

53. Do you have your contract allowables in your PM system so you know when you are not being paid correctly by contract?

54. Do you appeal unpaid or underpaid claims?

55. Do you check recoupments or requests for refunds from payers and make sure they truly should be refunded?

56. Do you send insurance and patient payments to a lockbox to be scanned and stored digitally for your staff to post from?

57. Do you make payment arrangements in the office for balances after insurance has paid, or payment plans by drafting credit or debit cards?

58. Do you have a policy of not sending statements?

59. Do you collect the patient’s portion of the service at the time of service?

60. Do you collect fees for elective services prior to providing these services?

61. Can your patients make payments online through your website?

62. Do you file a claim with a patient’s estate if they have died?

63. Do you accept cash only from patients who have passed bad checks?

64. Do you accept cash only from patients who have filed bankruptcy with your practice?

65. Do you inadvertently see patients who have been dismissed from your practice?

66. When adding a physician to the practice, do you timeline the credentialing appropriately so the physician can see patients with insurance as well as those without?

67. If your new physician is only partially credentialed with payers, do you have him/her see the patients with payers they are credentialed with and add payers to their schedule load as the credentialing comes through?

68. Do you meet with representatives from your largest payers monthly to establish relationships and bring problems to their attention? (the squeeky wheel theory of payer relations)

69. Are you pre-certing everything that needs pre-certification or pre-authorization or pre-notification to be sure the service will be paid?

70. Are you receiving payments via electronic funds transfer (EFT)?

71. Are you receiving explanation of benefits (EOBs) or remittance advice (RA) electronically?

72. Are you posting your RA electronically?

73. Are you protecting your practice from embezzlement? (see my post on this here.)

74. Is someone in the practice responsible for staying current on changing coding requirements for Medicare, Medicaid, Tricare and commercial payers?

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DECREASE EXPENSES:

75. Eliminate overtime. Evaluate the need for additional staff (part-time?) vs. overtime.

76. Send some staff home (sometimes called “low census”) when there are no patients to be seen.

77. Use volunteers. Tap into the local hospital volunteers, or recruit and train your own.

78. Hire an after-school student employee to do routine jobs.

79. Discontinue paying staff for inclement weather closings when the practice is not open.

80. Shop everything. Negotiate existing service contracts. Do not assume anything is non-negotiable. Negotiate the rent.

81. Get rid of yellow pages advertising. It rarely brings you new patients and is primarily a place to look up phone numbers. You will still get your white pages listing free with your phone service.

82. Utilize pre-employment testing to make sure job applicants have the skills you need.

83. Shop postage machines or look into stamps.com.

84. Join a group purchasing entity (hospital, professional association, etc.)

85. Improve your accounting cycle. Invoices and statements are matched up with packing slips and negotiated prices. Use purchase order numbers.

86. Get the payment discount by paying on time or early – ask vendors for an on-time or early payment discount.

87. Make sure office supplies are not going home with the employees. Make sure office supplies that are ordered are “really need” and not “sure would be nice.”

88. Remind patients of their appointments to decrease no-shows. Call patients who no-show and attempt to reschedule (unless they feel better!) Track no-shows and evaluate the reasons for them.

89. Consider charging for no-shows or dismissing patients for no-shows.

90. Have a good recall system in place. If patients leave without scheduling a needed follow-up, make sure that they are called if they have not scheduled within a certain amount of time. Keep track of annual wellness visits and remind patients to schedule them.

91. Take advantage of any discounts offered by your malpractice carrier by completing risk management surveys and having speakers give annual updates on decreasing malpractice claims. Some carriers give discounts for managers who are members of MGMA or Fellows in the ACMPE.

92. Evaluate any discounts on services or products offered by your physicians’ professional associations and societies.

93. Evaluate your leases – are those big old copiers and faxes worth paying for a service contract?

94. Consider speech recognition/voice recognition and eliminate transcription.

95. Review your computer maintenance contracts. Are you paying for maintenance on equipment or software that is no longer being used?

