Practice Management Alert

Stop Chasing After 'Welcome to Medicare' Exam Deductibles
"Happy retirement" no longer comes with unwelcome present. If your physicians perform "... Read more
You Be the Billing Expert:
NPP Billing Hospital Consultations
Question: We have some questions on billing hospital consults for NPPs. Our doctors woul... Read more
News You Can Use:
Medicare Lowers CF to $36.0666 for 2009
You won't feel as big a crunch, thanks to neutrality adjustment. CMS unofficially relea... Read more
Let 2 Questions Guide You on Deductible Collection
Save time, effort by learning the downsides of up-front collection. Collecting deductib... Read more
Payer Updates:
Get Ready for E-Prescribing With Blues of Massachusetts
Plus, Medicare owes millions in back pay to practices in three states. Practices that... Read more
Reader Questions:
Clear Up Filing Deadline Issues With Chart
Question: Our practice keeps getting denials because we are missing timely filing deadli... Read more
Reader Questions:
Avoid Overlapping WC, Medicare Visit Notes
Question: We have a longtime patient who we see for workers- comp disability and for per... Read more
Reader Questions:
Capture Supporting Information With E Codes
Question: I-ve never really understood E codes and when I should use them. Would you exp... Read more
Not Issuing Refunds? You May Be Asking for Trouble
Keeping overpayments can get you in hot water with patients, payers, and the law. If you ... Read more
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Ensure Payers Correctly Apply Every Refund That You Send
Use this sample letter to provide all of the information your payer needs. When you send ... Read more
News You Can Use:
Tell Florida Payers 'No' for Refunds After a Year
A new law will change one state's overpayment rules. After reading the cover article -Not... Read more
Payer Updates:
Trailblazer Overpaid By $100,000
Plus, Aetna offers free rescission reviews. Would you notice if you billed a $146 service... Read more
Reader Questions:
Expect Less From Medicare If Doc Owes the IRS
Question: My physician owes back taxes to the IRS. A colleague warned him that the IRS can... Read more
Reader Question:
Take Note of Medicare's 2009 Cost to Patients
Question: I heard CMS released the monthly payment amount for next year, but I can't find ... Read more
Reader Question:
Collect Copays Even If You're Non-Par
Question: Do we have any obligation to try to collect copays or deductibles when we are no... Read more
3 Tips Help You Negotiate Your Way to Better Payer Contracts
Key: Maintain good relations with your provider rep You know you should be reviewing yo... Read more
News You Can Use:
Mark Your Calendar: ICD-10 Could Hit in 2011
The code set will quadruple the number of dx codes you can bill You-re busy updating yo... Read more
Specialty Billing Focus:
Private Practice SLPs, Say Hello to Medicare
A lucky MIPPA provision gives SLPs the ticket If you bill for a speech-language patholo... Read more
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Overcome Consolidated Billing Troubles With an SNF Contract
Best bet: Use one for every SNF your provider works with To receive payment for the tec... Read more
Recipe for Billing Success:
Find Your Way Through the SNF Billing Maze
Consult Stark and consolidated billing rules first If your provider sees patients in a ... Read more
You Be the Billing Expert:
Deal With Financial Hardship for Self-Pay Patients
Question: Last month I read your article about having a financial hardship policy. The a... Read more
Payer Updates:
NY AG Reaches Settlement With Healthfirst
On Sept. 3, New York State Attorney General Andrew Cuomo announced a $35 million settlemen... Read more
Reader Questions:
CMS Offers You an ABN Reprieve
Question: I work for a large clinic, and we-ve struggled to implement the new ABN form. ... Read more
Reader Questions:
Payment Doesn't Affect Global Period
Question: When a self-pay patient has surgery in the hospital, do you still follow the i... Read more
Get Financial Hardship Proof Before Offering a Discount
If you don-t, your practice could face litigation and payer problems No doubt some of y... Read more
You Be the Billing Expert:
Does H.R. 6331 Affect NEMB Use?
