Talk to a billing specialist 
1-800-966-9270
Medical Billing Blog

Tagged Under : , ,

As of today, the new HIPAA requirements go into effect in less than 3 weeks. Are you ready?

If not, you have 20 days to get ready. That‘«÷s DAYS.

Time to prepare, folks.

As we have noted in previous blog posts, there are several steps that you need to take in order to protect your practice. In case you missed them, here are the highlights:

There are three relatively small changes that just about all offices will encounter:

Patients can now ask for copies of their electronic medical information in electronic format. Also, with both paper and electronic record requests, the office has only 30 days to produce the information. There‘«÷s no more 30-day extension for records that are inaccessible or kept off site.

When patients pay for services personally and in full, they can require that the office not share information about the treatment with their health plans.

The office can give immunization information to a school if the school is required by law to have it and if the parent or guardian gives written permission.

A larger change that practices will encounter involves business associates, which are now required to comply with HIPAA just as providers are. They have to have safeguards and policies and procedures for keeping data secure. They are required to have business associate agreements with their own subcontractors. And they can get hit with penalties if they don‘«÷t.

What you need to do

Steps that providers need to take before the September deadline to protect their practices, provided by Holly Carnell, JD, and Meggan Bushee, JD, Attorneys at McGuireWoods on?ŠBecker‘«÷s ASC Review, include:

1. Update your internal policies.

Key changes that a practice will need to make to its internal privacy policies include (See the full list):

A. Breach standard response– the Omnibus Rule changed the standard for determining whether a breach of unsecured PHI has occurred; the new breach standard should be included in providers‘«÷ internal policies on responding to a potential breach. Who must be notified has remained unchanged.

B. Marketing and sale of PHI – marketing of third party products and services and sale of PHI is generally prohibited, unless the provider has received valid authorization from the patient.

C. Decedents‘«÷ PHI – providers may disclose only PHI that is relevant to the family member, relative or friend‘«÷s involvement in the deceased‘«÷s care, and cannot disclose PHI if the provider is aware that the deceased person expressed a prior preference for it not to be disclosed to the person in question.

D. Disclosures to schools?Š- providers may disclose proof of immunization to schools if the school is required by state, or other, law to have proof of immunization prior to admitting the individual, and the provider obtains and documents the oral agreement to the disclosure by either a parent, guardian, or other person acting in loco parentis of the individual, or from the individual if he or she is an adult or emancipated minor.

E. Patient rights to limit disclosures?Š- a provider must comply with a patient‘«÷s request that PHI regarding a specific healthcare item or service not be disclosed to a health plan for purposes of payment or healthcare operations if the patient paid out-of-pocket, in full, for that item or service.

F. Provision of electronic copies of medical records?Š- providers complying with a patient‘«÷s request for an electronic copy of his or her PHI are required to provide access to such records in the electronic format requested by the patient if the records are maintained by the provider in an electronic designated record set and are readily producible in the requested format.

2. Provide staff training.

Make sure that your policies are both updated and implemented. Once your practice has updated your privacy policies, staff members should receive training on any new and revised policies.

3. Offer notice of privacy practices.

After you have updated your NPP, your practice must make the NPP readily available to existing patients who request a copy on or after the effective date of the revisions; must post the revised notice on its website, if applicable; and must post the notice in a prominent location on its premises.

4. Revise your business associate agreements.

Providers should revise their business associate agreement forms to reflect the new requirements under the Omnibus Rule. The deadline for this is September 23, 2013. However, existing BAAs that were entered into on or before January 25, 2013 and have not been modified after March 26, 2013 do not have to be updated until September 23, 2014.

You should note that the Final Rule broadened the definition of a business associate to include subcontractors, health information organizations, entities that offer a personal health record to individuals on behalf of a covered entity, and other entities that provide data transmission services for covered entities and that require access on a routine basis.

The Final Rule also provides a list of HIPAA Privacy and Security Rule requirements that apply directly to business associates, including requirements to:

A.?Š?Š?ŠMaintain detailed records?Šof uses or disclosures of protected health information (‘«£PHI‘«ō) to be produced upon request;

B.?Š?Š?ŠProvide an electronic copy of PHI?Što covered entities or individuals upon request;

C.?Š?Š?Š?ŠSign business associate agreements?Šwith subcontractors that?Šcreate or receive PHI on their behalf; and

D. ?Š?ŠMake reasonable efforts to limit release or use of PHI?Što the minimum necessary to accomplish the intended purpose of the use or disclosure.

Many of these new requirements were not previously believed to apply to business associates, so business associate agreements will need to be amended to comply with the new provisions.?Š For more information on your business associate agreements and what entities are covered under this definition, see this recent post on?ŠJD Supra Law News, which provided the BAA items above.

Once your practice has updated its BAA form, attorneys recommend conducting an inventory of all current BAAs (including BAAs in which the provider is the covered entity and BAAs in which the provider is a business associate or subcontractor). Each of these BAAs will need to be modified by an amendment or replaced with the practice‘«÷s revised BAA form. This may also be a good opportunity to consider whether the protections and restrictions in the form agreement go far enough in protecting patients and the practice.

You should review all your business relationships to ensure you have a BAA in place where one is required under HIPAA. Providers may have relationships that did not previously require a BAA, but which do now under the Omnibus Rule‘«÷s expansion of the definition of ‘«£business associate.‘«ō One key change to the definition of business associate is the inclusion of subcontractors of business associates that deal with PHI.?Š However, covered entities are not required to enter into BAAs with downstream subcontractors. Rather, the business associate who contracts with the subcontractor must enter into a BAA with the subcontractor.

