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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.

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Patient Financial Services Weekly Advisor

Issue 51, December 28, 2007

• Physicians saving Medicare millions

  Medicare is saving money in its "pay for performance" pilot program. The program, a four-year...

• Doctor sentenced for insurance fraud

  A Grand Rapids, MI, doctor was sentenced yesterday on 33 counts of healthcare fraud, including...

• Medicare Physician Fee Schedule

  Learn the answer from CMS.

Issue 50, December 21, 2007

• CMS announces changes to Inpatient Prospective Payment System, Long Term Care Hospital Prospective Payment System, and Inpatient Psychiatric Facility Prospective Payment System

  On December 3, CMS issued a MLN Matters article announcing changes to the FY 2008 Hospital...

• Fresh pain for healthcare providers, too

  Depending on whether you believe the hype or not, there are up to 47 million uninsured in this...

• Diagnostic tests provided to Skilled Nursing Facility residents

  Learn the answer from CMS.

Issue 49, December 14, 2007

• CDC report: 40 million Americans can't afford healthcare

  Health insurance is so costly these days, about 40 million Americans can't afford it. The CDC in...

• MA residents enrolling in health plan

  Massachusetts, the only state to require every individual to be insured, saw a big spike in...

Issue 48, December 7, 2007

• For hospitals, debt parade hasn't stopped--yet

  As the credit crunch facing much of the economy refuses to fade, and in fact grows stronger, one...

• New York mulls insurance plan to cover everyone

  New York lawmaker Richard N. Gottfried has proposed that the state create a $59 billion health...

• Condition codes

  Learn the answer from CMS.

• Quick Medicare compliance survey: Your feedback is important

  Quick Medicare compliance survey: Your feedback is important

• Quick Medicare compliance survey: Your feedback is important

  Quick Medicare compliance survey: Your feedback is important

Issue 47, November 30, 2007

• Hospital must find $200 million to stay in business

  An Atlanta hospital needs a lot of money by December 31 -- $200 million - if it wants to stay in...

• Legislators, hospital officials move to stop controversial Medicare auditing program

  An auditor denies a Medicare claim by a hospital. The auditor gets money off the denial. The...

• Medically Unlikely Edits

  Learn the answer, straight from CMS.

Issue 46, November 16, 2007

• Providers owe Medicaid $1 billion in back taxes

  Doctors, hospitals, and healthcare providers in seven states owe more than $1 billion in back taxes...

• Physicians to face largest reimbursement cut

  Doctors and physicians face the largest pay cuts by the Centers for Medicare & Medicaid...

• Skilled Nursing Facility determination

   

Issue 45, November 9, 2007

• CMS releases 2008 OPPS final rule

  In addition to finalizing most of its proposals, CMS created a new type of APC in its 2008 OPPS...

• Georgia doctor pleads guilty to Medicare fraud

  A Georgia doctor faces up to five years in prison, $600,000 in restitution, and $250,000 in fines...

• Q. Can you explain the use of modifier -27?

  Learn the answer, straight from CMS

Issue 44, November 2, 2007

• Feds to doctors: go electronic

  The US is urging healthcare officials to remove paperwork from their practice in exchange for...

• Important message from the Centers for Medicare & Medicaid Services regarding NPIs

  Medicare has always required that a provider identifier be reported for...

• When a patient goes from observation to inpatient

  Q: If an on-call doctor admits a patient from the ER to observation, and the attending doctor comes...

Issue 43, October 26, 2007

• Feds raid Medicare provider

  State and federal law-enforcement agents raided a Florida managed-care provider this week, causing...

• Medicare will not change ESA-drug policy

  Medicare will not budge on reimbursements for anemia drugs sold by Amgen Inc. and Johnson &...

• When a patient is not competent

  Q: When a patient is not competent, the representative cannot be located, and/or there is no...

Issue 42, October 19, 2007

• Lawmakers: Government should issue Medicare drug plan itself

  Democratic lawmakers to Congress: Get rid of the insurer and administer the Medicare drug program...

• Medicaid enrollment falls

  Medicaid enrollment fell for the first time in a decade for the fiscal year that ended June 30...

• Admitting mother/newborn into hospital

  Q. A mother has given birth to her newborn outside of the hospital. What is the correct way to...

Issue 41, October 12, 2007

• Insurers must correct Medicare practices

  The nation's largest insurers in the Medicare market use illegal marketing strategies and falsely...

• Healthcare lobbyists fight Washington on Medicare cuts

  Doctors, physician groups and hospitals are lobbying on the doors of the Democrat-controlled...

• Observation and post op

  Q: When would you start charging observation hours post op if the order is written and the patient...

Issue 40, October 5, 2007

• Important message from Medicare regarding NPI

  This is an important message for institutional providers that bill Medicare fiscal intermediaries...

