Are you a Nurse Practitioner or Physician Assistant? Do you see Medicare patients? If so, you’ll want to make sure you are listed in PECOS – Provider Enrollment, Chain and Ownership System.

CMS continues to urge physicians and non-physician practitioners who are enrolled in Medicare but who have not updated their Medicare enrollment record since November 2003 to update their enrollment record now. If these physicians and non-physician practitioners have no changes to their enrollment data, they need to submit an initial enrollment application which will establish a current enrollment record in PECOS.

Visit this CMS  page to learn more.

Early in the process of starting up your Nurse Practitioner practice, or even after you have been open for a while, you will be faced with what to do about billing. Your options are limited: you hire someone to come in, you do it yourself, or you outsource the billing. My choice, when I first opened was to outsource and while I thought that I was making good choices, my experience was less than poor. Let me share with you what I’ve learned since then so you can avoid my mistakes.

When you are looking for a billing company to outsource to the first thing you want to do is ask around. Who are your colleagues using? Why do they like/dislike them? Check the forums and social media where they are likely to talk about billing, like the EMR support forums or the coding forums. And of course, you can check the NPBO™ forum. And don’t forget to network with colleagues at conferences and gatherings.

When you find companies that you are interested in, Google them. Look for complaints as well as praises. If it’s an individual, are they certified? And if they say they are, can you get proof? You’ll also want to check references, but not just those listed (few people will give you the name of someone who will give them a bad reference). Again, ask around about this company or person and try and find references that are not listed.

So what are some of the questions you should ask?

1. What are their qualifications?
2. How long have they been in business?
3. How many people are handling the claims?
4. How are follow ups handled?
5. What happens when there is a denial?
6. Who is managing the accounts receivable (AR)? How often is it evaluated and worked? Who is responsible?
7. Communication Issues: What forms of communication are available? Is there a time difference? Is there a language difference?
8. Do they specialize in a particular area of billing such as primary care or surgery?
9. What kind of reports will you receive? Can you read them? Can you get help with them?
10. Is the company familiar with your regional issues?
11. Does this company know about NPs and are they familiar with some of the issues in billing for us? Are they familiar with your state regulations?
12. What other services do they provide?

This is not by any means an all inclusive list, but it will get you started when thinking about hiring a biller.

Nurse Practitioners that accept Medicare in their practices need to be aware of how this will impact their practices. With the exception of Midwives, NPs are allowed only 85% of the physician allowable. Here is the update:

The Continuing Extension Act of 2010, enacted on April 15, 2010, extended the zero percent (0%) update to the 2010 Medicare Physician Fee Schedule (MPFS) through May 31, 2010. At this time, Congress is debating the elimination of the negative update that took effect June 1, 2010. The Centers for Medicare & Medicaid Services (CMS) is hopeful that Congressional action will be taken within the next several days to avert the negative update.

To avoid disruption in the delivery of health care services to beneficiaries and payment of claims for physicians, non-physician practitioners, and other providers paid under the MPFS, CMS had instructed its contractors on May 27th to hold claims for services paid under the MPFS for the first 10 business days of June (i.e., through June 14, 2010). This hold only affects MPFS claims with dates of service of June 1, 2010, and later.

Given the possibility of Congressional action in the very near future, CMS is now directing its contractors to continue holding June 1 and later claims through Thursday, June 17, lifting the hold on Friday, June 18.

This action will facilitate accurate claims processing at the outset and minimize the need for claims reprocessing if Congressional action changes the negative update. It also should minimize the provider and beneficiary burdens and costs associated with reprocessing claims.

We understand that the delayed processing of Medicare claims may present cash flow problems for some Medicare providers. However, we expect that the delay, if any, beyond the normal processing period will be only a few days. Be on the alert for more information regarding the 2010 Medicare Physician Fee Schedule Update.

Source: LEARNRESOURCE-L Email Update, National Institutes of Health, U.S. Department of Health and Human Services dated June 14, 2010

Posted: 6/14/2010

Once again, Medicare is asking Nurse Practitioners and other providers to hold our Medicare Claims for 10 days until Congress can prevent a 21% reduction in reimbursement to providers.  We will not know the outcome until after Congress has a chance to reconvene on April 12 and they approve a pay patch.  However, it’s unclear to me, just how long before we will be faced with this issue again.

If you have not already done so, take a look at your payor mix. Do a bit of forecasting and determine how this will impact your practice overall. You may need to make some adjustments.

I’ll post more as it becomes available.

Nurse Practitioners, along with other health care providers can expect to have payments held for “up to the first 10 business days of January”.

According to CMS:

The President has signed the Department of Defense Appropriations Act of 2010 which provides for a zero percent (0%) update to the 2010 Medicare Physician Fee Schedule for a two month period, January 1, 2010 through February 28, 2010.

