As part of the HITECH legislation signed in 2009, Highmark is soon to begin the process of eliminating all paper EOB’s and making enrollment in EFT (Electronic Funds Transfer) mandatory.
Starting in October, 2010, any new enrollment applications for Highmark, for both individuals and assignment accounts, will require EFT and paperless EOB enrollment as well. EOB’s can be easily downloaded via Navinet.
Then beginning in early 2011, all providers currently enrolled with Highmark will be required to enroll in EFT and paperless EOB’s.
On the positive side, funds are available via EFT several days before they would be available via mail. Generally speaking, deposits are available in your account on Wednesday morning. as opposed to waiting for a paper check to arrive at your office on Friday or Saturday.
You will find this trend happening with all insurance companies as they prepare to be compliant with the HITECH requirements. We suggest that you are prepared for this change in advance of it becoming mandatory. If you would like to enroll in EFT for Highmark, Medicare, Aenta, or UPMC, we have the forms to complete and help you with enrollment.
As always, if you have any questions please contact any member of the MPMS team.
Posted in INSURANCE INDUSTRY NEWS, PRACTICE MANAGEMENT.
By admin
– July 20, 2010
We are often asked about processing patient payments via credit card. Some practices are not equipped for processing these transactions, and until now, the cost may have been prohibitive for adding this service. Yet, its a convenience that is becoming increasingly more of a necessity in many offices.
MPMS has arranged to offer an online alternative for processing credit cards for your practice. Our web service can create an online link from our website (and yours if you so choose) that will allow you, your patients or MPMS to process credit card transactions. Here are some highlights:
- All funds will be deposited directly into your bank account, generally in 24-48 hours;
- You and MPMS will receive notification of the transaction for record keeping purposes;
- Patients are able to go online and pay their bill;
- You can charge a patient’s card while they are in your office;
- MPMS can charge a patients card for your convenience;
- Secured transactions to protect your patients’ confidential information.
There will be some fees involved. Through our web service, you will be charged 2.85% of each transaction, and their is a transaction fee of $0.28. There are no statement fees and no monthly minimums. These fees are very competitive with the marketplace at this time.
There will also be a one time set up fee for programming, however, you will not need to purchase a terminal or software for use in your office. The provider will also need to complete all merchant account applications.
Debit and credit cards are the currency of our society. Additionally, many patients are utilizing health spending and health savings accounts that are accessed through debit cards. This option is being offered to provide you with a cost effective way to increase your collections as conveniently as possible.
Posted in PRACTICE MANAGEMENT.
By admin
– July 13, 2010
If you have a secondary insurance that requires an authorization, that must be obtain prior to the start of services, just as if it was for the primary insurance. Often, providers will exclude or overlook obtaining the authorization for a secondary insurance, but this will prevent you from receiving any additional payments from that secondary.
For example, a child has Highmark as a primary insurance, and Gateway as a secondary. Highmark may not require an authorization. In order to be paid by Gateway an authorization must be obtained at the start of care. Also, if the authorization expires, then it must be re-obtained. This applies even if no payment has been made by Gateway.
Additionally, if a patient is being treated under an auto accident but their personal insurance requires and authorization, then that authorization must be obtained, even if the personal insurance is not being billed.
Why is this so important, secondaries don’t often pay much money? Because if the primary benefits exhaust, you may be able to be paid under the secondary or personal insurance but not without the required authorizations. Generally speaking you can only back date an authorization for a few days, and in the case of some insurance companies a few hours.
If you have any questions, please do not hesitate to contact us directly.
Posted in PRACTICE MANAGEMENT.
By admin
– July 12, 2010
On June 25 President O bama signed into law the Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act. This act provides that the 2.2% increase to the Medicare Fee Schedule that was to be effective May 1, 2010 remain in effect until November 30, 2010. This act was designed to over ride the 21% reduction to the fee schedule CMS has order into effect as of June 1, 2010. Medicare has been holding claims until this legislation could be enacted.
As a result, Medicare is now processing claims with service dates after June 1, 2010 at the higher rate. You should start to see payments in the next week or so. Also, any claims processed the first three days of June at the reduced rate will not be reprocessed and supplemental payments will be sent to all providers.
This law was enacted in part to response from many providers who chose to withdraw from Medicare as a result of the significant decrease in reimbursement.
Should you have any questions, please feel free to contact Melissa.
Posted in MEDICARE.
By admin
– July 7, 2010
We frequently have a number of inquiries regarding the UPMC Health Plan policy for paying for chiropractic services. The following is an excerpt from their policy which addresses these inquiries:
For a given visit, coverage will be limited to chiropractic services, as follows:
One (1) service with a CMT Code: 98940-98943,
AND
- One (1) of the following adjunctive modality codes: 97012, 97014, 97032, 97033, 97035,
- AND One (1) service with CPT code 97110 (therapeutic exercise performed to build strength, endurance and flexibility),
OR
One (1) service with a CMT Code: 98940-98943 and Two (2) Therapeutics and no Adjunctive,
OR
One (1) service with a CMT Code: 98940-98943 and Two (2) Adjunctives and no Therapeutic.
