Sunday, 22 January 2017

Covered Counseling Service for Increased Risk Patients

When scheduling a patient for their first visit to your practice, you should advise them of what they need to bring to help ensure a smooth registration process and to assist your physician in making that first visit as thorough as possible.

Follow this check list as a guide:

Picture identification and current insurance card(s)

Hint:  Once provided with this information, you need to verify insurance coverage and benefits.  This is the optimum time to collect copayments from the patient.

Contact information for emergency contact and/or healthcare surrogate

Hint:  Make sure the patient indicates the name(s) of any authorized persons on your HIPAA notification form.

Contact information for all current healthcare providers

Hint:  Please have the patient add to the HIPAA form, the names of any physicians they would like your physician to communicate with or share their medical records.

Copies of any applicable medical records and recent diagnostic testing results

Hint:  If you are handed records that are the patient’s only copy, make your own copy and return the “originals” to the patient.  They may need them for another provider.  X-rays or radiology “films” stored on computer discs, should be logged in the patient’s record if they are left behind after the visit.

Complete list of current medications, both prescription and over the counter.

Hint:  Adding the pharmacy name and phone/fax number into the patient chart facilitates issuing any required prescriptions.

Medicare Covers STDs Screening

Sexually Transmitted Diseases (STDs) are no longer conditions that are only discussed in back alley clinics.  Proof is based on the fact that statistics show that STDs are commonly affecting those as young as 15 and Medicare now covers STD preventive services.  A diverse range of clinicians from Pediatrics to Geriatric Medicine are being called upon to help reduce STD’s in our communities.

Not all diseases are preventable, but in the case of STDs, awareness is the key to prevention as emphasized this month by Centers for Disease Control (CDC).  As always awareness goes hand in hand with education.  As the key sponsor of Sexually Transmitted Disease Awareness for the month of April, the CDC is offering a wide range of information for both the public and healthcare professionals alike.

Many people would be shocked to read these STD statistics:

Approximately 20 million new STD’s are diagnosed each year

Half of all new STD’s are attributed to people age 15-24

Annual cost of treating STD’s is almost $16 billion

Even though there have been noted disparities in the occurrence of STDs in certain populations, there is no race, sex, economic status or age group that is exempt.  It is of the utmost importance that healthcare professionals take advantage of each opportunity to have an open and frank discussion with all of their patients regarding these highly preventable conditions.  

These discussions should include these basics:

Inquiries about high risk behavior

Ways to prevent contracting a disease

The signs and symptoms associated with common STDs

As mentioned earlier in this article, as of November 8, 2011, CMS made Sexually Transmitted Infections (STIs) and High Intensity Behavioral Counseling (HIBC) part of its panel of covered preventive services.

The tables below highlight coverage information that can be found at: http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/PreventiveServices.html

Covered Screening Service for Increased Risk Patients

HCPCS/CPT Codes
ICD-9 Codes
Patient Financial Responsibility

Chlamydia
86631, 86632, 87110, 87270, 87320, 87490, 87491, 87810
Non-pregnant female:V74.5 & V69.8
Pregnant female: V74.5 & V69.8 & V22.0,V22.1, or V23.9
Deductible and coinsurance waived

Gonorrhea
87590, 97591, 87850
Non-pregnant female:V74.5 & V69.8
Pregnant female: V74.5 & V69.8 & V22.0,V22.1, or V23.9
Deductible and coinsurance waived

Combined Chlamydia and Gonorrhea
87800
Non-pregnant female:V74.5 & V69.8
Pregnant female: V74.5 & V69.8 & V22.0,V22.1, or V23.9
Deductible and coinsurance waived

Syphilis
86592, 86593, 86780
Non-pregnant female:V74.5 & V69.8
Pregnant female:V74.5 & V22.0, V22.1 or V23.9
Male: V74.5 & V69.8
Deductible and coinsurance waived

Hepatitis B
87340, 87341
Pregnant female: V73.89 & V69.8 & V22.0, V22.1, or V23.9
Deductible and coinsurance waived

Covered Counseling Service for Increased Risk Patients

HCPCS/CPT Codes
Frequency
Patient Financial Responsibility

High Intensity Behavioral Counseling
G0445
Up to two HIBC counseling sessions annually
Deductible and coinsurance waived

Equal Healthcare for Minorities

This April, National Minority Health Month is supported by the Office of Minority Health and other agencies to raise awareness about health disparities that continue to affect racial and ethnic minorities. The Patient Protection and Affordable Care Act's groundbreaking policies are aimed to reduce these disparities and achieve health equity.

