MEDICAL BILLING BLOG

If you accept Texas Medicaid then please note the following Texas medical billing changes that have begun as of August 2011. The Texas Health & Human Services Commission will be sending out new plastic Medicaid Cards to all eligible Medicaid Recipients.  The new plastic card will replace the monthly paper cards (Form 3087) to which you are accustomed. This is being done as part of the initiative to increase providers utilization of Texas Medicaid Web Resources for coverage verification and to cut down on the amount of paper that is sent to Texas Medicaid participants.

Many practices utilize the paper Medicaid cards to assist them with verification of benefits and to determine eligibility.  Please note, that in conjucntion with the move towards plastic cards, Texas Medicaid is now providing real-time; live eligibility and PCP information through their on-line tool at www.YourTexasBenefitsCard.com.

ClaimCare Medical Billing highly recommends that each Medicaid patients’ eligibility and PCP be verified with each provider visit.  If you are currently scanning traditional insurance cards into your system or EHR, we encourage you to now scan the Medicaid Plastic Cards for the Medicaid and CHIP patients that you serve.

Here is the relevant excerpt from the August 2011 Texas Medicaid Bulletin: "This week, HHSC is beginning to mail new plastic Your Texas Benefit Medicaid cards to 3.4 million Texans covered by Medicaid. The new cards will replace the paper Medicaid ID (Form 3087) Medicaid clients receive in the mail each month. Texans with Medicaid coverage should receive their new plastic cards by the end of August. They will also get one last paper Medicaid ID in a separate August mailing. The new plastic card will be the client's everyday Medicaid card and will only be replaced if the client changes health plans or the card is damaged or lost. Medicaid providers can now go to www.YourTexasBenefitscard.com and begin using the site for up-to-date information on a patient's eligibility and other services."

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Copyright 2011 by ClaimCare Inc. The author is Susan Price, Austin Office Manager of ClaimCare Medical Billing Service, one of the largest medical billing companies in the United States.

ClaimCare, Inc - June 15, 2010 - According to various media reports from Washington, action will come too late regarding the June 6 Senate announcement that it is ready to initiate a 19-month Medicare "doc fix." This means cash-flow problems will affect doctors across the country. Senator Charles Schumer (D-N.Y.) said at a press conference that the Senate is expected to have 60 votes to pass the bill "early next week (week of June 14)." But even if the votes come then, more than likely it will take several days for the bill to be passed by the House and signed into law by the President.

On Monday, June 14^th Medicare responded to this continued delay by Congress by deciding that it will extend its freeze on processing claims with June dates of service until Friday, June 18^th. It is possible that Congress will reverse the massive Medicare fee reduction by that date. Given, however, the time line outlined by Senator Schumer, it is unlikely the fix will be completed by that time.

So, on Monday, June 21^st, Medicare may well begin processing June 2010 claims using the 21.3% fee reduction that went into effect on June 1. However, it appears highly likely that within two weeks Congress will retroactively reverse the fee cut. This will result in Medicare claims being reprocessed, causing new "make-up payment" problems for providers. It is a situation that leaves providers to ask some important questions - and to make some important medical billing decisions.  

Question/Decision #1:  Should your medical billing department continue submitting your Medicare claims as usual - or should you hold them until Congress eliminates the 21.3% fee reduction?

If you submit your claims as usual, then you will receive payments as usual - but at the reduced fee rate. When Congress does eliminate the fee reduction, you will have a lot of work to do when Medicare reprocesses your claims. This work includes auditing to ensure Medicare has indeed made all of the make-up payments they should. It also includes responding to patients' questions and concerns about receiving two Explanation of Benefits (EOBs) from Medicare regarding their charges. The situation will be exacerbated when Medicare automatically crosses these lower-paid claims to secondary insurance payers. EOBs and payments involving secondary (and possibly tertiary) insurance payers will cause further confusion and complications for your office - and  for your patients.

If you hold your Medicare patient claims and then submit them after Congress passes the "doc fix" bill, you will not get hit with the 21.3% cut - but you will get paid later than usual. You also will have a much simpler time in terms of ensuring all payments are correct from both Medicare and secondary payers. Also, patients will receive only a single EOB for the dates of service during this "waiting" time period.

Question/Decision #2:  Should you collect co-insurance from Medicare patients under the fee schedule that was in place prior to June 1, 2010 - or under the significantly reduced fee schedule?

