The proposed rule , drafted jointly by CMS, the office of Civil Rights (OCR) and the Centers for Disease Control and Prevention (CDC), would amend a patient privacy provision of two federal laws to grant patients access to test results directly from laboratories through the use of health information technology (health IT). The purposed rule, posted on Sept 14 on the Office of the Federal Register's (OFR) website (www.gpo.gov/fdsys/search/getfrtoc.action), would amend the Clinical Laboratory Improvment Amendments of 1988 (CLIA) so that, at a patient's request, laboratories would be allowed to provide an individual with access to his or her complete test reports using the lab's authentication process to ensure privacy.
The proposed rule would also amend the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy Rule, HIPAA generally requires covered entities to give patients access to their records, but one exception to this general mandated is a provision that exempts entities subject to CLIA where a law bars disclosure. If finalized, the proposed HIPAA amendments will remove this exception and CLIA- certified labs and CLIA - exempt labs will be required to provide patients with access test reports.
For details please see the proposed rule (www.gpo.gov/fdsys/pkg/FR-2011-09-14/pdf/2011-23525.pdf).
Monday, October 24, 2011
2011 eRx Incentive Final Rule Posted
The Electronic Prescribing (eRx) Incentive Program 2011 final rule has been posted by CMS. The rule fulfills requirements laid out in the Medicare Improvements for Patients and Providers Act (MIPPA)by defining what a provider must do to avoid the Medicare Physician Fee Schedule (MPFS) adjustment should he or she not adopt a eRx. New "significant harship" exemptions are intended to help physicians who are unable to adopt the program.
Under MIPPA, those who are not successfully using eRx beginning in 2012 will receive 1 percent less than outlined in the MPFS for their services. In 2013 they face a 1.5 percent reduction in payments. Those unable to successfully adopt eRx by 2014 will substain a 2 percent hit. Methodology for identifying successful providers is based on the Physician Quality Reporting System (PQRS).
The rule defines what is an eligible professional (EP) or a group practice. New "significant hardship" exemptions are available to providers or practices who can demonstrate the following:
* EPs who register to participate in the Medicare or Medicaid electronic health record (EHR)
Incentive Program and adopt certified EHR technology;
* Inability to adopt eRx due to local state, or federal law or regulation;
* limited prescribing activity;or
* insufficient opportunities to report the eRx measure.
CMS says section 1848(a)(5)(B) of the act also provides for the secretary to excempt (on a case-by-case basis) and EP from the payment adjustment if the secretary determines (subject to annual renewal) the compliance with the eRx requirement would result in significant hardship. In the MPFS 2011 final rule, CMS established two significant hardship exemptions in the form of G codes for purposes of the 2012 payment adjustment:
* The EP practices in a rural area without sufficient high-speed Internet access (report code G8642
The eligible professional practices in a rural area without sufficient high-speed Internet access
and requests a hardship exemption from the application of the payment adjustment under section
1848(a)(5)(A) of the Social Security Act).
* The EP practices in an area without sufficient available pharmacies for eRx (report G8643 The
eligable professional practices in an area without sufficient available pharmacies for electronic
prescribing and requests a hardship exemption form the application of the payment adjustment
under section 1848(a)(5)(A) of the Social Security Act).
To request consideration for an exemption from the 2012 payment adjustment via one of these significant hardship HCPCS Level II G codes, the EP must have reported the G code at least one time on a claim between Jan. 1, 2011 and June. 30, 2011. A group practice participating in the eRx group practice reporting option for 2011 must have requested the significant hardship exemption at the time the practice self-nominated to participate.
Under MIPPA, those who are not successfully using eRx beginning in 2012 will receive 1 percent less than outlined in the MPFS for their services. In 2013 they face a 1.5 percent reduction in payments. Those unable to successfully adopt eRx by 2014 will substain a 2 percent hit. Methodology for identifying successful providers is based on the Physician Quality Reporting System (PQRS).
The rule defines what is an eligible professional (EP) or a group practice. New "significant hardship" exemptions are available to providers or practices who can demonstrate the following:
* EPs who register to participate in the Medicare or Medicaid electronic health record (EHR)
Incentive Program and adopt certified EHR technology;
* Inability to adopt eRx due to local state, or federal law or regulation;
* limited prescribing activity;or
* insufficient opportunities to report the eRx measure.
