TopMed-Pro Management, Inc.
Medical Practice Management & Consulting
NewsWire                                                                                              June 2010
In This Issue
Patient Out-of-Pocket on the Rise
PECOS Deadline Approaching Fast...Are You Listed?
Patient Out-of-Pocket on the Rise
Currently, more and more practices are reporting that their patient financial responsibilities are increasing. The shift to higher patient out-of-pocket portions also mean that more and more practice revenues are derived from patients.  MGMA is also reporting that practices are collecting $1 of every $4 directly from patients.
More out-of-pocket presents more challenges in collecting from patients.  Some of the challenges that practices are facing are the result of:
  • The failure of practices to confront and deal with collection issues;
  • The emergence of High-Deductible Health Plans (HDHP);
  • The economy, unemployment and uninsured patients; and
  • The nature of patient expectation.
Of the challenges listed above, confronting patients about their out-of-pocket portion is the most difficult part.  Sometimes practices fail to or are reluctant to confront patients about any collection issues.  One reason could be that practices may have long-term relationships with patients and have a hard time enforcing payment policies when their patients fall on hard times. Some practices do not even have patient collection policies.
The second challenge in collecting from patients is the rise in HDHPs.  Rise in HDHPs means more patients owe more of an out-of-pocket. Approximately 15% of total annual service revenue of some practices is derived from HDHP patients. Nationwide, HDHP coverage rose to 10 million members in January 2010, up from 3.2 million in January 2006.
The third reason is that patients are going through difficult economic times.  With increased unemployment, patient out-of-pocket receivables are increasing.  Respondents to an MGMA survey reported an average of 11.3% of their total accounts receivable is from patients in the last fiscal year.
Finally, patients are accustomed to low amounts of co-pays and deductibles. However, from the same MGMA survey, the respondents reported that the average amount due per office visit is about $110.
In summary, patient out-of-pocket portions have increased.  However, with the right payment policy and its enforcement, practices can better their collection rate from patients.
"Efficiency is doing things right; effectiveness is doing the right things." 
                       Peter Drucker
"Red Flags" Rule Postponed Until January 2011 - Again!
Sign-up to Receive Free FDA Drug Alerts (Read More Here)
Send to a Colleague
Join our Mailing List!
Quick Fact

Source: MGMA

PECOS Deadline Approaching Fast...Are You Listed?
Effective July 6, 2010, if the ordering/referring provider on the claim is not listed in PECOS, the claims will not be paid by Medicare. Patients may not be able to obtain their medical items they need, they may have problems with rented items and hospital discharges my be delayed.
What is PECOS?
PECOS stands for the Provider Enrollment and Chain/Ownership System.  It was created by CMS as an electronic portal for Medicare enrollment. 
PECOS is designed to electronically:
  • Enroll in the Medicare program
  • Make changes to Medicare enrollment information
  • View existing Medicare enrollment information
  • Withdraw from the Medicare program
  • Check the status of an Internet-submitted Medicare enrollment application
Are there any limitations to PECOS versus paper enrollment?
Providers cannot use PECOS to:
  • Change name or Social Security Number or Tax ID
  • Change an existing business structure or changes in Legal Business Name
  • Reassign benefits to another supplier if that supplier does not have a current Medicare enrollment record in PECOS
What are reportable events and what are the timeframes to report such events?
A reportable event is any change that affects information in a Medicare enrollment record.  A reportable event may affect claims processing, claims payment, or a provider's eligibility to participate in the Medicare program.
Providers are required to report the following changes within 30 days of the following reportable events:
  • Change in ownership
  • Change in practice location, and
  • Final adverse action
Providers are required to report the following changes within 90 days of the following reportable events:
  • Change in practice status (e.g., retirement, voluntary surrender of medical license or voluntary withdrawal from the Medicare program)
  • Change of business structure, Legal Business Name or Taxpayer ID
  • Banking arrangements or payment information
  • A change in the correspondence or special payments address
Who needs to enroll in PECOS?
  • Providers who have enrolled with Medicare for more than 6 years
  • Providers who have not submitted any updates or changes in more than 6 years
  • Providers who have currently enrolled in the Medicare program but have not submitted a complete Medicare enrollment application since November 2003
Although providers could still file paper enrollment applications when applying to Medicare, PECOS takes 45 days to process; paper enrollment applications could take 60 days to process. 
Click here to see if your name is listed in PECOS.
If you are interested to find out more about any of the topics mentioned, please do not hesitate to send us an email at or call us at (888) 549-1713.
Med-Pro Management, Inc.

FacebookTwitterWordPress (Blog)