The Second Referral is Always Better than the First
by Julia Porterfield
It is said that the hardest referral to get from a practice is the first; but truth be told it really is the second. Marketing blogs and books can help determine which specialists, social media or outreach avenues are most likely to provide the referrals you seek. However, obtaining a consistent referral source rather than just a onetime patient pass is much harder.
One of the easiest ways to achieve the second referral is through timely communication to the practice following the referred patient's first visit. Within one to two days of the initial visit, it is important to reach out with a simple phone call, email or even voice mail to provide an update about the patient. This communication lets the practice know you are aware of their referral and that you appreciate the trust they have given you.
Additionally, it is also important to notify the practice in the event a patient does not show or cancels their first appointment. This front office tactic of providing no show and cancel feedback to the referring practice is also a great marketing tactic. Typically the practice will provide their own follow-up by ensuring the patient reschedules and attends their next appointment or they will send another referral to make up for the missed patient.
It is exciting to receive that first referral but good follow-up will strengthen your relationship with the referring practice in order to create a consistent referral pattern for you.
Friday, February 24, 2012
PAYER GUIDELINES
Have You Read Yours?
by Cheryl Nash
We are well into 2012 and the insurance companies are releasing their Medical Necessity guidelines for Varicose Veins. Some changes are minor, or nonexistent, and some changes are major, and will completely alter the way you need to document the rationale for treating your patients.
There are a number of changes that seem to be a theme. One change that is becoming increasingly common is conservative treatment needing to be documented by the treating physician. Most payers are no longer accepting the patient's word on wearing compression stockings as sufficient. They are also requiring more than hose, and want these items to be ordered by you, the treating physician. These items include elevating the legs, walking frequently and compression hose for a limited amount of time. During this trial the patient may need to be seen to assess their progress (or lack thereof) and ultimately track them until the trial timeframe is expired. These visits are billable with an established patient visit code 99212 or 99213. At the end of the trial, it may also be appropriate to order another duplex scan to assess the patient clinical condition prior to initiating an authorization. This is also a billable service with cpt code 93970 or 93971, depending on the legs to be treated.
Another trend is the requirement to document the impact of the patient's condition to their activities of daily living citing specific examples. As always, good documentation of the diameter of the veins, location of reflux, and venous filling index in the US reports is critical. Some payers are again requiring photographs and will ask for them upon review of your claims. Other payers are requiring that the patient be treated in only two sessions or that sclerotherapy being performed at the same time as an ablation is going to be considered inclusive.
Each payer is different, and the requirements can be drastically different. Please note that an authorization does not guarantee payment (as stated in every phone call to the insurance company) and all claims are subject to medical review after services have been provided. Know your payers requirements, and as these guidelines are also subject to review and revision without notifying you, the provider, we recommend re-checking these on a frequent basis to ensure compliance.
by Cheryl Nash
We are well into 2012 and the insurance companies are releasing their Medical Necessity guidelines for Varicose Veins. Some changes are minor, or nonexistent, and some changes are major, and will completely alter the way you need to document the rationale for treating your patients.
There are a number of changes that seem to be a theme. One change that is becoming increasingly common is conservative treatment needing to be documented by the treating physician. Most payers are no longer accepting the patient's word on wearing compression stockings as sufficient. They are also requiring more than hose, and want these items to be ordered by you, the treating physician. These items include elevating the legs, walking frequently and compression hose for a limited amount of time. During this trial the patient may need to be seen to assess their progress (or lack thereof) and ultimately track them until the trial timeframe is expired. These visits are billable with an established patient visit code 99212 or 99213. At the end of the trial, it may also be appropriate to order another duplex scan to assess the patient clinical condition prior to initiating an authorization. This is also a billable service with cpt code 93970 or 93971, depending on the legs to be treated.
Another trend is the requirement to document the impact of the patient's condition to their activities of daily living citing specific examples. As always, good documentation of the diameter of the veins, location of reflux, and venous filling index in the US reports is critical. Some payers are again requiring photographs and will ask for them upon review of your claims. Other payers are requiring that the patient be treated in only two sessions or that sclerotherapy being performed at the same time as an ablation is going to be considered inclusive.
Each payer is different, and the requirements can be drastically different. Please note that an authorization does not guarantee payment (as stated in every phone call to the insurance company) and all claims are subject to medical review after services have been provided. Know your payers requirements, and as these guidelines are also subject to review and revision without notifying you, the provider, we recommend re-checking these on a frequent basis to ensure compliance.
