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Compliance Audits: Preventive Medicine for You Practice
August
2010
Imagine the patient who doesn't come to your practice until he is very ill. He's hospitalized, undergoing extensive procedures at a great cost. The sad part? His condition could have been prevented if he had come in for regular preventive care.
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Make sure your medical biller has the proper training
August
2010
Medical Billing is very complex and misunderstood. Some people think they can do it without any training, some people think all they need to do is buy a computer and book and they can be the next best thing since sliced French toast. Some practices lose their biller, so they take their receptionist and throw that person to the wolves by having that person now take over the complete financial responsibility of the practice. This is like giving a 2 year old a locked and loaded gun.
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10 Steps Toward A Disaster-Recovery Plan
August
2010
Disasters strike businesses every day. Some are big like pandemics, hurricanes and earthquakes. And some are small and go largely unnoticed by anyone outside the company, like lightning strikes, water leaks and server failures.
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Audit-proof your practice: Be prepared for RACs and MICs
August
2010
Ready or not, Recovery Audit Contractor (RAC) audits are a permanent program for Medicare providers. Although physician practices have long faced the possibility of an audit by the Centers for Medicare and Medicaid Services (CMS) and the Office of Inspector General (OIG), the RAC audit program has taken this exercise to an entirely new level. Since CMS announced that it had recovered more than $1 billion in overpayments to providers, it has expanded the original pilot program to all 50 states as of January 1, 2010. This translates to a substantial increase in the likelihood that practices billing for Medicare fee-for-service will be audited.
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Developing a Relative Value-Based Fee Schedule
August
2010
The resource-based relative value scale was implemented by CMS--or HCFA, as it was known at the time--for the Medicare physician fee schedule in 1992. In 2002, it transitioned wholly to a resourced-based methodology. Relative value units are updated annually. The conversion factors are driven by government budgetary requirements. Specialty societies and individuals are invited to submit comments and participate in relative value unit (RVU) evaluations.
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Dealing With Overpayments
August
2010
Sometimes a provider is reimbursed too much money for the services provided which results in an overpayment. Sometimes the overpayment is made by the insurance carrier and sometimes it is made by the patient. In either case, it is important that the overpayment be returned to the appropriate person or carrier.
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The Art of Renegotiating Insurance Contracts
August
2010
In the wake of health reform the medical field has faced many uncertainties when it comes to reimbursement, especially where Medicare is concerned. Many practices are left with wondering will they be hit with a 21.3% cut in Medicare reimbursement or will they see a slight increase of only 2.2% for the remainder of 2010 and an even lower increase of 1% for the year 2011.
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Reporting Nonselective Angiography to Medicare Means Assigning HCPCS Codes Rather Than CPT®
August
2010
When the physician performs nonselective renal or iliofemoral angiograms for Medicare beneficiaries during cardiac catheterization, the Centers for Medicare and Medicaid Services (CMS) requires HCPCS codes instead of CPT® codes. So make sure you are familiar with G0275-G0278 when reporting these procedures to your Medicare contractor.
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Present on Admission Indicators (POAs), Hospital Acquired Conditions (HACs): What's the Bottom Line? Do They Really End Up Affecting the Assigned MS-DRG?
August
2010
Imagine this scenario: You are a 70-year old Medicare patient who is extremely active and healthy (i.e., no co-morbid conditions). By virtue of being overactive, you've developed arthritis. You've just had a right total knee replacement performed two days ago and other than some expected pain, you seem to be doing just fine. But while relaxing watching TV in your hospital bed, you develop severe shortness of breath and call for the nurse immediately. The surgeon is called and you are subsequently diagnosed with a postoperative pulmonary embolism directly related to the knee replacement.
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Sustaining Operating Margins for the Long Term
July
2010
This issue of IMA Insights explores the implications for hospitals of recent and forecasted trends in patient services revenues and operating expenses. This article does so in the context of the continuing healthcare reform focusing on reducing waste from within the system. While much of the national discussion has focused on the long-term reduction, this article offers actions open to hospitals to address short-term needs and position themselves for long-term success.
