September 15, 2014

Novitas top claim submission errors for August Medicare Part B

Novitas Solutions has just released the August top Medicare Part B claim submission errors and related resolutions for Texas, Arkansas, Louisiana, Mississippi, and Oklahoma/New Mexico/Colorado. Reviewing these is always a good idea not only from an education standpoint but also to help you avoid them on future claim submissions.

 Top Claim Submission Errors (Medicare Part B)



September 10, 2014

A word about customer service in a physician practice

Whether you agree with calling patients customers or not; the reality is that patients are customers.  They routinely shop for value, for better and more relevant information, for treatment that not only meets their expectations, but exceeds it, and for genuine care of their whole person. They also want to be able to communicate with their providers via several options and use the technology they are used to using, in their health care world, as they are using it in their daily experiences with other business.

It has always been interesting to me what the specialty of plastic surgery has done with their practices to make it more "customer" appealing.  Their offices are richly designed and decorated, their staff in stylish color coordinated outfits give patients personalized care and the physician takes time to provide the "customer" with options and ideas with which the patient can make an informed decision.  What a concept!!

Now I can hear you now with your practices sees 25 patients a day the plastic surgeon of course can spend more time with patients.....and his patients are paying cash up front so he never has to wait for payment.....and his wife is an interior decorator so of course the office looks plush.

Just consider raising the bar in your own practice........doesn't have to be 10 feet......could be 1. Enhance the customer experience, offer new ways of scheduling appointments, at the very least re-cover those worn out chairs.  Engage patients in their wellness process. Make sure your front desk staff are friendly, helpful, and they smile. Just a few things to think about.

September 08, 2014

Another Reason Why Your Physician Practice Needs Assessment of Operations/Finances

In this age of uncertainty for healthcare practices, decisions made today for the future of your practice must be made based on facts.  The facts of your practice can be determined by an analysis of data, operational assessment based on best practices and a detailed assessment of the whole of your practice.

Many components go into the daily operation of a healthcare practice; some are complex, some are tedious and some governed by culture.  Having the whole picture can help your practice understand its current position financially and operationally, where improvements can be made and provide reality as a basis for planning, expanding or changing your practice.

Many practices have rushed into alliances with hospitals without first understanding options available to them based on current data driven facts.  This has inevitably led to misunderstanding, poor relationships, struggling practices under new leadership and employees seeking alternative employment options.

Some practices have decided to stay not to ally with other organizations, but are second guessing that decision.  Both the marketplace and government uncertainties have driven bad or unsuccessful decisions.

What we know today about the future can be summed up in 3 general areas:

1. IT will drive healthcare in the foreseen future 2. Patient satisfaction will continue to dominate patient choices 3. Patient demographics will have a greater and greater impact on practices as misinformation surrounding insurance options and MCD increases.

How your practices position themselves to meet these challenges will be closely linked to your operational and financial health today. Your practice cannot make informed and practice successful choices about the future without knowing where you are today. By seeking an assessment of your current operations and financials, your practice can begin to make those important decisions to improve service to patients, cut costs and spending IT dollars wisely.

September 04, 2014

2015 brings four NEW modifier 59 choices from CMS

On August 15, 2014, CMS released a new MedLearn Matters article concerning four new modifier choices available January 1, 2015 for bundled services. These four new modifiers are to be used as a subset (i.e., more specific version) of the commonly used Modifier -59

Link to article:


August 27, 2014

ACA IRS Rules and Reporting Requirements

The Internal Revenue Service has been working hard to arm us with some ACA navigational tools.  The most recent of which came in the form of... well... forms... both new and revised, which they issued in draft format.  We are hopeful that the instructions will be released by the beginning of September.  The AICPA will be reviewing these forms closely and offering recommendations to the IRS for ways to make them easier to use.

Here’s a snapshot of the new information reporting forms:

New Information   Reporting Forms



Form 1095-A,   Health Insurance Marketplace Statement

Marketplaces will report   information on coverage provided to each enrollee


Filing begins in the 2014   tax year

Form 1095-B, Health   Coverage

Insurers will report   information on coverage provided to each enrollee


Optional for the 2014 tax   year and mandatory for 2015

Form 1094-B, Transmittal   of Health Coverage Information Returns

To be used to report all   Forms 1095-B with the IRS


Optional for the 2014 tax   year and mandatory for 2015

Form 1095-C, Employer-Provided   Health Insurance Offer and Coverage

Applicable large   employers will report information on coverage for each employee

Optional for the 2014 tax   year and mandatory for the 2015 tax year


Form 1094-C, Transmittal   of Employer-Provided Health Insurance Offer and Coverage Information Returns

This form will be the   method of transmitting all Forms 1095-C to the IRS. 


