MDeverywhere

As a billing service for doctors, I am trying to find out what everyone’s opinion is in regards to the new Medicare Fee Schedule for Jan - Feb 28, 2010.  Are you changing your fee schedule now and then doing it again March 1st?  And is Medicare going to pay for the claims that have been sent in at a lower rate then Medicare is at now.  I would love an opinion from any medical billing outsourcing companies out there?  As I have a client who wants her fee schedule changed and then changed again.  Thanks.

In general,

Physicians are working harder than ever before to see even a small increase in their income. From 2004 to 2005 median gross charges for primary care doctors rose 6.8%, but their median compensation only increased 3.9%.

Why is this happening? More than ever before, physicians face an avalanche of complex billing rules, administrative regulations, and medical billing processes needed to run their businesses. At the same time, costs are increasing and reimbursement rates are declining. Medical practices also often lack access to financial and clinical performance data (internal and benchmark) that is vital for staying competitive and profitable. 

 Some of these drains are tactical issues that require a focus on revenue process optimization, such as keeping the physician's schedules full; accurately and completely charging for all medical procedures performed; and complying with payer rules for submitting medical claims. Other revenue killers require a more strategic view of your current business model to determine how you can revitalize it based on new patient, doctor, and payer realities. Finally, data accuracy is an important theme throughout the workflow, since capturing the right demographic information the first time means less re-work, better patient outcomes, and faster payment to the practice. Drawing on our experience with over 19,500 providers across the country, MDeverywhere, a leading full-service revenue cycle management and physician billing company has developed a simple, effective model to boost revenue, capture profitability, and improve quality of care.

I can honestly say that I am continuously wowed by the capabilities of MDeverywhere's IT department.  They have been able to create interfaces with any and every software product out there that has an HL7 interface.  They have even been able to honor special requests for the ability to import digital images and than auto populate the information back in to the correct fields.  This is huge for large practices as it cuts down on the data entry process and frees up their staff for more important tasks.  MDeverywhere continues to amaze me in their willingness to work with clients and their needs.  I have never in my 25 years of working in the healthcare industry seen a company do so much for their clients at no cost to them. 
I look forward to uncovering the next great service that MDe has to offer their client base.

Cathy

CMS had put out a notice that all providers that were not in the PECOS system would lose the ability to write prescriptions for Medicare beneficiaries for their durable medical equipment and get it paid for by Medicare.
This was to go into effect 1/1/09. Per Medicare a new credentialing form will need to be filled out by all providers that is not in the PECOS system or the above mentioned prescriptions will not be paid.
Medicare has recently moved the date for implementation for this to 4/1/10.

If you are not in the PECOS system, and need the Medicare application completed. Send me a message to bwylie@drsmgmt.com.

Sincerely,

Bethany Wylie, CPC, CEMC, CPMA

If you have coding questions and want to find out for free go to Doctorsmanagement.com and click on the coding tab. On the bottom of the coding main page is the link to a free message board.   On this message board you are able to ask a coding question for free and other coders can log on and answer or give a suggestion to the post that you initially made. The message board is there as a free resource. It is organized by topic or specialty and all are free to post a question or comment.

Bethany Wylie, CPC, CEMC, CPMA

One of the things that I have been a part of at DoctorsManagement is called problem solving 101. What do I mean?  I mean that we have monthly clients and when they are having a problem then I am having a problem.  I can't say that I am the coding department because some problems stem to the practices credentialing or recent contract negotiation. 

I had a problem today and a practice that our company had finished their credentialing billed out claims and they had about 50,000 in rejected claims. Their problem became my problem.

 I looked up the codes that were billed on the claims and they were good codes, I was concerned that the codes that they were billing might not go with the place of service per first glance, but maybe it was not a problem.  The other thing I noticed on the EOB that they had faxed to me is that the denial was only on one specific code pretty much.

I called Medicare. The problem was now with the newly completed Medicare application it was with the coding.  The provider had become effective on the 17th of the previous month. The code that they were billing was for 30 consecutive days of dialysis.  They bill out the claim with the 30 day code from the 1 to the 30th of the month. Since the credentialing did not go into effect till the 17^th, the carrier denied all of the charges on the claims with this information on it.

I called the practice and they re-billed all the things on the claim along with a different code that bills for daily dialysis for days 17 through the end of the month.  They were able to bill out for everything the provider performed and their problem is no longer my problem.

Bethany

On Saturday, Dec. 19, the Senate followed the House and approved a 60-day freeze on Medicare physician payment rates, thus, temporarily delaying the scheduled 21.2 percent cut to physician billing reimbursement.  The language in the legislation is specific to the conversion factor only and all other 2010 policy, physician billing and claim processing changes to the Medicare program will become effective on Jan. 1. Yesterday afternoon, President Obama signed this bill into law.

I am really excited that the NJ Medicaid claims will be going over to Medicaid NJ through our electronic medical billing service and will be stop going paper.  This is a big step in the right direction for our medical billing process.  This will ensure that claims will be processed quickly.  So excited!

