CPT CHANGES IN 2012

Using Modifier 33 (Preventive Services)

What this modifier does is designates that the code you are using is a preventive service which means that the patients receiving these services are receiving them at no cost, (no cost sharing happens when this modifier is used). 

 These services must be identified before billing so patients are not billed inappropriately which could prompt many phone calls to the office. 

 New Patients Versus Established Patients

The definition of a new patient is one that has not received any professional services within the past 3 years from the physician or another physician of the same exact specialty.  If you have a subspecialty in your practice, make sure you correctly identify when a patient can be billed as a “new” patient; In order to maximize your reimbursement.  By doing this you will see a difference in reimbursement of up to 15% to 20%. 

 Prolonged Evaluation and Management Services

Time that must be spent related to a patients visit is often times separate from the one-on-one or face to face codes that are often used.  For code 99358 (prolonged E/M service before/or after direct patient care for the first hour) the wording of “face to face” is not in the description, which can effect code 99359 (each additional 30 minutes).

 At one time, these two codes were once limited and could only be used by physicians, they are now available to use by other qualified healthcare professionals.  If your practice employs other qualified healthcare professionals, make sure that these codes are being used when it is necessary and appropriate. 

 Medicare Physician Fee Schedule

Medicare payment rate for the physician’s fee schedule was threatened to change for the year 2012.  There could have been a possible decrease in the physician’s fee schedule of 27.4% this year.  This would have really hurt doctors who treat Medicare patients, and would have made it harder for seniors to find physicians.

 However on Friday, February 17, 2012 Congress passed an extension of the payroll tax for the rest of 2012.

 Many physicians are very busy and don’t have the time to evaluate every single change made but it is very important to be proactive in their practice and keep up to date with the ever-changing rules and regulations set forth by different entities.  Time that is set aside to research such things will only make the physicians practice more efficient.

If you are using a Medical Billing Service, they should be keeping you up-to-date with the changes of 2012, so that you can just focus on your patients.

 Here are a few tips on ways to keep a steady cash flow during this time.

 (1)  Take the appointment schedule for the week or even each day and go through all returning patients and call the insurance company to verify how much of the deductible has been met. 

 (2) Start a separate list with the patients name and insurance and how much of the deductible has been met and what the deductible amount is.

 (3)  When making appointments, ask the patient if they have a deductible and if they say they do, then it would be wise to inform them that a portion will be collected at the time of service.

 (4)  Decide up front how much your office is going to collect, some offices collect between 20% to 30% of the total bill. 

 (5)  Make sure to indicate on the superbill for the insurance biller that the amount collected is for that days visit.  Otherwise the patient may have an outstanding account and you don’t want to confuse what date of service it should be applied to.

 (6)  Patients with Medicare may also have a deductible but if they have a secondary insurance, that insurance will usually pick up the secondary balance such as Medi-cal.

 Most patients know that they have a deductible and should not be surprised that they are responsible for that portion before their insurance starts to pay.  It’s best to be as tactful as possible when asking the patient that they are expected to pay up front when a lot of times the patient is ill and it may seem uncomfortable asking for payment under those circumstances but it is not unreasonable. 

 Even though this may be very time consuming for the office to handle, it really makes a difference during this time of year when you would normally be receiving payment from the insurance company but many offices have implemented this policy and have seen a big difference in their cash flow.  The office will truly benefit and it’s also a way to keep your patient portion accounts receivable lower. 

 Physicians are usually the “office manager” or they have designated someone in their office who fills that role.  Regardless of who it is many complain about several aspects of staff work ethic.  Here are a few:

*  Consistently late to work

*  Does not speak to patients with respect

*  Does not perform his or her duties in a timely manner

*  Calls in sick or takes days off consistently

*  Does not take direction well

*  Constantly having to remind them of policies and procedures of the office

There are several tips to work with these employees, if they applied themselves, could be an excellent asset to the practice.  When an employee is hired they should at that time be told of all their expected of.  Some physicians or office managers have even put this in a “Welcome Letter” that is given and gone over with after the hiring process.  This letter consists of a general listing of all the duties of the employee.  An example could look like this.

“Welcome to Dr. Jones Staff”

We are so pleased to have you join our staff and want to make your employment here  an enjoyable and a great working experience!  As our front office receptionist below is your duties in this position.

Answering phones                                                                  Be on time to work

Greeting patients                                                                     Treat patients with respect

Collecting co-pays                                                                  Be a team player

Making appointments

Fielding phone calls

Checking in patients

Checking out patients

Also helping in other areas of the office that is needed

Thank you for joining our staff and look forward to providing the best care we can to our patients which is our practices number one priority.

It also would be good to have the employee sign the bottom as well as the physician and also for the office manager.  This shows what’s all expected of that person.  So even though physicians may already have long time employees, it’s good to go over this with them and have them sign this form and keep it on file for the future.  Employers that are upfront with their staff and getting everyone on the same page is what has been known to work.  There’s no guessing game and it’s all in writing. A good employee that is going to be loyal and work well will respect and understand that. 

