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August 2010 Client Newsletter


Medicare is reminding all physicians regarding the PECOS requirements for providers who have not re-enrolled or updated their enrollment within the past 6 years. Providers will need an approved enrollment record in PECOS to continue to order or refer items or services for Medicare beneficiaries and to receive incentive payments made by Medicare and Medicaid. If you, or a colleague, need assistance using the internet-based PECOS, please call us.


The final Meaningful Use (MU) criteria came out on July 13th. CMS has lowered the # of standards that must be met in order to qualify for MU and meet the certification standard so providers can receive the incentive bonuses.

Mark Anderson, CEO of the AC Group, said they have conducted a review of 114 EHR vendors, and, as of July 15, believe that 83 of them can meet Stage 1 MU requirements. Although CCHIT is NOT an approved 2011 MU certification body yet, almost everyone assumes they will become one of the certifying bodies. Right now 28 EHR vendors have already received CCHIT 2011 certification and the CCHIT certification process requires more than just the Stage 1 MU requirements. CCHIT has opened up certification again and 48 additional EHR vendors have said they are in the process of getting CCHIT certified.

Primary Care Bonus Payments

Beginning in 2011 and effective until 2016, all primary care physicians, PA’s, NP’s, and CNS’s will be eligible for a 10% bonus in Medicare payments. To qualify, at least 60% of a physician’s total Medicare charges must be comprised of office, nursing home, and home care visits." We will forward details when they are released by CMS.


From Aetna: Electronic Funds Transfer (EFT) is available to all providers treating Aetna members for all benefits plans. If you choose free online electronic delivery of your claims payments via EFT, you:
  • Get payments transmitted directly into your bank account(s) up to one week faster than with paper EOBs and checks
  • Reduce mail, and eliminate trips to the bank, while providing a convenient audit trail.

    If you are interested, we can give you the contact information.


    Recently I was speaking with the Receptionist for one of our clients and reminding her how important it is to verify insurance each visit, plus copy and verify the photo ID for new patients. Her response was that she sometimes was too busy to do that. That was not a surprise since we had noticed a higher # of denials for wrong insurance at that office, which prompted the visit.

    Patients are not the only victims of medical identity theft - physicians and other healthcare providers are also victims. If a physician treats a patient who has provided fraudulent information, one of two bad outcomes are likely:
    · If the insurer has already caught the identity theft, the provider will not be paid for the services rendered.
    · If the provider already got paid by the insurance company, they will be required to return those funds when the identity theft is caught. The laws always exempt fraud when an insurer wants money back, so that does not prevent take-backs.

    The above can be prevented by carefully checking the photo ID. CPB’s appointment system allows copies of both driver’s licenses and insurance cards to be kept and viewed.

    In case you didn't know…
    IRS-CMS & Delinquent Tax Bills

    Legislation recently signed by President Obama that delays Medicare cuts until December 1 also establishes a data match program between the Centers for Medicare and Medicaid Services and the Internal Revenue Service. Under the new law, the IRS has the authority to disclose to CMS any information on delinquent tax debts for a provider who has applied to enroll or re-enroll in Medicare. CMS can use information obtained from the IRS in determining whether to deny a provider application for participation in Medicare or to apply enhanced oversight to the provider. Text of the enrolled version of the bill, H.R. 3962, is available at

    Cape Medical Billing
2010 Client Newsletter Archive