January 2007 Client Newsletter
A FEW REMINDERS
Â· 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 #.
Â· 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.
Â· 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.
Â· 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.
Â· 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:
â€¢ Prevents physician payment cuts in 2007 by freezing payment rates for physician services.
â€¢ Provides a 1.5 percent bonus-incentive payment to physicians who report on quality measures in 2007.
â€¢ Establishes a fund to promote physician payment stability and physician quality initiatives in 2008.
â€¢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 providerâ€™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.
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 #â€™s.
CPB has received NPI #â€™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 #â€™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 â€“ 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 â€“ so you will be providing the care for FREE!