HEALTHCARE: Pay for Performance and Electronic Health Records

This is a guest post from Jonathan Krasner from BEI, a healthcare IT company located in Reston, Virginia.  Jonathan talks about Pay for Performance and how it relates to Electronic Health Records (EHR).

We all know that our healthcare system is very expensive and massive efforts are underway to implement reforms. The reforms come in many different areas, with differing levels of impact as there is no “silver bullet” that will fix the system. One of the major reform undertakings has to do with how providers and hospitals are paid.

Currently we operate primarily in a “Fee for Service” (FFS) environment. Under FFS, providers are paid for performing a specific service: an operation, procedure, consult, etc. One of the problems with FFS is that it assumes that providing a service is synonymous with a patient achieving a certain, generally positive, outcome (remission from disease, for example). That is not always the case. Alternatively, if you were to ask a patient what he/she would like to “purchase” when seeing a provider, they would reply with something like “I would like to get my condition under control”, or “I would like to be cured of this disease”, i.e. the patient would like to “purchase” an “outcome” or “result”.

The concept of “purchasing” an “outcome” has been around for a while and is known by various names: Pay for Performance, Outcomes Based Payments, Value Based Purchasing and Accountable Care are a few. Over time, the industry will standardize on a single term, but in this article we use the term Pay for Performance (P4P). There are several important things to know about P4P:

• Essentially, P4P uses financial bonuses to encourage physicians to meet standardized performance quality measures and to boost positive clinical outcomes and patient satisfaction (just as an aside, in the US today, 75% of all companies associate at least part of an employee’s pay to measures of performance).

• It does not apply to treating an individual patient. Rather it applies to a group of patients in a panel, where outcomes can be statistically predicted with accuracy.

• It cannot apply to all conditions and diseases. It only applies to patient panels with specific conditions. These conditions are those where the outcomes can be predicted with statistical accuracy. For example, starting October 1, 2012, hospitals will be reimbursed differently for three conditions: heart attacks, heart failure and pneumonia. The payment rate allows only a certain amount of readmissions. If a hospital’s readmission rate is considered to be excessive, they will be subject to rate reductions.

We are not trying to argue the merits of P4P. However, it will become, in one shape or form, part of the payment system in the future. In addition to the Medicare announcement mentioned above, United Healthcare recently announced that they will be paying for some oncology services in this manner. Most major payers have some type of P4P program in place or are developing one.

But what does this have to do with EHRs? Plenty! Here are some thoughts:

• As mentioned above, P4P relies on a lot of data, from a lot of patients. You can’t P4P unless you can measure performance. You certainly cannot implement a P4P program with a physician that is using paper charts. The data that is resident in a physician’s EHR will be instrumental in determining what actual performance or outcomes are.

• As a side note to the above, the data must be available in a standardized electronic format for it to be evaluated.

• A shift to accepted evidence-based standards of care will be required. For certain conditions, physicians will be asked to use certain clinical policies and procedures. EHRs will be used to document that these standards have been adhered to.

• Many P4P programs will involve the concept of the Patient Centered Medical Home. This does not just apply to primary care physicians. Part of PCMH involves identifying gaps in care – as an example, making sure every patient over 50 receives a colonoscopy at the appropriate intervals. These gaps in care can only be identified by and addressed using the data in an EHR. The EHR cannot only be used to identify gaps in care, but also any type of medical data point, i.e. patients with certain lab results, patients on certain medications, etc. By rapidly identifying patients with certain characteristics, physicians can quickly target appropriate care.

Meaningful Use is just the first stop in the long journey of utilizing EHRs in the transformation of the healthcare system as we know it. EHRs will be used not only to improve clinical outcomes, increase practice efficiency, but will also be an integral part of the payment systems of the future.

Visit BEI at www.beihealthcare.com or call Jonathan at 571-612-3344 for more information on this topic. 

If You Liked this Post – Look at These:

• Your Guide to Meaningful Use from eRecords
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Manny Oliverez - Medical Billing Company CEO Pay for Performance and EHRs Medical Billing Company | Capture Billing - Medical Billing Company Helping Doctors Succeed

Loudoun County, VA – Capture Billing & Consulting, Inc., a medical billing company located in South Riding, Virginia, establishes its new education division. The new division will be managed by Michelle Ivanchukov, CPC, CSS-P (Certified Professional Coding) and Katie Jennings, RN(Registered Nurse).

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Manny Oliverez - Medical Billing Company CEO Medical Billing Education Outreach Program is Established by Capture Billing Medical Billing Company | Capture Billing - Medical Billing Company Helping Doctors Succeed

Loudoun County, VA – Capture Billing & Consulting, Inc., a national medical billing company located in South Riding, Virginia, will begin the first semester of 2012 teaching Medical Terminology for the Allied Health Professional at Northern Virginia Community College (NVCC), Loudoun Campus in Sterling, Virginia.

NVCC’s “Medical Terminology for the Allied Health Professional” class will be taught by Katie Jennings. Allied Health Professional; refers to individuals who work in a variety fields within the medical community. Katie’s experience as a medical biller and nurse has helped her navigate in both the clinical and administrative aspects of healthcare. Katie’s knowledge and use of medical terminology has been a great source of information in designing the class.

“This in-depth class will assist students interested in the medical billing field. Learning the fundamentals of medical terminology via the introduction of anatomy will help prepare students for the Certified Coding Professional (CPC) exam”, says Katie, “in addition to preparing students for a career in the healthcare industry”.

In this class students will learn medical prefixes, suffixes, root words, and commonly used medical terms by the allied health professional. The class structure will allow students a chance to learn the proper pronunciation and definitions of medical terminology and how physicians use them.

The five session class will help students prepare for the CPC certification exam and to succeed in the medical billing and coding field. As medical billing standards change and become more complicated, qualified individuals will be highly sought after.

To learn more about these and other medical billing course please visit:

5 Session Class: http://www.nvcc.edu/wdce/loudoun/courses/classinfo.asp?ID=HLTH+1567+

Northern Community College:  http://www.nvcc.edu/wdce/loudoun/courses/alphalist.asp

ABOUT CAPTURE BILLING

Capture Billing and Consulting, Inc., a leader in the outsourced medical billing services industry, offers one of the most cost effective outsourcing solutions to healthcare professionals available. By eliminating the need of an in-house medical billing staff, Capture Billing’s staff of expert medical billers and certified professional coders help to increase physician reimbursement by improving collection rates and ensuring proper ICD-9 and CPT coding. Practicing physician and CEO, Dr. John D. Farrell, Jr., formed Capture Billing in 2004 as the answer to one of the largest concerns physicians face today, how to receive proper insurance reimbursement for services they provided.

CONTACT INFORMATION

Capture Billing & Consulting Inc.
25055 Riding Plaza, Suite 160
South Riding, VA 20152
(703) 327-1800
Contact: Manny Oliverez
Website: http://www.CaptureBilling.com

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Manny Oliverez - Medical Billing Company CEO Medical Billing Company Teaches Medical Terminology for the Allied Health Professional at Local Community College Medical Billing Company | Capture Billing - Medical Billing Company Helping Doctors Succeed

Loudoun County, VA – Capture Billing & Consulting, Inc., a national medical billing company located in South Riding, Virginia, will be teaching a Certified Professional Coder (CPC) exam preparation class at the beginning of 2012 at Northern Virginia Community College (NVCC), Loudoun Campus in Sterling, Virginia.

Manny Oliverez, CEO and Co-Owner of Capture Billing and several of his experienced medical billers and coderswill be teaching an extensive class to prepare participants for the five and a half hour long CPC exam. The CPC preparation course will cover the principles and purpose of the Current Procedural Terminology (CPT), International Classification of Diseases (ICD-9 CM) and the Healthcare Common Procedural Coding System (HCPCS) coding manuals. The prep-course will also enable aspiring medical billing coders to assign procedure and diagnosis codes to the highest level of specificity.

“My experienced and knowledgeable staff has taught this class for the past couple of years and we have only had positive feedback from the participants who have completed it. The CPC certification exam is a thorough exam and anyone who plans to take it would greatly benefit from this preparation course”, says Manny.

This intensive preparation course will give the test taker access to the latest coding updates as well as review important aspects of the exam. The instructors will provide helpful test taking tips such as ways to tag and highlight the coding reference books to enable the test taker to move quickly from question to question, as well as time management suggestions such as which questions you should answer first. This valuable information will assist participants throughout the exam. They will also review and answer practice test questions and address any concerns regarding the exam.

To learn more please visit: www.capturebilling.com

ABOUT CAPTURE BILLING

Capture Billing and Consulting, Inc., a leader in the outsourced medical billing services industry, offers one of the most cost effective outsourcing solutions to healthcare professionals available. By eliminating the need of an in-house medical billing staff, Capture Billing’s staff of expert medical billers and certified professional coders help to increase physician reimbursement by improving collection rates and ensuring proper ICD-9 and CPT coding. Practicing physician and CEO, Dr. John D. Farrell, Jr., formed Capture Billing in 2004 as the answer to one of the largest concerns physicians face today, how to receive proper insurance reimbursement for services they provided.

CONTACT INFORMATION

Capture Billing & Consulting Inc.
25055 Riding Plaza, Suite 160
South Riding, VA 20152
(703) 327-1800

Contact: Manny Oliverez
Website: http://www.CaptureBilling.com

If You Liked this Post – Look at These:

• Medical Billing Education Outreach Program is Established by Capture Billing
• Medical Billing Company Teaches Medical Terminology for the Allied Health Professional at Local Community College
• American Academy of Professional Coders Local Chapter Elected Manny Oliverez of Capture Medical Billing for 2012 President

Manny Oliverez - Medical Billing Company CEO Medical Billing Company Teaches CPC Exam Preparation Course at Local Community College Medical Billing Company | Capture Billing - Medical Billing Company Helping Doctors Succeed

Loudoun County, VA – Capture Billing & Consulting, Inc., a medical billing company located in South Riding, Virginia, has produced several short educational videos to help medical office managers, medical coders and medical billers with coding and other similar topics. The short videos provide medical billing tips.

Capture Billing’s short medical billing videos are produced with medical billing tips in mind. Some of the topics these videos cover are coding for Medicare Flu Shots, Charging Patient No-show Fees, and information on electronic health records (EHRs) and Meaningful Use to name a few. Manny Oliverez, CEO and Co-Owner of Capture Billing, is not only a Certified Coding Professional he is also the creator and host of these videos.

“We began producing these videos to help inform physicians and medical practices of recent changes or current challenges that occur within the medical billing field. We have received thousands of views and a great deal of positive feedback to our medical billing videos which has encouraged us to produce more”, says Manny Oliverez.

The “Whiteboard Series” is a series of two to three minute videos focused on current topics within the medical billing field, as well as review of proper billing and coding procedures. All of the current videos have been posted on iTunes and on Capture Billing’s YouTube channel. Viewers may also subscribe to the series. By subscribing to the series of medical billing podcasts the viewer will be able to download current videos and they will be notified when new videos become available.

For more information on Capture Billing videos please visit: http://www.capturebilling.com/videos

 ABOUT CAPTURE BILLING

Capture Billing and Consulting, Inc., a leader in the outsourced medical billing services industry, offers one of the most cost effective outsourcing solutions to healthcare professionals available. By eliminating the need of an in-house medical billing staff, Capture Billing’s staff of expert medical billers and certified professional coders help to increase physician reimbursement by improving collection rates and ensuring proper ICD-9 and CPT coding. Practicing physician and CEO, Dr. John D. Farrell, Jr., formed Capture Billing in 2004 as the answer to one of the largest concerns physicians face today, how to receive proper insurance reimbursement for services they provided.

CONTACT INFORMATION

Capture Billing & Consulting Inc.
25055 Riding Plaza, Suite 160
South Riding, VA 20152
(703) 327-1800
Contact: Manny Oliverez
Website: http://www.CaptureBilling.com

If You Liked this Post – Look at These:

• Medical Billing Education Outreach Program is Established by Capture Billing
• Medical Billing Company Teaches Medical Terminology for the Allied Health Professional at Local Community College
• Medical Billing Company Teaches CPC Exam Preparation Course at Local Community College

Manny Oliverez - Medical Billing Company CEO Medical Billing Company Produces Medical Billing Tips Videos for iTunes and YouTube Medical Billing Company | Capture Billing - Medical Billing Company Helping Doctors Succeed

Loudoun County, VA – Capture Billing & Consulting, Inc., a Medical Billing Company located in South Riding, Virginia, is pleased to announce the success of its new website http://www.CaptureBilling.com. In its first few months of going live the website which is focused on Medical Billing received over 17,000 page views per
month, up from 200 only a year ago.

Capture Billing provides outsourced Medical Billing Services to small and large medical practices. Its new website outlines and describes all the services that Capture performs. Capture’s website goes beyond your typical medical billing website, which is one reason it has received so much attention and has built a large following.

One of the main features of the website is the Medical Billing and Coding Blog. Online searchers can find tips on medical billing and coding that include how to bill for flu shots, how to use Medicare modifiers, and other basic information about coding. The website also lists and reviews the steps involved in the process of submitting claims to insurance companies. In addition to our informational videos, Capture also provides a Sample Medical Billing Report that physicians and their medical practices need to run a financially successful business.

“We’ve come across many practices that do not supply monthly reporting to their clients, however we do. We have a sample report package available for download so that physicians can see what monthly reports they should be receiving from their medical billing companies or in-house billing staff. These reports inform physicians and medical managers about overall practice management, practice performance and coding, as well as insurance reimbursements and aging of accounts”, says Manny Oliverez CEO, and Co-Founder of Capture Billing. “The reports are an essential tool to help physicians keep their finger on the pulse of the practice to ensure profitability.”

Another popular feature is the Medical Billing Videos section. Each video comes with a searchable transcript and covers topics such as tips on Charging Patients No-show Fees and Coding for Medicare. The most popular video is the “High-Tech Act: Electronic Health Records and Meaningful Use” video which has been view thousands of times. All the videos as well as Podcasts are available by subscribing to iTunes or to the Capture Billing’s YouTube channel.

Capture is consistently updating their website with the newest medical billing and medical coding information available. They also add new features periodically; one update coming soon is a new report that covers Billing a Well Exam to Medicare.

ABOUT CAPTURE BILLING

Capture Billing and Consulting, Inc., a leader in the outsourced medical billing services industry, offers one of the most cost effective outsourcing solutions to healthcare professionals available. By eliminating the need of an in-house medical billing staff, Capture Billing’s staff of expert medical billers and certified professional coders help to increase physician reimbursement by improving collection rates and ensuring proper ICD-9 and CPT coding. Practicing physician and CEO, Dr. John D. Farrell, Jr., formed Capture Billing in 2004 as the answer to one of the largest concerns physicians face today, how to receive proper insurance reimbursement for services they provided.

CONTACT INFORMATION

Capture Billing & Consulting Inc.
25055 Riding Plaza, Suite 160
South Riding, VA 20152
(703) 327-1800
Contact: Manny Oliverez

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Loudoun County, VA – Capture Billing & Consulting, Inc., a nationwide medical billing company located in South Riding, Virginia, is pleased to announce the formation of its new OBGYN Medical Billing Department. Katie Jennings, an experienced teacher and seasoned employee at Capture Billing, has been chosen to head the new department.

