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Welcome to Cape Medical Billing

The world has changed!  Gone are the days of “submit a bill, get paid.”  In this new era, healthcare practices are the most affected, doing more work for less compensation.

• Are your services being coded and billed correctly for maximum payment?
• Are you collecting 100% of what you should be?

If you aren't sure, we can get you the answers! Call today for your FREE, No Obligation Practice Analysis.

Medical providers must respond by turning to an expert in medical billing for strategic solutions in reversing revenue loss.  That expert is Cape Medical Billing, serving providers from New Jersey to Georgia for over 20 years.

Cape Medical Billing is your single-source solution for the growing revenue leakage that plagues today's healthcare practices.  CMB is ready to reverse your revenue leakage with:

• Fast Results
• Proven Track Record
• Innovative Software
• Free Appointment System and access to your patient database
• Customized Billing Programs
• Personal Service You Deserve

We Collect the HARD Stuff!

Cape Medical Billing is an experienced and highly-skilled medical billing service for Medical and Surgical Physicians, Podiatrists, Physical and Occupational Therapists, Ambulance services and Mental Health professionals.

Cape Medical Billing has developed a sophisticated, cutting-edge computerized billing program that helps put more money in the pocket of the provider. Our powerful combination of technology, expertise and people drive unmatched results for our clients!

Digital Pen Technology

Ask about our "cutting-edge" digital pen technology!  Eliminate scanning, faxing and couriers - the digital pen delivers charge form data automatically for faster billing.  You will immediately increase the productivity of your practice by changing your pen! 

Call 888-MED-BILR (633-2457) TODAY for your free demo.

CMB August 2010 Newsletter

 

Electronic Medical Records (EMR’s)

Looking for the Right EMR? There are lots of potential pitfalls. Joan Gilhooly, CPC, CHCC is a nationally known coding and audit consultant and offers the following insight:

“Unfortunately, I don't have a recommendation for an EMR to choose.

But given the timeliness of this subject I want to use this as an opportunity issue a word of caution. It comes from my experience:
1. Auditing EMR progress notes,
2. With issues raised about EMR documentation in a fraud case I worked on a few years back,
3. As well more recent discussions with senior management in the Program Integrity unit at one of the Medicare carrier/MACs.

Whatever, you do, don't get caught in the trap of "documenting by exception" as a way to save time (meaning you'll have a "normal" template that explodes into multiple lines of clinical information). First and foremost, your notes about a particular encounter should paint a unique - and accurate - picture of what went on between you and the patient during that encounter. If there was a tape recorder in the room - and you had an opportunity to compare the transcript of what was on that tape recording with what was in your documentation, there should NEVER be anything in your documentation that wasn't also included on the transcript of the tape. And no matter how good you think you'll be at either changing values if the response or finding on a particular ROS question or exam element is different than what's in the template, you're human and will make mistakes. I guarantee that your rate of inaccuracy, if tested against a transcript of the actual encounter, will astound you.

Secondly, if you're concerned about supporting your level of E/M codes, don't think that your EMR is going to save you from yourself in that effort. First of all, Medicare has stated (since 2001) that the volume of documentation is not the sole criterion on which the level of service should be selected. Yes, you have to have *enough* documentation to support what you've billed. But if you have more, that doesn't automatically justify a higher level of service.

In other words, the documentation requirements only establish the MINIMUM amount of documentation to support the service you billed. They were never intended (despite what many EMR vendors have programmed into their system) to be an algorithm to determine the level of service to be billed (and no, having the doctor select the MDM level does not override this concern, despite what the vendors will tell you).

So, don't think of an EMR as a way to "avoid under-billing" or to remove your concerns about whether you have enough documentation. The OIG is also well aware of the rise in the average level of service that is paralleling the rise in use of EMR systems. While these higher levels of service might have "enough" E/M elements to support the code billed, the ultimate question (which is also subject to fraud and abuse investigations) is whether those higher levels of service reflect true medical necessity for the *extent* of the service.

Finally, I think I comment I once heard from a cardiologist about copious EMR documentation was particularly insightful. He told me that he was so frustrated with the quality of EMR records he was getting from both referring and consulting sources, stating "There's often so much superfluous information contained in those records, I can't figure out what, clinically, they were doing with my patient." Sad, but true. All too often I see the same thing when I'm auditing EMR records.

In other words, think of "time savings" and "efficiency" as the Sirens in Homer's "The Odyssey". Don't succumb, no matter how attractive the call. ACCURACY (as compared to the transcript of the hypothetical tape recorder in the room) and CLINICAL RELEVANCE need to be your first priorities when implementing an EMR system. Don't expect a decent EMR to save *you* time. A well implemented EMR should save STAFF time, but it should not be expected to save doctor time. There have been some interesting studies that have borne this out. An EMR, implemented appropriately, isn't going to allow a physician to see more patients in the day, regardless of what vendors may tell you.

And be your harshest critic when deciding what to create in a template. Don't ever create or use templates of normal responses or findings for ROS or for EXAM (I'm not a clinician, and even I can tell - in 10 records or less - when the doctor is using an ROS or EXAM template pre-loaded with normal responses/findings). The best templates are ones that function like a decision tree, where there are various paths the template will take you, depending on what the patient's presenting problem(s) are, and their responses to the HPI and ROS questions and to exam findings (i.e.,, more "clinical pathway" oriented).

So look for systems that harness the power of the computer to help you practice better medicine, whether that's including drug databases that warn you of possible drug interactions, the "clinical pathways" type functionality I described above, or utilizing various "clinical condition" databases for your specialty that prompt you to follow established evidence based protocols for your specialty, etc.

An EMR should be way more than just a simple alternative to paper charts and way more than a way to automate charge passing (i.e., eliminating superbills and the charge entry process). As the "meaningful use" guidelines imply, an investment in an EMR should be a way to improve how you practice medicine. Any other benefits your practice garners from it should be icing on the cake.”

MORE Electronic Medical Records (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.

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.

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.