CMS Issues Improper Payment Rates for Medicare, Medicaid and SCHIP

CMS reported earlier this month it protected roughly $400 million of taxpayer dollars as improper payments for Medicare Fee-for-Service (FFS) decreased from 3.9 percent in FY 2007 to 3.6 percent, or $10.4 billion, in FY 2008. The Medicare, Medicaid and SCHIP improper payment rates are issued annually as part of the HHS Agency Financial Report.

In addition to improved Medicare FFS payments for FY 2008, CMS reports its first Medicare Advantage improper payment rate of 10.6 percent, or $6.8 billion, in payments made in CY 2006. Also being reported for the first time are the FY 2007 national composite error rates for Medicaid and for SCHIP. The Medicaid composite error rate is 10.5 percent, or $32.7 billion, of which the federal share is $18.6 billion. For SCHIP, the rate is 14.7 percent, or $1.2 billion, with a federal share of $0.8 billion.

To read the complete CMS press release issued November 7, 2008, click here:
http://www.cms.hhs.gov/apps/media/press_releases.asp

2009 Standard Mileage Rates Released

The 2009 optional standard mileage rates have been released. The mileage rates will decrease from the second half of 2008. Beginning January 1, 2009, the standard business mileage rate will be 55 cents per mile, the standard medical or moving mileage rate will be 24 cents per mile, and the standard charitable rate will be 14 cents per mile. For January — June 2008, the rates were 50.5 cents per mile, 19 cents per mile, and 14 cents per mile, respectively. For July — December 2008, the rates were 58.5 cents per mile, 27 cents per mile, and 14 cents per mile.

Pay attention to who handles your accounts receivables

Staff who handle accounts receivable must know what they’re doing. Qualified billers, for example, are worth their weight in gold. Your biller may be an employee with many years of experience for this position, someone brand new, or someone who has slowly moved up the ranks and “inherited” the position, but whoever it is, your biller must be qualified for this function.

Although added knowledge and training always increases one’s qualifications, having a certified biller is not essential to achieving an efficient and comprehensive billing department. The person responsible for billing must, however, keep a breast of new codes, documentation guidelines, third-party protocols, Medicare regulations, compliance issues, and laws regarding claims filing.

The front-desk or admissions staff also handle accounts receivable. They input demographic information critical to filing and so should be well-versed on doing so correctly. Likewise, whoever enters the CPT and diagnosis codes should participate actively in periodic coding updates.

Customer service can reduce a physician's liability

Our experience in working through thousand of malpractice cases, available data, and interviews with top plaintiffs’ attorneys reveals that communication errors and service lapses usually are what cause plaintiffs to go to a lawyer in the first place. Lawyers look for service lapses when deciding whether to accept a case, and experts have an easier time finding fault. Ultimately, lapses can easily affect the way jurors evaluate a case.

Improved service and communication are at the core of a five-stare service culture. They will help to control malpractice exposure and will lessen the severity of every claim that you may have.

Patients who feel that their physician and the practices care about them and treat them well are more likely to seek guidance from the treating doctor when a complication occurs. On the other hand, if the relationship has already been strained, such complications can cause the patient who had pent-up anger or frustration to head to a lawyer’s office with horror stories about how mismanaged the physician’s practice is and how that mismanagement led to a terrible outcome.

S Corporation Officer's Compensation

An IRS fact sheet discusses compensation paid to S corporation officers for services rendered, which should be treated as wages and not as distributions or loans to the officers. While there are no concrete guidelines for determining when compensation is reasonable, some of the factors considered by the courts are (1) the officer's training, experience, duties, and responsibilities; (2) the time and effort devoted by the officer to the business; (3) the company's dividend history, payments to non-shareholder employees, and timing and manner of bonus payments; (4) what comparable businesses pay for similar services; (5) the existence and content of compensation agreements; and (6) the use of a formula to determine compensation. Furthermore, health and accident insurance premiums paid for greater-than-2%-shareholder-employees are deductible by the corporation as fringe benefits, and are wages for income tax withholding but not for FICA or FUTA purposes. Fact Sheet FS-2008-25.

Use your manager to help recruit new physicians

Many physicians believe that only they can handle the search for recruiting a new physician, and botch the effort! These failures are usually due to two shortages: time and attention. Doctors lack the time to prepare effective want ads and training program letters. They’re too preoccupied with day-to-day patient matters to thoughtfully cull the CVs they receive and to do some initial telephone screening.

New-doctor recruitment, though essential to a practice’s continued success, too often receives second-rate physician attention. It shouldn’t be that way!

Except for the critical aspects of interviews and selection, your manager or administrator can probably handle recruitment details better than you, the physician.

Take a closer look at new talking points in payer contracts

Many healthcare providers are revisiting the various services they provide and looking to make non-Medicare patients a larger component of their patient mix. That, in turn, puts a premium on commercial contracting.

For providers that are prepared to intensify their contracting efforts with commercial payers, try these tips:

1. Address contract clause and reimbursement rates. The most-favored-nation clause basically says the lowest rate that your facility accepts from any payer is the rate that you will accept with the negotiating payer, notwithstanding that payer’s fee schedule. Remove this clause from contracts altogether, and try to avoid Medicare-based reimbursement in commercial contracts.
2. Increase your negotiating power. Maximize your leverage in contract negotiations with commercial payers by illustrating your worth to them. Adding to or changing your range of services might boost your value to payers and could help you recover from reimbursement cuts that may have hit your main specialty.
3. Maximize the efficiency of your practice’s operations. The efficiency with which you provide any additional services is essential to your financial success. Although you may want to expand the types of services you provide, overall reimbursement rates are going down—so your efficiency is going to be the critical factor for success.

Understanding When to Use the New Patient E/M Codes

By CPT definition, a new patient is "one who has not received any professional services from the physician, or another physician of the same specialty who belongs to the same group practice, within the past three years." By contrast, an established patient has received professional services from the physician or another physician in the same group and the same specialty within the prior three years.

The distinction between new and established patients applies only to the categories of evaluation and management (E/M) services titled "Office or Other Outpatient Services" and "Preventive Medicine Services," but as a family physician, most of the codes you submit fall into these categories, and the definition is hard to incorporate into your coding habits. This article will explain why the difference matters and describe an approach you can use to make the definition easier to apply.

For the complete article, go to http://www.aafp.org/fpm/20030900/33unde.html

HIPAA - employer paying for employee physicals

If an employer pays for employee physicals or consultations that are performed for employment purposes, do patients (employees) under HIPAA have a right to access the records as they would if they had paid for the services? The answer is yes they do. Remember the information belongs to the patient, even if he or she is not responsible for paying for the healthcare services.

DOJ Recovers $1.12 Billion in Healthcare Cases

In fiscal year 2008, the Justice Department recovered $1.12 billion from settlements and judgments involving various healthcare organizations that allegedly defrauded the government. Nearly 60% of the amount recovered this year came from pharmaceutical manufacturers and retailers. The department recovered large figures over the past two years as well. In fiscal year 2007, the Justice Department recovered $1.53 billion. That year, healthcare cases accounted for approximately 84% of the $1.34 billion that the department secured from fraud and False Claims Act actions, the majority of which were initiated by whistle-blowers. In fiscal year 2006, the department recovered $2.3 billion. Organizations that enter into settlements with the government generally assert in those agreements that the decision does not reflect any admission of wrongdoing or liability.