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January 2013 Client Newsletter

CONGRESS - & the fiscal cliff

If Congress is unable to do what they were sent to Washington to do, we will again recommend that you ask us to hold your 2013 Medicare charges until agreement has been reached.  Otherwise, Medicare will pay the charges at the approximately 26% decrease – then have to go thru reprocessing.  That works “ok” for Medicare, but the 2’ insurances often have difficulty handling that.

FREE Eligibility Checking for CPB Appointment System Users!

Patient eligibility is now offered to all clients using the CPB Scheduler.  If you are interested in using it, please call Rich.  At least for the next few months, CPB will cover the cost.

Medicare Part B Deductible for 2013

The Medicare Part B Deductible for 2013 is $147. 

TherAPy Cap 2013 update

CMS announced that the Therapy Cap will be $1,900 for 2013.  The only catch is that the Therapy Caps were only authorized thru 2012 so we’ll have to see if they are extended.

Refunds – Please do not send refunds until cpb verifies

Just a reminder to not accept any insurance company’s request for a refund until CPB verifies it is correct.  Many of the insurances which providers participate with (Medicare, Medicaid, Horizon, Aetna, CIGNA, United healthcare, etc.) will do an automatic offset upon request – which we can initiate for you once we confirm the refund is due.  Be sure to send us a timely copy of the refund request. 

If you pay and they do an offset, we may not be aware of your payment and you could end up short! 


The G0180 Home Health Certification Code is only covered once per 60 days. If it is billed more frequently, patients may not be billed unless a properly completed ABN is received.


QualCare will not cover both an office visit and a Well visit on the same day.  They will pay the higher of the two, but even with the usual modifier, only one of the two services is covered. We suggest in these cases that the patient be brought back for a separate visit for the Well service.


According to a recent article in MGMA Connexion, $1 of every $4 owed is now paid by the patient.  That is 25% of the average practice’s revenue. 

Ways to collect these balances:
  • Verify patient eligibility when the appointment is made.  At the latest, verify it a day before the appointment so you can have the appropriate discussion on the date of service. 
  • Be sure patients know when the appointment is made that payment is due on the date of service.
  • Collect all co-pays before the patient is seen.
  • Accept credit & debit cards

Medicare CERT Audits

Medicare continues to perform their CERT (Comprehensive Error Rate Testing) Audits.  If a provider does not respond, the money in question is automatically recouped.  The envelope containing the request letter is very distinctive:

If no response is received within 30 days, they will send three more reminders with 15 days for each.  If still no response then the claim will be denied and a demand letter sent.
2013 Client Newsletter Archive