Medical Billing Blog

Providers should start preparing now for the implementation of ICD-10, which is scheduled to begin October 1, 2014.  Basically let’s talk about getting your practice's infrastructure in order. 

The Centers for Medicare & Medicaid Services (CMS) on November 1, 2012 issued its 1,362-page final rule of fee schedules for 57 physician and other specialty provider groups for calendar year 2013. 

Recovery Audit Contractors (RAC’s) are now reviewing high level evaluation and management (E&M) codes used in billing office visits in private practice.  E&M services are based on the providers understanding of the patient’s medical history, review of patient’s medications, a physical examination, and of course a medical decision.  According to Charles Fidel of AMedNews.com, Medicare paid $33.5 billion for E&M services in 2010.  Of the 442,000 physicians that billed for E&M services, only 1,669 providers consistently billed high-level E&M codes such as 99215.  A claim for a low-level visit by an established patient only paid about $20 in 2010, while a high-level new patient paid around $190.

Chances are that you like all the members of your staff, and that you appreciate their integrity, loyalty and hard work; so the thought that one of them could be stealing from you is probably not at the top of your list of things to worry about today.  But if you’re leaving everything to your staff while you focus on patient care, you might very well be tempting them with an irresistible carrot.  

Most medical offices have procedures in place that attempt to address the inevitable cases of last-minute cancellations and patient no shows. There are a number of tricks to handling them effectively to minimize their frequency and the damage they can do to the practice’s revenue in general. After all, a medical practice is a business, and the best business solutions are those that yield the greatest positive effect with the lowest overall cost financially and with the least effort. In the case of patient no shows, it is important to realize why and when they occur in order to devise the best combination of ways to respond to them and mitigate their effect on the schedule—and your revenue—over all. 

In a recently published article by Ricardo Alonso Zaldivar, reporting for the Associate Press, our healthcare system wastes $750 billion a year.  Almost 30 cents of every dollar is spent on unneeded care, paperwork, and fraud, according to the Institute of Medicine.

The United States Department of Justice (“DOJ”) and the State of Michigan filed suit on October 18, 2010 against Blue Cross Blue Shield of Michigan (BCBSM).  The DOJ alleges that BCBSM’s use of “Most Favored Nation” clauses in its contracts with hospitals and providers inMichiganis anticompetitive.  These preferential pricing policies, known in the hospital and insurance industries as “most favored nation” clauses typically require that BCBSM receive the lowest rates the participating providers and/or hospitals offer.  Participating providers and/or hospitals are then required to charge any competing plan an agreed percentage above the rate provided to BCBSM. 

The federal government has finalized a one-year delay for the nationwide conversion to ICD-10 code sets beginning Oct. 1, 2014.  HHS Secretary Kathleen Sebelius has announced a final rule establishing a one-year delay - from Oct. 1, 2013, to Oct. 1, 2014 in the use of the ICD-10 Coding system.   

On Thursday, August 23, 2012, U.S. Department of Health and Human Services Secretary Kathleen Sebelius announced that the Centers for Medicare & Medicaid Services (CMS) published the final rule for Stage 2 Meaningful Use for the Electronic Health Record (EHR) Incentive Programs. The rule provides new criteria that eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) must meet in order to successfully participate in the EHR Incentive Programs. 

For most practices, the process of adopting and implementing an Electronic Health Record System is daunting enough.  It can take as long as a year to fully integrate the EHR into the daily procedures of the practice, and most practices find themselves on a whirlwind roller coaster ride when it comes to devising and fine-tuning new routines to make using the EHR as effectively as possible.  In the long run, switching to electronic records is worth it in terms of time saved, errors reduced, and being able to offer the additional soft services available from those who use an electronic record system.