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Alta
Partners News & Tips. Information to Improve your Practice |
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Table of Contents:
It's That Time of the Year Again!
It's That Time of the Year Again! Now that flu season is upon us, it is important to understand the intricacies of billing Medicare for the flu vaccine. The Center for Medicare and Medicaid Services provides the following answers to a few Frequently Asked Questions regarding flu vaccinations.
Additional questions may be directed to your account representative at Alta Partners @ 440-808-3654. Additional information may also be found on the CMS website:
www.cms.hhs.gov/manuals/downloads/clm104c15.pdf
BREAKING NEWS:
How will this affect you? It depends upon which codes you use most. The 10.1 percent cut reflects a slash in the multiplier CMS uses to calculate payments for each code. If the relative value unit (RVU) of a specific code has been boosted or cut, your reimbursement rate will heighten or lessen. CMS has offered its own assessment of how the combination of payment changes it has proposed could impact various specialties. Here are their forecasted changes for a several groups:
How worried should I be? As in past years, there is much discussion of a last-minute congressional intervention to overrule the proposed cuts. There's already a bill in the House that will replace the cuts with a 0.5 percent physician payment increase. But that suggestion is tied to legislation reinstating and expanding the State Children's Health Insurance Program — which President Bush has recently vetoed Nothing is certain yet. Our best bet in trying to fight this reimbursement decrease is to join together as a profession and let our voices be heard by our local congress men and woman. Find out who that is and contact them today!
Alta Partners Rolls Out Payerpath
Claims
Management System To stay ahead of our competition, Alta Partners has recently made a commitment to implement a new technology in our claims management process which will make validating and correcting claims easier than ever. Simply put, Payerpath Claims Management Systems will help to slash the time, cost and bureaucracy typically associated with managing healthcare financial transactions.
The Payerpath Advantage
And
best of all, the implementation of this process will be
seamless and will not cause you, the client, to change
anything that you do! Alta Partners is rolling out
Payerpath during the first three months of 2008 and will
provide your staff with training needed to log-in, and work
with the software. If you have any questions or need more
information, contact Annie Hanzel, 440-808-3655.
In the last edition of the Alta newsletter, an update was given on a BWC policy change that could lead to physician’s becoming decertified as a BWC provider. You may recall that the Ohio BWC has announced that you can be decertified as a BWC provider IF, during a rolling 24 month period, you submit a Physician’s Request for Medical Service or Recommendation for Additional Conditions for Industrial Injury or Occupational Disease (C-9 form) or if you submit the medical documentation retroactively more than three times without just cause. In this article, we also mentioned that based upon a conversation on Friday, August 31 with a representative from the Bureau of Workman’s Compensation, no time-frame has been established for formal enforcement of this policy change. Since that time, we have evidence that the BWC is in fact actively enforcing this policy change. It has come to our attention that a letter dated August 29, 2007 has been sent to a local provider who provided treatment in the absence of a current C9 authorization and sent a request for retrospective authorization to the BWC after the one week treatment grace period. The letter states the following: “The attached C9 treatment request is found to be non-compliant for the requested date of service of 12/6/06. The purpose of this letter is to notify you that this situation has been reported to BWC for non-compliance. Further administrative action may be taken as appropriate.” As mentioned previously, failure to meet this new requirement can lead to serious detrimental effects for your practice. We strongly recommend that you begin to follow this new guideline immediately. Please contact our BWC specialist, Sharon Compton @ 440-808-3716, if you have any questions or need additional information.
Physician Quality Reporting Initiative (PQRI) You may have heard about it, but do you really know what it is and what is required to participate? The Tax Relief and Health Care Act of 2006 (TRHCA) authorized a physician quality reporting system and as many of you may be aware, this program, which CMS has named the “Physician Quality Reporting Initiative” (PQRI), was implemented on July 1, 2007. The PQRI program has established a financial incentive for eligible professionals to participate in a voluntary quality reporting program. Eligible professionals who successfully report a designated set of quality measures on claims for dates of service from July 1 to December 31, 2007, become eligible to earn a bonus payment, subject to a cap, of 1.5% of total allowed charges for covered Medicare physician fee schedule services. The overall goal of this initiative is to help physicians and Medicare provide the highest level of quality of care for people who have Medicare by establishing standards for best practices based on actual patient outcomes. CMS will continue the PQRI initiative in 2008 which will permit for bonus payments based on satisfactory submission of data on PQRI quality measures, during the year.
Understanding on what to report on can be confusing
as there are seven broad categories of 2008 PQRI measures including:
In order to be paid a bonus payment, practices have to report on at least three measures, at least 80 percent of the time that those measures were clinically applicable to the visit. Reporting will consist of adding the appropriate G-code or CPT II code (when available) to a Medicare service claim that also contains the relevant ICD-9 code. For those who do report and qualify for the bonus, the bonus a practice receives will be the lesser of either:
The cap formula will take into account the average allowable charge on all claims that have performance standards reported on them. CMS will calculate this figure in 2008, after the program has ended. Bonuses will be paid out as lump sums to appropriate practices in 2009. Before you decide on whether your practice should participate in this initiative, you need to complete a cost/benefit analysis of the PQRI program and consider the amount of your time and effort that is needed to successfully participate in the program. Bonus Reimbursement Example: As an example, we will present an analysis of a hypothetical internal medicine practice and what additional revenue that they may be eligible for by participating in PQRI. A typical practice in NE Ohio may have Medicare revenues that comprise 20-30 % of their total revenue stream. We will use 25% Medicare as our base example. Each physician in this practice generates $425,000 net revenue a year: % of Net Revenue from Medicare= $425,000 X 25% = $106,250 Medicare Reimbursement Bonus Revenue for participation in PQRI= $106,250 X .1.5%= $1,594 In this analysis, this provider would receive, at a maximum, an additional $1,594 from Medicare for their participation in PQRI, assuming that the Medicare cap does not reduce the reimbursement further. On November 27, 2007, CMS published an update to this program on its website. For this and other information, please visit: http://www.cms.hhs.gov/PQRI/ Or fee free to call Michael
Moran at Alta Partners for more information- 440-808-3649.
Thank You! Alta Partners sincerely thanks all of our clients for providing us with the opportunity to work for you. We have experienced much growth since our founding in 2000, but our goal has remained constant – provide exceptional service and performance to each client regardless of size; from the solo practices to the largest, multi-specialty groups. Our growth is due to many factors, but two stand apart. First are the new client referrals from our clients who communicate our integrity, service and performance. The power of these referrals is beyond description and the lifeblood of all successful businesses. The second is the tremendous dedication and effort of our staff that produce our service and performance in countless little ways each day. Billing is one of the most complicated businesses to manage because of the need for constant attention to small details that, if left unattended, will quickly lead to poor performance. We are continually looking for ways to improve our processes, service, and performance. Most of the time these efforts are invisible to you, but rest assured that every day we continually look for ways to improve. You place your trust in Alta Partners for the most important non-clinical aspect of your practice. Everyone at Alta Partners thanks you for selecting us and we reaffirm our commitment to provide you with exceptional service and performance.
Email your ideas to Michael Moran @ mjm@altapartnersllc.com.
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In the final 2008 Medicare
physician fee schedule, the Centers for Medicare & Medicaid
Services (CMS) announced that the cut to physician payment
for Medicare services has increased from 9.9 percent to 10.1
percent, unless Congress takes action prior to Jan. 1,
2008. 