Question: Since the Senate and House overruled the veto of Congressional bill H.R. 6331,... Read more
Recipe for Billing Success:
Boost Your Payment Rate By Verifying Coverage Even After Rendering Services
Adopt the "better late than never" policy rather than not verifying at all In recent mo... Read more
News You Can Use:
Reduce Pharmacy Call Time With E-Prescribing
Best part: Next year, you may see a Medicare bonus for e-scripts Electronic prescribing... Read more
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Decrease The Time You Spend Collecting Benefit Information
Let this proven sample form ease your efforts Verifying patient benefits is good practi... Read more
Compliance Corner:
Avoid Fraud Allegations With the Latest Stark Info
Navigate the 2008 twists and turns with this list As a biller, your practice's com... Read more
Payer Updates:
Stop Billing Medicare for 3 More Preventable Conditions
Plus, find out the potential repercussions of not being HIPAA-compliant As part of the ... Read more
Reader Questions:
Look to Your Contract for Help With Termination
Question: My practice is considering terminating a contract with one of our payers and b... Read more
Reader Questions:
Billing Before Credentialing -- When Is It a No-No?
Question: Our practice is expanding, and we will soon have two new physicians starting w... Read more
Easily Evaluate Your Billing Procedures With Internal Audits
Tip: Begin with a baseline audit and then make changes before outside auditors come knoc... Read more
You Be the Billing Expert:
Does the 72/24 Rule Apply to Your Billing?
Question: I bill for a multi-specialty group that also has an urgent care facility. Our ... Read more
News You Can Use:
Kiss the 10.6 Percent Pay Cut Goodbye, Finally
Congress ensures you-ll avoid a Medicare pay cut for 18 months You can breathe easier a... Read more
Correction:
Check Your State's Regulations Before Billing WC Claims
An established patient may not actually always be a new patient When you-re billing a w... Read more
Recipe for Billing Success:
Consider Collecting Up Front to Combat Increasing Deductibles
Time-of-service collections make your job easier and increase collection rates The numb... Read more
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Decrease Your Outstanding Claim Percentage With a Set Follow-Up Policy
Let this proven sample policy guide your efforts Every office has them -- outstanding c... Read more
Payer Updates:
Aetna Takes the Top Spot In PayerView Rankings
Plus, WellPoint settles with California hospitals, to the tune of $11.8 million At the ... Read more
Reader Questions:
Notifying the Payer Isn't Likely to Help Collections
Question: When we send a patient to collections because she hasn't paid her deductible o... Read more
Reader Questions:
Check With Facility Before Choosing POS
Question: I-m new to billing for a physician who visits patients in nursing facilities. ... Read more
Is Lack of Verification Costing Your Practice? Stop the Bleeding
Implement an eligibility check before the patient comes into your office Verifying insu... Read more
You Be the Billing Expert:
Learn the Do's and Don'ts of Setting Fees
Question: We have several patients who are cash/self-pay patients without insurance. My ... Read more
Ease Your Verification Woes With 6 Quick Tips
Check everyone's insurance card -- even established patients Insurance changes happen s... Read more
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Capture Every Insurance Detail With This Form
Tip: Remember to ask about secondary insurance Having a form you can use consistently t... Read more
News You Can Use:
Don't Yet Change Your Incident-To Billing
CMS rescinded its latest advice and doesn't plan to replace it If you-ve had Transmitta... Read more
Recipe for Billing Success:
Don't Rule Out Billing if Documentation Is Missing
3 steps ensure you-re using compliant documentation Every biller comes across this situ... Read more
Payer Updates:
Check to See if You Deserve a Share of the Capital Blue Settlement
Also, UHC offers a revised appeal form If you treat participants in Capital Blue Plans,... Read more
Reader Questions:
NPI Denials May Be From 1 Small Detail
Question: I applied for my NPI early, put it on my claims by the deadline, added my lega... Read more
Reader Questions:
Don't Ignore Patient Status for WC Claims
Question: My provider said that if an established patient comes in for workers- comp, we... Read more
Reader Questions:
Avoid Record Withholding As a Collections Effort
Question: A patient who owes us a lot of money is now seeing a new physician who has req... Read more
Avoid Collection Hassles by Getting the Lowdown on HSAs
First step: Review all payer agreements The number of patients with health savings acco... Read more
You Be the Billing Expert:
Is 'Professional Courtesy' Really Illegal?
