APRNs in Kentucky now have the authority to write prescriptions for non-scheduled drugs due to a new bill which allows APRNs to collaborate with physicians to prescribe drugs. The aim of the bill is to improve patient access to high-quality primary care and medications. After four years of writing prescriptions under the supervision of physicians, APRNs will be allowed to prescribe routine medications independently. In Connecticut, Governor Malloy’s administration has proposed a law which would allow APRNs to independently treat patients and prescribe medications.
Emergency room wait times across the country are soaring. Numerous hospitals are reporting wait times to be far above the national average; the average wait time to see a physician, nurse practitioner or physician assistant is 28 minutes. However, some emergency room wait times do vary depending on density and patient influx. According to newly published research, higher emergency patient volumes, as well as patients using the emergency room for dental care, could be the primary factors contributing to the higher numbers. Some emergency rooms across the nation are improving wait times through specialized staff training and changing the way the department sorts patients.
Although providers, payers, and claims clearinghouses were looking to delay the ICD-10 deadline, CMS has made it clear that this will not happen. However, CMS did state that it will make some case-by-case exemptions for providers having a hard time meeting their Meaningful Use Stage 2 targets. In addition, physicians and other eligible providers whose EHR incentive programs operate on the calender year, will have more time and three dates: the first days of April, July, and October to start their 90-day clocks. CMS officials also noted that Stages 2 and 3 of the EHR incentive payment program will need to fully meet all criteria by 2015, but providers and health IT vendors with legitimate issues may submit applications to CMS for “hardship exemptions.”
Being unprepared for ICD-10 could result in increased denials for your practice, impacting cash flow. HMS’ team of expert coders can get you on the right track to ICD-10 readiness/compliance so you can maintain your revenue stream.
Assessment package includes review of 10 records for $250:
A comprehensive review of each record submitted.
An analysis outlining findings on a clear and concise report.
A detailed summary report providing an in-depth explanation of each record reviewed.
Documentation, recommendations, and cross references to coding guidelines when applicable.
Co-pay and deductible amounts vary from policy to policy so it’s important to know your patients’ co-pay and deductible responsibilities. As part of patients’ contracts with their insurance companies, it is their responsibility to pay their portion. However, physician practices are also obligated by their contracts to collect co-pays and deductibles and failure to do so is a violation of contract terms.
Here are some helpful tips to help you maximize your collections:
If possible, it is best to understand your individual contracts with third party payers
Delegate a staff member to be responsible for maintaining current patient insurance information
Verifying insurance is extremely important. Enter all available information (i.e. insurance numbers, DOB) into your software system. You should also check the eligibility status prior to each patient’s visit to make sure the insurance information you have on file is current. If it is not, contact your patient before the visit to get the current insurance and enter it into the system so you can do a real-time eligibility check.
It is best to review the eligibility checks to confirm if the deductible is met or not. Some plans will not provide detailed information, making this task difficult at times. Keep in mind that patients could be seeing multiple providers for the first few months of the year.
Always advise your patients to bring current insurance cards and any applicable copay the day of their visit. Keep in mind that some services, such as preventative services and surgical global periods, may not be subject to co-pays, co-insurance or deductibles. Also, it is important to remember you cannot collect a deductible from Medicare patients (you can only collect applicable co-pays).
It is important to have a financial policy in place that is reviewed every year (at least). Display your policy to ensure patients understand their obligation upfront. Your policy should outline the expectation that: 1. Co-pays are expected at the time of service. 2. Patients with deductible plans are expected to pay a set amount (to be determined by practice, for example: $50) at the time of service. Also, note that once the claim is submitted and reconciled, the practice will refund any amounts overpaid (if applicable) within a specific time frame (this will help to ensure you get some upfront payments for the visit until the claims are reconciled).
Staff should understand the importance of your financial policy and be consistent about enforcing it. Develop talking points on what should be disclosed to patients. Most importantly, staff needs to know how to respond to objection easily and respectfully when attempting to collect money.
Make sure patients are aware there are multiple ways to pay, including cash, check, credit card, or debit card.
If you need help putting together a financial policy, please contact Sherrie Fairchild at (203) 294-6659.
CMS has issued special instructions for ICD-10 coding on home health claims that span October 1, 2014. CMS had stated in an earlier transmittal that it would “allow HHAs to use the payment group code derived from ICD-9-CM codes on claims which span 10/1, but require those claims to be submitted using ICD-10-CM codes.”
Facility fees that many hospitals and healthcare systems charge are growing in popularity and patients are quickly becoming fed up. Facility fees have continued to be a trend among hospitals, especially those that acquire medical practices. Most patients are typically unaware of the additional fees until they receive the bill. A survey of major local providers by the Miami Herald found that few providers could provide specifics as to what they based their facility fees on. In Connecticut, state regulators are pushing hospitals to disclose facility fees.