An OBGYN practice consists of obstetricians and gynecologists. Obstetricians are physicians who specialize in pregnancy, labor and postpartum (pueperium) and gynecologists specialize in the female reproductive system and associated detection and treatment of disorders and diseases.

OBGYN practices have unusual medical billing concerns but the most frequent and most frustrating issue is commonly known as “Broken Global”. Broken global occurs when a pregnant patient obtains new insurance or switches to a different practice during the course of her pregnancy. Each insurance carrier has their own specific billing policies and procedures regarding antepartum codes for single as well as multiple (twins, triplets, etc.) births. In order to bill correctly and in a timely manner medical billers and medical coders need to be well versed in each insurance carriers policies and procedures regarding broken global. Another dilemma OBGYN billers face is billing for multiple surgeries at one time. In many cases a doctor will perform more than one or more surgeries on a patient at a time and each surgery will need to be billed separately.

Katie’s knowledge and expertise not only comes from many years of billing for OBGYN, but also from teaching. Katie has been teaching medical billing and medical terminology at the local community college for over seven years. Her comprehensive knowledge of medical billing and her ability to understand the complex nature of the OBGYN billing process has played a huge role in her success as an employee and teacher.

“Working in the medical billing industry and keeping up to date with the rules and regulations regarding antepartum billing has allowed me to stay current in this constantly changing industry”, says Katie.

“Our growing success in streamlining medical billing processes for our clients and increasing their total revenue has made it possible for Capture to focus on OBGYN specialties. The difficulty around antepartum billing has given us a chance to expand our business by creating a department entirely focused on medical billing for OBGYN”, says Manny Oliverez, CEO of Capture Billing and Consulting.

Katie and her team will handle charge posting and review, patient billing functions and billing inquiry calls in addition to guiding doctors and their staff through the antepartum medical billing process; from charge entry, insurance claims submission and denial management to revenue follow-up. Capture’s focus is to alleviate the confusion that accompanies antepartum, and broken global billing and to help medical practices get paid for the services they provide. Capture wants to ensure that physicians and their practice’s get paid for all of the services that they provide, which will help their medical practices to continue to thrive.

Capture Billing’s expertise in complex claim submissions and appeal follow up will allow OBGYN practices to focus on their patients medical needs while eliminating loss of revenue. Capture will meet with individual practices and their employees to answer questions and review monthly reports that assist each practice in tracking their bottom line and their revenue growth.

ABOUT CAPTURE BILLING

Capture Billing and Consulting, Inc., a leader in the outsourced medical billing services industry, offers one of the most cost effective outsourcing solutions to healthcare professionals available. By eliminating the need of an in-house medical billing staff, Capture Billing’s staff of expert medical billers and certified professional coders help to increase physician reimbursement by improving collection rates and ensuring proper ICD-9 and CPT coding. Practicing physician and CEO, Dr. John D. Farrell, Jr., formed Capture Billing in 2004 as the answer to one of the largest concerns physicians face today, how to receive proper insurance reimbursement for services they provided.

If You Liked this Post – Look at These:

• Medical Billing Company Forms New Ophthalmology Billing Division
• Medical Billing Company Expands Their Pediatric Medical Billing Division
• American Academy of Professional Coders Has Elected Manny Oliverez of Capture Billing as Local Chapter Vice President for 2012

Manny Oliverez - Medical Billing Company CEO Medical Billing Company Forms New OBGYN Medical Billing Division Medical Billing Company | Capture Billing - Medical Billing Company Helping Doctors Succeed

5010 is the Standard Now: Are Your Insurance Claims Going to Get Paid?

Capture Billing has been working toward preparing for the transition to HIPAA Version 5010 for the past several months. The time has come and we are ready. As of January 1, 2012 all insurance claims must be submitted with the new 5010 format as mandated by the federal government.

Just because we are ready does this mean that insurance companies are ready? Will there still be some problems with insurance claims submission? Yes, I believe so.

The reason we estimate there will be problems is that as the insurance companies start receiving claims in the new 5010 format, even with all the testing that should have been done, there still may be issues with acceptance of the insurance claims. There are always glitches when software is upgraded and this is a big huge change.

My main concern is for small medical practices that may not be as tech savvy or have the resources to get help. Are they ready? Will all their claims be denied? Will they know how to work with their practice management software vendor and insurance company Electronic Data Interchange (EDI) departments to get their claims paid?

I think practices may have cash flow problems in the next few weeks as glitches in the system appear. And not just the small practices but the big medical practices also. Reimbursement issues may well extend into February before there is some relief.

We will be monitoring the 5010 transition situation very closely to make sure the medical practices we service don’t see a reduction in revenue or at least only a minimal change.

Keep a close eye on your claims to make sure they go through and are accepted by the clearinghouse and insurance companies. Make sure you carefully review all the Explanation of Benefits (EOBs) you receive from the insurance payers to ensure you are getting paid for the services you provided.

I would like to hear how your transition went and if you are having any problems. Please leave me a comment.

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Loudoun County, VA – Capture Billing & Consulting, Inc., a nationwide medical billing company located in South Riding, Virginia, is pleased to announce the formation of its new Ophthalmology Billing Department. Tonya Arevalo, an experienced and dedicated Team Leader at Capture Billing has been selected to head the new department.

After billing for Ophthalmology and Optometry offices for several years, Capture has decided to design a department strictly focused on Ophthalmology and Optometry billing. Through many years of experience in medical billing, medical coding and revenue cycle management, Capture has gained the trust and confidence of their specialized clients.

“We have had great success in streamlining medical billing processes for our clients as well as increasing their total revenue. Ophthalmology and Optometry billing has become an increasingly major part of our medical billing business, that is why we have decided to expand our business by creating a department entirely focused on that specialty”, says Manny Oliverez, CEO of Capture Billing and Consulting.

The head of the new Ophthalmology billing department, Tonya Arevalo, will oversee all ophthalmic billing functions. Tonya’s extensive knowledge in the ophthalmic field comes from not only working in Ophthalmology practices but from billing for several different ophthalmic practices.

Tonya and her team will handle charge posting, patient billing functions and billing inquiry calls in addition to guiding doctors and their staff through the medical billing process; from charge entry, insurance claims submission and denial management to revenue follow-up. Capture wants to ensure the physicians and their practices get paid for all of the services that they provide.

Typically ophthalmology and optometric practices struggle with following up on claim denials and patient payments which causes practices to lose revenue. Capture will meet with individual practices and their employees to answer questions and review monthly reports that assist each practice in tracking their bottom line and their revenue growth.

For more information on Capture Billing and its new division please visit: http://www.capturebilling.com

ABOUT CAPTURE BILLING
Capture Billing and Consulting, Inc., a leader in the outsourced medical billing services industry, offers one of the most cost effective outsourcing solutions to healthcare professionals available. By eliminating the need of an in-house medical billing staff, Capture Billing’s staff of expert medical billers and certified professional coders help to increase physician reimbursement by improving collection rates and ensuring proper ICD-9 and CPT coding. Practicing physician and CEO, Dr. John D. Farrell, Jr., formed Capture Billing in 2004 as the answer to one of the largest concerns physicians face today, how to receive proper insurance reimbursement for services they provided.

If You Liked this Post – Look at These:

• Medical Billing Company Forms New OBGYN Medical Billing Division
• Medical Billing Company Expands Their Pediatric Medical Billing Division
• American Academy of Professional Coders Has Elected Manny Oliverez of Capture Billing as Local Chapter Vice President for 2012

Manny Oliverez - Medical Billing Company CEO Medical Billing Company Forms New Ophthalmology Billing Division Medical Billing Company | Capture Billing - Medical Billing Company Helping Doctors Succeed

Pediatric Medical Billing Services Division Expansion by Capture Billing & Consulting, Inc. 

Loudoun County, VA – Capture Billing & Consulting, Inc., a medical billing company located in South Riding, Virginia, is pleased to announce the expansion of their Pediatric Medical Billing Division.

Over seven years ago Capture Medical Billing was formed when Dr. John Farrell and his Pediatric Medical office began thriving.  The quick growth of his Medical Practice left him with the challenging task of submitting medical claims to various insurance companies and ensuring the pediatric medical billing process and reimbursement rates were correct and completed in a timely manner.  This medical billing process required an infinite amount of time and resources.

As a Certified Professional Coder (CPC) and now CEO of Capture Billing, Manny Oliverez was able to assist Dr. Farrell in collecting his revenue from the insurance companies.

In 2004, based on Dr. Farrell’s success, another pediatric medical practice that had problems paying their bills and meeting payroll contacted Capture Billing for help.  Capture, using the medical pediatric billing methods and business practices it had developed, applied the methodology to their practice and took over their medical billing.  Within six months Capture was successful in turning them around and the practice became financially stable enough to hire a new doctor and expand their business.

There are several unique situations in Medical Billing for Pediatrics.  When submitting claims patient eligibility needs to be verified as well as who is financially responsible if the patient’s parents are divorced; some patients even have dual coverage.  These events require a knowledgeable and experienced medical biller to manage.  Other types of billing challenges, similar to the ones listed above have compelled Manny to add new members to his Pediatric Billing Services team.

“We have noticed an increase in the special circumstances that surround Pediatric billing so to ensure our clients are receiving their maximum revenue for the services they provide we have expanded our medical billing team, say Manny Oliverez.”

Capture wants to ensure the Pediatric practices receive revenue for all of the services that they provide, which will help their practices to continue to thrive.

For more information on Capture Billing, its new division and its medical billing and coding blog please visit:  http://www.capturebilling.com

ABOUT CAPTURE BILLING
Capture Billing and Consulting, Inc., a leader in the outsourced medical billing services industry, offers one of the most cost effective outsourcing solutions to healthcare professionals available. By eliminating the need of an in-house medical billing staff, Capture Billing’s staff of expert medical billers and certified professional coders help to increase physician reimbursement by improving collection rates and ensuring proper ICD-9 and CPT coding. Practicing physician and CEO, Dr. John D. Farrell, Jr., formed Capture Billing in 2004 as the answer to one of the largest concerns physicians face today, how to receive proper insurance reimbursement for services they provided.

CONTACT INFORMATION
Capture Billing & Consulting Inc.
25055 Riding Plaza, Suite 160
South Riding, VA 20152
(703) 327-1800
Contact: Manny Oliverez
Website: http://www.CaptureBilling.com

If You Liked this Post – Look at These:

• Medical Billing Company Forms New OBGYN Medical Billing Division
• Medical Billing Company Forms New Ophthalmology Billing Division
• American Academy of Professional Coders Has Elected Manny Oliverez of Capture Billing as Local Chapter Vice President for 2012

Manny Oliverez - Medical Billing Company CEO Medical Billing Company Expands Their Pediatric Medical Billing Division Medical Billing Company | Capture Billing - Medical Billing Company Helping Doctors Succeed

Loudoun County, VA – Capture Billing & Consulting, Inc., a nationwide medical billing company located in South Riding, Virginia, announces Manny Oliverez as the 2012 Vice President for the Leesburg, Virginia Chapter of American Academy of Professional Coders (AAPC).

According to AAPC (www.aapc.com) they are “the nation’s largest training and credentialing organization for the business side of medicine.”  Their organization consists of members in a variety of fields including medical coding and medical billing.  Their members “represent the highest level of expertise in the industry.”  The AAPC provides opportunities in networking, training and certifications as well other professional resources.

As Vice President of the Leesburg chapter of the AAPC, a few of Manny’s responsibilities include but are not limited to, assisting the president with chapter activities, proctoring certification exams, and ensure access to the chapter handbook.

“The AAPC has been a great resource for me.  The professional membership has allowed me to hire several members as employees at Capture Billing.  As 2012 Vice President of the Leesburg chapter of the AAPC I will be able to educate members of the changes happening in the medical billing field, as well as networking with a variety of professionals in the industry,” says Manny.

By utilizing the resources the AAPC has available for its members, Manny’s six year membership has enabled him to forge a variety of business relationships.  Manny encourages his employees to join the AAPC and to take advantage of the information that they provide.

Most of Manny’s employees at Capture Billing and most members of the AAPC have earned Continuing Education Units (CEUs) by attending monthly chapter meetings, or through workshops, webinars and national/regional events and conferences.  To learn more about the AAPC and earning CEUs contact your local chapter visit www.aapc.com.

To learn more about the medical billing services Capture Billing offers please visit: www.capturebilling.com.

ABOUT CAPTURE BILLING

Capture Billing and Consulting, Inc., a leader in the outsourced medical billing service industry, offers one of the most cost effective outsourcing solutions to healthcare professionals available.  By eliminating the need of an in-house medical billing staff, Capture Billing’s staff of expert medical billers and certified professional coders help to increase physician reimbursement by improving collection rates and ensuring proper ICD-9 and CPT coding, and soon will offer ICD-10 training.  Practicing physician and CEO, Dr. John D. Farrell, Jr., formed Capture Billing in 2004 as the answer to one of the largest concerns physicians face today, how to receive proper insurance reimbursement for services they provide.

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Manny Oliverez - Medical Billing Company CEO American Academy of Professional Coders Has Elected Manny Oliverez of Capture Billing as Local Chapter Vice President for 2012 Medical Billing Company | Capture Billing - Medical Billing Company Helping Doctors Succeed

Medicare and Newborns Codes cause some Confusion for Medical Practices

I received the following questions from Jean so I thought I would answer them here on the medical billing and coding blog in case anyone else could use the information.

Q: What is the CPT code for an annual exam for Medicare ….and what are the CPT codes for newborns for the first day, second day and discharge day … ?

A: The CPT code for the annual routine physical exam for Medicare is 99387 (preventative medicine E/M new patient age 65 and older) or 99397 (preventative medicine E/M established patient age 65 or older). This is the same code for all insurance companies. Remember that Medicare does not pay for these codes.  You are able to collect the fees for these services from the patient.  An Advance Beneficiary Notice (ABN) is not needed since this is a Medicare non-covered service.

If you are asking about the Annual Wellness Visit then the codes are G0438 and G0439. And don’t forget about the Welcome to Medicare exam, G0402.

Each of these codes are used for different reasons and have different requirements depending on what the patient needs or wants.

For more information check out my posts on the Welcome to Medicare visit using code G0402 for the Initial Preventative Physical Exam (IPPE), Annual Wellness Visit codes, and How to Bill a Well Woman Exam to Medicare using CPT codes 99387, 99397, G0101, Q0091, G0438 and G0439.

Now for the hospital newborn codes look at the following:

99460 – Initial, Newborn

99462 – Subsequent, Newborn

99238 – Discharge <30 min

99463 – Initial and Discharge Same Day, Newborn

Make sure you look up all these codes in your code book and use them appropriately and make sure your physicians document well.

