June 2012 Client Newsletter

COMBATING HIGH DEDUCTIBLE HEALTH PLANS
As mentioned a few weeks ago, we are seeing a significant increase in the # of HIGH deductible insurance plans – as high as $5,000 per year – with the resulting higher patient balances. Patients are taking longer to pay and even refusing to pay their deductible. Finding a way to avoid sending them to collections is important for your cash flow.
We have now looked at 6 vendors and have finished doing the formal comparison. We are now in the process of negotiating prices with 2 of the vendors. Should have a recommendation by the end of June.

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.

THERAPY CAPS – MAJOR CHANGE EFFECTIVE OCTOBER 1, 2012
The therapy cap amounts for 2012 are $1880 for occupational therapy services, and $1880 for the combined services for physical therapy and speech-language pathology. Suppliers and providers will continue to use the KX modifier to request an exception to the therapy caps on claims that are over these amounts. The use of the KX modifier indicates that the services are reasonable and necessary, and there is documentation of medical necessity in the patient’s medical record.
For services provided on or after October 1, 2012 and before January 1, 2013, there will be two new therapy services thresholds of $3700 per year: one annual threshold each for 1) Occupational Therapy (OT) services, and 2) Physical Therapy (PT) services and Speech-Language Pathology (SLP) services combined. Per-beneficiary services above these thresholds will require mandatory medical review .

We have attached a copy of the MLN Matters article for our PT/OT clients.

MEDICARE ANNUAL WELLNESS VISITS
Just a reminder that the Initial Preventive Physical Exam (IPPE) for Medicare, G0402, is only valid within the first 12 months of the patient reaching Medicare eligibility (age 65). So a patient who is age 66 or older usually will not qualify unless they did not start their Part B coverage right away.

So an older patient who has been on Medicare Part B for more than 1 year would start with the G0438 AWV code. Also, each of the codes (G0402, G0438 & G0439) have different H&P requirements for billing.

HEALTHPAC’S APPOINTMENT SCHEDULER
For clients using Healthpac’s Appointment Scheduler, it has had a nice feature update to allow a card reader to scan insurance cards, driver’s licenses, etc. direct to a PDF and automatically attaches to the correct pt account - rather than make a paper copy which then still needs to be scanned and manually attached. One product that has been tested is the ScanShell 800DXN Duplex Color Scanner:

http://www.scanshell-store.com/scanshell_800dxn_a6_duplex_card_scanner.htm
It is 8 inches by 3 inches so is quite compact and connects to your front desk PC via USB port. Online cost is $339 at Amazon and the link above.

If you decide to purchase a different product, the scheduler should work with any TWAIN compatible scanner. We do recommend one that can 1. duplex (scan both sides at the same time – which saves time) and 2. Scan in color so that the Driver’s License pictures will have color.
eRx

“Last call” – to avoid a 1.5% reduction in all Medicare reimbursement for 2013, be sure to use a qualified eRx program for at least 10 Medicare prescriptions between now and June 30, 2012 with a total of 100 by 12/31/12. This can be part of a certified EHR program or a standalone. For perspective, if you receive $120,000 in Medicare Allowed amounts, the 1.5% reduction would be $1,800 in lost revenue in 2013. The reimbursement loss increases to 2.0% in 2014.

The only alternative is to qualify for an exemption, which can be difficult.

EHR
If you miss qualifying for the 2012 EHR funding, you will lose $5,000 per provider from the total amount available over the 5 years. Providers include physicians, Podiatrists, Physician Assistants, Nurse Practitioners, etc. You must have at least 90 days of Meaningful Use (MU) before you can attest – this requires time to install the product, train everyone, & begin using it up to the point that it meets MU guidelines. Then the 90 days begins.