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How Good is Your Claim Scrubber?
July
2010
The best way to reduce outstanding receivables in a medical provider's office is to make sure that claims being sent out are clean. Clean claims require less effort in collecting payment and result in faster payments. Claims with errors come back as denials and then need to be corrected, resulting in a delay in payment for services, and possibly no payment at all. After all, 42% of denied claims are never appealed or corrected.
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ICD-10 The Time to Prepare is Now!
July
2010
The implementation date for the transition to ICD-10 is October 1, 2013. The date seems to be a long way off, so why prepare now? The process of implementing ICD-10 is not only complex but it will affect every aspect of the medical practice. If you are under the assumption that all you need to do is purchase an updated coding book, think again.
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Why You Are Not Getting PAID
July
2010
We are going to take a break from all this technical stuff to talk about . . . more technical stuff. But this time, we aren't going to focus on security, we are going to focus on why your claims reject, deny, or just don't get paid in general. If you are a doctor who does your billing in-house or a billing center wondering why you are collecting less than 90% of everything that goes out the door, then read on as this article is for you.
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KEY requirements in Health care reform that affect medical practice operations 2010 - 2016
July
2010
The Patient Protection and Affordable Care Act (H.R. 3590) was signed into law by President Obama on March 23, 2010. "Key" provisions in the Act affect several areas of practice operations. These are categorized and summarized in this article. It is important that physicians, providers, managers, and office personnel be informed and trained to recognize the provisions of this new law and requirements as well as changes in other pertinent laws.
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Setting your Fee Schedule: Tools and Tactics
July
2010
How much do you charge for removing earwax? How about performing well-child checks? You might know what health plans or Medicare will pay, but what are your fees? Practice management experts agree that your fee schedule should be set carefully and updated regularlyevery three to twelve months.
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Doing More with Less: A Look at Automating Processes
July
2010
Doing more with less is the mantra among many of today's businesses, but even more so among companies within the healthcare industry. Tighter regulations and decreased reimbursement, combined with the uncertainty of healthcare reform initiatives, has many hospitals and physician practices looking for ways to decrease costs and boost efficiency.
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Don't be afraid of what you don't understand.
July
2010
ERISA, The Employee Retirement Income Security Act, a Federal Law enacted more than 20 years ago is misunderstood or not understood at all by patients, doctors, and billers. Insurance companies understand it and use it to their benefit. They also know and understand State insurance laws and use them as they see fit, so that they can have the best of both worlds. They do this because they know few will recognize what they are doing and few will fight back.
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Coding for Pressure Ulcers
July
2010
Pressure ulcers (also called pressure sores or bed sores) are areas of skin that break down when you stay in one position for too long without shifting your weight. Depending on how a physician treats the ulcer will depend on how it is coded and billed. This article will address the formation of pressure ulcers, treatment of pressure ulcers, and coding of pressure ulcers.
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The Importance of Medicare Hospital Cost Report Reviews
June
2010
Complex issues concerning Medicare hospital reimbursement continue to present significant challenges for providers, as the perceived diminished importance of Medicare hospital cost reports has been greatly exaggerated. Interpreting proposed and final federal register notices as well as regulatory clarifications put forth by the Centers for Medicare and Medicaid Services (CMS) continue to be critical as they serve to shape a hospital's bottom line, and could potentially result in thousands to millions of dollars in annual Medicare reimbursement. In this article, we will discuss key Medicare hospital reimbursement issues that continue to pose challenges for providers, highlight recent developments in Medicare hospital cost report reimbursement, identify various provider issues which lend themselves to the importance of performing Medicare pre or post-filing cost report reviews, and provide IMA Consulting insights.
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Coding for Pressure Ulcers
June
2010
Pressure ulcers (also called pressure sores or bed sores) are areas of skin that break down when you stay in one position for too long without shifting your weight. Depending on how a physician treats the ulcer will depend on how it is coded and billed. This article will address the formation of pressure ulcers, treatment of pressure ulcers, and coding of pressure ulcers.
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