Posts Tagged ‘information’

List of AAPC Credentials

March 12, 2014

The American Academy of Professional Coders has medical coding certifications for several types of credentials. Each organization offers several types of credentials, some parallel each other like the CPC and CCS, while other credentials may be unique to the organization. Credentials that you can obtain are as follows:

CPC-A: Certified Professional Coder, Apprentice

CPC: Certified Professional Coder

CPC-P: Certified Professional Coder – Payer

CPC-H: Certified Professional Coder – Hospital

CPC-I: Certified Professional Coder – Instructor

Specialty Medical Coding Credentials are as follows:

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List of HCPCS Categories

December 11, 2013

The letters at the beginning of HCPCS Level II codes have the following meanings:

  • A-codes (example: A0021): Transportation, Medical & Surgical Supplies, Miscellaneous & Experimental
  • B-codes (example: B4034): Enteral and Parenteral Therapy
  • C-codes (example: C1300): Temporary Hospital Outpatient Prospective Payment System
  • D-codes: Dental Procedures
  • E-codes (example: E0100): Durable Medical Equipment
  • G-codes (example: G0008): Temporary Procedures & Professional Services
  • H-codes (example: H0001): Rehabilitative Services
  • J-codes (example: J0120): Drugs Administered Other Than Oral Method, Chemotherapy Drugs
  • K-codes (example: K0001): Temporary Codes for Durable Medical Equipment Regional Carriers
  • L-codes (example: L0112): Orthotic/Prosthetic Procedures
  • M-codes (example: M0064): Medical Services
  • P-codes (example: P2028): Pathology and Laboratory
  • Q-codes (example: Q0035): Temporary Codes
  • R-codes (example: R0070): Diagnostic Radiology Services
  • S-codes (example: S0012): Private Payer Codes
  • T-codes (example: T1000): State Medicaid Agency Codes
  • V-codes (example: V2020): Vision/Hearing Services

Medical & Business Industry Leaders to follow

November 14, 2013

We get asked frequently on who is a good resource for a Medical Practice.  We have comprised a list [specific in some areas to the State of Texas as that is where our business originates from].  Below is a list that will help you get started if you are working or interested in the Medical Field.

Stay informed on the changes in the industry to improve your viability and health of your practice.  Take classes, attend seminars, and share what you lead with your team.  Together you can be excellent in your industry as a Physician, Medical Practice Administrator, Medical Biller, Medical Coder and Nurse!

Why Don’t You Comment on My Blog?

October 10, 2013

Last week we discussed why I comment on blogs.  Today we will discuss reasons why people don’t comment on blogs.

  • Words.  They feel they have no words to share.  Largely because their voice has never mattered. They don’t feel it will now either.
  • Impression.  They are more concerned about what impression people will have about them.  This means more to them then sharing their thoughts.
  • Interest.  They are not interested in making a difference.  They are not interested in making an impact.
  • Fear.  They are afraid of what people will think of them.  They fear what they will say will be understood.  They fear what they will say might offend.  They fear what they think will not matter.  They fear having what they write be out there for everyone to see.  They fear
  • Meaning.  They don’t have meaning in their comment.  They don’t take time to make it meaningful.

What did I just spell out here with the first letter of each word listed in those 5 points?

 

WIIFM = What’s In It For Me

 

If you haven’t heard  of this before, you might not be used to WIIFM.  What’s in it for me.  That is the typical way people look at any situation.  Their focus is not WIIFO.

 

WIFFO = What’s In It For Others

 

They are concerned about how the comment on the post will benefit them not others.  If this holds you back, may I encourage you to change from WIIFM to WIIFO!

How to control your Facebook News Feed

September 26, 2013

If you are like me, you have lots of Facebook Friends and you support the companies you do business with, your strategic business partners, and ones that relate to your industry or hobbies.  However, sometimes it seems like what you are seeing in your News Feed isn’t encouraging, helpful, or interesting.  What do you do?

Well, my recommendation is to filter your settings so that you get what you want to see on a daily basis!  Also, are you aware that if you Share, Like or Comment on posts more regularly in your news feed that Facebook will detect you want more and create your News Feed accordingly?  Yup!  Tis true.

So how do you control your News Feed?

  1. Hover over the “Like” button on your friends wall or company page that you have liked and make sure “Show In News Feed” is selected.
  2. Once that is set, if you select “Settings”, you can choose from All, Most, or Only Important updates to display to change what will post into your News Feed.  The settings are automatically set to Most Updates, which I kinda think is crazy, but that is how it is!
  3. If you REALLY don’t want to miss a post, select “Get Notifications” from that same drop-down menu.  This will ensure you get every single post!
  4. Additionally, you can use Facebook’s new “Interest Lists”.
What other tips do you have to control and create a News Feed that inspires, encourages and benefits you?  Share with us!

