July 2017 Client Newsletter
WHEN TO CHECK INSURANCE ELIGIBILITY?
Every provider would like to collect more money for the services they provide. Bad debt in healthcare is projected to rise to $200 billion by 2019! One of the easiest ways to avoid some bad debt is to verify insurance. But when? On the day of the visit?
Waiting to verify a patient's insurance eligibility until the provider/supplier sees the patient, or your staff starts processing claims or preparing statements, is a recipe for coming up short. Even verifying coverage while the patient arrives at the office isn't soon enough. Verify the day the appointment is made! Then if the patient has an issue with their insurance, they have time to fix it. And you can fill your schedule with insured, paying patients! Then be sure to verify again on the day the patient arrives.
For Cape Medical Billing clients with our Scheduler, you can easily verify eligibility at no cost!
Once you know they have insurance, and the amount of their copay and unmet deductible - collect BOTH up front for at least the minimum services expected. Office appointments are rarely emergent or even urgent. So if a patient forgets their copay - especially a new patient - offer to make another appointment. Will they threaten to not return? Maybe- but with today's high deductible plans what will you lose? If the appointment is important enough to them, they will miraculously find the money.
Collecting the copay and deductible upon arrival is also the most cost-effective time to collect from patients-because money paid before you provide service will never cost you a penny to bill or need to be written off as bad debt.
If your front-desk staff isn't always successful at collecting payments, try role-playing actual scenarios. For instance, don't ask a patient if they want to pay, ask them HOW they want to pay.
INSURANCE ONLY BILLING
One of the sensitive topics of billing is "professional courtesy" and its cousin (AKA)"insurance only."
Accepting insurance only is a significant violation of both state and federal insurance laws, and all participation agreements. Copays and deductibles are required by your participation agreements, and state and federal laws to be collected - absent bona fide documented financial hardship.
Professional courtesy is permitted, to a limited extent. If you would like a copy of an article from the AMA which discusses professional courtesy, please email Rich.
Unfortunately, if copays and deductibles are forgiven without financial hardship qualification, the entire insurance payment is usually required to be refunded to the insurance company. Insurers want the same "discount" that you extend to patients.
Writing off patient balances is only permitted if the patient qualifies for financial hardship. The policy is required to be in writing, consistently followed, and documented each time it is granted within a practice. We can assist developing this, of course.
In order to protect our clients, Cape Medical Billing is only be able to write-off valid financial hardship instances. A copy of the financial hardship paperwork will be needed with the charges.
As mentioned in previous editions, 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 2019. Contact Rich if you need details.
Some providers are being told to do their 90 days starting Oct. 1. We STRONGLY disagree as that allows zero time to fix any mistakes. A better plan is to select a vendor to assist you (we can help with that) and the measures you will report. Start your 90 days and give the data to the vendor to calculate your score and let you know- was it sufficient - or not? If not, what was the problem. Then you can start another 90 days and still meet the 2017 requirements to avoid a cut, or even get a slight increase.
A second STRONG suggestion is to file via "Registry", rather than "Claims". There are numerous benefits - call Rich if you want the details. Cape Medical Billing can still enter all of the tracking codes and report that data to the registry on your behalf. Be sure to contact Rich so we can help coordinate this on your behalf.
Something else to keep in mind. Data entered for 2017 for the three sections: Quality (60% of the overall score), Advancing Care Information (25%), and Clinical Improvement Activities (15%) will not only affect your 2019 payments, but CMS will publish each physician's annual score on its Physician Compare website. It will also share that data with other third party ratings sites such as Google, HealthGrades, Yelp, and others.
So if a patient looks online, a low score would potentially reflect negatively on the practice. The scores will not have a "context" - they will not see why the score is low compared to other physicians. Your public reputation in your office service area could be tarnished by a low score.
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.
AMERIGROUP PROCEDURE LIMITS
Just FYI, AmeriGroup will only pay for a maximum of three procedures on the same day. Beyond that, the rest are required to be written-off.
PHYSICIANS RECEIVED MILLIONS IN MEANINGFUL USE OVER PAYMENTS
As reported by MGMA:"The Office of Inspector General (OIG) released a report claiming the Department of Health and Human Services (HHS) paid more than $792 million in Meaningful Use Incentive Program incentive payments to eligible professionals (EPs) that did not comply with federal requirements.
Using a sample size of 100 EPs (out of more than 250,000) OIG identified 14 who did not meet the Meaningful Use requirements because of insufficient attestation support, inappropriate reporting periods, or insufficiently used EHR technology.
OIG also identified other program irregularities. The payments to the 14 EPs totaled $291,000 with CMS extrapolating those figures to reach the $792 million figure. Among other recommendations, OIG called on HHS to recover the $792 million by increasing its audits of clinician documentation supporting attestations."