Some physicians have streamlined this process by having each individual of each duty have a half day or full day of training with them.  For example, if you have hired a new front office receptionist no doubt they would be involved in quite a few aspects of the office. 

First you would have an employee familiar with the front office procedures train them.  If the physicians office is busy like most offices are, this may require a full week of training or more.  When the office has hired a new receptionist or other type of employee it is very important that the new employee knows that first impressions mean everything. 

Secondly the receptionist will no doubt encounter phone calls from pharmacies or receive refill requests via fax or email.  This would be where the nurse or back office assistant could train them as to how to handle these requests.

Next, the office may encounter from time to time or for some offices Drug Company Representatives visit the office frequently.  Some physicians want to see them right away and do not want them to wait, some don’t mind them waiting for a bit while they finish up with a patient.  The physician may need to sit down and explain this to the new employee how important these visits are to them, or they can wait, or they may need to make an appointment to see the physician. 

Another aspect could be if the physician is a surgeon which requires someone to schedule dates and times for this.  The new employee would need to know the policies and procedures and who has the authority to make those scheduling decisions.

So there are many areas not mentioned that could come into play when hiring and training a new employee that should be gone over with them thoroughly and easily.  It’s very important to try not to go over every single aspect all at once but to go over things gradually so the person can comprehend things and grasp the direction so as not to overwhelm them.  One physicians office made a two week training schedule for the employee so they to knew what to expect to learn and go over each day.

 Privacy breaches can occur when medical e-mail is:

 *  sent to the wrong address

 *  accessed illegally by unauthorized individuals

 *  forwarded inappropriately

 *  left unattended on a computer screen

 Also, it’s important to keep in mind that there could be medical licensing issues if an e-mail crosses state lines and violates the state laws.

 It’s better to be safe than sorry

 These are some tips to help your medical practice avoid any potential problems and any HIPAA violations.

 *  Make sure that the patient’s know that e-mail should not be used in lieu of calling 911 in case of an emergency or if the problem they are having is urgent or a sensitive problem

 *  Unless your office is using an encrypted system, you should make sure you include a disclaimer telling the patient’s the message isn’t secure

 *  Inform all patients including adolescents, that when they send an e-mail to the office this will automatically become part of their medical records, either filed on the computer or the e-mail will be printed as a hard copy and be filed into their chart

 *  Include in another disclaimer letting patient’s know that e-mails aren’t read every day, or the physician is out of town for an extended period of time or if the office will be closed for the holidays or other occasion

 *  Use a  neutral subject line like “message from your doctor” to avoid revealing any sensitive content that you may be sending such as “your AIDS test results”

 *  Have one or more staff members be in charge of accessing e-mails and relaying the information to the appropriate person, whether it be a billing question, nurse question, front desk or the physician himself.

 *  E-mails should be checked at least every other day but preferably every day if possible

 * Take time to re-read your message before sending it, and never copy a third party without consent.

 *  Erase hard drives storing medical e-mails prior to disposal

 *  Patient’s should also be made aware that if the practice is closed on Saturdays and Sundays that e-mails will not be read until the next scheduled business day

 E-mail is such a convenient tool to communicate with patient’s and that’s why it is imperative to make sure these guidelines are in place to protect your practice from any violations or any problems.

 Create a Database

Online is a perfect place to research finding a free address-book tool.  There are many that can be useful to the practice.  Most of these programs let you pull up the specialist by name, type of specialty or area of medicine they practice and the types of insurance they accept.  Just one click and all of their info pops up, tax ID number, address, phone number, fax numbers and even other providers in their practice.  There’s even a field to where the office can make notes.  Another click and the information is ready to go to give to the patient.

 Most of the programs do require that you enter the specialist information into the system, which is well worth the time considering how much time the office will save by having this easy referral system as opposed to the time it takes to find the information and hand write it for the patient.  With this tool it will free up more time to be able to accomplish more things throughout the day.

 Another tip on your practice to save time and improve efficiency is to establish a secure patient portal on your practice’s website.

 Web-based Tools

 Patients can use this tool to request prescription refills, referrals, make appointments and to get test results.  Some even have a application for e-mailed appointment reminders that sends the office back a confirmation notice so you know the patient received your messages.  This feature also helps to let patients know when their due for their annual visits and screening tests.  This can eliminate and cut back on the number of incoming calls and outgoing calls which can often be very time consuming.

 In some medical practices nurse practitioners handle all the prescriptions and prescription refills but with these web portals they are able to have a better handle on refill requests and they are able to spend more quality time with the patients.

 These tips have proven to save time, keep the office running smoothly and efficiently but most importantly, improved communication with patients.

 Target Areas for Improvement

 Turning negatives into positives.

 *  Create spread sheets for the three most likely sources of complaints.  Patient/family member, carriers and other physicians.  Each one will typically be handled differently.

 *  Record the date, time and type of complaint that was being made, (e.g. billing issue, staff behavior, quality of care, wait times, etc. )

 *  Log what was done or what needs to be done to resolve the complaint.

 *  Log the date and time the issue was resolved.

