Congress (Again!) To Address Medicare Physician Payment

I apologize - this posting is LONG overdue! Every year, as you may know. Medicare's physician payments are adjusted based on something called the Sustainable Growth Rate, or SGR. This is a formula that was put in place many years ago, and was intended to connect health-care costs with the overall economy. Health care costs started exceeding the overall economy growth in 2001, and each year since then, Congress has had to address the result - cuts in Medicare payments to physicians. And, each year Congress has, at the last minute (and sometimes too late, resulting in all kinds of headaches for billing companies and office staff), stopped the cuts, and left the physician payments in the same place, or provided for a very slight increase. If Congress didn't stop the cuts, physicians might stop seeing Medicare patients, which would cause a huge outcry from some of the most powerful lobbies out there, specifically, AARP.

This year, the cut was set to be 27.4%. When Congress voted to delay the payroll tax vacation expiration two months, the reduction to the SGR was postponed to March 1 also. The Medical Group Management Association, along with other physician-advocacy organizations, is lobbying Congress hard to permanently fix the Medicare physician payment formula before March 1. Keep your fingers crossed, and write your Congressman!

Red Flag Rules Delayed - Again!

Just thought you might like to know where Congress is on the Red Flag rules: On May 28, 2010, the FTC announced that it is again delaying enforcement of the Red Flags Rule (the Rule), at the request of several members of Congress. Unless Congress enacts legislation modifying the Rule, the new enforcement date will be January 1, 2011. This constitutes the fourth time that the FTC has delayed enforcement of the Rule, which was originally scheduled for enforcement on November 1, 2008.

RAC Audits - What Are They?

RAC stands for Recovery Audit Contractor. If you participate with Medicare, and you haven't heard of RAC audits, you need to learn more! They are part of CMS's Medicare Integrity Program, and it's purpose is to audit Medicare claims to see where incorrect payments may have been made from things like erroneous coding, duplicate services, or services that weren't medically necessary. All practices that submit claims to governement programs may be subject to a RAC. There are ways to prepare for one of these audits, including reviewing billing procedures, putting appropriate procedures in place, and conducting regular audits, preferably by an independent third pary. For more information, visit the CMS website.

How will Health Care Reform Affect Medical Billing?

From what I have learned about proposed health care reform, both the Senate and House bills, little will change in the way medical billing is peformed. The biggest reason physician practices have billing staff, or outsource to medial billing companies is: adminstrative complexity. Did you know that the Medicare enrollment form for practitioners is 55 pages long??? PSP has a full-time Credentialing Coordinator who is dedicated to enrolling phyiscians in different insurance plans (every plan has their own enrollment form). When it comes to claims submission, insurance companies use the same form (HCFA 1500), but many require different items in different fields. We track the rejections we get from insurance companies just to be sure that we are accurately completing every claim form. This is labor intensive, but it helps our clients get paid more, and faster. So, don't expect too much to change in how bills are submitted and paid when health care reform finally passes. We can just be happy that, hopefully, more people will be covered by health insurance.

Red Flag Rules Implementation Delayed

In case you hadn't heard about them, the Red Flag Rules are designed to protect patients from identity theft. If you offer credit (that is, bill any of your patients) you're subject to the rules. The AMA and others have complained to the FTC that physician practices should be exempt, but to date, the FTC has not excluded physician practices or hospitals from the rule.

It means that first you must conduct a risk assessment of your facility to identify all the ways that you might learn that one of your pateint's identities might have been stolen or compromised in some way. For example, someone could call and say they got a bill for services from your facility or doctor, when they've never been a patient. Then, you'll have to put procedures in place to follow up on those cases where someone's identity might have been stolen, and to ensure that the person checking in to your facility is who they say they are. This can be done by checking driver's licenses, or verifing addresses through utility bills/phone bills, etc.

The rules were to have gone into effect on 5/1/09. But, the Federal Trade Commission has decided to delay enforcement of the new “Red Flags Rule” until August 1, 2009, to give creditors and financial institutions more time to develop and implement written identity theft prevention programs. For entities that have a low risk of identity theft, such as businesses that know their customers personally, the Commission will soon release a template to help them comply with the law. For more information, go to www.ftc.gov/redflagsrule.