June 6th, 2012 
Issue No. 1
In This Issue
Are You Living Your Compliance Plan?
Great Lakes Health Plan Name Change
Work Comp & Auto
BCBS Timely Filing Limit
Continuing Education
Quick Links
OIG Compliance Program for Individual and Small Group Physician Practices
Meet Our New IPC Employee, Jules
IPC welcomes our new hire, Jules Soentgen. Jules has been in the medical billing field for 25 years. 


Newsletter Archive

Want to read a back issue of IPC's newsletter?

Welcome to the IPC Billing newsletter.

Are You Living Your Compliance Plan?

Federal Fraud and Abuse recoveries exceeded $2 billion in 2011. Why should you care? After all, you aren't trying to defraud the federal government. Well, have you ever billed with the wrong date of service? How about billed the wrong patient? Hey, but these were just honest mistakes, right? You are correct that the intent was not to commit fraud, but these errors can be construed as "abuse." Billing with the wrong date of service is billing "for goods and services that were never delivered or rendered." Billing the wrong patient is billing "for work or tests not performed." Remember: Your compliance plan is your best defense if the OIG ever comes knocking at your door. The existence of an effective compliance plan provides evidence that any mistakes were inadvertent. A well-written compliance plan also protects you from a civil False Claims Action [Qui Tam] brought by one of your employees by clearly identifying your employees' responsibility to bring forth problematic situations/occurrences to your attention.


When is the last time you reviewed your Compliance plan? Hopefully it is not sitting on a shelf with a thick layer of dust. Is your Compliance Officer conducting regular training and education programs for providers and staff? Do you contract with a coding professional to perform a coding audit on a regular basis to make sure what you code matches what you document? Are you fully documenting when a problem is discovered and the steps you are taking to rectify it? Having a coding audit is particularly important after converting to an EMR to make sure that what is being electronically recorded matches what was actually done.


Here at IPC Billing, we strive to have a "culture of compliance." We hope the same is true at your office.

Great Lakes Health Plan Name Change

Great Lakes Health Plan is now United Healthcare Community Plan.  Be sure to check insurance cards carefully because the plan name sounds a lot like other United Healthcare commercial products - but it isn't.  It's a Medicaid HMO.  Authorizations are required and no retro auths are granted if you are non-par. You won't get paid without an auth. The card looks the same as United Healthcare commercial except for the name.

Work Comp and Auto

Be sure that your front office staff obtains the following information:


For W/C: Claim info, injury covered, if claim is open, has the W/C insurance been paying their bills and what type of injury they are covering.


Auto: Ask if the patient has open claim, if the auto carrier has been paying their bills and determine what diagnosis is covered. They also need to ask if the auto is primary or is it a co-ordination of benefits arrangement.

BCBS Timely Filing Limit

In the April Record, BCBSM states its filing limit is 180 days.  This is true for both the traditional and PPO plans.  BCBSM used to have a 1-year filing limit.

Continuing Education
IPC Employee, Sandy Reatini, Billing Supervisor attended the following:
  • 5/16/12 MMBA (Michigan Medical Billers Association) Billing Expo in Flint   

Insurance Carrier Follow Up:


Earlier this week, staff met with Beth Mehall, Blue Cross Blue Shield Provider Consultant, regarding problems encountered when billing Avastin, the new EMG codes, new diagnoses that have not been added to their claim processing system and miscellaneous issues with Medicare Plus Blue and Blue Card.


Please let us know if there are any upcoming events your office is interested in attending with IPC.
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.


Innovative Practice Concepts, LLC -- A full service medical billing company
Your Bottom Line is our Top Priority!