 *  Have the office do this for at least two weeks or up to one month to get a good feel for all aspects of problem areas.  Example – Patient portion’s of what they owe on their end usually is sent out once a month, so this could be included in evaluating any billing issues.

 Now analyze the data, looking for patterns.

 For quality-of-care issues, is there an upward trend in post-procedure infections or are staff being accused of improper hand washing or any other practices?  Ideally, complaints should be received by one person with authority to address most of them without seeking approval.

 Staff not in a position to resolve the issue themselves could say “This sounds important.  May I transfer you to my supervisor so this can be addressed right away?”  If there’s no immediate resolution, inform the person there’ll be a delay and explain why.  This shows that the practice does care about the matter and is not just sweeping it under the rug.  It’s important that from wherever the complaint is coming from that it be handled with tact and the person with the complaint is being heard.

 At the end of the two weeks or up to one month period that your practice has been tracking complaints and issues, it’s good to go over with the entire staff the results of what was recorded.  This is a good time for the entire staff to work together as a team and find ways to resolve issues and also to help the office to run smoother and have it be everyone’s goal to have less complaints.

 Also a practice that is thriving is usually an office that has a high referral rate.  It’s very important that other physicians that call the office or refer a patient be treated with the up most respect and dignity because they will be more likely to  refer patients.  Some practices even have a separate phone line just for physicians.  This is so that they will not be on hold for a long period of time.

 Remember, more carriers are implementing pay-for-performance programs, and patient satisfaction is a heavily weighted element.

 The solutions will vary depending on the practice, but generally, if a patient expressed financial concerns before care is provided, physicians can consider whether lower-cost options are available without actually discounting their services.

 Some patient’s have even made it clear up front that cost is an important factor in medical care decision-making.  Some of these articles have advised patient’s to ask for discounts if the bills are beyond what they can afford.  Experts say practice’s should be prepared to negotiate by following well established procedures.  It’s very important to consider any practice that may violate government regulations and third-party contracts.

 The first step is to determine who should you go into negotiations with?  Would it just be patient’s who don’t have insurance, or for some, have insurance coverage but have a high deductible health plan.  Discounts on co-pays and deductibles for insured patient’s may be possible depending on the practice’s contract with the third-party payers.  Some patient’s need to understand that physicians are already taking a cut from what they receive from the insurance company.  Some patient’s either don’t know that or understand it, so it should tactfully be explained.

 Other questions to consider are:  Who will handle the negotiating process in the office?  Will a patient’s word be good enough?  Practice’s should decide what discount is possible if a patient needs to spread payments over several months.  A patient may be able to pay part of the balance on the spot.  A prompt-pay discount is common, because a medical practice saves money on billing if a patient takes care of a charge before leaving the office.

 The amount of a discount that allows a patient to pay his or her bill but keep the office financially secure needs to be determined.  Practice’s should not just look at their fee schedule but also determine how much it costs to provide certain services and you need to know what a reasonable discount is.  The practice also should have a collection policy in place that tells the staff under what circumstances they can negotiate.

 The next step is to decide how these policies will be implemented and communicated to the patient’s.  Possible ways are adding wording or signage or patient forms that says if a patient has difficulty paying a bill, he or she should bring the matter up with a staff member.  Advertising specific discounts is not recommended but the wording makes it the patient’s responsibility to start a conversation.

Marina Hall is a Certified Medical Reimbursement Specialist (CMRS) and founder of MariAnn Medical Billing Service. To read a full “Interview with Marina Hall” visit her website at http://www.inscoding.com/aboutus.php

Click here to read testimonies regarding MariAnn Medical Billing Service http://www.inscoding.com/testimonials.php

It’s so hard when you have a lot of patients coming in and out of the office, some are ill, some not, but no matter what; there are germs in the air.  Especially when cold and flu season hits.  Not only are the employees exposed but other patients as well as the physician.  Most medical practices these days are short staffed as it is, so when one employee is out sick, it impacts the whole office.

Some offices offer a “play area” for children in their offices.  They can include, games, toys, books, even a small kids table with chairs.  This can be the perfect environment for germs to be spread from child to child but also for the employees who clean up the area at the end of the day.  There are little germs lurking around those toys and many areas that are not cleaned but missed.

One way to eliminate this problem would be to take away the “kids play area”.  Also by placing hand sanitizer dispensers in different parts of the office, especially the front desk.  Also signs can be posted reminding patients to cover their sneezes and coughs.  Some offices even have a designated area for patients that are ill and patients that are well.  Some offices have even tried to schedule patients that are ill in the morning and well patients in the afternoon during cold and flu season, with the patients consent to avoid any spreading of germs.

Areas where there is heavy contact such as phones, desks, computer keyboards, copy machines, it would be good to use a anti-bacterial solution to wipe these items down every day.  A sign on the back of a patient restroom also would help in reminding them to wash their hands after using the restroom facilities.

Many discount stores offer great deals on anti-bacterial products which the office can stock up on to keep germ free as much as possible.  These are small measures that can be taken to keep everyone healthy in your medical practice which keeps the office running smooth and efficient.