July 2012 Client Newsletter

CPB BACKUP GENERATOR
In response to the changing weather elements, and to support all clients with the highest level of service possible, CPB will be installing a back-up generator by Sunday, July 15th to ensure that we will not be without power. Many CPB clients use our scheduler, or connect with our billing software, so this will add another layer of security to ensure our daily operations are not interrupted.

If you have any questions, please feel free to contact me.

COMBATING HIGH DEDUCTIBLE HEALTH PLANS
When patient's have a high deductible, it is worth considering requiring the patient to sign an agreement to use their credit card to pay any deductible or co-insurance balance not covered by insurance. Your credit card company vendor should have a document that can be signed by the patient permitting this. Then if they fail to pay their patient statements, the credit card would be a next option.

If anyone else is interested in Patient Payment Portals and/ or Credit Cards, please contact Rich.

OUT-OF-NETWORK PATIENTS
As the Summer approaches, we occasionally get calls asking how to handle patients who are tourists and far from their home network physician. We STRONGLY recommend that such patients be seen on a CASH basis (or debit/credit card if you accept those) only. Collecting payment ($125?) PRIOR to seeing the provider assures that you will at least be paid something. The patient can be told that you will bill their insurance and refund any overpayment. It is a lot easier to refund than to collect from a patient who has returned home. If they do not want to pay when they need a service, it is not likely they will pay later. And, no need to wait for payment.

MEDICARE TIMELY FILING EXCEPTIONS
The time limit for filing all Medicare fee-for-service claims (Part A and Part B claims) is 12 months, or 1 calendar year from the date services were furnished. Exceptions to the 1 calendar year time limit for filing Medicare claims are as follows:

(1) Error or misrepresentation by an employee, Medicare contractor, or agent of the Department of HHS that was performing Medicare functions and acting within the scope of its authority;

(2) Retroactive Medicare entitlement to or before the date of the furnished service;

(3) Retroactive Medicare entitlement where a State Medicaid Agency recoups money from a provider or supplier 6 months or more after the service was furnished;

(4) A Medicare Advantage plan or Program of All-inclusive Care for the Elderly (PACE) provider organization recoups money from a provider or supplier 6 months or more after the service was furnished to a beneficiary who was retroactively disenrolled to or before the date of the furnished service.
NJMVA FEE SCHEDULE
Please be advised that the NJ MVA Fee Schedule has a $99.00 per day limit for all providers. You are STRONGLY urged to ask patients if they were seen by any other provider each day or will be seeing another provider the day they see you. The Code states:
"NJ Administrative Code 11.3-29.4

(m) The daily maximum allowable fee shall be $99.00 for the Physical Medicine and Rehabilitation CPT codes listed in subchapter Appendix, Exhibit 6, incorporated herein by reference, that are commonly provided together. The daily maximum applies when such services are performed for the same patient on the same date. The daily maximum applies to all providers, including dentists. However, when the provider can demonstrate that the severity or extent of the injury is such that extraordinary time and effort is needed for effective treatment, the insurer shall reimburse in excess of the daily maximum. Such injuries could include, but are not limited to, severe brain injury and non-soft-tissue injuries to more than one part of the body. Such injuries would not include diagnoses for which there are care paths in N.J.A.C. 11:3-4.. Unless already provided to the insurer as part of a decision point review or precertification request, the billing shall be accompanied by documentation of why the extraordinary time and effort for treatment was needed."

If you have an MVA pt, you may want to make sure to verify they have not seen another provider on the same day of service. If they have, send us their billing information (including any required reports) so we can get their billing sent ASAP.