• Hospitals can sue insurer, avoid lengthy Medicare appeals process

  A group of Texas hospitals can sue a major national insurer for failure to reimburse it for medical...

• Hiring a patient access staff member

  Q. How many interviews should I conduct when filling a patient access staff position?

Issue 39, September 28, 2007

• Minnesota hospitals will not charge insurers and patients for their own errors

  In healthcare, there is rarely a redo free of charge. A hospital bills insurers and patients for...

• Consumer group: One-third of Americans had no health insurance for all or part of last two years

  Most presidential candidates say providing health care insurance for more Americans is a campaign...

• Important Message from Medicare and observation patients

  Q. Can the Important Message from Medicare (IM) be given at the time of an observation registration?

Issue 38, September 21, 2007

• Texas hospitals adapt to more Spanish-speaking patients

  Hospitals are adjusting to a growing number of Spanish-speaking patients by creating Spanish...

• Video/audio system implemented in NC hospital

  Pitt County Memorial Hospital in Greenville, NC, for the first time launched a new video/audio...

• Critical Access Hospitals and Medicare

  Q: What do critical access hospitals (CAHs) who have elected Method II have to provide to their...

Issue 37, September 14, 2007

• MA hospitals may see cuts from treating uninsured patients

  Massachusetts hospitals could see cuts in the millions of dollars from state reimbursements for...

• Insurance premiums on the rise

  The cost of health insurance premiums rose this year at its lowest rate since 1999, but the prices...

• NPIs

  Q: Do medical students, interns, and residents need National Provider Identifiers (NPIs)?

• Take our Patient Access Director's survey!

  The editors at HCPro are researching a new handbook just for Patient Access directors. Please take...

Issue 36, September 7, 2007

• Scope of new Important Message from Medicare

  Q: Do the Important Message from Medicare and the Detailed Notice need to be given to all patients...

• Michigan insurance providers target specific age groups with custom plans

  Several of Michigan's largest health insurers, including Aetna, Health Alliance Plan, and Blue...

• Federal government proposes cuts to Medicaid payments to schools

  The federal government issued a proposal August 31 to restrict Medicaid payments to schools by...

Issue 35, August 31, 2007

• Record numbers of Americans lack health insurance

  The number of uninsured Americans rose 5% between 2005 and 2006, resulting in a record 47 million...

• Romney introduces plan for nationwide universal health coverage

  Massachusetts governor Mitt Romney recently presented another plan for universal healthcare...

• Letter to the editor

  I just read the reply to the question "we recently billed incision of the heart sac as an...

Issue 34, August 24, 2007

• Illinois Blue Cross disputes payments for medical center

  Rush University Medical Center, an academic hospital in Chicago, is involved in a dispute with...

• University of Chicago Medical Center may hand off Medicaid patients

  The University of Chicago Medical Center is discussing the possibility of sending patients covered...

• Medicare makes changes to vaccine reimbursements

  Q: I heard that CMS is changing the way it reimburses vaccines. Can you provide any additional...

Issue 33, August 17, 2007

• Lawsuit claims hospital monopoly meant higher prices for patients

  The day after Evanston Northwestern Healthcare was ruled as "anti-competitive" by the FTC, Jeffrey...

• Health insurers aim to increase paying customers

  With future government Medicare cuts likely, health insurers are reaching out to paying customers...

• Just say no to identity theft

  Q: How can I eliminate identify theft or minimize the occurrence at our facility?

Issue 32, August 9, 2007

• Inpatient procedure billed as outpatient

  Q: We recently billed incision of the heart sac (33025) as an outpatient procedure. Medicare denied...

• Michigan delays $54 million in scheduled payments to hospitals

  Michigan's financial troubles mean that its hospitals will need to wait until September 26 for...

• New York healthcare providers to reimburse $7 million for duplicate billing

  New York healthcare providers Healthfirst PHSP and St. Barnabas Community Health Plan, also known...

Issue 31, August 2, 2007

• Medi-Cal funding halted due to budget impasse

  California healthcare providers face imminent crisis as Medi-Cal, the state's Medicare program, ran...

• New Orleans hospitals drowning under financial burdens

  When Hurricane Katrina flooded, and closed, Charity Hospital in 2005, New Orleans lost a major...

• Important Message from Medicare Notice: Inpatient transfers

  Q: Two hospitals have different Medicare ID (provider) numbers. Patients are transferred from one...

Issue 30, July 27, 2007

• Illinois hospital wins battle in charity care case

  Provena Covenant Medical Center, based in Mokena, IL, won a victory last week in its prolonged...

• Kaiser fined for the second time in one year

  Kaiser Permanente, the largest HMO in California, was fined $3 million on accounts of contestable...

