January 2012 Client Newsletter

Just a reminder to our office clients that it is important to send a list of patients seen each day so we can verify all patient charges have been received. Ideally it would be the first page after the Batch Cover Sheet.


AtlantiCare notified all employees and area providers on December 13th that their insurance will be changing effective January 1, 2012 to 1 of 2 unique Horizon plans – Engaged and PPO. They are also “transitioning to an Accountable Care type model” differentiating providers who are in and out of network. AtlantiCare Tier Network physicians (medical & specialists) have a $10 copay except for preventive care, which is $0 (zero). Non-network physicians have a $35 copay.


Due to phenomenal growth, CMB has now reached the point that we began to send patient statements twice a month in order to spread patient calls out and further improve your cash flow.


January & February are usually the time of year when patients are meeting their annual deductibles. These have increased significantly in the past few years as more policies are being purchased with $1,500 - $5,000 deductibles. As you know, we strongly recommend collecting these balances on the date of service if the patient has no other coverage.
One way to avoid this loss of cash flow early in the year is to include a Well Visit for Medicare patients (and HMO/PPO patients, if they have such coverage). The services are separate and distinct from a non-well visit and can be provided on the same day. The medical record needs to clearly reflect the 2 types of visits and the appropriate co-pay collected.


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.
Providers should be aware by now from CPB Monthly Client Bulletins that on January 1, 2012 new data requirements go into effect for the submission of electronic claims. The primary affect on providers is that certain additional data is now required in order to be paid. Some of this we have already taken care of on your behalf, such as adding the “Pay To” field which allows payments to be sent to PO Boxes instead of street addresses, and 9 digit zip codes for the location of services.


For those who see Workers Comp cases, 5010 now requires the name and address of the employer. Failure to provide it will mean the claim will be rejected.
If your office uses the New Patient Form or the Established Patient Form which CPB created, they may need to be updated to capture this information. Please notify me if you need that done.

For those offices which use your own form, you will need to either switch to ours or make provision to capture this information from patients while they are in the office. Let me know ASAP if you need us to prepare one for you.


For our ambulance clients, the same requirement pertains. If you are able to capture this information, along with the other information you are already capturing, it will facilitate payment. Failure to obtain it will mean a delay in being able to submit the claim until the patient provides it.

As mentioned above, don’t shoot the messenger. We aren’t excited about it either since it creates additional data entry for us and 1 more reason for W/C carriers to deny claims – resulting in follow-up work. Please call Rich with any questions.


HIPAA did away with "minimum" charges for copying medical records - or any other method of charging that exceeds the ACTUAL costs of making the copies. HIPAA provides that, in states where the patient may be charged for copies of the chart, the charge may not exceed the actual cost, including labor and postage, of making and sending out the copies.

Note also that if you keep your records in electronic form, the patient can request that that the records be provided in electronic form. In that case the charge would be the cost of labor to make the e-copy, along with the cost of the CD-ROM or other medium used. Remember, if you produce these records in electronic format you should at a minimum password protect them and ideally encrypt them. Only give the password to the patient or legal representative.