CMS says section 1848(a)(5)(B) of the act also provides for the secretary to excempt (on a case-by-case basis) and EP from the payment adjustment if the secretary determines (subject to annual renewal) the compliance with the eRx requirement would result in significant hardship. In the MPFS 2011 final rule, CMS established two significant hardship exemptions in the form of G codes for purposes of the 2012 payment adjustment:
* The EP practices in a rural area without sufficient high-speed Internet access (report code G8642
The eligible professional practices in a rural area without sufficient high-speed Internet access
and requests a hardship exemption from the application of the payment adjustment under section
1848(a)(5)(A) of the Social Security Act).
* The EP practices in an area without sufficient available pharmacies for eRx (report G8643 The
eligable professional practices in an area without sufficient available pharmacies for electronic
prescribing and requests a hardship exemption form the application of the payment adjustment
under section 1848(a)(5)(A) of the Social Security Act).
To request consideration for an exemption from the 2012 payment adjustment via one of these significant hardship HCPCS Level II G codes, the EP must have reported the G code at least one time on a claim between Jan. 1, 2011 and June. 30, 2011. A group practice participating in the eRx group practice reporting option for 2011 must have requested the significant hardship exemption at the time the practice self-nominated to participate.
Use Revised ABN by Jan.1 2012
Providers (including independent laboratories), physicians, practitioners, and suppliers now have until Jan. 1 2012 to begin using revised Advanced Beneficiary Notice of Noncoverage (ABN) Form CMS-R-131.
The orginal implementation date was Sept 1 2011 but the Centers for Medicare & Medicaid Services (CMS) extended the manditory use date to Nov. 1 2011 and then Jan. 1 2012 to give providers and suppliers more time to transistion to using the new form, and to use up stockpiles of old forms.
The revised form replaces the ABN-G (Form CMS-R-131G), ABN-L (Form CMS-R-131L), and NEMB(Form CMS-20007). The latest version of the ABN has a release date of March 2011 printed in the lower- left corner. All ABNs with a release date of March 2008 that are used on or after Jan.1 2012 will be considered invalid.
The ABN should be used in situations where Medicare payments is expected to be denied. Skilled nursing facilities (SNFs) should use the revised ABN form when services are expected to be denied under Medicare Part B only.
Download the revised ABN at www.cms.gov/BNI/02_ABN.asp, available now for immediate use.
The orginal implementation date was Sept 1 2011 but the Centers for Medicare & Medicaid Services (CMS) extended the manditory use date to Nov. 1 2011 and then Jan. 1 2012 to give providers and suppliers more time to transistion to using the new form, and to use up stockpiles of old forms.
The revised form replaces the ABN-G (Form CMS-R-131G), ABN-L (Form CMS-R-131L), and NEMB(Form CMS-20007). The latest version of the ABN has a release date of March 2011 printed in the lower- left corner. All ABNs with a release date of March 2008 that are used on or after Jan.1 2012 will be considered invalid.
The ABN should be used in situations where Medicare payments is expected to be denied. Skilled nursing facilities (SNFs) should use the revised ABN form when services are expected to be denied under Medicare Part B only.
Download the revised ABN at www.cms.gov/BNI/02_ABN.asp, available now for immediate use.
Thursday, October 20, 2011
What to look for in a Medical Biller or Medical Billing Company
Medical billing or practice management is not to be taken lightly. We are not here to tell you that anyone can do it. We are here to say that, as physicians, you must choose this person or company with extra care because your practice depends on it!
Before you can choose a Billing Center, you need to pre-define your goals. Some practices benefit by outsourcing their billing to keep patient care separate from billing and reimbursement issues. Decide first if outsourcing your billing is indeed what is best for you.
The following are what healthcare providers should look for:
charges billed? Do they have a start-up fee and what does that start-up or set up fee include? Be aware that it is practical for a billing company to evaluate your practice and needs before they quote you a fee for services.
Note: some States do NOT allow a physician to enter into a fee-splitting arrangement with a practice management company or any non-medical provider. This means you should be careful about entering into a contract with an outsourced billing company who charges based on a percentage of collection. Also the OIG has issued guidelines for third party medical billing companies and frowns upon this method of contracting.
Remember ... this is your practice and your livelihood depends on the revenue that it brings in!
Before you can choose a Billing Center, you need to pre-define your goals. Some practices benefit by outsourcing their billing to keep patient care separate from billing and reimbursement issues. Decide first if outsourcing your billing is indeed what is best for you.
We don't just focus our priorities on education of medical billing specialists, we know the importance of the billing specialist TO the provider. We take pride in letting healthcare providers know that WE CARE about their bottom line!
