February 2009 Client Newsletter
ePRESCRIBING (eRx)Just a reminder that providers that can qualify for the 2% Medicare bonus must send 1 of 3 special codes to Medicare when billing each office visit or consult code. They cannot be sent at a later time. There are other requirements that make it important for you to begin sending these codes ASAP. We can add these codes to your Charge form – just let us know - and we will automatically handle the rest for you when we enter the patient charges. If you want to know what your bonus might be based on 2008 Medicare payments/Allowed Amounts, contact Rich. If you know your total Medicare payments, divide by .80 and you will be fairly close to the full Allowed Amount.
PQRI is also still an option for another 2% bonus but will need to start quickly in order to meet the 80% threshold of annual claims. Charge form changes are necessary and the program is a bit more complicated than eRx – contact Rich if interested.
HIGHMARK Medicare Audits – COMPLIANCE ISSUES
Attached with this month’s Client Bulletin are 3 audit reports from Highmark which were announced January 28, 2009 that were performed on Washington, D.C. providers. For the codes reviewed, they found the following codes billed incorrectly X% of the time:
· 99244 66% Office Consult
· 99245 89% Office Consult
· 99254 82% Hospital Consult
· 99255 89% Hospital Consult
· 99233 79% Hospital Subsequent Visit
As a result, it is VERY likely that Highmark will be doing the same audits on providers in NJ and the other states they handle. A few suggestions if you receive a request for medical records:
1. Be sure to respond timely. No response means Medicare’s full payment will be recouped for that service.
2. Be sure each document requested is sent, including visit notes, reports, etc.
3. Be sure all documentation is complete, legible (a big issue for handwritten notes) and supports the level of service billed. If it cannot be read, it is considered to not have been done.
4. If necessary, include a Cover letter with each record explaining anything that will help the reviewer understand the service billed. Make it easy for them.
Repeated patterns of incorrect billing fall into the “fraud†category and can lead a provider to be placed on 100% prepayment review – meaning all charges must be sent on paper claims with the supporting documentation attached. Payment delays can be 45 -60 days vs. 14 you have now when we send electronically.
ECONOMY – Collection of CO-PAYS, DEDUCTIBLES & CO-INSURANCES
Every day the newspaper & TV are telling lots of stories of layoffs, decreases in hours, pay-cuts, bankruptcies, etc. as I am sure you have also heard. CPB is expecting to see slower payments by insurers, increased denials (to delay payment) with subsequent appeals, etc. A few ideas to deal with impacts on your practice:
· Implement a patient recall program to remind patients when a service is due. Book the next appointment when talking with the patient.
· Set limits on “virtual†appointments – treating patients over the phone. Recently diagnosed problems may be OK, but for new problems it may be better to see the patient.
· Postpone raises – far better than a layoff.
· Re-evaluate staffing hours and employee benefits
· Hire part-time staff if possible, without benefits
· Delay equipment purchases that cannot be cost or function justified.
With the poor economy, it is more important than ever that you make every effort to collect all co-pays, deductibles (if known), and co-insurances on the date of service. We are beginning to see significant numbers of patients who say they have no job and will not be able to pay their bill. In some cases this may be true, but most are on unemployment and probably would pay if asked before seeing the provider. The key is getting the payment before they receive your services, or at worst, before they leave your office. Our highest collection rate clients have this policy already in place and are very successful in collecting co-pay, deductibles, etc. on the day of services.
Offices that have problems with patients not being prepared to pay their co-pay (especially offices that take credit card payments!) are due to the front desk “training†the patient that this is acceptable behavior. Of course, providers need to support their Front Desk staff when a patient tries to avoid payment. If you want to take care of the chronic "I forgot my payment" syndrome, you need to make it more advantageous for the patient to REMEMBER their payment instead!
When patients are given the option to reschedule their appointment, you'll be surprised at the number of people who "suddenly" remember that emergency $20 bill stuck in a pocket in their wallets, purse, or in their car, remember their credit card number, or will call their spouse to get it!
Payers require you in your contract to collect co-pays as a disincentive to over-utilize services. Patients need to know in advance (a month or 2 is plenty) and be sure it applies to patients from all payers who require co-pays and co-insurances (patients without secondary insurances). This policy should become a permanent part of your practice's financial policy statement. It also helps to have a professionally designed sign on the wall next to the check in desk announcing the policy. Patients also should be reminded when their appointment is made to please bring their co-pay. New and established patients should be provided with a copy of the new financial policy to sign at their first appointment after the policy statement has been revised. CPB has sample Financial Policies upon request.
FTC “Red Flag†Rules Delayed UNTIL May 1, 2009
See the separate information enclosed in your monthly packet.