New Medicare Cards

Q: The Centers for Medicare and Medicaid Services (CMS) started issuing new Medicare cards to beneficiaries in April of this year. What do I need to know about these changes to limit disruption to my patients and medical practice? A: CMS is required to issue new Medicare cards as a part of the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015, which mandates that CMS remove Social Security Numbers (SSN) from all Medicare cards by April of 2019. The primary reason behind the change is to combat identity theft …
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Reduction in Reimbursements for Modifier -25

Q: Last fall, Anthem Blue Cross Blue Shield sent a notice to physicians in several states regarding their intent to reduce reimbursement rates on any evaluation and management (E/M) services billed with modifier -25, “significant, separately identifiable E/M,” by 50% effective January 1, 2018. What are the implications for urgent care? A: This announcement initially spurred action from the California Medical Association (CMA) to coordinate with the American Medical Association (AMA), as well as other state medical and dermatology societies, to squelch the effort. Based on that feedback, Anthem then …
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The Incidentals of ‘Incident-to’ Billing

Q: I plan to hire physician assistants and other nonphysician providers in my urgent care clinic. I understand that I can use “incident to” billing to have their patient visits reimbursed at the physician rate. What are the rules for “incident-to” billing? A: The Centers for Medicare and Medicaid Services (CMS) defines “incident to” as “those services that are furnished incident to physician professional services in the physician’s office (whether located in a separate office suite or within an institution) or in a patient’s home.” Services must be provided by …
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Turning Patient Accounts Over to a Collection Agency—the Right Way

Q: Should patient accounts ever get turned over to a collection agency? A: The altruistic nature of running an urgent care center—to serve the public—can make it difficult to send patient accounts to collection, but it must be done if you want your center to survive. Some urgent care centers choose to leave patient balances in their billing systems indefinitely, but this puts a serious burden on the business by creating additional statement costs, wreaking havoc on financial reports, and inflating a center’s days in A/R. It also damages an …
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Get the Most Out of Providing Medicare Wellness Exams

Q: Are there specific requirements for Medicare wellness exams and who can perform them? A: Medicare offers an initial preventive physical examination (IPPE), which is also known as the “Welcome to Medicare” preventive visit or the annual wellness visit (AWV). Either a physician (a doctor of medicine or osteopathy) or a qualified nonphysician practitioner (a physician assistant, nurse practitioner, or certified clinical nurse specialist) can provide the services. The IPPE is a one-time initial examination that is covered within the first 12-month period after a participant is enrolled in Part …
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