1. PRESENTED BY MSG ONLINE WEBINARS COPY WRITE 2010© Medical Billing Continuing Education Course

2. Table Contents Improving accounts receivable collections Current trends for accurate claims submission. Claims follow up techniques Winning appeals How to evaluate you’re A/R The new regulations and provider compensation for EHR. www.Onlinewebinars.info

3. Improving accounts receivable collections A/R Collections starts at the front desk 1. Accurate collections of client information. 2. Confirmation, is there another insurance, name of insured? 3. Obtaining required signatures 4. Up-dating client information 5. Collecting co-pays Accurate claims submission can only happen when there is accurate data to submit. www.Onlinewebinars.info

4. Improving A/R Collection Ratios. Step #1 Insurance Verification. Current Trends Verify patient’s plan benefits for services you plan to offer. Verify the billing address. Estimate cost for services, insurance payment and patient balance. Document the information obtained and make it available to follow-up/collection staff. www.Onlinewebinars.info

5. Documentation Patient Registration Form Area to list more then 1 insurance. Emergency contact information Assignment of benefits Financial responsibility Release of medical information Statement of patient confidentiality. www.Onlinewebinars.info

6. American collections association and the US Department of Commerce surveys have concluded A accounts receivable collections depreciation Months Past Due 1 MO. 3 MO. 4MO. 6MO. 12MO. Amount Collected 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% Losses 5% 26% 35% 70% 90% Early A/R collections is a major key to limiting profit lost and increasing profit gain. $1.00.95.74.65.30.10 www.Onlinewebinars.info

7. Verification of Benefits Sample Doctor ordered a endoscopic procedure. Estimated cost $1400 (outpatient, in the office procedure). Per insurance verification, patients benefits are as follows. With authorization from the insurance benefits are as follows. Deductible: $250 (to-date -0- met). Then Insurance will pay $80% Patient 20% of allowed amount. Procedure $1400 less deductible, which is patient’s responsibility. Total Billed Ins pymt Pt Bal $1400 less $250 ded = $1150 x 80% (estimated ins bnfts) $920 $480 (patient’s balance is $250 deductible + $230 (the 20% of 1150). Using the above estimate, the office staff can make payment arrangements with the patient before services are rendered. www.Onlinewebinars.info

8. A/R Collections Tips Follow-up to insurance carriers on the status of a claim. Respond to inquiries for information timely. Complete request for authorization to treat, immediately! www.Onlinewebinars.info

9. Definition: Clean Claim CMS 1500 for Professional Provider Claims A accurately completed CMS-1500/ UB04 claim form submitted within the timely filing period, as required of the insurer. Current trends for accurate claims submission www.Onlinewebinars.info

10. Improving A/R Collection Ratios. Step #2 Accurate and timely claim submission. Communicate claim timely filing limits with staff, per payers. Bill electronically using a clearing house. Review acknowledgement reports Complete CMS 1500 per Medicare regulations Follow-up submitted claims with- in 10-15 days. www.Onlinewebinars.info

11. Resources to Stay Up-to-Date Insurance company provider manuals Seminars and continuing education www.Onlinewebinars.info www.justcoding.com www.AHIMA.org www.AAPC.com Federal Register document Government published updates, revisions changes, and deletions in laws. November and December issues contain outpatient facility updates. http://listserv.accessgpo.gov Reference Materials www.PMIConline.com CPT, ICD, HCPCS Guidelines.

12. Winning Appeals www.Onlinewebinars.info Step One Compare the EOB/RA with the insurance verification information. Step Two Review the reason for denial or short pay Step Three Determine if an appeal is warranted. Step Four Call insurance carrier for denial explanation. Or review denial on web site of carrier. Step five Ask what is the best way to appeal.

13. Items needed A time period Total A/R (billed amount) for that time period Total payments collected for the same time period. Example: Jan 1, 2008 – December 31, 2008 Total Collected ÷ Total Billed = Collections Ratio 226,000.00 421,322.00 54% How to calculate the collections ratio of your practice. www.Onlinewebinars.info How to Evaluate Your Facilities Accounts Receivable

