Blog

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 opportunities. Older physicians nearing reti...


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 preventive services that may already be covered and...


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 hear complaining about the government in genera...


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 of Ecentral Medical Management a leader in he...


May
30
Medicaid 20% Payment Policy Change

RE: NEW YORK STATE MEDICAIDDue to new policy changes Medicaid will no longer pay the full 20 percent of the Part B coinsurance after Medicare pays its 80%. Instead, the total Medicare / Medicaid payment will not exceed the amount that Medicaid would have paid for a Medicaid-only patient. If the Medicare payment is greater than the Medicaid fee, Medicaid will make no additional payment. This revised reimbursement methodology was thought to be overturned or not in affect due to Medicaid paying for the 20% after the July deadline but in recent weeks we are seeing Medicaid request refunds for those payments and they are not paying current claims. Since the Medicaid payment system is not necessarily up to date it causes confusion on predictin...


May
30
PQRS Deadline March 18 2016

ATTENTION ALL PROVIDERS:
PQRS Has Extended their Deadline!!!

This information below is directly from the Qualified Registry and we wanted to make sure each practice is aware of the extension and the upcoming deadline. Remember the 2% potential reimbursement penalty from Medicare . You still have time and we would be happy to assist you. Give Tony a call at 516-775-8605 or email at anthonyv@ecmmgt.com and he will talk to you about your requirements and send out the appropriate group information. DON’T WAIT!!! IF you have not done this on your own please give us a call!!

PQRS Measures Group Reporting

Eligible individual providers can select Measures Group reporting to satisfy their 2015 PQRS requirements. This reporting option is only...


May
30
Last Call Million Hearts Cardiac Disease Reduction Incentive Program

EXTENDED DEADLINE APRIL 15TH 2016
Providers: Medicare will pay you $10 Per Medicare Patient Per Month for qualified patients without any risk to your practice. In addition to this monthly payment there are other incentive payouts for being a part of this program. Don’t be left out!! Value Based Medicine is here!!

The Practice must have

1 Medical Provider

Certified E.H.R.

Must have met meaningful use

The patients must have

Medicare Primary

18-79

No previous heart attack or stroke

ECM and its partners will assist your practice with the requirements needed to retrieve revenue from this and many other government incentives. Please contact Anthony Vuozzo at 516-775-8605 or via email @ Anthonyv@ecmmgt.com for further information.

Remember...


May
30
Hey Aetna where are my EOBs?

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 op...