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In this issue
November
is "Heal the Claim"™ Month
MGMA has
partnered with the American Medical Association (AMA) to encourage members
to participate in the AMA’s "Heal
the Claims Process"™ campaign. The AMA campaign’s goal is to
reduce the cost of submitting claims for the physician practice from as
much as 14 percent of total collections to just 1 percent. During
November, practices are encouraged to perform a claims process check-up,
review claims payments from payers for accuracy and appropriateness, and
appeal any inappropriate delays, denials or reductions in payment.
MGMA
introduces new member benefit: Patient Touch Points for Clean Claims
Toolkit
Over the
past 10 years, medical practices' total operating costs have outpaced total
medical revenue in every specialty tracked except anesthesiology, MGMA Cost
Survey data show. The data also showed that 36.1 percent of delayed medical
practice payments were due to provider error. The most common reasons for
delayed payment were:
- The provider
incorrectly set up the account (15.2 percent)
- The provider
did not follow up on denied claims (12.9 percent)
- The payer
incorrectly processed the invoice (11.6 percent).
MGMA has
designed Patient
Touch Points for Clean Claims to help medical practices correctly
process a “clean” claim on the first submission. This tool will help
medical practices implement procedures essential to processing clean claims
in a proactive manner. The tool is designed to pair patient “touch points,”
(instances where medical practice staff interact with patients and have
opportunities to gather claims-pertinent information) with the elements of
the CMS-1500 form.
MGMA
comments on Breach Notification Interim Final Rule
The
Medical Group Management Association (MGMA) submitted comments to the
Office for Civil Rights (OCR) on the interim final rule entitled “Breach Notification
for Unsecured Protected Health Information.” Under existing federal rules,
physician practices must take necessary and appropriate steps to protect
all information related to treated or covered individuals. Under the new
regulation, should an improper disclosure occur, the practice is required
to take available steps to "mitigate" the harm of disclosure,
which may include notifying the individual whose information was breached.
Should a breach occur, the interim final rule requires practices to perform
a risk assessment to determine whether the violation poses a significant
risk of financial, reputational or other harm to an individual. Practices
that reasonably determine that no harm has occurred or would occur from the
breach of information would not have to notify their patients.
In comments to the OCR, MGMA supported the inclusion of this “harm”
standard and recommended that OCR expand the exception for “limited data
sets” and increase the time practices and their business associates have to
notify patients of a breach. MGMA also called on the government to work
with healthcare providers to offer assistance in implementing these new
requirements. While the regulations became effective on Sept. 23, 2009, the
government has indicated that it will not impose penalties for violations
that occur prior to Feb. 22, 2010. However, practices and their business
associates are expected to comply with the breach notification regulations
during this interim period.
Read
MGMA’s full comments
Access
the OCR breach notification Website
Red Flags Rule set to become
effective Nov. 1
The Federal Trade Commission's
(FTC) Red Flags Rule becomes effective on Nov. 1. The Red Flags Rule requires
creditors and financial institutions to develop identity theft prevention
programs. The FTC considers healthcare providers to be creditors when they
accept insurance and bill patients after services are rendered for amounts
that insurance does not pay, or if they regularly allow patients to set up
payment plans after services have been rendered.
While the FTC has delayed
enforcement of this rule several times, at this time we are not expecting
another delay and are encouraging practices to prepare for enforcement. As
we have reported in previous publications, the Red Flags Rule was
originally scheduled to become effective on Nov. 1, 2008. Due to concerns
expressed by the Medical Group Management Association (MGMA) and others,
the FTC extended this date to May 1, then to Aug. 1 and finally to Nov. 1.
Last week the House of
Representatives passed a bill (H.R. 3763) that would exempt health care
practices with 20 or fewer employees from the Red Flags Rule. This bill is
currently awaiting consideration in the Senate.
MGMA will keep you informed of
further action on the bill. You can visit the MGMA
Red Flags Rule Resource Center for help preparing your identity
theft prevention plan.
CMS allows coverage of MRI for
blood flow determination
The Centers for Medicare &
Medicaid Services (CMS) has decided to allow local Medicare contractors to
determine whether they will pay for magnetic resonance imaging (MRI) for
blood flow measurement. Although the Medicare National Coverage
Determination Manual lists blood flow as a nationally non-covered
indication for MRI, CMS has found that this blanket non-coverage is no long
supported by the available evidence. Coverage may be allowed for services
performed on or after Sept. 28, 2009 if the local contractor exercises its
discretion to cover these services. Contractors will not search for claims
with dates of service on or after Sept. 28 but have been directed by CMS to
adjust any claims brought to their attention.
The following cardiac MRI codes
will be changed from non-covered to covered: 75558, 75560, 75562 and 75564.
All other uses of MRI remain unchanged.
Read CMS’s MLN
Matters article.
Read CMS’s transmittal
modifying Pub. 100-03, Medicare National Coverage Determinations.
Read CMS’s transmittal modifying
Pub. 100-04, Medicare Claims Processing.
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