Remember that ‘«£business associate‘«ō includes such partners as:

– Medical billing service

– Attorney

– Marketing group

– IT support

– Etc.

If you‘«÷re unclear on whether a vendor is a ‘«£business associate‘«ō there are several good?Šdecision trees?Šonline developed by other groups that help define the term.

The penalties get higher

Finally, lest you think you can ignore these changes, remember that the penalties for noncompliance have gone up ‘«Ű significantly.

The amount depends on the level of negligence. Previously, the limit was $25,000 per violation; now it‘«÷s $50,000, with an annual limit of $1.5 million.

And the Office of Civil Rights, which enforces HIPAA, cautions that it‘«÷s looking hard for violations and plans to enforce HIPAA ‘«£vigorously.‘«ō

If you‘«÷re concerned about whether your medical billing service will be HIPAA compliant under the new rules, contact?ŠMedical-Billing.com?Šat?Š800-966-9270. Medical-Billing.com maintains strict HIPAA compliance at each of its 5 nationwide branches, and we will help you bring more to the bottom line while keeping you in compliance.

 

Additional Resources

HIPAA: What Your Medical Practice Needs to Do for the September 23, 2013 Deadline

HIPAA: Why Your Practice Needs to Worry About the September 23, 2013 Deadline

Be Prepared for the New HIPAA Rules ‘«Ų Coming Soon to Your Practice

Tagged Under : , ,

Many medical billing software/EMR companies are offering medical billing services as an add-on to their technology offerings these days, but is that really the best way to handle your revenue cycle management, the lifeblood of your practice? We don‘«÷t think so, and here are 5 reasons why.

1. You deserve freedom of choice when it comes to technology. If a technology company is handling your medical billing, guess who chooses the software you will use? They do! They can‘«÷t possibly know enough about your work flow and staffing to choose the right software for you, and why shouldn‘«÷t you have the freedom to choose what you prefer?

2. You deserve a medical billing service that is focused on getting you paid. I‘«÷ve worked in a software company, and I can tell you that the focus tends to be on the software and engineering new features in the software. Don‘«÷t you want a medical billing service that is focused on your revenue cycle management? Of course you do.

3. You deserve thorough follow-up on your claims. One technology company that provided medical billing services for a low rate neglected to tell its provider customers that the low rate didn‘«÷t include follow up on the claims‘«Ųthe company submitted the claims and that was it. You don‘«÷t need that kind of surprise!

4. You deserve real customer service. When you‘«÷re one of several thousand customers, it‘«÷s hard to feel like your business has any importance to your medical billing service, isn‘«÷t it? You want a medical billing service that makes you feel like your practice and your business is important to them‘«Ųpreferably one that provides you with a dedicated Account Manager just for your practice.

5. You deserve a medical billing service that will make sure your practice is ready for the changes coming at you: HIPAA changes as of September 23, 2013, ICD-10 as of October 1, 2014, and others as they arise. A medical billing service that focuses on revenue cycle management (and has for years) is up to speed on the regulatory changes and what it means to medical billing; will a software company be prepared? Don‘«÷t take the chance.

At Medical-Billing.com, we offer all of these benefits and more. With five locations nationwide that offer more than five decades of collective top management experience in medical billing services, we have the depth and breadth of experience to get your claims paid.

Plus, Medical-billing.com allocates over 50% of its billing costs to the successful collection of the last 20-30% of charges that typically do not get paid on first submission. We want to make sure you receive payment for every claim, and that‘«÷s why we say on our home page, ‘«£Every claim paid. Guaranteed.‘«ō

And to make you comfortable with the whole process, we provide you with a dedicated Account Manager who works closely with your practice and understands your unique concerns and challenges.

Why not find out how we can help you bring more to the bottom line? Contact Medical-Billing.com today at 800-966-9270 or email Sales@Medical-Billing.com

Tagged Under : , ,

ICD-10 is just over 400 days away, yet many practices have not yet begun to plan for it. Here‘«÷s a review of the latest news and tips on preparing for this change that‘«÷s being called ‘«£the Y2K of healthcare.‘«ō

ICD-10 Could Cause Healthcare Reimbursements to Take a Hit
Becker‘«÷s ASC Review

Providers who are not prepared for the ICD-10 transition may see their bottom lines suffer, according to aMediGainreport. The?ŠHealthcare Billing and Management Association?Šrecently stressed the importance of being prepared for the change to ICD-10’s more granular code set. Holly Louie, chair of the organization’s ICD-10/5010 committee, testified before Congress that the economic stability of the country’s healthcare reimbursement system is hinging upon this successful switch‘«™ Read More

ICD-10 Budgeting: Do You Know How Much the Transition Will Cost?
ICD-10 Watch

The true cost of the ICD-10 transition may not be as easy to calculate as you think. Sure you can call healthcare vendors to get quotes on modifications to software and hardware, upgrades and purchases of new software, systems and equipment.

But that’s not the whole price. You need to get your best estimates of the following elements‘«™ Read More

61% of Providers Say ICD-10 Testing Will Take 9 to 12 Months
Becker‘«÷s ASC Review

A new?Šreport?Šfrom Qualitest Group shows that around 75 percent of healthcare organizations have not begun testing for ICD-10 despite the looming deadline for a full transition next year‘«™ Read More

ICD-10 Transition: Maybe It’s Time to Panic a Little
ICD-10 Watch

We are about 14 months away from the ICD-10 implementation deadline. Surveys report that healthcare providers are in various states of readiness. QualiTest Group?Šsurveyed more than 300 professionals?Šabout their ICD-10 testing plans. The two major findings are:

– Most respondents have either completed ICD-10 assessments or are in the process of assessments.

