Looking for Expert in NYC Area

We have been asked by an attorney in NYC to help locate an expert in the NYC area on billing relative to veinapuncture procedures. The doctor has been billed by the insurance carrier for upcoding and the attorney needs an expert to help. If you have experience in this field and would be interested in speaking to this attorney for possible “expert testimony” please send me an email and I will forward it to the attorney.

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Thanks to our readers

My thoughts this month are just to say Thanks! Thank you to all of our readers. Thank you for taking the time to read our newsletter, to post on our forum, to participate in our programs and for your kind words. Alice and I vowed from the beginning to help others in any way that we can. And we’ve tried to do that once we got things figured out for ourselves! We do as much as we can, much of it being free, thru our newsletter, our forum and our free articles. But of course we also have to make a living so it can’t all be for free. So another BIG thank you to all who support us thru the purchase of our books and participation in our marketing and training programs. Today is CUSTOMER APPRECIATION DAY! Use the coupon code THANKS to get 20% off any purchase (with the exception of the Medical Billing Business in a Box options).

Good thru April 1, 2011

Marketing Your Medical Billing Business

Marketing is the hardest part of medical billing for most owners of medical billing services. Billing, entering charges and payments, following up on denied or unpaid claims, that’s the easy part. Getting the clients is usually what holds most people back. Dan Kennedy (a very successful marketing consultant) says that “marketing is not something you learn, it’s something you do”. He’s absolutely right.

We all know ways to market. Some are easier than others, some cost more, some require us to get out of our comfort zone. It’s not that we don’t know marketing techniques. In most cases it’s that we really don’t like to market. Nobody likes rejection. I don’t think anybody gets up in the morning and says “Yes! I should get about 20 ‘no’s’ today!” So we avoid it.

Avoiding marketing only hurts ourselves. It doesn’t hurt the providers we aren’t marketing to. Unless you truly believe that you are the only billing service out there that can provide the service to get them reimbursed all that they are entitled to. Avoiding marketing prevents you from growing, and taking your business where you want it to go.

OK, so we’ve established that marketing is a necessity to grow your business. So what can one do to make marketing less painful? Well one strategy is efficiency. If you develop your marketing to target providers that will most likely be interested in using your service you will reduce the number of ‘no’s’ you will get. For example, if you specialize in a certain field then you would want to target your efforts in that field since you can use your expertise in that field as leverage.

Another way to make your marketing efforts more efficient is to do some research about the providers you are going to market to. If you have some clients, you can ask them if they have any colleagues that they feel may benefit from your services. Doctors talk to each other. They know who is having issues in their offices. If you are doing a good job for your doctor, they should be willing to refer you to others. Make sure you ask if you can use their name. It always helps to say “Dr. Soandso suggested that I contact you.”

The best way to make marketing less painful is to do it smart and make your marketing efforts more effective.

Mental Health Parity – How it Affects Us

In the past, many insurance carriers used to discriminate against mental health services by having different benefits for mental health than for medical services. For example, a patient could have a plan that paid 80% of covered charges for any medical services, but the insurance only paid a flat $10 for a mental health visit and the patient was responsible for the rest. The patient responsibility in some cases exceeded 80%. Many people felt this was a blatant form of health insurance discrimination.

Some of the restrictions that were placed on mental health benefits were higher copays or deductibles, limited outpatient treatment, and a cap on lifetime benefits. Most mental health providers felt this limited proper treatment and hampered results. It certainly put a strain on the patients and the families of patients who couldn’t afford the recommended treatment. Over the years, lawmakers have passed many laws trying to even out the playing field.

One such federal law was the Mental Health Parity and Addiction Equity Act of 2008. MHPAEA is a federal law that provides patients who already have benefits under mental health and substance use disorder (MH/SUD) coverage parity or equality with benefits limitations under their medical/surgical coverage. This stopped insurance carriers at a federal level from having separate reimbursement rates for mental health services and basically said that the benefits for mental health services must be equal with the benefits for medical services.

