Q: I have been a provider with Medicare for 15 years and receive paper checks. I plan on moving to a new practice location next month and understand that I must update my Medicare provider enrollment file indicating my address change. Will this enrollment change require that I convert from paper checks to Medicare Electronic Funds Transfers (EFT) into my bank account?
Internal Medicine,
Hallandale
A: Medicare requires the EFT authorization agreement (CMS-588) form if you are submitting an initial provider enrollment application or a change to an existing Medicare provider file that has not previously been set up for electronic funds transfer. Therefore, you will need to submit with your CMS 855 address changes, EFT form CMS-588. The form can be downloaded from the CMS Website or from FloridaMedicare.com. The form must be complete and include your original signature as well as the signature date. You must also include a copy of a voided check and/or deposit slip with the EFT authorization.
Be careful and check with your bank to insure that you submit the proper electronic routing number on your EFT form. Not all banks use the routing number located at the bottom of your preprinted check or deposit ticket or may use the automated clearing house (ACH) number located elsewhere on the check or deposit ticket.

* For the complete story, call our Circulation Department at 800-327-3736 ext. 137

Q: Should I be doing anything now in order to benefit from the incentives---and avoid the penalties---of the electronic health records (EHR) provisions in the Obama stimulus plan?
A: According to Leigh Burchell, director of governmental affairs for a national electronic records vendor, “if you want to be at the front of the line to collect those incentive payments and move your practice onto the electronic health-care highway, the time to start driving is now.”
Beginning in 2011, less than 20 months from now, practitioners and providers of all sizes who serve Medicare or Medicaid patients will become eligible for substantial federal financial incentives to become “meaningful users” of EHR. Beginning in 2015, laggards will begin to suffer financial penalties. Early adopters will get larger incentives than those who wait until just before the penalties kick in.
Where is this “electronic health-care highway” going to come from? In May of this year, the Florida legislature passed the Florida Electronic Health Records Act. The new legislation aligns Florida’s electronic records law with the federal statutes and charges the Florida Agency for Healthcare Administration (AHCA) with responsibility for creating a statewide infrastructure for safe, efficient and legally compliant patient health information sharing among providers, practitioners and payors. AHCA will serve as the pass-through for the federal grants and loans needed to grow the new infrastructure. By 2011, when the provider incentives begin, the statewide information system is scheduled to be on line.
A Florida physician, who sees Medicare patients and has a compliant EHR system in place when the incentives begin, will be eligible for up to $44,000 in financial assistance over a five year period. Medicaid providers can get up to $64,000. CMS also has discretion to award the incentives in a lump sum.

* For the complete story, call our Circulation Department at 800-327-3736 ext. 137

There has been a great deal of hoopla about Electronic Medical Records (EMR) and Electronic Health Records (EHR) recently in the media. (The difference between EMR and EHR is the degree of connectivity across the health-care spectrum; EMR within one health-care organization, EHR across more than one.) Most of the justification centers around the projected benefits of improved care and cost savings. The driving force behind all these changes is that the current system is economically unsustainable.
Take for example health spending in the United States, averaged $7,421 per person in 2007, totaling $2.2 trillion, or 16.2% of our nation’s economy, up from 7.2% of GDP in 1970 and 12.3% of GDP in 1990. I think we can all agree something needs to be done -- but carefully.
Point
In 2009, the President signed H.R. 1, the “American Recovery and Reinvestment Act” -- the so-called “economic stimulus package.” The basic premise is investing heavily in EHR by offering providers incentives. Under
this scheme Medicare and Medicaid providers (both part A and B) will be eligible for up to $17 billion in incentive payments to adopt electronic health records. Medical practices meeting certain qualifications could see incentive payments of up to $44,000 per physician. Based upon the dollars it sounds good, but one does not know until one performs an in depth analysis of their needs. The bill also targets hospitals for incentive programs.
Conversely, Medical practices not adopting this technology will likely see their Medicare payments reduced 1% starting in 2015. Should one persist in this voluntary, non-participatory attitude reimbursement will drop to a maximum of 5% in 2019, and almost certainly result in bigger reductions in revenue over time. Certainly, it’s a carrot and stick approach.

* For the complete story, call our Circulation Department at 800-327-3736 ext. 137

Medical insurance billing can be an overwhelming and complex process, even for those who are involved with it daily. The effectiveness of the billing process can significantly impact the finances of a practice. Following these 10 steps can assist a practice in achieving prompt and accurate payment for services.
(1) Contracting and provider enrollment is the first step in a successful billing process. Identify and work closely with a provider representative at each insurance carrier to negotiate a fair reimbursement contract. Once the contract is set, the practice needs to monitor payments on an ongoing basis to verify the contractual agreement is being met. Provider enrollment paperwork needs to be submitted to the carrier in a timely manner and identify which carriers allow the provider to see patients during the enrollment process. Periodic follow-up with the carriers should also be done until the provider’s enrollment is complete.
The next step involves gathering (2) accurate patient demographic and insurance information. Front desk staff should obtain copies of identification and insurance cards from the patient for entry into the practice management system. These copies can also be referred to later if there are insurance eligibility denials.
(3) Verification of insurance coverage and benefits with the carrier has become a critical step in billing a successful medical claim. With high deductible health plans, health saving accounts, coupled with economic issues such as layoffs and unemployment, practices are seeing more patients whose insurance coverage has been affected. Verification is a step the practice cannot afford to skip.
(4) Continuing education for insurance and coding updates allows everyone in the practice to stay current with an ever-changing health-care industry. This knowledge will help staff make collection decisions and help physicians to code and chart accurately.
Once the patient visit has been completed, the provider needs to

* For the complete story, call our Circulation Department at 800-327-3736 ext. 137