August 2011 Client Newsletter

Medicare Annual wellness visits and ekg’s

Medicare does not have a separate CPT code to bill an EKG on the same day as a Medicare Annual Wellness Visit (G0438 & G0439) like they do for an IPPE (G0402). Thus, to bill an EKG with either a G0438 or G0439 you will need one of the “normal” diagnosis indications.

GOOD OFFICE FINANCIAL POLICIES

By 2010, more than 54 percent of large employers offered their employees at least one high-deductible health plan, according to a Rand Corporation survey (http://www.rand.org/pubs/external_publications/EP20110086.html).

Patients are responsible for increasingly larger portions of their medical bills – in fact patients’ financial responsibility is the largest it’s been since medical insurance came onto the scene in the mid-20th Century. Copayments, coinsurance and deductibles have never been higher. We have seen deductibles now as high as $5,000 per year! If you are relying solely on your billing staff to respond to this trend, you won’t be successful. Your patients are your worst payers – and asking them for money long after the fact only results in higher postage costs and accounts receivable. Requiring your front office to perform date-of-service collections is essential for financial success.

Here are seven (7) steps to successfully dealing with today’s reimbursement environment.
Check eligibility 1-2 days before the patient’s appointment. This allows you to confirm the patient is covered, who the insured is, amount of co-pay, deductible, and/or coinsurance. Critical information if you want to be paid. It also spells the difference between charity care and bad debt!
Set expectations. Develop a financial policy to distribute to patients when they arrive & make it available on your website, if you have one. Hang tasteful but clear signage in the front office. Don’t beat around the bush by printing signs that say, “Our Practice Expects You to Pay Your Copayment.” Instead, be direct with signs that read, “Your Insurance Company Requires You to Pay Your Copayment.” Send the message professionally, but make it clear that you expect to receive payment at the time of service. If the patient owes a co-pay, ask for payment prior to seeing the provider, not after.
Know how to ask. There is an art to collections, and a large part is knowing how to ask for money. Instruct your staff to stop asking patients, “Would you like to pay?” Replace that request with “How would you like to pay today?” Be sure to ask for past open patient balances at the same time. As they ask for payment, staff must make eye contact with the patient (or guarantor) and use his/her name during the conversation. Print a statement for all patients at check out that reflects any payments they have made as well as any remaining balance due. Giving these statements to patients at check-out is essentially free (no postage), and it reinforces your expectations of getting paid. It also eliminates the excuse patients so often give to your business office: “I never received a statement.”
Accept all forms of payment. Allow patients to pay by cash, debit or credit card. Personal checks could be an option, but consider using a check verification service if you encounter bad checks. Look at the commission rates on credit card services to make sure you get the best deal possible from card merchants. Don’t hesitate to steer your patients to a particular form of payment. For example, you might get a better rate when patients use debit cards for amounts under $20, but a more favorable rate when patients use credit cards for amounts over $20. Of course, you should not hesitate to accept any form of payment, but it doesn’t hurt to request a particular type of payment depending on which is more advantageous to you. Most patients won’t care one way or another because it is you, not they, who gets charged the commission going to the card processing company.
Consider pre-authorized credit cards. Pre-authorized cards allow you to accept pre-payments via credit card without encountering the hassle and danger of storing the patient’s credit card information. These systems capture and store credit card information for you to use later when the claim has been adjudicated. These systems also allow you to set up payment plans securely and seamlessly.
Determine what to ask for. If you have a contract with an insurance company, review it to determine whether you can request the payment of the coinsurance and unmet deductible at the time of service. Despite the well-entrenched urban myth that circulates in the medical practice industry, most insurers do allow you to collect the patient’s copayment, coinsurance and unmet deductible at the time of service. Once you’ve identified any exceptions, ask the patient for these payments prior to seeing the provider. For coinsurance and unmet deductibles, you’ll need to know what services the patient is receiving (because allowances are based on CPT® codes). Thus, you’ll need to perform this collection activity as patients check out of your practice. Some insurers offer a web-based look-up tool to locate the correct rate. Develop a spreadsheet that lists your top CPT® codes and the corresponding allowances for each code by each of your major payers for your check-out staff to look up the codes on this spreadsheet.
Collect a deposit from the uninsured. For patients who do not carry insurance, request a minimum deposit. Set the “deposit” as your full charge, a reduced flat rate, or an average of the copayment that would be expected of your commercially insured patients. You may choose to collect different deposit amounts from new patients versus established patients (typically, deposits required of new patients are higher because there is no relationship or history with your practice), but be consistent within the categories. For patients who can’t afford to pay, offer a financial hardship policy that grants discounts based on the level of hardship. The key to making this work is to take a consistent approach to charging deposits – and have a written hardship policy that you follow consistently.
These days, more insured patients owe higher deductibles, copayments and coinsurance amounts. You can no longer afford to let these patients walk out the door of your practice without paying. Administrative costs and low collection rates make after-the-fact collections a losing proposition for most medical practices. Update your practice’s operations and financial policies and look for other ways to improve the revenue cycle in your practice so that you collect 100 percent of patient time-of-service payments due every day.

