Free Revenue Cycle e-Newsletters

APCs Weekly Monitor CDI Strategies Coding Educator Compliance Monitor Healthcare Auditing Weekly HealthLeaders Media Corner Office HealthLeaders Media Finance JustCoding News: Inpatient Medicare Weekly Update Patient Access Weekly Advisor Patient Financial Services Weekly Advisor The RAC Report

Patient Financial Services Weekly Advisor

Looking to improve your facility's bottom line and more effectively manage your patient financial services department? Get this free weekly e-mail that provides tips, advice and real-world strategies.

2009 | 2008 | 2007 | 2006 | 2005 | 2004

Patient Financial Services Weekly Advisor

Issue 50, December 23, 2005

• Budget bill: States given new rights to regulate Medicaid

  A final Congressional agreement on a budget bill will give states the right to impose premiums and...

Issue 49, February 16, 2005

• HHS: 21 million Part D enrollees, and counting

  The new Medicare Part D drug program, which begins on January 1, will enroll more than 21 million...

Issue 48, December 9, 2005

• Charitable Medicaid program may end in NY

  A charitable Medicaid program that has helped to insure thousands of New Yorkers may be abolished...

Issue 47, December 2, 2005

• CMS proposes Medicare coverage for bariatric surgery

  The Centers for Medicare & Medicaid Services (CMS) recently announced its plan to change Medicare...

Issue 44, November 4, 2005

• CMS announced payment rate changes for outpatient services in 2006

  A final Outpatient Prospective Payment System (OPPS) rule states that acute care hospitals will...

Issue 43, October 28, 2005

• Many equipment suppliers guilty of fraud, raising Medicare premiums

  Medicare is an easy target for fraud, say government investigators, and the illegal activity raises...

Issue 42, October 21, 2005

• Study: Hospitals adopting new guidelines for billing uninsured patients

  Hospitals are slowly changing the way they bill and collect for low-income, uninsured patients in...

Issue 41, October 14, 2005

• Study: Hospitals adopting new guidelines for billing uninsured patients

  Hospitals are slowly changing the way they bill and collect for low-income, uninsured patients in...

Issue 40, October 7, 2005

• Survey: Billing errors common, hit patients hard in the wallet

  A recent Consumer Reports survey reveals that 5% of medical bills contain "major" errors, the...

Issue 39, September 30, 2005

• WellPoint acquires WellChoice in giant health insurance merger

  The nation's largest health insurer grew even larger on Sept. 28 when Indianapolis-based WellPoint...

Issue 38, September 23, 2005

• EMR systems could save billions

  A new study estimates that adopting a standardized electronic medical records (EMR) system over the...

Issue 37, September 16, 2005

• Tip: Building a case for automated demographic validation

  Most Patient Access departments have traditionally monitored registration accuracy via some kind of...

• 2006 OPPS final rule

  A: The effective date for APCs is January 1 of each year, not October 1. You can find the 2006 OPPS...

• Survey: In face of rising costs, fewer companies offer health benefits

  As health insurance costs rise, the number of companies offering health benefits to their employees...

Issue 36, September 9, 2005

• Tip: Best practices to secure appropriate reimbursement

  Take the following steps to stay aware of what you're owed to secure revenue, says healthcare...

• Who can bill for an x-ray when a patient requires surgery?

  A: The surgeon should not bill for the interpretation of the x-ray. The surgeon is merely using the...

• Regulations relaxed in wake of hurricane

  CMS and state governments are relaxing many normal operating procedures to speed the provision of...

Issue 35, September 2, 2005

• Tip: Train staff to verify immigrant status

  The federal government will give hospitals money this year to offset the cost of treating illegal...

• Chargemaster maintenance

  A: I recommend that it be an ongoing process, but it should be done at least quarterly, because CMS...

• CMS issues Stark advisory opinion

  CMS has issued an advisory opinion allowing a group of physicians to hold stock in their nonprofit...

Issue 34, August 26, 2005

• Tip: Evaluating gainsharing agreements

  Gainsharing is an arrangement that rewards physicians who achieve cost-saving measures. Although...

• ESRD patient billing

  A: For ESRD patients, other than home dialysis patients, who are hospitalized during the month, the...

