CMS issues draconian Medicare enrollment changes

The final 2009 Medicare physician fee schedule includes a number of changes that will have a detrimental effect on medial practices and practitioners' ability to enroll in the Medicare program. Most significantly, beginning on Jan. 1, the Centers for Medicare & Medicaid Services (CMS) will limit the ability of practices to retroactively bill for services provided to Medicare patients by defining the effective date for billing privileges for practitioners and medical practices as the later of:
The filing date of a Medicare enrollment application that was subsequently approved by a Medicare contractor; or
The date an enrolled physician or nonphysician practitioner began furnishing services at a new practice location.
CMS has provided for limited circumstances in which medical practices and practitioners will be able to retroactively bill for services provided prior to the effective date.
To further complicate the enrollment situation, the agency will now instruct contractors to deny applications that are not completed correctly instead of rejecting them. Denied applications can only be reopened if they are appealed. Practices and practitioners have a limited time in which they can file an appeal. Denial notices from Medicare contractors should clearly indicate this time limitation and appeal requirements.
Have questions on Medicare provider enrollment? Ask CMS directly when you sign up for "How to Deal with Changes in Medicare Provider Enrollment". Allen Gillespie and Sandra Olson from CMS's Division of Provider/Supplier Enrollment will instruct MGMA members on how to ensure timely processing of Medicare provider enrollment applications, so practices can get paid appropriately.

CMS releases specifications on qualifying for e-prescribing bonuses

The Centers for Medicare & Medicaid Services (CMS) recently released the e-prescribing measure specification which includes the appropriate reporting codes needed for eligible medical groups to qualify for the e-prescribing bonus. Practices that meet the e-prescribing criteria can earn a 2 percent bonus of the allowed Part B charges in 2009 and 2010, a 1 percent bonus in 2011 and 2012 and a 0.5 percent bonus in 2013. Medical practices not e-prescribing will face a 1 percent cut in 2012 and 2013. That cut will grow to 2 percent in 2014 and beyond. Although e-prescribing will no longer be an eligible measure under the Physician Quality Reporting Initiative (PQRI) after 2008, CMS will permit practices to receive separate bonuses from both the e-prescribing program and the PQRI --- to a maximum 4 percent award

Billing: Finding Lost Revenue

The search for billing and coding gold

In the days before managed care, billing was a snap. It seemed you could simply look sidewise at a third-party payer and get paid. 

Today, as legalistic coding rules have taken root and payers have gotten stingier, collecting what you’re owed requires fighting a battle on two fronts: the draconian payers on one front — and patients on the other. 

You need the latest tools and tactics just to avoid losing ground in this struggle. You can’t afford to keep doing things “the old way.” Accordingly, we’ve asked a coterie of practice-management consultants and administrators for advanced tips on getting what you’ve earned 

Notebooks out, pencils sharpened. Class is in session. 

Computerize your previsit homework 

You’ve heard this advice before: 

To ensure a clean claim, collect the patient’s demographic and insurance information before the visit. Practices have traditionally done that over the phone or by mailing patients the usual registration forms for them to complete and return. To take this advice up one notch, post those forms on your practice Web site, assuming you have one (and you should). Patients can print out and complete the forms and then mail or fax them in advance of their visit. 

Better yet, enable your Web site to allow patients to complete the forms and transmit them to you electronically (using encryption). Or use waiting-room kiosks to capture the information, rather than handing patients a stack of forms and a pen. Handwritten forms are sometimes illegible, causing staffers to enter inaccurate data that leads to claim denials. At four-physician Northern Virginia Family Practice Associates in Alexandria, almost 100 percent of new patients register online. “Our errors have gone down and our revenue has gone up” since the practice made the switch, says administrator Mary Dooher. 

Employees type in the online data just as they would working with a hard copy. What’s more efficient is a Web site that sends registration information straight into your practice management system without rekeying (although you should review it beforehand for accuracy). The major physician connectivity companies — Medfusion, Medem, and RelayHealth — offer such software integration. 