Health disparities defined

The National Institutes of Health (NIH) defines health disparities as differences in the incidence, prevalence, mortality, and burden of diseases and other adverse health conditions that exist among specific population groups.

The Patient Protection and Affordable Care Act also created the National Institute on Minority Health and Health Disparities (NIMHD) at NIH. The NIMHD will control all aspects of the NIH in regards to these minority health issues. The main goal is to bring attention to and find solutions for the unequal burden of illness affecting minority, rural and poor populations in this country.

The United States Department of Health and Human Services (HHS) drew on the same legislation when developing its Disparities Action Plan. The HHS Action Plan to Reduce Racial and Ethnic Health Disparities outlines goals and actions HHS will take to reduce health disparities among racial and ethnic minorities that include current common healthcare improvement strategies of evidence-based programs, integrated approaches and best practices.

Racial and ethnic minorities

The HHS Disparities Action Plan is designed around race and ethnicity, but those are not the only American populations effected by health disparity. Geographical location and poverty have long been associated with reduced healthcare equity. Religion, gender, age mental health, disability, sexual orientation or gender identity can all provide obstacles to appropriate healthcare.

Even though causes of health disparities can vary as widely as the diversity of the population, one issue consistently shows to be a key indicator in the quality of health care received by minority populations: insurance coverage. Statistics have shown that racial and ethnic minorities are significantly less likely than the rest of the population to have health insurance. (See table below)

This article highlights how the ACA will facilitate access to insurance:

As we have seen numerous public agencies have all joined together to affect change in the area of health disparities. Each of them plays a significant role in achieving the goals of the Healthy People 2020 initiative. Additional information can be found on the main CDC Minority Health website.

2010 United States Census has published the following insurance coverage statistics:

Race/Ethnic Group % of Population with No Insurance
African-Americans 20.8
American Indians/Alaska Natives 29.2
Asian-Americans 18
Hispanics 30.7
Native Hawaiians/Pacific Islanders 17.4
Non-Hispanic Whites 11.7

Saturday, 21 January 2017

Allergy Immunotherapy Billing

Allergy Immunotherapy Billing

Whoever wrote “April showers bring May flowers” held the key to the peak Allergy and Asthma season.  May has been designated an awareness month for Allergy and Asthma by the Asthma and Allergy Foundation on America (AAFA).  Asthma and allergy are commonly “linked” together as allergies can be one of the major contributing factors for those patients diagnosed with asthma.

Asthma and allergy have been estimated to affect one in five Americans.  As a health care professional, there are significantly high odds you encounter these conditions in a high proportion of your patient population.  If you are a primary care type provider, you may be able to adequately treat those mild sufferers.  For those with more severe symptoms, a referral to an Allergy and Asthma Specialist will be warranted.

A common treatment for allergies is Allergen Immunotherapy or “allergy shots”.  This type of treatment is prescribed by the Allergy specialist who also may administer the treatment personally.  In today’s healthcare environment though, many managed care organizations prefer the patient receive the treatment via their assigned primary care provider.  The table below provides CPT codes that are used in the billing of allergen immunotherapy.

Tips for Allergy Sufferers

See the following tips on allergy exposure and prevention.  For more detailed information on Allergy and Asthma see the website for the Asthma and Allergy Foundation on America (AAFA).

