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June 2016 Client Newsletter

Durable Medical Equipment Medicare Administrative Contractor to Transition July 1st
As mentioned before, the Durable Medical Equipment Medicare Administrative Contractor for jurisdiction A (DME MAC A) will transition from NHIS to Noridian on July 1st. Cape Medical Billing has been thru this numerous times before and we do not expect any issues.
 ACA Exchange Plans - Non-Payment of Premiums
We are beginning to see some denials for patients with ACA Exchange Plans who do not pay their premiums. ACA allows a 90 day "grace period" for the premium to be paid! This is especially critical for surgical patients. The patient may have coverage for the office visit, but it needs to be re-verified a few days prior to the surgery. If they are in the grace period, you risk non-payment!
The best way to handle this is to verify eligibility two-to-three days in advance of the appointment. When premiums are not current they are listed as either "grace period" or "delinquent." In such cases we recommend the patient be informed in advance of being seen (either by phone call or on the date of service upon arrival and before seeing the provider) and given two choices:
  1. They can be seen as "self-pay" (and payment collected when they walk in the door!), or
  2. Their appointment/surgery can be rescheduled so they have time to reactivate their coverage.
This avoids the dreaded non-coverage denial, ignoring patient statements, and collections. It also means immediate cash flow! If insurance later pays, the overpayment can then be refunded. Though refunds are a "pain in the neck" - they avoid the alternative.
Importance of Verifying Eligibility/Insurance
2-3 Days Before the Visit
With the recent increase in the number of high-deductible plans, and the ever- increasing deductibles themselves, insurance cards are changing at an increased frequency. This makes it critical to verify eligibility two-to-three days in advance of the visit and to obtain a copy of the insurance card to send to Cape Medical Billing so we can update each patient's account. For clients who utilize the Cape Medical Billing's Scheduler software, we will be updating the charge forms to add the "deductible" to help alert you to those patients.  
Recovery Audit Contractor (RAC)
You may have heard of the Medicare Recovery Audit Contractors (aka RAC) who do data analysis to recover "overpayments."  Their process has now changed slightly.  The VERY tight timeframes (30 days) for responses and challenging their decisions are very strict.  Missing a deadline means they will automatically take the money back and you lose appeal rights! 
If you receive a RAC letter asking for documentation, it is imperative that you get Cape Medical Billing involved immediately to assist with this process.  Send a copy of the letter via fax and make it to Rich's attention
  • Before any medical records are returned, you need to review them from a clinical perspective and we need to look at signatures, etc.  If it appears the records may not contain all of the information the auditor will need, add a cover letter to explain (do not change the medical records). 
  • Even one illegible procedure can result in denial of the claim.  There are acceptable ways to Medicare to make sure the signature is considered valid. 
2016 Client Newsletter Archive