• E-mailing patient information during registration processes

  Q: A provider affiliated with or employed by a covered entity would like to e-mail patient...

Issue 29, July 20, 2007

• New OPPS proposed rule pushes wholesale packaging: CMS takes initial steps towar

  The outpatient prospective payment system (OPPS) has seen its fair share of changes every year...

• Bush plans to stop expansion of children's healthcare plan

  President Bush plans to stop the expansion of a healthcare program that offers coverage to the...

Issue 28, July 13, 2007

• Uninsured Americans raise Medicare costs

  A recent study revealed that the Medicare recipients who were uninsured before qualifying for...

• Price shopping: Customers don't always know the whole story

  Healthcare consumers everywhere are jumping online to search for the best prices, but experts warn...

• How should we discipline staff who remove medical records from the facility?

  Q: What is an appropriate disciplinary action to enforce for staff members who take medical records...

• Can you report on more than one PQRI measure at the same visit?

  Q: Can you report on more than one PQRI measure at the same visit?

Issue 27, July 6, 2007

• Senate committee approves healthcare IT bill

  The Senate Health, Education, Labor and Pensions Committee passed the Wired for Health Care Quality...

• Deadline extended for publication of provider reimbursement final rule

  On June 22, CMS published in the Federal Register a notice extending, until June 28, 2008, its...

• Prepare for mandatory present on admission reporting

  Q: Do you have any information on the present on admission (POA) indicator? Is it required? Do we...

Issue 26, June 29, 2007

• Study addresses low enrollment, low satisfaction with consumer driven plans

  Eight to 10 million enrollees in consumer-directed health plans spend less on medical care than...

• CMS publishes NPI notice

  CMS published the National Plan and Provider Enumeration System (NPPES) data dissemination notice...

Issue 25, June 22, 2007

• Study: Many of country's uninsured population are veterans

  Of the 45 million uninsured Americans, 1.8 million are U.S. veterans younger than age 65, according...

• "Sicko" will surely stir the healthcare pot

  If insurers aren't feeling the heat yet, they likely soon will when Michael Moore's documentary...

Issue 24, June 15, 2007

• Los Angeles hospital given 23 days to correct emergency procedures

  The Los Angeles hospital where a mother of three collapsed and died in the emergency room (ER) in...

• CMS issues FAQs regarding NPPES

  CMS has posted a series of frequently-asked questions (FAQ) related to the National Plan and...

Issue 23, June 8, 2007

• Study: P4P program not working-yet

  According to a recent study, the pay-for-performance (P4P) program hasn't significantly improved...

• WellPoint CFO asked to resign

  David C. Colby, chief financial officer of WellPoint, Inc., the operator of a large network of Blue...

Issue 22, June 1, 2007

• Providers face July 1 deadline to begin delivering discharge message

  On May 22, CMS posted the final version of the "Important Message from Medicare." Beginning...

• Florida Hospital promises emergency-room patients an hour wait

  Florida Hospital is promising emergency-room patients less than an hour wait to see a physician at...

Issue 21, May 25, 2007

• Survey: Patients in favor of EHRs

  Forty-seven percent of respondents to Kaiser Permanente's recent telephone survey of 1,000...

• Aetna changes reimbursement procedures

  Aetna is changing its reimbursement procedures to expand on its transparency initiatives and to...

Issue 20, May 18, 2007

• Study: U.S. healthcare system compares poorly to other wealthy countries

  A new study reveals that the United States ranks last in healthcare quality, access, and efficiency...

• CMS offers guidance for hospitals that provide emergency services

  CMS released new guidance last week clarifying the responsibility of hospitals that provide...

Issue 19, May 11, 2007

• Future doesn't bode well for healthcare

  The over-65 population will nearly triple between 1980 and 2030 as a result of the aging baby...

• HCA execs head to Washington, propose uninsured program

  Politicians have presented their case over the last year. Now the nation's largest hospital group...

Issue 18, May 4, 2007

• Katrina physicians suing Louisiana over uncompensated care

  Physicians at West Jefferson Medical Center outside of New Orleans is suing the state of Louisiana...

• Anthem Blue Cross in Indiana offers price shopping tool for members

  Anthem Blue Cross and Blue Shield recently unveiled an Internet tool that will allow members to...

Issue 17, April 27, 2007

• Wal-Mart set to open as many as 400 retail clinics

  Bad news for providers: Wal-Mart Stores announced plans this week to open as many as 400 in-store...

• New Jersey may soon collect co-pays from Medicaid recipients

  New Jersey, one of five states that does not require low-income people to pay co-pays for hospital...

Issue 16, April 20, 2007

• Report: NJ marred by fraudulent charity care program

  A New Jersey State Commission of Investigation report this week found that taxpayers have spent...