The Centers for Medicare & Medicaid Services (CMS) is working with Congress, health care providers, and the beneficiary community to avoid disruption in the delivery of health care services and payment of claims for physicians, non-physician practitioners, and other providers of services paid under the Medicare physician fee schedule, beginning January 1, 2010.  In this regard, CMS has instructed its contractors to hold claims for services paid under the Medicare Physician Fee Schedule (MPFS) for up to the first 10 business days of January (January 1 through January 15) for 2010 dates of service. This should have minimum impact on provider cash flow because, by law, clean electronic claims are not paid any sooner than 14 calendar days (29 days for paper claims) after the date of receipt. Meanwhile, all claims for services delivered on or before December 31, 2009, will be processed and paid under normal procedures.

The holding of claims allows Medicare contractors time to receive the new, updated payment files and perform necessary testing before paying claims at the new rates. CMS has instructed contractors to begin processing claims at the new rates no later than January 19, 2010.  Please note that most contractors are closed on the January 18 Martin Luther King Day holiday. Therefore, even absent a new update, most claims likely would not have been paid any sooner than January 19, 2010, given the aforementioned statutory 14-day payment floor.

CMS has extended the 2010 Annual Participation Enrollment Program end date from January 31, 2010, to March 17, 2010- therefore, the enrollment period now runs from November 13, 2009, through March 17, 2010.

The effective date for any Participation status change during the extension, however, remains January 1, 2010, and will be in force for the entire year.

Contractors will accept and process any Participation elections or withdrawals, made during the extended enrollment period that are received or post-marked on or before March 17, 2010.

In addition, be on the alert for more information about other legislative provisions which may affect you.

Many independent NP practices are concerned with the proposed changes in Medicare reimbursement. At this time, it stands at -21.2% of the physician allowable. Of course, for NPs and PAs that figure is a bit more.  The good news is the proposed cuts in payment have been delayed until March 1, 2010.

In terms of the elimination of the consultation codes, there does not seem to be any changes. Those codes will be eliminated as of January 1, 2010.

In order to see where you will stand in terms of reimbursement, visit the website of your local fiscal intermediary and download the most recent fee schedule. Dont’ know who you intermediary is? You can find it here – Medicare Intermediary , which is a PDF file and will have all the contact information for your region.

Smart offices will have been looking at this information and trying to assess what changes, if any, they will need to make in 2010. How will this affect your office and your patients, and how to you think you will respond? Feel free to leave your comments below.

The AP reported the proposed Medicare cuts would be delayed by 10 days. Read the excerpt below:

Amid intense political pressure from the nation’s doctors, the Bush administration said Monday it would hold off on a 10 percent fee cut in Medicare payments to doctors that was slated to kick in Tuesday.

The Bush administration is giving members of Congress time to prevent the reduction in payments from the federal health insurance program for the elderly when lawmakers return from a July 4 recess. The administration said the Centers for Medicare & Medicaid Services would not process Medicare claims for the first 10 days of the month, which in effect would allow Congress time to reconsider a vote to stave off the cut.

What this means is, regardless of what congress will do, Medicare will be holding your claims for 10 and probably more day until processing them. If you see a lot of Medicare clients, that means you cash flow could be seriously impacted and, depending on your client mix….you business.

As we’ve written in the past, take a look at your client mix, make alternative plans. If you have a large Medicare client base, this could very definitely impact your business negatively (as would the proposed cuts). Are you prepared to weather this storm?

Our next interview will be with Mylikia Ross, CMBS. Ms. Ross is the NPBO Billing Expert. She’s going to talk with us about finding that perfect biller and just what to expect from them! In addition to answering your questions, she has prepared some questions that you can use when you interview as well.

If you have already signed up for these updates, you?ll recieve the information to access the call either via phone or via webcast. If you have not signed up, please do so now at www.NPInterviews.com.

Welcome to 2008! It’s already been a busy time. If you have not already done so, make sure you evaluate your fee schedules. There are new CPT codes and new reimbursements in place or will be put in place shortly.

While the intended Medicare 10% cut has not yet happened, the new rates are only good until June. Watch for impending changes…they may not be good for those of us who see lots of Medicare folks as 10% can be a huge cut in reimbursement.

At the same time, I noticed that Medicaid has cut its reimbursement and many of the commercial carriers are holding steady with last years rates.

Unlike business owners in other lines of work, health care providers, at least for now, seem to be at the mercy of the insurance carriers. While we can negotiate fees with carriers, it appears it will be a battle. I’m going to be working on one carrier shortly….I’ll let you know what happens. In the meantime to learn more, Medical Economics has published an article tis month: You Can Negotiate with Health Plans.

I got a call this evening from an NP friend of mine who opened her practice in November 2006. She’s been dealing with doing electronic billing with Medicare. She tells me that after months of working with them, doing test runs, etc…they were all ready to do. Now mind you, these test runs were done with Medicare…everyone said it’s a go.

So they upload billing going back SEVEN months. And guess what? Medicare kicked them all back and said she could not bill.

Apparently, in her prior job, they opted out of Medicare. Guess what? That opt out form is apparently good for two years. It follows you where-ever you go. Medicare is now telling her she cannot bill for ANY visits until after July 1, 2007. It is possible this is correct?

I gave her the number for the local regional office where hopefully she can talk with someone who has a bit more knowledge than those answering the call center phones. Any other ideas?