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August 2012 Client Newsletter

I am pleased to announce that the office backup generator installation was completed on July 17th ! This is a substantial commitment to our clients and staff to ensure that our ability to service clients and perform our daily work will not be interrupted by a loss of electric. Very few billing services have gone to this level of backup.

In the event of a power outage, the individual hardware battery backups will carry the equipment for the 10 second delay until the generator starts. Since it is fueled by natural gas, it should never run out. We also protect your data with both an automatic onsite and offsite data backup every 2 hours.

We thank all of you for allowing us to serve you!

There has been speculation & discussion about the real effects of the Patient Protection and Affordable Care Act (aka Obamacare) now that the Supreme Court has upheld most of that law.

First, no one can say for certain what will happen with physician or other payments over the next few years. Much depends on whether people actually will purchase the insurance since there are essentially no penalties if they do not (withholding tax return money can easily be avoided by not having as much withheld).

Second, what might happen to physician payments in one specialty may not be what is realized by physicians in other specialties. With increased emphasis on "primary care" it is entirely conceivable that payments for primary care services and primary care providers will increase over the next few years whereas payments for certain specialists could go down.
Finally, there is strong pressure both from government and employers to get healthcare costs under control and that appears to be translating into changing how healthcare is delivered & paid for.

Any time there is change, there will be winners and losers and healthcare is no different. Some specialties (physician and non-physician) may see improved revenues and others see reduced revenues.

CMS announced 2 New Exemptions to Avoid the 2013 eRx Payment Adjustment

CMS has created two additional hardship exemptions to avoid the 2013 Medicare e-Prescribing Payment Adjustment. The new exemptions are:

Eligible Professionals (EPs) that have achieved or are planning on attesting to Meaningful Use on or before October 14, 2012.

Eligible Professionals that show intent to be part of the EHR incentive program through registration and adoption of a certified EHR.

The deadline for these new exemption categories is October 15, 2012. To request a significant hardship exemption, EPs and group practices must submit their hardship exemption requests through
Physicians are billing Medicare for far more intensive evaluation and management services than they did a decade ago, according to a Dept. of Health and Human Services Office of Inspector General report released in May.

Use of the two highest-level codes for established patient office visits has increased by 17%, as doctors have billed Medicare for fewer low- and mid-level codes from 2001 to 2010, the OIG said. Utilization of the high-level code for billing an emergency department visit also has risen 21%, while the top code for subsequent inpatient hospital care has increased 9%.

The OIG concludes in the report that several factors have led to these increases, including a boost in the overall number of services provided to patients and the average payment for evaluation and management services. "However, changes in physicians" billing of E&M codes also contributed to this increase," the report states.
The inspector general did make note of aberrant billing patterns during its review and sent the Centers for Medicare & Medicaid Services a list of 1,669 physicians who billed many more complex and expensive codes than their peers. The Medicare agency will forward the list to its contractors and direct them to focus on the top 10 billers in each jurisdiction for further review, according to a March 28 memo from acting CMS Administrator Marilyn Tavenner.
The health professionals singled out in the report had billed high-level codes at least 95% of the time and could find themselves in trouble with the government, Nicoletti said. The three specialties with the largest percentage of physicians using high-level codes were Internal Medicine, Family Practice and Emergency Medicine.
Medicare plans to publish its own report targeting 5,000 physicians who billed high-level evaluation and management services consistently. The report is not intended to be an indication of fraud. "The intent is to be proactive and provide statements that will support helpful insights into physician coding and billing practices," Tavenner said. That report was scheduled for release in June."

Ambulance Clients
Obtaining insurance information is key to getting paid. Hospitals provide information (tho often a week or more later). Patients often ignore both phone calls and statements which often results in them going to collections - and no or less money for the municipality. It is harder for patients to ignore when you are face-to-face.
We recognize that patient care is your first priority, as it should be.
But when you are obtaining other information from the patients, if you could get insurance information it would greatly help the municipality and avoid collections for some patients.

Just a reminder to please get not only the Name of the insurance company, but also the policy and Group #'s.

Many insurers, including MVA & W/C, service claims out of multiple offices. In those cases, getting the address of the correct office is critical to billing the claim - we can then call the adjuster and get the required Claim #'s.

We appreciate your assistance.

Medicare Billing Issues
The information below is intended to assist EMTs with the nuances of the new Medicare ambulance payment policy. It is not intended to suggest documenting signs or symptoms that are not present. It is intended to encourage:

1. Documenting all signs or symptoms that are found.

2. Asking more probing questions to support the patient's condition as found and include those answers in the Run Report.
The codes selected are based on what is written in the Run Reports.

"Weakness and Dizziness"
For weakness to be covered, the patient must not be able to walk or stand - which needs to be documented in the Run Report. Dizziness is not considered clinically to be the same as altered mental status

Page 26 of the Medicare Ambulance Policy:

-Statements such as the following, absent supporting information, are insufficient to justify Medicare payment for ambulance services:
-Patient complained of shortness of breath.

-History of stroke.

-Past history of knee replacement.


-Chest pain.

-Generalized weakness.

"Is bed-confined."
If possible, try to determine what might be causing the weakness.
Shortness of Breath vs. Respiratory Distress

Shortness of breath (786.05) is not covered. Respiratory "insufficiency/distress" (786.09) is covered. Be sure to differentiate. Providing oxygen is covered.

2012 Client Newsletter Archive