Health care reform explained in “Health Reform Hits Main Street.”nnConfused about how the new health care reform law really works? This short, animated movie — featuring the “YouToons” — explains the problems with the current health care system, the changes that are happening now, and the big changes coming in 2014.nnnnSource: www.healthreform.kff.org; Kaiser Family Foundation; September 17, 2010.
Medicare has started the 3 year effort to re-validate ALL Medicare providers!nnYou will be receiving a notification letter. You (the provider) only have 60 days to complete and submit the proper forms that must be completed.nn
Credentialing is NOT just filling out paper work…nCredentialing IS an increasingly complex and time sensitive process where the right information has to get to the right place, correctly, (even in the right color ink) and on-time in order for you to be paid correctly and consistently!nnFailure to properly fill out the “paper work” will cause, and has been causing disruptions in payment, inability to obtain referrals, improper co-pay and deductibles being applied and even regulatory audits (when a provider is mis-categorized and loaded improperly in the payer’s system!).nnIf your practice is experiencing:n
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n…You need assistance with Credentialing!nCall us at 303.534.0388 or email us at info@WHPelter.com!nnWe have an entire credentialing department ready and willing to assist with these issues and help get your practice back on track!nnAdditional Important Credentialing Updates:nn Effective October 29, 2012 Novitas Solutions, Inc. (formerly Highmark Medicare Services) will become the new Medicare Contractor (MAC) for Colorado (no longer Trailblazer). With this transition, Novitas will REQUIRE new EFT’s (form 588) be completed and submitted for ALL practices and providers! Failure to complete an updated 588 for Novitas will result in claims denials and disruptions in your cash flow!nn Medicare has started the 3 year effort to re-validate ALL Medicare providers!n You will be receiving a notification letter. You (the provider) only have 60 days to complete and submit the proper forms that must be completed.nn All Physical Therapy Assistants must be certified by the State Physical Therapy Board by June 1, 2012 in order to work as a PTA in Colorado! To learn more, visit www.dora.state.co.us.nn Ensure your physicians/providers PECOS enrollment information is up to date! Failure to do so can result in unexpected denials of claims due to the provider being terminated from Medicare!nn Effective July 1, 2012 there will be a change in copay amounts for some Child Health Plan Plus (CHP+) State Managed Care Network members. Members will begin receiving new ID cards in June with the updated copay amount.nn Practices that employ a Surgical Assistant will be required to go through a new and more extensive credentialing process with HealthOne facilities in order to maintain privileges. The new process is more time consuming so start early! nn If you need assistance with any of the above, please call or email us!
Some practices may find that they cannot increase revenue as easily as they can decrease expenses. Both or a combination of the two can make a practice more profitable.nnExpenses:nRent, personnel, supplies, equipment, etc. What if you could lower the cost of one or more, maybe all of these?nnRent:nIf space is not needed don’t rent it! If you can out source a function that takes up space, it may be worth it.nnPersonnel:nThese days no one wants to be laid off or suggest that there be a reduction in staffing, but if it makes sense to do so, you have got to do it. Health care is complicated and new regulations and challenges may require new/different people and processes. Maybe even less people but higher skilled.nnSupplies:nGet tough, get what you pay for, get lean. There is a lot of competition out there to supply your office. With that competition come JIT (Just In Time) delivery. You may be paying for space to store supplies when you could get the supplies cheaper and delivered with a day of need!nnEquipment:nSome things you have to have. But when it comes time to replace them don’t be afraid to be creative. Look carefully at leasing. Like supplies, there is a lot of competition for your business. Computers and anything electronic is coming down in price, but be careful – often times paying a little more may get you a whole lot more. Consider outsourcing your IT hardware, especially server needs!nnCall us! We can help with all of the above. Spending money is okay if it is done with strategy and with a plan to bring down overall Expenses. You don’t have to just increase revenue to increase your profitability!
The following is a portion of the article “Mapping Out Revenue-Cycle Solutions” as provided by Health Leaders Magazine.nThe full version may be found here. nn
The payer and provider communities are still dealing with HIPAA 5010, and trying to shift attention to ICD-10 is tough,” says Craig Collins, division chair for revenue cycle and administrative lead of the ICD-10 transition at the Rochester, Minn.–based Mayo Clinic. “We put together a strategic plan and process map because we’re trying to be first to the plate to do the ICD-10 testing with the payers. Our hope is that in early 2013 we can begin testing with larger payers.”nnThe Mayo Clinic, like many other healthcare organizations, is making strides to prepare for the largest overhaul of healthcare codes in the past 30 years. The process—regardless of Health and Human Services’ decision to extend the ICD-10 transition deadline to October 2014—includes a process map of the revenue cycle in the hopes of keeping this project revenue neutral.nnAlthough the code set change is intended to be revenue neutral, ICD-10 includes more than 155,000 codes, a significant expansion from the current 17,000 codes in ICD-9. The transition touches nearly every member of a hospital or health system: physicians, clinicians, coders, IT, HIM, and finance. The mandated coding expansion influences documentation, productivity, contracts and business processes, HIM, practice management, budgets, payment conversions, claims edits, and disease and utilization management.nnICD-10 is expected to have significant impact on the revenue cycle. Nearly half of healthcare leaders (46%) expect to lose money while shifting to the new system, according to the July 2011 HealthLeaders Media Intelligence Report, ICD-10 Puts Revenue at Risk. An important step to avoid revenue hits is completing a process map that digs into the effect the transition will have on the revenue cycle.nnThe process map is work flow plan driven by multiple repositionable notes created to give an accurate picture of all the activities connected to the current and future processes at an organization. It is a full structural analysis of how all processes flow and connect to each other. The map can show gaps in specific areas that are preventing optimal performance or, in the case of ICD-10, areas that will require special attention to prevent an impact on the organization’s revenue.nnWith some 212 IT systems and 80 geographical sites across Minnesota, Arizona, and Florida that include physician practices and several hospitals, the Mayo Clinic finds the process map to be essential for a successful ICD-10 conversion—and that starts with the right team and clear accountability. Click here for the rest of the article.nnSource: healthleadersmedia.com;Karen Minich-Pourshadi; May 1, 2012.
As you may be aware United Healthcare and its Secure Horizons product line has recently taken interest in the use of CPT code 99211 with a sudden increase in audit activity. Along with UHC, more and more payers are requesting notes in an effort to verify proper provider documentation, coding and claims payments.nnSecure Horizons, and any payer, has the right to audit documentation they also have t
he right to withhold payment and request refunds for improperly coded services.nn99211 is a minimal level service, but it is still governed by the same billing and documentation rules that ALL E&M codes have.nnAs with all services billed to Medicare, code 99211 services must be reasonable and necessary for the diagnosis or treatment of an illness or injury. Unlike the other E/M CPT codes, the CPT book does not specify completion of particular levels of work for code 99211 in terms of key components or contributory factors. Also, unlike the other E/M codes, CMS did not provide documentation requirements for CPT code 99211 in the “E&M Documentation Guidelines”.nnAmong other reasons, code 99211 should not be used to bill Medicare/Secure Horizons:n
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nWe urge you to use 99211 and other E&M codes when the services are rendered and documented properly.nnIf you receive a documentation request from Medicare, Secure Horizons or any other payer please fully comply as non-compliance may initiate non-payment. If your notes are reviewed and you disagree with the results, we can help you develop a strategy to appeal the finding!nnIf you need assistance please call us at 303.534.0388 or email us at info@rtwelter.com