Another advantage of computerized registration — whether it’s done on a practice Web site or a waiting-room kiosk — is that you can structure the form so the patient can’t proceed unless he fills in all the blanks. “Patients will skip half the questions if you let them,” says Beth McGinnis, the billing and IT manager for the 120-doctor Iowa Clinic in Des Moines, which has installed kiosks in half of its waiting rooms. 

And make sure you’re capturing all the information you need, including patients’ cell phone numbers, says practice management consultant Deborah Walker Keegan. After all, almost 70 percents of adults polled online recently by Harris Interactive reported that they have both a cell and a land line. (Some have only cell phones.) “If you can’t reach them about a past-due balance on the land line, try the cell,” says Keegan, coauthor of “The Physician Billing Process.” Also, you can contact patients during their 9-to-5 jobs on their cells instead of waiting to call their landlines at night, although Keegan suggests getting their approval beforehand to ring their cell. 

this article is copied from physicians practice magzine.

Florida Medicaid ERA stopped

Q: We have been receiving Florida Medicaid EOB's Electronically till Aug.2008, now it has stopped and we do not receive any paper EOB's as well? A: this is the common issue with Florida Medicaid as local agent in Florida has changed and they did notify most of the physicians by a letter stating that doctors office can create a web based log in and pull the EOB's from their website. The new website name to enter the pin letter no is https://public.flmmis.com/public/pinletter/ , once you register there you can change the settings and add your clearinghouse as an agent to receive your EOB, this is the only way to reinstate your ERA. You can also pull your old EOB's from the website.

How to Obtain the Patient data from previous Billing company

Q: Lot of our new clients asks this question, How to get the data from previous billing company or what format it should be given so that it can easily be transferred to the required format?

A: This is a simple questions but answer is very tricky , Data migration or transfer from previous software to new software or billing company depends on various factors:

1. if your agreement allow you to get the patients data from your previous company then this is the first step. If it allows then your billing company should be able to generate data in the windows based CSV format , Excel or Access . These are the most common format used by most popular software in the industry to migrate your previous data into their software.
Now remember there is a trick here. if your agreement with the billing company simply states that you can take the data then they can cut a CD of your data and give it to you in any format? Also if you have in house practice management software and your software company can ask any amount in order to provide you the data in the required format. In any event someone can ask you thousands of dollars to convert the format of the data. So make sure when you negotiate these things you or your technical person understands the entire scope of data conversion very well.

Medicare Denials for invalid ssn Qualifier

Q: We have received medicare denials even after fixing the SSN instead of Tax id?

A: in above scenario there are some software where you can insert SSN in place of Tax id however this does not actually send s the qualifier which is required for the claims to get accepted all claims which are supposed to go through SSN should have SY qualifier in the end where as any other claims goes through Tax id should have Fy qualifier in the end. therefor work with billing software and see if this is fixed before you send any claims.

Medicare denials due to SSN tied to the NPI

Q: our medicare claims getting rejected because our Tax id is not registered with the medicare id.
Answer: Lot of practices or solo physician were enrolled in medicare program through their SSN , this has resulted into confusion when a new billing company starts submitting their claims using the tax id. You have 2 choices.

1. The billing software should be able to generate claims with 2 different ids; for medicare it should send the claims using SSN and for all other commercial insurances it should be able to generate claims using Tax ID.
2. Practice can fill a practice demographics form and send it to medicare for demographic changes which typically take 90 to 120 days.

MEDICARE DENIALS FOR NPI CROSSWALK

Q: Solo physicians should submit the claims under individual NPI or They have to apply for a group NPI?

Answer: this questions has been raised several time since the NPI crossover is implemented and our experience with this is as follows.
medicare asks new physicians or practices who apply for medicare no to have separate NPI for their corporation even if they are solo. once they apply for a separate NPI medicare assigns them 2 PTAN no which are associated with group and individual NPI's respectively. Practice management software should have a capability to populate the right PTAN in box 33 and 24 on CMS 1500 form in order to get the claims accepted with medicare.

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