– 75 percent of respondents have not yet begun ICD-10 testing.

While starting sooner than later is important, this survey doesn’t raise too many alarm bells. It does report a great deal of planning and progress in the ICD-10 transition. Other surveys released in the past few months have found less preparation.

Perhaps a more troubling indicator is the amount of newly released literature that suggests there is an audience that hasn’t heard of ICD-10 implementation. If the healthcare industry is on its way to a smooth ICD-10 transition, we wouldn’t need so many guides to planning ICD-10 implementation. Read More

Physician Practice Costs for ICD-10: Clinical Documentation
ICD-10 Monitor

Physician offices are inching slowly toward ICD-10 ‘«Ų very slowly. A recent survey of 1,200 practices conducted by MGMA reveals that loss of physician productivity, staff efficiency, and changes to clinical documentation are still major concerns.

While MGMA and the physician community at large are reluctant to implement ICD-10 (and have raised many roadblocks to its progress), the organization‘«÷s May 16, 2012, letter to CMS provides valuable guidance regarding the six key areas of cost impact to watch.

MGMA advises ICD-10 will add significant costs for physician practices and clinical laboratories in these six areas:

  • – Staff education and training
  • – Business-process analysis
  • – Changes to ‘«£superbills‘«ō
  • – IT system changes
  • – Increased documentation costs
  • – Cash flow disruption

Read More

ICD-10 Transition: What It Takes to Work with Healthcare Payers
ICD-10 Watch

You could put off communicating with your healthcare payers until you submit your first ICD-10 coded claim Oct. 1, 2014. What could go wrong?

Early communication will help healthcare providers test the ICD-10 claims process and gain insight into how reimbursements will be affected after Oct. 1, 2014. That second part will help prepare for DRG shifts. This puts a price tag on procrastination. Read More

Fast Tracking ICD-10: Building the Action Plan
ICD-10 Monitor

It‘«÷s time to get geared up for ICD-10 by building an action plan. We just finished developing a budget for a large hospital system and found that the bulk of the budget will go to software applications, hardware upgrades, and education and training. These also happen to be three high-risk areas as it pertains to compliance.

Now we have to turn the impact assessment and gap analysis into the action plan. I am finding that working with hospital systems that have large steering committees with several sub-committees helps distribute the action items evenly. For example, every department will need education, whether in the form of simple awareness, fundamental instruction, documentation courses or in-depth training. By assigning this task to the education subcommittee, an organization can map out an education plan listed front and center in the action plan. I find that, for large health systems and hospitals, it is helpful to map out action items and milestones in an Intranet portal so every steering committee member and subcommittee chair can track progress along the way‘«™ Read More

Tagged Under : , ,

Big changes are occurring in health care, and to help you stay abreast of them, we‘«÷ve gathered the latest news that can affect your practice revenue. Below you‘«÷ll find articles on health insurance exchanges, collaborating with other practices to save money, getting tax breaks for your practice, online patient payments, and much more.

5 Ways Health Insurance Exchanges Could Impact Physician Income
Becker‘«÷s ASC Review

The Patient Protection and Affordable Care Act’s health insurance exchanges will open on Jan. 1, 2014, and likely have an impact on physician income, according to a?ŠMedscape News?Šreport.

The exchanges will be open online Oct. 1, 2013, designed to allow uninsured people to choose coverage for the next year. According to the report, primary care physicians and specialists could see:

‘«ů?Š?Š ?ŠLower reimbursement rates from insurance companies participating in the exchange
‘«ů?Š?Š ?ŠLess control over the number of patients from exchanges they see
‘«ů?Š?Š ?ŠProblems collecting out-of-pocket from exchange patients
‘«ů?Š?Š ?ŠPatients who aren’t familiar with following treatment regimens
‘«ů?Š?Š ?ŠFormation of narrow networks for insurers, which begin with hospitals and then decide how physicians are included with the potential for “cost profiling”

Read More

Collaboration Can Save Medical Practices Time, Money and Effort
AmedNews

Physicians can share front office staff and an electronic health record system. However, they need to prove integration efforts are legal to avoid antitrust violations‘«™
Read More

Patients More Willing to Pay Healthcare Bills Online
Becker‘«÷s ASC Review

In 2012, around 13 percent of the gross dollar volume of all patient payments was made online, according to “Trends in Healthcare Payments Annual Report: 2012,” a recent report by vendor Instamed. The figure is up from around 8 percent in 2010‘«™ Read More

How to Get Tax Breaks for Your Medical Practice
AmedNews

Federal, state and local governments offer doctors incentives because practices are recognized as economic engines. But physicians must know how and where to find them‘«™ Read More

Waste Not, Want Not: Billing Unused Drug Supplies
AAPC News

Physicians sometimes must discard an unused portion of a drug. If the physician (rather than the patient and/or facility) supplies the drug, Medicare may allow compensation for this ‘«£wasted‘«ō portion.

As instructed by the National Medicare guidelines for reporting drug waste found in the?ŠClaims Processing Manual, chapter 17, ?ļ 40.0, drug waste is reported?Šin addition to?Šthe drug administered‘«™ Read More

A Quick Guide to ‘«£Separate Procedures‘«ō
AAPC News

CPT?ę codes designated as ‘«£separate procedures‘«ō are considered to be incidental and bundled with any related comprehensive/major procedure when performed during the same session, through the same incision, and/or at same anatomic site. A separate procedure may be reported only if:

1. It is the only procedure performed,?Šor

2. It is unrelated to or distinct from other procedures performed during the same operative session (e.g., separate incision or site, performed on the ipsilateral/contralateral side, etc.).

