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May 2017 Client Newsletter

CHECK ELIGIBILITY WHEN MAKING THE APPOINTMENT  AND UPON ARRIVAL

In the current insurance environment, it is vital to check the status of a patient's eligibility at the time the appointment is made and again upon arrival for the appointment. 

Under The Affordable Healthcare Act (aka Obamacare), patients have a "grace" period in order to pay their claims.  If that "grace" period is during a visit to your office and the patient does not pay the premium for that month, your claim will be denied.  We have seen instances where the premium was paid for the month the appointment was made, but then was not paid for the month of the appointment.  It could have been discovered if eligibility had been checked on the service date. 

Other patients also lose their insurance for various reasons, or have LARGE deductibles that have not been met.  The only way you will know the status is by checking eligibility. 

For those with the Healthpac Scheduler, it is quite easy (and FREE!) to check that eligibility.  Let us know if you need any training.  If the patient's insurance is questionable, best to ALWAYS require a larger payment on the service date commensurate with the services received that day.  It is better financially to refund an over-payment than send an account to collections. 

Beta site - Healthpac updated the eligibility output format to allow us to select the type of service being checked.  Currently it only functions in the Billing side, but we hope to extend it to the Scheduler side once it has been properly tested.  Stay tuned! 

MIPS - IT IS TIME TO GET STARTED

As mentioned before, if you have not made arrangements to participate in 2017, you will receive a four percent decrease in 2019.  It is VERY easy to avoid a cut in 2017.  Contact Rich if you need details. 

HBMA has developed a MIPS Estimator.  As a member of HBMA, Cape Medical Billing is making it available FREE to all of our clients.  Just contact Rich if you wish to use it.

POWER MOBILITY PAYMENT FOR PHYSICIAN TO DOCUMENT NEED

It isn't much, but Medicare does allow, and does pay, $9.44 for a physician to do the paperwork for a patient's Power Mobility device.  If you want this added to your charge form, please let Rich know.  Don't spend it all in one place, of course. 

HUMANA AWARDED THE TRICARE EAST REGION EFFECTIVE JANUARY 1, 2018

Humana was awarded the TriCare East Region effective January 1, 2018.  We have heard from colleagues that Humana has been offering rates to providers that are 35 percent below previous rates!  If true, that is an outrageous decrease.

If you have very few of these types of patients, be careful.  If you aren't sure, let me know so we can run a report for you.  Also, don't forget that we offer to review any participation agreement for you and provide free consultation. 

VALID SIGNATURES ARE REQUIRED 

We are beginning to read about and see more charts being audited for various reason.  Two of the easiest way to fail an audit are to not respond at all, and the other is to send invalid signatures (missing, etc.).

When we send appeals (we usually review and send) or insurers request documents to audit your charges (usually sent by clients directly), it is critical that the medical records be properly signed, or as auditors like to call it - " authenticated."

Components of a valid signature:

  • Signature must be legible, or needs a printed/typed name underneath it.
  • Signatures MUST be dated timely.  Medicare does not define that, however.  Probably a day or two would be acceptable.  More than a week should have a clear explanation included with the records if sent for an appeal or requested for audit. 
  • Can be electronically signed.

A signature with no date, is not considered valid by any insurer or auditor.  So if you hand-write the signature, be sure to date it.  Otherwise, the auditor will deny your claim(s). 

Any questions, feel free to contact Rich. 

PROLONGED SERVICES CODES

With Medicare now covering 99358-99359 we wanted to provide some guidance. 

Per CPT Assistant: "Total time, time thresholds, and typical times are important factors. For a service to be prolonged, it needs to be 30 minutes or longer beyond the typical time for the service. The 30 minutes is a minimal threshold. This also requires that there is an established "typical time" from which to determine whether it was exceeded by 30 minutes or longer.  

Office visits, consults, hospital visits, etc. do have typical times indicated in the description with which to use.  If you need that information, please contact Rich.

Once the initial 30- minute threshold has been met to report code 99354 or 99356, each additional 30 minutes (codes 99355 and 99357) is met when the 15-minute midpoint occurs. For example, code 99354 is reported when over 30 minutes of prolonged services are provided, up to an additional 44 minutes (the hour plus 14 minutes). At 75 minutes, the midpoint for code 99355 is met, and for 75-104 minutes one also reports code 99355. The table available in the CPT codebook might help alleviate math anxiety."

Many other E/M services do not have typical times, or the code already incorporates time, making prolonged services codes inappropriate to use. Emergency Department Services involve intermittent or repeated assessments of multiple patients, and therefore typical times are not established. Prolonged services therefore may not be reported for Emergency Department Services. Critical care services, pediatric/neonatal critical care, and continuing intensive care services are codes that are reported in time units of hours or a day and therefore, there is no role for prolonged services codes with these services.

DOES A PATIENT HAVE A RIGHT TO PAY CASH AND NOT HAVE THEIR INSURANCE BILLED? 

Yes, they do have that right, including Medicare.  If they make that request, be sure to have them sign a document indicating that they are specifically asking that you accept their cash payment in lieu of billing insurance.  The patient should be asked to pay at least an office visit before seeing the provider, and any balance prior to leaving the office.  This is strictly a cash/credit or debit card transaction and be wary of payment by check unless you know the patient. 

LAUGHING OUT LOUD

"You know what they say dear... April showers bring May flowers!"

2017 Client Newsletter Archive