• CMS issues final interim rule on power wheelchairs

  CMS clarified August 24 the requirements for prescribing, supplying, and receiving payment for...

Issue 33, August 19, 2005

• Tip: Five more keys to monitor medical necessity

  Last week, we discussed that Medicare's medical necessity requirements are often ambiguous and...

• Advice for billing inpatient admission in error

  A: When a hospital admits a patient in error, and wishes to submit the claim for payment, it has...

Issue 32, August 12, 2005

• Tip: Five keys to monitor medical necessity

  Medicare's medical necessity requirements are often ambiguous, so when you're verifying medical...

• Staffing guidelines to set OR facility fees

  A: The practice of setting the OR rate with this methodology could be interpreted as double billing...

• Judge approves class-action settlement between Tenet Healthcare

  A Los Angeles judge approved an agreement by Tenet Healthcare Corp. to settle a class-action...

Issue 31, August 5, 2005

• Tip: Three ways to get started using physicians in a denial program

  If you decide to make physician participation an integral or more regular part of your denial...

• CPT coding for urgent care clinics

  A: To answer this question, first let's examine the definition of urgent care. The Urgent Care...

• President Bush approves medical errors database

  President George W. Bush signed a bill last week that will create a database for healthcare...

Issue 30, July 29, 2005

• Tip: What to do when patients won't sign an ABN

  Under Medicare's Limitations on Liability provision, providers can bill beneficiaries who refuse to...

• Waiting period for Medicare coverage

  A: The waiting period is called the test of permanence. The client may receive his or her Medicare...

• CA hospital pays $3.6 million to settle upcoding allegations

  A California healthcare provider has paid $3.6 million to settle allegations that it routinely...

Issue 29, July 22, 2005

• Tip: Use physicians to prevent and appeal denials

  There are several ways physicians can help your denial management program.

• Charge diagnostic mammogram for patient with history of cancer

  A: There is much confusion regarding screening v. diagnostic mammograms, but the issue is simple...

• Study: Patients sent home before tests are in

  Hospital patients are often sent home before the results of all their tests are in, and some lab...

Issue 28, July 15, 2005

• Tip: Decide whether to divulge your CDM to a health plan

  More and more health plans are asking hospitals for their chargemaster (CDM). It may be because...

• Improving in-house collection strategies

  A: You may feel that your own billing staff can handle delinquent accounts better than an agency...

• WellPoint to settle in physician disptute

  WellPoint, the nation’s largest health insurer, announced a settlement July 11 with 700,000...

Issue 27, July 8, 2005

• Tip: Scrutinize denials for reasons, check plan procedures

  If you receive a denial based on medical review (i.e., utilization management and/or medical...

• Time constraints with CT scans

  A: You would only see this edit if the scans were performed on the same date of service. So the...

• Blue Cross of CA fined for overcharging members

  California regulators fined Blue Cross of California $150,000 for overcharging nearly 45,000 debit...

Issue 26, July 1, 2005

• Tip: Check out the new AMA pay-for-performance principles

  The American Medical Association (AMA) House of Delegates recently approved a set of...

• Medicare bonus payment program improving quality of care

  Federal health officials say a pay-for-performance Medicare bonus payment system is resulting in...

• Inpatient-only procedure list

  A: CMS updated the inpatient-only procedure list in its OPPS final rule. This information is in...

• Empire Blue Cross issues bonuses for NY-area hospitals

  Thirty-seven New York-area hospitals received a total of $741,200 in bonuses over the past two...

Issue 25, June 24, 2005

• Tip: Use phone scripting to improve charity-care collections

  Within the pre-service area, staff needs to know how to discuss payment options with patients in...

• Senate approves cuts in Medicare, Medicaid

  The Senate last week voted to approve the fiscal year 2006 Senate budget reconciliation bill, which...

• Bill 70470 for CT scan without, then with contrast

  A: Procedure code 70470 describes a CT procedure without contrast followed by a CT procedure with...

• OIG semiannual report shows savings in billions

  The OIG on June 13 announced the publication of its semiannual report, claiming savings and...

• Study: 89% of hospital execs receive annual bonuses

  The prevalence of annual incentive plans in acute-care hospitals was 89% in 2005, according to Hay...

Issue 24, June 17, 2005

• Tip: How to apply charity-care criteria

  Because a number of factors are involved in making an appropriate charity determination, staff...