§ Experience or Training: While experience is always a plus, don't rule out the new billing center who is knowledgeable and continues to educate themselves. A billing center without current clients, or with only one or two clients, means extra time they have to spend on your practice. Just make sure their knowledge is up to speed in your specialty. Ask for credentials, type of education they have accomplished and what their future goals are for their business. Small billing companies can offer your practice a more personalized service! Unlike a large corporate billing centerr who can afford to lose a few practices, a small billing service will most like put forth that extra effort. They want to keep your business and, most of all, they rely on your references when seeking new business.
§ Request the amount of knowledge or credentials they have in coding. While coding ultimately should be the responsibility of the physician, a good billing person should be knowledgeable about coding issues and be able to spot errors and advise on corrective action
§ Is the billing company HIPAA ready? What steps have they taken to create a HIPAA compliant policy and environment for their company?
§ Request references. If references are not available, ask them if they can give you some references from Association Directors, teachers, course instructors, etc. If they are a new company, references from prior employers can give you an idea of their work ethic.
§ Request to see the billing company's compliance plan. A committed billing service will have a full compliance plan in place. This is the road map and guide for their business and you can determine the commitment of the billing company by looking at their compliance plan.
§ Ask questions such as "How will you follow up on claims?". What type of appeal system do you have in place?
§ Ask what type of reports you will receive for your practice? How frequently (monthly, quarterly, annually, etc.)? Reports should consist of the following BASIC reports:
Accounts Receivable - aged by either date of entry or date of service
Practice Analysis - overall reporting of the practice charges and receivables
Transaction Report - general report of payments, charges and adjustments
Claims Report - to show claims submitted for a reporting period
Managed Care - reports to show loss of revenue, adjustments, timely payment and referral tracking
Practice Analysis - overall reporting of the practice charges and receivables
Transaction Report - general report of payments, charges and adjustments
Claims Report - to show claims submitted for a reporting period
Managed Care - reports to show loss of revenue, adjustments, timely payment and referral tracking
§ Can they track and manage managed care visits, including capitation utilization? (for those who are participating or interested in participating in managed care programs)
§ What type of practice management software are they using? Can they provide you with remote access and/or a read-only copy in the office to help you and your staff collect the appropriate co-payment amounts? Discuss the various types of solutions available for accessing your account at your office. Keep HIPAA in mind when outsourcing to a company with remote access capabilities, your computer in your office should be HIPAA ready and the access should be restricted as well as maintaining compliance with HIPAA regulations (computer log in and log off)
§ Are they up to date on their coding books?
§ What are their collection practices and procedures? (i.e., do they provide soft collections, alert you to take action on accounts needing extra attention?)
§ What kind of safeguards are in place within their company for security of data backup?
§ Does the billing company have a backup company or person that can take over in the unfortunate event of death or illness?
Ask to see a copy of the companies policies and procedures as well as compliance plan which should have written documentation as to a backup policy or emergency procedure plan.
Ask to see a copy of the companies policies and procedures as well as compliance plan which should have written documentation as to a backup policy or emergency procedure plan.
§ How can you reach them if you should need them? Are their hours of operation consistent and can you depend on them to be there during your regular business hours?
What are their fees? If it is based on a percentage, will it be of total practice collections or totalWhen contracting with an outside billing service, minimize your risk through the following measures:
- Request a copy of the service's compliance plan;
- Determine if the billing service has ever been investigated for fraud and abuse;
- Ask if the service has periodic audits performed by an outside auditing firm;
- Request three references of current clients, and call the clients to ask if they are satisfied with the company;
- Inquire about the qualifications of the service's billing staff;
- Request a list of the standard financial reports that the service gives its practices clients, and
- Ensure that the service has insurance coverage for errors and omissions.
Note: some States do NOT allow a physician to enter into a fee-splitting arrangement with a practice management company or any non-medical provider. This means you should be careful about entering into a contract with an outsourced billing company who charges based on a percentage of collection. Also the OIG has issued guidelines for third party medical billing companies and frowns upon this method of contracting.
Remember ... this is your practice and your livelihood depends on the revenue that it brings in!
Tuesday, October 18, 2011
Why OutSource Medical Billing
Medical billing is one of the fastest-growing and most dynamic sectors of the health care industry. As a medical billing company, we serve as intermediaries between physicians or other health care providers and insurance companies, be they private or government-owned. Our process involves collecting fees from insurance companies in order to compensate doctors and healthcare providers for their services. We excel at providing one of the best services in the industry, helping our clients collect from the insurance companies faster than ever before.
