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June 2008 Client Newsletter

NPI # Information From Medicare

This is no longer an issue. Payments are flowing properly!


The NPI # became mandatory for all insurers on May 23rd. As of 6/2/08 we have not received any rejected claims and are sending NPI #’s only (as required by law). We will continue to watch and address any issues as needed.


CPB now has a new main phone #: 609-465-8900 (note it is not “463”). The old # (609-463-8107) will continue to work indefinitely and the toll free # for your patients has not changed.


Technology has now reached the point that we can now send patient statements via email. The billing industry has been sending them for the past 2 years. This appears to be working smoothly and saves providers the cost of USPS postage. We will be contacting each client to discuss implementing this over the next few months. If you have any comments or concerns, please give Rich a call.


Questions are occasionally asked about billing for a patient who is not insured using a spouse’s insurance card and name. This is more common with the higher insurance deductibles that are now being seen but can occur for other reasons, as well.
This is clearly insurance fraud and not something any provider should be part of. The OIG takes a particularly dim view of this and, if caught, can lead to exclusion from treating patients from Medicare, Medicaid and other federal programs for a period of 5 years, plus state sanctions including fines and imprisonment. We strongly advise that provider’s not allow a patient to put them into such a position to risk losing their medical license. If you wish to treat such a patient it would be better to work out a discounted payment plan with them.

There are companies that have the ability to keep credit card information on file which can then be used to set up payments to pay patient co-pay, deductible, and co-insurance balances. If you are interested in considering such an option, let Rich know[RCP1] . We can show you some pretty interesting options.


We just became aware that Medicare will be updating the Benefit Policy Manual (Pub 100-2, Chapter 15, Section 60) with what they are referring to as a "clarification" of the "Incident To" regulations. The effective date is June 2, 2008.

The most significant new requirements in this transmittal appear to be:
· The original plan of care must now explicitly "authorize" the subsequent service by the NPP (which is the billed “Incident To” service).
· Additionally, the physician who is in the office and supervising when the "incident to" service is provided must now also be documented in the medical record (prior to this, it just needed to be billed under the supervising doctor's name. It wasn't necessary for that to be documented in the medical record, too).
· If a follow-up visit wasn’t anticipated, but occurs with a non-physician, it will need to be specifically authorized in writing in the medical record by the physician in the office at that time prior to the patient being seen by the non-physician practitioner (PA, NP, etc.) or other trained employee.
Offices who utilize the "Incident To" provisions may want to read the full document (see link below) carefully so that any operational changes your office needs to make will be able to be in place by the beginning of next month! The “meat” of the article begins on page 9. Feel free to call with any questions. .
2008 Client Newsletter Archive