If You Liked this Post – Look at These:

• Medicare G0438 — G0439: Two New Annual Wellness Visit Codes
• Medicare Billing for a Well Woman — G0101,Q0091,G0438,G0439,99387 & 99397
• New Medicare Advance Beneficiary Notice ABN CMS-R-131 to be used by January 1, 2012

Manny Oliverez - Medical Billing Company CEO Q&A: What are the Medicare Annual Exam Codes and Newborn Codes? Medical Billing Company | Capture Billing - Medical Billing Company Helping Doctors Succeed

Loudoun County, VA – Capture Billing & Consulting, Inc., a medical billing company located in South Riding, Virginia, announces Britt Hansen as the 2012 Treasurer for the Leesburg Virginia Chapter of the American Academy of Professional Coders (AAPC).

According to the AAPC they are “the nation’s largest training and credentialing organization for the business side of medicine”. Their organization consists of members in a variety of fields including medical billing and coding. Their members “represent the highest level of expertise in the industry”. The AAPC provides opportunities in networking, training and certifications as well other professional resources accessed through meetings or online.

“I am excited to be elected as treasurer for my local chapter of the AAPC. I have seen a great deal of growth occur over the last year and I am looking forward to becoming an integral part of the future continued growth of the organization. The information that is shared in the monthly meetings has proven to be extremely valuable in my career in medical billing and coding”, says Britt.

Some of the AAPC treasurer’s major responsibilities are to maintain chapter funds, be primary signer on chapter checking account, and request local chapter reimbursements from AAPC.

A majority of Capture Billing employees and most members of the AAPC have earned Continuing Education Units (CEUs) by attending monthly chapter meetings, or through workshops, webinars and national/regional events and conferences. To learn more about the AAPC and earning CEUs contact your local chapter or visit: www.aapc.com.

To learn more about the medical billing services Capture Billing offers please visit: www.capturebilling.com.

ABOUT CAPTURE BILLING

Capture Billing and Consulting, Inc., a leader in the outsourced medical billing service industry, offers one of the most cost effective outsourcing solutions to healthcare professionals available. By eliminating the need of an in-house medical billing staff, Capture Billing’s staff of expert medical billers and certified professional coders help to increase physician reimbursement by improving collection rates and ensuring proper ICD-9 and CPT coding, and soon will offer ICD-10 training. Practicing physician and CEO, Dr. John D. Farrell, Jr., formed Capture Billing in 2004 as the answer to one of the largest concerns physicians face today, how to receive proper insurance reimbursement for services they provide.

CONTACT INFORMATION

Capture Billing & Consulting Inc.
25055 Riding Plaza, Suite 160
South Riding, VA 20152
(703) 327-1800
Contact: Manny Oliverez

If You Liked this Post – Look at These:

• American Academy of Professional Coders Has Elected Manny Oliverez of Capture Billing as Local Chapter Vice President for 2012
• Medical Billing Company Member Michelle Ivanchukov Elected as American Academy of Professional Coders Local Chapter President for 2012
• Medical Billing Company Forms New OBGYN Medical Billing Division

Manny Oliverez - Medical Billing Company CEO Medical Billing Company Member Britt Hansen Elected as American Academy of Professional Coders Local Chapter Treasurer for 2012 Medical Billing Company | Capture Billing - Medical Billing Company Helping Doctors Succeed

Michelle Ivanchukov from Capture Billing has been elected the 2012 President for the Leesburg, Virginia Chapter of American Academy of Professional Coders

Loudoun County, VA – Capture Billing & Consulting, Inc., a nationwide medical billing company located in South Riding, Virginia, announces Michelle Ivanchukov as the 2012 President for the Leesburg, Virginia Chapter of American Academy of Professional Coders (AAPC).

The AAPC provides continuing education and various certifications to coders and medical billers. Over 100,000 of the AAPC’s members have access to training, networking and job opportunities in the medical coding field and can attend local chapter meetings. The varied certifications available, including Certified Professional Coder (CPC), can be achieved through testing at any local chapter of the AAPC.

“Becoming president of my local chapter of the AAPC has energized me to share my understanding and experiences in medical billing and coding with other chapter members. It also allows me to expand my knowledge base in a variety of medical specialty backgrounds”, say Michelle.

According to the AAPC, as president, some of Michelle’s primary responsibilities are to ensure certification examinations are administered correctly, communicate with other chapter officers and ensure the overall well-being of the chapter.

Michelle has been working for Capture Billing over the past six years and has been a member of the AAPC for 3 years. She will be replacing Jackie Ly in 2012 as President of the Leesburg, Virginia Chapter of the AAPC. Her membership with AAPC has enabled her to stay current on coding and medical billing standards.

A majority of Capture Billing employees and most members of the AAPC have earned Continuing Education Units (CEUs) by attending monthly chapter meetings, or through workshops, webinars and national/regional events and conferences. To learn more about the AAPC and earning CEUs contact your local chapter visit www.aapc.com.

To learn more about the medical billing services Capture Billing offers please visit: www.capturebilling.com.

ABOUT CAPTURE BILLING

Capture Billing and Consulting, Inc., a leader in the outsourced medical billing service industry, offers one of the most cost effective outsourcing solutions to healthcare professionals available. By eliminating the need of an in-house medical billing staff, Capture Billing’s staff of expert medical billers and certified professional coders help to increase physician reimbursement by improving collection rates and ensuring proper ICD-9 and CPT coding, and soon will offer ICD-10 training. Practicing physician and CEO, Dr. John D. Farrell, Jr., formed Capture Billing in 2004 as the answer to one of the largest concerns physicians face today, how to receive proper insurance reimbursement for services they provide.

If You Liked this Post – Look at These:

• American Academy of Professional Coders Has Elected Manny Oliverez of Capture Billing as Local Chapter Vice President for 2012
• Medical Billing Company Member Britt Hansen Elected as American Academy of Professional Coders Local Chapter Treasurer for 2012
• Medical Billing Company Forms New OBGYN Medical Billing Division

Manny Oliverez - Medical Billing Company CEO Medical Billing Company Member Michelle Ivanchukov Elected as American Academy of Professional Coders Local Chapter President for 2012 Medical Billing Company | Capture Billing - Medical Billing Company Helping Doctors Succeed

Loudoun County, VA – Capture Billing & Consulting, Inc., a medical billing company located in South Riding, Virginia, will begin the first semester of 2012 with a fast paced two part class on medical billing, medical coding and collections at Northern Virginia Community College (NVCC), Loudoun Campus in Sterling, Virginia.

NVCC’s “Medical Billing, Coding, and Collections” class will be taught by Katie Jennings. Katie not only teaches medical billing classes but her experience as a nurse and medical biller has given her the knowledge and insight into both the medical and business aspects of healthcare. Katie’s familiarity with diagnosis codes and insurance companies’ claims processes has helped influence the design of the class.

“This class is a great introduction into the medical billing field. I cover all aspects involved in medical billing as well as the medical billing process from beginning to end”, says Katie.

Part one of the two part class consists of lecture and theory. A few of the topics that will be covered in the class are claim preparation, documentation, reimbursements, and collections. Part two of the class will be a hands-on computerized class. Participants will learn about data entry, claim adjustments, write-offs as well as other topics, with an introduction to medical billing software and management. The class will also review real life medical billing situations.

Part one and Part two of the program both consist of four sessions each. They will help students prepare to enter the medical billing field as well as those who would like a career change. As medical billing standards change and become more complicated medical offices and medical billing companies will be seeking qualified individuals to manage the billing process.

To learn more about these and other medical billing course please visit:
Part One: http://www.nvcc.edu/wdce/loudoun/courses/classinfo.asp?ID=HLTH+1745
Part Two: http://www.nvcc.edu/wdce/loudoun/courses/classinfo.asp?ID=HLTH+1746
http://www.nvcc.edu/wdce/loudoun/courses/alphalist.asp

ABOUT CAPTURE BILLING

Capture Billing and Consulting, Inc., a leader in the outsourced medical billing services industry, offers one of the most cost effective outsourcing solutions to healthcare professionals available. By eliminating the need of an in-house medical billing staff, Capture Billing’s staff of expert medical billers and certified professional coders help to increase physician reimbursement by improving collection rates and ensuring proper ICD-9 and CPT coding. Practicing physician and CEO, Dr. John D. Farrell, Jr., formed Capture Billing in 2004 as the answer to one of the largest concerns physicians face today, how to receive proper insurance reimbursement for services they provided.

CONTACT INFORMATION

Capture Billing & Consulting Inc.
25055 Riding Plaza, Suite 160
South Riding, VA 20152
(703) 327-1800
Contact: Manny Oliverez
Website: http://www.CaptureBilling.com

If You Liked this Post – Look at These:

• Medical Billing Education Outreach Program is Established by Capture Billing
• Medical Billing Company Forms New OBGYN Medical Billing Division
• Medical Billing Company Forms New Ophthalmology Billing Division

Manny Oliverez - Medical Billing Company CEO Medical Billing Company Teaches Medical Billing, Coding and Collections at Local Community College Medical Billing Company | Capture Billing - Medical Billing Company Helping Doctors Succeed

Loudoun County, VA – Capture Billing & Consulting, Inc., a medical billing company located in South Riding, Virginia, is pleased to announce the formation of the Internal Medicine Medical Billing Division supervised by Britt Hansen, CPC (Certified Professional Coder).

According to ACP (American College of Physicians) “doctors of Internal Medicine focus on adult medicine and have had special study and training focusing on the prevention and treatment of adult diseases”. These doctors are often sought out by other physicians as consultants to assist in the analysis of perplexing diagnoses.

Internal medicine brings a new variety of diagnoses and procedures to the medical billing field. This is why Capture Billing has decided to form a division solely focused on Medical Billing for Internal Medicine. Britt will be overseeing her team of CPCs to ensure all medical claims are submitted with the correct diagnosis codes.

“The broad spectrum of diagnoses and procedures within Internal Medicine has increased my knowledge and understanding of the specific codes insurance companies require to process these individual claims”, says Britt.

Britt and her team will handle posting, patient billing functions and billing inquiry calls in addition to guiding doctors and their staff throughout the entire Internal Medicine Billing process; from charge entry, insurance claims submission and denial management to revenue follow-up. Capture wants to ensure that physicians and their medical practices are paid for all services they provide, which will help increase their revenue.

Capture will meet with individual Internal Medicine practices and their staff to examine billing and coding concerns and review the medical billing process. These meetings are also used to review monthly reports containing but not limited to; current A/R, practice analysis and patient and insurance outstanding detail.

They will review monthly reports assisting individual practices with their revenue growth.

For more information on Capture Billing and its new Internal Medicine Billing division please visit: http://www.capturebilling.com

ABOUT CAPTURE BILLING

Capture Billing and Consulting, Inc., a leader in the outsourced medical billing services industry, offers one of the most cost effective outsourcing solutions to healthcare professionals available. By eliminating the need of an in-house medical billing staff, Capture Billing’s staff of expert medical billers and certified professional coders help to increase physician reimbursement by improving collection rates and ensuring proper ICD-9 and CPT coding. Practicing physician and CEO, Dr. John D. Farrell, Jr., formed Capture Billing in 2004 as the answer to one of the largest concerns physicians face today, how to receive proper insurance reimbursement for services they provided.

Capture Billing & Consulting Inc.

25055 Riding Plaza, Suite 160
South Riding, VA 20152
(703) 327-1800
Contact: Manny Oliverez
Website: http://www.CaptureBilling.com

If You Liked this Post – Look at These:

• Medical Billing Company Forms New OBGYN Medical Billing Division
• Medical Billing Company Forms New Ophthalmology Billing Division
• Medical Billing Company Expands Their Pediatric Medical Billing Division

Manny Oliverez - Medical Billing Company CEO Medical Billing Company Forms Internal Medicine Billing Division Medical Billing Company | Capture Billing - Medical Billing Company Helping Doctors Succeed

Medical Billing Software for Mac | 2011 Guide to Mac Medical Billing Systems

Another piece from Software Advice caught my attention, and I wanted to share it with you because I thought you might find it useful. This one’s on medical billing software – but there’s a twist. Katie Matlack, the blogger covering medical software for Software Advice, noted that with the rise in popularity of iPhones and iPads, many doctors are looking for the same simplicity and convenience in the products they use at work. She also made the point that one area in which doctors are always looking to improve is in medical billing, and from there went on to discuss options that folks with Mac systems have when it comes to medical billing software.

There are several things to keep in mind when you are exploring Mac-compatible medical billing software.

● Can the software support a practice of your size?

● Is your software is appropriate for the specialty your practice serves?

● Do you want to purchase a web-based solution (also known as a hosted or software-as-a-service option – or a traditional Mac-based software system that’s installed on-site at your office)?

That last point can often make people take a step back and wonder what the difference between web-based solutions and native-based solutions and fortunately, Katie talks about the differences in her post, pointing out that web-based solutions are the norm for Mac users in the medical world because the vast majority of medical practices are still PC based (and so there are very few software solutions built specifically for the Mac). However, she also make sthe point that, for offices that run entirely on Apple computers and are looking for a consistent Apple OS look and feel, finding a native Mac solution (such as MacPractice MD) can be the preferred choice.

Katie includes a list of medical billing software options, covering both native Mac solutions as well as web based ones. Head on over to her blog post for a more detailed discussion of how to choose the right medical billing software for your Mac-based office.

If You Liked this Post – Look at These:

• Medical Billing Software — Capture Billing and Advanced Data Systems
• Medical Billing Videos

Manny Oliverez - Medical Billing Company CEO Medical Billing Software for Macs Medical Billing Company | Capture Billing - Medical Billing Company Helping Doctors Succeed

Loudoun County, VA – Capture Billing & Consulting, Inc., a nationwide medical billing company located in South Riding, Virginia, is pleased to announce the broadening of their Family Practice Medical Billing Division.

Capture Billing originally began medical billing for primary care physicians in 2004. Over the past seven years Capture has broadened its client base to include Family Practice Billing and other specialty fields.

Each medical practice has different hurdles they face in medical billing and coding. This is why it is imperative they have qualified and certified medical billing specialists to handle the demanding task of collecting revenue from individual insurance companies to ensure maximum reimbursement.

“Owning my own medical practice has given me the opportunity to see the complexity of the medical billing and coding process first hand. Knowing that insurance and governmental rules and regulations are constantly changing I feel reassured that employing Capture Billing to handle Family Practice Billing will help physicians maximize their insurance reimbursements”, says Dr. John Farrell, co-founder of Capture Billing. “Capture staff undergoes continuous training to stay abreast of all the changes in healthcare.”

Billing for Family Practices involve an array of unique challenges. When processing claims the medical biller needs to know how to code specific courses of action for example; ancillary procedures (venipunctures, injections, EKGs) and minor surgical procedures such as lesion excision, foreign body removal and fracture care.

Capture Billing is experienced with billing for Family Practices and has extensive experience in the claim submission process, from timely claim submissions to maximizing insurance and patient reimbursements. This extensive process is handled by Capture so the practice and it’s physicians can focus on their patients and their patients needs. Capture Billing works with each client separately to ensure they are informed of the medical billing process and to review their revenue growth and provides monthly reports for further analysis.