96. Take advantage of online CME for physicians, midlevel providers, clinical staff and managers.

97. Make plans to attend face-to-face seminars well in advance to take advantage of early enrollment discounts and good flight deals.

98. Evaluate outsourcing. Think about outsourcing transcription, coding, billing, pre-authorizations, credentialing, switchboard, payroll, accounting and medical records copying.

99. Replace your answering service with an answering machine educating patients on the limited reasons for calling after hours and giving the number of the physician on call.

100. Destroy archived financial and medical records that you are paying to store, once you have ascertained that they exceed the required time limit.

101. Hold a brainstorming session with the staff and ask for their ideas for increasing revenue and reducing expenses. The people on the front lines will have excellent ideas. In return, do not nickle and dime the staff to death by charging for coffee, reducing parking stipends or eliminating uniform allowances. Keep in mind that for your rank and file staff, having to pay for their own uniforms or paying more for parking might be a deal-breaker that causes them to search for work elsewhere. Try to focus on the bigger items for savings and make sure the staff know you are trying to keep their small benefits in place in appreciation for their work.




Provider Revalidation: CMS Answers Your Questions on October 27th National Provider Call

CMS will hold a National Provider Call to discuss the revalidation of Medicare provider enrollment information on Thursday, October 27th, 2011; from 12:30 – 2PM Eastern.  Most providers and suppliers who are enrolled in the Medicare program will have to revalidate their enrollment which will be reviewed under the new risk screening criteria required by the Affordable Care Act Section 6401(a).  Learn what you can expect and how to prepare for this process.

Target Audience:  All providers and suppliers enrolled with Medicare prior to March 25, 2011 and who expect to receive payment from Medicare for services provided!!!!!! (I had to add those exclamation points – what a statement – if you expect to be paid, you need to revalidate.)

The agenda will include:

  1. What is Revalidation?
  2. ACA Screening Requirements
  3. Electronic Funds Transfer
  4. Streamlining the Process
  5. Phased Revalidation
  6. Tips on Revalidation
  7. Question and Answer Session (my favorite!)

Registration Information In order to receive the call-in information, you must register for the call.  Registration will close at 12pm on Thursday, October 27, 2011 or when available space has been filled; no exceptions will be made, so please register early.  For more details, including instructions on registering for the call, click here. The audio recording and written transcript will be posted after the call.

Presentation:  The presentation will be posted at least one day before the call in the “Downloads” section of the page here.

For more information about provider enrollment revalidation, review the Medicare Learning Network’s®  publication here.




My Notes from the CMS Open Door Forum on May 19, 2010: PECOS, DMEPOS and Blue Ink on Paper Forms

CMS held a two-hour Open Door Forum today and there was so much good information shared that I thought I’d pass my notes from the call along to you.

New EFT Form

The revised EFT (Electronic Funds Transfer) authorization form 588 is available here (pdf.) The old form will still work for a few months longer before it becomes invalid.

Changes to the Medicare Program Integrity Manual

The Program Integrity Manual (publication 100-08) will have revisions related to the changes in provider enrollment.  The online-only manual here will have content moved from Chapter 10 to Chapter 15 and the provider enrollment information will be easier to understand. 🙂

The Question on Everyone’s Lips

How do I know if I’m listed in PECOS (Provider Enrollment and Chain/Ownership System) and how do I know if others are listed in PECOS?  A new downloadable file is now available here (12,000 pages!) and everyone listed in this Ordering/Referring file has approved enrollment status.  Anyone not appearing on this list is not in approved status, or has opted completely out of the Medicare program.

Advanced Diagnostic Imaging

Beginning in January 2012, all diagnostic magnetic resonance imaging (MRI), computed tomography (CT), and nuclear medicine imaging such as positron emission tomography (PET) must be performed in a facility accredited by the American College of Radiology (ACR), The Joint Commission (TJC) or the Intersocietal Accreditation Commission (IAC) for the technical component of the test to be reimbursed by Medicare.  This rule does not apply to x-rays, ultrasound, fluoroscopy, mammography or DEXA scans and does not apply to any professional component.