Some facts about allergy exposure:

Allergens can be inhaled  airborne allergens / ingested food allergies / penicillian allergy  injected / insect venom / absorbed through the skin contact allergy

Jackson, MS ranked #1 in the AAFA report on the 100 most challenging places to live with allergies  mississippi

Prevention tips: 

dust to control mites /  dust mites / vacuum often  indoor allergies
pet dander / reduce pet dander /  outdoor allergies  shut out pollen   mold  avoid mold spores

CPT CODE : DESCRIPTION

95115

One Injection only, no serum-PROFESSIONAL SERVICES FOR ALLERGEN IMMUNOTHERAPY NOT INCLUDING PROVISION OF ALLERGENIC EXTRACTS; SINGLE 
INJECTION

95117

Two or more injections,  no serum-PROFESSIONAL SERVICES FOR ALLERGEN IMMUNOTHERAPY NOT INCLUDING PROVISION OF ALLERGENIC EXTRACTS; 2 OR MORE INJECTIONS

95144

Serum only, single dose vial, bill number of vials-PROFESSIONAL SERVICES FOR THE SUPERVISION OF PREPARATION AND PROVISION OF ANTIGENS FOR ALLERGEN IMMUNOTHERAPY, SINGLE DOSE VIAL(S) (SPECIFY NUMBER OF VIALS)

95145

Single insect venom only, multi-dose vial, bill number of does-PROFESSIONAL SERVICES FOR THE SUPERVISION OF PREPARATION AND PROVISION OF ANTIGENS FOR ALLERGEN IMMUNOTHERAPY (SPECIFY NUMBER OF DOSES); SINGLE STINGING INSECT VENOM

95146

Two insect venoms only, multi-dose vial, bill number of does-PROFESSIONAL SERVICES FOR THE SUPERVISION OF PREPARATION AND PROVISION OF ANTIGENS FOR ALLERGEN IMMUNOTHERAPY (SPECIFY NUMBER OF DOSES); 2 SINGLE STINGING INSECT VENOMS

95147

Three insect venoms only, multi-dose vial, bill number of does-PROFESSIONAL SERVICES FOR THE SUPERVISION OF PREPARATION AND PROVISION OF ANTIGENS FOR ALLERGEN IMMUNOTHERAPY (SPECIFY NUMBER OF DOSES); 3 SINGLE STINGING INSECT VENOMS

95148

Four insect venoms only, multi-dose vial, bill number of does-PROFESSIONAL SERVICES FOR THE SUPERVISION OF PREPARATION AND PROVISION OF ANTIGENS FOR ALLERGEN IMMUNOTHERAPY (SPECIFY NUMBER OF DOSES); 4 SINGLE STINGING INSECT VENOMS

95149

Five insect venoms only, multi-dose vial, bill number of does-PROFESSIONAL SERVICES FOR THE SUPERVISION OF PREPARATION AND PROVISION OF ANTIGENS FOR ALLERGEN IMMUNOTHERAPY (SPECIFY NUMBER OF DOSES); 5 SINGLE STINGING INSECT VENOMS

95165

Serum only, multi-dose vial, bill number of doses-PROFESSIONAL SERVICES FOR THE SUPERVISION OF PREPARATION AND PROVISION OF ANTIGENS FOR ALLERGEN IMMUNOTHERAPY; SINGLE OR MULTIPLE ANTIGENS (SPECIFY NUMBER OF DOSES)

May 6th. is Melanoma Monday

The American Academy of Dermatology (AAD) designates the first Monday in May as Melanoma Monday®.  The AAD spearheads the effort to raise awareness of melanoma and other types of skin cancer. 

Skin Cancer Statistics skin cancer statistics

• Skin cancer is the most common cancer in the United States.

• Current estimates are that one in five Americans will be diagnosed with skin cancer in their lifetime.

• Melanoma, the deadliest form of skin cancer, is the most common cancer for 25- to 29-year-olds.

Don’t be one of those statistics.  Use the tools below:

Check your skin skin cancer self examination  Early detection through self-exams can sometimes be the difference between life and death.

Free cancer screeningFree Cancer Screening   Dermatologists across the country volunteer their time to provide free skin cancer screenings. 

Prevent Skin Cancer prevent skin cancer  The most preventable risk factor for developing skin cancer is sun exposure.

Friday, 20 January 2017

Participate in regular physical activity that should include something from each of these three categories:

Aerobic conditioning, muscle strengthening, and balance and flexibility training. In the Active Living portion of the National Prevention Strategy the Surgeon General recommends:

For adults  at least 150 minutes of moderate-intensity activity each week works out to be less than 25 minutes per day.

Educational materials to help you add activity into your daily life can be found on the CDC website. For children and teenagers one hour of activity  at least one hour of activity each day can easily replace time spent on the computer or in front of the television.