Read More

For Some Post-Op Care, a Phone Call May Be All That’s Needed
AmedNews

Scheduling a call instead of an in-person visit could reduce patient no-shows, which would help physicians better manage patient loads and follow-up care‘«™ Read More

The Top Five Essential Tips for Successful Appeals
California Medical Association

How you present appeals to your carrier can make the difference between success and failure. AAPC‘«÷s Managing Editor?ŠG. John Verhovshek, MA, CPC,?Šrecently offered five tips for successful appeals in an article published by?ŠCalifornia Medical Association.

  1. – Be prepared
  2. – Write a proper appeal letter
  3. – Correct the claim before you appeal
  4. – Code only what documentation supports
  5. – Avoid obvious mistakes

Read More

Prompt Proper Assistant-at-surgery Payment
AAPC News

Successful coding and billing for surgical assistants depends on three principal factors:

  1. – Does the payer allow additional reimbursement for surgical assistance for the reported procedure?
  2. – Has the surgeon sufficiently documented the need for and role of the surgical assistant?
  3. – Has the proper modifier been appended to the claim?

Here are some tips and techniques for ensuring your assistant-at-surgery claims prompt proper payment‘«™ Read More

Advance: Appending Modifiers 50, 51, and 59
AAPC News/Advance

Modifiers are crucial to telling the story of a claim by identifying procedures that have been altered, without changing the core meaning of the code(s) submitted. AAPC‘«÷s National Advisory Board Member Relations Officer Nancy Clark, CPC, CPB, CPMA, CPC-I,?Š recently published an article in?ŠAdvance for Health Information Professionals, in which she expounded on the proper application of modifiers 50, 51, and 59. Ms. Clark provided examples, tables, and even comparisons between modifiers.

1. Modifier 50?ŠBilateral procedure?Šdescribes procedures or services that take place on identical, opposing structures (e.g., shoulder joints, breasts, eyes).

2. Use modifier 51?ŠMultiple procedures?Što show that the same provider performed multiple procedures (other than E/M services) during the same session.

3. Modifier 59?ŠDistinct procedural service?Šindicates a:

– Different encounter or session;

– Different procedure;

– Different site; or

– Separate incision, excision, injury, lesion, or body part.

Read More

15 Statistics on Surgery Center Accounts Receivable Days
Becker‘«÷s ASC Review

In all ASCs:
1. 0 to 30 days: 53.4 percent
2. 31 to 60 days: 17.2 percent
3. 61 to 90 days: 8.2 percent
4. 91 to 120 days: 5.4 percent
5. Over 120 days: 15.9 percent

The article also provides data on AR days In ASCs with fewer than 3,000 cases and ASCs with at least 6,000 cases. Read More

Tagged Under : , ,

Survey reveals top challenges for medical practices include financial management, increasing practice efficiencyYet another recently released survey shows that physicians in the U.S. are struggling with financial management‘«Ų90% report this as a concern, and it‘«÷s second in the list of top challenges second only to shifting reimbursement models (91%). The survey, conducted by Wolters Kluwer Health, revealed that the financial management challenges are coming from increased costs, healthcare IT adoption and the Affordable Care Act/increasing legislation.

When asked about their top focus areas for the next three to five years, physicians cite increasing their practice‘«÷s efficiency (48 percent), exploring different business models such as mergers, becoming part of a hospital system or patient-centered medical homes (34 percent) and adopting technology to improve clinical decision making or support evidence-based decision making (31 percent).

For those of us in the revenue cycle management field, the first item is key: increasing a practice‘«÷s efficiency.

This is something we have always encouraged, and continue to do so. Here are some things you should consider in terms of making your practice more efficient:

1. Make sure you‘«÷re getting paid for all of your care. I recently heard of a practice that hadn‘«÷t looked at their missed encounter reports for a year. When the reports were reviewed, the practice discovered that they had 15 missed encounter reports for just one code. That meant thousands of dollars of revenue lost! Don‘«÷t let this happen to your practice‘«Ųmissed encounter and other reports should be reviewed on a regular basis‘«Ųweekly reviews are recommended.

2. Are you maximizing your schedule? Look at your no-show rate, and if you have a no-show rate of 25%, you should be double-booking 1 of 4 appointments. If you don‘«÷t, you could be losing up to $1.2 million per year, according to practice management consultant Rochelle Glassman. You should also keep a waiting list as many dentists do, says Glassman. That way when your schedule opens up, your staff can fill it quickly with patients who want to be seen‘«Ųand will rarely be no-shows.

3. Are you expanding your schedule? As we mentioned in a recent blog post entitled Physicians: Are You Prepared to Compete with Retail Clinics?, ?Šyou need to be aware that your competition now includes the Minute Clinics and Urgent Care Centers opening on nearly every corner. These centers are popular because many patients are no longer comfortable taking time off work, or they want to get help for their screaming baby first thing with a walk-in or same-day appointment. In order to compete, you need to take two steps according to Glassman:

A. Offer expanded hours before and after your current normal office hours, on Saturdays and during the lunch hours. You don‘«÷t have to cover these hours yourself; consider bringing on a part-time physician or non-physician provider to see these patients.

B. Review your schedule and arrange it to offer walk-in and same-day appointments. How can you do this while double-booking? Set specific times, and use your wait list to fill the appointments if needed. Don‘«÷t lose your long-time and new patients to the retail clinics.

4. Consider how you‘«÷re using your office space. Are you using valuable office footage for administrative functions when you could be using it to see patients? Functions like medical record storage and medical billing do not need to‘«Ųand shouldn‘«÷t be‘«Ųhoused in your office when that office space could be generating revenue.

