You may be already aware that the Senate failed to vote on a measure to delay the Medicare 21.2% cut for physician fee schedule services.  The cuts went into effect today, March 1, 2010.  However, the government did act as CMS instructed its contractors to hold claims for 10 days in the hopes that this will be fixed in that time frame. 

However, you may still submit all Medicare claims with dates of service prior to March 1, 2010 as those claims will not be affected. 

For a good article on this matter, click here.

Labels: medicare cuts, medicare sgr

Imagine collecting 41% of past due and slow pay accounts, guaranteed for as little as 5% of each outstanding account? If this was true, businesses and doctors would be able to collect a large amount of money that they were ready to "write off." Whether a business has hundreds of accounts or only a few, our Profit Recovery Service will accelerate their cash flow and virtually eliminate the need to turn accounts over to a traditional collection agency.

Traditional collection agencies can be upsetting because they give the impression to the debtor that they have been “turned in.” Businesses and Doctors love our service because we offer them professional guaranteed results that do not upset their customers like other collection methods.

Benefits of the Profit Recovery Service

• Because the collection demand is intensified and applied sooner, using more powerful tools than a traditional agency can deliver, we collect more than traditional methods for much less
• Recovery is also increased because every possible legal alternative is communicated to the debtor while the account is still collectable.
• Security of funds will be maintained, because the business receives all payments directly.
• Collection cost will be little or nothing! The cost of the system is partially or completely offset by the savings in internal expense. 

For more information, visit our profit recovery service page at www.profastbilling.com.

Labels: accounts receivable, collection agency, collections, profit recovery

1. Be a doctor again
You are a doctor, that is what you do best.  All of the other duties of your practice are administration, which take time away from seeing patients if you are wrapped up in the day-to-day operations.  With Medicare cuts, insurance paying less, costs rising, seeing more patients is as important as ever.  Handing these functions over to an outside medical billing service can free up staff to perform other essential operations that sometimes get pushed aside.  Likewise, outsourcing billing can also prevent your billing, collections, and follow up from being pushed aside as so often happens when the office gets busy.

2. Stay current with the latest updates
Healthcare billing is more complex now than even just 5 years ago.  Insurance carriers are constantly changing their rules, making updates, compliance and regulatory agencies do also.  And when the mandated switch to ICD-10 diagnosis coding occurs, there will be more than ever before to keep current with.  The focus of a professional biller is on the pulse of healthcare billing.  A good medical billing company can be a partner
to your success.

3. Reduce denials and collections
Denials can run up to 30% or more of a practice's billing.  Collections can be put off until the debt is so old it is uncollectable.  Even having an in-house billing person does not always resolve this.  It is inevitable that other tasks will draw the attention of staff throughout the day.  A medical billing specialist is dedicated to getting as much of your money for you as possible.  After all, they do not get paid if you do not get paid.

4. Lower your costs
This is a result of the last reason, as well as overall it is much more cost effective to outsource your medical billing.  The cost to hire, train, and employ an in-house biller can far exceed that of referring your claims filing to an outside source.  Plus, the motivation to collect your money for you is often times greater.  In-house staff gets paid whether your denials and unpaid claims are 35% or 2%.  For an outside biller, their pay is tied to your pay.  Who do you think is going to be more motivated?

5. Keep compliant without the cost
Another money saving consideration.  Think about what it costs you to stay compliant with your billing function.  Keeping a compliance plan in place, training, education for staff.  When you outsource, the cost of compliance and a compliance officer is taken on by the billing company who in turn is able to spread their cost out over several clients.

6. Technology is expensive - and requires constant updates
The cost savings just keep adding up when you outsource your medical insurance claims.  In-house billing software is expensive.  And it requires constant updates which are expensive.  Even if you use web-based applications, there are monthly costs associated with those as well.  Pass these costs off to a billing company. 

7. Payroll is one of your biggest expenses
The Society of Human Resources Management estimates that the cost of recruiting, hiring, and training a new employee is $3500.  Finding qualified billers can be difficult as well.  Factor in sick time, vacation time, employee turnover, benefits, taxes on employees and the costs add up.

8. Reduce employee theft
I wish I did not have to put this reason here, but you would be surprised at some of the stories I have come across.  Unfortunately there are people out there who might take advantage of you.  Having one person in-house handle the billing and the money could create an unwanted opportunity.  Having an outside company handle your claims filing will not eliminate this threat.  You will still handle the money in-house.  However, an independent medical billing service creates another "check and balance".  It is always a good idea to split the responsibilites that involve money between a few people.  This is not always possible in-house. 

So why would you not?
Sending your billing outside can feel like you are giving up control, and that is a legitimate concern.  If I did not address that here then I would be doing you a disservice.  After all, your claims are what keep the lights on.  It can be scary trusting the most important administration function of your practice to a third party biller.

