March 2015 Client Newsletter
CAPE MEDICAL BILLING
MEDICARE CHRONIC CARE MANAGEMENT (CCM) CODE (99490)
CMS has now released more specific guidelines for the new Chronic Care Management code. If you would like a copy of the guidelines, please email Rich and we will be glad to forward.
CREDIT CARD ON FILE (CCF)
Patient balances can be quite a challenge to collect once the patient leaves the office. Collecting on the date of service (DOS) is still the best way to go when you know what the patient balance will be. However, when the patient balance cannot be collected on the DOS, what option other than sending a patient statement is there? Some are now using Patient Portals that include the option to pay by ACH (eCheck) or credit/debit cards- much like paying other bills online. But wait, there’s more!
CCF is not simply the secure storage of a patient’s payment account information for later use. CCF is a powerful tool that enables you to secure from your patient, in advance, at the time of service, a method of payment and a promise to pay the estimated patient liability after a claim has been adjudicated. The CCF authorizes the provider to collect the patient responsibility after the patient has left the office—without creating a paper statement and then waiting for the patient to pay.
With a signed CCF—patients pre-approve charges to be made to their credit/debit, checking/savings account up to a specified amount. When the insurance claim is adjudicated and patient responsibility is identified, CPB can upload a claim remittance file that will automatically generate an email or a text message to notify the patient that a payment authorized by their CCF is scheduled. The system then automatically processes the payment based on a timeline preset by the practice that allows X number of days between the upload/patient notification and the processing of the payment.
Save time, and money, and get paid quicker. It’s that simple. Here’s how.
How it works from patient check in to processed payment
- Provider collects co-pay on the date of service (if any) and provides an estimate of patient liability after insurance
- CCF payment agreement is generated and presented to the patient for signature, preauthorizing payment of the estimated amount of liability when the claim has been adjudicated
- Patient keeps a copy of the CCF, practice keeps a copy of CCF and a copy is stored by the vendor.
- Claim is submitted to insurance—processed and insurance payment is made. Patient liability is established and a claims remittance (835/ERA) is created indicating the patient balance (same as it is today).
- CPB uploads the remittance file to the vendor.
- Vendor matches the remittance file to the patient CCF stored by vendor and automatically generates the email or text and schedules the payment.
Recently, several companies have begun marketing this option. If interested, CPB can get you the details. Just something else to consider.
From HBMA’s Washington Representative, Bill Finerfrock:
Meaningful Use Program Continues to Disappoint
As 2014 came to a close, the Meaningful Use program continued to fall short of its intended goals. Although more than 500,000 providers have registered for the Meaningful Use program, only 4% of professionals and 35% of hospitals have attested to Stage 2 of the program. These disappointing numbers come despite the fact that CMS watered down some of the requirements and moved the deadline back from November 30th to December 31st. Many providers are calling for the CMS to reduce its 365 day reporting requirement to 90 days but CMS remains steadfast behind the 365 day requirement.
The latest projections indicated that as many 257,000 providers will face payment penalty in 2015 for failing to achieve the Meaningful Use (MU) requirements for 2014. The MU penalty for 2015 will be a 1% reduction in physician fee schedule payments. Additionally, 28,000 doctors face a 2% penalty in 2015 for failing to meet not only the MU requirements but also the e-prescribing criteria. About 200 hospitals will face similar penalties. The penalties affect Medicare claims beginning January 5, 2015, and providers have until February 28, 2015 to appeal the penalty.
A survey from the Office of the National Coordinator for Health Information Technology (ONC) has found that incentive payments are the biggest reason that providers have adopted EHR systems. The survey found that 59% of providers reported having a meaningful use EHR. Almost two-thirds of those providers said that incentive payments were a major reason that they adopted the EHR. CMS has paid billions in incentive payments to date.
EHR adoption was divided between primary care providers and specialists. Most primary care providers have adopted EHR systems, but many specialists have not. Among those providers who did not adopt EHR systems, two-thirds stated it was because they did not have adequate time, money, or staff.
In its press release, ONC referred to interoperability as a major driver of adoption, even though data exchange capability was mentioned as a factor for only 36% of those who had adopted EHR systems. Other factors, including certification requirements, were larger factors for adopters.
CMS, however, is looking to make some changes in the way quality is measured for the Meaningful Use Program. The National Quality Forum (NQF) is looking at new quality measures to use for 20 federal programs, including Meaningful Use. The NQF is considering 202 new measures, of which a number will be adopted for the coming year. The proposed new measures are open for public comment.
AUDIT LETTERS - MEDICARE, HORIZON, etc.
In the event you receive an audit letter from any insurers – Medicare (RAC, ZPIC, etc.), Horizon, etc., please be sure to forward a copy to Rich to review and discuss how to handle. It is important that the response is carefully reviewed before sending documentation. And it is not wise to wait until the last minute – send a copy and call as soon as it is received.
PNEUMOCOCCAL VACCINATIONS UPDATE FROM CMS
Received January 29th from CMS (and sent via email):
“Update from CMS: Medicare Part B coverage of pneumococcal vaccinations — Modification
Prior to 2015, pneumococcal vaccine was covered once in a beneficiary’s lifetime, with revaccinations covered for those at highest risk if 5 years have passed since the last vaccination or if the beneficiary’s vaccination history was unknown. The Advisory Committee on Immunization Practices (ACIP) recently updated its guidelines regarding pneumococcal vaccines. The ACIP recommends administration of two different pneumococcal vaccinations.
CMS updated the Medicare coverage requirements to more closely align with the updated ACIP recommendations. An initial pneumococcal vaccine may be administered to all Medicare beneficiaries who have never received a pneumococcal vaccine under Medicare Part B. A different, second pneumococcal vaccine may be administered 1 year after the first vaccine was administered (i.e., 11 full months have passed following the month in which the last pneumococcal vaccine was administered). Refer to MLN Matters® Article #MM9051 for more information on this coverage change.
Note: The pneumococcal vaccine and its administration are covered under Medicare Part B. The pneumococcal vaccine is not a Part D-covered drug.”
Our experience with CMS’ definition of “11 full months” is that they change it to 12 full months without announcing it. My advice is to use 365 days whenever possible.