Archive for June, 2012

Medicare’s 3-Day Payment Rule Updated

Medicare’s 3-day payment rule reducing payments to physicians in practices that are wholly owned or wholly operated by hospitals for preoperative testing and related procedures will be implemented July 1, 2012.

Medicare will pay a reduced fee for physician’s services that are clinically related to an inpatient admission, occur within the 72 hours before the admission, and are furnished by a physician practice or clinic wholly owned and operated by a hospital. If the hospital and the physician are both owned by a third party, the 3-day window does not apply. A new modifier of PD is used to identify these claims.

What does that mean?

Have you ever asked yourself “What does that mean?” when reviewing an EOB or medical bill?  Well we certainly have which is what led us to compile our own comprehensive list of commonly used medical and billing terms and their definition.  This Glossary has been formatted in alphabetical order for quick and easy reference.   

Click here to view our glossary.

Feds Announce Plans to Push Health Information Exchange Adoption

Healthcare organizations trying to participate in Health Information Exchanges (HIE) may soon get assistance from the federal government. 

The Office of the National Coordinator for Health Information Technology (ONC) said the use of HIEs will be voluntary, but will grant incentives and assess penalties to encourage providers to share information in a certified way.

More details for the government’s plan will be released at a later time.

Reimbursement Manager Monitors Payment Accuracy

Committed to maximizing revenue for our partners, our IT department designed a system application to make certain the medical groups we serve are being accurately reimbursed.  The Reimbursement Manager component of our software recognizes any primary insurance payment that does not match the contracted and expected reimbursement.  The system will generate an appeal letter to request payment for the difference.   Monitoring the integrity of every payment is paramount to delivering the results our partners deserve.

Major Improvements to Medicare’s Internet-based PECOS

The Centers for Medicare Services (CMS) has made improvements to the electronic signature process to allow an authorized official (AO) or delegated official (DO) of an organization to e-sign your application within an authenticated Internet-based PECOS session.

 The AO or DO of an organization listed in the “Individual Control” section of the organization’s enrollment application will be permitted to e-sign the applicable certification and/or authorization statements as well as the CMS-588 (electronic funds transfer form) within Internet-based PECOS.