August 1, 2011

Workwell

WorkWell is a third-party workman’s comp physical therapy administrator who started in Pennsylvania in 1982 and is now entering the NJ market for some large employers. Each of you has signed their agreement.

CPB was able to negotiate more favorable terms than originally proposed:
$75 per diem (was $70) based on providing at least 4 modalities.
Payment to be made in 45 days (was 60).
If they change your fees, you can opt out immediately (previously no provision).

Billing:
When the patient is scheduled they will provide the patient’s Social Security # as their policy #. Please be sure to forward that to CPB.
Billing needs to be at weekly. More often is better, of course.
All claims require a copy of their “Physical Therapy Notes” form be attached to the claim. WorkWell requires the PT notes have times clearly documented along with the procedures done that day.
We have also negotiated a way to submit these electronically to get the payment clock running sooner.

CLIENT BULLETIN PRIMARY CARE SUPPLEMENT
August 1, 2011

Medicare Preventive Services

In the June 1, 2011 edition of the Highmark Medicare Services “Medicare Report,” page 5,
( https://www.highmarkmedicareservices.com/bulletins/partb/med-reports/pdf/mr0611.pdf )

Medicare specifies what is included in both an Initial and Subsequent AWV. Please note that providing “smoking cessation” counseling (G0436 & G0437) is included with at least the G0438 and will be denied when billed together.

What is Included in an Initial AWV with PPPS (G0438)?
The initial AWV providing PPPS provides for the following services to an eligible beneficiary by a health professional:
• Establishment of an individual’s medical/family history.
• Establishment of a list of current providers and suppliers that are regularly involved in providing medical care to the individual.
• Measurement of an individual’s height, weight, BMI (or waist circumference, if appropriate), BP, and other routine measurements as deemed appropriate, based on the beneficiary’s medical/family history.
• Detection of any cognitive impairment that the individual may have as defined in this section.
• Review of the individual’s potential (risk factors) for depression, including current or past experiences with depression or other mood disorders, based on the use of an appropriate screening instrument for persons without a current diagnosis of depression, which the health professional may select from various available standardized screening tests designed for this purpose and recognized by national medical professional organizations.
• Review of the individual’s functional ability and level of safety based on direct observation, or the use of appropriate screening questions or a screening questionnaire, which the health professional may select from various available screening questions or standardized questionnaires designed for this purpose and recognized by national professional medical organizations.
• Establishment of a written screening schedule for the individual, such as a checklist for the next 5 to 10 years, as appropriate, based on recommendations of the United States Preventive Services Task Force (USPSTF) and the Advisory Committee on Immunization Practices (ACIP), as well as the individual’s health status, screening history, and age-appropriate preventive services covered by Medicare.
• Establishment of a list of risk factors and conditions for which primary, secondary, or tertiary interventions are recommended or are underway for the individual, including any mental health conditions or any such risk factors or conditions that have been identified through an IPPE, and a list of treatment options and their associated risks and benefits.
• Furnishing of personalized health advice to the individual and a referral, as appropriate, to health education or preventive counseling services or programs aimed at reducing identified risk factors and improving self-management, or community-based lifestyle interventions to reduce health risks and promote self-management and wellness, including weight loss, physical activity, smoking cessation, fall prevention, and nutrition.
• Any other element(s) determined appropriate by the Secretary of Health and Human Services through the National Coverage Determination (NCD) process.


What would be Included in a Subsequent AWV/PPPS (G0439)?
In subsequent AWVs, the following services would be provided to an eligible beneficiary by a health professional:
• An update of the individual’s medical/family history.
• An update of the list of current providers and suppliers that are regularly involved in providing medical care to the individual, as that list was developed for the first AWV providing PPPS.
• Measurement of an individual’s weight (or waist circumference), BP, and other routine measurements as deemed appropriate, based on the individual’s medical/family history.
• Detection of any cognitive impairment that the individual may have as defined in this section.
• An update to the written screening schedule for the individual, as that schedule is defined in this section, that was developed at the first AWV providing PPPS.
• An update to the list of risk factors and conditions for which primary, secondary, or tertiary interventions are recommended or are under way for the individual, as that list was developed at the first AWV providing PPPS.
• Furnishing of personalized health advice to the individual and a referral, as appropriate, to health education or preventive counseling services or programs.
• Any other element(s) determined by the Secretary through the NCD process.