Dilemmas with Friends on Social Media

September 24, 2013

Social Media is a great tool!  You can connect with people all over the world.  However, as with all tools, you have to ensure that you are using them to your best advantage.

I get asked frequently how to handle “Friend Requests” on Facebook.  The friend terminology is sort of a loose term.  Friend on what level?

In order to answer that, you need to understand why you have a platform on Social Media.  Specifically in today’s blog post we will discuss Facebook and the relationship with requests to be connected.  Once you have determined what your platform is and why you have it, you can move on to answer other questions, but without knowing this, you are going to be limited at knowing how to effectively address them.

Here are some questions to help you figure out that dilemma of adding someone to your network.

  • Is the request you received from someone you know?
  • If so, do you want to interact with them?  Do you want to know what is going on in their lives?  Do you want them to know what is going on in your life?
  • If not, do you have mutual friends?
  • If not, are they someone who may have connections to others that you wish to interact with?
  • If not, are they a competitor?
  • Is the request SPAM or solicitation that you don’t want?
  • Do they work for a company that you want to be connected to?
  • Are they well known in the community as someone who serves and is giving and you would like to know?
  • Do they have a profile picture or are they hiding and not being honest about who they are?
  • Do you share mutual interests?
  • Were you referred to them?

Some of these things are hard to answer before you have accepted the friend request.  However, you can always check out LinkedIn and even Google them to see what comes up.  You can learn a lot about someone online.

Additionally, I don’t think you should be afraid to reach out and say “Hey, Thanks for the connection. I apologize, but I don’t recognize your name or picture.  Can you tell me where we met?  Or how you know me?  If you don’t mind me asking, what is your reason for connecting?”

How someone responds or doesn’t respond tells you a lot about their request too!  Make sure that the friends you connect with support your platform and reason for using Social Media, particularly Facebook and you will ensure your interactions are fun, supportive and beneficial.

Do you have other questions you think are good ones to ask yourself when reviewing accepting a “Friend Request”?

Learning to do what You Love

September 20, 2013

This week, we posted a picture to encourage you in your Entrepreneurship Journey…it read:

Do What You Love

Love What You Do

Today we ask you to consider:

  1. Are you doing what you love?
  2. Do you love what you do?

Are those the same things?

For some people they are.  For some people, they aren’t.

How can you align them?  First you have to figure out what you love.

What are you drawn to?

What makes you excited?

What do you think is a great thing to be involved in?

What makes you absolutely passionate about it?

What can you do even when utterly exhausted, you find more energy to pursue that?

What gives you energy?

What makes you want to make a difference?

Make a list of these questions.  Add more question to it.  Look inside.  Find the answer deep within you.  This is what you Love.  You LOVE!

Go do that.  You will find you will be happy.  You will be encouraged.  You will be blessed.  You will thrive.  You will bring life.

Social Media Questions

August 16, 2013

Facebook is a main form of Social Media interaction today.  Everyone uses it for a different platform.  Some people are out to vent about their day.  Some people check in at every spot they go.  Some people never post, never like, never comment, never share, never seem alive.  Some people even have a generic profile picture because they want to look like they are hiding.  No matter your reasons, your method, your choice of which Social Media you use, we all must address these questions:

  • What do I want to get out of Social Media?
  • Who do I want to interact with?
  • Why do I want to be on Social Media?
  • Who are my “friends”?
  • What happens if someone disagrees with my post?
  • What happens if I hurt someone’s feelings?
  • What message do I want my Social Media to say about me?
  • How often do I wish to engage on Social Media?
  • Who am I trying to target with my Social Media?
  • What are the benefits of Social Media?

These are a few questions that you must answer in order to create and have the online Social Media presence you want.  Once these are answered, you can move forward with implementing the purpose and vision you have for Social Media.

As you reflect on the answer to these questions above, are there others you feel need to be asked?  If so, share them with the readers below!

We look forward to hearing from you and you sharing the what, why, and who of Social Media with us!

Why Good Communication is Key

August 8, 2013

In order to be a great leader you must be a great communicator. The key to becoming a skillful communicator is rarely found in what has been taught in the world of education.  From our earliest days in the classroom we are trained to focus on enunciation, vocabulary, presence, delivery, grammar, syntax and the like. In other words, we are taught to focus on ourselves. While each of these things are important to learn, the critical elements of communication are rarely taught.

