PROTECTING YOUR
PRACTICE
CMS & The Admitting Physician Service in 2010
• For dates of service after January 1st,
2010, CMS requires the
"physician of record" or what we have always called the "attending
physician" to bill the admission code (99221 - 99223) with an AI
modifier.
CMS & Consultation Codes in 2010
• CMS will no longer cover consultation codes
99251 - 99255 or 99241 -
99245 if the date of service is after January 1, 2010.
• When performing an evaluation (consultation) in an outpatient or
clinic location, bill the appropriate new or established CPT codes
(99201 - 99215) depending on the level of service performed.
• When performing an evaluation (consultation) in an inpatient
location, bill 99221 - 99223 depending on the level of service
performed.
CMS & Consultation Code Crosswalk for 2010
• The purpose of the CMS published cross-walk
from consultation
codes to the hospital/outpatient codes was to establish CMS budget
neutrality. CMS has made it clear it is not to be used for billing
guidance and is advising physicians they should bill the E/M code
most appropriate for the service provided.
Denied Claims Cost Your Practice Money
• Are you ready to lose 5% of your annual
revenue? In the real world
this means for every $100,000 in annual revenue, you will lose
$5,ooo. That is how much money will not be collected when your
practice has too many denied claims. It equates to 5% of your annual
revenues.
Probability of Collecting Older Accounts
• Experts now say, you will lose 50% of the
money that is due you once
an account reaches the 60 day past due mark.
When to Hire a Consultant
-
There are many reasons when the best choice
for your practice maybe to hire a consultant. When an objective
point of view is needed, if a situation requires special
proficiency, the practice is facing a major crisis, or if
management seems to be operating in crisis mode.
Closing, Relocating, Change
in Status, or Changes in Members
- Physicians and
other suppliers are required to contact the Medicare contractor
to update records, if they decide to close or move their
practice or change members of a group within 30 days of the
change.
Terminating Reassignment
Agreements
- Individual practitioners should notify
Medicare within 30 days
of any change in reassignment agreements, since failure to do so
allows the previous entity to continue billing Medicare.
Individual practitioners and/or suppliers can terminate a
reassignment with the designated Medicare fee-for-service
contractor.
Routine Waiver of Patient
Responsibility
-
"There are a few instances where a provider is allowed to
write off the balance after Medicare has made payment.
This is not allowed on a routine basis. The provider must
make a reasonable effort to collect the coinsurance and/or
deductible. Providers that routinely waive the collections
of the coinsurance and/or deductible are in violation of the law
pertaining to false claims and kickbacks." According to
the Trailblazer Medicare Part B Newsletter No. 08-077, February
29, 2008
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