A. Oh yes, Medicare is in a bit of flux these day.  Congress voted just before Christmas to delay the Medicare Physician Fee Schedule (MPFS) cut until March 1. The stage is set for a repeat of 2010 when Congress voted five separate times to delay the MPFS cut and in the middle of the year voted a 2% retroactive increase.

Things could get confusing.  Here are a few key Medicare points you should be aware of (and keep a watchful eye on):

• For 2012, Medicare has a $140 deductible with the same 80/20% co-insurance for allowable services.  (Interesting note: That’s LESS than last year’s deductible!).
• The latest version of the Advanced Beneficiary Notice of Noncoverage (ABN), with the release date of 3/2011 printed in the lower left hand corner, should now be in use at your office.  Mandatory use of this version began on January 1, 2012. All ABNs with the release date of 3/2008 that are issued on or after January 1, 2012 will be considered invalid.  If you need the new version, you can find it here.
• At this time any fee schedule reductions have been put on hold until March 1, 2012 and you should continue to bill as normal.  Per a special email announcement from us, and various posts to our Facebook page, we passed along the advice of Ron Short, Heartland Consulting Group, who advised that the best way to protect yourself from the uncertainty and a repeat of 2010′s chaos was to become a participating provider (if you were not one already).  Ron says…

“As a par provider you can bill Medicare your full fee. They will reduce it to the allowed amount, whatever that may be at the time, and you write off the rest. You will also receive any retroactive fee increases. Due to the uncertainty, Medicare has extended the deadline for changing your participation status to February 16. Act now to protect yourself in these uncertain times.”

To become a participating provider, you will want to submit a CMS-460 Participation Agreement form, which you can download here. If you are not a participating provider, you’ll want to take action on this quickly.  If you have questions, we recommend contacting Dr. Ron Short directly by phone at 217-285-2300 or by email.

Above all, keep your eye on your email’s inbox and on our Facebook page for continued updates.

A. We get this question quite often and while many chiropractic coaches and practice management programs advise DC’s to collect fees for services weeks ahead of the actual service date, for your Medicare patients, this procedure is a problem.

PLEASE BE AWARE:
It is against the law to receive pre-payment for services from your Medicare patients.

The rules for the Advance Beneficiary Notice (ABN) state that on all Medicare patients, the Doctor must make an assessment each and every visit so he/she can inform the patient TODAY if they believe those services will be payable (or not payable) by the Medicare carrier.

If not payable by the Medicare carrier, the Doctor MUST inform the patient PRIOR to that service so the patient can make an informed consumer decision whether to take financial responsibility for the non-payable service or decline receiving that service alltogether.

It doesn’t make a difference if you are a PARTICIPATING PROVIDER OR A NON-PARTICIPATING PROVIDER. Collecting money for services in the future for this patient is illegal. If you have been doing this in your office we recommending ending this procedure immediately!

Medicare can be an excellent program, providing services to people who otherwise could not receive them.  However, you must follow the rules so you don’t find yourself in Medicare trouble!

A. We rely on Dr. Ron Short, Heartland Consulting Group, to keep his finger on the pulse of the latest developments in Medicare.  Yesterday afternoon Ron passed along an urgent alert so your question is very timely.

Many DCs have been paying close attention to the pending legislation regarding the Medicare Physician Fee Schedule (MPFS) “negative adjustment” (Washington-speak for “drastic cut”).  At this point it doesn’t look likely the issue will be resolved before the end of the session and before the cuts go into effect.

This happened once before.  According to Ron:

“In 2010 Congress enacted a retroactive 2% increase to the MPFS.  Those providers that were Participating Providers and were billing Medicare their full fee were automatically paid this 2% increase.  Those providers that were not participating or did not bill their full fee to Medicare did not receive the retroactive portion of the increase.  If you are a non-participating provider you have until the end of December to change your participation status.”

And that’s precisely what Ron is recommending you do:

“I recommend that you become a participating provider with Medicare if you are not already.  Participation means that you will accept assignment on all Medicare claims for the year.  Non-participation does not provide you with any protection from audits or reviews or from refunding overpayments.”

Ron was kind enough to include the form needed to become a participating provider (CMS-460 Participation Agreement) and we’ve added a link to the form for your convenience.

If you are not a participating provider, you’ll want to take action on this quickly.  If you have questions, we recommend contacting Dr. Ron Short directly by phone at 217-285-2300 or by email at ChiroMedicare@gmail.com.

A. Yes, you’re correct, there are new rules for recovering Medicare overpayments and it is very important that you understand what constitutes an overpayment and how Medicare collects overpayments.

