For a while, CMS's Recovery Audit Contractor program was on  hold, held back by a stop-work order instituted over a dispute involving vendor contracts. Now, however, CMS has resolved the dispute and has made plans to move ahead with the national rollout of the program.

The RAC program, which was suspended last November, has already proved controversial, with a number of providers questioning the fairness of auditors' conclusions. PRG-Schultz, meanwhile, has come under additional scrutiny, in part because it's co-owned by U.S. Senator Dianne Feinstein (D-CA).

To settle the vendor challenges, two contractors that first filed a protest with CMS over the business arrangements will serve as subcontractors to two permanent RAC contractors. PRG-Schultz International will serve as a subcontractor to HealthDataInsights, and Viant Health Payment Solutions will subcontract to Connolly Consulting.

To learn more about the program:
- read this Modern Healthcare

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20090206/REG/302069975&nocache=1&nocache=1

I get this question very frequently.  And according to the Medicare 2008 billing guide below (sections 40 thru 40.4), the answer is a resounding Yes.  According to Medicare all physicians who have not opted out of Medicare have to bill for covered services provided to a Medicare patient, on the behalf of the patient.  It also says that Chiropractors are not qualified as physicians who can opt out of Medicare.  So, yes, you have to bill for covered services.  Now let's define covered services.  Covered services are defined as those services listed in your Medicare LCD, or Medicare Chiropractic Billing Guide, as being covered by Medicare and are medically necessary.  In the Chiropractic case this is 98940, 98941 and 98942, for the time being.  Any codes outside these, that are listed, are excluded from being covered when provided by a Chiropractor, ie. exams, x-rays, extraspinal adjustments and other therapies.  Adjustments must also be medically necessary.  Pain is expected by Medicare to be alleviated in about 12 visits or so, depending on the patient and the diagnosis related to the pain.  When the pain is gone, then there is no longer medical necessity and you are then treating your patients for maintenance care which is not covered, ever, by Medicare.  You do not have to bill for services that you know are not covered by Medicare, but you do have to let the patient know what services will not be covered by Medicare and why, before the patient receives these services, so that the patient has an opportunity to opt out of the care.  This is called the Advance Beneficiary Notice.  Learn how to use these and when to use them.  Chiropractors, not enrolling in Medicare does not exempt you from billing Medicare.  If you are not enrolled in Medicare and you are providing covered services to Medicare patients, you are committing fraud, cheating your patients and putting yourself in a very bad position.  Read below for specifics.  If you have any other questions regarding Medicare billing call  888-570-3042

Leslie Barlow, CMC, CMRS

http://www.cms.hhs.gov/manuals/downloads/bp102c15.pdf

For those of you who work for providers who prefer that you do the paperwork for them, this will be good to know.  The PECOS system has become available in all 50 states for the Medicare 855I form as of Monday and will be available for the the Medicare 855B form.  This is a great and long awaited tool for practices that is supposed to speed the processes of enrollment and changes to Medicare enrollment information.  However, during the open forum conference last week, it was stated that providers only will be allowed to access this site.  Providers will not be able to assign representatives, even in large practices, to access this site as it would qualify as misrepresentation.  So, it appears that we continue to be strapped with paper forms and snail mail to get enrollments and changes done for our providers. Visit the following link for more detailed information regarding PECOS.

  http://www.cms.hhs.gov/MedicareProviderSupEnroll/Downloads/Internet-basedPECOSFAQ.pdf

A recorded link to last week's open forum conference regarding PECOS is not available at this time.  Please continue to check in with Medicare to get the link when it becomes available if you missed the original conference.

With the economic downturn that all businesses are facing, we are forced to make tough choices between the “gotta have” and the “wanna have”.  If this is you, we can help.  You “gotta have” a strong billing department in order to keep the cash flowing.  We can help you enhance your billing department and make your “gotta have” efficient and affordable.  Now, more than ever, is the time to focus on getting claims paid old and new.  Let  Synergy Healthcare Resources help you maximize your cash flow without adding more staff, more space and more unneeded expenses.

Leslie Barlow, CMC, CMRS

888-570-3042

In the 10 years I have been in business, I have worked with 3 different clearinghouses.  They ranged from very expensive to cheap, from no customer service to excellent customer service.  In today's industry you really need to shop for your clearinghouse and the cheapest one may not be the best one.  Make sure that you are getting what you need to keep up with all the format changes that need to be made to your electronic claim.  My current and favorite clearinghouse is Zirmed.  I have the best customer service representatives, better than I have ever had.  I really like that when I call, I get an english speaking, American based representative.  When I send e-mails, they are answered within 24 hours and when I need training, they are there to help at no extra charge.  Yes, I pay about twice as much as the cheap clearinghouse whose call center is in India.  Is it worth it?  Definitely.  I know that my claims are going through.  If they get rejected, I know why almost immediately.  I can make changes online if needed and get the claims back out.  Rejections are very clear and understandable and when we have a problem, I have help to get it solved instead of finger pointing at my software vendor or me.  Insurance companies make enough mistakes to keep us on the phone all day; we don't need to be wasting time with unresponsive clearinghouses using inadequate customer service.

Synergy Healthcare Resources assists with clearinghouse set-up.  Give us a call when you need to make a change.  888-570-3042

2009 for America is the first year that a black president will lead our nation.  This milestone is symbolic of America's ongoing efforts to blend many different cultures toward the ultimate goal of building a strong nation.  This is a time to celebrate and also a time to reflect. 

As you look at 2009 for your business, what culture do you intend to cultivate?  What are your goals, core values and key services that you need to focus on?  Who will be the key people to help you reach your goals?    With a weak economy at hand, do you also face some tough decisions over what level to take your business and when?

As one of the industry’s leaders in medical billing, software development and revenue cycle management; we are focused on innovative software solutions, improving the operational and financial performance of physicians and hands-on support & training.  As the complexities of managing a medical practice rise, physicians are turning to medical billing companies; such as, Synergy Healthcare Resources to put them in control of their practice.

Whether you have small, temporary projects or need services for the long term, come to Synergy for practice management solutions, revenue cycle management, EMR, coding, staff training, practice management software, billing, scheduling software, computer/network support, compliance resources, consulting, credentialing, AR cleanup, soft collections, electronic claims/electronic patient statements, auto-payment posting software, NPI resolution, payor problems, appeals, credit card merchant accounts and fitness/theraapy equipment.  WE'RE HERE FOR THE BUSINESS SIDE OF HEALTHCARE          888-570-3042

Okay, now that I have the initial, what I'm all about out of the way, it's your turn.  My vision for this page, is to add another great resource for posting and sharing.  We all face a lot of changes and issues in our work every day and sometimes we need all the help we can get.  

I have been in medical billing for 10 years and I have earned my certifciations in coding and medical reimbursement.  I have had the pleasure of learning from great mentors like Don Self, Steve Verno and many other seasoned professionals in this industry, without whom, much time would have been lost on learning even the simplest of rules and billing techniques.  My most important values are constant learning, excellent customer service and increasing the bottom lines.  I joined Synergy Healthcare Resources as a franchise owner in March 2008 with the vision of growing my business under a nationally recognized brand.  I am also partnering with PMI to bring educational resources closer to home in Western Colorado where I live, work and play.  I will keep you posted on future class schedules as they become available.

See you soon

Leslie Barlow, CMC, CMRS