Question: My physicians have asked me whether they can offer professional courtesy disco... Read more
Compare Your HSA Struggles With Other Billers'
A billing association survey reveals the top HSA troubles If your practice is trying to... Read more
Cross All Your T's or Face Revalidation Nightmares
Prepare to be dropped if you don't have a handle on the rules When's the last time you ... Read more
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Assess Revalidation Efforts in 12 Questions
Start to revise your processes if you-re answering -no- 1. Is your provider's Medicare ... Read more
Recipe for Billing Success:
Ask for a Specialist to Review Appeals
Secret: You-ve got more power than you think When you bill a complicated specialty pro... Read more
Payer Updates:
Aetna Moves Forward With Personalized Search Engine
Plus, CMS clarifies incident-to regulations Aetna announced that it is partnering with ... Read more
Reader Questions:
Reserve CLIA for Billing Lab Codes
Question: I need some clarification on CLIA numbers and who needs them for billing. I-m ... Read more
Reader Questions:
Apply Contract Requirements to Orthotics, Too
Question: I work with a podiatrist who supplies custom orthotics for his patients. They ... Read more
Reader Questions:
Stick to What Shows on the Superbill
Question: Our office uses an outside biller. In reviewing some of the EOBs, I-ve found i... Read more
Reader Questions:
Unlock Global-Period Mysteries With Fee Schedule
Question: I listened to a conference during which the speaker cautioned against billing ... Read more
Have Your NPI Stars Aligned? Now's the Time
Key: Check your NPPES record and make the necessary corrections May 23, 2008. The Natio... Read more
You Be the Billing Expert:
Duplicate Claims Submission
Question: We have several claims that our payer is taking more than 30 days to process o... Read more
Finally, the Time's Come to Adopt the New ABN
Bonus: NEMBs may be a thing of the past Billers have been waiting for months to see i... Read more
Increase Your ABN Know-How With These 5 Sample Scenarios
The new ABN is only good news if you know when to use it and know which modifiers to app... Read more
Recipe for Billing Success:
Drive Your Capitation Status Home Every Time
Avoid hassles by sending a form letter to secondary payers If secondary payers keep pro... Read more
Payer Updates:
One Payer Questions Cost-Benefit of EMR Systems
And in denial news, TrailBlazer shares a top-10 list to avoid Some practices have been ... Read more
Reader Questions:
Age Is a Factor in Financial Responsibility
Question: We have a patient who is covered by his mother's insurance, but he is over 18.... Read more
Reader Questions:
Offer a Cost Range for Self-Pay Patients
Question: Our office is trying to figure out how to increase the collection rate for sel... Read more
Reader Questions:
Apply Incident-To Based on Payer
Question: My physician hired a physician assistant (PA) whom he is going to pay an hourl... Read more
Reader Questions:
Get a Handle on Timely Filing Date Rules
Question: What is the best way to handle a claim that is past the timely filing date for... Read more
Boost Efficiency and Speed Up Reimbursement With RTCA
Several payers are offering real-time claims adjudication -- are you taking full advanta... Read more
You Be the Billing Expert:
Could 4 Little Numbers Be Sabotaging Your Claims?
Question: We are getting denials from Medicare saying they can't see box 32 in our claim... Read more
What Is Real-Time Claims Adjudication?
For professional (CMS-1500) 837P claims, real-time claims adjudication (RTCA) consists of ... Read more
Case Study:
Could RTCA Double Your Front-End Collections?