“A Medicare overpayment is a payment that a physician or supplier has received in excess of amounts due and payable under Medicare statute and regulations.”

If an overpayment of $10 or more is identified the following steps will be taken:

• A demand letter will be sent to the provider requesting payment.
• If no response is received a second demand letter is sent.
• If no response is received within 41 days from the date of the first letter then recoupment procedures will begin.

Recoupment involves withholding future payments.  They can also raid your bank account using the Electronic Funds Transfer process.  An appeal will stop recoupment, but it has to be filed within 30 days.

A. Congratulations on your move! We’ve been through it and between furniture and computers, address change forms and telephone numbers, moving your office location is a huge undertaking. Still, if you follow these steps below (many of which you could even delegate to staff) you’re sure to have at least the insurance and billing aspects of your move handled.

IN-Network insurances: Many companies, especially government programs (medicare & medicaid), require paperwork to be submitted in order to validate a change of address. You will want to contact each insurance that you are in-network with and ask what forms, if any, are required for a change of address. As a precaution, you will also want to ask if all claims can be submitted under your new address (including dates of service prior to your move date).

OUT-of-Network: Usually, you don’t need to fill out forms. Just complete a w9 form and send it into the insurance companies (if billing by paper) when you send in your patient claims…..(this is assuming you are submitting HCFA 1500 claims on behalf of your patients and not giving itemized statements/receipts to your patients to submit for themselves.) If you are billing claims electronically, simply send the w-9′s separately to each insurance company.

IRS: Make sure you fill out a change of address form so they know what address your tax id# is registered to for the state and the federal government.

NPI: Make sure to update your change of address information with the NPI website.

If you are a Money Tree client: Let us know your new address, when the change will be effective and fill out a w9 Form for our records.

A. Yes, audits aren’t pleasant, that’s for sure.  They are uncomfortable and stressful.  Worse, they take you off track and distract you from other important things like pratient care, marketing and managing your team.

While you can never protect yourself 100% from an audit, there are some basic things you can do to avoid triggering one and below we spotlight our 4 best tips…

1. Don’t use the same treatment code on everyone! Medicare requires that the services you bill for are supported diagnostically. If the patient has complaints in only one area, bill for one area. If there are issues up & down the spine, bill for it – but diagnose it appropriately. You can now send electronic claims to Medicare with up to six diagnoses.

2. Use diagnoses from Medicare’s approved list. Contact us if you didn’t know there was one.

3. Update the patient’s condition when there is a change.  That means updating the date of injury and the diagnosis whenever the patient presents with a new condition, or a re-injury of a previous condition. Document it in your treatment notes!

4. If a patient is receiving “maintenance care,” as defined by Medicare, you need to bill it that way, using the correct modifier. Have the patient sign an ABN. Medicare does not pay for maintenance care, and they go by their definition, not yours. Be aware & try to judge each visit. Explain fully to your patients that Medicare does not cover maintenance care visits and that the services won’t be reimbursed.

A. This short video will guide you through the process of uploading documents to your secure FileBox account to share with your billing specialistis at Money Tree Billing, LLC.

A. This short video will  guide you through the process of reviewing and downloading documents placed in your secure FileBox account by Money Tree Billing, LLC.

A. We get asked this question a lot and we have many success stories that make for some pretty compelling evidence that outsourcing insurance billing makes sense for most offices.  We also know that at its core, this question is about money, time and value.  Perhaps what you’re really asking is, “Will I save money by outsourcing and will outsourcing really make a positive impact on my office’s bottom-line?”

Well as they say, “There’s an app for that,” or at least an online form!  The best way to know the costs associated with handling your insurance billing in-house, with that of outsourcing to Money Tree Billing, is to complete our online Billing Cost Analysis.  Completing this simple online form allows us to create a customized report which outlines your in-house costs and the dollars, if any, that could be saved and added to your practice’s bottom-line.

You have nothing to lose, and you receive your personalized report without any obligation.  Complete your Billing Cost Analysis today!

A. Yes it’s true!  Not only do you have timely filing limits when originally billing a claim but you also have timely filing limits when appealing a claim.  The limit for filing timely appeals ranges for most companies from 90-days to 1-year.  Best rule to apply here – is the “One Touch Rule”…File your appeal the minute you receive your timely filing denial.

Also, be sure to follow up within 30-days to verify that your appeal is on file.  Unfortunately, it’s common for your appeals to “mysteriously” never arrive.  Also verify with insurance companies whether they have a specific form required and whether or not your appeals can (or have to be) submitted online.