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April 2020 Client Newsletter

Aetna Is Replacing NaviNet With Availity on April 30th
As I am sure everyone knows by now, Availity will replace NaviNet effective May 1, 2020.   Be sure to register all of your staff so you can continue to access the required information to treat patients.
Should Provider's Be Lenders?
As you know, medical practices are the only entities that are willing to provide services then wait for insurance and patient payments. Go anywhere else - grocery store, McDonald's, movies, etc. - and you pay BEFORE getting the service! When patients do not pay their balances, you become their de facto lending institution! And, many providers do not even charge interest!
We are already billing your claims and process most payments electronically so there is not much more that can be done to obtain insurers' payments faster.
BUT, for patient balances, the approach has changed significantly the past 1-2 years.
You already are, or should be, requiring patients to pay all co-pays when checking in and before being taken to the treatment room. If you are not doing that, you are way behind the times!
Office-based practices should also be using the eligibility feature either in your EHR or Healthpac to verify insurance at the time the appointment is made. How else would you know if the patient has valid insurance? Review the amount of the co-pay & deductible? If a patient doesn't want to give you that information over the phone - red flags should be going UP!
Then on the day of the visit prior to the pt. arriving, or the day before a surgical procedure, check eligibility AGAIN. If you cannot confirm the insurance, use the old fashion "insurance" aka "CASH." The patient should be required to pay the minimum expected level of service instead of a copy - also prior to being seen. You can always refund an overpayment - instead of chasing it.
Finally, Credit Card on File (CCOF). Capturing that information is the key to decreasing your collections accounts to nearly zero and speeds our payments significantly. The additional cost is very low compared to the amount going to collections. This is how modern practices handle patient balances now.
One of our forward-thinking clients asks us to send a "pre-statement" report to them. Her staff then compares to the list of patients with a CCOF. Last month the first list resulted in using CCOF to collect over $2,000 before the first statement run, and over $1,000 before the 2nd statement run. She got her money before the patients' statements would have even been mailed!  
Make paying easy. Mobile devices are the choice for Millennials.
Solo Physician Hit With $100k HIPAA Fine
The Office for Civil Rights (OCR), the federal agency charged with enforcing the HIPAA Privacy and Security rules, announced a $100,000 Settlement with a solo physician for failing to implement HIPAA Security Rule requirements. OCR began investigating the practice after it filed a breach report related to a dispute with a business associate. OCR determined that the practice had never conducted a risk analysis and, despite significant technical assistance throughout the investigation, had failed to complete an accurate and thorough risk analysis after the breach. The practice also failed to implement security measures "sufficient to reduce risks and vulnerabilities to a reasonable and appropriate level." In addition to the monetary settlement, the practice is required to undertake a corrective action plan that includes two years of monitoring.
The practice of Steven A. Porter, M.D., has agreed to pay $100,000 to the Office for Civil Rights (OCR) at the U.S. Department of Health and Human Services (HHS) and to adopt a corrective action plan to settle a potential violation of the Health Insurance Portability and Accountability Act (HIPAA) Security Rule.  Dr. Porter's medical practice provides gastroenterological services to over 3,000 patients per year in Ogden, Utah. 
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.
Horizon NJ Health
HNJH will only pay for up to 3 procedures per day. Any more than that, and the payment is called "FREE." So, you will only be paid for up to 3 CPT codes per day. If it is appropriate clinically, you may want to stage the procedures.
Just Announced by United Healthcare (UHC)
Verbatim from UHC:

"UnitedHealthcare is launching initiatives to replace paper checks with electronic payments throughout 2020 and will no longer be sending paper checks for provider payment.*
You will have the option of signing up for Automated Clearing House (ACH)/direct deposit, our preferred method of Virtual Card payment, or to receive a payment (Virtual Card). The only alternative to a Virtual Card is direct deposit. Both of these options allow you to get paid quickly and securely. The electronic payment solutions will roll out in phases throughout the year, with the first phase beginning mid-2020.
Why Choose the Automated Clearing House (ACH) Direct Deposit?
  • Direct deposit puts payment directly into your bank account
  • Easiest and fastest way to get paid
  • Improved financial control; no paper checks or remittance information to lose or misplace
  • Ability to track information on our online portal
What Does This Mean to You?
  •  If your practice/healthcare organization is still receiving paper checks, you can enroll in ACH/direct deposit for your claim payments now. If you don't elect to sign up for ACH/direct deposit, a Virtual Card will be automatically sent in place of paper checks.
  • To sign up for the ACH/direct deposit visit
  • If your practice/healthcare organization is already enrolled and receiving your claim payments through AHC/direct deposit from Optum PayTM  or receiving Virtual Cards, there is no action you need to take. (Cape STRONGLY advises all clients to avoid the cost of Virtual Credit Cards - VCCs.)
  • Because this initiative will roll out in phases, you may receive Virtual Card Payments (VCP) for some claim payments and check payments for others (if not enrolled for direct deposit).
* In Florida, New Mexico, New York or Oregon out-of-network providers and all Colorado providers have to consent to receive a virtual card payment. Processing of the Virtual Card is your consent to receive and accept it as payment in full from the payer. If you don't consent, when you receive a Virtual Card, please call the number provided on your Virtual Card payment to arrange an alternative payment method."
2020 Client Newsletter Archive