January 2007 Client Newsletter
A FEW REMINDERS
· The new Medicaid ID cards have a CCN #
listed. This is not the Medicaid ID# needed to bill with. To ensure
the patient is covered Medicaid requires you to follow their procedure
to contact them and obtain their Medicaid #.
· Make sure when a
patient is filling out the Patient Information form that they indicate
whether the charges are related to an auto accident or Worker's Comp
injury. If so the date of the accident/injury is required by insurers.
Not receiving this information can significantly delay payment.
·
When updated insurance info is sent, we need to know if this
replaces what we have on file or is in addition to what we have on file.
If in addition to, then is the new insurance primary or secondary?
Also, if the insured is not the patient, insurers require the
subscriber's name and DOB.
· Since the New Year is
approaching, this may be a good time to ask patients for a current copy
of their insurance cards. This, as you know, is vital information.
·
The new year is also a good time to review your HMO, PPO and
other managed care agreements for the fees you are being paid. If the
fees have lagged behind other insurers, it may be a good time to
renegotiate them. More details on this next month.
2007 Medicare Fee ScheduleS
Congress
has passed a law to keep the Medicare physician fee schedule Conversion
Factor the same as 2006 and President Bush has signed it. Ambulance
payments are slated for 4.3% increase.
The following is a summary of the compromise agreed to between House and Senate negotiators. To view the entire document, go to:
http://waysandmeans.house.gov/media/pdf/taxdocs/hr6408healthsummary.pdf
Highlights
• Prevents physician payment cuts in 2007 by freezing payment rates for physician services.
• Provides a 1.5 percent bonus-incentive payment to physicians who report on quality measures in 2007.
• Establishes a fund to promote physician payment stability and physician quality initiatives in 2008.
•Provides
a one-year extension of the exceptions process established in the
Deficit Reduction Act to allow patients to apply for additional
physical, occupational, and speech language therapy services if their
treatment is expected to exceed the annual cap on therapy services.
2007 PART B DEDUCTIBLE
The
Centers for Medicare & Medicaid Services (CMS) announced the Part B
annual deductible for 2007 is $131.00 (up from $124 for 2006). Empire
Medicare Services, does allow you to call them to find out the
patient's deductible status. If you are interested, you can check all
Medicare patients that either don't have a secondary insurance, or a
secondary insurance that does not pay their deductible. Then you can
collect the deductible on the day of service.
If a patient
questions you, inform him/her that as of that day, they've met $xx.xx of
their deductible. If the patient pays you on the day of service, be
sure to let CPB know the amount paid on the Charge form so we can post
it on the claim that we submit electronically. If, by chance, another
provider’s claim gets there before ours, inform the patient that they
will receive a check directly from Medicare for the amount overpaid
since their payment to you will have been reported. You can explain
that it saves having to send a bill to the patient, and, in the event,
that you get paid twice (Medicare also pays you), you will send a refund
check to the patient.
NPI NUMBERS
As of October, CMS
had issued slightly fewer than 1.3 million NPIs, or about 50% of the
total 2.3 million CMS expects to issue. With the May 23, 2007 deadline
looming, many in the healthcare community worry that there will not be
enough time to test all of the transactions requiring NPI #’s.
CPB
has received NPI #’s for all of our clients which puts you in good shape
and is working with various insurers to send them with claims. Empire
Medicare is still testing their software.
Insurers and other
providers are now beginning to ask for both individual & Group NPI
#’s. Please be sure to either respond to insurer requests (& copy
CPB) or send all requests to CPB & we will do it (no cost). If you
respond it is important that CPB receive a copy so we can add it to your
file for reference if payment problems develop later.
If other
providers call and ask for your NPI # to replace your UPIN (this is
correct), they only need your individual NPI # not your group #. The
Group # is only needed for billing your claims.
HOSPICE & HOME HEALTH PATIENTS – PT/OT & DME PATIENTS
Medicare
Hospice and Home Health patients have restrictions on payments to
providers because Medicare pays them under Part A to provide a
significant amount of care to those patients. You MUST be sure to ask
the patient if they are under the care of one of those programs BEFORE
treating them. If so, be sure to get the date care started/ended.
Medicare will not make any payment to you if they are or will take the
money back later if paid in error – so you will be providing the care
for FREE!