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January 2018 Client Newsletter

January 2018 Client Newsletter

Industry report: 83% of practices experienced a cybersecurity attack

From the December 13, 2017 “MGMA Washington Connection:”

“In a survey of 1,300 physicians, Accenture and the American Medical Association found that 83% reported having experienced a cyber security attack on their practice. The report highlighted “phishing” as the most common type of cyber attack, with 55% of physicians going through this form of attack, and computer viruses (48%) cited as the next most common form. Medium and large practices were twice as likely as small practices to experience these forms of attacks. The research also found that 64% of those who faced a cyber attack experienced up to four hours of system downtime before they resumed operations, with 29% reporting they experienced nearly a full day of downtime. The report emphasizes the need for physician practices to take the steps necessary to protect computer systems and patient information. Access the MGMA HIPAA Resource Center for member-benefit educational materials and cyber security tools.”

If anyone is interested in cyber security tools, let me know.  Your best contact is your computer tech – s/he can usually recommend additional protections based on your office setup. 

Office Visits and Annual Wellness Visits

As discussed in previous Newsletters, office visits and Annual Wellness Visits are 2 separate and distinct services which are billable & payable - as long as BOTH services are properly documented. 

Occasionally patients will complain about being required to pay their copay for the office visit. 

When a patient calls to complain, it is important to explain that the patient did receive 2 separate (and valuable!) services important for their health which were billed in accordance with their insurers’ policies.  Insurers want patients to be seen annually for well visits – it is part of their insurance plan.  And presumably patients prefer 1 visit to coincide with other non-well issues…

Unfortunately, copays are owed (and required to be paid per the insurers) for office visits.

Patients need to be educated to the difference between the 2 services – and the value to their health that is obtained.  At a time when insurers are paying as little as possible, these services are a benefit to your patients and a source of additional revenue to the practice.  It is not appropriate to only bill the well visit when in fact the patient received more. Be aware that if you bill the office visit, then decide to change to the Well visit only, insurers will ask for a copy of the medical record before changing their records.  So be sure to document the services each patient receives. 

2018 Medicare Part B Deductible

The Medicare Part B deductible will be the same as this year:  $183. 

New Insurance Cards

When patients provide new insurance cards, please ask your staff to indicate on the copy we receive whether it is “new” insurance, is it an additional policy (1’, 2’ ?) or which insurance it replaces.  Insurers also require knowing who the insured party is and the date of birth of the person. 

ABN’s (Advanced Beneficialy Notices) for Medicare Patients

Just a reminder about ABN’s:

  • They are required for Medicare & Medicare patients IF a product or service is usually covered, but does not qualify for some reason (medical necessity, frequency, etc.).  The notice MUST use the current ABN form, and be specific to the product or service being supplied.  It cannot be a general “if Medicare doesn’t pay, you will be billed.” 

CPB will need a copy of the ABN – Medicare requires that we review it for compliance with the ABN policy, and if it meets that policy, we then add a specific modifier to notify Medicare that the patient signed a valid ABN. 

  • Is NOT required if the product or service is never a covered service.  HOWEVER, it is strongly advised to still obtain a properly completed & signed ABN in order to prove the patient was notified that the product/service was not covered by the Medicare program – and thus is owed by the patient.  Of course, in these cases, we strongly recommend collecting the full fee when the product is dispensed or service provided.  Patients are very unlikely to pay later – and many will change providers over even low $$ amounts. 
2018 Client Newsletter Archive