For more information on Capture Billing and its new division please visit: http://www.capturebilling.com

ABOUT CAPTURE BILLING

Capture Billing and Consulting, Inc., a leader in the outsourced medical billing services industry, offers one of the most cost effective outsourcing solutions to healthcare professionals available. By eliminating the need of an in-house medical billing staff, Capture Billing’s staff of expert medical billers and certified professional coders help to increase physician reimbursement by improving collection rates and ensuring proper ICD-9 and CPT coding. Practicing physician and CEO, Dr. John D. Farrell, Jr., formed Capture Billing in 2004 as the answer to one of the largest concerns physicians face today, how to receive proper insurance reimbursement for services they provided.

CONTACT INFORMATION
Capture Billing & Consulting Inc.
25055 Riding Plaza, Suite 160
South Riding, VA 20152
(703) 327-1800
Contact: Manny Oliverez
Website: http://www.CaptureBilling.com

If You Liked this Post – Look at These:

• Medical Billing Company Forms New OBGYN Medical Billing Division
• Medical Billing Company Forms New Ophthalmology Billing Division
• Medical Billing Company Expands Their Pediatric Medical Billing Division

Manny Oliverez - Medical Billing Company CEO Medical Billing Company Broadens Family Practice Billing Division Medical Billing Company | Capture Billing - Medical Billing Company Helping Doctors Succeed

Loudoun County, VA – Capture Billing & Consulting, Inc., a nationwide medical billing company located in South Riding, Virginia, is pleased to announce the formation of its new Otolaryngology Billing Department. Stacy White, an experienced and dedicated Manager at Capture Billing has been selected to head the new department.

As the oldest existing field of specialty medicine in the United States, Otolaryngology (ENT) physicians are trained in medical and surgical procedures. Their main focus is on treating patients with disorders and diseases of the ear, nose, and throat. These physicians may also practice in specialized fields such as allergy, laryngology and facial plastic and reconstructive surgery to name a few. Otolaryngology practices not only bill for office visits, but they also bill for surgical procedures that add to the complexity of the entire medical billing process.

Prior to Capture Billing, Stacy was the billing manager for one of the largest and most successful Otolaryngology practices in the state of Virginia. Her extensive knowledge and experience with medical billing for Otolaryngology procedures and surgeries will enabled Capture Billing to increase its ENT billing.

“We have had great success in streamlining medical billing processes for our clients as well as increasing their total revenue. The uniqueness of Otolaryngology billing has given us a chance to expand our business by creating a department entirely focused on that specialty”, says Manny Oliverez, CEO of Capture Billing.

As the head of the new Otolaryngology billing department, Stacy will oversee all Otolaryngology billing functions. Stacy’s extensive knowledge in the Otolaryngology field comes from over 18 years of experience in the physician billing, 8 of which come from working in Otolaryngology practices.

“There are two very common billing issues that occur in the Otolaryngology field. First, the improper use of modifier 50; this affects reimbursements when billing bilateral procedures. And second, claim denials for CPT code 30520 (septoplasty). These denials require appeals and additional medical documentation. Handling these claims improperly can result in a loss of revenue for the individual practices”, says Stacy. “We will be able to help our practices with these and other billing problems to recoup this income and increase their profitability.”

Stacy and her team will handle all aspects of otolaryngology billing in addition to guiding doctors and their staff through the medical billing process; from charge entry, insurance claims submission, patient billing and denial management to revenue follow-up. Capture wants to ensure the physicians and their practices get paid for all of the services that they provide, which will help medical practices to continue to thrive.

Otolaryngology practices are able to focus on their patients and alleviate the loss of revenue when they allow a company such as Capture Billing to provide them with expert medical billing services.

For more information on Capture Billing, its new division and its medical billing and coding blog please visit: http://www.capturebilling.com

ABOUT CAPTURE BILLING

Capture Billing and Consulting, Inc., a leader in the outsourced medical billing services industry, offers one of the most cost effective outsourcing solutions to healthcare professionals available. By eliminating the need of an in-house medical billing staff, Capture Billing’s staff of expert medical billers and certified professional coders help to increase physician reimbursement by improving collection rates and ensuring proper ICD-9 and CPT coding. Practicing physician and CEO, Dr. John D. Farrell, Jr., formed Capture Billing in 2004 as the answer to one of the largest concerns physicians face today, how to receive proper insurance reimbursement for services they provided.

CONTACT INFORMATION

Capture Billing & Consulting Inc.
25055 Riding Plaza, Suite 160
South Riding, VA 20152
(703) 327-1800
Contact: Manny Oliverez

If You Liked this Post – Look at These:

• Medical Billing Company Forms New OBGYN Medical Billing Division
• Medical Billing Company Forms New Ophthalmology Billing Division
• Medical Billing Company Expands Their Pediatric Medical Billing Division

Manny Oliverez - Medical Billing Company CEO Medical Billing Company Forms New Otolaryngology Billing Division Medical Billing Company | Capture Billing - Medical Billing Company Helping Doctors Succeed

Use New Medicare Advance Beneficiary Notice ABN CMS-R-131 by January 1, 2012

I received an email from the CMS listserv today reminding me about the new Advance Beneficiary Notice ABN we all have to start using by January 1, 2012.  I wanted to share that information with you all in case you do not subscribe to the Medicare emails.  Below is the info right from CMS.

2011 Version of Advance Beneficiary Notice of Noncoverage Must Be Used Beginning Sun Jan 1, 2012

In May 2011, CMS released an updated version of the Advance Beneficiary Notice of Noncoverage (ABN) (form CMS-R-131), which will replace the 2008 version of this form. The 2011 version contains no substantive changes from the 2008 version of the notice and was approved by the Office of Management and Budget. The 2008 and 2011 ABN notices are identical except that the release date of “3/11” is printed in the lower left hand corner of the new version. The ABN is used by all providers, practitioners, and suppliers paid under Medicare Part B, as well as hospice providers and religious non-medical healthcare institutions (RNHCIs) paid exclusively under Part A.

When the 2011 ABN was posted to the CMS website on Mon May 16, CMS announced a mandatory use date of Thu Sep 1 and permitted providers and suppliers to begin using the new form immediately. Subsequently, we received requests from the industry to extend this deadline in order to permit providers and suppliers with pre-printed stockpiles of ABNs time to exhaust their supplies.

Providers and suppliers are allowed to use either the 2008 or 2011 version of the ABN through the end of this year; beginning Sun Jan 1, 2012, they must begin using the 2011 version. ABNs issued after Sun Jan 1 that are prepared using the 2008 version of the notice will be considered invalid by Medicare contractors. 2008 versions of the ABN that were issued prior to Sun Jan 1 as long-term notification for repetitive services delivered for up to one year will remain effective for the length of time specified on the notice.

Information and a copy of the 2011 version of the ABN (form CMS-R-131) can be found online at http://www.CMS.gov/BNI , under the “FFS Revised ABN” link.

To DOWNLOAD the Revised ABN form CLICK HERE

____________________

It’s Your Turn

What Do you think? Are you using then new ABN? Have you been successful getting Medicare patients to pay for services that were denied? Share your experience in the comments box below.

If You Liked this Post – Look at These:

• Medicare Billing for a Well Woman — G0101,Q0091,G0438,G0439,99387 & 99397
• Medicare Advance Beneficiary Notice (ABN): A Quick How To
• Commonly Used Medicare Modifiers — GA, GX, GY, GZ

Manny Oliverez - Medical Billing Company CEO New Medicare Advance Beneficiary Notice ABN CMS-R-131 to be used by January 1, 2012 Medical Billing Company | Capture Billing - Medical Billing Company Helping Doctors Succeed

How to Attest for Meaningful Use (MU): 3 Tips from a Meaningful User

My friend Huston Neal over at Software Advice just published a piece on how to attest for meaningful use. He interviewed a Dr. Kevin Spencer who uses Greenway PrimeSUITE in his group practice.

Dr. Spencer from Premier Family Physicians in Austin Texas, is a physician that recently attested to meaningful use. In this article he provides three tips to make successfully attesting meaningful use easier for other practices. According to Dr. Spencer, the key components to successfully attesting were:

• Choosing the right EHR software company;

• Undergoing meaningful use training; and,

• Changing documentation processes to fit meaningful use guidelines.

Here is a short excerpt from the post.

“Premier’s patients are also benefiting from the practice’s EHR and MU attestation process. They are more educated about their disease state; they have more information available to them, and; they can be more involved in their health care. Patients can also sign up for Premier’s patient portal and check their medication lists, drug allergies, diagnosis and treatment instructions. Currently, more than 10,600 patients have registered, which is a significant level of engagement.”

I thought readers would find this article to be a useful resource.

You can view the entire post on Houston’s blog at: http://blog.softwareadvice.com/articles/medical/how-to-attest-for-meaningful-use-mu-3-tips-from-a-meaningful-user-1101711/.

If You Liked this Post – Look at These:

• Your Guide to Meaningful Use from eRecords
• EHR Update: 6 More Things to Consider
• HITECH Act: Electronic Health Records and Meaningful Use Made Easy

Manny Oliverez - Medical Billing Company CEO 3 Tips from a EHR Meaningful Use User Medical Billing Company | Capture Billing - Medical Billing Company Helping Doctors Succeed

Billing Flu Shots to Medicare and Commercial Insurance Companies

Since it is now flu season I have been getting a lot of questions on how to bill flu shots to commercial insurance companies and Medicare. The codes used for a particular vaccine will vary depending on intramuscular vs. intranasal use, age of patient, formulation, preservative free, and split or live virus. If you are unsure of what code to use I suggest looking at the package information that came with the vaccine. Usually you can find the code on the packaging, and if you can’t find it in the documentation then call the supplier.

This is how most of our primary care practices bill for flu shots. Your situation may be different so make sure to check all the influenza vaccine codes 90654-90668 and use the appropriate code for the vaccine administered to the patient.

Commercial Insurance Carriers

90471 Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid)
90658 Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use

Medicare

G0008 Administration of Influenza Virus Vaccine
Q203x Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use

Keep in mind that there are several codes for the flu vaccine when you bill for Medicare flu shots. The code you use is dependent on the manufacturer of the vaccine. Replace the code above with the correct vaccine code below.

Here is the list of the new Medicare Flu Vaccine codes for 2011. Choose the code based on the manufacture:

Q2035 Afluria Vaccine: Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Afluria)

Q2036 Flulaval Vaccine: Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Flulaval)

Q2037 Fluvirin Vaccine: Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Fluvirin)

Q2038 Fluzone Vaccine: Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Fluzone)

Q2039 NOS (Not Otherwise Specified) Vaccine: Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Not Otherwise Specified)

Check out the short video we made about coding for the Medicare flu shot CLICK HERE

Pediatric Billing

If a child is under the age of 9 and has not previously received a flu shot, then usually two shots are given one month apart. After the initial series, in subsequent years only one shot is needed. When billing for the initial flu shot keep in mind that insurance should pay for both the initial flu shot and the flu shot given 30 days later. Be sure to follow up with the insurance companies if reimbursement is not issued for the second shot of the initial series. Typically these are denied but can be paid with a simple appeal or phone call correcting the denial.

90471 Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid)

Use the age appropriate codes as needed.
90657 Influenza virus vaccine, split virus, when administered to children 6-35 months of age, for intramuscular use
Or
90658 Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use

CPT copyright 2010 American Medical Association. All rights reserved.
CPT is a registered trademark of the American Medical Association.

If You Liked this Post – Look at These:

• Medicare: Video Helps Explain New Influenza Vaccine Q Codes for 2011
• 2011 Medicare Codes for Flu Shots: Q2035, Q2036, Q2037, Q2038
• Coding for the 2010 Flu Shot: Three Vaccines, One Code

Manny Oliverez - Medical Billing Company CEO How to Bill for Flu Shots Medical Billing Company | Capture Billing - Medical Billing Company Helping Doctors Succeed

Medical Billing Tips Video Podcast
Coding for the H1N1 Swine Flu Vaccine
Episode 1

This episode of Medical Billing Tips helps physicians and medical billers to bill for the H1N1 Swine Flu Vaccine.

http://www.youtube.com/watch?v=DZz7eAeGmhc

Video Transcript & Show Notes

Ouch! I just got the Swine Flu Shot officially known as the H1N1 vaccine. There’s been a lot of confusion on how medical practices should bill for the H1N1, so let’s find out how they should.

Since the government is providing the vaccine you won’t be able to bill for it, but you are allowed to charge for administering the vaccine. Use CPT code 90470 this includes the administration and counseling for either intramuscular or intranasal versions of the vaccine.

The CPT code for the H1N1 vaccine is 90663, Medicare of course has come up with their own code, G9141 for the admin and G9142 for the vaccine.

The ICD-9 or diagnosis code should be V04.81. Even though the vaccine is provided for free, some insurers want you to code for the vaccine and some don’t. If you do code for it submit a fee of zero and be aware that some insurers have announced that a patient will not have to pay a co-pay or co-insurance, and you can now code an additional 99211 for a nurse visit.

Check with your insurance carriers, Medicare and Medicaid for specific billing requirements. My name is Manny Oliverez and this has been the Medical Billing Tips podcast.

If You Liked this Post – Look at These:

• Medical Billing Videos
• How to Bill for Flu Shots

Manny Oliverez - Medical Billing Company CEO Medical Billing Tips | Billing for the H1N1 Swine Flu Vaccine Medical Billing Company | Capture Billing - Medical Billing Company Helping Doctors Succeed

Medical Billing Tips Audio Podcast
Coding for the H1N1 Swine Flu Vaccine
Episode 1

This episode of Medical Billing Tips helps physicians and medical billers to bill for the H1N1 Swine Flu Vaccine. The use of code 90470, 90663 and Medicare G codes G9141 and G9142 are discussed. Check with your insurance carriers, Medicare and Medicaid for specific billing requirements.

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Manny Oliverez - Medical Billing Company CEO Coding for the H1N1 Swine Flu Vaccine Medical Billing Company | Capture Billing - Medical Billing Company Helping Doctors Succeed

Capture’s Medical Billing client Bao Nguyen of Generations Family Practice is named one of the “Best Doctors in America” for 2011-2012

Loudoun County, VA – Capture Billing & Consulting, Inc., a leading national medical billing company headquartered in South Riding, Virginia, is pleased to announce that one of their clients physicians, Bao Nguyen, DO of Generations Family Practice located in Reston Virginia, was named one of the “Best Doctors in America” 2011-2012.

Boston-based Best Doctors, Inc., founded by physicians in 1989, gives the “The Best Doctors in America” award to physicians. Its database is compiled from a comprehensive survey of more than 45,000 physicians in the United States. Only doctors in the top 3-5% of their specialty earn the prestigious honor of being named one of the “Best Doctors in America”.

“We are honored to have Dr. Nguyen and Generations as a client.” says, Manny Oliverez CEO of Capture Billing.

Winners of the “Best Doctor in America” are chosen by a panel of their peers and recognized for their expertise in their field.  Along with Dr. Nguyen, Capture has worked with other physicians who have won a variety of prestigious awards including Dr. John Farrell, owner of Farrell Pediatrics.

To receive some of the same billing tips Dr. Nguyen receives visit the Medical Billing and Coding Blog.

