Blog

Mar
29
COVID-19 TELEHEALTH BILLING UPDATES

In our continuing effort to simplify the information being distributed by top insurers during this pandemic regarding their current adjusted billing rules, we are providing this summary. It contains information taken directly from each insurer’s website, augmented by our telephone conversations with representatives of the various companies. Additionally, for further clarity we are providing links to the most complete explanations each payer has distributed to date. We have highlighted certain points in bold to facilitate your ability to quickly review the information. We must caution this is a guide based on the most current information available to us.


Please reach out to us if you are...


Mar
19
Breaking News: CMS Allows E/M Codes to be Billed for Telephone Visits During Covid-19 Outbreak

Here is the latest information, simplified. Click here to view the CMS Medicare Telemedicine Health Care Provider Fact Sheet


Understanding the Difference Between Telemedicine, Telehealth, Virtual Check-ins, E-visits



  • Telemedicine is audio only (99441-3) based on time see attached – established patients only

  • Telehealth is audio AND video (99201-99215 new and established patient E/M). Audio could be anything from Skype to Zoom to Doxy.me to iChat etc.

  • Virtual check-in is audio - CMS only (G2012) established patients only

  • E-visit is online (99421-3 for MD & G2061-3 for non-MD, qualified professional)

  • Modifier to use for any of the above is 95 and place of service is 02

  • Document consent of pati...

Mar
18
Can I Bill for Telephone Consults?

As social isolation becomes a reality for increasing numbers of us, many physicians are wondering whether telephone check-ins are reimbursable by private payers, Medicare and Medicaid.


While commercial carriers have been reluctant to reimburse for telephone check-ins in the past, more recently both Medicaid and some private carriers have indicated that they will reimburse for these virtual visits. Here at E Central Medical Management, we are tracking carriers and gathering data so that we can confidently advise our clients on whether or not these claims are actually being honored.


Medicaid and Commercial Carriers


CPT offers codes to report telephone services provided by a physician or other qua...


Sep
30
Doctor? Manager? Leader? You are All Three

Remember all those management and leadership classes you took in medical school? Of course not. Learning how to diagnose and treat disease left no time in your schedule for anything unrelated to medicine.


The only problem is that today, you may find yourself wearing two hats – not just a clinician, but the owner of a small business, your medical practice. In that second role, leadership and management skills are essential.


Owning your practice means that in addition to being a clinician, you are also an entrepreneur, a boss, a manager and a leader. Cultivating some basic management and leadership skills, and understanding the difference between the two, will help ensure that your practic...


May
30
Aetna Opt Out

Click here to download the Aetna Opt Out form.


May
30
Joining A Practice?


CONSIDER FACTORS OF JOINING A PRACTICE
BY STEVEN PELTZ, CHBC


Physicians are among the few professionals who tend to start their own businesses. While this affords them great flexibility in terms of establishing a working environment tailored to their liking, it also presents them with large responsibilities. Oftentimes, they find it beneficial for their practice and themselves to recruit a partner.


A solo practitioner's decision to hire a new partner stems from growing practical needs. Solo practitioners tend to resort to recruiting a partner when they find that the time they have is not sufficient for the number of patients they see. A second practitioner may be needed to take advantage of new...


May
30
Turning Lemons Into Lemonade: Medicaid’s Compliance Plan Requirement

QUESTION:
Jennifer,


I read your email a few weeks ago about Medicaid’s compliance plan requirement and after considering that “ordered” services are included in the $500,000 precipice as well as straight Medicaid payments and all Medicaid HMO payments, I realized that my practice does qualify. I can’t believe there this is another thing I need to put money into that the government is requiring, when all the government does is take money away from my practice’s reimbursement. Are there any benefits of purchasing a compliance plan since I have to get one?


Dr. P.O.’ed


ANSWER:
Doc, I understand your frustration. You are not the first, nor will you be the last I hea...


May
30
Bill Medicare for Preventative Visits

Effective January 1, 2011, CMS is expanding their coverage to include AWV’s (Annual Wellness Visit) which will include PPPS (Personal Preventative Plan Services) for members who are no longer within their 12 month effective date of their first Medicare Part B coverage. As customary with preventive services Coinsurance and Part B deductibles do not apply. The AWV will have to include establishment of, or update to, the individual’s medical and family history, measurement of his or her height, weight, body-mass index (BMI) or waist circumference, and blood pressure (BP), with the goal of health promotion and disease detection and fostering the coordination of the screening and prev...


May
30
Primary Care Rate Increase Fee Schedule

Effective for Dates of service January 1, 2013 – December 31, 2014 Medicaid Primary Care Specialties (including subspecialties that have 60% E&M and Vac administration codes) are required by federal law to reimburse at Medicare rates. See the below link for example. If you aren’t receiving the rates shown please contact an ECM practice solutions representative.

PRIMARY CARE RATE INCREASE FEE SCHEDULE PDF


May
30
NYC'S Largest Health Insurers!!

As a Provider of services you should know what are the largest Insurance Carriers in your area. In New York City Empire Blue Cross & Blue Shield is by far the largest carrier based on statistics from Crain's Business News with companies like Emblem Health and Healthfirst not far behind. This information is helpful if you are a new provider considering which insurance companies to become a participating with or a seasoned provider considering disenrollment . Ultimately you need to analyze what are the largest carries within your practicing area in order to make an informed decision.


I f you have any questions in regards to credentialing or analyzing insurance carriers please contact Bert Lurch...