5. Is your medical billing team the right one for your practice today? The medical field is changing rapidly, and methods that once worked are no longer optimal for today‘«÷s medical practices. Hiring a front office person and teaching her to handle your medical billing is no longer sufficient with today‘«÷s more stringent‘«Ųand complicated‘«Ųrequirements. Similarly, a one-person medical billing company is no longer the best choice to insure you are receiving maximum reimbursement.

In these challenging times, you need to choose the best, most cost-efficient means for insuring your practice profitability. That means the right medical billing team, and with the challenging reimbursement environment today, you need a top-notch team.

That‘«÷s why you should talk to a nationwide medical billing company with offices across the country. Medical-Billing.com is proud to say that we have experienced teams in cities across the country, providing a depth of experience and resources unmatched by most internal billing teams or medical billing companies.

To find out how we can help you improve your practice profitability, contact us today at 800-966-9270 or by email at Sales@Medical-Billing.com.

Posted on July 23, 2013 by · Leave a Comment
Filed under: Medical Billing, News, Physician billing, Tips and Tricks  

Tagged Under : , ,

‘«£Well, either you’re closing your eyes

To a situation you do not wish to acknowledge

Or you are not aware of the caliber of disaster indicated

By the presence of a retail clinic in your community.

Ya got trouble, my friend‘«™‘«ō

This, of course, is a paraphrase of the lyrics to a song from one of my favorite musicals, The Music Man. In the film, the main character incites the townpeople by talking about the problems sure to be caused by a pool table in their small town.

I‘«÷m not trying to start a boys‘«÷ band (his solution), but I do think physicians need to pay attention to the challenges presented by the rapid proliferation of retail clinics. These challenges include:

– Loss of patients

– Interruption of continuity of care

– Loss of revenue

A recent Medscape article cited a study by JAMA Pediatrics that found ‘«£almost 1 in 4 parents who had a relationship with a pediatrician took their children to retail clinics for minor problems, mostly because of the convenience.‘«ō

And lest you think the problem is primarily for pediatricians, remember that many patients who would ordinarily see primary care physicians, allergists and other specialists may instead opt to visit the local retail clinic. Why would they go to an unknown physician or even a PA or NP instead of seeing you, their trusted doctor?

Convenience.

It‘«÷s all about convenience these days, and if you think that doesn‘«÷t apply in healthcare, think again. The very fact that these clinics are growing as quickly as they are indicates that convenience is a major factor for patients.

How fast are they growing?

In the coming years, the number of walk-in medical clinics at big box retail stores is expected to increase by an annual rate of 25% to 30%, according to a new Accenture report.

According to?ŠAccenture?Šresearchers, the growth rate of in-store health clinics was between 50% and 150% from 2001 to 2008, with the exception of 2005 when the growth rate shot up to 442%. In 2009 and 2010, the growth rate fell sharply to between just 1% and 3%. However, the rate has picked up in the past couple of years, reaching 14.7% in 2011 and 2012, the researchers found.

‘«£Most of my patients will never leave me for one of these places,‘«ō you‘«÷d like to think. But why take a chance?

There are steps you can take to maintain‘«Ųand grow‘«Ųyour patient base. Without having to be at your practice 24/7 yourself. Here are some ideas from consultant Rochelle Glassman, who has successfully advised multiple practices on these issues:

1. Extend your hours. Fight fire with fire‘«Ųextend your hours so that you‘«÷re open before and after work/school hours. Your patients need options for when they can see you.

2. Consider Saturday hours. Many of your patients would appreciate the opportunity to get medical care on Saturdays so they don‘«÷t have to be away from their jobs. Due to the down economy, many people were afraid to take time off work even for medical care, and that unfortunately has not changed yet.

Wait, you say‘«ŲI don‘«÷t want to work 20 hours a day and give up my Saturdays. You don‘«÷t have to. Hire another provider, either a physician or non-physician provider, to handle those extra hours. Chances are they can handle most of the problems that will come in during those hours, and you can make arrangements for those patients who need to see you.

This idea, according to Glassman, has the added benefit of opening up your schedule during your current office hours for walk-in and same day appointments.

To survive the coming changes in healthcare, you need to evaluate your practice and see where you need to make changes. Don‘«÷t wait until your revenue has dropped due to the competition from either these clinics or other practices that have adjusted; get ahead of the wave.

And if you also need to reevaluate your revenue cycle management and make sure you‘«÷re being reimbursed for every claim, contact Medical-Billing.com. On average, our physician clients get paid faster than 75% of multi-specialty group practices nationwide as surveyed by the Medical Group Management Association and Healthcare Billing Management Association for Days Revenue in AR.

We‘«÷d like to help you get paid faster and more completely.

Posted on July 15, 2013 by · Leave a Comment
Filed under: Medical Billing, News, Tips and Tricks  

Tagged Under : , ,

New 1500 Claim Form Approved to Accommodate ICD-9 or ICD-10 Diagnosis Codes
ManageMyPractice.com
Version 02/12 1500 Health Insurance Claim Form (1500 Claim Form), which accommodates reporting needs for ICD-10, was approved, the National Uniform Claim Committee (NUCC ) announced on June 17, 2013. The Office of Management and Budget (OMB) has approved the 1500 Claim Form under OMB Number 0938-1197.

During its work, the NUCC was made aware by the healthcare industry of two priorities that were included in the revisions to the 1500 Claim Form. The first was the addition of an indicator in Item Number 21 to identify the version of the diagnosis code set being reported; i.e., ICD-9 or ICD-10.

The need to identify which version of the code set is being reported will be important during the implementation period of ICD-10.