But you do not have to give up control when you outsource your billing.  When hiring a billing company, ask questions, discuss expectations.  Keep good communication with your consultant.  Make sure they provide you with reports.  A company that files claims using web-based software can give you 24/7 access in real-time to the status of your money.

Physicians are already working harder than ever, and with changes in healthcare coming down the pipe, your burdens are bound to increase.  One question you may ask yourself is why have the additional burden of running a medical billing service?  Many business people today live by the rule - never do anything that you can have someone else do more efficiently and at a lesser cost.  Your practice is a business.  Could it run more efficient?  There are eight things for you to consider.  Ultimately, it is your decision.

Labels: healthcare claims outsourcing, outsource medical billing

by Jaun Paul

If the old HIPAA penalty rules confused you, don't expect too much from the new one; it's just a little better than the old one.

HSS issued an interim final rule with request for comments under the HITECH Act revisions on October 30, 2009. The HITECH stature requires HHS to develop new penalties for violations of health care security that occur after Feb 18, 2009. According to HHS, the rule making takes effect on Nov 30, 2009, which will consider comments until December 29 this year.

As per the proposed new rule, violations would be subject to penalty ranges that correspond to what the violator knew or didn't know: if he did not know about the violation, he would be subject to a penalty of $100 to $50,000 per violation; if a violation occurred due to reasonable cause, the penalty would be $1,000 to $50,000 per violation. The penalty would be between $10,000 and $50,000 per violation if there was willful neglect. And in case it was not corrected, the minimum penalty is $50,000 per violation.

According to Robert Markette, a partner with Gilliland & Markette LLP, one of the less clear areas of the HITECH Act was the penalties. She adds, "The way the statute was worded made it sound like the high end of the penalties was basically the same for all violations, which did not make much sense."

This can certainly be the case, but you should note that one can be penalized at the low and high ends for the exact amount of $50,000 per violation; HHS has tried to come up with a more rationale plan for civil penalties.

Markette says, "HHS should have structured it so that each tier ends at a level below the next tier, although I understand that they felt the statute tied their hands. It'll be interesting to see how penalties under these ranges play out."

Penalties are subject to an overall cap of $1.5 million for all violations of an identical provision in a year. That's about 6,000 % increase in the maximum penalty an organization or provider can pay for a HIPAA violation.

About the Author

We provide the latest developments of Compliance Law in health care according to health care security and offers advanced Learning Opportunities about HIPAA violation for healthcare executives, hospitals and physicians.

Labels: HIPAA, HITECH Act

By Angela S. Martin

Like any other healthcare provider, you probably have recurring nightmares about the OIG knocking at your door. But if you use certain audit strategies for OIG compliance, you can come out clean. Depending on what type of facility or physician office you work in, your audit strategies may vary. For some specialties and types of facilities, the OIG has specific concerns.

There are, however, many audit strategies for OIG compliance that all types of providers can use to their advantage.

Eye Care Services Are on the OIG's Hit List

Audit strategies for OIG compliance that some providers are using in terms of eye care services include:

• Shoring up medical necessity and documentation strategies to secure claims in the event of an OIG audit;
• Knowing exactly what you need with your E/M codes and how eye code requirements are entirely different;
• Understanding how to keep your E/M versus eye code ratios on target; and
• Nailing down reporting best practices to understand what E/M and eye codes should look like.

Secure Your OIG Compliance By Nailing Down Modifiers 25 and 59

Modifiers 25 and 59 are notoriously misused -- and the OIG is cracking down on these mistakes now more than ever. Include in your audit strategies for OIG compliance a clear understanding of how to use these two modifiers.

Instead of being afraid of using modifiers 25 and 59 -- and losing out on deserved reimbursement by failing to use them where appropriate -- you must take the time to learn the right way to append them. A quick-reference sheet can come in handy, and heed the OIG's own recommendations on how to use modifiers 25 and 59.

How to Survive an OIG Audit

One of the most important audit strategies for OIG compliance is preparation. You must understand how to handle an unannounced onsite audit and how to respond to a chart review. Comprehending the OIG Work Plan is also key to designing coding and reimbursement processes that keep your healthcare organization compliant and profitable.

If you don't already have one, you should develop an effective auditing and monitoring program for your medical practice. This internal program will not only lock in your compliance, but it can also increase your revenue and improve your quality of care. Most of all, an auditing and monitoring program will fully prepare you for an OIG audit.

One of the most important audit strategies for OIG compliance is preparation. You must understand how to handle an unannounced onsite audit and how to respond to a chart review by audit strategies for OIG compliance.

Article Source: http://EzineArticles.com/?expert=Angela_S._Martin

http://EzineArticles.com/?Audit-Strategies-For-OIG-Compliance&id=2585882

Labels: audit strategies, oig audit, oig compliance