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July 2015 Client Newsletter


When ICD-10 goes into effect on October 1, 2015, it will be important to have become familiar well in advance to ensure you know what needs to be documented in your medical records - office, nursing home, Operative Reports, etc. If you have not done it yet, now is a good time!


If you are going to code yourself, you may want to begin by purchasing a good coding option that will convert ICD-9 to ICD-10 options. There are options, both paper and electronic, and both free (see below) and purchase options (Optum, etc.). Test by coding two to three charts per week for July, and then per day in August so when October 1st arrives, it will be a non-event. Or at least that part will be!


Cape Medical Billing be able to handle ICD-10 coding for our clients just as we have ICD-9.


For those looking for inexpensive coding assistance, offers online access for a rather economical fee - FREE! And it works on tablets and smartphones. Since ICD-10 requires more information than ICD-9, you should take a look at some of your common diagnosis to view the various additional information that is required - you will likely be surprised. Many of the "Misc." ICD-9 codes do not have ICD-10 equivalents.


Referring providers: For specialists and sub-specialists - have you verified that your referring providers are prepared to send you valid ICD-10 codes?



Annual Wellness visits - ekg's

Just a reminder that Medicare allows billing of:

  • G0403 (Electrocardiogram, routine ECG with 12 leads; performed as a screening for the initial preventive physical examination with interpretation and report) along with the G0402. Medicare pays $18.67.
  • G0402 (Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of Medicare enrollment

All Wellness codes (including G0438 & G0439) are paid in full with no patient co-insurance due.

These codes are only payable by TRADITIONAL Medicare (including Railroad Medicare) - not the HMOS's.


Note that at least 12 months must pass before the next Wellness code is paid, and they must be billed in order. G0402 ($180.16) and G0403 are first, then the next time G0438 (186.20), then G0439 $126.45) for subsequent years.


One caveat, only one provider will be paid per 12 months.



Medicare Fraud

The article link below is a good example of what makes our job getting clients paid a bit more challenging. We work hard to keep our clients out of trouble while getting paid the maximum allowed.




We occasionally have patients who ask that their deducible be written-off, yet decline to send any documentation to support financial hardship. We often hear similar stories from our clients.


A possible way to handle this is to remind the patient that they and their insurer selected the high deductible plan. Then offer to forgive the same percentage that the insurer is willing to pay!



Virtual Credit Cards

In the June 12, 2015 "Washington Connection" MGMA reported:


"MGMA survey data reveals virtual credit card abuses

MGMA, along with the American Medical Association and American Dental Association, conducted research where more than 1,100 practices shared their experiences with virtual credit cards (VCCs) and electronic funds transfer (EFT) forms of payment. Increasingly, practices are being sent a 16-digit credit card number via mail, fax or email by a health plan or vendor as payment for medical services but as a result, they incur the standard credit card fees for each transaction. 


Key findings from the survey include:

  • More than two-thirds of practices have been asked to accept VCC payments, with 86% citing increased use over the past year. 
  • An overwhelming majority of respondents (87%) became aware of VCC usage only after receiving their first payment and a significant number (42%) were unaware of the transaction fees.
  • Close to half (46%) were unaware that they could refuse VCCs and receive payments instead via EFT and a large majority (84%) were given no information on alternative forms of payment from their health plans. By law, all health plans must offer EFT payments once they are requested by the provider." 

Remember that you are NOT required to accept such an expensive form of payment. This cost is usually two-to-three percent - the same as your credit cards.



SGR Factor

The SGR repeal/replace effort finally fell into place on April 16th when President Obama signed into law the Medicare Access and CHIP Reauthorization Act of 2015.


This legislation not only immediately repealed the SGR - retroactive to April 1, 2015, it set in place a transition from traditional fee-for-service payments by Medicare to a new "value based" or "quality based" payment model that would be fully in place by 2019.


This bill will transition Medicare FFS payments towards a value-based payment system and incentivize the development of new, value-based payment models.


Before fully transitioning to the new payment models, there will be a period of relative stability and predictability to Medicare payments. Later this year (July 1, 2015) Medicare Physician Fee Schedule Conversion Factor (CF) will be automatically adjusted upward by .5%. Then, each January 1st, for the next four years, the CF will be automatically adjusted upward by .5%.


Adjustment to Conversion Factor



CF Automatic Adjustment

July 1, 2015


January 1, 2016


January 1, 2017


January 1, 2018


January 1, 2019



These increases are automatic and will not require any additional action by Congress to take effect. Between now and 2019, CMS has been directed to work with physicians specialty organizations and other stakeholders to develop Alternative Payment Models (APMs). Broadly, these will be payment models built on the fee-for-service payment architecture but that incorporate the concepts of value and quality into the final payment received by the provider.


CMS and their stakeholder partners will also use this time period to develop more bundled payment opportunities where providers will be paid a pre-determined amount of money based upon the primary diagnosis of the patient and the expected level of patient involvement. The goal here is to pay providers for treating and managing the patient rather than paying the provider for the accumulated value of the services rendered.


Beginning in 2019, the Conversion Factor will be frozen for five years. There will be no automatic updates. Instead, provides will have to "earn" their annual updates either through participation in one of a number of "to-be-developed" Alternative Payment Models or, through participation in a new program called MIPS - Merit-based Incentive Payment System.


MIPS will essentially be combining the existing PQRS, EHR Meaningful Use and Value Based Payment programs into a single new update initiative that will allow providers to obtain increases (or be subject to decreases) depending upon how well a provider scores on these initiatives compared to his/her peers.


Some providers may not want to participate in either MIPS or APM and the law gives the Secretary of Health and Human Services the authority to exempt providers. How easy or extensive that process will be remains to be seen. The operating assumption is, however, that remaining in traditional fee-for-service will be very unattractive financially due to the freeze and so the expectation is that the vast majority of providers will "voluntarily" move to either an APM or MIPS.



OIG Begins EHR Data Security

and Meaningful Use Audits 

The Department of Health and Human Services (HHS) Office of the Inspector General (OIG) has begun auditing electronic health record (EHR) systems of HIPAA covered entities to ensure that they are compliant with HIPAA data security standards. These audits were outlined in the 2015 OIG work plan.


Additionally, OIG is conducting audits of providers who have received incentive payments from both the Medicare and Medicaid EHR meaningful use (MU) incentive program to determine if they're meeting the MU requirements to which they are attesting. OIG has already published reports on Medicaid MU payments.


The audits generally take two to three weeks to complete and have been described as thorough and technical by entities who have been subjected to them. The audits examine EHR security plans and procedures for the entities and their business associates with access to EHR data.



As we have done for many years, Morey's Piers allows us to share our Corporate Discount with our clients. Clients interested in taking advantage of these savings for waterpark and amusement rides can email Rich at for the website and login informati

2015 Client Newsletter Archive