The Centers for Medicare & Medicaid Services (CMS) published the final Medicare physician fee schedule for 2010 in the Federal Register on Nov. 25. The fee schedule contains payment rates for covered services, changes to Medicare policy, and a number of other changes that will significantly affect medical practices. The rule:

• Eliminates the use of all consultation codes (inpatient and office/outpatient codes for various places of service except telehealth consultation G-codes) on a budget-neutral basis by increasing the work relative value units (RVUs) for new and established office visits, increasing the work RVUs for initial hospital and initial nursing facility visits, and incorporating the increased use of these visits into practice expense (PE) and malpractice RVU calculations.
• Finalizes a proposal to remove physician-administered drugs from the definition of “physician services” for purposes of computing the physician update formula. This long-awaited administrative step mitigates the size of future Medicare Part B reductions.
• Phases in new PE RVUs over four years using revised survey data that will result in significant increases and decreases to the PE values of many codes.
• Establishes a Physician Quality Reporting Initiative (PQRI) reporting mechanism via qualified electronic health records.
• Defines the size of a group practice as at least 200 providers for the new PQRI group-practice reporting option.
• Increases the utilization assumption for diagnostic equipment priced at more than $1 million, which will decrease the technical component payment for services performed on this equipment. This change will be phased in over four years.

We all know the medical climate we are facing on a daily basis. With the economy the way it is, your practice's health is vital now more than ever. Some of the challenges that you have faced in the past or may be facing now are:

1. Higher deductibles, increased co-pays, and lower insurance coverage that have dramatically increased the self-pay bucket of medical practices and this trend will continue.

2. Most administrators do not believe the Health Savings Account’s and Flexible Spending Account’s will help offset the increase in their self-pay.

3. Labor costs are soaring.

4. Overhead (utilities, supplies, rent, etc) continues to escalate.

5. Malpractice premiums continue to increase.

6. Many docs are already overworked and seeing their revenues decrease 10-15%.

MDeverywhere's leadership knew they had a best in class Practice Management product that dramatically decreased their client's days outstanding. They also recognized the trend in increased patient responsibility and set out to build a tool set that was best in class in attaining the maximum yield in patient pay.

At Transworld we believe the revenue needed by medical practices to offset all the increased costs and decreased reimbursements by the insurance carriers, can be found in their self- pay aging bucket at 90 days and beyond. This is why we became partners!!

We have built an interface directly into MDeverywhere's Dashboard that allows our clients to send us all of their delinquent patients with a single click of the mouse. We do all of the rest!!

With the help of MDeverywhere and Transworld working together, we can increase our clients’ revenues by 10 to 15% or more.

To find out more contact your MDeverywhere Account Manager or Anthony D'Eri at Transworld Systems.

A quick video on Transworld's industry leading medical collections

http://www.transworldsystems.com/video/medical_video.html

Anthony D’Eri

Healthcare Consultant

Transworld Systems

O 845-367-4389

C 914-772-0911

anthony.deri@transworldsystems.com

In speaking with am MDeverywhere customer today, she noted that the company has been a life saver for them as far as revenue.  In the past it took them well over 3 plus months to get paid on claims.  Even then it was notated that they were shorted on their fees repeatedly by multiple insurance companies.  Since MDeverywhere has taken over their billing she no longer has to worry about the billing process and payments.  She receives her money faster and had noticed that get more of it sooner as MDeverywhere is busy chasing the funds down daily. 
I must say that I was very pleased to hear that MDeverywhere was able to make their practice run more efficiently.

Cathy

What kinds of services are provided by an outsourced Doctors Billing Service?

Following are some of the main services provided by MDeverywhere Medical billing service.

* They process medical claims and follow up on rejected or problematic claims and resubmit them after rectifying any problems.

* Medical billing service generates reports with details of payments and claims. Comprehensive reporting helps you adjust your billing practices and improve cash flow. They provide you with all pertinent reports.

* There are many ways to send claims information to the medical billing service provider. You should prefer one that accepts claims information via a web browser hosted on your computers. Such data transfer is secure, efficient and less prone to error. Sending claims information on paper or via email is highly inefficient and error prone.

* Your provider may also offer Medical practice management (MPM) and Electronic medical records (EMR) software. These are significant buying decision and you may want to consider them separately from your decision to hire a billing service provider.

What else do I need to know before hiring a medical billing services provider?

Consider the following before making the final decision.

* How much experience does the provider have?

* ASP hosted billing software is preferable over one that is hosted on your computers. You don't have to worry about maintaining ASP software.

* Good software system is important but so is expertise of the staff in handling difficult claims.

* How is their track record? MDeverywhere has a proven track record with stellar results.

* Ask them to show you the reports they would generate for you.

* Are they 100% HIPPA compliant. Make sure their billing and reporting software too complies with HIPPA and SSL security to ensure patient information secrecy.

* Can they handle the NPI or National Provider Identifier system?

* Are they willing to train your staff to use the billing software?

* Make sure their references are stellar.

How much does a medical billing service cost?

Pricing depends on the level of service and your location. To get the best deal, compare price quotes from multiple medical billing service providers at a B2B marketplace. Major portion of the payment is in the form of commission. Low price is important but it should not be the sole criteria in hiring a medical billing service provider. Consider someone who is an expert in collecting denied or difficult claims.