• NPP frequency

  A: Direct treatment providers that are covered entities (CEs) are only required to give out their...

Issue 23, June 10, 2005

• Tip: Use pay-for-performance data to negotiate with plans

  If you have the ability to collect pay-for-performance data now, you may want to go to the table...

• Discount policies

  A: Each provider is able to customize the charity policy to best serve the needs of the patient...

• Study: Caring for uninsured raises costs for others

  Providing healthcare for the uninsured increases the annual cost of insurance premiums for the...

Issue 22, June 3, 2005

• Tip: Color-code observation patients

  Because observation is a status, not a location, hospitals don’t need an area dedicated...

• Dialysis for transient patients

  A: In the case of a patient dialyzing in an outpatient facility, all renal-related problems are...

• Judge dismisses charity care lawsuit against North Mississippi Health Services

  A federal judge dismissed a lawsuit filed against North Mississippi Health Services (NMHS) by a...

Issue 21, May 27, 2005

• Tip: Make sure your ER meets EMTALA compliance

  An emergency room (ER) requires flexibility, cooperation, and organization to perform...

• Brand name v. generic medications

  A: Begin by reviewing the following CMS documents with pharmacy, clinical, and purchasing personnel:

• Grassley asks 10 nonprofits to account for charitable activities

  Senate Finance Committee Chairman Senator Chuck Grassley sent a letter May 25 to 10 nonprofit...

Issue 20, May 20, 2005

• Tip: Front-end process target areas to improve the revenue cycle, part 2

  Assessing front-end processes are integral to long-lasting change and improvement in your...

• Reducing fee to less than Medicare allowable rate

  A: In general Medicare currently pays physicians on an RVU-based fee schedule, regardless of the...

• NY hospital repays Medicaid $76.5 million

  Staten Island University Hospital said it will repay $76.5 million that prosecutors say it...

Issue 19, May 13, 2005

• Tip: Improving the revenue cycle starts with the front end

  Assessing your front end to identify target areas for improvement means paying close attention to...

• Setting OR facility fees and staffing guidelines

  A: The practice of setting the OR rate with this methodology could be interpreted as double billing...

• Blue Cross of Michigan bestows grant on 20 free clinics

  Twenty free health clinics that serve residents in 33 counties in the state will receive grants...

Issue 18, May 6, 2005

• Tip: Manage PPO contracts to avoid scam insurance companies

  A number of fraudulent health insurance companies are selling coverage ranging from traditional...

• Defining clearinghouses

  A: A healthcare clearinghouse is a public or private entity, including a billing service, repricing...

• CMS proposes 2006 rate increases for inpatient stays in acute-care hospitals

  CMS announced April 25 that acute-care hospitals that submit data on 10 quality measures will...

Issue 17, April 29, 2005

• Noncovered services and status indicator E

  A: Whether required to provide an Advance Beneficiary Notice (ABN), hospital ABN (HABN), home...

• Carle Foundation's tax-exempt status called into question

  Most of the lawsuits filed in federal court by Richard Scruggs and other attorneys alleging...

Issue 16, April 22, 2005

• Tip: Five steps to better phone communication skills

  The following are five key points that I addressed with my patient accounting staff to improve...

• Survey: Proliferation of health savings accounts yields positives for patients

  The majority of health savings accounts (HSA) and health reimbursement arrangements (HRA) are being...

Issue 15, April 15, 2005

• Tip: Managing uncompensated care

  Healthcare financial managers face the increasing challenge of managing not only revenue and...

• Waiving deductibles and copays

  A: Yes, the warning applies for private payers as well. Consider the following:

• CMS sets aside $31.7 million to fund SHIPs

  CMS announced April 11 a 50% increase-$31.7 million-in funding for the State Health Insurance...

Issue 14, April 8, 2005

• Tip: Inappropriate bed assignments contribute to denials

  Mary Johnson, RN, BS, CPHQ, came to Maine Medical Center in Portland in January 2003 facing more...

Issue 13, April 1, 2005

• Beware of waiving copays and deductibles

  The network/nonnetwork and preferred/nonpreferred issues are always top of mind for providers...

• Deductibles and financial assistance

  A: From a high-level perspective, a hospital's financial aid policies should be clearly documented...