If you collect patients' 20% Medicare co-insurance under the reduced fee schedule and the reduction is reversed by Congress, then under Medicare rules you will need to bill patients for any extra amount they owe over $5.00. (You are not forced to try and collect balances that will cost more to pursue than will be yielded in revenue). This will lead to additional expense and patient confusion.

On the other hand, if you collect co-insurance amounts in accordance with the pre-June 1 fee schedule and Congress does not reverse the fee reduction, then you will need to reimburse patients any overpayments greater than $5.00. (The same financially reasonable principle applies to patient refunds.) Since it is unlikely that the fee reduction will stand, this is an unlikely outcome.

Question/Decision #3:  Most likely, you have already filed some June 2010 Medicare patient claims. These will start being processed on Tuesday and will generate many of the issues mentioned above. (The decisions you make now regard being able to minimize the complications rather than being able to avoid them completely.)  These already-filed claims force you to ask and decide: Should you bill patients and secondary insurance payers for the June 1 to June 14 dates of service you submitted (and for which Medicare will begin receiving payment over the coming days) or should you wait for these claims to be reprocessed and paid correctly after Congress reverses the 21.3% Medicare fee cut?

The pros and cons outlined for the questions/decisions in #1 and #2 also apply to #3. If you proceed with billing patients (and secondary insurances that do not automatically cross over), you will have confused patients who receive an initial statement from you and then receive a second statement from you for additional money after Congress retroactively reverses the fee cut.   

On the other hand, not billing patients and secondary insurances until after Congress acts will delay your collections - but will lead to much less patient and office confusion.

My Recommendation:  Every practice must make its own decision about these issues, but a decision must indeed be made. If you can handle the temporary cash flow reduction, then my recommendation is:

1. Hold your claims until Congress retroactively reverses the Medicare fee cut;
2. Collect patient co-insurance under the pre-June 2010 fee schedule;
3. Do not bill patients or secondary insurance for the June 1, 2010 to June 18, 2010 dates of service for which you will start receiving payments over the coming days. Instead, bill the patients and secondary insurances after these dates of service are reprocessed when Congress reverses the Medicare fee cut.

This approach will minimize confusion in the practice and among your patients. It will also minimize the chance you are underpaid for your claims.

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Copyright 2010 by Carl Mays II. Carl is President and CEO of ClaimCare Medical Billing Service, one of the largest medical billing companies in the United States.

Everyone in the medical billing field is hopeful that Congress will act to defer (and ultimately eliminate) the proposed 21% fee reduction for Medicare.  Keep in mind, however, that March 2010 collections will likely suffer a delay even if the fee cut is deferred.  The coming months will be a challenging time for medical practices and medical billing companies.

In January 2010 Medicare had a 2 to 3 week delay in processing claims because they needed to update their system after Congress deferred the 21% Medicare fee reduction.  As of today, Medicare is still catching up in their claims processing (a fact that have not officially acknowledged).  ClaimCare found that as of February 23, 2010, Medicare was still at least a week behind in their typical claim processing time frame.  And this level of a delay happened when Medicare had plenty of advance warning concerning the deferral, so you can imagine what delays could result when they have less advance notice.  In addition to this delay, Medicare had a system problem that resulted in multiple weeks worth of secondary claims not crossing over properly.  This Medicare system problem has compounded the delay in collections.

There is every reason to expect another delay in Medicare payments in March 2010 if Congress issues a last-minute deferral of the 21% fee reduction.  Based upon past evidence and experience, if Congress does issue a deferment, we anticipate a 2 to 3 week delay in the Medicare claims processing and payments.  Therefore, when thinking about your cash flow for March 2010, you should plan for at least an additional 2 to 3 week delay for Medicare payments.

If Congress decides to delay the fee reduction for only 30 to 45 days (as they are considering), then this problem will be repeated and exacerbated in April if they pass yet another last-minute deferral.  Practices and medical billing companies need to plan on Medicare collections being less predicable and fairly erratic over the next few months.  As I stated earlier, this is a challenging time to be a medical practice or a medical billing company.

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Copyright 2010 by Carl Mays II. Carl is President and CEO of ClaimCare Medical Billing Service, one of the largest medical billing companies in the United States.