Let’s Move is the initiative backed by President and Mrs. Obama to encourage our youth to be more active. 

Adopt healthy eating habits by following the guidelines from the USDA. 

Here is a sample of the guidelines for an average adult:

2000 calories per day composed of 6 ounces of whole grains, 2and ½ cups of vegetables, 2 cups fruit, 3, cups low fat dairy, and 5 and ½ ounces of lean protein.

Go to the USDA Choose My Plate website for tips to help you create your family’s healthy eating plan.

Get adequate sleep as indicated in the chart below from the National Sleep Foundation. 

Incorporating some of these tips can help you fall asleep easier and rest better.  

Maintain a consistent bed and wake time.  

Following a relaxing pre-bedtime ritual 

Make sure where you sleep is dark, quiet, cozy and at a comfortable temperature

Avoid working or watching television in bed

Exercise regularly 

Eat at least 2-3 hours before bed and avoid alcohol and nicotine near bedtime

NEWBORNS : (0–2 months)

12–18 hours

INFANTS : (3–11 months)

14–15 hours

TODDLERS : (1–3 years)

12–14 hours

PRESCHOOLERS : (3–5 years)

11–13 hours

SCHOOL-AGE CHILDREN : (5–10 years)

10–11 hours

TEENS : (10–17)

8.5–9.25 hours

ADULTS

7–9 hours

Obtain regular medical check-ups to ensure a well-rounded and thorough approach to your good health.

Make an annual visit to your medical doctor for physical and routine labs.  Also follow any recommendations for additional screening examinations or diagnostic testing. 

The ADA advises at least one visit to the dentist per year, preferably two. 

Even people who do not require vision correction should have an examination by an eye care professional.  See the American Optometric Association website for age specific recommendations.

“The quality or state of being in good health especially as an actively sought goal.”

Take advantage of May as Family Wellness month, to make not just your wellness, but that of your entire family your actively sought goal.

If we think about this word “goal”, we must conclude that achieving true wellness requires proper effort, maybe even real work and a strong strategy.

wellness strategy

Each of these items below is a key team player in winning the wellness game for your family.


Thursday, 19 January 2017

Medical Office Workflow Step 2: Proper Insurance Verification

For successful claims processing and payment, it all starts with the proper verification of insurance coverage and benefits.

Proper claims reimbursement

Follow the guide below to ensure you are gathering all the necessary information to create a complete and accurate patient benefit profile.

Medical billing hint 

Basic information needed before contacting the insurance company:

1.First and last name of patient and the subscriber (if other than the patient)

2. Patient’s date of birth

3. Policy number as shown on the insurance card

Medical billing hint

(The insurance card is one piece of essential information your patient should bring on their first visit.  Please see this New Patient Checklist other important documents, etc.)

4.Diagnosis or chief complaint

5. CPT codes for anticipated procedures

Verify medical benefits

Ask these questions to build your patient benefit profile:

1.What are the effective dates of the current policy?

2.Are they any pre-existing conditions limitations?

3.What are the benefits for the anticipated service?

a.Does a deductible apply (see b) or only a copayment (see d)?

b.If there is a deductible, how much is the deductible and how much is met?

c.After the deductible, what is the co-insurance amount?

d.How much is the copayment?

e.What is the annual out of pocket maximum and how much is met?

f.Do the deductible and copayments apply toward meeting the out of pocket maximum?

4.Does this policy require any type of authorization of the anticipated service(s)?    If yes, make sure to obtain the proper contact information for that internal department or outside agency.

Verify medical benefits : If you are unaware of the entities process for obtaining authorizations, immediately contact them by phone or review available information on their website.  This is a huge time saver to have this information on hand before you may actually need it.

5.Is there an annual, lifetime or per illness/diagnosis maximum benefit?  If so, how much has been met?

Medical billing terms : If some of the above terms seem confusing, refer to the table below for helpful explanations.

Pre-existing Condition

Most often occurs with a lapse of insurance coverage.  The new insurer can refuse to cover a condition that was diagnosed before the effective date of the policy.

Deductible

Amount the subscriber is responsible to pay before insurance will pay their portion.

Copayment

A flat rate assigned to specific procedures that the subscriber is required to pay.  Most commonly to office visits and outpatient diagnostic procedures.