See filing requirements   for Form 1095-C


And, the new/revised forms to be filed with a taxpayer’s federal income tax return, beginning in 2014 are:

New or Revised   Tax Return Related Forms


Form 1040

Line 46 - report the   excess of any Premium Tax Credit received throughout the year.


Line 61 - report whether   the taxpayer has minimum essential coverage or owes a penalty


Line 69 – report the   amount of PTC


Form 8941, Credit   for Small Employer Health Insurance Premiums

Updated to accommodate   the recently released final regulations


Form 8962, Premium   Tax Credit (PTC)

New form to be used to   claim the PTC or to reconcile any advanced PTC amounts received during the   year to cover health insurance premiums


Form 8965, Health   Coverage Exemptions

New form to be used to   report an exemption from the insurance requirements


August 25, 2014

Reminder to conduct background checks for new medical practice employees

In addition to conducting reference checks when hiring new medical practice employees, you should also do a complete background check. Background checks can include the following:

• Social security verification • Criminal records • Driving records • Professional license verification • Credit reports • Education verification

Many vendors offer this service. One you might want to check out is PreCheck at:

August 22, 2014

Billed charge and related payer allowable

When I negotiate managed care contracts on behalf of clients, one part of the process is to take a practice's top 20 CPT codes and then pull the most recent EOBs from that payer showing these codes. An excel spreadsheet is then created showing the payer's allowable for each of the 20 codes and a comparison to current Medicare rates.

When looking at these EOBs, I still find sometimes (like this week!!) billed charges that are approved 100% for payment by the payer. THIS MEANS THE PRACTICE FEE IS TOO LOW AND THE PRACTICE IS LOSING REVENUE!!! Posters should be instructed that any EOB that comes across their desk where the billed charge is approved for payment in its entirety, that this EOB should immediately be copied and given to the practice administrator for review and a related fee adjustment.

I just wish medical practice's would quick losing money simply as a result of poor internal processes and oversight management.

August 20, 2014

A quick way to increase patient volume

The following was from a recent post to one of the MGMA listservs:

I fully agree that once you have your fixed overhead covered it is good business to try to fill up the rest of your capacity with "lesser reimbursement" patients. Once those fixed expenses are met you just have variable incremental expenses on the remaining credence to the theory that "you can make profit from volumes of lesser payors."

I too agree with this. Why complain about physician productivity if you can increase it simply by adding additional managed care plan participation to the practice? Of course you would want to add an "out" mechanism if the other contracts in place become more profitable and/or additional patient steerage occurs.

Of course people will say that additional overhead will occur by adding certain payors to the practice (ex. HMOs) but I have found that statement might not be true, especially if you negotiate out some of the related "red tape" that causes overhead to rise accordingly.

August 14, 2014

IRS Releases Draft Forms Health Care Information Reporting

The IRS has released draft versions of the long-anticipated information returns that employers and insurers will use to meet the reporting requirements mandated by health care reform. Form 1095-B (and the related transmittal Form 1094-B will be filed by insurers and plan sponsors of self-insured plans to report information on health coverage provided to individuals, as required by IRC Sec. 6055. This information will assist the IRS in administering the individual shared responsibility penalty. Form 1095-C (and the related transmittal Form 1094-C will be filed by applicable large employers to report on coverage offered to employees, as required by IRC Sec. 6056 . The IRS will use information from this form to enforce the employer shared responsibility penalty and identify individuals that are ineligible for premium assistance credits. The draft forms are available at: .

August 13, 2014

Providers Enrolled as a ‘Sole Practitioner’, or ‘Private Practice’– Medicare Claim Submission Requirements for the Billing and Rendering Information

If a physician is are enrolled as a ‘Sole Practitioner’, or ‘Private Practice’ Provider, only the Billing NPI assigned should be submitted on the claim to Medicare. It is not required to also report an NPI as the Rendering Provider. Incorrectly reporting a Rendering Provider NPI that is not required, the system will automatically reject the claim based on the system editing for the Billing and Rendering information.

Please note that Organizational Groups who are enrolled are required to submit the Billing NPI and a Rendering NPI.