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May 2011 Client Newsletter

Credit card payments

With more insurance policies than ever having high patient and family deductibles (we have seen them as high as $5,000 per year!), you may want to consider offering credit cards as one of your payment options.

We have researched this and it appears that an average cost per month for 75-80 patients to charge $2,500 (an average of about $32 each) is less than $100. Vendors now give offices more ways to collect payments, which gives patients more flexible payment options, including Front Office Payments (card swipe, internet, or both), automated Payment Plans, and Patient Payment Portal solutions. CMB patient statements have the ability to show whichever credit cards you accept so the patient can pay that way for statements also.

If interested we have 2 companies we have interviewed which you could consider.

Consults

Consults, by definition, require a referring physician which cannot be the provider performing the service. If the charge form is missing the name of a referring physician, CMB will always ask if there is one. If not, the only alternative which is compliant with billing rules is to bill a CPT code other than a consult (office visit, subsequent hospital visit, etc.).

Medicare Attestation Begins on April 18. (From CMS)

“Attestation for the Medicare Electronic Health Record (EHR) Incentive Program began on April 18, 2011. In order to receive your Medicare EHR incentive payment, you must attest through CMS' web-based Medicare and Medicaid EHR Incentive Programs Registration and Attestation System.

CMS will release additional information about the Medicare attestation process soon, including User Guides that provide step-by-step instructions for completing attestation, and educational webinars that describe the attestation process in depth.

Here is more information to help you prepare for Medicare attestation: You need to understand the required meaningful use criteria to successfully attest. Meaningful use requirements for eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) participating in the Medicare EHR Incentive Program are different:
EP Meaningful Use Criteria – Must report on 15 core measures, 5 of 10 menu measures, and 6 clinical quality measures, consisting of 3 required core measures and 3 additional measures.
Go to the Stage 1 EHR Meaningful Use Specification Sheets for EPs for information on core and menu measures for EPs.
Go to the Clinical Quality Measures page for information on the required clinical quality measures for EPs.

You should also make sure that you begin your 90-day reporting period in time to attest and receive a Medicare payment in 2011. The last day to begin your 90-day reporting period for 2011 incentive payments is October 1, 2011, for EPs.”

More ICD-10

While ICD-10 starts on October 1, 2013 (2.5 years away), it is only mandatory for HIPAA covered entities/plans. However, some insurers, specifically Medicaid, may not be able to comply with the deadlines. Workers Compensation, auto, attorneys and other types of non-health insurance indemnity plans are not subject to HIPAA and can continue to use ICD-9 - even though it will no longer be maintained or updated. The most current information we have indicates we will indeed see this, so it is critically important to expect coding and operational issues that will result. CMB will be ready, but there are major systems issues that could cause serious disruptions in payments regardless of what you bill with.

FILLING OUT AN ATTORNEY’S QUESTIONAIRE

Question: If you have a patient who was injured and has filed personal injury suit against a company and his attorney is requesting that you fill out a questionnaire regarding your patient to help with his suit, do you have to comply? Should you request payment for your service? If so, how do I determine a reasonable billing rate for my time and effort?

Answer: You are free to either respond or not respond to the attorney's questionnaire. A questionnaire is not the same as responding to a subpoena. It is reasonable for you to be paid for your time if you choose to respond, but you may want to contact the attorney and ask if he is willing to compensate you and to clarify the amount of your charges. If he/she is not willing to pay, then you can decide how to proceed. I would not just unilaterally fill out the questionnaire and then charge the attorney without having a written understanding first. Recognize also that if you "get involved" by responding to the attorney, you may be nominating yourself to become a witness in the litigation. This does not bother some people; others would dread such a possibility. Bottom line is to make a wise choice based on the possible future consequences.

More eRx – Avoiding the 2012 Payment Adjustment

In November, the Centers for Medicare & Medicaid Services announced that, beginning in calendar year 2012, eligible professionals who are not successful electronic prescribers based on claims submitted between January 1, 2011 – June 30, 2011, may be subject to a payment adjustment on their Medicare Part B Physician Fee Schedule (PFS) covered professional services. Section 132 of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) authorizes CMS to apply this payment adjustment whether or not the eligible professional is planning to participate in the eRx Incentive Program.

From 2012 through 2014, the payment adjustment will increase each calendar year. In 2012, the payment adjustment for not being a successful electronic prescriber will result in an eligible professional or group practice receiving 99% of their Medicare Part B PFS amount that would otherwise apply to such services. In 2013, an eligible professional or group practice will receive 98.5% of their Medicare Part B PFS covered professional services for not being a successful electronic prescriber in 2011 or as defined in a future regulation. In 2014, the payment adjustment for not being a successful electronic prescriber is 2%, resulting in an eligible professional or group practice receiving 98% of their Medicare Part B PFS covered professional services.

The payment adjustment does not apply if <10% of an eligible professional’s (or group practice’s) allowed charges for the January 1, 2011 through June 30, 2011 reporting period are comprised of codes in the denominator of the 2011 eRx measure.

Please note that earning an eRx incentive for 2011 will NOT necessarily exempt an eligible professional or group practice from the payment adjustment in 2012.

How to Avoid the 2012 eRx Payment Adjustment
· Eligible professionals – An eligible professional can avoid the 2012 eRx Payment Adjustment if (s)he:
-- Is not a physician (MD, DO, or podiatrist), nurse practitioner, or physician assistant as of Jun 30, 2011 based on primary taxonomy code in NPPES;
-- Does not have prescribing privileges. Note: (S)he must report (G8644) at least one time on an eligible claim prior to June 30, 2011;
-- Does not have at least 100 cases containing an encounter code in the measure denominator;
-- Becomes a successful e-prescriber; and
-- Reports the eRx measure for at least 10 unique eRx events for patients in the denominator of the measure.
· Group Practices - For group practices that are participating in eRx GPRO I or GPRO II during 2011, the group practice MUST become a successful e-prescriber.
-- Depending on the group’s size, the group practice must report the eRx measure for 75-2,500 unique eRx events for patients in the denominator of the measure.
2011 Client Newsletter Archive