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.
A major change is coming. The format of all transmissions of all claims to all payers is about to change. It’s called 5010 and it’s the precursor for ICD‐10. 5010 refers to the electronic transmission of claims sent to insurance payors. The transition to 5010 will be completed on January 1, 2012, when all claims will be required to use this new format.
The Centers for Medicare and Medicaid Services (CMS) released a new ICD-9-CM code set that deals specifically with malignant neoplasms for medical billing. These updated dermatology codes become effective October 1, 2011.
The decision whether or not to outsource your billing is less complex of a decision than most physicians make it out to be. Today’s medical billing takes a highly specialized set of skills and resources to be successful. Billing has become an ever-changing complex field of codes, modifiers, rules and regulations. So here are the top 5 reasons you should outsource your practice’s medical billing function:
We are taught from an early age that we should always return something that does not belong to us. As adults the rules are the same. This is especially important in our roles as billing agents and collectors; we are the stewards of our client’s finances. Just ask the Office of the Inspector General (OIG). In 1998, the OIG published its Compliance Program Guidance for Third-Party Medical Billing Companies, which included a list of risk factors the OIG identifies as “particularly problematic.” Bullet five on this list is “Inadequate Resolution of Overpayments,” otherwise known in the billing industry as resolution of credit balances. In essence, it says that providers may not keep payments that do not belong to them.
CMS has announced that some Medicare Providers will be required to revalidate their enrollment status in order to comply with Section 6401(a) of the Affordable Care Act. Any provider who enrolled prior to March 25, 2011 may be affected by the requirement. Beginning now and going through March 23, 2013, Medicare Administrative Contractors (MAC’s) will be contacting providers who need to revalidate their enrollment. Only Providers who are contacted by a MAC need to revalidate their enrollment, and they must wait until after they are contacted.