ABOUT CAPTURE BILLING
Capture Billing and Consulting, Inc., a leader in the outsourced medical billing service industry, offers one of the most cost effective outsourcing solutions to healthcare professionals available.  By eliminating the need of an in-house medical billing staff, Capture Billing’s staff of expert medical billers and certified professional coders help to increase physician reimbursement by improving collection rates and ensuring proper ICD-9 and CPT coding, and soon will offer ICD-10 training.  Practicing physician and CEO, Dr. John D. Farrell, Jr., formed Capture Billing in 2004 as the answer to one of the largest concerns physicians face today, how to receive proper insurance claim reimbursement for services they provide.

CONTACT INFORMATION
Capture Billing & Consulting, Inc.
25055 Ridging Plaza, Suite 160
South Riding, VA 20152
(703) 327-1800
Contact: Manny Oliverez
Pressroom: Medical Billing News
Website: www.CaptureBilling.com

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Manny Oliverez - Medical Billing Company CEO Medical Billing Company Client is Voted One of the “Best Doctors in America” for 2011-2012 Medical Billing Company | Capture Billing - Medical Billing Company Helping Doctors Succeed

Manny Oliverez of Capture Billing & Consulting, Inc. will be teaching a Medical Revenue Cycle Management class at Local Community College.

Loudoun County, VA – Capture Billing & Consulting, Inc., a national medical billing company located in South Riding, Virginia, is excited to announce that Manny Oliverez, CEO of Capture Billing, will be teaching Medical Revenue Cycle Management on Saturday, August 27, 2011 at the Loudoun Campus of Northern Virginia Community College (NVCC).

The Medical Revenue Cycle Management class is part of a series of 5 classes of the Medical Office Administration Program in the Workforce Development Department of the college. The courses are geared towards helping individuals with specific training needs in the field of medical billing.  Students that take all the classes receive a Certificate.

Students of the Revenue Cycle class consist of workers in the medical billing and coding field updating their current skills, students entering or re-entering the workforce and students changing careers.  The course will cover the entire medical billing revenue cycle and will provide practical hands-on solutions on how to best manage medical billing claims and how to get them paid quickly.

“In today’s economy of lower insurance reimbursements and higher deductibles it is important for insurance claims to get paid quickly and for patients to be billed correctly, which is why I designed the Medical Revenue Cycle Management class”, says Oliverez.

Manny Oliverez is a Certified Professional Coder (CPC) as well as the co-founder of his own medical billing company.  Oliverez has been in the healthcare industry for over 17 years and has noticed a demand for helping medical practices collect their revenue in a more efficient manner.

A few of the topics the course will examine are best practices for over-the-counter collections, electronic insurance claim submissions, claim appeals, patient billing and the use of reports designed for benchmarking and setting goals to keep bringing in revenue.

To learn more about the NVCC’s Medical Office Administration Program please visit: http://www.nvcc.edu/wdce/loudoun/certificate/certificate2.asp?p=Medical+Office+Administration#cList

ABOUT CAPTURE BILLING
Capture Billing and Consulting, Inc., a leader in the outsourced medical billing service industry, offers one of the most cost effective outsourcing solutions to healthcare professionals available.  By eliminating the need of an in-house medical billing staff, Capture Billing’s staff of expert medical billers and certified professional coders help to increase physician reimbursement by improving collection rates and ensuring proper ICD-9 and CPT coding, and soon will offer ICD-10 training.  Practicing physician and CEO, Dr. John D. Farrell, Jr., formed Capture Billing in 2004 as the answer to one of the largest concerns physicians face today, how to receive proper insurance reimbursement for services they provide.

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• American Academy of Professional Coders Local Chapter Elected Manny Oliverez of Capture Medical Billing for 2012 President
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• Medical Billing Company is Co-Founder of Healthcare Business Alliance – An Organization for Assisting Physicians in the Business of Healthcare

Manny Oliverez - Medical Billing Company CEO Medical Billing Company CEO Offers Medical Revenue Cycle Management Class through Local Community College Medical Billing Company | Capture Billing - Medical Billing Company Helping Doctors Succeed

Medicare Billing for Well Woman Exam Using Codes G0101 and Q0091 and Annual Wellness Visits AWV G0438 and G0439

As we are all aware, Medicare now allows for the Annual Wellness Visit (AWV) G0438 or subsequent AWV G0439, but how does this relate to an annual Well Woman Exam?  IT DOESN’T.

An annual Well Woman Exam is a completely separate evaluation and management service from an AWV and unless the provider specifically evaluates a patient for both the AWV and a Well Woman Exam, the AWV should not be billed out.  So how does a provider bill out for an annual Well Woman Exam for a patient covered by Medicare?  Let’s discuss the components of the annual exam first.

What does an Annual Exam include?

Preventive Medicine Service codes are defined by the CPT book as evaluation or reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures.

The purpose of the annual exam includes screening for disease, assessment risk of future medical problems, promoting a healthy lifestyle, and to update vaccinations. Aspects of the annual exam may include all or some of the following:

1. Review of History
2. Checking Vital Signs
3. General Appearance
4. Heart Exam
5. Lung Exam
6. Head and Neck Exam
7. Abdominal Exam
8. Neurological Exam
9. Dermatological Exam
10. Extremities Exam
11. Males: Testicular and Prostate Exams
12. Females: Breast and Pelvic Exams
13. Counseling
14. Routine Laboratory Tests
15. Immunizations

Does an Annual Exam also include a Well Woman Exam?

Yes.  The annual exam also includes the components of a Well Woman Exam.  If a patient is seen by her primary care physician (PCP) for an annual, the provider will also include the pelvic and breast exam and a pap smear collection.  If the patient elects to have the Well Woman Exam performed by her Gynecologist, the PCP must document that the Pelvic and Breast exams and pap smear collection were deferred and will be performed by a Gynecologist.

Incorrect Billing Procedures

1. What if you run out of time? If the patient is seen for an annual and the well woman exam portions are not done during the same visit, the provider may need to see the patient again in order to complete the comprehensive exam.  This second visit is merely a continuation and is not billable.

2. Can you bill an annual with a V72.31 Annual Gynecological Exam diagnosis and get paid separately? No.  If you have already billed out an annual in a given year (V70.0) then you cannot charge another annual with a different diagnosis.

3. What if the patient did not want the Well Woman Exam portions done during the regular annual? If the patient did not want the pelvic/breast exam and pap smear collection during the routine physical but later decided to not see the Gynecologist and comes back for these screenings you still cannot bill for these separately.  They are already included in the annual.  The patient may be seen but it cannot be billed.

Requirements of Coding and Billing an Annual Well Woman Exam to Medicare

Medicare does not cover preventive services such as an annual (besides the AWV) but certain Well Woman Exam screenings are reimbursed either every two years or annually.

Covered Services

Medicare covers the following screening exams in conjunction with a Well Woman Exam:

1. G0101 Cervical or Vaginal Cancer Screening; Pelvic and Clinic Breast Examination

a. G0101 is reimbursed by Medicare every two years unless the patient is considered high risk and then it is allowed on an annual basis.
b. According the CMS website, the ICD-9-CM Codes billable with the G0101 are V76.2, V76.47, V76.49, V15.89, and V72.31.  Select the appropriate codes.

i. V76.2 Special screening for malignant neoplasms, cervix
ii. V76.47 Special screening for malignant neoplasms, vagina
iii. V76.49 Special screening for malignant neoplasms, other sites
iv. V15.89 Other specified personal history presenting hazards to health
v. V72.31 Routine gynecological exam

2. Q0091 Screening Papanicolaou Smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory

a. Q0091 is reimbursed by Medicare every two years unless the patient is considered high risk and then it is allowed on an annual basis.
b. Per the CMS website, the ICD-9-CM Codes billable with the Q0091 are V76.2, V76.47, V76.49, V15.89, and V72.31.  Select the appropriate codes.

3. 82270 Fecal Occult Blood Test

a. 82270 can be billed on an annual basis.
b. Per the CMS website, the appropriate code varies by carrier.  An applicable code is V76.51 Special Screening for Malignant Neoplasms; Colon.

High Risk Factors and Frequency

High Risk Factors determine whether or not a patient may have the G0101 and Q0091 on an annual basis.  If a patient is considered high risk then these screening tests may be done annually.

According to the CMS Website the following factors are listed as high risk factors for screening pap smears and pelvic exams:

1. Cervical High Risk Factors
a. Early onset of sexual activity (under 16 years of age)
b. Multiple sexual partners (five or more in a lifetime)
c. History of a sexually transmitted disease (including HIV infection)
d. Fewer than three negative pap smears within the previous 7 years
2. Vaginal Cancer High Risk Factors: DES (diethylstilbestrol) exposed daughters of women who took DES during pregnancy
3. Personal History of Health Hazards: If a patient has a specified personal history presenting hazards to health then apply the V15.89 diagnosis and the appropriate health history hazard (example: V10.3 History of Breast Malignancy).  Any V15.89 diagnosis is considered high risk and also eligible for the yearly G0101 and Q0091.

Advanced Beneficiary Notices (ABNs)

An Advanced Beneficiary Notice is a Medicare Waiver of Liability that providers are required to give a Medicare patient for services provided that may not be covered or considered medically necessary.  ABNs do not apply to services that are specifically excluded from Medicare coverage, such as an annual.

A completed and signed ABN is key for reimbursement.  It also notifies Medicare that the patient acknowledges that certain procedures were provided and that the patient will be personally responsible for full payment if Medicare denies payment for a specific procedure or treatment.  If there is no signed ABN then you cannot bill the patient and it must be written off if denied by Medicare (translation: Free Services, Lost Revenue).

ABN Criteria

1. The ABN must be given to the patient prior to any provided service or procedure
2. Patient’s name, specific service and estimated charge amount must be listed on the ABN
3. ABN cannot be given to a patient who is under duress or requires emergency treatment
4. Check for specific criteria and download the form at http://www.cms.gov/BNI/02_ABN.asp

Appropriate Medicare Modifiers

Certain Medicare modifiers are required when billing with an ABN.

1. GA Modifier: Waiver of Liability Statement Issued as Required by Payer Policy.  This modifier indicates that an ABN is on file and allows the provider to bill the patient if not covered by Medicare.

2. GX Modifier: Notice of Liability Issued, Voluntary Under Payer Policy.  Report this modifier only to indicate that a voluntary ABN was issued for services that are not covered.

3. GY Modifier: Notice of Liability Not Issued, Not Required Under Payer Policy.  This modifier is used to obtain a denial on a non covered service.  Use this modifier to notify Medicare that you know this service is excluded.

4. GZ Modifier: Item or Service Expected to Be Denied as Not Reasonable and Necessary.  When an ABN may be required but was not obtained this modifier should be applied.

Billing a Well Woman Exam

Fee for Service

Since specific well woman screening components of the routine annual exam are covered by Medicare, these are billed out separately.  These screenings are carved out from the provider’s usual fee for preventive service since they are allowable and reimbursable by Medicare.  The remainder balance is the patient’s financial responsibility.  The total fee does not change, only how it is billed and who pays.

The G0101 and the Q0091 are the services that are reimbursed and carved out of the regular annual fee.  The Medicare reimbursement for the G & Q and patient portion equal the same annual fee that a non Medicare patient would be charged.

For example, if the fee for an annual for a non Medicare patient is $235.00 this is the breakdown for a Medicare patient:

It is the same original fee for the but billed out differently.   For additional clarification please refer to: http://www.acog.org/departments/coding/MedicareScreeningServices.pdf

Billing Medicare

Following is an example of a typical Well Woman Exam with a signed ABN that is billed out to Medicare:

Reference

Medicare billing policies are constantly changing at CMS and with your local carrier so before your do anything check with them and your coding specialist to make sure you are billing correctly.

The CMS website has a quick reference guide for Medicare Preventive Services which lists applicable tests, diagnoses and frequencies: http://www.cms.gov/MLNProducts/Downloads/MPS_QuickReferenceChart_1.pdf

CPT copyright 2011 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.

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Manny Oliverez - Medical Billing Company CEO Medicare Billing for a Well Woman – G0101,Q0091,G0438,G0439,99387 & 99397 Medical Billing Company | Capture Billing - Medical Billing Company Helping Doctors Succeed

Manny Oliverez, CEO and Co-founder of Capture Billing has been elected the 2012 President for the Leesburg Virginia Chapter of American Academy of Professional Coders

Loundoun County, VA (PRWEB) – Capture Billing & Consulting, Inc., a nationwide medical billing company located in South Riding, Virginia, announces Manny Oliverez as the 2012 President-Elect for the Leesburg Virginia Chapter of American Academy of Professional Coders (AAPC).

AAPC is an organization which provides continuing education and various certifications to coders and medical billers. Over 100,000 of AAPC’s members have access to training, networking and job opportunities in the medical coding field. The diverse certifications available, including Certified Professional Coder (CPC), can be obtained through testing at any local chapter of the AAPC.

Many of Capture Billing’s employees have received their coding certifications through the local chapter of AAPC as well as holding elected positions as the 2011 President and Secretary. President Jackie Ly, CPC and Secretary Michelle Ivanchukov, CPC, CCS-P are both long time active members of AAPC.

“Networking with a variety of professionals in the medical field such as medical billers, doctors, and insurance representatives has furnished me with information I may not have learned in text books”, says Jackie.

“Being on the board of our local chapter of AAPC has enriched my medical billing and coding knowledge. It has been very interesting to meet individuals from different medical specialty backgrounds”, says Michelle.

“I look forward to the challenge of keeping our members educated and current in the complex transition from ICD-9 to ICD-10”, says Manny. “In regards to our company, we will be able to provide the most current coding and medical billing services available to aid our practices in the ICD-10 transition on October 1, 2013”.

Members of AAPC can earn Continuing Education Units (CEUs) by attending monthly chapter meetings, or through workshops, webinars and national/regional events and conferences. To learn more about AAPC or to contact your local chapter visit http://www.aapc.com.

To learn more about the medical billing services Capture Billing offers please visit: http://www.capturebilling.com.

ABOUT CAPTURE BILLING
Capture Billing and Consulting, Inc., a leader in the outsourced medical billing service industry, offers one of the most cost effective outsourcing solutions to healthcare professionals available. By eliminating the need of an in-house medical billing staff, Capture Billing’s staff of expert medical billers and certified professional coders help to increase physician reimbursement by improving collection rates and ensuring proper ICD-9 and CPT coding, and soon will offer ICD-10 training. Practicing physician and CEO, Dr. John D. Farrell, Jr., formed Capture Billing in 2004 as the answer to one of the largest concerns physicians face today, how to receive proper insurance reimbursement for services they provide.

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CEO of Capture Medical Billing, Manny Oliverez, is one of ten founders of Healthcare Business Alliance, an organization dedicated to help physicians with the business of healthcare.

South Riding, VA (PRWEB) August 02, 2011 – Capture Billing & Consulting, Inc., a nationwide medical billing company located in South Riding, Virginia, is one of ten healthcare businesses that came together to form Healthcare Business Alliance (HCBA).