Learn from one practice that successfully implemented RTCA So you-ve weighed the pros a... Read more
Capitation May Be on the Horizon:
Get Ready
Find out whether capitation will help, or harm, your practice Capitation was a commonly... Read more
Recipe for Billing Success:
New Software Can Be the Answer to Medicare Secondary-Payer Woes
Good starting point: Turn to your clearinghouse for help If you-re wrangling with your ... Read more
Payer Updates:
NY Attorney General Says He'll File Suit Against UHG
Also: California legislators trying to prevent unwarranted policy cancellations New Yor... Read more
Reader Questions:
NPI Deadlines Still Loom -- Be Prepared
Question: I-m still confused about what the May 23 deadline is for the NPI changes. Can ... Read more
Reader Questions:
RACs Are Here to Stay
Question: I keep hearing about RACs. What are they and why are billers so wary of them? ... Read more
Considering a Medicare Opt Out? Here's What You Need to Know
You can free yourself from fee schedule concerns -- but is it worth potentially losing v... Read more
You Be the Billing Expert:
Medical vs. Auto Insurance
Question: When a patient comes to us for treatment following a motor vehicle accident, s... Read more
Quick Quiz Answers:
Are You Well-Versed in Many Areas? Check Now
Find out how you fared on last month's quiz In the last issue of Medical Office Billing... Read more
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Navigate the Opt-Out Process With Ease
Follow these 5 steps if your practice says no to Medicare Your practice has weighed the... Read more
News You Can Use:
Don't Miss -- Update Your Appeal Flowcharts
You have one more change to incorporate into your billing arsenal this year. CMS directe... Read more
Recipe for Billing Success:
Follow 4 Steps to Shield PHI From Unauthorized Eyes and Secure Your HIPAA Compliance
The government has convicted HIPAA violators -- make sure you-re not at risk HIPAA comp... Read more
Reader Questions:
When Is Redetermination the Best Option?
Question: We performed a service that we know was medically necessary, but the carrier d... Read more
Reader Questions:
Write-Off Doesn't Equal 1099
Question: We ended up writing off some patient balances as bad debts. Should we be sendi... Read more
Reader Questions:
Correct Claims for More Than Just Money
Question: Within the past few months, on two occasions my billing department submitted c... Read more
Study These Expert ERISA Tips Before Filing Your Next Appeal
What you don't know about ERISA could be costing your practice big bucks If just t... Read more
You Be the Billing Expert:
Get the Lowdown on When You Can -- and Can't -- Bill for Supplies
Denials may be carrier-specific, so when in doubt, ask Question: We perform many in-off... Read more
ERISA Terms to Know
ERISA: Employee Retirement Income Security Act -- a federal law governing private-sector... Read more
Recipe for Billing Success:
Weigh the Options for Dealing With Potential Mid-Year Fee Cuts
Good news: Your reimbursement is safe for 6 months Billers and physicians who were hopi... Read more
Quick Quiz:
Are You Well-Versed in Multiple Billing Areas?
5 questions help you get a grip on challenging billing topics and avoid billing catastro... Read more
Reader Questions:
Prepare for 'UHC Meets CCI'
Question: I-ve heard that I-m going to have to start changing some of the codes that I b... Read more
Reader Questions:
Collecting From the Deceased Takes Research
Question: A self-pay patient of ours died, and we sent the outstanding bill to his spous... Read more
Streamline Copay Collection in 3 Easy Steps
A simple sign may make your job a lot easier If you-re having trouble getting patients ... Read more
You Be the Billing Expert:
Avoid Patient Upset and Fraud -- Get the Scoop on Balance Billing
Warning: Check your contract before charging the patient Question: Another practice in ... Read more
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Overcome 'Forgot the Checkbook' Excuses With This Checklist
Offering patients multiple payment options will increase collections When you get the o... Read more
Stay Intent on Documentation in Lieu of Consult Clarification
Ensure you know the 5 consultation keys -- we-ll tell you what they are Rumors have ci... Read more
Recipe for Billing Success:
Stop Avoiding the NPI Switch Before It's Too Late
Some carriers are already testing your readiness You have one less thing to worry abo... Read more
Avoid Consult Dilemmas With Standard Form
Until clear consultation guidelines come out, cover your bases with this form It's time t... Read more
Reader Questions:
Brace for the Latest Fee Schedule News
Question: I-ve been hearing disturbing news that CMS may cut the fee schedule reimburse... Read more
Reader Questions:
New Physician Doesn't Mean New Patient
Question: We have a new physician in our group whose patients from his previous group fo... Read more
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