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Alta
Partners News & Tips. Information to Improve your Practice |
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Table of Contents:
Alta
Says Goodbye To Jeff Kovacs As He Embarks On A New Career Challenge
Alta Partners
would like to congratulate and extend well wishes to Jeff Kovacs as he
begins the next phase of his professional career. Jeff has accepted a
position with a national ambulance service organization (publicly traded
business) that provides services in 35 states. As Director of Finance,
Jeff will move to a billing office that employs 350 staff and provide
financial support services to managers all over the country. Jeff’s
last day at Alta Partners was May 23rd. Jeff’s tenure with the organization predates Alta’s owners, Dan Kasinec and Stan Kasmarcak, as Jeff started working with the Fairview Medical Group while in college in patient registration/charge entry prior to when charges were entered at the physician office. We have all watched Jeff graduate college, get married, have two beautiful kids, and become a Certified Public Accountant (CPA). Jeff was instrumental in developing Alta’s current financial reporting activities he will be greatly missed by all of us for his contributions to the business as well as for his friendship. All of us at Alta Partners wish Jeff continued successes in his future career.
As of Monday, March 3, 2008, all providers (physicians and non physician practitioners) were able to use the revised ABN for all situations where Medicare payment is expected to be denied. The revised ABN replaces the existing ABN-G (Form CMS-R-131G), ABN-L (Form CMS-R-131L), and NEMB (Form CMS-2007). It has been announced that CMS will allow a 6-month transition period from the date of implementation of March 3, 2008 for use of the revised form and instructions. All providers must begin using the revised ABN (CMS-R-131) no later than September 1, 2008. To download the revised Medicare ABN form, please visit our website: http://www.altapartnersllc.com/client.htm and click on CMS ABN.
The Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) mandate the adoption of a standard unique health identifier for each health care provider. The (NPI) final rule, published on January 23, 2004, establishes the NPI as this standard. In accordance with the NPI final rule, when an identifier is reported on a claim for ordering/referring /attending/operating/other service facility provider or for any provider that is not a billing, pay-to or rendering provider, that identifier must be an NPI. For Medicare purposes this means that submission of an NPI for an ordering/referring/attending/operating/other service facility provider has been made mandatory effective May 23, 2008. Legacy numbers cannot be reported on any claims sent to Medicare on or after May 23, 2008. Medicare will not pay for referred/ordered services or items unless the name and NPI number of the referring/ordering/attending/operating/other/service facility provider is on the claim. It is the responsibility of the
claim/bill submitter to obtain the ordering/referring/
attending/operating/other service facility NPI for health care
providers. If the NPI is not directly furnished by the
ordering/referring provider at the time of the order, the provider
expected to furnish the services or items should contact that provider
for his/her NPI prior to delivery of the services/items. Providers who
have not obtained an NPI by May 23, 2008, are not permitted to
refer/order services or items for Medicare beneficiaries.
For more information of questions, please contact your Alta Partners account representative at 400-808-3654.
Trying to identify whether a patient has Medicare as the primary or secondary payer? Trying to load a patient’s insurance detail for patients who have Medicare as a secondary Payer (MSP)? Although these two processes seem like simple tasks, if either is done incorrectly, your practice may see a delay in payment for services rendered on these accounts. To help make these processes simpler, Alta has found a tool to help. Palmetto GBA (http://www.palmettogba.com/palmetto/providers.nsf/msp?OpenForm) has created an assessment tool with specific questions and answers that will help you determine whether or not a patient has Medicare as a Secondary Payer. The tool is simplistic and easy to use, but the patient must be present to assure the questions within the tool are answered correctly. Once all of the questions are answered, the website will specifically tell the provider if Medicare is the primary insurer or the secondary insurer. Below is a list of the Valid Medicare Secondary payer Types:
If it is determined that a patient has Medicare as a Secondary Payer, care must be taken to correctly enter the insurance detail into the billing system so that the claim can be processed correctly (If an MSP claim is submitted that does not correspond to the information that Medicare has on file, Medicare states that the claim will be rejected and the claim will have to be resubmitted with corrected information.). With this in mind, we have outlined the following steps to help you assure that the MSP patient information is correctly entered into your billing system:
The remaining data entry to a MSP patient remains the same as for any payer. Whether you are using Optimum or a DOS based program, the above steps are the same, although they may look a bit different. Please refer to the applicable picture below and follow steps 1-4 as outlined above for the system that your office uses. Optimum users:
Vision users:
For additional
questions regarding Medicare as a Secondary Payer, please
contact your Alta Partners representative @ 440-808-3654 or
refer to the Palmetto GBA website at
www.palmettobga.com.
Congratulations to Dan Kasinec, FACMPE Alta Partners own Dan Kasinec, FACMPE, was named Chair of the American College of Medical Practice Executives Professional Papers Committee and will be serving through October 2008. ACMPE is the certification and standard setting body of the Medical Group Management Association (MGMA), the leading practice management professional organization. Dan has served on the Professional Papers Committee for the past six years and has actively encouraged many MGMA members to attain ACMPE fellowship. Is this the year you become a Fellow in the American College of Medical Practice Executives (FACMPE)? Dan is encouraging all certified members to start the process to become a fellow and would particularly like to see a large number of new fellows from Ohio this year. There are several ways to learn more about ACMPE fellowship:
Important Reminder: Medicare 10.6% Physician Payment Cut Scheduled for July 1, 2008. Unless Congress acts to stop the Medicare payment cut scheduled to take place in July, family physicians will be hit with a decrease of more than 10 percent in Medicare payments. A decrease of this magnitude will make it more and more difficult for family physicians to keep their doors open to Medicare patients. Under ever increasing financial stress, some physicians may opt out of caring for Medicare patients, at a time when the number of Medicare beneficiaries is projected to reach all time highs. This “perfect storm” could bring devastating results to the health of our aging population!
Your legislators will soon be voting to
determine whether family physicians will see a payment
increase, freeze or cut. Congress needs to hear from YOU!
Support house bill S.2785,
the Save Medicare Act of 2008.
Contact your legislator today and tell him/her how proposed
cuts to the Medicare physician payment system, slated to go
into effect July 1, would affect your practice and the
patients you care for.
Although the use of the RBRVS is supposed to allow for an apple to apples comparison of inter-specialty services across the country, the PE and PLI components can vary greatly, causing variances in overall reimbursement. It should be noted that these reimbursement variances not only occur across the country, but even in similar geographic regions. Using Ohio reimbursement rates as the benchmark an analysis of the top procedure codes for a typical internal medicine physician reveals that in 2007, the average revenue / 2007 WRVU was $58.34. For the same service mix, the Medicare Fee Schedule would pay an internal medicine physician in Detroit $64.57 (110.7%), in Chicago $65.43 (112.1%), In Los Angeles, $71.59 (122.7%) and in Boston $75.63 (129.6%).
Understanding these differences is important when attempting to use national or even regional data to benchmark the operational efficacy of a physician practice. When a comparison such as this is used, the author(s) of the comparison must make a point to explain to the audience that although reimbursement varies from one area to the next, these variances should be commensurate with the differences in the physician practice expense (PE) and the professional liability insurance expense (PLI). For a more accurate analysis of a practice, it becomes important to understand what the benchmarks are for the region, or better yet, the particular area that a practice operates within (i.e. Northeast Ohio). As this data is not readily accessible, this level of comparison becomes difficult for most practices. But, a general understanding of these differences will make these operational analyses more meaningful. |
