Imagine going on Amazon, buying an Electronic Spin the Bottle Game for its listed price of $32.92, receiving the product (sparing the arduous effort required to spin the bottle) and…
In response to a reporter’s question, notorious bank robber Willie Sutton was quoted as saying thieves rob banks “because that’s where the money is”. Today, the money is in a…
Insurers in nine states, that is Arizona, Idaho, Louisiana, Missouri, Montana, Nebraska, Virginia, Wisconsin, and Wyoming have asked for rate increases as high as 24 percent.
Question: Our state’s Medicaid carrier denies our claims when we submit 62311 with modifier 59 for postoperative pain management. They say the 62311 is bundled with the anesthesia procedure code. How should we handle this? -Ohio Subscriber Answer: ...
How many times has it happened with you that you submit a clean claim but still don’t get paid even three months later? Do you have any recourse? Yes, thanks to the prompt pay laws that each payer must follow when paying your medical claims.
Verify Which Laws Apply to Your Practice
Each state requires private insurers to pay all clean claims within a certain time frame. If the insurer does not pay the claim in a timely manner, then the payer is subject to paying interest on the charges owed to the practice (or directly to the beneficiary). Most time frames range from 15 to 45 working days, with 30 days about the average.
“If you are a little adventurous, you could search for your state law on the Internet,” says Joseph Lamm, office manager with Stark County Surgeons, Inc. in Massillon, Ohio. Lamm warns, however, that “reading through state laws and their multiple exceptions, references to other sections of state law, and ‘legalese’ can make this a very frustrating exercise.”
“Take advantage of your local or state medical society and the experts they employ to see if your state has a prompt pay law, and to which insurance companies it applies,” Lamm suggests. “The medical societies are on your side and will give you the correct information.”
State prompt pay laws do not apply to federal insurers, because the Federal Government dictates that clean claims must be paid in 30 days for Medicare Part B.
“If a state wants a prompt pay rule that’s longer or shorter, they certainly can do that with reference to other payer services,” says Connie A. Raffa, Esq., partner with Arent Fox, LLP in New York, NY. “But Medicare rules are federal and span across the country.”
If your private payer...
Despite disadvantages, a new tax ID is a must when physicians leave your group.
Question: One of our optometrists wants to stop billing under the group’s tax ID and start billing under his own tax ID. I’m concerned that doing so will confuse the insurance companies and slow down his income, even though he has personally called some to notify them of the change and the effective date. Some payers are now asking for new W9 forms. Is there an easy way to do it?
Answer: Your optometrist can change his tax ID at any time, but you must submit a new W9 to your payers, in addition to a letter explaining that he will no longer be practicing under the group’s tax ID.
Downside: Yes, the optometrist’s income will be slowed. You also run the risk that the payer’s enrollment department does not handle the paperwork properly. Other billers have reported instances of the income being paid to the old tax ID or not being paid at all. Claims can also be lost even though the correct paperwork has been submitted multiple times.
If your optometrist is currently part of a group, and he is leaving the group, he needs his own tax ID. Many legal issues will arise from this. For example, if he is staying in the same office suite, he will have to pay market rent for the offices and staff that he is using. When patients move between the old practice and his new practice, questions will arise about which patients are considered new and which are considered established patients.
Much of this will have to be determined by the legal structure that is set up as he leaves the group. This can be a much more complex change than it appears on the...
Practice size does not matter when dealing with compliance — even solo practitioners have to stay on the straight and narrow.
Even small dermatology practices have to stay compliant with government regulations — and although this sounds like a simple fact, it’s one that many Part B providers may overlook.
Ensuring physician practice compliance can be a complex path, and many practices think of it is something that large hospitals should focus on — after all, those are the entities that get all of the media exposure when they violate compliance rules. But every practice is responsible for compliance, no matter how big or small.
Doctors Take Note
In some cases, small practices think compliance rules don’t affect them — but also don’t realize they’re at risk of being noncompliant.
Example: “I met with a solo practitioner a few years ago who hired me as a consultant,” says Laura E. Hill, CPC, CPC-I, an Arizona- based compliance consultant.
“It was my sad duty to let him know that his office manager,who submitted all of his claims, was upcoding all of his office visits as she entered them into the computer so that she could pay his quarterly malpractice-insurance premiums,” Hill says. “She had been working for him for 10 years and was a loyal and trustworthy employee.”
The fault was the physician’s, because he never took the time to review the monthly reports that the office manager gave to him, Hill says. He also never looked closely at his deposits into his corporate checking account, where there was an obvious trend toward increased deposits every third month.
Pay attention to your advisors: In the example above, the physician’s accountant had pointed the problem out to him, “but he accepted his office manager’s explanation that insurance...
Caution: You may need to incorporate the call into an in-office E/M service. If you’re reporting services your physician provides over the phone, but you’re not getting paid, the reason might be one of two things — you’re not following the coding rules surrounding the codes or your payer just isn’t paying for those services. Check out these [...] Related articles: