With an estimated $60 Billion wasted in Medicare fraud annually, our government has enacted various laws in an effort to reduce healthcare fraud. They are going after healthcare fraud in a major way as part of the effort to balance the national budget, and there are a few new programs that are making a significant difference in healthcare reimbursements. They are RACs, MACs, ZPICs and Strike Forces.
Do not fall into the trap of downcoding just to be ‘on the safe side.’ As a physician, it is your responsibility to code based on your documentation. If you continue to downcode, you’re not only at risk of losing thousands of dollars in revenue per year, but you’re also potentially triggering an audit of your practice.
By now every provider should be aware of 5010. 5010 is the new electronic claims transmission format that becomes effective January 1, 2012. Commercial and grvernment payers are all required to use this new format.
Medical Billing and coding for hypertension claims is easy if you follow these five basic rules of ICD-9. ICD-9 codes are updated every year. And with these updates, codes are becoming more comprehensive as payers steer away from unspecified code sets. Hypertension, a disease that according to the Centers for Disease Control and Prevention (CDC) affects thirty-three percent of adults over the age of twenty, has seen its coding become increasingly reliant upon the information found in patients’ medical records. This means if your HTN coding is not first-rate, your practice could be losing revenue on every claim! In order to keep your coding compliant with ICD-9, as well as to receive full compensation, you should apply these five rules based on the ICD-9 official guidelines.
In our current economic recession, medical practices across the nation are facing ever increasing bad debt from their patients. With an average of 10% unemployment, high foreclosure rates, never-to-return jobs, and high insurance deductibles, patients are avoiding paying their doctor bills, and more and more patients are being sent to collections. But there is an easy way to reduce patient bad debt starting today.
As part of an ongoing effort to reduce fraudulent payments from Medicare and Medicaid, CMS announced the launch of the Recovery Audit Prepayment Review Demonstration Program. In the prepayment review program, recovery auditors will review medical billing claims before they are paid to ensure that providers comply with all Medicare payment rules. Recovery Auditors will conduct prepayment reviews on certain types of claims that historically result in high rates of improper payments.
Beginning this month, the Office for Civil Rights will begin auditing Covered Entities and Business Associates in order to gauge their level of compliance with regard to the HIPAA Privacy and Security Rule and Breach Notification Standards. These audits, called for under the HITECH Act by the Department of Health and Human Services, will be part of a pilot program to be conducted through December 2012 intended to determine if guidelines relating to privacy are being followed.
On September 20, 2011, Governor Rick Snyder signed into law a 1% tax on all health care claims paid in the state of Michiganfor the purpose of funding it’s Medicaid program. Michigan will now be eligible for an additional $780 million in federal funding for Medicaid patients. The new law, aptly called the Health Insurance Claims Assessment Act, or HICAA, is a blanket 1% tax on all payments expected to cover previous losses. The law will be in effect for one calendar year, starting on January 1st, 2012 and ending on December 31st, 2012.
Let’s face it, no provider really wants to implement and maintain a compliance program in their office, but if nobody bothered then the estimated $60 billion in Medicare fraud would continue to prosper. Like every other law and regulation our government imposes, medical office compliance programs are intended to better society. An effectively designed compliance plan should be implemented and enforced with the goals of preventing, detecting, and correcting inappropriate and potentially criminal conduct.
Want More Cash? Better Pay Attention To Your Modifiers! It’s extremely difficult, especially when you combine the CPT modifiers with Medicare’s ever-changing regulations, to use modifiers accurately for a provided/ordered service. Therefore, if you’re not up to date on your modifier coding practices, you’re not only at risk of losing deserved pay, but it could also slow down your cash flow! To avoid this, take a look at our top four tips about modifiers.
