2010 Volume 2 Issue 2
June 18, 2010
Issue No. 1
In This Issue
New Medicaid Disclosures
Medicare Timely Filing Requirements
Medicare Investigating CPT 99213
FTC Extends Enforcement Deadline
New Rate for Assistant Surgeons
For Our Scheduler Clients: Cross Reference Accounts
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Goodbye Rachel
Sadly, we said goodbye to IPC employee Rachel as her last day was May 28th. Rachel moved to South Dakota where she is now pursuing her dream of becoming a CPA. Although we miss her a lot we wish her the best of luck!

Meet Our Staff
Angela has worked at IPC since January 2010. She spends most of her time entering charges and calculating patient balances for office schedules, but she also helps with A/R. Her favorite thing about her position is that there is something new to learn every day. She has lived in the Grand Rapids area her entire life, and in her free time she enjoys spending time with her 2-year-old son, Owen.


Thank you to everyone who attended our Compliance Training in May. We had a total of 36 attendees who helped make the event a huge success.

For those of you who were not able to attend, you will receive an outline of the topics we covered as well as a CD with some useful resources for your reference.

We appreciate all of the questions and feedback we've received and look forward to the next time we meet!

New Medicaid Disclosures
Recently, Medicaid added new disclosures that must be made by providers on their CHAMPS profiles. CHAMPS is the online enrollment program for the State of Michigan. Pat Nevala maintains those profiles for almost all of our clients as a courtesy. Please be aware that she will be asking you for the following:

     1)  If you have had any malpractice settlements,      
          judgments or agreements, you must provide the dollar 
          amount(s) and date(s).

     2)  The name and Social Security Number of the practice
          office manager (if you have none, the group
          president's name and SSN will be substituted).

     3)  Attestation that Nurse Practitioners have a
          collaborative agreement with a physician (a copy does
          not need to be supplied but you must have an

Timely Filing Requirements for Medicare Fee-For-Service Claims
New legislation signed into law in March amended the time period for filing Medicare fee-for-service (FFS) claims. That new provision is one of many aimed at curbing fraud, waste, and abuse in the Medicare program. The "timely filing limit" is now one calendar year following the date of service. Under old regulations, claims could theoretically be filed for nearly two years from the date of service. While IPC clients are generally prompt in getting charges to us or responding to our requests for billing information, be aware that the clock is ticking. The new law could also impact our clients when there's a dispute about who is the legal primary payer. If a payer recoups payments they made years earlier, it may be too late for IPC to bill the new primary payer. That happened recently when Medicare Plus Blue recovered payments made as up to three years earlier. 

Provider Bulletins, April 01, 2010
Medicare Investigating CPT 99213
WPS Medicare (Michigan's Medicare carrier) announced that it will undertake a large-scale review of CPT 99213 - the most commonly billed E/M service. In sample reviews, Medicare discovered that documentation did not support the use of the code or documentation was missing completely. Under the newly announced audit, Medicare will send providers an Additional Documentation Request (ADR) Letter requesting medical records for specific services. If an ADR is received, you MUST RESPOND within 30 days. Send ALL the documentation that is necessary to support the medical necessity for each billed service. This may require you to contact other providers, agencies, and/or facilities to obtain the requested medical records. Please alert IPC if you receive an ADR Letter. 

WPS Medicare Part B, June 11, 2010
FTC Extends Enforcement Deadline for Identity Theft Red Flag Rule
The Federal Trade Commission has decided to delay enforcement of the "Red Flag" Rule through December 31, 2010. Most clients have implemented a process to check patient identity and we expect they will continue to do so even though enforcement will be delayed.

Federal Trade Commission, May 28, 2010
New Rate for Assistant Surgeons
Effective May 1, 2010, Aetna has changed their rate for physicians assisting at surgery. The rate has changed from 20 percent of the negotiated rate or recognized charge based on Aetna reimbursement policies to 16 percent of the negotiated rate or recognized change.

Aetna will reimburse multiple eligible assistant surgery codes as follows:

       ∙ 16 percent for the primary procedure
       8 percent for the second eligible procedure             
       4 percent for each additional eligible procedure       
Aetna OfficeLink Updates, March 2010                                                        Aetna Logo
Volume 7, Issue 1               
For Our Scheduler Clients: Cross Reference Accounts in Healthpac
Each client has a Cross Reference account to refer to when searching for patients. These accounts can be helpful when looking for a patient that has had a name change. To access this account, do a patient search for "Reference, Cross." First select the appropriate account, then under Demographics select Patient Comments. Here you will find notes referring to the name change.

For example, Jane Smith gets married and becomes Jane Doe. We will update Jane's account to reflect her new last name, but we will also put a note in the cross reference account that says "Doe, Jane aka Smith, Jane."
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

Please feel free to forward this newsletter to your staff and peers.

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