HCBA is an organization founded to help physicians stay informed with issues that arise in the constantly changing medical field. HCBA brings together experts in the fields of marketing, real estate, accounting, insurance, law, practice management and medical billing that specialize specifically in healthcare.

Manny Oliverez, CEO of Capture Billing and Consulting, Inc. and one of the ten founding members of HCBA, understands the complexity of running and maintaining a medical practice having run several practices himself.

“When starting HCBA we looked around to see if there was one place for physicians to find the resources and advice they need to operate and expand their medical practices,” says Oliverez. “Not just advice from anyone, but advice from professionals that deal with healthcare issues and physicians on a daily basis. We couldn’t find a “One-Stop” place so HCBA was formed to fill the gap.”

Once a month HCBA hosts an event consisting of relevant and current healthcare topics that help physician members enhance and grow their practices. HCBA also offers a place for physicians to network with other physicians so they can learn from each other and develop beneficial relationships.

HCBA hosts a website with links to a variety of resources, services, daily healthcare news and up-to-date information in the medical billing and coding field. To learn more about HCBA or to become a member please visit: http://www.HCBAlliance.org

To learn more about the medical billing services Capture Billing offers please visit: http://www.capturebilling.com

About Capture Billing

Capture Billing and Consulting, Inc., a leader in the outsourced medical billing services industry, offers one of the most cost effective outsourcing solutions to healthcare professionals available. By eliminating the need of an in-house medical billing staff, Capture Billing’s staff of expert medical billers and certified professional coders help to increase physician reimbursement by improving collection rates and ensuring proper ICD-9 and CPT coding. Practicing physician and CEO, Dr. John D. Farrell, Jr., formed Capture Billing in 2004 as the answer to one of the largest concerns physicians face today, how to receive proper insurance reimbursement for services they provided.

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Loudoun County, VA – Capture Billing & Consulting, Inc., a nationwide medical billing company located in South Riding, Virginia, has created an online newspaper named Medical Billing and Coding News.

Today’s professionals in the healthcare, medical billing and coding industry use a variety of media outlets to gain knowledge and information about the changes and challenges facing the healthcare industry. Many of these professional have difficulty finding the time to sort through these outlets to find pertinent and useful information.

Capture Billing understands the importance of these educational resources and the limited time professionals have to sift through the immense amount of information available to them. To help with this demand Capture now posts a daily online newspaper that compiles and organizes significant information physicians and healthcare professionals need to operate their practices into one place.

“My staff and I need to stay abreast of what is new and what is changing in the medical billing and coding field. Capture Billing’s online Medical Billing and Coding News has been a great resource for us and we thought other physicians, practice administrators, medical billers and coders in the field would benefit as well” says Manny Oliverez CEO of Capture Billing and Consulting, Inc.

To register for Medical Billing and Coding News, our online newspaper services please visit http://www.paper.li/Capture_Billing/1309807499

To learn more about the medical billing services Capture Billing offers please visit www.capturebilling.com.

ABOUT CAPTURE BILLING

Capture Billing and Consulting, Inc., a leader in the outsourced medical billing services industry, offers one of the most cost effective outsourcing solutions to healthcare professionals available. By eliminating the need of an in-house medical billing staff, Capture Billing’s staff of expert medical billers and certified professional coders help to increase physician reimbursement by improving collection rates and ensuring proper ICD-9 and CPT coding. Practicing physician and CEO, Dr. John D. Farrell, Jr., formed Capture Billing in 2004 as the answer to one of the largest concerns physicians face today, how to receive proper insurance reimbursement for services they provided.

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Manny Oliverez - Medical Billing Company CEO Medical Billing Company Creates Daily Online Newspaper Medical Billing Company | Capture Billing - Medical Billing Company Helping Doctors Succeed

What is HIPAA 5010 and Does it Effect My Medical Practice?

Effective January 1, 2012 HIPAA version 5010 becomes mandatory.  All of us in the healthcare industry will need to understand, implement and transition to the new Health Insurance Portability and Accountability Act (HIPAA) version 5010 well before the mandated compliance date.  Testing should begin as soon as possible to avoid any delays in claims payments and rejections.

What is 5010 and how does it affect the Healthcare Industry?

5010 refers to the set of rules implemented and regulated under HIPAA which determines how electronic information is transmitted.  The current standard of electronic transactions and designated code sets is the 4010 version (Version 004010 of the ASC X12 transaction implementation guides), which will be phased out and replaced by 5010.  5010 will allow for more efficient, more improved and larger information exchange.  The 5010 version will also transition the healthcare industry from ICD-9 to ICD-10.

The 5010 code set is expected to save $12 billion according to The Department of Health and Human Services. Cost savings will come from eliminating inefficient manual processing of transactions. These cost savings are mandated by the Affordable Care Act.

Even though the current standard is 4010, multiple systems are still in use by insurance carriers.  The new 5010 rules will now provide greater uniformity in the transmission of information.  Any systems not meeting the 5010 transition deadline of January 1, 2012 will no longer be able to communicate with any insurance companies, seriously affecting the bottom line!  Any disruption of claims payments will adversely impact any medical practice.

Is there a Choice?

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Initial Preventative Physical Exam (IPPE) G0402 is know as the “Welcome to Medicare Visit” to most Medical Billers

What is a Welcome to Medicare visit and how do you bill for it?  Let’s see if I can help and explain and point you in the right direction to gather more information.

A patient who has just qualified for Medicare Part B is allowed this once in a lifetime benefit within the first 12 months of Medicare eligibility.  Medicare calls this exam the Initial Preventative Physical Exam or IPPE but it is more widely known as the “Welcome to Medicare Visit”. This is a great benefit that also includes several exams that are normally not covered. A properly trained front desk staff scheduling appropriate appointments is essential, for both your office and for your newly Medicare eligible patient, to properly utilize these once in a lifetime benefits.

The IPPE is designed for “health promotion and disease detection” per Medicare. The following requirements of the IPPE can found at the CMS website at: http://www.cms.gov/MLNProducts/downloads/MPS_QRI_IPPE001a.pdf

What are the requirements of the IPPE? The following requirements must be met in order to bill for the IPPE:

• Review of medical and social history to include past medical/surgical history; current medications and supplements; family history; history of alcohol; tobacco and illicit drug use; diet; and physical activities

• Review of potential risk factors for depression and other mood disorders

• Review of functional ability and level of safety for hearing impairment; activities of daily living; falls risk; and home safety

• Examination to obtain height, weight and blood pressure; visual acuity screen; measurement of body mass index; and other factors deemed appropriate based on the beneficiary’s medical/social history and current clinical standards

• End of life planning is a required service with the patient’s consent to discuss an advance directive; and whether or not the physician is willing to follow the beneficiary’s wishes as expressed in the advance directive

• Education, counseling and referral based on the previous five components, as appropriate

• Education, counseling and referral for other preventive services in the form of a brief written plan for the beneficiary to obtain a screening electrocardiogram and any other preventive services/screenings covered by Medicare Part B benefits

The IPPE is billed out using HCPCS Code G0402.

Additional once in a lifetime benefits in conjunction with the IPPE

Screening Electrocardiogram (EKG) – Medicare no longer deems the screening EKG as a mandatory service component of the IPPE. However, there is a once in a lifetime screening EKG that is allowed as a result of a referral from an IPPE and must be performed at the time of the IPPE. The screening EKG and IPPE must both be completed before they can be billed to Medicare and the beneficiary will be responsible for any copayment, coinsurance or deductible that is assessed by Medicare.

• G0403 Complete screening EKG with 12 leads; for IPPE that includes the tracing, interpretation and report (copayment/coinsurance/deductible applies)

• G0404 Screening EKG with 12 leads; tracing only without interpretation and report (copayment/coinsurance/deductible applies)

• G0405 Screening EKG with 12 leads; interpretation and report only, without tracing

See the rules for the IPPE screening EKG provided in the Medicare Claims Processing Manual at: http://www.cms.gov/manuals/downloads/clm104c12.pdf

Ultrasound Screening for Abdominal Aortic Aneurysm (AAA) – patient must receive a referral for an AAA ultrasound screening as a result of an IPPE and must meet the criteria to have this screening ordered. Medicare will pay for this once in a lifetime benefit as long as your patient meets the following requirements:

• Beneficiaries at risk that have a family history of AAA

• Men age 65 to 75 who have smoked at least 100 cigarettes in their lifetime

The HCPCS code for the AAA is G0389 and the beneficiary’s copayment/coinsurance, deductible is waived.

Pneumococcal Vaccine – This vaccine is also considered a once in a lifetime benefit but additional vaccinations based on risk and only once every five years may also be allowed. Beneficiary’s copayment/coinsurance, deductible is waived. This does not need to be billed out with the IPPE but highlighted here because of the once in a lifetime benefit stipulation.

Who should be immunized?
If a beneficiary is uncertain about their vaccination history in the past five years then it is recommended that the vaccine be given. It is also recommended that persons 65 years of age or older and anyone considered high risk be immunized.

Who else is considered to be at increased risk?
According to the Advisory Committee on Immunization Practices (ACIP), that advises the Department of Health and Human Services, the following groups are considered high risk and should receive the initial pneumococcal vaccine or revaccination every five years:

• Persons 2 years of age and older with a normal immune system who have a chronic illness such as: cardiovascular or pulmonary disease, diabetes, alcoholism, chronic liver disease, cerebrospinal fluid leak, cochlear implant

• Immuno-compromised persons 2 years of age and older who have: splenic dysfunction, Hodgkin disease, lymphoma, multiple myeloma, chronic renal failure, nephritic syndrome, organ transplantation, immunosuppressed from chemotherapy or high dose corticosteroid therapy, asymptomatic/symptomatic HIV infection

See additional information at: http://www.cms.gov/AdultImmunizations/Downloads/20102011ImmunizersGuide.pdf

Bill for the Pneumococcal Vaccine with the following applicable codes plus the Administration of the vaccine G0009:

• 90669 Pneumococcal Conjugate Vaccine, polyvalent, when administered to children younger than 5 years, for intramuscular use

• 90670 Pneumococcal Conjugate Vaccine, 13 valent, for intramuscular use

• 90732 Pneumococcal Polysaccharide Vaccine, 23 valent, adult or immunosuppressed patient dosage, when administered to individuals 2 years or older, for subcutaneous or intramuscular use

o Use diagnosis code V03.82 for just the Pneumococcal vaccination visit
o Otherwise use diagnosis code V06.6 when the purpose of visit was to receive both pneumococcal and seasonal influenza virus vaccines.

Additional information regarding immunization can be found at:
http://www.cms.gov/MLNProducts/downloads/adult_immunization.pdf

Hope this information helps.  Please go to the top of the page and Google +1 me and leave me a message below. I would like to hear your comments, thoughts and what is happening in your medical practice.

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• Award Given for Outstanding Medical Billing Instructor

Manny Oliverez - Medical Billing Company CEO “Welcome to Medicare Visit” aka IPPE aka G0402 Medical Billing Company | Capture Billing - Medical Billing Company Helping Doctors Succeed

My friend, David Lee, over at eRecords puts out a monthly newsletter where he shares the latest news, updates and analyses in the world of the HITECH Act and Meaningful Use. He combs through hundreds of articles and facts and picks out ones he believes to be of  interest and the most relevant to physicians and healthcare professionals. David has made it his mission is to keep everyone informed by arming them with the correct information to meet the meaningful use criteria when implementing their certified electronic health records EHR software. Below you will find excerpts from his newsletter I wanted to share with you.

Interesting Facts and Figures

13 and 25. How many RHIOs can meet the basic criteria for the meaningful use of EHR out of 75.  How many are financially viable.  Speaks volumes on the state of HIE/HIO.  Read the coverage here.

7/3. The last day that Eligible Hospital and CAHs can begin their 90-day reporting period in Fiscal Year 2011 for the Medicare EHR Incentive Program.

$5M. Size of the contracted awarded to two companies during ONC’s launch of the Investing in Innovations Initiative (i2 Initiative).  You can read the press release here and we’ll try to keep track of how much impact this will have.

76%. Percentage of Fortune 50 that are either in health industry or with a health division.  A report from PwC, “The new gold rush:  Prospectors are hoping to mine the opportunities from the health industry”, with rosy outlook.

75 and 10,989,838. How far, in miles, paper patient records were found after a tornado hit a Missouri based hospital and total individuals, so far, affected by data breach according to this government web site. In somewhat related news, a proposed rule was issued (pdf) by HHS Office for Civil Rights on strengthening the accounting of disclosures.

24 and 359. Number of certified complete EHRs on 10/15/2010 and 6/14/2011.

Latest Meaningful News

Health IT Policy Committee endorses the recommendation to delay Stage 2 of Meaningful Use. During the meeting held on June 8, Health IT Policy Committee endorsed the recommendation to the delay of Stage 2 roll out by one year until 2014 for those providers attesting to Stage 1 this year.  As a result, providers will have three years, through 2013, to meet Stage 1 meaningful use requirements.   The primary reason for this delay seems to be centered on the original 2013 timeframe not giving EHR vendors enough time to meet Stage 2 requirements.  Ripple effect of this delay should be wide, affecting ICD 10, ACO program and others.  For a more detailed article, please click here.

First Medicare Incentive Payments Made. On May 19, 2011, CMS issued the first round of payments totaling $75 million to providers under the Medicare EHR Incentive Program.  Also, $83 million dollars has been paid to Medicaid providers under the Medicaid EHR Incentive Program.  Of course, the importance of Medicare announcement is that these providers actually met the MU and CQM measure requirements whereas Medicaid payments are under A/I/U.  For the full press release, click here.

CMS has also compiled a consolidated list of Frequently Asked Questions on the EHR Incentive Programs and made that list available through their website. To view this FAQ, click here.

ONC Names Approved Accreditor for EHR Certification Program. ONC has named American National Standard Institute (ANSI) as the ONC-AA (ONC Authorized Accreditor).  This sole accreditor will be tasked with accrediting ONC authorized EHR certification entities.  Current authorized EHR certification entities include Surescripts, ICSA Labs, SLI Global Solutions, InfoGard Laboratories, CCHIT and Drummond Group.  For the full story, please click here.

Lawmakers seek changes to EHR Incentive Payments for multi-campus hospitals. Rep. Michael Burgess is planning to introduce a bill that would require CMS to provide EHR incentive payments to each campus in a multi-campus hospital system.  Under the current regulation, incentive payments are paid according hospitals Medicare provider numbers, not individual campuses.  If this bill is passed, it would have a significant financial benefit to multi-campus hospitals.  For the full article, click here.

Three Regional Extension Centers reach its enrollment goals. Regional extension centers in Maryland, South Carolina and Massachusetts were the first set of Regional Extension Centers to reach their respective enrollment goals.

ONC announces Health Information Technology Professional (HIT Pro) competency examination. It will be interesting to see how well this “certification” will be received by the industry compared to existing certifications and credentials.  HIT Pro exams parallel the “roles” trained under Work Force development program.  The cost of each exam is $299 but qualified candidates can request 1 free voucher.  Find out more at HIT Pro homepage.

eRECORDS was founded with the vision to power innovations in access, efficiency and quality of healthcare delivery through connected technologies and intelligence.  Their Mission is to be the trusted expert, guide and partner in achieving meaningful use. Worry FreeTM Dashboard, eRECORDS’ flagship product, is the leading solution for Meaningful Use administration, planning and performance management.

