October 2009 Client NewsletterPatientâ€™S WITH INJURIES
Please be pro-active - we are starting to see more delayed claims due to diagnoses that indicate the patient was injured. Diagnoses such as laceration, fracture, etc. often cause insurers to delay payment until the patient is sent a Coordination of Benefits (COB) letter and returns it â€“ which often is not done very timely. To avoid this, please ask patients to tell you where & how the injury occurred, and the date. Then we need to know if it was MVA, Workmanâ€™s Comp or other so we can indicate that on the claim also to minimize payment delay. The â€œregularâ€ insurers do not owe payment as primary for WC and only rarely for MVA, so will always â€œpendâ€ those claims until the patient responds directly to them.
Medicareâ€™S RECOVERY AUDIT CONTRACTORS (RACâ€™s)
CPB will begin to include information about the Recovery Audit Contractors (RACs) in the monthly bulletins as relevant information is found. RACs were created by Congress to audit all Medicare payments retroactively and to recover what has been deemed to have been paid incorrectly. In the initial RAC test program, billions of dollars were recovered so this program MUST be taken seriously.
However, the RAC auditors (there are 4 of them for the USA) are required to propose what issues each will audit and receive approval from CMS in advance. The Region A RAC has received approval for 3 DME audits so the process has begun. We expect to see other issues approved within the next few months that will target other providers.
One of the more common reasons that money is refunded is for failure of the provider to respond to the RACâ€™s request for documentation! In those cases, the auditor has the authority to take back all money paid for the services it requested documentation for. And, you can expect that will draw more attention to that providerâ€™s practice to audit other services.
As always, payment is based on the written documentation in the patientâ€™s medical record so that document is key. Before replying to a records request,
Â· Review what is being requested
Â· Review the chart documentation to be sure it addresses ALL of the request. If documentation from other visits, reports, etc. is needed to completely show why a service was provided, be sure to include it when responding. If necessary, include a cover letter explaining why each service was performed.
Be sure to respond before the deadline. The sooner the better.
RED FLAG RULES & HITECH
The FTC announced on July 29th that the Red Flag Rules will be delayed again with a new date of November 1, 2009. CPB expects this to be the final delay, or not! Once the FTC releases their guidance, CPB will create a sample policy & procedure available to all clients which can be modified to suit each provider.
HITECH also requires changes to HIPAA Privacy & Security. We expect to create a sample policy & procedure by mid-November for that also which will be available for clients.
If you are interested in either or both, please give Rich a call.
CPB is always looking for new clients and appreciates referrals from our existing clients.
If you know a colleague who is experiencing slow cash flow, poor insurance collections, or any of the many non-payment issues â€“ please refer them to CPB. In todayâ€™s economy, providers cannot afford to â€œleave money on the floorâ€ or only collect the easy money.
Insurers pay lots of people to find reasons not to pay providers. With our cutting edge, comprehensive, strategic financial systems to collect not just the easy money but also the difficult reimbursement that takes human effort. CPB results are tough to beat!
Several physician clients have expressed an interest in starting to look at EHR programs. We now have the names of 5 promising programs. If you are interested in becoming part of the demos, let me know.