Hospital Revalidations

Hospitals not enrolled in PECOS or not receiving EFT (Electronic Funds Transfer) will be contacted by CMS in an attempt to get all hospitals revalidated.

PECOS (pronounced “pay-cose”)

CMS recommends that anyone with questions or just getting started in PECOS read the “Getting Started Guide”, of which there are two versions, both available here in pdf form.  One is for providers and one is for suppliers of DMEPOS (Durable Medical Equipment, Prosthetics, Orthotics, and Supplies.) You need to know your corporate structure before getting started because the business must enroll before the providers can assign benefits to the business.  The 855I is for individual/solos providers and the 855B is for non-individuals (multiple owners) billing Medicare Part B and assigning benefits to a legal entity/corporation.  Dentists and pediatricians who order or refer services for Medicare patients are required to have an enrollment record in the PECOS. Residents and interns are exempt from the enrollment requirement, but an attending physician needs to be identified on the claim when a service is ordered or referred. The main page for enrollment is https://www.cms.gov/MedicareProviderSupEnroll/

Two Ways to Get Into PECOS

One is to complete the paper form in BLUE INK (and if time is of the essence CMS suggests that you use the paper form) and let the MAC enter it into PECOS for you.  The other is to use the internet-PECOS system directly, and sign, date and mail the certification statement to complete the process.  Submit the participation form or EFT form if required.  The certification form for the paper process is NOT the same as the certification from for the internet-PECOS process.

What is the 30-day rule?

The 30-day rule states that you can bill for services provided to Medicare patients up to 30 days prior to your filing date.  The filing date is the date your enrollment is accepted, not the date you mailed it.  Online it will say “Status Approved”, and you will receive an email, and then a letter confirming it. You will appear on the Ordering/Referring file on the CMS website.

What happens to payments for patients that were referred by a provider not enrolled on PECOS?

Even though you are enrolled, if the referring physician is not enrolled, you will not be paid for that patient’s services.  However, if that referrer becomes enrolled, you can resubmit the claim and it will be paid.

What happens on July 6, 2010? When does this happen?

July 6, 2010 The compliance date for Part A providers (hospitals, skilled nursing homes and home health agencies) and Part B providers (physicians, ambulance) must be enrolled in PECOS as ordering/referring physicians for payments to be made has been delayed indefinitely!

What happens on July 13, 2010?

DMEPOS (pronounced “demmy-pos”) providers must be enrolled in PECOS to receive Medicare payments.

What should be done if a provider leaves a group?

The provider or his Authorized Official (CEO, CFO, Manager) should file a 855R or make the change in PECOS as soon as possible.

Why do provider offices still request UPINs from our office?

Unclear.  UPINs were no longer required as of May 23, 2008.  The NPI is the only number accepted on Medicare claims.

Should the information submitted on a 855 be the same information in PECOS?

Yes, if it isn’t, contact the Help Desk.  Their toll-free number is 1-866-484-8049 and their e-mail address is eussupport@cgi.com.

For more information on the nuts and bolts of PECOS, see my post here.




101 Ideas for Increasing Revenue and Decreasing Expenses in Your Medical Practice

BUILD ON WHAT YOU’RE CURRENTLY DOING:

1.  Add physician hours – add evening or weekend hours; start your office hours earlier and end hours later.

2.  Reduce physician time off – decrease vacation or change weekly days off to 1/2 days off.

3.  Set a minimum number of providers to be in the office seeing patients at all times the office is open.

4.  Have each provider add one new patient visit to his/her schedule weekly.

5.  Add ePrescribing to recoup additional Medicare revenue and streamline prescribing (there are free ePrescribing software packages available, but evaluate them carefully so they don’t add more complexity to the system instead of less.)

6.  Report PQRI measures to recoup additional Medicare revenue.

7.  Charge patients an out-of-pocket fee for completing patient forms – disability forms, etc. and reserve office visits for treating patients.

8.  Choose an EMR that qualifies your practice for the ARRA money (although it has been widely promoted that in a larger practice, an EMR and its associated work will cost more than you will get from the government.)

