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March 2014 Client Newsletter





March 1, 2014


Just a reminder that due to the many deductibles that have to be met early in the year, cash flow slows in January & February.  This has applied to Medicare patients for many years, of course, but this year will affect more patients than ever.  Before Obamacare started January 1st, we have seen estimates of 30+% of all plans being written are now high deductible health plans of $1,000 -$5,000 per individual, with family deductibles twice that.  Effectively, until the deductible has been met, the patient has no insurance!  With the new Obamacare care plans and their high deductibles, that adds to the slowdown.  Be sure to collect co-pays in the office before the patient sees the provider. 

Plus February only has 28 days instead of 30 or 31.  So total charges & payments will also be lower.


You may find this interesting, our initial few Obamacare patient charges have taken 28- 30 days to be adjudicated back to CPB electronically.  In all cases, the insurer did not make a payment, only applied the balance to the deductible.  The problem is exacerbated because Obamacare allows patients up to 90 days to pay for their 1st month – so insurers are not unreasonably reluctant to adjudicate a claim until they are sure the patient is a paying customer. 


Nearly all of our clients have now decided how they will handle ICD-10 implementation and we are preparing accordingly.  Of course there is only so much that we can control – insurers still have to be prepared to process those claims correctly. 

As mentioned last month, experts are strongly recommending providers build up a cash reserve so it is available in October and later in case insurers are not able to process payments correctly.  Now would be a good time to contact your bank to establish a Line of Credit.  CPB software is ready and we will be testing with Medicare March 3-7.  Staff training continues.  We anticipate finishing our preparations by June 1.  If the insurers do what they should, this will not be much of a problem.


We have extensively researched which lab tests providers may perform for Horizon pts. – and be paid for.  We reviewed their manual and spoke with the local Horizon Provider Rep, Ann Marie Coles.  Simple answer – NONE. 

Horizon severely limits the Lab work that providers may perform in their offices.  Except for a small # of specialists (and even they are permitted only a very limited #), there are No Lab tests that primary care providers can bill for.  Zero.  Nada.  Ditto Cardiology, most Surgeons, Podiatry, etc.

However, Horizon will allow you to perform Rapid Strep tests but you must order the Rapid Strep Test Kit supplies from Lab Corp.   It is our understanding from Ann Marie that these kits are FREE.

Options to get the Test Kits:
1. You can call your local Lab Corp Field Representative at 1-888-LabCorp (522-2677), option 3, or
2. Call 1-800-631-5250, extension 2704 to obtain the form to order these kits. 

Of course the other testing option is to send the patient to the Lab and wait for the results. 

Considering the above, any Lab work provided to Horizon pts. is a write-off as your Horizon contract does not allow you to bill the pt. if unless Horizon assigns the balance to them.

There is an alternative.   If you obtain a signature on a document similar to a Medicare ABN that shows the pt.:
• Was offered the option to go to a lab,
• Given the cost of doing it in your office, and
• Then chose to pay to be tested in the office at their expense (we can help you draft that document). 

In that case, we strongly recommend collecting money for the test that day and not billing Horizon.  DON’T lose that “ABN” paper!  You can scan it with the charges and we will then have it on file in case you are audited.  We will be glad to assist you with this document.

Our experience trying to collect after billing Horizon is the pts. will often call Horizon to ask why it is not covered, then are told they may not be billed.  The pt. then calls us to tell us Horizon said they cannot be billed.  We remind them of the document they signed – and it is a struggle at best. 


Be advised that TriCare does not cover either of the Transitional Care codes:  99495 or 99496.  In those cases, just bill your usual office or Home visit code on the dates the patient was seen.


2014 Client Newsletter Archive