ron l. nelson, pa president 2 east main street fremont, michigan 49412 ph: 231-924-0244 fx:...
TRANSCRIPT
RON L. NELSON, PAPRESIDENT
2 East Main StreetFremont, Michigan 49412
Ph: 231-924-0244Fx: 231-924-4882
Health Services Associates, Inc.
Website: www.hsagroup.net
Email: [email protected]
Understanding Billing Issues
•RHC/FQHC Services
•Part B Services
•Provider Based vs. Independent
RHC Services
•Physician Services
•PA/NP/CNM
•Psychologist
•Clinical Social Worker
•Services and Supplies “Incident-To” to the above Services
Part B Services
• Inpatient – Professional Component
•Lab – Technical
•X Ray – Technical
•Diagnostic – Technical
•Radiologist Fees (four walls test applies)
Billing for PA/NP/CNM
•Obtain UPIN’s for PA’s, NP’s and/or CNM’s
•Medicare Advantage – review how PA, NP, CNM are covered
•Medicaid – review participation agreements
VaccinesVaccines
•Flu
•Pneumococcal
What information do I need to capture?
Billing for Procedures
•Endoscopies
•Biopsies
•Surgical Procedures (office based)
•Commingling – defined
How can we correctly carve out procedures?
MEDICAID – What is Covered?
•Core Services
•Other Services
•Managed Care
How to analyze its impact
Behavioral Health Services Health Services
•Clinical Psychologist (PhD)
•Clinical Social Worker (CSW)
• Initial Diagnostic Visit Paid at 100%
•Four walls test applies
Telehealth
•Bill to RHC/FQHC Program
•Q3014 code is paid separately from all all-inclusive rate
•Bill for $20, transmission fee
•Real Time Audio/Video Transmission
•Separate service not subject to fee schedule restrictions
SNF, Swing Bed Visits
• January 1, 2005 - bill all to RHC FI
•The requirements for visits are every 30 days (not less than 21 days)
•Medical necessity allows acute visits
Billing for Procedures
•Endoscopies
•Biopsies
•Surgical Procedures (office based)
Billing Billing Crossovers
•Problems with EOB with EOB
• How to get PaidHow to get Paid
• How to Remain CompliantHow to Remain Compliant
Provider-Based Issues
•Only Visits Billed to Intermediary
•Ancillaries Billed Under Hospital Fee Schedule Hospital provider type
•Exceptions – CAH – offsite clinics
What constitutes a visit
•Face to face encounter a patient and a physician, physician assistant, nurse practitioner, nurse-midwife, or visiting nurse.
•Encounters with more than one health professional and/or multiple encounters with the same health profession that take place on the same day at a single location constitutes a single visit.
Pap/Pelvic
Bill Professional component to FI under revenue code 521Bill Technical component to the Part B CarrierSee Medi 913-01
Colorectal Screening/Bone Mass/Prostate Cancer Screening
Bill Professional component to FI under revenue code 521Bill Technical component to the Part B CarrierSee Medi 799-00
Diabetic Outpatient Self-Management Training Services
Not reimbursed by Medicare at this time for services rendered by RHC.
SERVICES RENDERED ON NON-VISIT
DAYSCan be combined with claims with visits
Recommend they be within 30 days
List only the date of the visit
Show charges for all services
Adjustments OK
Otherwise, handle thru cost report
LIST ACTUAL CHARGES
The RHC should list their actual charge for each service.
Do not automatically default to listing the all-inclusive rate amount only.
SIGNATURESMEDICAL RECORDS- ACCEPTABLE- HANDWRITTEN ELECTRONIC STAMPED + HANDWRITTEN
UNACCEPTABLE- STAMPED STAMPED + INITIALS
CLAIMS- ACCEPTABLE - HANDWRITTEN ELECTRONIC STAMPED “SIGNATURE ON FILE”
Medicare Reimbursement
ONE VISIT PER PATIENT PER DAY WITH FEW EXCEPTIONS
SECOND ENCOUNTER ON SAME DAY MAY BE BILLED IF UNRELATED (SORE THROAT AND BROKEN HAND)
MAY BILL FOR A PART A VISIT AND A PART B non-RHC/FQHC VISIT (HOSPITAL VISIT) ON SAME DAY
Medicare Reimbursement (continued)
Pneumonia and Influenza immunizations
Medicare will pay cost at the end of the year on the cost report.
Cost based reimbursement is two to three times standard payment levels
Do not bill Medicare. The clinic is only required to maintain a log
Medicare Reimbursement (continued)
Pneumonia and Influenza logs required
Must include all patients
Separate log for pneumonia and for influenza
Information needed:
Date of service
Patient name
Patient Medicare number, if Medicare patient
Bonus Payment Non RHC/FQHC Part B ServicesHealth Professional Shortage Area:
HPSA Geographic10%
Physician Scarcity Areas:PSA 5%
Specialty Physician Scarcity Area:SPSA 5%
www.cms.hhs.gov/providers/bonuspayment
Apply to physician services – not services provided by non physicians.