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Alta
Partners News & Tips. Information to Improve your Practice |
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Table of Contents:
Alta
Partners to Present at 2009 OHA Annual Meeting
Stan Kasmarcak, Principal and Michael Moran, Consultant have been selected to present at the 2009 OHA (Ohio Hospital Association) Annual Meeting. The meeting will take place at the Hilton Easton in Columbus on June 15, 16 and 17. Stan has been selected to present in the Physician Recruitment curriculum. His presentation entitled “Physician Compensation: Plan Designs that Align the Incentives of Your Organization and Your Employed Physician”, will provide an overview of different strategies to incentivize an employed physician to remain actively engaged in the strategic vision of an organization. Michael has been selected to present as part of the Business Development curriculum. His presentation entitled “Benchmarking: The State of Physician Practices in Ohio” will provide an overview of the methods used to benchmark physician practice’s and will provide real data from the Ohio marketplace to demonstrate what separates a successful practice from one that operates at a loss. If you are in attendance to this years meeting, stop by and hear what Stan and Mike have to say!
BWC's 2009 Provider Fee Schedule Rule Passes On Jan. 29, 2009, the Joint Commission on Agency Rule Review (JCARR) passed the BWC 2009 fee schedule rule for medical services providers, Administrative Code (OAC) 4123-6-08. The 2009 rule became effective Feb. 19, 2009. Services rendered on or after Feb 19, 2009, will be reimbursed under the newly passed rule and corresponding fee schedule. Services that were rendered prior to Feb. 19, 2009, will be reimbursed pursuant to the fee schedule that was in effect at the time those services were rendered.
Introducing Our New Client Support Employee Kathy! Alta Partners would
like to acknowledge the advancement of Kathy Osborne to
client support representative. Kathy has been training
for the past few months and
is now ready to support all of our clients needs.
Kathy can be
reached at 440-808-3662 or
kao@altapartnersllc.com.
Please keep her contact information handy and don't be shy
to give her a call next time you need support!
Medicare Prevention Program - Diabetes Did you know that 11% of Individuals living in Northeast Ohio are diabetic, a rate that is 4% higher than the national average for this disease? And did you know that chronic diseases—such as diabetes—are the leading causes of death and disability in the United States. Diabetes can cause serious health complications, including heart disease, stroke, blindness, and leg and foot amputations. It is the leading cause of blindness and end stage renal disease. People with diabetes are more susceptible to other illnesses, and once they acquire them, they often have worse prognoses. For example, people with diabetes are more likely to die of pneumonia and influenza than people who don't have diabetes. But now the good news that you may or may not know - Medicare covers services to help people with diabetes manage their condition so they can prevent or reduce the severity of diabetes-related complications. Coverage Information Medicare Beneficiaries who have any of the following risk factors for diabetes are eligible for this benefit: •
Hypertension OR Beneficiaries who have a risk factor consisting of at least two of the following characteristics are eligible for this benefit: •
Overweight (a body mass index greater than 25 but less than
30 kg/m2) DIABETES SELF-MANAGEMENT TRAINING (DSMT) Medicare provides coverage for diabetes self-management training (DSMT) services for beneficiaries who have been recently diagnosed with diabetes, determined to be at risk for complications from diabetes, or were previously diagnosed with diabetes before meeting Medicare eligibility requirements and have since become eligible for coverage under the Medicare Program. DSMT services are intended to educate beneficiaries in the successful self-management of diabetes. The program includes instructions in self-monitoring of blood glucose; education about diet and exercise; an insulin treatment plan developed specifically for the patient who is insulin-dependent; and motivation for patients to use the skills for self-management. Medicare provides coverage of DSMT services only if the treating physician or treating qualified non-physician practitioner managing the beneficiary’s diabetic condition provides a referral certifying that DSMT services are needed. Eligible beneficiaries may receive 10 hours of initial training and 2 hours of follow-up training for subsequent years following the initial training, when ordered. Coverage for DSMT services is provided as a Medicare Part B benefit. The coinsurance or co-payment applies after the yearly Medicare Part B deductible has been met MEDICAL NUTRITION THERAPY (MNT) Medicare provides coverage of medical nutrition therapy (MNT) for beneficiaries diagnosed with diabetes or renal disease (except for those receiving dialysis). Renal Disease For the purpose of this benefit, renal disease means chronic renal insufficiency or the medical condition of a beneficiary who has been discharged from the hospital after a successful renal transplant within the last 36 months. Chronic renal insufficiency means a reduction in renal function not severe enough to require dialysis or transplantation [Glomerular Filtration Rate (GFR) 13-50 ml/min/1.73m2] Medicare-Covered MNT Services For the purpose of disease management, MNT services covered by Medicare include: • An
initial nutrition and lifestyle assessment The MNT benefit is a completely separate benefit from the DSMT benefit. MNT services covered by Medicare may only be provided by a registered dietitian or nutrition professional who meet certain provider qualification requirements, or a “grandfathered” dietitian or nutritionist who was licensed or certified in a State as of December 21, 2000. A treating physician (primary care physician or specialist coordinating care for beneficiary with diabetes or renal disease) must make a referral for MNT services and indicate a diagnosis of diabetes or renal disease. The referral must be renewed yearly for follow-up care if continuing treatment is needed into another calendar year. This benefit provides 3 hours of one-on-one MNT services for the first year and 2 hours of coverage for each subsequent year. Additional hours may be covered if the treating physician orders additional hours of MNT based on a change in medical condition, diagnosis, or treatment regimen. COVERED SUPPLIES AND OTHER SERVICES FOR BENEFICIARIES WITH DIABETES Medicare provides limited coverage of the following supplies for beneficiaries with diabetes: • Blood
