July 2009 Client Newsletter

July 4th Holiday

Since July 4th falls on a Saturday, CPB will be closed on Friday, July 3rd to celebrate the holiday.


CIGNA

After hours care. CIGNA will allow separate reimbursement for after-hours CPT codes 99050 and 99058. CPT descriptions:
· 99050 is "services provided in the office at times other than regularly scheduled office hours, or days when the office is normally closed (e.g., holidays, Saturday or Sunday), in addition to the basic service.”
· 99058 “services provided on an emergency basis in the office, which disrupts other scheduled office services, in addition to the basic service.”

Effective April 20, 2009, CIGNA will begin requiring documentation for certain CPT code combinations when modifier 25 is used and on April 27th the same will begin for modifier 59.


Cost of Injections and Other Supplies

Before deciding to purchase and administer various medications and supplies, it is critical that you verify what Medicare & other insurers will pay for the products you wish to use, then negotiate with the suppliers what you are willing to pay. CPB can assist with insurance allowances. Be sure to factor in the cost of your usual bad debt percent (most of our clients are around 1% or less). This way you will know if it is financially worthwhile and can weight other factors.

The typical concern we hear is that the cost product exceeds the payment - which is usually learned after the product was already purchased. Knowing the reimbursement in advance allows you to negotiate from a position of strength with the sales person.


HITECH & Electronic Health Records (EHR) Payments

Medicare will pay up to $44,000 per physician for the “meaningful use” of Electronic Health Records. Medicaid will pay up to $65,000 per eligible provider. The ARRA references the Medicare definition of physician found in Section 1861(r) of the Social Security Act. This includes MD, DO, Dentist, podiatrist, optometry and chiropractor.

NPs & CNMs are eligible for Medicaid incentives but not Medicare incentives. PAs are only eligible to the extent they work in Rural Health Clinics “led” by the PA. In order to receive the Medicaid incentive payment, the 30% of patient visits must be with Medicaid patients. Thus, even though the Medicaid incentives are higher, most physicians will not be able to meet the 30% threshold. Pediatricians can receive a lower Medicaid incentive payment by achieving a 20% Medicaid Threshold.

The incentive program specifically excludes “hospital based” physicians such as emergency medicine, pathology and anesthesiology. The secretary is authorized to define other physician specialists as hospital-based. The rationale behind this exclusion is that these physicians will use a system bought by the hospital and not incur any direct or indirect costs associated with the purchase or use of the EHR.

These incentives are available for each "provider" in a group practice. For example two physicians and three PAs, would be eligible for up to $65k EACH under the Medicaid plan. As written, the incentive payment is available for each “eligible professional”. Therefore the amount of the incentive is calculated on a per provider basis rather than per organization.

One final note, providers who qualify for both can collect from either Medicare or Medicaid, but not both.

MORE EHR

Several physician clients have expressed an interest in starting to look at EHR programs. We have the names of 2 promising programs, one of which has some interesting features. If you are interested in becoming part of the demos, let me know.