To subscribe to David Lee’s “Your Guide to Meaningful Use” monthly newsletter CLICK HERE

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Manny Oliverez - Medical Billing Company CEO Your Guide to Meaningful Use from eRecords Medical Billing Company | Capture Billing - Medical Billing Company Helping Doctors Succeed

Capture Billing is pleased to announce Stacy White as the new Medical Billing Operations Manager.

Loudoun County, VA – Capture Billing & Consulting, Inc., a nationwide medical billing company located in South Riding, Virginia, brings aboard Stacy White as the newest member of its management team.

Stacy has over 18 years of experience in the medical billing field from a variety of medical specialties. She will be responsible for daily billing operations, maximizing client revenue, and client management.

“I am excited to be working side by side with Dr. John Farrell (owner of Farrell Pediatrics and co-founder of Capture Billing) and Manny Oliverez (CEO and co-founder of Capture Billing). I look forward to absorbing the wealth of knowledge and expertise that both gentlemen bring to the consistently changing medical billing industry” says Stacy.

“We are excited to have Stacy as the newest asset to the Capture Billing team. Her familiarity with coding for a variety of specialties will enhance Capture’s ability to service both current and future clients”, say Manny Oliverez.

Stacy is currently working to obtain her CPC (Certified Professional Coder) and CCS-P (Certified Coding Specialist – Physician Based) certifications in the next couple of months. To learn more about the medical billing services Capture Billing offers please visit www.capturebilling.com.

ABOUT CAPTURE BILLING

Capture Billing and Consulting, Inc., a leader in the outsourced medical billing services industry, offers one of the most cost effective outsourcing solutions to healthcare professionals available. By eliminating the need of an in-house medical billing staff, Capture Billing’s staff of expert medical billers and certified professional coders help to increase physician reimbursement by improving collection rates and ensuring proper ICD-9 and CPT coding. Practicing physician and CEO, Dr. John D. Farrell, Jr., formed Capture Billing in 2004 as the answer to one of the largest concerns physicians face today, how to receive proper insurance reimbursement for services they provided.

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New Medicare Benefit: Annual Wellness Visits Now Covered

Good news for Medicare patients. Effective January 1, 2011 Medicare started to provide coverage for Annual Wellness Visits. This benefit was included in the Affordable Care Act of 2010. Medicare has come up with two new HCPCS codes for these well visits for medical billing purposes. The codes are G0438 and G0439.

G0438 Annual Wellness Visit, Initial (AWV)

Annual wellness visit, including a personalized prevention plan of service (PPPS), first visit.

G0439 Annual Wellness Visit, Subsequent (AWV)

Annual Wellness visit, including a personalized prevention plan of service (PPPS), subsequent visit. Annual Wellness Visits can be for either new or established patients as the code does not differentiate. The initial AWV, G0438, is performed on patients that have been enrolled with Medicare for more than one year.

What is included in an Initial AWV with PPPS?

- Medical and family history
– List of current medical providers
– Height, weight, BMI, BP and other appropriate routine measurements
– Detection of cognitive impairment
– Review risk factors
– Review of functional ability
– Establish a written screening schedule for next 5-10 years
– Establish list of risk factors
– Provide advice and referrals to health education and preventative counseling services
– Other elements as determined by the Secretary of Health and Human Services

The above list is just a summary. Check out MLN Matters Number MM7079 for additional information and links to other Medicare resources on services that must be provided at the AWV and subsequent AWV. Preventative Medicine codes 99387 and 99397, better known to offices as Complete Physical Exams or Well Checks for 65 and older, still remain a non-covered, routine service from Medicare.

One final thought. Do not bill G0439, AVW Subsequent, in 2011. It will deny. Why? Since the first initial AWV, G0438, for any Medicare patient could only be billed starting on January 1, 2011 that means the first time any Medicare patient could be billed for the subsequent AWV, G0439, would be January 1, 2012. For additional information, specifics and more details visit the CMS or you local carrier’s website or contact them directly. Please drop us a comment or visit us at our Medical Billing Blog for more tips and information on medical billing.

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Manny Oliverez - Medical Billing Company CEO Medicare G0438 – G0439: Two New Annual Wellness Visit Codes Medical Billing Company | Capture Billing - Medical Billing Company Helping Doctors Succeed

Visualizing the Electronic Medical Practice of 2015

I just read an interesting article on the benefits of electronic health record (EHR) adoption. The article was written by Jeanette Borzo over at Software Advice. I thought it was a good narrative to share with our readers.

In the article, Jeanette depicts a doctor’s office in 2015, the year when financial penalties for failing to adopt EHRs are set to kick in. The article discusses everything from tracking patient health histories on an iPad to automating medical billing and insurance claims.

Jeanette writes, “… Dr. Smith tells the EHR software to send diagnostic and treatment codes to the billing team, who quickly submit an electronic claim to the insurance company.

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Coding for Medicare Flu Shots Q2035, Q2036, Q2037, Q2038

New Medical Billing Guidelines

Watch the coding for Medicare flu shots video and learn that as of January 1, 2011 if you bill Medicare CPT Code 90658, for the Influenza Virus Vaccine, you will not get paid. Medicare has established five separate influenza vaccine Q Codes to distinguish between the brand-names of influenza vaccines.

http://www.youtube.com/watch?v=fLoCevIoJ9k

The HCPCS code G0008 Administration of Influenza Virus Vaccine must still be used for the administration of the flu vaccine for Medicare patients.

What are the New Influenza Vaccine Codes?

Q2035 Afluria Vaccine

Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Afluria)

Q2036 Flulaval Vaccine

Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Flulaval)

Q2037 Fluvirin Vaccine

Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Fluvirin)

Q2038 Fluzone Vaccine

Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Fluzone)

Q2039 NOS (Not Otherwise Specified) Vaccine

Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Not Otherwise Specified)

Additional information direct from Medicare on medical billing for influenza vaccines can be found at: http://www.cms.gov/MLNMattersArticles/downloads/MM7234.pdf

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New Medicare Influenza Vaccine Q Codes for 2011

Effective January 1, 2011 the Centers for Medicare & Medicaid Services (CMS) will no longer recognize and no longer reimburse CPT Code 90658 Influenza Virus Vaccine, Split Virus for flu shots. CMS has established five separate influenza vaccine HCPCS codes to distinguish between the brand-names of influenza vaccines for governmental tracking purposes. Make sure to use these new codes in your medical billing.

The New HCPCS Medicare Flu Vaccine Codes

Q2035 Afluria Vaccine:

Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Afluria)

Q2036 Flulaval Vaccine:

Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Flulaval)

Q2037 Fluvirin Vaccine:

Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Fluvirin)

Q2038 Fluzone Vaccine:

Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Fluzone)

Q2039 NOS (Not Otherwise Specified) Vaccine:

Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Not Otherwise Specified)

Reimbursement Rates

The national average for Medicare payment allowance may vary by geographical location and you will need to check the CMS Fee Schedule for your correct reimbursement rate. HCPCS codes Q2035 & Q2039 do not have national payment limits and will be determined by the local Medicare carrier.

National allowables for the Q2036 is $7.439, Q2037 is $13.253, and Q2038 is $12.593.

Please refer to the CMS Physician Fee Schedule at: http://www.cms.gov/PhysicianFeeSched/01_overview.asp

Additional information can also be found at: http://www.cms.gov/MLNMattersArticles/downloads/MM7234.pdf

For a video on Medicare flu shot coding go to:  What are the Medicare Flu Shot Codes

_______________________________________________________________

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Was this Post helpful? If so please recommend us by clicking on the Google +1 Button and sharing with your Facebook Friends. Don’t forget to Comment below. Thanks!  –Manny

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HITECH Act and Meaningful Use: Reasons to Implement and EHR

I just got an email from Jonathan Krasner from BEI Healthcare with an interesting article he wrote about things to consider in your Electronic Health Records (EHR) selection that I would like to share.

Here is the text of Jonathan’s post:
While HITECH and Meaningful Use have given practice managers and physicians good reason to look at implementing EHRs, many other trends and themes related to EHRs are beginning to crop up that could also influence decisions to implement, install and use an EHR. Let’s take a look at a few of these:

1. ACOs and PCMH

ACOs (Accountable Care Organizations) and PCMH (Patient Centered Medical Home) are the hot new acronyms of healthcare reform. The central idea with both is to coordinate care across settings and providers. How can that realistically happen if there is no efficient and timely mechanism to document encounters? The short answer: it can’t. Not only are EHRs necessary to document encounters and coordinate care, they are also necessary to produce data showing clinical outcomes. PCMH will not only be pushed by CMS (Centers for Medicare & Medicaid Services); you can bet that payers will be coming out with their own PCMH programs. In order to participate, physicians will have to use an EHR.

2. Payers

In many instances, policies adopted by CMS are replicated in some shape or form by the commercial payer market (see PCMH above). A recent article in Health Affairs stated, “based on personal communications with the firms’ chief medical officers, several payers, notably, Highmark Blue Cross Blue Shield, Well-Point, Aetna, and United HealthCare—have announced programs to better align existing incentive programs with the definition of Meaningful Use. Several smaller payers have expressed interest in developing these types of programs as well. America’s Health Insurance Plans, the health insurance industry group, has voiced strong support for the concept of Meaningful Use and potential alignment around it.” While payers have had EHR incentives in the past, without CMS support these incentives failed to gain critical mass. Another reason why these programs did not receive widespread acceptance was the lack of standardization of EHRs. Both of these issues have changed due to the enactment of HITECH and the Meaningful Use criteria. 

3. Medical Students

Medical students today are being trained on EHRs in medical school. Going to a practice that runs on paper will seem like going backwards to these new providers. These people grew up on online and with smartphones. They are very comfortable and actually prefer these devices. From a recent EON article: “Students have high expectations for EHRs – Having an electronic health record is a very important factor for 70 percent of medical students in deciding where they will practice medicine. In contrast to industry predictions, students believe the benefits to medical practices will be the main driver for EHR implementation, rather than government initiatives. This is largely due to early exposure to EHR systems, as more than half of respondents said they are satisfied with the level of training their program provided on EHR use.” Whether or not you have an EHR could be the deciding factor for a younger physician considering employment in your practice.

4. Health Systems

IDNs (Integrated Delivery Networks) are increasingly touting their use of EHRs in advertising to consumers on radio and TV. Recent ads by Kaiser in the DC area not only tout EHRs as being able to deliver more efficient communication with providers, but also as delivering better outcomes and better health. As an example of this type of advertising take a look at: http://thrivewithkp.org/about-thrive/better-connections-lead-to-better-health. Other IDNs and outside entities such as IBM are also airing similar advertising. Expect these ads to become more frequent as IDNs implement EHRs. They will tout having an EHR as a competitive advantage to lure patients to their networks.

5. State Medical Boards

The ABMS (American Board of Medical Specialties) and the Federation of State Medical Boards have announced their intention to make health IT deployment a standard in their assessment and certification of physician competency. They announced an initiative “to promote the meaningful use of health information technology (HIT) and incorporate them into [its] Maintenance of Certification program”. The board certifies more than 750,000 physicians in the United States. Meanwhile, the Federation of State Medical Boards President and CEO, Humayun Chaudhry, anticipates physicians’ using “electronic health records as a tool to assess ongoing clinical competence for medical licensure.” According to John Pulley, a writer who focuses on government IT, the boards’ endorsements provide another impetus for doctors to adopt electronic medical records. Until now, the question of adoption has revolved around federal financial incentives. Linking adoption to licensure moves the debate’s focus from cost to competence.

6. Consumers

Ultimately, the push to EHRs will be consumer driven. All practices can expect more and more patients asking for electronic copies of their records, and pushing copies of their records to physicians via PHRs. The above noted advertising campaigns and adoption of EHRs by more and more providers will drive awareness of EHRs way up. For instance, CMS has launched a “Blue Button” service that allows 47 million Medicare beneficiaries to electronically view, download and print their complete medical records, Federal Computer Week reported. The feature is available on the MyMedicare website. The option is similar to the Blue Button program on the Department of Veterans Affairs’ MyHealthVet website. Since VA’s Blue Button feature was introduced in August, more than 60,000 veterans have downloaded their medical records.

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Scanning medical records makes retrieval fast and easy for medical staff

WASHINGTON, DC – A major problem in the physicians’ office is storage of medical records. These medical records run the gambit from medical billing records such as EOBs, encounter forms, patient registration forms and insurance cards to full thick medical charts. Boxes and piles of these old documents usually fill closets, are under or next to desks, or stacked high in the hall just getting in the way. They can’t be discarded because your staff needs to access them for insurance follow-up or when patients request copies of old medical records. Storage units along with physician basements or garages (which are not HIPAA compliant) may be storage options but are not quickly or easily accessible.

On top of that, those records are legal documents that have to be retained for up to 10 years. This archiving of records can result in what could become hundreds of boxes of documents that will accumulate over the years and take up more and more space. One solution that has become practical and cost effective is to digitize, or scan documents, into electronic storage. Now you can store all those boxes of important documents from the last 5, 10 or 30 years, and the years to come, in one location that does not take up any space, the internet.

The preferred way to store your records is digitally. And the best way to do that is by outsourcing your scanning. With a phone call an electronic document storage company will come out and pick up all your boxes of document. They will scan them into their secure servers and index them for easy retrieval. Documents can be indexed by a variety of criteria; by patient name, date of birth or account number. Once all the records are scanned the original paper records can then be shredded.

The scanned records are immediately available for viewing at your location usually through a secure web portal that you can access with a standard web browser such as Microsoft’s Internet Explorer. You are not only able to view the records but you can also print the entire record or just one page. Each of your locations can have access to the records through the encrypted, password protected, web portal. The cost of such a service is typically, a fee per page or chart, and then a monthly access and storage fee.

Can you scan documents in your own office? Sure, but lets look at the cost. Even a small practice will need a high speed scanner. A scanner from the local office supply store may be good for scanning insurance cards but it cannot handle the volume of medical records that will need to be digitized even in a small office. Good scanners that can handle 90 pagers per minute, front and back, start at about $6,000. Add to that the cost of a file server with lots of storage. That sever should be equipped with multiple hard drives (RAID) incase one hard drive fails.

A tape drive for daily backups is a must. Expect to pay between $3,000 to $5,000 for a decent server. You still have to purchase a software database in which to store your files on the computer. At one end of the scale a simple database from a small company such as E-Drawer can be had for about $2,000. On the other end, Captaris offers an outstanding product but will set you back about $25,000. Hold on, you are not finished yet. Don’t forget you still have to have a technician install and add your system to your computer network. Then you will have to maintain the system and pay a person to scan. For a larger practice you may have to purchase two scanners and pay for more staff. The originals will have to be shredded. This may or may not be cost effective.