Coinsurance

The percentage of the charge that is the subscriber’s responsibility.  Refers to benefits like”80/20”, the insurance pays 80%, the patient pays 20%.

Out of pocket Maximum

This is the total patient’s out of pocket financial responsibility designated by the payer.  Once the subscriber has met this amount, services then become covered at 100% by the payer.
Benefit Maximum

This is the monetary payment limit set on the subscriber’s policy.  Once this maximum is reached the payer has no more financial liability and the subscriber must pay for the rendered services.

Iridium Suite

Practice Management software from Medical Business Systems has an integrated insurance Real Time Eligibility function that can do most of this work for you.  See how Iridium Suite can help you “work smarter not harder”.

Office Workflow Step 1: New Patient Check List

When scheduling a patient for their first visit to your practice, you should advise them of what they need to bring to help ensure a smooth registration process and to assist your physician in making that first visit as thorough as possible. 

Follow this check list as a guide:

Picture identification and current insurance card(s)

Hint:  Once provided with this information, you need to verify insurance coverage and benefits.  This is the optimum time to collect copayments from the patient.

Contact information for emergency contact and/or healthcare surrogate

Hint:  Make sure the patient indicates the name(s) of any authorized persons on your HIPAA notification form.

Contact information for all current healthcare providers

Hint:  Please have the patient add to the HIPAA form, the names of any physicians they would like your physician to communicate with or share their medical records.

Copies of any applicable medical records and recent diagnostic testing results

Hint:  If you are handed records that are the patient’s only copy, make your own copy and return the “originals” to the patient.  They may need them for another provider.  X-rays or radiology “films” stored on computer discs, should be logged in the patient’s record if they are left behind after the visit.

Complete list of current medications, both prescription and over the counter.

Hint:  Adding the pharmacy name and phone/fax number into the patient chart facilitates issuing any required prescriptions.

Observe National Women's Health Week

National Women’s Health Week is May 12-18 and is a weeklong health observance coordinated by the HHS Office on Women's Health.

Per 2009 statistics from Center for Disease Control and Prevention Office of Women’s Health the top three causes of death in the United States for women are: heart disease, cancer and stroke.

Take this week to encourage all the women in your life to make their health a priority. Have them schedule preventative medical services and screenings such as:

Annual physical including basic lab tests Cancer screenings (mammogram, pap test, pelvic exam, clinical breast exam, and colorectal cancer screening)

Information on women's health

CMS now covers many preventive services and screenings under its Medicare Part b benefits for eligible beneficiaries.  For further information see the following:
  • MLN Preventive Services Educational Products for Health Professionals
  • CMS Prevention website
  • CMS Immunizations website
  • Discuss the importance of making healthy lifestyle choices:
  • Participate in regular physical activity for a minimum of 2 and ½ hours per week.
  • Consume a healthy daily diet of fruits, vegetables and whole grains, with limits on foods with high calories, sugar, salt and fat. 
  • Eliminate tobacco use and avoid tobacco smoke exposure.
  • Limit alcohol consumption to one drink per day.


Wednesday, 18 January 2017

Medical Office Workflow Step 4: Collecting Your Charges and Filing Claims

By properly registering your patient and verifying their benefits, you have laid the groundwork for correct claims reimbursement.  See these previous articles for more information:  New Patient Checklist and Proper Insurance Verification.

Office workflow step 4 

You now need to establish a reliable process for collecting charge date and filing claims.  One of the best ways to accomplish this is to utilize your Practice Schedule.  You will want to verify you have received a charge slip or “superbill” for each patient that has been marked as seen on your schedule.

Information on medical billing software

Integrating multiple systems can enhance your work environment and improve efficiency. A medical billing software that is able to directly import charge data from your EHR will eliminate the need for manual charge entry from “superbills”.

Iridium Suite

Iridium Suite Practice Management software now comes with the Connectivity Clearinghouse enabling connections to multiple EHR systems.
prevent denials

To prevent denials and receive proper reimbursement:

·Be aware of any services/procedures you provide that may conflict with others or be bundled together according to NCCI (National Correct Coding Initiative) edits.

Iridium Suite

Iridium Suite features a built-in claim scrubber that has many capabilities, so a biller can be confident that coding violations will be caught before the claim is generated.

Information on medical billing software

This article contains additional information on preventing common claim denials: http://www.iridiumsuite.com/mbs-blog/prevent-these-high-volume-claim-denials

·Stay informed of your commercial payers’ Medical Policies and government payers Coverage Guidelines.

Information on medical billing software

These two articles can provide more detailed guidelines on payer’s policies:  Reviewing Commercial Carriers Medical Policies/Clinical Guidelines and Understanding Medicare Fiscal Intermediaries.

Now that you have entered your “clean claims”, it is time to get them off to the payer.  Filing your claims can be done:

HCFA 1500 claim formvia paper on the standard HCFA-1500 claim form, or sent electronically electronic claims.

Information on medical billing software

Sending claims electronically utilizes Electronic data interchange (EDI). EDIis the structured transmission of data between organizations by electronic means.  Claims are batched in the medical billing software, and then transmitted in an electronic format directly to the payer or to a clearinghouse.

Iridium SuiteIridium Suite utilizes EDI to improve your claims processing in the following ways:

·Ability to track the Electronic Claims from receipt by the clearinghouse to the acknowledgement and acceptance by the payer.

·Electronic claims are pre-screened for certain errors with notices being sent back to the medical practice within days for quick correction and resubmittal.

·Due to their formatting, electronic claims are much more quickly processed by the payer, reducing the wait for reimbursement in some cases from weeks to days.

Medical Office Workflow Step 3: Obtaining Procedure Authorization

During your insurance verification process, you became aware that one or more of the services you will be either providing or ordering for your patient require an authorization.

For a guide on Proper Insurance Verification follow this link: http://www.iridiumsuite.com/mbs-blog/medical-office-workflow-step-2-proper-insurance-verification.

If you have no current method in place for obtaining authorizations, use the following suggestions to create your office process.

1 Gather all pertinent patient information: name, date of birth, insurance policy number and contact information for the authorizing entity.

The authorizing entity can be the insurance company, but more and more frequently payers are contracting out to third party organizations to perform this function.

2 Obtain the following data:  accurate diagnosis including the ICD9 or 10 code, copies of related medical records, the history and physical report from your physician, and the procedure(s) ordered with the appropriate CPT code(s).

Because you will need accurate medical data on your patient and in some cases actual office notes to provide to the authorizing entity, your hands may be tied in regards to the speed in which the authorization can be obtained.  For this reason, it is always helpful when possible to schedule the services enough into the future as to allow for processing time.

3  Now that you have the basics you are ready to begin the authorization process.  Follow the guidelines indicated by the authorizing entity to complete your authorization request.  This can vary from phoned in requests, to online or faxed submissions.  Make sure to complete any forms as accurately and thoroughly as possible.

 It is helpful to compile a file on authorization processes for each authorizing entity you encounter.  This allows you to have the information readily available again and again.
 
4 Now you wait.  With online submissions, you may have your authorization within seconds or minutes.  Other authorizing entities may take 24-48 business hours as their standard turn around.  You may even on occasion experience a week or more time between the request and the response.


 If you fail to get a response in the time specified by the entity, do not wait idly by.  Call or email as follow up.  You may discover the request was incomplete so you are able to provide the additional needed information.   Unfortunately, sometimes it is just floundering around on someone’s desk and you have to make sure it is brought to their attention.

Now that you understand the terminology, you can begin to post your remittance:

As you match on the service date and procedure, you will enter the appropriate indicated amounts for payments, contractual write off amounts, and patient responsibility.  The patient responsibilities, such as co-pays, co-insurance and deductibles, are allocated to the next responsible financial party; this may be the patient or another insurance company.

Medical billing hint

Once you have completed entering the data for the service line, the remaining balance should be $0 for the payer you are processing.  Any allowed amount, but not paid, would now be showing as the responsibility of another party, either patient or an additional payer.

Prevent claim denials

Identify a DENIAL by a $0 allowed amount.  You should never assume without verification that a $0 allowed amount has been processed correctly by the payer.  Carefully review the adjustment code against payer payment policies, NCCI edits, your billing records for the account and the patient’s medical record.  Only when you are convinced the service has been denied appropriately should you accept this write-off amount.

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