As a medical billing company, our role is very significant in achieving efficiency for healthcare companies. Healthcare companies outsource their physician billing requirements for various reasons like reducing the facility costs and labour costs requeried. Outsourcing medical billing can increase the revenue of the healthcare facilities to a large extent. There is a high chance of encountering losses by managing the billing process on their own. For this main reason these companies go for outsourcing the physician billing services. As leaders in the industry we also strive to achieve maximum profits for our medical insurance billing clients.
Medical billing is a function that is crucial to any medical practice and hospital, big or small. More practices have run into trouble because they neglected financial part of their practice. It used to be normal for either the doctor to handle this himself or just hire someone to come into his office and take care of this either full time or part time. But things have changed drastically over the years and it is simply not practical for a doctor or any medical practitioner to take care of the medical billing and coding himself or hire someone who is not trained for this.
It also used to be very difficult and cumbersome in the days when the entire physician billing and claims filling and processing was done manually. It was slow and prone to a lot of errors. It was also very expensive. For a small practice or hospital with a few hundred or thousand patients, it became very difficult to maintain records. It was extremely difficult and slow to store, maintain and retrieve any information. There are many medical billing companies, but we are confident that we will remain as the industry leader, providing excellent services at a reasonable price. Here at T.E.A.M Medical Billing Services LLC we do just that.
We have a number of health care providers as our clients who rely on our medical billing service process rather than handling their billing on their own. We save physicians and their practices valuable time that they can instead devote to providing better care to their patients, and their expertise ensures that the procedure is carried out correctly. This makes the process easier on the insurance companies, and enables doctors to receive their payments in a more timely fashion. Additionally, our professional processes saves patients the trouble of dealing with doctors, insurance providers or even collections agencies. Often times a doctor will have to spend countless hours trying to make light of a rejected insurance claim, or trying to get ahead of aging account receivables. We provide an essencial solution to these doctors, allowing for increased ROI and better use of the physicians time.
Contact us today
T.E.A.M Medical Billing Services LLC
24 Blue Water Court
Wendell, NC 27591
1-800-881-0563
1-800-963-1686 http://teammedicalbilling.com
As a medical billing company, our role is very significant in achieving efficiency for healthcare companies. Healthcare companies outsource their physician billing requirements for various reasons like reducing the facility costs and labour costs requeried. Outsourcing medical billing can increase the revenue of the healthcare facilities to a large extent. There is a high chance of encountering losses by managing the billing process on their own. For this main reason these companies go for outsourcing the physician billing services. As leaders in the industry we also strive to achieve maximum profits for our medical insurance billing clients.
Medical billing is a function that is crucial to any medical practice and hospital, big or small. More practices have run into trouble because they neglected financial part of their practice. It used to be normal for either the doctor to handle this himself or just hire someone to come into his office and take care of this either full time or part time. But things have changed drastically over the years and it is simply not practical for a doctor or any medical practitioner to take care of the medical billing and coding himself or hire someone who is not trained for this.
It also used to be very difficult and cumbersome in the days when the entire physician billing and claims filling and processing was done manually. It was slow and prone to a lot of errors. It was also very expensive. For a small practice or hospital with a few hundred or thousand patients, it became very difficult to maintain records. It was extremely difficult and slow to store, maintain and retrieve any information. There are many medical billing companies, but we are confident that we will remain as the industry leader, providing excellent services at a reasonable price. Here at T.E.A.M Medical Billing Services LLC we do just that.
We have a number of health care providers as our clients who rely on our medical billing service process rather than handling their billing on their own. We save physicians and their practices valuable time that they can instead devote to providing better care to their patients, and their expertise ensures that the procedure is carried out correctly. This makes the process easier on the insurance companies, and enables doctors to receive their payments in a more timely fashion. Additionally, our professional processes saves patients the trouble of dealing with doctors, insurance providers or even collections agencies. Often times a doctor will have to spend countless hours trying to make light of a rejected insurance claim, or trying to get ahead of aging account receivables. We provide an essencial solution to these doctors, allowing for increased ROI and better use of the physicians time.
Contact us today
T.E.A.M Medical Billing Services LLC
24 Blue Water Court
Wendell, NC 27591
1-800-881-0563
1-800-963-1686 http://teammedicalbilling.com
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