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Find solutions to those pesky, persistent provider enrollment problems

06/23/2014

During DecisionHealth’s National Provider Enrollment Workshop in April, attendees received answers to their most pressing enrollment questions. Below is a list of the questions and answers that apply to practices regardless of size and specialty.

HHS projects more than 1 million appeals caught in the ALJ swamp

06/23/2014

by: Burt Schorr

Providers who have had denied Medicare claims snagged in what’s now a nearly three-year wait for administrative law judge (ALJ) reviews will have more company by Sept. 30, when federal fiscal year 2014 ends.

Tolerance, initiative among top attributes to look for in nonclinical staff

06/23/2014

by: Roy Edroso

Don’t lose time and money by making the wrong hires for your non-clinical staff. Look for key attributes in candidates that predict good performance, consider newcomers to the field and prepare to invest time and money to bring the best people to your practice.

How to catch delinquent patient dollars on the ‘last mile’ before collections

06/23/2014

by: Roy Edroso

When patients are behind on their bills, talk to them before abandoning their debt to collections – or you’ll leave money on the table.

Charge patients correctly when billable, non-covered services done for same visit

06/23/2014

by: Scott Kraft

Use your actual charges when calculating how much a patient owes you out-of-pocket when the patient receives non-covered preventive and covered services on the same date. Medicare requires that process, known as a carve-out of the covered visit, to ensure the patient pays fairly.

CMS 2012 data: Modifier GA doesn’t mean automatic denials

06/23/2014

by: Roy Edroso

The modifier GA (Waiver of liability on file) indicates that you gave the patient an advanced beneficiary notice of non-coverage (ABN), and you’re only supposed to do that if you have good cause to believe the claim will be rejected – otherwise you could get in trouble for issuing “blanket” notices (PBN 5/6/13). Yet surprisingly, only 21% of codes filed with GA have a 100% denial rate. And some of the codes most often submitted with GA are denied less often than they are without the modifier.

Protect your EHR hardship exception if CMS doesn’t confirm online submission

06/13/2014

by: Roy Edroso

Use workarounds such as a delivery and read receipt requests from your email program when submitting your meaningful use hardship exception form because reports indicate CMS confirmation emails have not been reliable.

RAC alert: Admitting, discharging docs must be same group, same specialty

06/13/2014

by: Roy Edroso

If your practice’s procedure is for physicians of different specialties to routinely admit and discharge the same patient from a hospital, revise that arrangement or risk losing as much as $107 per claim.

Try creative methods to teach your staff about HIPAA, OSHA, compliance issues

06/13/2014

by: Ben Hartman

Use face-to-face competition, online games and skits to give your staff and physicians, who are notorious for shirking regulatory training, an appealing reason to attend the mandatory sessions.

Modifier 22 – Be prepared to show your work when you report increased services

06/13/2014

by: Julia Kyles

Protect additional revenue you deserve for increased services by sharing the definition of modifier 22, documenting specifics of services and watching your carriers for announcements about the increased procedural services modifier.

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