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With the large number of new patients enrolled after the full ACA roll out, both Medical Assistance and some traditional carriers have experienced delays in fully enrolling some of the new participants causing delays in payments for services rendered. Practices need to keep this in mind and may need to modify the billing protocols to make certain the carrier has received and processed (even if the payment is on hold) the claim. If 60 days goes by and the practice has not received payment or a notification of a hold due to eligibility verification (even though the law generally requires a 30 day processing) the practice should consider resubmission to toll any time limits from expiring.

Close coordination with the MA carrier and with any other carrier of substance will go a long way to eliminating a later SNAFU on ultimate collection when all of the dust has settled (and we’re sure it will ultimately settle).


Published Date: June 10, 2014
By: Donna Marbury

 

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While the attached Medical Economics article raises a caution for physicians and their office staff regarding E&M coding, there is often a significant difference between an initial reading by certain HHS staff and what is ultimately determined to be the actual documentation in the patient chart after a more in depth review with the Medicare examiner. None the less, it raises the need to take precautionary steps, such as we often do for clients, to make a test of the billing and charts for a period of time and see what the level of documentation supports.

Publish Date: June 2, 2014
By Daniel R. Verdon 

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The Centers for Medicare & Medicaid Services today announced plans to expand a successful demonstration for prior authorization for power mobility devices, test prior authorization in additional services in two new demonstration programs, and propose regulation for prior authorization for certain durable medical equipment, prosthetics, orthotics, and supplies. Prior authorization supports the administration’s ongoing efforts to safeguard beneficiaries’ access to medically necessary items and services, while reducing improper Medicare billing and payments. The proposed rule is estimated to reduce Medicare spending by $100 to $740 million over the next ten years.

“With prior authorization, Medicare beneficiaries will have greater confidence that their medical items and services are covered before services and supplies are rendered. This will improve access to services and quality of care,” said CMS Administrator Marilyn Tavenner.  

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The Center for Medicare and Medicaid Services (CMS) announced through the release of the July 7, 2014 Federal Register (Vol .79 No. 129) a proposed rule concerning the update to the Home Health Prospective Payment System. (HH PPS) rates, including the national, standardized 60 day episode payment rates, the national per-visit rates and the non-routine medical supply (NRS) conversation factor effective January 1, 2015. 

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Data breaches are extremely important in any business, but in healthcare it has even broader implications. Marcum has done extensive work in the healthcare industry in evaluating and improving data security. The risk to an organization of a data breach is tremendous; in negative publicity as well as in direct financial cost. For any healthcare organization that has not completed an extensive data security analysis, "there's no time like the present" is an apt phrase.

The number of data breaches of patient health information, and the financial impact of those breaches both declined in 2013, although concerns over patient privacy and information security remained high due to provisions of the Affordable Care Act (ACA) 

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In a recent publication from CMS it was announced that the average annual growth in per capita personal health care spending for the elderly was 4.1 percent from 2002 to 2010, the lowest among any other age groups studied, according to a report by the Centers for Medicare & Medicaid Services’ Office of the Actuary released today and published in the journal Health Affairs.

These estimates are a subset of the annually-issued National Health Expenditure (NHE) data, which measures health care spending in the United States. The report examines aggregate and per-capita health spending by gender and major age groups.  

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While hospitals may currently profit from complications and readmissions, the trend in reimbursement is away from such benefits. In fact, many hospitals are working on hospital/physician co-management agreements to more closely align the financial benefits of less complications. Even where a hospital “loses” money based on better outcomes, the hospitals are incentivizing physicians and administration staff on better outcomes and less readmissions. Marcum assists in the determination of fair market value determination in many of the co-management arrangements.

Hospitals make more of a profit when surgical patients develop complications finds a new study published Wednesday in JAMA. A team of researchers  analyzed findings from nearly 35,000 surgical discharges from a 12-hospital system in the southern U.S. They found that the occurrence of postsurgical complications was associated with a higher per-encounter hospital contribution margin for patients covered by Medicare and private insurance but a lower margin for patients covered by Medicaid and those who self-paid. 

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CMS has learned that Part A providers (such as hospitals, skilled nursing facilities, home health agencies and hospices) may be receiving paper notices (114 Reports) from their Medicare Administrative Contractor (MAC) that contain error code “000000,” with no further information as to why their patients’ claims cannot be crossed over to supplemental insurers. This sometimes happens when the CMS Benefits Coordination & Recovery Center (BCRC) makes an exception to its H25407 compliance edit (“Admitting diagnosis must be used because this claim is for inpatient services.”) for HIPAA 837 version 5010A2 claims. This exception is made for 21x type of bills, for example, in accordance with current CMS claims processing policy.  

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On May 19, 2014, the Centers for Medicare & Medicaid Services (CMS) issued final regulations for the Medicare Advantage and prescription drug benefit (Part D) programs aimed at reducing fraud and abuse and improve benefits and the quality of care of these programs. The final rule is projected to save an estimated $1.615 billion over the next ten years 2015 – 2024.

The Centers for Medicare & Medicaid Services (CMS) today issued final regulations (CMS-4159-F) for the Medicare Advantage and prescription drug benefit (Part D) programs that continue efforts to curb fraud and abuse and to improve benefits and the quality of care for seniors and people with disabilities enrolled in these programs. The final rule is projected to save an estimated $1.615 billion over the next ten years 2015 – 2024. 

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If you have a financial interest in or signature authority over a non-U.S. financial account, you're probably familiar with Form TD F 90-22.1. Starting with the 2013 tax year, U.S. tax filers must instead file new FinCEN Form 114. Normally referred to as the FBAR (or Foreign Bank Account Report), it is due June 30th of each year, for the previous calendar year. This form does not have an extension of time to file and there could be substantial penalties for the failure to timely file.

FinCEN Form 114 is required to be filed, if during 2013:  

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