14. ELECTRONIC MEDICAL RECORD ELECTRONIC HEALTH RECORD YOU MUST START NOW. MAXIMUM INCENTIVES (INCLUDING $3,000 BONUS) WILL BE PAID AS FOLLOWS: $18,000 FOR THE 1ST YEAR $12,000 FOR THE 2ND YEAR $8,000 FOR THE 3RD YEAR $4,000 FOR THE 4TH YEAR $2,000 FOR THE 5TH YEAR QUALIFYING UNDER THE MEDICAID PROVISION PROVIDERS QUALIFYING UNDER MEDICAID ARE ELIGIBLE FOR UP TO $63,750 OVER SIX YEARS. YOUR PAYMENT IS CALCULATED AS 85% OF THE EHR COST (UP TO $25,000 FOR THE FIRST YEAR), AND 85% OF ANNUAL COST (UP TO $10,000) OVER THE FOLLOWING FIVE YEARS. TO QUALIFY FOR THE MEDICAID PROVISION, AT LEAST 30% OF YOUR CASES MUST BE ATTRIBUTABLE TO MEDICAID. FOR PEDIATRICIANS, THE MINIMUM PERCENTAGE OF MEDICAID PATIENTS IS REDUCED TO 20%. HOWEVER, OFFICE-BASED PEDIATRICIANS ARE ONLY ELIGIBLE TO RECEIVE UP TO TWO THIRDS OF THE MAXIMUM PAYMENT. www.Onlinewebinars.info EMR/EHR are here to stay!

15. EHR Incentive Program www.Onlinewebinars.info

16. EHR Continued

17. To Qualify for the Incentives (Continued) www.Onlinewebinars.info There are two ways you can qualify for the incentive. Qualified providers can qualify under either incentive, but not both. You can qualify either under Medicare or Medicaid. Physicians qualifying under the Medicare portion can receive up to $44,000 and those qualifying under the Medicaid incentive can qualify for up to $64,000. You can receive your incentive payments starting in January of 2011. Physicians who do not implement EHR technology by 2015 will suffer from a 1% reduction in Medicare Payments (reductions will continue to increase after 2015 up to 5%). Qualifying Under the Medicare Provision Physicians qualifying under the Medicare provision are eligible for up to $44,000. The total amount that you receive is based on how early you adopt and your Medicare Part B billings. (You must submit Medicare Part B claims to qualify.) You will receive the lesser amount of either 75% of your Medicare Part B charges or $44,000 over a five year period from 2011 to 2015. You can also qualify for an early adopter incentive of $3,000 (if you qualify for either 2011 or 2012.) Remember, to receive your maximum payment

18. Summary of the EHR Incentive www.Onlinewebinars.info How you can Qualify for your Incentive Payment: The stimulus package passed for the year 2009 pumps $19 billion into the medical industry to help implement technology that makes healthcare safer and more connected. Those who prove meaningful use of Electronic Health Records can receive an incentive reimbursement of up to $64,000 over six years. Hospitals can qualify for $2-8 million in funding. Remember, 70% of the incentive comes within the first two years. This means that in order to receive the maximum reimbursement, you must start early. It is believed that the definition of meaningful use will be very similar to the CCHIT certifications. For more information on CCHIT certifications, see cchit.org or click here.cchit.org or click here. The definition of "meaningfull use" includes: Use EMR software at point of care Prescribe electronically Choose an EMR that ensures interoperability or data sharing Use an EMR capable of clinical reporting

19. EHR Continued www.Onlinewebinars.info 2011 qualification criteria also includes: 90 day reporting period to prove meaningful use through required measures At least one clinical decision support rule relevant to a specialty or a high clinical priority Electronic claim submission to payors Electronically check insurance eligibility (when possible) Provide patients with timely electronic access to their health information; Provide patients, upon request, with an electronic copy of their discharge instructions and procedures at the time of discharge; and Require the capability to exchange health information where possible in 2011, with participation in a national health information exchange by 2015 *By 2013, it is also expected that criteria will extend to include the ability to provide patients with access to their personal helath records populated in real time. Here's How it Works: There are two ways you can qualify for the incentive. Qualified providers can qualify under either incentive, but not both. You can qualify either under Medicare or Medicaid. Physicians qualifying under the Medicare portion can receive up to $44,000 and those qualifying under the Medicaid incentive can qualify for up to $64,000. You can receive your incentive payments starting in January of 2011. Physicians who do not implement EHR technology by 2015 will suffer from a 1% reduction in Medicare Payments (reductions will continue to increase after 2015 up to 5%). Qualifying Under the Medicare Provision Physicians qualifying under the Medicare provision are eligible for up to $44,000. The total amount that you receive is based on how early you adopt and your Medicare Part B billings. (You must submit Medicare Part B claims to qualify.) You will receive the lesser amount of either 75% of your Medicare Part B charges or $44,000 over a five year period from 2011 to 2015. You can also qualify for an early adopter incentive of $3,000 (if you qualify for either 2011 or 2012.) Remember, to receive your maximum payment,

20. CONCLUSION/QUESTIONS www.Onlinewebinars.info