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November 2016 Client Newsletter

New Medicare Policy Numbers to be issued

 Medicare announced in early October that they will be issuing new Medicare policy numbers starting not before April 1, 2018 thru 2020.  We have already obtained the policy number format as part of our error checking system and have loaded it.  Other than the extra work of changing the MANY Medicare policy numbers, it is not a significant event.  Just like updating other insurances, but on a bigger scale.

 New Fingerprinting Requirement From Medicare Now Rescinded

 "In accordance with the  Patient Protection and Affordable Care Act, Section 6401 and 42 CFR Section 424.518(c)(2)(B), (308 KB) all new and existing providers must be reevaluated under the new screening guidelines. Part of these new screening guidelines is a requirement to fingerprint certain individuals identified in the enrollment records. 

As of last week, CMS has now rescinded this requirement. 

Ambulance Clients

Clover is a new Medicare Advantage plan.  In the past, no insurers have required zip + 4 for the pickup location - but Clover is requiring it.   Just a reminder to include the zip + 4 in the Run Report. 


Medicare Preventive Services


Medicare offers 21 different preventive services and in many cases, the patient does not owe a deductible or con-insurance.  For a complete listing, including the requirements for each:

 Medicare mailing PQRS penalty notices;submit an appeal by Nov. 30

 BE SURE you reviewed your CMS PQRS report! 

The Centers for Medicare & Medicaid Services (CMS) is mailing letters to notify physicians and groups who are scheduled to receive a 2% penalty in 2017 based on 2015 PQRS reporting. As a reminder, practices have until Nov. 30 to appeal an unwarranted penalty through the informal review process. For more detailed information about the informal review process and how to download your PQRS Feedback Report, which contains detailed information about your 2015 PQRS results, review MGMA's member resource, What Practice Leaders Should Know: Medicare Quality and Cost Feedback .


In case you need an incentive to participate, below is how the Medicare payment reductions will work if you do not participate in either MIPS or MACRA starting in 2017.  If you are looking to remain independent, remember that Cape Medical Billing supports our clients' efforts to meet these requirements to avoid these reductions. 

 Each year you start out "fresh" using the same basic fee schedule as everyone else.  The adjustment is from the basic fee schedule each year.  The reductions are not cumulative.  The amount of any adjustment (positive or negative) is based upon the clinicians scoring during the reporting year (generally two years prior to when the adjustment will occur) and only affects payment for that year.

 The max reductions, by year, are as follows:

  • 2019 - 4%
  • 2020 - 5%
  • 2021 - 7%
  • 2022 - and beyond  - 9%

Avoid Denials by Checking Eligibility

 Two of the most common reasons for denials are:

  1. Patient not eligible (provider is out-of-network, procedure not covered, etc.)
  2. Claim not covered by insurer.

With high deductible plans, it is more important than ever to check patient insurance eligibility.  During a recent webinar, we were told that only 75% of providers check eligibility, and only 25% check at every patient visit.

 At a minimum, eligibility must be checked when the appointment is made for ANY service (office visits, surgeries, procedures, tests, etc.), but even better is to check it again when the patient arrives for the appointment - BEFORE they are treated.  This allows patients with no active insurance to pay on the date of service - or leave without taking the providers valuable time.  These two steps alone will virtually eliminate denials for lack of coverage.   

2016 Client Newsletter Archive