9.  If you are in an underserved or rural area, check to see if there might be grants or funds available locally, in the state or federally, for adding a service to your practice.

10.  If your practice does Independent Medical Exams (IMEs), reviews records or depositions, make sure that your fee schedule for such services is current and that the fees are collected before the physician provides the service.


ADD TO YOUR CURRENT SERVICES:

11.  Allergy testing & treatment

12.  Dispensing pharmaceuticals

13.  Dispensing nutriceuticals

14.  Dispensing Durable Medical Equipment

15.  Group patient visits

16.  Coumadin Clinic

17.  Heart Failure Clinic

18.  Diabetes Education Classes

19.  Add primary care to specialty care practices

20.  Add specialty care to primary care practices

21.  Research

22.  Joint Ventures with other practices or hospital

23.  Lease space to other entities

24.  eVisits (virtual visits or email visits)

25.  Elective procedures or services

26.  Mid-level providers

27.  Walk-in clinic

28.  Occupational medicine: drug screens, employment physicals, etc.

29.  Hospitalists

30.  Medical Director of local nursing homes

31.  Complementary & alternative medicine (CAM)

32.  Aging in Place services

33.  Social worker

34.  Concierge practice

35.  School team physician

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EVALUATE YOUR REVENUE CYCLE MANAGEMENT:

36.  Are you renegotiating payer contracts regularly?

37.  Do your scheduling staff know how to educate patients about what payers you have contracts with and are in network with and what the patient’s financial responsibility will be?

38.  Do staff know what typical new patient charges are to tell the patient?

39.  Do you check every patient’s eligibility for insurance benefits immediately prior to every service?

40.  Do you have patients sign a financial policy to acknowledge what they are responsible for based on their payer type?

41.  Do you copy the patient’s insurance cards at every visit, or at least compare their current card to the card you have on file?  Are you able to scan patient insurance cards and driver’s licenses into your practice management (PM) system?

42.  Is your PM system able to download the information from the scan into the patient registration screen?  If not, do you have a way to confirm that demographic and insurance information has been entered correctly from the cards?

43.  Are your charges being posted daily?

44.  Does the person who provides the service, or a documentation coding specialist, choose the CPT and ICD9 code?

45.  Is the documentation for the charges being completed within 24 hours of the service?

46.  Is your encounter form up-to-date with current CPT and ICD9 codes; do you order smaller batches of them so you can change the codes as new services are added in the practice?

47.  Do you check the CPT and ICDD9 matching to make sure the codes are valid for the year, the codes adhere to NCCI and LCD edits before you finalize the charges?

48.  Do you regularly audit medical records for coding and documentation and give providers feedback on where coding could be improved?

49.  Are you using ABNs for Medicare patients who want services that Medicare might not pay for?

50.  Do you file claims daily?

51.  Do you correct claims daily when they are rejected at the practice management, claims clearinghouse or payer level?

52.  Do you correct claims daily when they are rejected at the claim level and are not paid for for reasons that can be corrected?

53.  Do you have your contract allowables in your PM system so you know when you are not being paid correctly by contract?

54.  Do you appeal unpaid or underpaid claims?

55.  Do you check recoupments or requests for refunds from payers and make sure they truly should be refunded?

56.  Do you send insurance and patient payments to a lockbox to be scanned and stored digitally for your staff to post from?

57.  Do you make payment arrangements in the office for balances after insurance has paid, or payment plans by drafting credit or debit cards?

58.  Do you have a policy of not sending statements?

59.  Do you collect the patient’s portion of the service at the time of service?

60.  Do you collect fees for elective services prior to providing these services?

61.  Can your patients make payments online through your website?

62.  Do you file a claim with a patient’s estate if they have died?

63.  Do you accept cash only from patients who have passed bad checks?

64. Do you accept cash only from patients who have filed bankruptcy with your practice?

65.  Do you inadvertently see patients who have been dismissed from your practice?

66.  When adding a physician to the practice, do you timeline the credentialing appropriately so the physician can see patients with insurance as well as those without?

67.  If your new physician is only partially credentialed with payers, do you have him/her see the patients with payers they are credentialed with and add payers to their schedule load as the credentialing comes through?

