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October 2018 Client Newsletter

ICD-10 Codes - Urgent

Just a reminder that Cape Billing has the capability to add up to 12 ICD-10 codes per claim. In these days of insurers using data analytic techniques to review claims, and to use that information to decide when to do audits, it is important to include all medically relevant diagnosis codes on each charge form. This provides a more accurate picture of the patient's health status to justify the level of E&M codes selected, and the procedures performed.  

Ideally the codes should be "linked" (via a line on the charge form from each Dx to the CPT or HCPCS code) so the data entry staff knows which ICD-10 codes to attach each to each charge. This, along with good documentation of medical necessity, goes a long way toward avoiding audits.  

Any questions, please give Rich a call. 

 

New Medicare Patients

If you have a patient who has just qualified for Medicare, remember that Medicare has an annual deductible of $182 that must be met. This can be a challenge for patients with lower financial abilities.

You may remember that at the beginning of each year about half of our clients delay their billing for 1-2 months to allow deductibles to be met by other Plan B providers. This is especially helpful if the patient:

  • Has either a Medicaid plan as 2' (a Qualified Medicare Beneficiary, aka QMB). Also see next article
  • Has a high deductible plan as 2'
  • Has no 2' insurance at all, or
  • You do not participate with that Medicaid plan or insurance.

In some cases, you should require cash payment prior to seeing the patient. For those using the Healthpac Scheduler, you can use the FREE eligibility feature to check insurance status. NaviNet offers eligibility also.

However, this is also an issue for newly eligible Medicare patient who would not have met their Medicare deductible yet. Be sure to check their 2' insurance status. If they fall into 1 of the categories above, you may want to consider delaying their Medicare billing.

Feel free to call Rich if you have any questions.

 

QMB's

If a patient has Medicare & Medicaid, that group of patients is known as QMB's - Qualified Medicare Beneficiaries.

Even if you do not participate with Medicaid, those patients cannot be balance billed under any circumstances. In those cases, your only option is to accept what is paid from Medicare or Medicaid or discharge them from your practice.

The following document is from CMS - see the 2nd paragraph under the "Executive Summary."

https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/Downloads/Access_to_Care_Issues_Among_Qualified_Medicare_Beneficiaries.pdf

Laughing Out Loud

 

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2018 Client Newsletter Archive