May 2018 Client Newsletter

Insurance Cards

We are noticing that MANY physician offices, Lab Corp, AMI (radiology) and others are now taking a copy of insurance cards EVERY visit.  This is something worth considering for your office if you aren’t already.  In addition to new insurances, it helps catch changing co-pays & deductibles and gets the staff in the habit of getting the info every time.  

We strongly recommend updating your office policy if you are not already doing this.  If you have our Scheduler, you can just scan the card images. 

Health Insurer’s CEO Pay

You will find this article very interesting! A direct correlation between the Insurance Company’s CEO pay and the percent of denied claims. 
https://www.huffingtonpost.com/wendell-potter/the-higher-health-insurer_b_3137831.html

Effective 5/1/18: United Healthcare Will Require Anatomical Modifiers

UHC announced in its February 2018 Bulletin that claims for services performed on the eyelids, fingers, or toes, submitted on or after 5/1/18, will require anatomical modifiers. Claims that do not include the anatomical modifier after 5/1/18 will be denied, but may be resubmitted for payment with the appropriate modifier.

NEW Medicare CARDS

Just a reminder that the new Medicare Cards started to be sent out  April 1, 2018.  This is no different than any other insurance card changing – OTHER THAN the fact that it will happen for ALL Medicare patients.  So just continue to ask all patients if their insurance has changed, and when it did, obtain a copy of the insurance cards and forward to CPB.

Medicare will not be updating all at the same time – the new cards will be spread out over time so a Medicare recipient may not have their new card yet.  Remember, also that the new cards will not have Social Security Numbers on them. 

An additional point regarding Railroad Medicare (RRMC); in the past, their policy numbers were unique such that it was obvious it was RRMC.  With the new cards, that will no longer be the case since they are using the same policy format as traditional Medicare.  The only difference is “Railroad Retirement Board” is specifically written at the bottom of the new cards.  Other than that, the cards are identical. 

NEW PATIENT?

According to CMS and other insurers, a new patient is defined as a patient who has not received any professional services, i.e., evaluation and management service or other face-to-face service (e.g., surgical procedure) from the physician or physician group practice (same physician specialty) within the previous three years.

• Patient is new to your group practice for the provider specialty billed
• Physicians and NPP are trained as a different specialty or sub-specialty than the providers within your group practice that have previously treated the patient

An established patient is a patient who has had a professional face-to-face service from the practitioner or from a practitioner of the same specialty in the group within three previous years.