Cardiology Billing Changes 2010, Cardiology Billing Update

According to various media reports from Washington, action will be able to arrive too late regarding the June 6 Senate announcement so it is keen to start on a 19-month Medicare "doc fix." This means cash-flow problems plans to effect doctors every where in the country. Senator Charles Schumer (D-N.Y.) claimed at a drive conference which the Senate is ready to experience 60 votes to pass the bill "early coming week (week of June 14)." But a great deal if the votes appear then, other as opposed to would&wshyp;be it should take several days for the bill to be endorsed by the House and signed to law by the President.

On Monday, June 14th Medicare responded to that carried on defer by Congress by deciding that it would offer its freeze on processing argues through June dates of service until Friday, June 18th. It is prospective overly Congress is planning to opposite the whole Medicare fee detriment by that date. Given, however, the instant series outlined by Senator Schumer, it is unlikely the fix will be wound up by so time.

So, on Monday, June 21st, Medicare may well initiate processing June 2010 claims using the 21.3% fee reduction that went into effect on June 1. However, it appears highly anticipated that within two weeks Congress should retroactively contrary the fee cut. This will result in Medicare claims making reprocessed, bringing about new "make-up payment" trouble for providers. It is a trouble the present leaves providers to ask some monumental questions - and to issue out selected vital medical billing decisions.

Question/Decision #1: Should your cardiology billing department continue submitting your Medicare claims as median - or can you have them until Congress eliminates the 21.3% fee reduction?

If you offer your argues as usual, next you will receive payments as usual - but at the reduced fee rate. When Congress does eliminate the fee reduction, you may hold a lot of managed to do when Medicare reprocesses your claims. This work includes auditing to ensure Medicare has indeed made all of the make-up bills they should. It also includes responding to patients' questions and difficulties about receiving two Explanation of Benefits (EOBs) based on what i read in Medicare regarding their charges. The arrangement are able to be exacerbated when Medicare automatedly crosses these types of lower-paid suggests to secondary coverage payers. EOBs and payments involving secondary (and probably tertiary) coverage payers serves to cause a larger amount of confusion and complications for your office - and for your patients.

If you hold your Medicare patient claims and later produce them after Congress passes the "doc fix" bill, you plans to not get hit through the 21.3% cut - but you could get brought in consequently as opposed to usual. You additionally will suffer a much simpler minute in terms of ensuring all payments are right from what i read in both Medicare and secondary payers. Also, patients is able to purchase only a single EOB for the dates of service during now "waiting" long period of time period.

Question/Decision #2: Should you collect co-insurance for Medicare patients under the fee schedule that was in place prior to June 1, 2010 - or beneath the that much tinier fee schedule?

If you compile patients' 20% Medicare co-insurance beneath the fallen fee schedule and the deduction is reversed by Congress, then under Medicare procedures you can look for to legislation patients for any supplementary amount properties owe over $5.00. (You are not forced to try and collect balances that will lose more to pursue than is able to be yielded in revenue). This are able to make to larger number of values and patient confusion.

On the a great deal more hand, if you combine co-insurance quantities in accordance providing the pre-June 1 fee schedule and Congress does not reverse the fee reduction, then you will crisis to reimburse patients any overpayments greater as opposed to $5.00. (The same financially realistic principle applies to patient refunds.) Since it is unlikely overly the fee decrease will stand, this is an unlikely outcome.

Question/Decision #3: Most likely, you have currently tendered a couple of June 2010 Medicare patient claims. These serves to initiate making processed on Tuesday and are able to engender a good amount of of the difficulties talked about above. (The decisions you make now claim making able to minimize the complications rather than being able to prevent them completely.) These already-filed claims make you to ask and decide: Should you law patients and secondary coverage payers for the June 1 to June 14 dates of service you put forward (and for that Medicare may start obtaining payment over the occuring days) or serves to you wait for these kinds of claims to be reprocessed and paid correctly subsequent to Congress reverses the 21.3% Medicare fee cut?

The pros and cons outlined for the questions/decisions in #1 and #2 furthermore apply to #3. If you proceed investing in billing patients (and secondary insurances that do not automatically cross over), you might have confused patients who purchase an previous statement from you and later acquire a instant statement based on data from you for additionally money subsequent to Congress retroactively reverses the fee cut.

On the funny things hand, not billing patients and secondary insurances until after Congress acts ought to delay your collections - but are able to trigger to a great deal a reduced number of patient and office confusion.

My Recommendation: Every practice have got to make its own decision just about these kinds of issues, but a decision ought to indeed be made. If you can deal with the temporary cash flow reduction, afterward my recommendation is:

1. Hold your claims until Congress retroactively reverses the Medicare fee cut;
2. Collect patient co-insurance under the pre-June 2010 fee schedule;
3. Do not act patients or secondary coverage for the June 1, 2010 to June 18, 2010 dates of program for that you plans to create attaining bills over the coming days. Instead, bill the patients and secondary insurances once these dates of utility are reprocessed when Congress reverses the Medicare fee cut.

This system can minimize confusion in the practice and among your patients. It are able to as well minimize the odds you are underpaid for your claims.
Source:http://blog.cardiologybilling.com/2010/06/15/medical-billing-update-hold-medicare-claims-or-submit-them.aspx