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As a medical care provider, summer may bring a seasonal dip in your volume. You might use this time to sit back, relax, and enjoy the sunshine. But really savvy providers take advantage of the down time to review their office policies and procedures. An annual review can ensure that your office is running as efficiently as possible so that you can maximize your revenue once things get busy again.

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Happy Doctors' Day From ECentral Medical Management! We support the independent providers! #nationaldoctorsday #macra #mips

Medicare is no longer accepting office consultations codes (99241-99245) or hospital consultations codes (99251-99255), as of January 1, 2010. Why? Well, the Office of Inspector General estimates that approximately 75% of consultations billed to Medicare were incorrect;specifically, 47% of consultation billing to Medicare involved wrong type or level of service, 19% did not meet definition of consult and 9% lacked appropriate documentation. Also, OIG audits have uncovered that in 2006 overpayments for consultations by the Medicare program amounted to approximately $1.1 billion in 2001.

Instead, “consultation” services will fall under the following codes, depending on the services rendered:Office Visits ( New patient or establ...

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Some of my clients are charging extra fees on top of copays that are due. I keep telling them this may be insurance fraud, but they just don't listen. What do you think? I'm pretty sure this is a common practice and should be addressed.

Bert Lurch, President of E Central Medical Management
(718) 525-4898

Answer:

The short answer is, you are correct Bert, that charging an extra administrative fee on top of a co-pay may be insurance fraud. For the extra charge to be legitimate, a Practice would have to have certain policies promulgated. Because a co-pay is determined by contract between a third-party payor and the patient, the amount is fixed and is to be collected as a fixed rate to represent the patient responsibility for those services rendered...

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Q. I have a private practice and have privileges at a local hospital. Sometimes I schedule follow-up outpatient visits for my and the patient's convenience at the hospital, if they live closer to the hospital than my office. The space I use is in the ER, but the patients do not register with the ER. What place of service should I use for billing?

The below answer is provided by Louis Burke of E Central Management, a billing and management company that works with medical practices with code changes, patient billing and follow-up, and immediate appeals on underpaid or denied claims.

A. This is a tough one. The appropriate answer is that if you physically see a patient in the ER, even for outpatient services, you should be billing a code 23...

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Dear All,

I’ve been getting a lot of questions about EMR. As we all know, the government is aggressively pushing for everyone to utilize EMR. I reached out to my friend, Bert Lurch, the CEO of E Central Medical Management, Inc. and asked him to provide some general information on EMR.

Bert said that in his mind the top three reasons why EMRs are being prioritized are to:

1. reduce paperwork, which will hopefully decrease inefficiency;2. allow doctors to have “educated” and “interactive” medical charts, in that the doctors will be able to see and track trends in their practices; and3. encourage practices to submit claims faster since coding will be done by the EMR software which alleviates the charge entry st...

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Question:

Dear Jennifer,
In a group practice situation where a provider is not credentialed by an insurance company and does not wish to bill as an "out of network" provider, is it acceptable for another provider to "supervise" the non-credentialed provider and to bill under the supervising provider's id number?

Thank you.
E

Answer:

There are multiple components to this question, but our answer is limited to the Billing and Legal Perspective, which follow:

Billing Perspective - Bert Lurch, President of E Central Medical Management explains that from the billing standpoint each insurer has different policies, and therefore in some instances, a practice may get paid if a “supervising” provider bills for the service. More specifically, some plans...

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Congress has reversed the 21% cut put into action last Friday and have now imposed a TEMPORARY 2.2% increase. Claims with June dates of service which were processed with the 21% reduced fee will be automatically reprocessed within two weeks (allegedly, don’t hold your breath) and claims send with the charge amount lower then the 2.2% increase will be paid at that lowered rate. Raise your fees to reflect the greater amount or face the challenge of calling on each one individually.

Remember claims were held and will be held again until the increase can be correctly applied. Try to budget accordingly.

Problem

If you have been receiving checks from Aetna without an explanation of benefits (EOBs) and don’t know what to do your in the right place. As of June 14th Aetna has started the process of reducing their paper usage by discontinuing mailings of paper EOBs. This means if you are not enrolled with Navinet or receiving EOBs from your clearinghouse you have now way of tracking your payments and reconciling your accounts receivable.

Solutions

1. Enroll in Navinet at www.navinet.net to get access to Aetna EOBs for printing or importing into your practice management system (PMS).

Or

2. Have your PMS Vendor / Clearinghouse enroll you for Aetna EOB access. This is also termed electronic remittance advice (ERA)

Or

3. Complete an Aetna opt out form to ...

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Later this year a transformation is coming to the mysterious world of medical billing. Overnight, the entire health care system, Medicare, Medicaid, private insurers, hospitals, doctors and all the middlemen, will switch to a new set of computerized codes used for determining what illness’ patients have and how much they and their insurers should pay for a specific treatment.

The changes are unrelated to the Obama administration’s new health care law. But given the unsteady start of the federal health insurance website, HealthCare.gov, some doctors and health care information technology specialist’s fear there will be major disruptions to health care delivery if the new coding system; which is also heavily computer-reli...

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E Central Medical Management, Inc.

2050 Lakeville Road,

New Hyde Park, NY 11040

Phone. 516-775-8606

Email. info@ecmmgt.com