What is on the horizon for the New Year? Here are my top 3 predictions for 2010.
1. Higher deductibles. Insurance companies use subtle tactics to increase revenues, usually in the form of reducing benefits and/or raising deductibles. Least obvious is the raising of deductibles. We are starting to see plans that last year had a $250 deductible now having a $300 or highter deductible. This is why it is important to verify all existing patients at the first of the year. Do not assume things are the same. You also can't rely on the counter sign:"Inform us of any changes to your policy". Alot of patients aren't aware of changes. If you are waiting for an insurance to pay you - make sure the money will be coming - VERIFY every patient in the New Year.
2. Health Savings Accounts. Just like with higher deductibles, small to medium employer groups are opting for high deductible plans and offering patients a health savings account to off set some of the deductible. Patients may or may not have an opportunity to contribute. Those with voluntary contributions tend to have a better grasp of their HSA and how it works. You need to be very aware when a patient has a plan like this, some are funded all at once, and some are doled out quarterly. Usually the HSA is used first, then after it is exhausted, the remaining deductible kicks in, then after the deductible is met, actual benefits can be used. HSA monies can be used for more than treatments, so the HSA can be used without affecting the actual deductible. It is important to keep track of how much a patient has in his account. If he doesn't know, and you can't find out, err on the side of caution and collect at the time of service. Again, there is no point in waiting for a payment that will never come.
3. Documentation, Documentation, Documentation We are seeing more and more insurance carriers require patient progress notes to substantiate the need for care and ultimately pay the claim. While a few years ago only Worker's Comp consistently requested patient notes, now all Personal Injury does as well. In the past after a certain number of visits the carrier would request notes, we are now seeing them requested for the very FIRST visit! What does this mean for your office? You must consistently and completely document each patient's treatment.; The old saying goes, "If it isn't documented, it didn't happen." Be prepared to supply notes and get them off quickly. Be proactive, we're seeing alot of Aetna claims requiring notes right from the start. If you see such a case, why not provide the notes with the claims, rather than have your claim pended while they send back a request for notes. We're also seeing timely filing limits to supply those notes.
Remember - "Knowlege is Power." If you are aware of the possibilities, you can plan for them. Sure, it requires some work on the part of your office, but you can't increase your bottom line without doing something.
Monday, January 18, 2010
Monday, July 13, 2009
Red Flags are coming August 1, 2009
On August 1,2009 a new set of rules will be put in place that affect healthcare providers. These rules known as "Red Flags Rule" are enforced by the federal trade commission and while they can over lap HIPAA requirements these rules are for a different purpose. HIPPA focuses on protection of health information while Red Flag rules are a way of validating a person's identity and monitoring identity theft.
Basically these new rules state you know must take steps to confirm that the patient IS the person he/she says they are and should you come across something suspicious, you must have a plan in place to deal with the issue. These rules are more about awareness, and running your practice so that should a situation develop, you have an action plan to deal with it.
Here's an example: Some offices hand a patient an intake form and take a copy of the insurance card- that's it. How do you confirm the patient IS who he says he is? New office policy would state that this office now takes a copy of the patient's driver's license or other photo ID. Should they not have a photo ID, there would be policy in place for other forms of identification.
Another example: A patient calls up and states that he is moving, please send all bills to a new address. How do you know that person IS who he says he is? Office policy would now state that person would have to confirm last four digits of social security number, or someother identifying factor.
Simply the new rules want offices to identify the situations they are likely to run into, develop written policy for dealing with those issues. Finally all staff should be trained to understand the policy and there should be an "officer" or person in charge with monitoring and documenting each case where a situation developed and how it was dealt with.
Once a plan is developed, it should be updated yearly. Each new employee should understand and agree to follow the plan. To recap: 1. put together a list of situations that might present in your office. 2. put together a list of responses for each situation. 3. designate someone to be "in charge" of monitoring the plan and logging any situation that develops. 4. update it should your office situation change, or train any new person involved in your office.
Finally as the owner of your practice, while you can designate someone else to be "in charge" of your red flags plan, understand you are ultimately responsible for creating it and carrying it out. You can be financially penalized should there be identity theft and you did not have a plan in place.
Basically these new rules state you know must take steps to confirm that the patient IS the person he/she says they are and should you come across something suspicious, you must have a plan in place to deal with the issue. These rules are more about awareness, and running your practice so that should a situation develop, you have an action plan to deal with it.
