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July 2014 Client Newsletter




July 1, 2014


Screening EKG’s for Work or school


Routine and screening EKG’s for work or school are rarely, if ever, covered by insurance.  If you are participating, many insurers will not even allow you to balance bill the patient without the patient signing an “Advanced Beneficiary Notice” type document.  So, we recommend 2 ways to protect yourself from providing free services:

  1. Have the patient or guarantor sign a document that clearly spells out 1. what the services are (e.g., routine/screening EKG), 2. the cost for each, and 3. that they agree to pay $X if insurance denies payment (no less than Medicare rate).
  2. Nothing brings the cost to the patient’s attention more than paying for that care on the date of the visit – prior to being seen.  Collect the payment on the DOS – prior to the patient being seen, if possible, and let the patient know you will refund if insurance pays.  If you prefer to wait until after the patient is seen, give the patient an estimate of the amount that will be owed when they arrive and ask how they plan to pay.  If the patient will not pay you then (or at least collect half), they rarely will not pay you later.  We have seen it MANY times. 


EHR Penalties Scheduled to Begin


Use of a 2014 certified EHR is required by 10/1/2014 in order to avoid 2015 penalties. This means you need to start using a certified EHR for at least 80% of all of your patients (not just Medicare patients) by July of this year in order to achieve 90 day of Meaningful Use by 10/1/2014.


The good news:  Even if you don't make it by 10/1/2014 (to avoid the 2015 penalties) you still have until the 4th quarter of this year to achieve Meaningful Use and earn the 2014 Medicare EHR Incentives. However, 2014 is the last year for Medicare providers to start EHR and earn any incentives.  Providers who wait to start EHR until after 2014 will not only miss the 2014 incentives, they will also miss the incentives for 2015 and 2016.  However, such providers can still implement EHR late in order to avoid future Medicare penalties, which increase each year. 


AMA Virtual Credit Card Payments

(Reprinted from the AMA)


Effective January 1, 2014, health plans were required to offer electronic funds transfer (EFT) payments using the Automated Clearing House (ACH) Network to physician practices that request this method of claims payment.  ACH EFT, similar to direct deposit of paychecks utilized by many employers, is a funds transfer tool in which payer-to-provider payment is processed through the ACH Network, a payment system implemented by NACHA - The Electronic Payments Association.

When compared to paper checks and virtual credit cards (a widely used form of electronic payer-to-provider payment), ACH EFT offers several advantages to physician practices. The AMA urges physicians to consider registering for ACH EFT with their health plans for the following reasons:

(1) Maximize payment amounts
By eliminating the need to commit financial resources to processing and delivering paper checks to the bank, electronic reimbursements maximize claim payments.  Unlike payments made via virtual credit cards, which can reduce physician payments by as much as 5%, health plans are required to offer ACH EFT payments that do not have percentage-based processing costs.  Standard ACH EFT payments only cost about $0.34 per payment, regardless of the payment amount. 

(2) Save time and money spent processing transactions
Paper checks require staff time to open, internally process, and deliver checks to the bank, or payments for lockbox services.  As a result, being paid electronically is generally faster than paper checks. Virtual credit cards require staff processing of payments by following health plan instructions and utilizing point of sale (POS) credit card processing equipment.  Payments made through ACH EFT are automatically posted to the provider’s bank account, thereby preserving valuable staff time for other administrative tasks.

(3) Reduce risk
ACH EFT payments are processed directly from a health plan’s bank to a physician’s bank over the secure ACH Network.  As a result, payments do not face the risks of lost or stolen paper checks or fraudulent use of virtual credit cards.

(4) Optimize processing of electronic remittance advice (ERA)
The healthcare ACH EFT system was designed to ensure easy reconciliation of the Health Insurance Portability and Accountability Act (HIPAA) standard electronic remittance information with payments using the Reassociation Trace Number.  Virtual credit card information cannot be carried in compliant HIPAA electronic remittance advice transactions, thereby making reconciliation of payment totals and remittance information challenging and administratively burdensome.  Paper checks require manual keying for reassociation with the ERA.

(5) Avoid a shift in payment processing costs
Virtual credit cardsPDF FIle place the payment processing costs squarely on the physician through credit card interchange fees.  Moreover, many vendors will rebate a percentage of these interchange fees paid by the provider back to the health plan for utilizing the service.  ACH EFT eliminates this improper pay structure by keeping more of the contractual payment with the physician.  The AMA has created a resourcePDF FIle to help physicians understand their rights in order to make ACH EFT work most efficiently for their practice.


Electronic Funds Transfer (EFT) Toolkit



2014 Client Newsletter Archive