2010 Volume 2 Issue 2
April 2, 2010
Issue No. 1
In This Issue
Healthcare Reform Provisions
Prolonged Care Procedure Codes
Medicaid Enrollment Snapshot
Newsletter Archive
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Training Sessions
During May and June we are hosting mandatory front desk training sessions for your office. The purpose of these sessions is to review proper front desk procedures and promote effective usage of software.

 Meet Our Staff
Kristen joined us after working as an A/R Specialist in the Chicagoland area. She has a degree in Psychology from Western Michigan University as well as a certificate in Billing and Coding. Besides working on A/R Kristen also helps train on using Scheduler. She is excited to join the IPC Billing team and looks forward to working with everyone!



IPC would like to blow its own horn!

"Days in A/R" is a common measure of billing effectiveness - that is, how quickly claims are converted from charges into payments.
The most recent statistics published by the Medical Group Management Association has a range of 31 days (family practice) to 41 days (orthopaedics), with most other specialties somewhere in-between. Across all clients, IPC has about 25 days in A/R.

Such a low Days in A/R doesn't happen by accident. Our employees work hard to keep your accounts current. We encourage you to share our success with any of your colleagues looking for medical billing options. We reward existing clients for a successful referral.

Healthcare Reform Provisions Kick in Over 10 Years
Many of the provisions included in the healthcare reform legislation approved Sunday--and the bill that adds fixes to that measure that was sent to the Senate--would take place not immediately, but along a 10-year timeline through 2020. Here's a glimpse of how that timeline rolls out:

  • Adults with pre-existing conditions who have been uninsured for at least six months can enroll in a temporary high risk health insurance pool and receive subsidized premiums--beginning three months after the bill's passage. (The pools expire when exchanges are implemented in 2014.)
  • All health insurance plans are to offer dependent coverage for children through age 26; insurers are prohibited from denying coverage to children because of pre existing health problems.
  • Insurance companies can no longer put lifetime dollar limits on coverage and cancel policies--except in cases of fraud.
  • Tax credits will be provided to help small businesses with 25 employees or fewer to get and keep coverage for these employees.
  • The Medicare "doughnut hole," in which beneficiaries had to pay full cost of their prescription drugs, begins narrowing by providing a $250 rebate this year to those in the gap, which starts this year after they have spent $2,830. The doughnut hole fully closes by 2020.
  • Indoor tanning has a 10% sales tax.
Click here to read changes through 2020

Janice Simmons, for HealthLeaders Media , March 23, 2010
Janice Simmons is a senior editor and Washington, DC, correspondent for HealthLeaders Media Online.
Clarification on the Use of Prolonged Care Procedure Codes
With the discontinuance of consultation codes for services provided January 1, 2010, and after, there have been many questions concerning the use of prolonged care procedure codes. In order to use a prolonged care code (99354 and 99355 for outpatient or 99356 and 99357 for facility), a provider must document the total of the face-to-face time (including the visit) spent with the patient to support the use of the procedure code. The Centers for Medicare & Medicaid Services (CMS) Internet Only Manual (IOM) Publication 100-04, Chapter 12, Section 30.6.15 discusses the use of prolonged services and provides a chart showing the face-to-face threshold times required. This section also provides examples of when a prolonged care code is and is not appropriate.

Click here to continue reading
Medicaid Enrollment: June 2009 Data Snapshot
An analysis from the Kaiser Commission on Medicaid and the Uninsured
This analysis finds that, with the country in a deep recession, nearly 3.3 million more people were enrolled in state Medicaid programs in June 2009 compared to the previous June. It was the biggest ever one-year increase in terms of absolute numbers, and boosted the June monthly Medicaid enrollment by 7.5 percent to 46.9 million people nationally.

It was the first time since the early 1990s that every state experienced an increase in Medicaid enrollment, and in 32 states enrollment grew at least twice as fast as the year before, according to the analysis, which includes data breakouts by state.

The increase in enrollment reflects the role that Medicaid plays in reducing the numbers of people who become uninsured when the economy falters, with many people turning to the program for help after being laid off and losing their employer-based health insurance. Millions more who were not eligible for Medicaid likely joined the ranks of the nation's uninsured.

At a state level Michigan felt an even higher impact than the rest of the nation. In June 2009 roughly 1,645,500 Michigan residents were enrolled in Medicaid.

Medicaid Enrollment

Publication Number: 8050
Publish Date: 2010-02-18
ProlongedCareClarification on the Use of Prolonged Care Procedure Codes Continued
Providers choose the procedure code that most accurately reflects their services in one of two ways. Providers can document the level of the history, exam, and medical decision making. In order to evaluate whether a prolonged care code is appropriate, the documentation must show the total face-to-face time (including the visit) the physician or non-physician practitioner spent with the patient (does not have to be continuous), and that total time is used to determine whether a prolonged care code is appropriate. Time the patient spends away from the provider does not count toward the use of a prolonged care procedure code.

The other way a provider may choose a procedure code is based on time when more than 50% of the face-to-face time in the office or time spent on the floor or unit in a facility is spent in counseling and/or coordination of care. When assessing whether a prolonged care code is appropriate, again only the total face-to-face time (including the visit) spent with the patient is used. When assessing the use of prolonged care codes when time has been used to document the service, then only the highest level of service in the family of codes may be used. In a facility, time spent on the floor or unit in providing the service is not counted toward the use of the prolonged care codes. Time spent in gathering information from the family or discussing the medical decision options with the family not in the presence of the patient does not count toward the use of prolonged care codes.

WPS Medicare Part B Legacy eNews for Monday, February 1, 2010
About Us
If you have any questions regarding this newsletter, you can contact us at:

         Mary Ellen Duffy
         Patricia Nevala pat@ipcbilling.com

or call us at 616-459-6867 or 800-606-1455

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