Fees

Establish Patient Financial Responsibility (Resource 149)

Financial responsibility (insurance, cash, etc) should be established as soon as possible, preferably before the patient comes in for the first visit. Both provider and patient need to understand who is responsible for payment of services. The patient needs to understand what they are responsible for versus what the insurance plan or company will or will not pay. Consider the following:

TENS Rentals

Q: How do you submit TENS (Transcutaneous Electrical Nerve Stimulation) rentals for reimbursement? I have some insurance companies that pay without question and others that deny this.

A:Use the correct TENS unit code, either E0720 for two lead or E0730 for four lead, and append the modifier -RR to designate Rental. Example E0720-RR.

Other popular supply modifiers include -NU to signify a new product and -UE to signify the sale of a used product.

Virtual Cards

Sometimes called "disposable," "temporary" or "one-time use" numbers, a virtual credit card number is "like putting a wall" between your transaction and your regular account, says Steve Kenneally, vice president of the American Bankers Association. Although these cards can protect the cardholder from fraud, the use of virtual cards as a form of electronic funds transfers (EFT) payments for healthcare services can present some problems for healthcare providers.

Each new year brings a bundle of surprises in terms of changes and updates that practices must learn and implement. In an effort to aid in the preparation of this year, I have listed some common helpful tips that you might follow in order to best manage your workload ahead.

Evaluate fees: Fee schedules are often compared to peers. Practices should use a reliable source to evaluate fees annually to ensure that your fee schedule is consistent with statistical expectations.

Beware of the changes sneaking in as “money streams” in the name of EFT standards. Virtual Credit Cards are being used in provider’s offices as payments from payers; clearinghouses are starting to offer this service as well.

Sustainable Growth Rate

What is the Sustainable Growth Rate (SGR) and How Does It Affect Medicare Payments?

The Balanced Budget Act of 1997 included a provision to balance the Medicare budget by adjusting the dollar conversion factor by a complicated formula based on the following four items:

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