glucose self-testing equipment and associated accessories
Medicare also provides coverage of the following services for beneficiaries with diabetes: • Foot
care DIABETES SUPPLIES AND SERVICES NOT COVERED BY MEDICARE Medicare Part B may not cover all supplies and equipment for beneficiaries with diabetes. The following may be excluded: • Insulin pens Note: Insulin not used with an external insulin pump and certain medical supplies used to inject insulin are covered under Medicare prescription drug coverage. For more information on coverage exclusions, contact your local Medicare Contractor. For more information about coverage, coding, billing, and reimbursement of Medicare-covered preventive services and screenings, visit:
http://www.cms.hhs.gov/MLNProducts/35_PreventiveServices.asp
Alta Partners Celebrates Our Ninth Annual NCAA Basketball Charity Tournament It’s certain that spring is just around the corner when NCAA college basketball starts to take over all of the sports headlines. To help to celebrate all of the action (and help get rid of a serious case of “cabin fever” from the long winter), Alta Partners once again sponsored a fund raiser NCAA Basketball Tournament for family, friends, and business associates. This year’s tournament raised money for the non-for-profit organization, Community Challenge, who is dedicated to the prevention of youth alcohol and drug abuse in the western suburbs of greater Cleveland. Collectively, this year’s tournament players raised $1,140 for the organization. Alta Partners matched the amount raised with a donation of our own for a total contribution of $2,280. So who were this
year’s winners?? Fred DeGrandis, from the Cleveland
Clinic Health System took the first place prize by being the
only participant out of 114 players to correctly pick the
Final Four, the two finalists, North Carolina and Michigan
State, and the ultimate winner, North Carolina. Second
place went to Brian Kenyon, CFO of the Rock n Roll
Hall of Fame, and third place was earned by Margo Moore,
Director of EMH’s Medworks in North Ridgeville. Thank
you everyone who participated this year! We look
forward to sponsoring another fine charity and another great
tourney next spring.
Patient Demographic Data- How accurate is your office?
With the postal service becoming much strict with the delivery of mail and with there always seeming to be a delay in the return of mail that is misaddressed, inputting correct patient data remains a high priority of front office personnel. One example of a common data entry mistake that can delay the prompt payment of a claim: The use of acronyms on address street names causing the Post Office states “no such street”: 142 SR 242 should be 142 State Route 242 356 TR 62 “ 356 Township Rd 62 Another common mistake is a simple misspelling of a street name: 891 Benny St “ 891 Denny St In the past, some experts recommended utilizing the white pages to try and verify mailing addresses that were in question. Although time consuming on the front end, this effort saved time in the overall life cycle of the claim. But, in this new age of communication, this process is becoming less informative with the onset of our patients’ use of cell phones and unlisted phone numbers. Just a moment of verification at the onset of each patient visit to verify personal information saves much time spent later trying to correct these errors. An added benefit of this simple process is a cleaner Accounts Receivable Aging report, which in turn makes all of our lives much happier.
CMS Recovery Audit
Contractors - In the Tax Relief and Health Care Act of 2006, The United States Congress required a permanent and national Recovery Audit Contractor (RAC) program to be in place by January 1, 2010. The national RAC program is the outgrowth of a successful demonstration program that used RAC’s to identify Medicare overpayments and underpayments to health care providers and suppliers in California, Florida, New York, Massachusetts, South Carolina and Arizona. The demonstration resulted in over $900 million in overpayments being returned to the Medicare Trust Fund between 2005 and 2008 and nearly $38 million in underpayments returned to health care providers. The goal of the recovery audit program is to identify improper payments made on claims of health care services provided to Medicare beneficiaries. Improper payments may be overpayments or underpayments. Overpayments can occur when health care providers submit claims that do not meet Medicare’s coding or medical necessity policies. Underpayments can occur when health care providers submit claims for a simple procedure but the medical record reveals that a more complicated procedure was actually performed. Health care providers that might be reviewed include hospitals, physician practices, nursing homes, home health agencies, durable medical equipment suppliers and any other provider or supplier that bills Medicare Parts A and B. As part of preparing Medicare providers for the RAC program as it is phased in nationally, CMS will continue working closely with national and state medical, hospital and nursing home associations to strengthen relationships to be more proactive and anticipate the needs and concerns of health care providers. Before work begins, the RACs will hold “Town Hall” type meetings in each state with health care providers and CMS staff and representatives. Health care providers can get more information about these meetings and the date the program will begin in their states by checking the CMS RAC Web site: www.cms.hhs.gov/RAC/Downloads/RAC%20Expansion%20Schedule%20Web.pdf. To prepare for the start of the program, health care providers should consider conducting an internal assessment to ensure that submitted claims meet the Medicare rules. Other steps that providers should take include: · Identifying where improper payments have been persistent by reviewing the RACs’ Web-sites and identifying any patterns of denied claims within their own practice or facility. · Implementing procedures to promptly respond to RAC requests for medical records. · If the provider disagrees with the RAC determination, filing an appeal before the 120-day deadline. · Keeping track of denied claims and correcting these previous errors. · Determining what corrective actions need to be taken to ensure compliance with Medicare’s requirements and to avoid submitting incorrect claims in the future. CMS will continue to
monitor the efforts of the RACs to ensure they are providing
sufficient information and undertaking outreach activities
to reach all the health care providers in their regions so
no provider feels unreasonably burdened.
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