The second priority was to expand the number of diagnosis codes that can be reported in Item Number 21, which was increased from 4 to 12. Additional revisions will improve the accuracy of the data reported, such as being able to identify the role of the provider reported in Item Number 17 and the specific dates reported in Item Number 14.

Read More: http://managemypractice.com/new-1500-claim-form-can-accommodate-icd-9-or-icd-10-diagnosis-codes/

 

For Billing Purposes, When Should a New Provider Start Seeing Patients? Review 3 FAQs to Avoid Giving Away Free Services
The Coding Institute
When a new physician joins your practice, if you don’t think about getting the new provider’s credentialing info to your payers before he starts seeing patients, you will actually lose money, upset patients, and possible face fraud charges before you see any benefits.

Review these three frequently asked questions to make sure you are equipped to face the challenge of how to bill for the provider’s services to both new and established patients who visit him at your practice.

1. ?ŠCan We Bill Retroactively?
When you can bill for a new physician’s services depends on when you’re able to get him/her credentialed. You’ll also need to know the differences between the payers you bill, because they do not all follow the same policies.

For Medicare, you’re allowed to bill 30 days retroactively. Regardless of when the provider starts with your practice, you’ll only be able to retroactively bill Medicare for services your physician rendered up to 30 days prior to the date he received his Medicare credentialing status.

Note: In the past you had a full 27-month window during which you could retroactively bill. That changed in 2009.

2. ?ŠCan We Just Use Another Provider’s NPI?
In a word, “No.” While it may be tempting, you should not use another credentialed doctor’s national provider identifier (NPI) on the new doctor’s claims to get paid for services the new physician performs before being credentialed. Doing this is considered fraud.

Either avoid having the new physician see patients until the Medicare credentials come through, or have the physician see only patients who are self-pay or who have insurance that allows you to bill before credentialing.

Question: You can just report the new doctor’s service under an existing physician’s ID number and append the locum tenens modifier to it, right?

Answer: No. Locum tenens is designed to represent services performed “in the absence of the regular physician,”?ō according to chapter 1 of the Medicare Claims Processing Manual. Practices that simply report the new physician’s service as if it was performed by a locum tenens doctor, are violating the original intent of the locum tenens rules.

3. ?ŠWhat is the Best Way to Ensure We Get Paid?
Allow your office more time when trying to credential a new physician.

The process can take 90 days or even longer, according to Medicare. Experts recommend that you initiate this process as far in advance of your new physician’s starting date as you can (once you have all the necessary information such as the state license and DEA number); two months ahead of time, if not more. Experts advise that with the advent of PECOS, things should move quicker, but say that some of the commercial payers could take as much as six months.

If you act early, you’ll have the necessary credentials in place when the physician starts seeing patients and you won’t have to hassle with delayed payments.

 

Medicare to Boost Physician Payments for Complex Care Management
HealthcareFinanceNews.com

CMS issued a proposed rule on July 8 that would update payment policies and payment rates for services furnished under the Medicare Physician Fee Schedule (PFS) at the start of 2014. Currently, Medicare only pays for primary care management services as part of a face-to-face visit; under the proposed rule, CMS would make a separate payment to physicians for managing select Medicare patients’ care needs beginning in 2015. CMS will accept comments on the new rule until Sept. 6, then will generate the final rule by Nov. 1.

Read More: http://www.healthcarefinancenews.com/news/medicare-boost-physician-payments-complex-care-management

 

Monitor Revenue to Strengthen Bottom Line
physbiztech.com

In a competitive healthcare marketplace like Dallas-Ft. Worth, a physician practice must tightly manage its revenue cycle. Texas Health Physicians Group (THPG) is doing that by tracking five key financial metrics.Sam Civello, vice president at THPG, told attendees at the 2013 HFMA ANI conference that THPG follows five metrics it considers critical to physician revenue performance. They are:

–?Š?ŠClaim entry dates?Š– Two days or less from the date of service.
–?Š?ŠUn-reconciled visits?Š– Maintain at 0.5 percent or less.
–?Š?ŠPre-bill rejection rates?Š– Maintain at 4 percent or less.
–?Š?ŠFirst-pass denial rates?Š– Keep them at less than 10 percent.
–?Š?ŠPass-through rates?Š– Keep them below 3 percent.

Read more: http://www.physbiztech.com/best-practices/business/monitor-revenue-strengthen-your-bottom-line?

Posted on July 12, 2013 by · Leave a Comment
Filed under: ICD 10, Medical Billing, News, Resources  

Tagged Under : , ,

ICD-10 continues to be a hot topic in healthcare, with many practices not yet having started on their implementation plans. Here are some of the top articles this month:

Top Ten ICD-10 Readiness Questions to Ask Your Vendors
One of the biggest challenges facing the industry ahead of ICD-10 is coordination among tens or hundreds of business partners. The questions you should be asking include:

1. Who is my dedicated contact person?

2. When will your ICD-10 compliant system be ready?

3. Are there any additional costs involved for upgrades or ongoing maintenance?

4. Are there new hardware requirements on my end

5. Will there be new things to learn within the software interface?

6. What customer support and training will be provided?

7. What is the basis of your crosswalk or mapping strategy?

8. Will your product support dual coding?

9. What is your external testing strategy?

10. Do you have a contingency plan if you’re not ready by October 2014?

For the full explanations of each point, see the complete article at: http://ehrintelligence.com/2013/07/10/top-ten-icd-10-readiness-questions-to-ask-your-vendors/

 

5 Lessons from 5010 the Healthcare Industry Can Apply to ICD-10
The?ŠHealthcare Billing and Management Association?Štestified before the National Committee on Vital and Health Statistics’ Subcommittee on Standards in Washington, D.C., on mistakes the healthcare industry can avoid during the ICD-10 coding transition.