5010 TRANSITION
Some Interesting... and Disturbing... Results
by Cheryl Nash
As you may be aware, electronic claim formats have been switched from an older 4010 format to a newer 5010 format. The new format was to be implemented on January 1, 2012 to be ICD-10 compliant prior to mandatory use in October of 2013. Live sending commenced after the first of this year.
What this Means to You: This has caused many unforeseen electronic claim responses. We have seen and heard reports of multiple erroneous claim rejections in the past month, such as claims being rejected for no patient insurance identification number, no Tax ID number, and no referring provider just to name a couple. Of course all of this information has been on the claims, but the rejections are caused by clearinghouses not being able to read, or payers not able to receive, this data. The mistakes are random, and are seen nationwide, across all payers and clearinghouses, and are causing some delays in claim submission and processing. This ultimately causes delays in payment to the providers as well.
How to Correct: A timely response to the clearinghouse to report erroneous rejections as soon as they are seen is the best action. Most rejections are addressed by the clearinghouse, and the claim re-sent with no further action on your part. However, if no solution can be found quickly, we recommend contacting the payer to see about a desired alternative way to submit claims. Fax is the next best submission format after e-claims, as it generates a tangible proof of timely filing, and paper is a last resort, but of course there are some payers (like Medicare) who will not accept claims in fax or paper fashion. Check with the insurance payers to be sure the format will be accepted!
*** Update to ICD-10- CMS has released this update to the ICD-10 implementation date as a response to feedback from providers and agencies nationwide such as the AMA lobbying for a delay to the Oct. 2013 effective date.
Marilyn Tavenner, acting CMS administrator, told a conference of the American Medical Association today that CMS may "re-examine the pace at which we implement ICD-10," .
All HIPAA-covered healthcare providers must transition from ICD-9 to ICD-10 by Oct. 1, 2013. Although Ms. Tavenner did not say if there would be an actual delay, she said CMS would create new regulations over the coming days.
"There's concern that folks can't get their work done around [adoption of health information technology], their work done around ICD-10 implementation and be ready for [the health law's insurance] exchange," Ms. Tavenner said in the report. "So we're trying to listen to that and be responsive."
by Cheryl Nash
As you may be aware, electronic claim formats have been switched from an older 4010 format to a newer 5010 format. The new format was to be implemented on January 1, 2012 to be ICD-10 compliant prior to mandatory use in October of 2013. Live sending commenced after the first of this year.
What this Means to You: This has caused many unforeseen electronic claim responses. We have seen and heard reports of multiple erroneous claim rejections in the past month, such as claims being rejected for no patient insurance identification number, no Tax ID number, and no referring provider just to name a couple. Of course all of this information has been on the claims, but the rejections are caused by clearinghouses not being able to read, or payers not able to receive, this data. The mistakes are random, and are seen nationwide, across all payers and clearinghouses, and are causing some delays in claim submission and processing. This ultimately causes delays in payment to the providers as well.
How to Correct: A timely response to the clearinghouse to report erroneous rejections as soon as they are seen is the best action. Most rejections are addressed by the clearinghouse, and the claim re-sent with no further action on your part. However, if no solution can be found quickly, we recommend contacting the payer to see about a desired alternative way to submit claims. Fax is the next best submission format after e-claims, as it generates a tangible proof of timely filing, and paper is a last resort, but of course there are some payers (like Medicare) who will not accept claims in fax or paper fashion. Check with the insurance payers to be sure the format will be accepted!
*** Update to ICD-10- CMS has released this update to the ICD-10 implementation date as a response to feedback from providers and agencies nationwide such as the AMA lobbying for a delay to the Oct. 2013 effective date.
Marilyn Tavenner, acting CMS administrator, told a conference of the American Medical Association today that CMS may "re-examine the pace at which we implement ICD-10," .
All HIPAA-covered healthcare providers must transition from ICD-9 to ICD-10 by Oct. 1, 2013. Although Ms. Tavenner did not say if there would be an actual delay, she said CMS would create new regulations over the coming days.
"There's concern that folks can't get their work done around [adoption of health information technology], their work done around ICD-10 implementation and be ready for [the health law's insurance] exchange," Ms. Tavenner said in the report. "So we're trying to listen to that and be responsive."
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