 Each state has passed a Clean Claim Law. The level of benefit these laws provide to medical practices and facilities starts on the low end with states such as South Dakota that provide little more than a slap on the insurance company's wrist to states such as Texas which levy substantial financial penalties on tardy payers.

The basic idea of the law is that a payer has to respond to a clean claim within a set time (usually around 30 days for electronic claims). In order to utilize the clean claim law effectively you must have a tracking system built into your medical billing process that flags:

• To which insurance companies does your state's clean claim law apply (some payers are exempt);
• The date your practice initially submits each medical claim;
• Events that stop the clean claim clock (e.g., an information request from the payer),
• When your practice has taken actions in response to payer requests;
• The date when you received the payer's final adjudication decision.

The idea of systematically tracking all of this information may be daunting, but with a smart system design it is possible and most definitely a worthwhile undertaking. After submitting a few Clean Claim law violation reports you will see your claims pay faster. I have seen situations where payers have actually called just to assure the practice that claims will be quickly processed.

One way to quickly get started using the clean claim law is to run a trial on a payer that you feel consistently takes more than 30 days to ajudicates claims. Find a small number of large claims for this payer that have gone past 30 days and then conduct a trial run with those claims. This will allow you to learn the fundamentals of how to submit and monitor complaints and see the results of your complaints.

Copyright 2006 by ClaimCare Medical Billing Services

 With the correct set of non-traditional billing tools and programs you can drive down the initial working capital needs of a new or existing medical practice by 90% . These tools are quite unique to ClaimCare and go well beyond a pure medical billing service or an in-house billing department.

All of these tools will have a positive operational impact on how you think about staffing and/or cash flow management/financing in your practice. If these tools are implemented when the practice opens its doors it could dramatically lower working capital requirements and make the practice cash flow positive extraordinarily fast.

1. ClaimCare Instant Payment Program - (Start bringing in the bulk of the insurance payments within 24 hours of opening the practice's doors) With this program you will receive the bulk of your insurance money within 24 hours of seeing a patient. This will significantly drive down working capital needs in the first few months of a new practice. In addition, the program can be dropped at any time, so it can be used purely as a bridge to get through the early days of a practice.
2. ClaimCare patient checkout tool (Bring in the bulk of the patient responsibility - about 20% of practice revenue - in the day the doors open and lower staffing requirements at the front desk) - With this tool the practice can substantially increase cash flow quickly by collecting patient balances (not just the co-pay of $20 but the co-insurance which can add up substantially more than a co-pay). This will have a huge cash flow impact, since with this tool the bulk of the patient balances can be collected before the patient leaves the office instead of 60 to 90 days after the visit. In addition, since the tool automates insurance verification it can reduce the work load requirements of the front desk (and allow you to have fewer staff members).
3. Vendor Instant Payment Program - (A free 60 day bridge loan to help minimize working capital needs for the first two months of the practice) This is another program that could help a lot with working capital needs - and best of all it is actually free. With this program all of your vendors are paid within 24 hours of an invoice being approved. As long as the practice repays ClaimCare within 60 days there is no charge for the service. If the practice pays within 30 days they actually get a discount off the bill. This works because ClaimCare negotiates a fast pay discount with the vendors. If we are paid back by the practice within 30 days we share the discount with the practice. If we are paid between 31 and 60 days we keep the discount. As you can see, in the early days of a practice this can give you a 60 day free float on vendor payments. Once you are out of the start-up mode this program will allow you to lower your vendor costs.
4. Equipment servicing contracts - (Lower the cost of maintenance contracts) As the practice buys their equipment they can save a substantial amount on the maintenance contracts through our leasing service program. This program has a great track record and basically self-insures the maintenance agreements. With this approach we are able to save about 20 to 25% off equipment maintenance agreements. This can really add up for a medical practice. This basically applies to any piece of equipment that plugs into the wall.
5. EMR -(Start paperless without the upfront investment in either an EMR or paper medical record storage system) With our EMR offering we can get a practice on an EMR right out of the gate without any upfront cost. This can save you money and improve operations since you will not need to spend the money on typically paper medical record supplies and will, of course, be able to see the benefits from an EMR with the big price tag.

Combining all of this with a world-class billing solution provides a powerful set of tools for starting a medical practice with much less working capital and lower cost.

Copyright 2008 by Carl Mays II