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June 2017 Client Newsletter


We are just hearing about a company called "Zelis" which is a "payments technology company," according to their website.  As with all of these similar companies, be very careful!  We are hearing that they are calling providers' offices and asking for bank accounts and routing numbers - then charging the provider for the payment!  This is similar to the Virtual Credit Cards form of payment where the provider essentially pays this intermediary company for the ability to be paid.  What a convoluted process. 

How to handle?  Demand a paper check or free EFT.  Better, refer them to Rich to deal with.  The insurer has to pay you - but you are not required to pay these companies in order to be paid. 


As mentioned before, if you have not made arrangements to participate in 2017, you will receive a four percent decrease in 2019.  It is VERY easy to avoid a cut in 2017.  Contact Rich if you need details. 

Q: Do I earn a higher MIPS score for reporting longer than 90 days? 

A: While practices are welcome to report data over longer intervals of time to improve their numerator for certain measures, there is no inherent benefit to a clinician's or practice's MIPS score for reporting data for longer than 90 days in 2017. In other words, if two practices both perform the same on a particular measure and one reported for the full year while the other reported for 90 consecutive days, both would receive the same score.

Q: Can I choose which 90 days of data to report? 

A: Yes, practices may choose any window of time they would like to report up to a full year, as long as it is consecutive and a minimum of 90 days. Practices may choose different reporting periods for each of the performance categories.

HBMA has developed a MIPS estimator.  As a member of HBMA, Cape Medical Billing is making it available FREE to all of our clients.  Just contact Rich if you wish to use it.


A few years ago, HITECH added a requirement to process ALL credit balance refunds - insurance and patients - within 60 days.  Credits cannot be held beyond 60 days without running afoul of these requirements.  There are several legal settlements for practices that did not refund timely that were VERY expensive for the practice.  If you would like a copy, let me know. 


All insurers require that medical records be properly signed.  If the signature is not valid, then the rest of the document also is not valid.  The service essentially never happened!  If it is an audit, the audit fails.  If medical records are requested prepayment, payment is denied.  

Valid signatures are a BIG deal, and include:

  • A legible signature and a date, or
  • An electronically signed signature and a date, or
  • An illegible signature with a typed/Printed name underneath, and a date, or
  • An illegible signature with an Attestation Statement.

What is not allowed:

  • Signing a medical record late.  Dates cannot be weeks later - they are required to be signed "contemporaneously."
  • Signature stamps
  • Someone else signing a provider's name

If you would like a copy of the Medicare Signatures Requirements document, let Rich know.


Just a reminder, that whoever signs the document verifying the ambulance service was provided for a Medicare patient - whether it is the patient or someone at the receiving facility - the SIGNATURE must also have the printed/typed name.  This person must be identifiable during an audit.  If the signature is not legible, it is only valid if the printed/typed name is present.  If the signor does not print their name, then one of the EMT's will need to do it.  Of course a date also must be with the signature. 

If the signature is not considered "valid" by Medicare's signature policy, the whole run will be denied.  This is being reinforced with my staff and non-valid signature runs will be returned to the client.  This is SERIOUS as submitting an invalid claim violates Medicare billing policy. 

Summary:  The person also must be identified as to their position and the signature needs to be dated in order to be considered valid. 


In case you hear it from your peers, beginning July 1, 2017, the Centers for Medicare and Medicaid Services (CMS) will require providers who practice in groups with ten or more practitioners in New Jersey, Florida, Kentucky, Louisiana, Nevada, North Dakota, Ohio, Oregon and Rhode Island to report CPT code 99024 for each post-operative visit during certain 10- and 90-day global surgical periods. CMS has indicated it may use this data to change the valuation of the global surgical packages in the future if the data analysis shows post-operative visits are not accurately reflected in existing global code definitions.


Be advised that for Care Plan Oversight, Medicare requires seeing a patient for a face-to-face encounter no more than six months prior to the first care plan oversight billing.  Only E&M services are acceptable.  Affected codes are G0179, G0180, G0181, and G0182.


Beta site - Healthpac updated the Eligibility output format to allow us to select the type of service being checked.  Currently it only functions in the Billing side, but we hope to extend it to the Scheduler side once it has been properly tested.  Stay tuned! 

2017 Client Newsletter Archive