What Does Sequestration Mean to Medicare?

Medicare News Group published an article titled: "What Does Sequestration Mean to Medicare?" Key takeaways from the article are as follows:

• Medicare provider payments will be cut by 2% April 1st, 2013 unless Congress passes an alternate deficit reduction plan before then.
• Cuts will be applied to: 
• Medicare Hospital Insurance (Part A)
• Medicare Medical Insurance (Part B)
• Contractual Payments to Medicare Advantage Plans (Part C)
• Medicare Prescription Drug Plans (Part D)
• 90% of Medicare spending is limited to the 2% in cuts and 8% exemption
• If the sequestration goes into effect, an estimated $11.085 billion in cuts will occur
• From, 2013 to 2021 - the article stated that the Congressional Budget Office estimates that $31 billion will be spent because of the sequestration. 

To view the full article, please click the following link: What Does Sequestration Mean to Medicare?

For additional billing and coding resources, please click the following link: Medical Reimbursement Billing and Coding Resources

How Social Media Can Improve Your Medical Practice

American Medical News (Amednews.com) published an article on "4 Ways Social Media Can Improve Your Medical Practice"

1. Discover Needed Services
• Gain insight on what patients will do to improve their health
• What obstacles stand in their way to improve their health
• Find out what services interest people
2. Improve Customer Service
• Pay attention to complaints
• Respond to complaints with a public apology & offer to correct the situation 
3. Gather Feedback on Medications
• Monitor buzz on social media sites such as Twitter to see if people are talking about a certain medication
• They can monitor if the treatment works or doesn't work by the social media buzz that it produces.
4. Compare and Improve Quality
• Look at your competitor's social media sites and see what they are doing
• Learn from your competitor's mistakes as to not do that yourself
• Patient privacy is a concern

To read the full article, please click the following link: "4 Ways Social Media Can Improve Your Medical Practice" from American Medical News

For additional billing and coding resources, please click the following link: Medical Reimbursement, Inc. Resources Page

Services Covered and Summary of Benefits Covered (SBC)

Healthcare.gov published an article on "Services Covered and Summary of Benefits Covered (SBC)" In the article, they highlighted the following bullets:

What services are covered under my insurance?

• Coverage for Preventive Care
• Coverage for Pre-Existing Conditions
• Children's Pre-Existing Conditions
• Pre-Existing Conditions for anyone
• Temporary Exclusions in job-based plans
• Coverage for Pregnancy under Job-Based Plans
• Coverage under Small Employer Policies

How can i find out what is covered in my insurance plan?

• Health Plan Summaries
• Summary plan descriptions
• Questions on job-based insurance?
• More Information on What's Covered

What does my health insurance company or job-based plan have to disclose to me about my health coverage?

• They must give you a SBC (Summary of Benefits and Coverage)

What's in a Summary of Benefits and Coverage (SBC)? 

• Summary of benefits plan covers with cost-sharing associated with coverage.  The article lists the information it all covers.

When can I get an SBC?

• You can get an SBC when you make a request, apply for coverage and more listed in the article

What other information may i need to make a decision about coverage?

• Check the premium what access to doctors and prescription drug plans

Can I get the SBC in languages other than English?

• Yes, if 10% of people speak another language you may request it in the other language.

Additional questions answered in the article were:
Will this SBC change throughout the year?
What if I have more questions?

To download the full article, please click the following link: Services Covered and Summary of Benefits Covered (SBC)

For additional billing, coding, and reimbursement resources, please click the following link: Medical Reimbursement Resources Page

FREE Critical Care Webinar - April 24th, 2013

Join us on April 24th, 2013 at 12pm EST, for a FREE Critical Care Webinar

In this webinar, we'll discuss:

• Are you losing money by not billing Critical Care?
• Critical Care Scenarios
• Critical Care Questions and Answers

Space is limited to the first 150 attendees who sign up


To register for the webinar, please click the following link: Critical Care Webinar

For additional, billing, coding, and reimbursement resources, please click the following link: Medical Reimbursement Resources Page

Research Reveals Reasons Underlying Patient No-Shows

ACP (American College of Physicians) published an article highlighting reasons for patient no-shows for a psychiatric practice. Although this article highlights the reasons for no-shows in a psychiatric practice, these reasons could be similar in other practices as well:

• The no-show rate was between 19% and 22%
• Between $11 million and $19 million was lost.
• The research studied over 11,000 visits and they found that socioeconomic factors do affect whether or not the patient will show up for their appointment
• The time and the type of patient they scheduled determined whether or not they were going to show up for their appointment.
• Patients who lived:
• 5-10 miles away were very likely to show
• 19 and 60 miles were more likely to miss their appointments
• Greater than 60 miles they almost always showed up
• The study found that there were many logistical factors & demographic characteristics (whether the patient was married, what their gender was) played a role in if they were to show up for their appointment.

To read the full article, please click the following link: Research Reveals Reasons Underlying Patient No-Shows

For additional billing, coding, and reimbursement resources, please click the following link: Medical Reimbursement Resources Page

Doctors Fear For Medicine's Future

In an article by FrontPage Magazine, results from a survey state that many doctors fear for the future of medicine.

The survey went as follows:

• 36,000 physicians completed the survey
• 90 percent said that the medical system is "on the wrong track"
• 83 percent say they are "thinking about quitting"
• 61 percent said the system "challenges their ethics"
• 70 percent say "reducing government would be the single best fix"

Some key views from those surveyed were:

• 2/3 said the EMR (electronic medical records) compromise medical privacy and confidentiality
• One physician opted out of Medicare and Medicaid over 12 years ago and they stated they have never been busier.
• 2/3 said they are just barely squeaking by or losing money and expect the financial situation to worsen in the next 5 years.
• Increasing regulations have a direct impact om cost of care increasing.

To view the full article, please click the following link: Doctors Fear For Medicine's Future

For additional billing, coding, and reimbursement resources, please click here: Medical Reimbursement Resources Page

How to Bill for Critical Care and Dual Services

Today's Hospitalist published an article on how to bill for critical care and dual services.  The article discussed the codes for ICD-9 that hospitalists should be using to bill for the critical care services.

Teaching Requirements

• According to the CMS both the resident and the attending physician must be present to bill 00291
• The time for critical care does not need to be continuous

Dual Services

Consult vs. Observation Codes

• Outpatient consult codes 99241-99245
• Office or other outpatient codes 99201-99215
• Subsequent observation care codes 99224-99226
• Outpatient consultation codes 99241-99245

Short-Stay Admissions

• Initial hospital care codes 99221-99223
• Admission and discharge on the same date 99234-99236 - must stay a minimum of 8 hours before you can bill that code set.

To read the full article, please click the following link: How to Bill for Critical Care and Dual Services

For additional billing, coding and reimbursement resources, please click the following link: Medical Reimbursement Resources Page