Covered Adjunctive Procedures: The following CPT codes represent procedures identified as adjunctive procedures that shall be covered by UPMC Health Plan, unless an individual product has benefit exclusions or other limitations that apply to chiropractic care:
- 97012 Application of a modality to one or more areas; traction, mechanical (unattended)
- 97014 Application of a modality to one or more areas; electrical stimulation (unattended)
- 97032 Application of a modality to one or more areas; electrical stimulation (manual), each 15 minutes
- 97033 Application of a modality to one or more areas; iontophoresis (attended), each 15 minutes
- 97035 Application of a modality to one or more areas; ultrasound (attended), each 15 minutes
- 97140 Manual therapy techniques (e.g., mobilization/ manipulation, manual lymphatic drainage, manual traction), one or more regions, each 15 minutes
UPMC will not pay for any chiropractic services for children enrolled in the CHiPs program.
This policy went into effect September, 2009.
If you should have any other questions, please do not hesitate to ask.
Posted in INSURANCE INDUSTRY NEWS.
By admin
– July 1, 2010
Highmark has released a statement indicating that they will begin processing claims for dates of service of June 1 – June 8, 2010. Claims for dates of service after June 8 will remain on hold until further notice. These claims will be processed based upon the May fee schedule, which provided for some increase in reimbursement for certain codes.
As a reminder, this delay is due to a 21% across the board reduction in reimbursement rates mandated by CMS, and a push by the President and Congress to reverse this action. Highmark claims they are holding processing to avoid having to then recoup over payments if the reduction actually is to go into place.
As we get more information, we will surely use this forum to pass that along. If you have any questions, please don’t hesitate to ask.
Posted in MEDICARE.
By admin
– June 30, 2010
We often talk about an internal processes of “working your aging” and i am not always sure that clients understand what this process means.
“Aging” is the process of follow up on claims that have not been paid in a timely fashion. By law in PA, insurance companies have 45 days to pay a claim. Once a month we print a report of all claims that have not been posted as paid in our system, and that it is more than 60 days from the billing date. Beverly Gratton then calls on each claim that is not listed as paid in our system to determine the status of the claim.
A few things happen from this point:
- She may determine from the insurance company that more information is necessary to process the claim. That detail is then communicated to your Reimbursement Specialist who will contact you for the necessary information. Examples of this could be that a policy has cancelled, enrollment demographics could be incorrect, or information regarding other coverage may be needed from the patient.
- She may determine that the claim was not “received” by the insurance company. This information is then passed to your Reimbursement Specialist who will queue the claim to rebill. This is often the reason why we may request documentaiton for a claim, even though you have previously sent that documentation (we don’t keep a copy, that would be a logistical nightmare!).
- She may determine that payment was made. She will then verify that the check was processed and received by you. We then post the claims as paid in our system.
Aging is a laborsome process. And you can help in a few simple ways. First, be sure that we receive your eobs in a timely fashion. If a claim is posted as paid, it will not appear on your aging report. We then will not need to pay on a claim that is already received. Second, respond in a timely fashion to requests for further information, corrected information, or documentation, Our goal is to get you paid, and if we are needing information in order to resubmit a claim, we cannot get you paid.
As always, if you have any questions, please feel free to ask.
Posted in MPMS NEWS, PRACTICE MANAGEMENT.
By admin
– June 9, 2010
Effective June 14th, Aetna will no longer mail eobs to providers. Instead providers can download explanation of benefits through the Navinet Website.
We will have access to download this information and post to your patient accounts. If you need assistance in setting this up for your office do not hesitate to ask.
Also, we encourage you to enroll in EFT to ensure that you are able to receive your payments in a timely fashion.
Posted in INSURANCE INDUSTRY NEWS.
By admin
– June 3, 2010
As you know, Medicare requires EFT for all routine payments. But did you know that you can sign up to get electronic eobs?
The eobs will be transmitted to us for electronic posting. If you want to receive a papercopy we can provide that to you. If you do not require a paper copy, than we can store that electronically.
This is a great way to save paper and eliminate the need to maintain paper files. If you would like more information, please contact Melissa.
Posted in MEDICARE.
By admin
– June 1, 2010
The Continuing Extension act of 2010, which primarily extends Unemployment Compensation, is set to expire June 1, 2010. Because this act also affects payments made by Medicare, CMS has announced that they will be holding claims for the first 10 business days of June. This will only affect claims with dates of service after June 1. Since Medicare naturally holds claims for 14 days before payment is issued, this should not have any affect on cash flow for providers.
If you have any questions, please feel free to contact Melissa.
Posted in INSURANCE INDUSTRY NEWS.
By admin
– May 29, 2010