Here's an example: Some offices hand a patient an intake form and take a copy of the insurance card- that's it. How do you confirm the patient IS who he says he is? New office policy would state that this office now takes a copy of the patient's driver's license or other photo ID. Should they not have a photo ID, there would be policy in place for other forms of identification.
Another example: A patient calls up and states that he is moving, please send all bills to a new address. How do you know that person IS who he says he is? Office policy would now state that person would have to confirm last four digits of social security number, or someother identifying factor.
Simply the new rules want offices to identify the situations they are likely to run into, develop written policy for dealing with those issues. Finally all staff should be trained to understand the policy and there should be an "officer" or person in charge with monitoring and documenting each case where a situation developed and how it was dealt with.
Once a plan is developed, it should be updated yearly. Each new employee should understand and agree to follow the plan. To recap: 1. put together a list of situations that might present in your office. 2. put together a list of responses for each situation. 3. designate someone to be "in charge" of monitoring the plan and logging any situation that develops. 4. update it should your office situation change, or train any new person involved in your office.
Finally as the owner of your practice, while you can designate someone else to be "in charge" of your red flags plan, understand you are ultimately responsible for creating it and carrying it out. You can be financially penalized should there be identity theft and you did not have a plan in place.
Thursday, June 11, 2009
Good News For Acupuncturists In Florida
On July 1 a new law takes effect in Florida. This bill will mandate that providers of service can now receive direct payments from insurance companies whether or not they are in-network.
This is important because Florida's largest carrier, Blue Cross/Blue Shield of Fl has never created a network for acupuncturists. This created problems for acupuncture patients in Florida that have federal benefits. BC/BS would not honor an assignment of benefits for these patients stating that the federal government directed BC/BS to send payments to the patients. (In states without assignment laws in place, carriers do not honor an assignment of benefits in an effort to persuade practitioners to join their networks. It's the carrot and the stick: Do you want to have the money sent to directly to you?- Then join our network.) However in this particular case- they NEVER created a network!
I repeatedly contacted both representatives at BC/BS as well as the representatives in the government responsible for contracting with BC/BS. The fed reps would say, it's the state's responsibility to create a network, while the insurance reps say they were just following federal orders. In addition our clients in Florida had their federal patients send hundreds of letters stating they want their acupuncturists to be paid directly. It never happened, until now.
We haven't been able to get a network in place, but at least we know that acupuncturists in Florida will now have their checks sent directly to them, a step in the right direction.
This is important because Florida's largest carrier, Blue Cross/Blue Shield of Fl has never created a network for acupuncturists. This created problems for acupuncture patients in Florida that have federal benefits. BC/BS would not honor an assignment of benefits for these patients stating that the federal government directed BC/BS to send payments to the patients. (In states without assignment laws in place, carriers do not honor an assignment of benefits in an effort to persuade practitioners to join their networks. It's the carrot and the stick: Do you want to have the money sent to directly to you?- Then join our network.) However in this particular case- they NEVER created a network!
I repeatedly contacted both representatives at BC/BS as well as the representatives in the government responsible for contracting with BC/BS. The fed reps would say, it's the state's responsibility to create a network, while the insurance reps say they were just following federal orders. In addition our clients in Florida had their federal patients send hundreds of letters stating they want their acupuncturists to be paid directly. It never happened, until now.
We haven't been able to get a network in place, but at least we know that acupuncturists in Florida will now have their checks sent directly to them, a step in the right direction.
Tuesday, June 2, 2009
646 - Is In the House!
I think it is fitting that my very first blog would be about the federal bill to include Acupuncture in the Medicare program. Now that's not a new concept, there has been a bill presented for the last few years, each dying a slow death in committees where not much attention was paid. It's different now, an administration that actively promotes alternative care, that promises to work towards medical care for all. The time is ripe for change. Acupuncturists actually have a chance to work with and for 54 million Americans - those covered by medicare and the federal program. There is lots of work to be done. First - we all must contact our congressman and make our voices heard, we can't wait for others to get involved we must. Second we have to spread the word, to as many others as we can. Here's an easy way to get started. Go to:http://www.aaaomonline.org/hr646
This link will help you send a letter directly to your representatives in Congress. It's an easy way to make your voice heard. Pass this link on to as many people as you can. Show Washington we change, together we can make a difference.
This link will help you send a letter directly to your representatives in Congress. It's an easy way to make your voice heard. Pass this link on to as many people as you can. Show Washington we change, together we can make a difference.
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