In order to be a great communicator, you have to be intentional in your communication.  You have to be keenly focused on the relationship and your interaction with others.  Your message won’t be taken to heart by your audience and won’t be understood, let alone make an impact if you don’t.

While developing an understanding of great communication skills is easier than one might think, being able to appropriately draw upon said skills when the chips are down is not always as easy as one might hope for.

The best communicators are great listeners and astute in their observations. Great communicators are skilled at reading a person/group by sensing the moods, dynamics, attitudes, values and concerns of those being communicated with. Not only do they read their environment well, but they possess the uncanny ability to adapt their messaging to said environment without missing a beat. The key is that the message is not about the messenger, it must be 100% about the listener and meeting the needs and the expectations of those you’re communicating with.

What ways do you practice your communication skills?

5 Keys to Establish You Know What You are Talking About

August 1, 2013

In order to create a rapport with your team, you need to establish a relationship with them that you know what you are talking about. Nobody wants to be taught from someone who “thinks” they know the right thing. It is pertinent that you have your data and facts in order and spend time understanding them to be able to explain it in detail to someone who doesn’t. This means that you must develop a technical command over your subject matter. If you don’t possess subject matter expertise, few people will give you the time of day. You will be passed off as a “wanna be” and someone who “thinks they know it all”. People have little interest in listening to those individuals who cannot add value to a situation or topic, but force themselves into a conversation just to hear themselves speak. You must bring value to the table to be heard.

1. Spend time learning your subject matter.
2. Create articles to support what you know.
3. Be willing to have discussions around the topic to answer the why’s and how’s people have about it.
4. Find like minded people who have an interest in what you do so that you can learn to share your ideas and knowledge with others.
5. Perform speaking engagements to perfect your skill.

How do you get physicians to buy into ICD-10?

July 10, 2013

Each phase is the prerequisite for the next. Acquiring physician “buy‐in” must be accomplished in order to proceed to the planning and implementation phases. Because many physicians don’t know what they need to know about ICD‐10 in order to implement, analyze, and make informed choices, most practices are currently in Phase One: Engaging and educating physicians and staff. Take the time to create the foundation for the awareness and education necessary to achieve transition success and ensures you know ICD‐10 and that it is an opportunity for your organization and not a predicament.

Write your boss a letter like this:

“Doctor, thank you for all you do. Thank you for taking such great care of your patients and for taking such great care of your staff. We appreciate you and will do whatever we can to ensure the success of our practice. You always said
we could come to you if we had some thing really important to talk to you about. Well…this is really important.

As you know, we are talking about getting the practice ready for the ICD‐10 transition. You have committed budget to make sure we receive proper training. We are scheduling extra hours so we can have time to learn the new system. We are working with our IT vendors and business partners to make sure our software has been tested and ready to submit claims. We have made a good plan. Everything will be ready but we are concerned. Without you capturing the new documentation elements in order for us to be able to submit a properly coded claim, all the planning, budget, and new technology will be wasted. All the training hours and time away from our daily duties will be for naught. You see, it all starts with you. If you don’t document, all the planning, training, and technology in the world can’t help us.

The new codes are SO specific, documentation elements you’ve never had to capture before must be recorded or we can’t submit a claim. Denied claims due to insufficient documentation and therefore unspecific codes will cause a
rippling effect that means we have to chase you down in order to re‐submit. We are already so busy with our day‐to‐day duties it will be difficult to find time to do the extra work that would not have been necessary had you just recorded what was needed in the first place. I am asking you to do this for us but mostly…this is for you. We want you to continue to be able to give amazing care to our patients and to us. We want you to continue to be successful. We want you to know we care enough to write this note to you in the first place.

So, Doc, we promise we’ll be ready. All we ask is this. Help us help you.”
– Letter written by CPTICDPros.com

8 Simple Ways to Improve Quality of Sleep

July 3, 2013

1. Exercise, but not after the early evening.
2. Don’t drink caffeine after 2 p.m.
3. Avoid late night eating or alcohol (but don’t go to bed hungry either!).
4. Don’t use electronic devices before sleeping. They stimulate the brain and the screen light acts like sunlight in the morning.
5. Don’t study, etc. in your bed. Reserve it for the other three S’s: Sleep, Sex, Sickness.
6. Maintain a regular schedule. If you have off days, try not to sleep in too much.
7. Avoid naps, especially after 2 p.m. and not longer than 20 minutes.
8. Try to go to sleep at the same time every night. You can set an alarm at night to remind you of bedtime. This will help you develop a healthy sleeping pattern and hopefully, feel better in the morning.

