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February 2018 Client Newsletter

Client Newsletter February 2018

Patient Deductibles – Reset on January 1st Each Year

With deductibles continuing to grow in both number and amount, the key to avoiding negative cash flow is to have a strong office financial policy.  Collecting deductibles is a challenge not just for the office, but also the patient.  Patients often do not adequately plan to pay deductibles.  Consider the following:

  • High patient deductibles will increase your Days in Aged Receivables, especially early in the year, unless handled properly.  Once deductibles are met, insurers pay their maximum.  But until that happens it is important to collect 50% of the antipated Allowed amount on the day of service.   That minimizes waiting for patient payments.  Usually better to refund $ than chase it. 
  • First & foremost, be sure to offer a variety of options for patients to make payments.  It is important to offer the “old” checks and credit/debit cards for the older population, in addition to the online options, including ACH (essentially an electronic check). 
  • Technology today allows providers to keep payment information on file in the form of credit & debit cards, and ACH information.  That info is stored by a PCI compliant vendor to ensure the safety of the data.  When the patient has a balance, that information can then be used to pay the balance.  Milllenials as a group are very technology savy – so this is a particularly good way to arrange payments. 

New NJ Healthcare Laws

A2665.  Governor Christy signed A.2665, which extends the time period in which newborn children are covered under their parents' health benefits coverage to up to 60 days after birth. Current law limits the coverage of newly born children to 30 days from their birth. Effective immediately.

AmeriHealth Postpones Consult Code Policy

Last year AmeriHealth proposed a policy change to no longer pay for consultation CPT codes 99241-99245 and 99251-99255 for dates of service on and after January 1, 2018. AmeriHealth posted notice to its website that it will now postpone implementation of this policy.

This follows United Healthcare delaying implementation of a similar policy last year.

Ambulance Run Reports

Occasionally, EMS is called to doctor offices to transport patients to hospitals.  Less commonly, a physician’s office calls EMS to transport a patient from home to the hospital. 

All insurers work from a list of approved diagnoses which includes a mix of signs, symptoms, & clinical diagnoses.  If the Run Report shows one of the approved signs, symptoms, and/or diagnoses then it typically is approved and paid (based on each patient’s benefits). 

For example, patients with Deep Venous Thrombosis (DVT) may not have symptoms, but if a physician ordered a test, then the patient definitely had some signs and/or symptoms for the test to be medically necessary (a requirement for insurers to pay for the test).  In those cases, be sure to ask the patient and document all signs & symptoms.  For DVT common symptoms are pain in the calf, leg or foot, and may also include swelling in the extremities, tenderness, or warm skin.  Leg pain, if present, is a covered diagnosis along with the DVT diagnosis. 

Unfortunately, without documentation of medical necessity to support a BLS ambulance, a trip does not meet the insurance regulations for billing.  While EMT’s cannot diagnose, including the signs/symptoms in the Run Report can make the difference between the EMS organization getting paid – or the patient balance being assigned by insurance to the patient.

Another educational item worth mentioning; the phrase “unable to walk without assistance” is not a description of why a patient needs an ambulance. It might describe why a patient needs wheelchair transport, but not an ambulance. 

To qualify for “Bed Confined” all of the following 3 requirements must also be true:

  • Unable to get up from bed without assistance
  • Unable to ambulate
  • Unable to sit in a chair (including a wheelchair). 

New Insurance Cards

When patients provide new insurance cards (including the new Medicare cards to start being sent April 1st ), please ask your staff to indicate on the copy we receive whether it is:

  • A New insurance

  • Is an additional policy (1’, 2’ ?),

  • Replaces existing insurance (if so, which one).

    Insurers also require knowing who the insured party is (self, spouse, parent) and the date of birth of the insured person.

2018 Client Newsletter Archive