Hot Topics in Medical Billing for 2015


Info Services Inc 2015 Hot Topics

Let’s take a look at some of the 2015 hot topics in medical billing impacting health care providers. While some may be obstacles, others may become opportunities. Staying abreast of changes is now more important than ever- the financial health of your practice depends on it!

ICD-10 Is On!

ICD-10 is scheduled for implementation on October 1, 2015. Although history has proven that anything can happen, providers should not expect another delay such as we saw in 2014. If you haven’t already begun to review your coding, billing and documentation plans for ICD-10, you should make immediate plans to start! Did you receive training in 2014 but now need a refresher? Certainly any change is stressful, but providers who make it a priority now to prepare will surely face fewer headaches than those who do not. Info Services, Inc. is offering five traditional 6-hour face-to-face classroom training sessions [Click here for Brochure] as well as shorter ONLINE webinar-type training sessions. The online sessions are still “live” events and include seven different ICD-10 topics [Click Here for a schedule of online sessions]:

  • ICD-10-CM Basics

  • ICD-10-CM Refresher

  • ICD-10-CM Documentation

  • ICD-10-CM 7th Character

  • ICD-10-CM Family Practice Top 5

  • ICD-10-CM OBGYN

  • ICD-10-CM Ear/Eye.

PQRS Penalties!

The Physician Quality Reporting System (PQRS) has been using incentive payments, and will begin to use payment adjustments(aka penalties) in 2015, to encourage eligible health care professionals (EPs) to report on specific quality measures. Penalties for not adhering to Medicare’s PQRS begin in 2015 at 1.5% and increase to 2% in 2016 and beyond. Providers who wish to stop this penalty should research the best reporting method to utilize and begin participation in 2015. Acceptable methods include Part B claim additional information, EHRs and companies who provide data registries. There are many specific reportable measurements that require medical record documentation to complete. The 2015 CMS Manual for Claims and Registry Reporting is 593 pages long. [For more information click Here.]

Mississippi Medicaid PCP Bonus!

The federal Primary Care Physician program may have ended in 2014, but during 2014 the Mississippi DOM was granted authority by the Legislature to CONTINUE reimbursing eligible providers, as determined by the ACA, at 100 % of the Medicaid fee schedule. This bonus is available for qualifying physicians and non-physician practitioners.

Effective 7/1/2015, reimbursement of primary care services provided by eligible providers will be at 100% of the fee schedule in effect as of January 1 of each year. To receive the bonus, providers who qualify must accurately “self-attest” by completing the 1/1/2015-6/30/2016 Self-Attestation Statement Form. Don’t delay! The deadline to submit the Self-Attestation form to receive the bonus effective 1/1/2015 is 3/31/2015. [For more information click Here.]

Meaningful Use Stage 2!

CMS realized that very few providers had successfully attested to Stage 2 Meaningful Use, so in August 2014, they released a final rule that grants flexibility to providers who are unable to fully implement 2014 Edition CEHRT for an EHR reporting period in 2014 due to delays in 2014 Edition CEHRT availability. It basically allows the ability to revert back to Stage 1. Valid reasons to delay include:

  • Waiting for software updates or delayed or missing updates; or

  • Software presenting problems with functionality or the software itself renders a provider unable to reliably use the software; or

  • Software does not yet contain all required components; or

  • The provider has been unable to train staff or test the updated system or put new workflows in place.

CMS has created Flexibility Rule Decision Tool to help providers understand the new option.

New Chronic Care Management Services!

At the first of this year, Medicare began paying for chronic care management (CCM) in an effort to recognize the value that primary care services provide to patients. CPT code 99490 can be billed once per patient per month by one provider. At least 20 minutes a month of care management activities (non face-to-face) by clinical staff (not necessarily a physician) is required to be able to bill once a month. CCM is a nice benefit for a primary care provider (think about getting paid around $40 each month for each of your patients with chronic diseases whether you see them or not), however, as usual, there are stipulations. CCM pertains only to patients with two or more chronic conditions; participation requires eight elements, including access to care 24/7, continuity of care and management of care transitions between all of the patient’s providers; a written care plan; the provider must utilize an EHR; and the patient must sign an agreement to receive the services. CCM is not exempted from coinsurance, so normal deductibles and copays will apply. Since the services are not face-to-face, patients may be confused on what exactly they are being charged. There are also still some unanswered questions regarding the billing of CCM, such as what date of service should be used, and no specific patient consent form template has been published by CMS. If you can live with the requirements it might be a good source of new revenue for 2015, or at the very least, a way to mitigate the Medicare reductions such as Sequestration, PQRS, EHR, ePrescribe, etc. If you are a member of AAFP (American Academy of Family Physicians) you can download several CCM tools to assist in the documentation requirements.

Patient Balances!

Like never before, patients are being forced to contract with insurances which carry high deductibles and copays. With the continual decline of insurance reimbursements, providers have no choice but to be intentional about collecting all that is owed at the time of service. The chances of getting paid significantly decline once a patient leaves the clinic. Intentionally waiving copays and deductibles put the provider at risk for insurance fraud. If your fee is $125 and you waive the $40 copay, you’ve just reported an incorrect charge amount to the insurance company. By waiving the copay you have, in essence, adjusted your fee.

Get creative in your collection approach: How many times does your front office hear this? “Oh goodness- I’ve forgotten my wallet and checkbook!” – No problem. Just explain to the patient that they can call in their credit card payment by the end of the day to avoid an additional late fee.