Issue 12, March 25, 2005

• Tip: How to use condition code 44 to change patient status

  Facilities can change a patient’s status through the use of condition code 44 (inpatient...

• ABNs and status indicator E

  A: An Advance Beneficiary Notice (ABN) informs a beneficiary when an otherwise covered item or...

Issue 11, March 18, 2005

• Tip: Three rules to reduce your online risk

  The Internet is a valuable resource for providers to seek advice from colleagues and ask how they...

• Tenet to settle class-action lawsuits on pricing for uninsured patients

  Dallas-based Tenet Healthcare Corp. agreed to settle some class-action lawsuits over prices that...

Issue 10, March 11, 2005

• Tip: Stay aware of what's next on the horizon: APC groups

  Achieving a significant reduction in clinical denials is no small feat. But Mary Johnson, RN, BS...

• EOBs

  A: Most hospitals are developing document retention plans. If your hospital has one, you should...

• NC hospital seeks to end BCBS contract

  Baptist Hospital, based in Winston-Salem NC, announced March 3 that it would end its relationship...

Issue 9, March 4, 2005

• Tip: Get paid what you’re due

  Front-end and back-end processes play a part in securing reimbursement and proper revenue cycle...

• Ask the expert: Mail returns

  A: The national average is 7%, but many providers simply do not track this number/percentage. Like...

• Florida sues Tenet for improper Medicare reimbursements

  Florida sued Tenet Healthcare Corp. on racketeering charges March 2, alleging the company inflated...

Issue 8, February 25, 2005

• ABNs

  A: The regulations speak to the need to issue an ABN under certain circumstances, in order to hold...

• BCBS of RI collects $2.5 million from Perot Systems

  Blue Cross/Blue Shield of Rhode Island collected $2.5 million from Perot Systems Corp. for...

Issue 7, February 18, 2005

• Help physicians learn to perform a medical necessity check

  Before performing a medical-necessity check, be sure physicians review test orders for all required...

• BCBS of PA funds coverage for low-income residents

  Blue Cross/Blue Shield plans in Pennsylvania agreed to give $150 million a year toward healthcare...

Issue 6, February 11, 2005 - VIEW THE FULL ISSUE

• Linking charge capture to the revenue cycle

  Charge capture has a significant impact on a facility's revenue. Each department in the hospital...

Issue 5, February 4, 2005

• Tip: Medical necessity checks help stamp out denials

  Denials for medical necessity are a major concern for many medical facilities. NorthEast Medical...

• OIG's compliance guidance supports efforts in managing uninsured patients

  Discounts to the uninsured was covered in the OIG’s final supplemental compliance guidance...

Issue 4, January 28, 2005

• Strategies for when a health plan asks for your CDM

  Health plans are increasingly asking hospitals for copies of their description masters (CDM). It...

• Patients sue Seattle hospital for overbilling

  Two patients of Virginia Mason Medical Center in Seattle sued the hospital, claiming they were...

Issue 3, January 21, 2005

• Tip: Hardline tactics for reducing denied claims

  The number of denied claims from Elkhart (IN) General Hospital decreased significantly in 2004 from...

• Facility fees

  A: Facility fees are largely cost and volume based at Willis-Knighton Health System (WKHS...

• CMS to expand coverage of implantable cardiac devices

  CMS said January 19 it will expand coverage for implantable devices that can help prevent sudden...

Issue 2, January 14, 2005

• Tip: One take on how to classify self-pay patients

  Children's National Medical Center in Washington, DC, segments "self-pay" patients into three...

• UB-92 forms for uninsured patients

  A: On December 28, 2000, HHS issued a final rule establishing "Standards for Privacy of...

• Healthcare spending decreased overall in 2003, CMS says

  The pace of health spending growth slowed in 2003; it grew 7.7% in 2003 to $1.7 trillion, down from...

Issue 1, January 7, 2005

• Tip: Real-life examples of revenue-cycle team initiatives

  Saving revenue and cost can show up in unlikely places. Craig Stumpenhorst, assistant director of...

• Collecting copays in the ED

  A: I oversee the ED registration staff and financial counselors, and our area is a bit different...

• HCPro survey reveals providers' top charity-care processing concerns

  A recent HCPro survey to healthcare finance professionals found that bad debt write-offs continue...