Category: Business
I Am Going to File A Complaint!!!!
Now you do! POET has scoured the Universe. We have compiled information on how to file a complaint, with just about anybody you might want to file a compliant with. The OIG, TDI, BBB, CMS, TRS, ERS, Texas School Board, State Employees, Federal Employees, CHIPS, Self Funded Employee Groups, TMHP, Tricare, the Attorney General… Check it out, downloaded it, get out your pen….
Aetna OfficeLink Updates Published 12/1/2020
For new and updated information on:
- Changes to Aetna’s National Precertification List (NPL)
- Surgical procedures performed in the ER, modifier 54, rate change
- Beginning March 1, 2021 you may see new claim edits. These will be part of Aetna’s 3rd Party Claim and Code Review Program.
- Individual Service Codes are being assigned to Service Groups (a lot of changes are coming)
- Changes in Commercial and Medicare Drug list
- Changes in Prior Authorization Requirements
TMA’s Reimbursement Specialist Want You to Know
About These Items That Are Listed in the UnitedHealthCare December Bulletin:
- Starting January 1, UHC will follow the revised 2021 E&M coding and guideline changes for the AMA and CMS.
- January 1, for Medicare Advantage plans, UHC will expand prior authorization requirements and site-of-service medical necessity reviews.
- And, UHC has delayed implementation of its Laboratory Test Registry protocol
New coding guidelines a recipe for improved revenue 11/20/2020
Bill Dacey, MHA, MBA, CPC-I is principal in The Dacey Group, Inc., a consulting firm dedicated to coding, documentation and compliance concerns for physicians.
36 Guidelines to Evaluate a Practice Management
Need to know where to begin:
- Financial Management – Billing and Collections
- Financial Management – General
- Personnel Management
- Marketing and Practice Promotion
- Self Development
- Leadership Skills
Optimizing Advanced Practice Providers
MGMA, October 2020
The COVID-19 pandemic has amplified the previously growing importance of advanced practice providers (APPs) in care delivery and practice performance.
Increasing demands for healthcare point to a projected physician shortage, estimated to reach between 54,100 and 139,000 physicians by 2033.1 One strategy to address this shortage is to close gaps in primary care access through increased use of APPs. One estimate points to expanded use of nurse practitioners (NPs) could reduce primary care physician (PCP) shortages by 70%.2
Many practices already recognize the substantial boost that APPs can provide to practice performance, with APP utilization growing. MGMA data show that almost 67% of Better Performer practices employ APPs; for physician-owned practices, that rate jumps to
almost 87%.3
Cigna Online Appeals and Claim Reconsideration 11/9/2020
Now you can submit appeals and claim reconsideration requests online for medical claims using the Cigna for Health Care Professionals website (CignaforHCP.com). This is an enhancement you’ve been asking for and we’ve been working hard to provide you with an easy-to-use tool
Ransomware Threat Targeting HealthCare Providers. 11/09/2020
You can’t afford to continue to look the other way.
SOME GREAT TIPS TO SHARE WITH YOUR STAFF.
[embeddoc url=”https://community.poetllc.org/wp-content/uploads/2020/11/Ransomware-Threat-Targeting-Health-Care-11062020.pdf” download=”all” viewer=”google”]HEIGHTENED RANSOMWARE THREAT: ACTION STEPS
MGMA members-the federal government has announced a heightened risk of malware/ransomware attacks on the healthcare industry-including physician practices and inpatient facilities. We wanted to identify some actions you can take to reduce your risk and resources to assist you.
Actions to reduce your risk:
- Discuss the issue of cybersecurity with your IT/website vendor and have them block known sites that provide known functionality to the malware (reference the IOC list below)
- Have your IT/website vendor monitor endpoint detection on servers and workstations for changes in applications and running services
- Have your IT/website vendor monitor all new account creations. Especially critical are those with administrator access
- Have your IT/website vendor confirm that your data backup systems are in place and working effectively. Remember that offsite data storage is preferable
- Ensure your practice’s business continuity and disaster recovery plans are up-to-date and readily available
- Discuss the heightened threat with your administrative and clinical staff and the increased need to stay highly diligent during this time
- Consider instituting a practice-wide policy prohibiting staff use of personal email accounts as a method to decrease your risk
- Remind staff not to open emails and/or attachments from unknown senders (and even be cautious with attachments from recognized senders)
- Encourage staff to inform you regarding any suspicious email or cyber incident
Resources:
HHS Bulletin: us-cert.cisa.gov/sites/default/files/publications/…
IOC List: gist.github.com/aaronst/…
MGMA member-benefit Cybersecurity Action Steps
Robert Tennant MA
Director of Health Information Technology Policy MGMA Government Affairs
Washington DC
REPAYMENT OF ADVANCE PAYMENTS
QUESTION: We have received letters indicating when repayment of Advanced Payments will begin. Has Medicare released anything on exactly how that will work and how the remit will look? Will there be specific CARC or RARC codes used? Thanks!
MGMA REPLY:
Thanks for posting this question! Earlier this month, CMS announced the details of Medicare Accelerated & Advance Payment (AAP) recoupment, which are consistent with legislation passed by Congress in September:
“Providers were required to make payments starting in August of this year, but with this action, repayment will be delayed until one year after payment was issued. After that first year, Medicare will automatically recoup 25 percent of Medicare payments otherwise owed to the provider or supplier for eleven months. At the end of the eleven-month period, recoupment will increase to 50 percent for another six months. If the provider or supplier is unable to repay the total amount of the AAP during this time-period (a total of 29 months), CMS will issue letters requiring repayment of any outstanding balance, subject to an interest rate of four percent.”
Regarding remits, CMS indicates in its AAP FAQ, “Providers and suppliers will see the offset amount reflected on their Remittance Advice. Providers and suppliers should contact their MAC to receive current balance and payment information related to the repayment of their AAP payment.” I have not yet seen specifics around which codes will be used on the remits. However, the Agency plans to issue further information on the recoupment process at a later date, and the details of these adjustment codes may be covered in future guidance.
Please let me know if I can provide any further clarification!
Best,
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Matt Devino
Associate Director, Government Affairs MGMA
Washington DC
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