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March 2007 Client Newsletter


Just as we are about to get past the cash flow slow-down due to the annual deductibles another looms on May 23rd. As you probably know by now, NPI #’s are required for payment on and after May 23rd. Providers with NPI #’s that have not been properly linked by insurers will likely be part of the financial crisis for providers across the nation. Current information is that nearly 50% of providers have not obtained their NPI # and many who have still need their # linked at every insurance company to get paid.

Even if providers all had their NPI # (which they do not) the government still requires the individual NPI #’s to be used in place of UPINs. But the list of provider NPI #’s has not been made available for adding to referring physician files. It has been promised for over a year!

And we are being told that many software vendors and insurers are not ready to receive and process NPI #’s. Finally, the new HCFA 1500 form that replaces the current form and is required on April 1st, may compound the problem.

We have also filed the #s with various insurers as we are aware of their needs. In many cases they required a copy of the actual letter giving the NPI # sent by NPPES. For those clients that provided that form to CPB you were included with those insurers that required it.

CPB & its software vendor are ready and have successfully tested as far as insurers have allowed. All CPB clients have their NPI #s and those #’s have been sent on claim submissions since early January. Even tho CPB is ready those insurers who are not may not pay timely. If you have not signed up for electronic fund transfer (EFT) may want to seriously consider doing so as it will facilitate payments better than paper checks.

CPB strongly encourages you to be very frugal with your cash until we see how this conversion progresses thru June.

Date of Birth Needs to Be On All Charge Forms

The patient’s date of birth (DOB) is an important item of information on Charge forms especially for patients with the same or similar names in your practice. DOBs are also used by our staff for HIPAA Privacy purposes to confirm the identity of all patients prior to entering charges.

United Healthcare – Oops!

Due to a question about our United Healthcare article last month we contacted Wendy Licorich (sp?), South Jersey's Local Network Account Representative with United Healthcare. United Healthcare allows one Initial Inpatient Consultation per consultant (provider), per patient confinement. Any additional visits by that provider/consultant must be billed as subsequent hospital care – (codes 99231-99233). She did apologize for the unclear wording as it did prompt many calls.

NJ Medicaid Inpatient Consults

We recently clarified with NJ Medicaid how they will handle inpatient consultations. They stated that a provider is allowed to perform 1 inpatient consult per 335 “rolling” days (not 365) per patient regardless of whether the patient receives inpatient consults from other providers during that time frame. In other words, if a provider performs an inpatient consultation & the patient also has another inpatient consultation performed by another provider, it is no longer a first in - first paid situation. Both providers are eligible for payment as long as they have not performed another inpatient consult for the same patient during the previous 335 days.

One inpatient consultation per patient, per individual provider, during the past 335 days.
2007 Client Newsletter Archive