March 2020 Client Newsletter
Credit Care On File (CCOF)
If you aren't already using Credit Card on File (CCOF), it is something worth strongly considering. It is available with many credit card vendors, including the one we have used for many years, InstaMed.
As the term implies, InstaMed keeps the credit card information on file in their secure PCI compliant system. It is NOT maintained by Cape Billing nor your practice/office. The responsibility for security remains with InstaMed.
InstaMed offers this at no added cost - just the same processing fee that is already paid when a patient pays with a credit or debit card, or ACH.
The benefit of allowing your patients to pay with CCOF is that they agree to allow you to automatically process patient balances on the credit/debit card without sending them a statement. Thus, you can process it without the cost or delay of sending a patient statement.
A related option, is the ability to set up automatic payment plans that allows you to control the parameters. For instance, you can decide the minimum amount that can be charged to avoid unacceptably low payments (e.g., $5.00 per month for a $1,000 balance). There is small cost for the automatic processing of the future payments = $.15 per scheduled payment).
The process would look like this:
- Patient arrives for their office visit and has a $30 copay. This can be paid with their credit card before seeing the provider as you should already be doing today.
- While there, they agree to CCOF and sign the required paperwork determining what they will allow to be charged (e.g., max of $200 per month).
- While at the appointment, the Patient also receives additional treatment in your office. Insurance processes the claim but assigns it to the patient's deductible for $500.
- Patient has no 2' insurance.
- This balance normally would go out on a statement for the patient to eventually get around to paying. Or not. ?
- With CCOF, the balance is processed for payment without waiting for a patient statement by you or CPB through the InstaMed portal and also avoids the cost of a paper or eStatement. Again, no additional cost than the usual processing fee (unless a payment plan is set up, as above).
- The patient is also notified via email that the payment will be processed in X days.
- If a payment plan is used, the patient is notified 7 days in advance that the payment will be processed, then InstaMed automatically processes the payment.
- Each day, InstaMed notifies CPB the amounts and patients who paid so we can enter the payment(s).
If you are interested, let me know and we will ask InstaMed to turn this feature on. Again, there is no cost for CCOF.
UHC Medicare Advantage New Emergency Department (ED) Professional E/M Coding Policy
Effective for dates of service on or after May 1, 2020, UnitedHealthcare will implement a new Emergency Department (ED) Professional Evaluation and Management (E/M) reimbursement policy that will focus on professional ED claims submitted with level 5(99285) E/M code for Medicare Advantage plans.
"In accordance with American Medical Association guidelines that are further supported by CMS, ED E/M codes must meet or exceed all three key components of History, Exam, and Medical Decision Making (MDM) to qualify for a specific level of E/M service. Therefore, when only two of the three key components meet or exceed the requirement to qualify for a particular level of E/M service, the third key component is utilized to select the appropriate level of E/M service.
In an effort to reduce the administrative burden of requesting and submitting medical records for review, we will begin using the Optum Evaluation and Management Professional (E/M Pro) tool, which determines appropriate E/M coding levels based on data, such as patient's age and conditions, for the MDM key component. We will presume the provider meets the requirements of the E/M code level they have submitted related to the History and Exam key components for the initial adjudication of the claim.
The E/M Pro tool accounts for diagnosis codes submitted on the claim and determines the appropriate level of complexity that correlates with the E/M service reimbursement. Since MDM and problem complexity is the primary driver, the E/M Pro tool calculates the appropriate E/M level based on submitted diagnosis codes. This will result in fair and appropriate reimbursement for ED services rendered.
Once implemented, your claims for ED Level 5 E/M code (99285) may experience adjustments to reflect the appropriate level E/M code, based on the reimbursement structure within your agreements with us."
ICD-10 Codes For Procedures
When adding ICD-10 codes to procedures, do NOT include unrelated diagnosis codes. We are getting denials due to insurers' software seeing a heart-related Dx. code on both a procedure & an office visit (or future office visit within the Global period) - and ignore/deny the E&M code because it sees the unrelated ICD-10 code on the procedure.
BUT, be sure to include additional ICD-10 codes on E&M codes in order to support higher levels of service. If the medical condition and/or injury are relevant to the treatment be sure to include all such ICD-10 codes.