Many of these laws were introduced because of a tragic situation. For example, Timothy’s law in New York State is named after Timothy O’Clair, a Schenectady boy who completed suicide in 2001, seven weeks prior to his 13th birthday. His parents felt that his suicide was due to the discrimination that he faced at the hands of his parent’s insurance company and they made it their personal crusade to make changes in insurance coverage. Many other states have also had laws passed due to tragic situations.

Of course there are exceptions for these laws. For example, businesses with less than 50 employees, employers who do not currently offer mental health benefits, and small group health plans are all exempt from MHPAEA. That still excludes a lot of people.

Most of the individual states also have mental health parity laws in effect too which are stronger than the federal law. The state mental health parity laws vary greatly from state to state. Some states exclude the V codes. The individual states also may set limits on the diagnoses they will cover. Some states parity laws will not cover the mentally handicapped or learning disorders. Most of the states have the 50 employee exemption while some have 25 employee exemptions. A few states have no mental health parity laws in effect so they are covered only by the federal law.

Along with the mental health benefits the parity laws also cover substance abuse. If an insurance policy covers mental health and substance abuse benefits then they must now line up with benefits for medical and surgical treatment.

Even with the new laws, it It is not uncommon for a patient to have different benefits for mental health than they do for medical visits. For example, they may have a $25 copay for primary care visits but they have a $40 copay for specialist’s visits including mental health visits.

At any rate to be sure the provider is paid for any mental health services, benefits should be checked prior to seeing the patient. When asking for the mental health benefits, you will determine if there is a copay involved, if there is a deductible, if an authorization is required from the insurance carrier and if a referral is needed from the primary care physician.

Overall mental health parity laws were a big step in the right direction toward making it possible for more people to be treated for mental health diseases. But we still have a way to go.

Medicare Announces Charging for Enrollment

Medicare will start charging fees for some enrollment applications

Wow, I’m not sure why this surprised me so much but when I saw this email I was surprised. Medicare is going to start charging providers who submit enrollment applications? Well it’s not all providers, but still it is going to affect many. But the CMS (Centers for Medicare and Medicaid Services) announced that effective Friday, March 25, 2011 Medicare Administrative Contractors will begin collecting application fees for certain provider/supplier enrollment applications. This is for both paper and online, or PECOS, applications.

How much will this application fee be? That is the first question I had. But the answer is not clear. There is a published document at http://www.GPO.gov/fdsys/pkg/FR-2011-02-02/pdf/2011-1686.pdf but it was a little difficult to wade thru all 110 pages. It appears that they are charging $500 for new enrollments for 2010 but since it wasn’t effective until March of 2011 I was left a little perplexed. Anyway, it looks like the fee for 2011 is $512 for new enrollments and $200 for revalidations and/or adding practice locations.

Also, the fee is not applicable to all providers. The fees do not apply to physicians, non-physician practitioners, physician organizations, and non-physician organizations. It is only applicable for institutional providers of medical or other items or services or suppliers. It is applicable for the CMS-855A, CMS-855B (not including physician and non-physician practitioner organizations), and CMS-855S applications.

Personally, I think this is going to cause some major confusion. As if it wasn’t hard enough for providers to just figure out what forms need to be submitted, now they need to determine if they need to pay. Also, some of the MAC’s (Medicare Administrative Contractors) are already difficult to deal with. (Just for the record, some are very pleasant and helpful.) Now they have another way that they can return apps stating that the fee was not included, even if no fee was needed. As we all know, Medicare being a government agency is full of red tape. If the provider makes a mistake they have to fix it, but if the MAC makes a mistake, the provider still has to fix it.

And I find it very ironic that Medicare is now requiring all providers to accept payments thru EFT (electronic funds transfer) but they are requiring payment for these apps by paper check. They haven’t developed a mechanism yet for receiving payment electronically. Of course they will have exceptions based on hardship but those will be determined on a case by case basis at the discretion of the MAC. I think consistency will be an issue there.

I’m usually a “glass is half full” person and as I read back thru this I feel I’m being quite negative. However, after doing thousands of Medicare applications over the past several years, I have seen many problems in the application process. To me, this addition of a fee is just going to complicate things even more. We’ll be watching to see how it plays out!