Cape Medical Billing: Providing Expert Medical Billing Solutions

Like Cape Medical Billing on Facebook

Call Today 888-MED-BILR

May 2008 Client Newsletter

NPI # Information From Medicare

We are pleased to report that CPB has been sending only the NPI # to Medicare for several weeks without any problems getting paid. At least for Medicare patients, it appears we are in good shape for May 23rd.


There is still potential for cash flow interruption when the NPI # becomes mandatory for all insurers on May 23rd. Our concern now is that other insurers (including Blue Shields, Medicaid’s, etc.) do not seem to be doing much testing.

We recommend taking this into consideration if you plan to make any significant purchases until we see how well the national system (Medicaid, Horizon, other Blue Shields, CIGNA, AETNA, etc.) handles the NPI # only.

We will continue to test claims as insurers indicate they are ready.


The long awaited new ABN form was released by CMS in March 2008 (form # "CMS-R-131 (03-08)” and now combines the “General” and “Lab” versions into one document. All providers are required to begin using it no later than September 1, 2008, but can begin anytime.

The new form includes a mandatory field in which the provider indicates the estimated cost of the services. It also includes a field which can function as the "Notice of Exclusion from Medicare Benefits" (NEMB) instead of using a separate form.
As in the past, the form cannot be altered - including translating it into another language. A Spanish version is available. If you are currently using an ABN that CPB prepared for you, please let Rich know so we can update the information to the new form and send it to you.

Co-pays that exceed the Allowed Amount have created unnecessary credit balances so we recently decided to ask Horizon & AmeriHealth how they should be handled. To our amazement, each handles a different way!

For Horizon, per Maria Marsh, the co-pay is due in-full regardless of the Allowed Amount. In such cases, no credit balance will created so no refund will be necessary,
For AmeriHealth, per Bo Thompson, anything greater than the Allowed Amount needs to be refunded to the patient.

Competitive acquisition program (cap)

If you sell any DMEPOS products and bill Medicare for these items, this program will be impacting your ability to be paid for these products when dispensed to Medicare patients. This program REQUIRES anyone selling to Medicare patients in certain product categories to be accredited no later than September 30, 2009 in order to be paid by Medicare. If you do not become accredited by that date, the NSC is required to deactivate your provider #. CMS estimates the average amount of time to become accredited from the filing of the application to awarding of accreditation is 7 months and they expect a lot of applications.

If you are interested in more information please give Rich a call.

If you would like discounted Morey’s Pier tickets (waterpark & amusement pier) CPB has arranged for a 29% discount for our staff and clients. Go to You will need an ID # - just call and Rich or one of the staff will be glad to provide it.
2008 Client Newsletter Archive