• CMS proposed rule moves toward severity-adjusted DRGs

  In its proposed rule updating the hospital inpatient prospective payment system (IPPS) for fiscal...

Issue 15, April 12, 2007

• UnitedHealth: No more long waits for claims decisions

  There will be no more waiting days or weeks for a decision on a claim if you're working with the...

• CMS to hold NPI roundtable

  CMS will host a national roundtable on the recently released NPI Compliance Contingency Guidance on...

Issue 14, April 6, 2007

• Study: Consumers embracing retail clinics

  A recent Market Strategies, Inc. study revealed that more consumers are ready to transition to...

• CMS: Initial NPI deadline will not be enforced

  CMS will not enforce the May 23 deadline for national provider identifier (NPI) implementation, as...

Issue 13, March 29, 2007

• Texas Web site provides price transparency

  A new Web site in Texas allows healthcare consumers to price shop for common medical procedures...

• NC collaborative to coordinate better care for uninsured population

  Health leaders in Wake County (NC) have set out to unclog area ERs and alleviate the strain on...

Issue 12, March 19, 2007

• MA healthcare initiative hits another snag

  Massachusetts' ambitious universal healthcare initiative, which officials in many other states have...

• CMS proposes changes to ABN form

  CMS proposes to substantially revise advanced beneficiary notification forms CMS published in the...

• UB-04: What is meant by 'service location?'

  Q: I've heard that "FL1" must be completed with the service location of the provider. For the...

Issue 11, March 16, 2007

• New program helps emergency responders identify hospital destinations quicker

  Emergency workers now can quickly and easily track patient capacity at Rhode Island hospitals...

• HCA hospitals now on the forefront of transparency movement

  The nation's largest hospital chain will soon notify patients in advance how much they will pay for...

• UB-04: Should we read into changes in 'source of referral' definition?

  Q: Regarding "FL15-Source of Referral for Admission or Visit," the definition in the UB-04...

• What’s new on PARC

  Find a training tool that will help staff identify true cost for the procedures and services you...

• Free benchmarking report

  When it comes to registration accuracy rates, where does your organization stand among its peers...

Issue 10, March 8, 2007

• TN hospital takes proactive approach to make up for reimbursement losses

  A Tennessee hospital is taking a unique approach to offset losses from payer reimbursement and...

• UB-04: Priority type of visit: Required for all patient types?

  Q: Regarding the "FL14" field for "Priority Type of Visit" on the UB-04 form, is it needed on all...

Issue 1, March 29, 2007

• UB-04: Is a 'how-to' manual available?

  Q: I would like to know if there is a manual explaining each box on the form and what information...

• Want to share some of your PFS and patient access knowledge?

  We'd love to pick your brain to get ideas about what HCPro can do to improve the quality of our...

• UB-04: Is box 70 the same diagnosis as box 69?

  Q: Could you please verify that box 70 is the same diagnosis as box 69? Also, what is box 81 a, b...

• NPIs for teaching hospital residents?

  Q: Our hospital is a teaching hospital. Are our residents required to have an NPI?

• Where is state transparency coming from?

  Q: Who is driving the push for state transparency? Is it generally a government authority or a...

• Are we ready for hospital-branded credit cards?

  Q: What are your thoughts on the movement toward hospital-branded credit cards and how they may tie...

• NPIs: Taxonomy code for psychiatric residents?

  Q: We are told that teaching hospitals must apply for NPIs for residents. What does one use for the...

• What's NEW on PARC this week!

  Find a management tool that will show you sample charity care income guidelines from a rural...

• HIPAA: Can we inform a teen's parents about child's hospital visit?

  Q: A 19-year-old presents an insurance card listing him or her as a qualified dependent on a...

• Free patient access salary survey

  What is your current salary range? What is the highest level of education you've achieved? Do you...

• Can physician move patient directly into observation after surgery?

  Q: We have come across cases in which the physician performs either a surgery or procedure on a...

• Are we required to include a disclaimer on all faxes?

  Q: Does HIPAA require us to send a disclaimer with all faxes?

• Can someone e-mail patient information to a registration department?

  Q: A provider affiliated with or employed by a covered entity would like to e-mail patient...

• Having trouble appealing your denied claims?

  Please take a moment to complete this short, 10-question survey to tell us how we can develop an...

• Any suggestions on non-scheduled patients who cannot make a deposit?

  Q: Do you have any suggestions on non-scheduled X-Rays and walk-in lab self-pay patients that...

• Can patient access staff give out ED information over the phone?

  Q: Can the hospital’s front desk receptionist give information to a caller asking whether a...

• Are hospitals bound by InterQual criteria when determining patient status?

  Q: I have a question about what to do when a physician writes orders to admit a patient to the...

• What’s new on PARC this week!

  Find a management tool that will help you identify potential candidates for a new, unique position...