Here are five lessons, according to HBMA, that the healthcare industry should heed during the ICD-10 switch:

1. Complete end-to-end testing with all payers to ensure readiness.
2. CMS must establish good benchmarks for readiness, not to be ignored by industry members.
3. Physicians and staff cannot rely on a vendor or software coding tool for accurate documentation and coding. Rather, appropriate education is the only way to be prepared.
4. Payer policies published by Oct. 1 must allow time for education, training and data analysis.
5. Payers only accepting 4010 claims must be 5010 compliant by Jan. 1, 2014, to be ICD-10-CM ready.

http://www.beckersasc.com/asc-coding-billing-and-collections/hbma-s-5-lessons-from-5010-the-healthcare-industry-can-apply-to-icd-10.html

 

Most Practices Not Ready for ICD-10 Implementation
Most practices are not ready to meet the October 1, 2013 deadline for compliance with International Classification of Diseases, Tenth Revision (ICD-10), according to a report published by the Medical Group Management Association (MGMA).

A survey by MGMA revealed that only 4.8% of practices reported they had made significant progress toward overall readiness for ICD-10 implementation, and 55.4% reported they had not yet started on the process. The survey involved about 55,000 physicians from 1,200 practices.

More than 70% of practices surveyed reported that they had not heard from the major health plans regarding the ability to test claims, and 59.7% reported the same of claims clearinghouses.

Overall costs (81.1%), changes to clinical documentation (88%), and loss of clinician and coding staff productivity (87.5%) after implementation were among top clinician concerns. Expected difficulties included ability to document patient encounters and ability to select the appropriate diagnosis code.

Just 32.% of respondents reported their cost to upgrade or replace their practice management system software will be covered by their vendor. Only 37% said their vendor will cover the cost to upgrade/replace their EHR.

For organizations that must cover the costs themselves, the average cost for a 10-physician practice to upgrade or replace their practice management system and EHR software to accommodate ICD-10 is $201,690.

Read the full article at: http://www.clinicaladvisor.com/most-practices-not-ready-for-icd-10-implementation/article/302109/

See articles on ICD-10 on our blog at http://www.medical-billing.com/blog/category/icd-10-2/

Posted on July 11, 2013 by · Leave a Comment
Filed under: Medical Billing, News  

Tagged Under : , ,

Several recent surveys have revealed interesting data on denial statistics for practices, the top challenges facing ASCs and ophthalmologist practices, the number of physicians planning to leave medicine, and more.

PayerView 2013: Getting Paid at Your Medical Practice
The average denial rate for practices declined slightly, to 7.2 percent, according to a recent survey. The 2013 PayerView data also revealed modest improvements in a number of metrics. Higher deductibles continue to impact provider collection burden, a measure of how much of the patient’s bill must be collected by the practice.

http://www.physicianspractice.com/payers/payerview-2013-getting-paid-your-medical-practice#sthash.YBt8gZrh.dpuf

 

Healthcare Executives: 10 Top Financial Challenges
Medicaid reimbursement is the leading financial challenge facing healthcare executives, according to the American College of Healthcare Executives’?Šsurvey. The top ten financial challenges include:

1. Medicaid reimbursement –?ō 83 percent
2. Government funding cuts –?Š81 percent
3. Medicare reimbursement ?Š–?ō 72 percent
4. Bad debt?Š–?ō 69 percent
5. Decreasing inpatient volume?Š–?ō 61 percent
6. Increasing costs for staff, supplies, etc. –?ō 52 percent
7. Inadequate funding for capital improvements ?Š–?ō 43 percent
8. Other commercial insurance reimbursement ?Š–?ō 40 percent
9. Managed care payments ?Š–?ō 35 percent
10. Revenue cycle management –?ō 34 percent

http://www.beckersasc.com/asc-industry-leaders/healthcare-executives-10-top-financial-challenges.html

 

Will Ophthalmologists Stop Accepting Insurers That Pay Poorly? 42% Say Yes
A large percentage of ophthalmologists plan to drop insurers that commonly deny claims and don’t pay well, according to the?ŠMedscape Ophthalmologist Compensation Report: 2013.

According to the report:
–?Š42 percent of ophthalmologists plan to drop insurers that do not pay well
–?Š22 percent of ophthalmologists will not drop these insurers because they need all payers
–?Š12 percent of ophthalmologist will not drop these insurers because they think it is inappropriate behavior

http://www.beckersasc.com/ophthalmology/will-ophthalmologists-stop-accepting-insurers-that-pay-poorly-42-say-yes.html

 

Report: 36% of Physicians Plan to Leave Medicine Within 10 Years
Thirty-six percent of physicians plan to retire or leave medical practice in the next 10 years, according to a?Šsurvey of 3,456 physicians polled between March 7 and April 1, 2013.

The reasons cited for wanting to leave or retire, according to the survey, were:

  • Feeling burned out ?Š–?ō 60 percent cited this as one of the reasons.
  • Not wanting to practice in an era of healthcare reform ?Š–?ō 58 percent cited this as one of the reasons.
  • Economic factors such as malpractice insurance, overhead, using EMRs, etc. –?ō 50 percent cited this as one of the reasons.

http://www.beckersasc.com/news-analysis/report-36-of-physicians-plan-to-leave-medicine-within-10-years.html

Posted on July 11, 2013 by · 1 Comment
Filed under: Medical Billing, News, Resources, Tips and Tricks  

Tagged Under : , ,

As we mentioned yesterday, now is the time for medical practices to bring their processes and documents into compliance with the new Health Insurance Portability and Accountability Act (HIPAA) Omnibus Final Rule, released in January of this year and effective on September 23, 2013. Read the first blog post now.