Scanning is an excellent solution to getting rid of all those boxes full of charts, EOBs, fee tickets and other documents that are stored around the office or off-site that must be retained for years. Many electronic data storage companies make it not only simple but cost effective for small, medium and even large medial practices to outsource their scanning. The archived documents can then be easily accessed by the medical staff via the internet.

About Manny Oliverez

Manny Oliverez is a Certified Professional Coder (CPC) and the Director of  Operations for Capture Billing & Consulting, Inc., in South Riding,  VA and provides outsourced medical billing services for physician offices. If you  would like more information about improving your accounts receivable or  other practice management and billing issues, contact him at  (703)327-1800.

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Medical Billing Company creates short animated video to help medical offices understand the HITECH Act, certified EHRs and the financial incentives associated with Meaningful Use.

South Riding, Virginia (Vocus) November 11, 2010 - Capture Billing and Consulting, Inc., a medical billing company and practice management consulting firm, has just announced the release of its educational video outlining the basics of Electronic Health Records (EHR) and Meaningful Use. In this easy to understand and short animated video, Capture Billing simplifies the confusion associated with the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 and sheds light on the basic requirements set forth by the EHR incentive program.

The video provides a simple explanation and background of the HITECH Act, the financial incentives for adopting EHRs, and demonstrates how requirements of the core and menu set objectives must be met to qualify for the incentive money from the government. The financial benefits offered by the Medicare and Medicaid EHR incentive programs include up to $44,000 per eligible Medicare provider and up to $63,750 per eligible Medicaid provider. The government is offering this incentive program to providers to transition to EHRs in order to meet the five healthcare goals set forth by the HITECH Act. These five goals are to improve quality of care, engage patients and families in their care, promote public and population health, improve care coordination and to promote the privacy and security of EHRs.

“The purpose of our educational video is to help physicians, practice administrators and medical office managers understand that the transition to EHRs, although challenging, is not insurmountable. We created this video to let providers know that Capture Billing is ready to begin preparing and transitioning offices to an EHR system to meet the requirements for the Meaningful Use criteria”, explains Manny Oliverez, Director of Operations.

As practices become overwhelmed by the implementation of an EHR system, reimbursement incentives and meaningful use requirements, Capture Billing now provides the perfect solution. Capture Billing will not only provide its elite medical billing services, it will also provide an EHR system and will take on the technical burden of hosting it. In this perfect relationship between Capture Billing and healthcare providers, Capture will also continuously monitor practice requirements for meeting meaningful use in all three stages of implementation and relieve this administrative burden from already busy medical practices.

“Capture Billing’s ultimate goal is to offer a top quality EHR for its medical billing clients. Long after the EHR vendor is gone, as a medical billing company, we will still be providing medical billing services and helping practices continue to achieve meaningful use. We are already there each month providing our medical billing services to our clients so it makes sense to help them achieve the meaningful use criteria and provide them with an EHR” indicates Oliverez. “We will also be ready to help train and transition all offices with the release of the heavily anticipated and confusing ICD-10 diagnosis changes”. Capture Billing is poised to meet the future of healthcare reform head on and really provide medical practices with a one of a kind specialized service.

As the requirements of Meaningful Use will be released in three stages, Capture Billing will continue to provide educational videos for each and every stage to help providers understand the EHR transitional process better, and is a great addition to Capture Billing’s informational Medical Billing Minute Videos.

The video “The HITECH Act: Electronic Health Records and Meaningful Use” is available for viewing at YouTube.

About Capture Billing

Capture Billing and Consulting, Inc., a leader in the outsourced medical billing services industry, offers one of the most cost effective outsourcing solutions to healthcare professionals available. By eliminating the need of an in-house medical billing staff, Capture Billing’s staff of expert medical billers and certified professional coders help to increase physician reimbursement by improving collection rates and ensuring proper ICD-9 and CPT coding. Practicing physician and CEO, Dr. John D. Farrell, Jr., formed Capture Billing in 2004 as the answer to one of the largest concerns physicians face today, how to receive proper insurance reimbursement for services they provided.

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Electronic Health Record Contracts

I just finished reading an article about how to negotiate an Electronic Health Record software license agreement (SLA), by Houston Neal an EHR Market Analyst at Software Advice. I thought it would be a great resource for our readers.

In the article, Houston’s focus is on the five key areas of medical software contracts: the user license, implementation, service obligations, hardware and interfaces and HITECH Act clauses.

If your medical practice is in the process of contract negotiations with your EMR vendor, this is a must read. You can view the entire article at: http://www.softwareadvice.com/articles/medical/the-guide-to-negotiating-an-ehr-software-license-agreement-1102810/.

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EHR and Meaningful Use – Get Your Incentive Money

The HITECH Act provides incentive money for physicians to purchase, implement and use certified electronic health records. One of the criteria for receiving government stimulus money is to demonstrate meaningful use of the EHR.

We at Capture Billing have produced a short educational video for physicians, practice administrators and medical office managers to explain the main elements of the HITECH Act. We show though animation how to qualify for the federal government incentive money that is available upon the proper implementation of a certified EHR and achieving meaningful use.

http://www.youtube.com/watch?v=GzeUKKWvC0o

We would like to hear your thoughts and where you are in the process of implementing electronic health records for your practice. Please leave us a note.

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H1N1 and Flu Vaccine Coding Made Easy

This year’s flu vaccine has been selected by the US Food and Drug Administration (FDA) to contain three vaccines in one single shot which makes medical billing a breeze this season.  The FDA has determined that one single flu shot containing vaccines for the H1N1, H3N2 and B/Brisbane influenza viruses should be sufficient to ward off this coming season’s most common circulating viruses and to protect the community.  A single flu shot means a single code which eliminates last minute medical billing confusion like last year’s H1N1 outbreak.

Influenza Vaccine Billing Guidelines

Use one of the following CPT codes and one of the Immunization Administration codes plus diagnosis V04.81 (Prophylactic vaccination and inoculation against influenza) to bill for reimbursement:

Coding The Flu Shot

CPT Codes:

90655 Influenza Virus Vaccine, split virus, preservative free (children 6 – 35 months)

90656 Influenza Virus Vaccine, split virus, preservative free (ages 3 and older)

90657 Influenza Virus Vaccine, split virus (children 6 – 35 months)

90658 Influenza Virus Vaccine, split virus (ages 3 and older)

90662 Influenza Virus Vaccine, split virus, preservative free, enhanced immunogenicity via increased antigen content

Immunization Administration Codes:

90465 Immunization administration younger than 8 years of age, first injection

90466 Immunization administration younger than 8 years of age, each additional injection (bill this only in addition to primary administration codes 90465, 90467)

90471 Immunization administration, 1 vaccine (single or combination vaccine/toxoid)

90472 Immunization administration, each additional vaccine (bill this only in addition to primary administration codes 90471, 90473)

G0008 Administration of Influenza virus vaccine for Medicare patients

Coding The Flu Vaccine Nasal Spray

CPT Code:

90660 Influenza Virus Vaccine, live, intranasal

Immunization Administration Codes:

90467 Immunization administration by intranasal or oral route; younger than 8 years of age

90468 Immunization administration by intranasal or oral route; younger than 8 years of age, each additional administration (bill this only in addition to primary administration codes 90465, 90467)

90473 Immunization administration by intranasal or oral route; 1 vaccine (single or combination vaccine/toxoid)

90474 Immunization administration by intranasal or oral route; each additional vaccine (bill this only in addition to primary administration codes 90471, 90473)

Flu Shot Coding Examples

• A patient 65 years old with Medicare coverage who received a flu shot should be billed as follows:
• 90656 dx V04.81
• G0008 dx V04.81

• A patient 35 years old with commercial insurance coverage who received the flu nasal spray should be billed as follows:
• 90660 dx V04.81
• 90743 dx V04.81

Additional Resources
www.flu.gov
http://www.cdc.gov/flu/

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Authorized Testing and Certification Bodies Named to Certify EHRs

As of Monday August 30, 2010 the Office of the National Coordinator for Health Information Technology (ONC) has named the inital two companies that have been selected as Authorized Testing and Certification Bodies (ATCBs) to certify Electronic Health Records (EHR), CCHIT and the Drummond Group Inc. They have been authorized to test and certify EHRs for compliance to the certification criteria that was issued by the Department of Health and Human Services.

So now EHR vendors can have their software products certified that they meet meaningful use criteria. Why is this important? If you want to qualify for the HITECH Act’s incentive money for adopting an EHR you must first be using a government “certified” EHR.  Then secondly, meet meaningful use requirements. This incentive money can add up to $44,000 through Medicare and $64,000 for Medicaid for eligible providers.

Don’t forget you may need new computer hardware too.

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Meaningful Use: Core and Menu Sets

The criteria for Meaningful Use is detailed in a list of 25 requirements issued by the Office of the National Coordinator (ONC) which is part of the Department Health & Human Services.  The criteria is broken down into two sets of objectives and measures; A Core Set and a Menu Set. In the core set, there are 15 objectives that each provider must comply with. In the Menu set,  providers are free to choose 5  items from among a menu of 10 to implement. This brings the total to 20 objectives that must be met to demonstrate meaningful use of your certified electronic health record EHR. Fail to meet even one, and you may not qualify for the incentives.

CORE REQUIREMENTS

CPOE
Implement Drug-Drug and Drug-Allergy Interation Checks
ePrescribing
Demographics
Problem Lists
Medication List
Medication Allergy List
Vital Signs
Smoking Status
Clinical Decision Support
Calculate and Transmit CMS Quality Measures
Electronic Copy of Health Information
Electronic Copy of Discharge Health Information
Clinical Summaries
Exchange Key Clinical Information
Privacy/Security

MENU REQUIREMENTS

Implement Drug-Formulary Checks
Advanced Directives
Lab Results into EHR
Patient Lists
Patient Reminders
Timely Electronic Access to Health Information
Patient Specific Education
Medication Reconciliation
Summary of Care
Immunization Registries
Submit Lab Results to Public Health Agencies
Syndromic Surveillance

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Number of Diganosis Codes to Skyrocket from 17,000 to over 140,000 under ICD-10

The new ICD-10 diagnosis codes take effect on October 1, 2013, and all healthcare providers are required to comply with the new regulations or they may have trouble with insurance reimbursement. These changes in the medical billing practices are significant enough to have caused marked slowdowns in billing and payment in other countries.

So what can a healthcare provider expect when their office phases out ICD-9 and incorporates the ICD-10 billing requirements into their healthcare practice? First, there is an increase in the number of billing codes, from 17,000 to 140,000. Coders will need to have a more detailed knowledge of anatomy and physiology, as well as medical terminology.

The new ICD-10 codes also mean changes in patient coverage. Doctors will need to be more specific in their documentation and code observations such as stages of healing. The new ICD-10 codes include more payment limitations for services. Case managers’ phone call volume will increase as they deal with an increased need for patient education on coverage charges.

Medical providers can expect a slow down in accounts receivable which decreases cash flow. Medical billing departments can expect an increase in call volume for confusing or rejected claims; the number of billing audits may also increase.

Other countries that have already implemented the ICD-10 codes report a 50% longer turnaround time for medical accounts receivable and a decrease of 50% in coder productivity. If the changes are implemented over time and proper education given, these changes hopefully will have only a short-term and minimal effect on the financial health of the healthcare provider.

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If Doctors Want to Get Paid They May Have to Buy an EHR

I was reading a blog post from John at “EMR and HIPAA” entitled “Commercial Insurance Implementing Meaningful Use” that stated on August 5, 2010, four insurance companies would now include Meaningful Use criteria in their pay for performance (P4P) programs.

Meaningful Use is being able to demonstrate the use of an Electronic Health Record (EHR) based on the criteria set by the government. Even if you have an EHR and are using it, but do not meet the standards, it will not count. Don’t have an EHR? Well that really does not count.

The meeting took place at the Health Industry Forum held in Washington DC by the United States Health & Human Services Department (HHS). The insurance companies and the government met to discuss their collaboration to support providers in the adoption of certified health records which includes Meaningful Use.

The four carriers that met were Aetna, United Healthcare, Wellpoint and Highmark Blue Cross Blue Shield.

These 4 insurance carriers may just be the start.  Now that the federal government has made “clear” the criteria and how to achieve Stage one of Meaningful Use (yes, there are 3 stages), how many more insurance payers will jump on the bandwagon?

One thing is for sure, healthcare is getting more and more complicated.  It is going to be tough for small to mid-sized medical practices, and even large ones, to keep up. Ongoing training for office staff, buying new computer equipment and software, or outsourcing medical billing and EHRs are going to be the only alternatives to continue to get paid for the work the physicians perform.

Do nothing and some practices may go out of business.

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Tips on How to Run Your Medical Front Desk Effectively

The Front Desk is a very important facet of your medical practice, and a friendly and efficient front desk staff leaves a positive impact on your patients.  Medical receptionists are the first and last impression a patient has of your practice and can make a huge difference in patient retention rate and new patient referrals.

1. Do make sure your medical office staff greets each patient in a timely manner.  Although the medical receptionists juggle so many things throughout the day at the front desk, patients should always be greeted and checked in as quickly as possible.  The more courteous the staff is, the more successful the medical practice is.  Do not let a patient wait too long!  If the providers are running extremely behind, make sure that the patient is aware of the delay and reschedule appointments as necessary.  Patients should not have to wait beyond a reasonable time.
2. Do make sure that updated patient demographics and insurance information is obtained.  Demographic updates should be completed on an annual basis and insurance cards should be copied or scanned every time a patient is seen.  Do not let the patient leave without getting updated information!  The front desk should be vigilant with patients who have not been seen in a long time. Easy to complete forms should be readily available for your front desk to give to your patients. If the medical billing staff does not have the most current information then your insurance reimbursements will be delayed.
3. Do make sure that the patient checks out with the front desk and that the encounter form is signed and dated by the patient or guardian.  If copays were not collected at check in then they must be collected at check out.  Do not let the patient leave without paying their copay.  The receptionist must be able to review account balances and remind the patient of past due balances.  A designated in-house biller or your medical billing company should be readily accessible to discuss payment options and set up payment plans as needed.
4. Do make sure that when the patient checks out, the front desk schedules the next appointment. Do not let your patient leave without a future appointment!  This guarantees a practice with a busy schedule and positive cash flow.
5. Do make sure that that charges are not entered at the Front Desk!  A medical biller should not be interrupted and should not have any distractions.  Billers are directly responsible for insurance reimbursements and practices cannot afford to have charges entered incorrectly.

Reassess your front desk procedures and implement these suggestions.  We guarantee this will help your bottom line!

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Anyone Can Access Your Computer

I remember back in 1984 when I got my first modem for my computer. It was a 300 BAUD modem. In today’s terms think 186 times slower than dial-up. But WOW it opened up the world. No longer was my IBM compatible confined to my desk. My computer could now go anywhere in the world. Of course there weren’t too many anywheres to go. Now I can access almost any computer on the planet. Well you know what? Anyone on the planet can also access your PC now too.

From what I hear in my dealings with medical practices, most are not aware of the compliance requirements and their computer systems are vulnerable. Hopefully within the next year the word gets out more and medical practices really start to take computer security seriously.

I would love to hear from you.  Please leave me a comment below.

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