68.  Do you meet with representatives from your largest payers monthly to establish relationships and bring problems to their attention? (the squeeky wheel theory of payer relations)

69.  Are you pre-certing everything that needs pre-certification or pre-authorization or pre-notification to be sure the service will be paid?

70.  Are you receiving payments via electronic funds transfer (EFT)?

71.  Are you receiving explanation of benefits (EOBs) or remittance advice (RA) electronically?

72.  Are you posting your RA electronically?

73.  Are you protecting your practice from embezzlement? (see my post on this here.)

74.  Is someone in the practice responsible for staying current on changing coding requirements for Medicare, Medicaid, Tricare and commercial payers?

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DECREASE EXPENSES:

75.  Eliminate overtime. Evaluate the need for additional staff (part-time?) vs. overtime.

76.  Send some staff home (sometimes called “low census”) when there are no patients to be seen.

77.  Use volunteers. Tap into the local hospital volunteers, or recruit and train your own.

78.  Hire an after-school student employee to do routine jobs.

79. Discontinue paying staff for inclement weather closings when the practice is not open.

80.  Shop everything. Negotiate existing service contracts.  Do not assume anything is non-negotiable.  Negotiate the rent.

81.  Get rid of yellow pages advertising. It rarely brings you new patients and is primarily a place to look up phone numbers.  You will still get your white pages listing free with your phone service.

82.  Utilize pre-employment testing to make sure job applicants have the skills you need.

83.  Shop postage machines or look into stamps.com.

84.  Join a group purchasing entity (hospital, professional association, etc.)

85.  Improve your accounting cycle. Invoices and statements are matched up with packing slips and negotiated prices.  Use purchase order numbers.

86.  Get the payment discount by paying on time or early – ask vendors for an on-time or early payment discount.

87.  Make sure office supplies are not going home with the employees.  Make sure office supplies that are ordered are “really need” and not “sure would be nice.”

88.  Remind patients of their appointments to decrease no-shows.  Call patients who no-show and attempt to reschedule (unless they feel better!)  Track no-shows and evaluate the reasons for them.

89.  Consider charging for no-shows or dismissing patients for no-shows.

90.  Have a good recall system in place.  If patients leave without scheduling a needed follow-up, make sure that they are called if they have not scheduled within a certain amount of time.  Keep track of annual wellness visits and remind patients to schedule them.

91.  Take advantage of any discounts offered by your malpractice carrier by completing risk management surveys and having speakers give annual updates on decreasing malpractice claims.  Some carriers give discounts for managers who are members of MGMA or Fellows in the ACMPE.

92.  Evaluate any discounts on services or products offered by your physicians’ professional associations and societies.

93.  Evaluate your leases – are those big old copiers and faxes worth paying for a service contract?

94.  Consider speech recognition/voice recognition and eliminate transcription.

95.  Review your computer maintenance contracts. Are you paying for maintenance on equipment or software that is no longer being used?

96.  Take advantage of online CME for physicians, midlevel providers, clinical staff and managers.

97.  Make plans to attend face-to-face seminars well in advance to take advantage of early enrollment discounts and good flight deals.

98.  Evaluate outsourcing. Think about outsourcing transcription, coding, billing, pre-authorizations, credentialing, switchboard, payroll, accounting and medical records copying.

99.  Replace your answering service with an answering machine educating patients on the limited reasons for calling after hours and giving the number of the physician on call.

100. Destroy archived financial and medical records that you are paying to store, once you have ascertained that they exceed the required time limit.

101.  Hold a brainstorming session with the staff and ask for their ideas for increasing revenue and reducing expenses.  The people on the front lines will have excellent ideas.  In return, do not nickle and dime the staff to death by charging for coffee, reducing parking stipends or eliminating uniform allowances.  Keep in mind that for your rank and file staff, having to pay for their own uniforms or paying more for parking might be a deal-breaker that causes them to search for work elsewhere.  Try to focus on the bigger items for savings and make sure the staff know you are trying to keep their small benefits in place in appreciation for their work.