Medical Billing Blog

Under the Medicare Recovery Audit Contractor (RAC) program, the Contractors get paid a percentage of the” inappropriate” payments they identify and recover.  Some have compared this to a Medicare “bounty hunter” program.

On Jan. 25, 2013, the Department of Health and Human Services (HHS) published the “Omnibus Rule,” which is a final set of regulations that enforces various provisions of Health Information Technology for Economic and Clinical Health (HITECH) Act which in turn is designed to enhance the Health Insurance Portability and Accountability Act (HIPAA).  In general, the new rules expand the obligations of physicians and other health care providers to protect patients’ protected health information (PHI), extend these obligations to who has access to PHI, and increase the penalties for violations.
There are basic areas providers will need to comply with:

When the transition to ICD-10 officially begins on October 1, 2014, those in the US healthcare industry will be in a position to benefit greatly from lessons learned by our neighbors inCanada, who also recently made the transition between 2001 and 2004.  Canadians already experienced similar transition situations to what the United States will be facing according to Cindy Grant, Certified Healthcare Information Manager (CHIM) and ICD-10 practice lead at TELUS Health Solutions in Toronto,Ontario; and Kerry Johnson, MAEd, CHIM, senior lecturer and HIM instructional coordinator at the University of Ontario, Institute of Technology in Oshawa,Ontario.  Coders in Canada struggled most with anatomy and physiology, not the coding logic itself.  "It wasn't so much the coding system and how the codes work," says Johnson.  "We found them struggling with anatomy and physiology and understanding what exactly the intervention was, including determining the root operation."

A recent survey conducted by the Workgroup for Electronic Data Interchange (WEDI) regarding the preparations for transitioning to ICD-10 being conducted by healthcare providers shows that nearly half of the survey group either have not started preparing for ICD-10 or do not know when they expect to start their testing. 

Managing a successful medical practice involves more than just practicing medicine.  You must also view it as a successful business, and put into place sound business practices, as well.  Many providers are seeing their revenues decline as payers are reducing fee schedules, so it’s more important than ever to collect every dollar that you’re entitled to, and to manage how you budget that revenue to keep your practice running in the black. 

As a follow up to my recent post “Avoiding Payment Denials for Cloned Notes,” the Centers for Medicare & Medicaid Services (CMS) has issued new instructions to Medicare Administrative Contractors (MAC’s), Recovery Audit Contractors (RAC’s), and Zone Program Integrity Contractors (ZPIC’s) to look for claims generated from Electronic Health Records (EHR’s) that do not contain adequate information.

It is said that “a bird in the hand is worth two in the bush,” and that is especially true when you’re talking about collecting payments from patients at the time of service.  According to the AMA, the average cost to physicians for collecting monies owed and processing claims is 10 – 14 percent of gross revenue, butthere are ways to be more efficient, reduce these costs, and collect payments faster.  The AMA website offers a Point-of-Care Pricing Toolkit to help you collect payment from patients before they walk out the door. 

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.