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February 2012 Client Newsletter


It is very important for offices to check each patient’s insurance each time they are seen. Insurance plans are written with anniversary dates of either the 1st or 15th – so insurance can change or be lost – on those dates. Clients using the appointment system and who scan insurance cards into it can simply view the insurance card from the last visit & scan the new card into the software, if needed. Without correct insurance information, you will not be paid.
NJ Medicaid benefits are month-to-month & should be verified with Medicaid on EVERY visit before the patient is seen. The card they carry is not an insurance card and does not insure benefits. If the Medicaid system says they are not covered, you should seriously consider collecting payment before the patient is seen.


If you plan to participate in the Medicare EHR Incentive program, you must start in 2012 in order to be able to collect the full $44,000. Not starting until 2013 decreases the total amount to $39,000 and not starting until 2014 decreases it to $24,000. We strongly recommend getting started ASAP as it can take time to install the program, learn to use it “meaningfully,” & begin billing with the proper code to document the use with Medicare (has to be done at the same time charges are billed – cannot be done later). Billing the special code is how Medicare tracks the eligible charges. You need a minimum of 90 days plus $24,000 of Allowed charges in order to qualify for the $18,000 first year payment. “Ramp up” for an EMR is usually 60-90 days once you “go live” plus 4-8 weeks from contract signature to ‘go live” depending on the EHR vendor’s backlog.

If you have questions, feel free to call Rich.


United Healthcare/Oxford Will Start Covering Gardasil for Males Age 9-26 On February 1, 2012.


In March 2011, CMS revised the Advanced Beneficiary Notice of Noncoverage (ABN) form used by healthcare professionals, including physicians, when they expect Medicare will deny payment. The mandatory date to use this revised form is January 1, 2012. Old forms used on or after January 1, 2012, are considered invalid. As mentioned in Client Bulletins earlier this year, if you are using a form prepared by CPB please let us know so it can be updated to the new form. Using the old form means it will not be considered valid.


On January 1, 2012 the medical billing industry must begin submitting claims and applying payments using the 5010 version. CPB has been submitting all electronic claims in the 5010 format since mid-December and have not seen any significant problems. However, Medicare has had problems returning complete payment information & we are working thru those issues.


Important components of a strong office financial policy:

1. Always collect money at check-in and never at check-out.

2. Be sure to verify insurance before the visit. Be sure to identify either the co-pay amount or a co-insurance/deductible status. If a high dollar procedure for a patient with a high deductible plan is to be performed in the office, determine patient responsibility. Document all of this in the system so money can be collected at check-in. The minimum collected should be your cost

3. Clients using the CPB Appointment system can run a report showing all patients with patient balances. That amount also prints on the Charge Form when you print it.

4. Each practice must have a clear policy on collecting co-pays and balances on the account at each visit. If the balance is large, how much is an acceptable payment if it cannot be paid in full? The key to this policy is to reschedule the appointment, even when the patient showed up for the visit, if appropriate payment is not made so long as it is medically, ethically and legally permissible.

5. If the practice is not using the CPB Appointment System, it is available at no cost. Even if you do not want to use it for appointments, you can still check patient balances.

6. As part of our Month-end Reports, we include the amount collected on the date of service. We track this each month for each client.

7. With the increase in high deductible plans (estimated at 16% in 2011), we are searching for a tool that will allow the patient to authorize automatic withdrawals from their checking account each month or from their credit card. This way the patient is committed to payment.


Now that 5010 is safely behind us, we will begin focusing on the transition to and implementation of ICD-10 coding which is effective on October 1, 2013. While that sounds like a far off date, the ICD-10 codes are very different – yet also similar – than ICD-9. For all of our clients that only affects diagnosis codes – not CPT codes. Over the next 20 months we will include a brief paragraph each month to help bring you up to speed so we have another smooth transition.

eRx for 2012

In order to avoid a penalty in 2013, you must report code G8553 at least 10 times on eligible visits prior to June 30, 2012 and 25 times prior to 12/31/12. An eligible visit is 1) a visit by a patient who has Medicare Part B, 2) an encounter billed as an E/M code, and 3) one that a prescription was submitted electronically (and was associated with the visit).
2012 Client Newsletter Archive