Our post yesterday discussed why you need to be concerned about the new rule and outlined the possible fines. Today we‘«÷ll look a little closer at what you need to do.

There are several steps that providers need to take before the September deadline to protect their practices, provided by Holly Carnell, JD, and Meggan Bushee, JD, Attorneys at McGuireWoods on Becker‘«÷s ASC Review:

1. Update your internal policies.

Key changes that a practice will need to make to its internal privacy policies include (See the full list):

A. Breach standard. The Omnibus Rule changed the standard for determining whether a breach of unsecured PHI has occurred; the new breach standard should be included in providers‘«÷ internal policies on responding to a potential breach. Who must be notified has remained unchanged.

B. Marketing and sale of PHI. The marketing of third party products and services and sale of PHI is generally prohibited, unless the provider has received valid authorization from the patient.

C. Decedents‘«÷ PHI. The definition of ‘«£protected health information‘«ō now expressly excludes the health information of a person who has been deceased for more than 50 years. Providers may disclose only PHI that is relevant to the family member, relative or friend‘«÷s involvement in the deceased‘«÷s care, and cannot disclose PHI if the provider is aware that the deceased person expressed a prior preference for it not to be disclosed to the person in question.

D. Disclosures to schools. Providers may disclose proof of immunization to schools if the school is required by state, or other, law to have proof of immunization prior to admitting the individual, and the provider obtains and documents the oral agreement to the disclosure by either a parent, guardian, or other person acting in loco parentis of the individual, or from the individual if he or she is an adult or emancipated minor.

E. Patient rights to limit disclosures. A provider must comply with a patient‘«÷s request that PHI regarding a specific healthcare item or service not be disclosed to a health plan for purposes of payment or healthcare operations if the patient paid out-of-pocket, in full, for that item or service.

F. Provision of electronic copies of medical records. Providers complying with a patient‘«÷s request for an electronic copy of his or her PHI are required to provide access to such records in the electronic format requested by the patient if the records are maintained by the provider in an electronic designated record set and are readily producible in the requested format.

2. Provide staff training.

Make sure that your policies are both updated and implemented. Once your practice has updated your privacy policies, staff members should receive training on any new and revised policies. In particular, management and higher-level employees should be fully trained on the new breach standard, so that, if necessary, they can correctly perform the required analysis.

3. Offer notice of privacy practices.

After you have updated your NPP, your practice must make the NPP readily available to existing patients who request a copy on or after the effective date of the revisions; must post the revised notice on its website, if applicable; and must post the notice in a prominent location on its premises. Your new patients who receive services for the first time after modification of an NPP should be provided with a copy of the revised NPP. Consistent with the existing rules, your practice should retain copies of previous versions of your NPPs and of any written acknowledgements by patients of receipt of NPPs.

4. Revise your business associate agreements.

Providers should revise their business associate agreement forms to reflect the new requirements under the Omnibus Rule. The deadline for this is September 23, 2013. However, existing BAAs that were entered into on or before January 25, 2013 and have not been modified after March 26, 2013 do not have to be updated until September 23, 2014.

Note that the Final Rule broadened the definition of a business associate to include subcontractors, health information organizations, entities that offer a personal health record to individuals on behalf of a covered entity, and other entities that provide data transmission services for covered entities and that require access on a routine basis.

The Final Rule also provides a list of HIPAA Privacy and Security Rule requirements that apply directly to business associates, including requirements to:

A.?Š?Š?ŠMaintain detailed records of uses or disclosures of protected health information (“PHI”) to be produced upo request;

B.?Š?Š?Š Provide an electronic copy of PHI to covered entities or individuals upon request;

C.?Š?Š?Š Sign business associate agreements with subcontractors that?Šcreate or receive PHI on their behalf; and

D. ?Š Make reasonable efforts to limit release or use of PHI to the minimum necessary to accomplish the intended purpose of the use or disclosure.

Many of these new requirements were not traditionally thought to apply to business associates, so business associate agreements will need to be amended to comply with the new provisions.?Š For more information on your business associate agreements and what entities are covered under this definition, see this recent post on JD Supra Law News, which provided the BAA items above.

Once your practice has updated its BAA form, attorneys recommend conducting an inventory of all current BAAs (including BAAs in which the provider is the covered entity and BAAs in which the provider is a business associate or subcontractor). Each of these BAAs will need to be modified by an amendment or replaced with the practice‘«÷s revised BAA form. This may also be a good opportunity to consider whether the protections and restrictions in the form agreement go far enough in protecting patients and the practice.

Your practice should review all business relationships to ensure you have a BAA in place where one is required under HIPAA. Providers may have relationships that did not previously require a BAA, but do now under the Omnibus Rule‘«÷s expansion of the definition of ‘«£business associate.‘«ō One key change to the definition of business associate is the inclusion of subcontractors of business associates that deal with PHI.?Š However, covered entities are not required to enter into BAAs with downstream subcontractors. Rather, the business associate who contracts with the subcontractor must enter into a BAA with the subcontractor.

And remember, ‘«£business associates‘«ō include medical billing, as we noted in our blog post yesterday. If you have any questions about how your medical billing service is handling PHI on your behalf, please contact Medical-Billing.com and we‘«÷ll be happy to advise you on how to improve the situation.

Specialty:
Billing Status:

Stop waiting for Your Money
Talk to a live specialist
or Call Us Today! @ 800-966-9270
Talk to a billing specialist 24/7