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June 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.


Days in Accounts Receivable (DAR) is a standard measure of how fast money that is owed to you is collected. It is usually calculated over the previous 3 months by dividing your actual accounts receivable (AR) (minus bad debt and other long term receivables, such as litigation) by the average daily charges. The lower the number the better – the lower the # means it took less days to collect your money.

Recently our professional association, Healthcare Billing and Management Association (HBMA), performed its first annual DAR survey and we participated. I am extremely pleased to report that in our specialties CPB was as much as 50% lower than both the national average and median DAR! To help you compare your numbers, on the back of your Monthly Letter under the DAR Graph, we have included the statistics for your specialty so you can compare to the graph.

This is objective confirmation of the high quality work that CPB performs for you!

Red Flag Rules Delayed Again

On April 30th the FTC again delayed the implementation of the Red Flag Rules from May 1 to August 1, 2009. The FTC indicated that it is allowing this extra time for Congress to act to either exclude medical practices or not. My guess is that politically they will not do so due to pressure from identity theft groups who would say it increases consumer risk.


Whenever you have a patient sign an ABN, we strongly recommend that you collect your fee that day. If the patient balks at paying that day, our experience is that they will not pay later either. You are using the ABN because you are fairly certain that Medicare (or other payors) will not be paying. Let the patient know you will submit the charges to their insurance and refund the payment if insurance pays.

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.


Clients doing the PQRI program, be SURE to follow the guides and use the correct codes and modifiers. The PQRI codes are required for patients whether Medicare is primary, secondary, or tertiary. Failure to do so will result in not being counted toward the required 80% of claims which could result in zero payment.

For those who have not started, a new reporting period begins July 1 – December 31, 2009 for Measures Groups (30 consecutive patients). Medicare will pay 2% for all charges for all patients for claims with those dates of service.

If you are interested, contact Rich before June 10th so there is time to modify your charge forms.
2009 Client Newsletter Archive