ICD‐9 AND ICD‐10 Diagnosis Code Format and Differences

June 26, 2013

ICD‐9‐CM diagnosis codes vs ICD‐10‐CM diagnosis codes

  • 3‐5 characters in length vs 3‐7 characters in length
  • Approximately 14,000 codes vs Approximately 69,000 available codes
  • First digit may be alpha (E or V) or numeric & Digits 2‐5 are numeric vs Digit one is alpha & Digits two and three are numeric & Digits 4‐7 are alpha or numeric
  • Limited space for adding new codes vs Flexible for adding new codes
  • Lacks detail vs Very specific
  • Lacks laterality vs Has laterality
  • Difficult to analyze data due to nonspecific codes vs Specificity improves coding accuracy and richness of data for analysis
  • Codes are non‐specific and do not adequately define diagnosis needed for medical research vs Detail improves the accuracy of data used for medical research
  • Does not support interoperability because it is not used by other countries vs Supports interoperability and the exchange of health data between other countries and the United States

Why do we need ICD-10?

June 19, 2013

ICD‐9‐CM is outdated, over 30 years old, and cannot adequately accommodate the dramatic advances in
medicine and medical terminology. Many categories are full and not descriptive enough. Originally utilized for indexing purposes in the hospital inpatient setting, it was never intended to be part of the reimbursement process.

An effective coding system needs to be:

  • Flexible enough to quickly incorporate emerging diagnoses
  • Specific enough to precisely identify diagnoses and procedures resulting in
    • a reduction in claims denials due to increased granularity
    • improved coding accuracy
  • Able to support health IT and data exchange initiatives facilitating
    • data exchange between the U.S. and other countries
    • public health surveillance
    • improved quality of care measures and disease management

The ICD-10-CM Foundation and Background

June 12, 2013

Definition of Terms

In order to be able to discuss the transition from ICD‐9‐CM to ICD10‐CM, you first need to understand
the “language” in which the new coding process communicates. Following are terms you need to know.

Important Terms for ICD-10

Covered Entity: Providers, payers and clearinghouses who conduct specific administrative transactions electronically.

EDI: Electronic Data Interchange. Usually used in conjunction with the transmission of health data between providers and clearinghouses/insurance payers.

EHR: Electronic Health Record. This acronym is interchangeable with EMR (Electronic Medical Record). Generally means software that digitally stores patient charts and automates patient care functions such as computerized order entry and ePrescribing.

GEMs: “General Equivalence Mapping” is an approximate conversion and reference
mapping system that attempts to include all valid relationships between the codes in ICD‐9‐CM and ICD‐10‐CM. The relationships can be “one to many,” “many to one,” and in some cases, “one to one.” GEMs is an excellent tool to be used for ICD‐10‐CM staff training and chart auditing.

HIPAA: Health Insurance Portability and Accountability Act of 1996 established not just new rules for ensuring the privacy of health records but also set standards for the electronic transaction of interchanged health data.

HHS: The U.S. Department of Health and Human Services.

ICD‐9‐CM: The Diagnosis Coding lexicon currently in use. It is outdated, inflexible and many categories are full. ICD‐9‐CM contains approximately 13,000 diagnosis codes using a 5 numeric character structure and is electronically communicated using the traditional v.4010 data format.

ICD‐10‐CM: The Diagnosis Coding lexicon mandated for use on Oct. 1, 2014. Developed by World Health Organization (WHO), and used in most industrialized nations, this code structure requires a new data format (v.5010) because it contains up to 7 alphanumeric characters unlike the 5 numeric characters used in ICD‐9‐CM. Comprised of approximately 68,000 codes, it requires providers to code and document to much greater “specificity”.

ICD‐10‐PCS: For use in Inpatient Hospital procedure coding only. Physician outpatient settings will continue to use CPT‐4 to report procedures and services.

O.N.C.: Stands for the Office of the National Coordinator for Health Information
Technology and is a division of the U.S. Department of Health and Human Services (HHS). Under ONC, there are three bodies that can certify Electronic Medical Record technology for “Meaningful Use”.

Placeholder: When a seven character ICD‐10‐CM code requires a seventh character but the sixth position character has no function (e.g. no category, etiology or location), a “placeholder” consisting of the letter “X” is inserted in the sixth character position in order to hold that place in the code so that a seventh character can be used.

PM Software: “Front End” practice management software that schedules, tracks and codes patient encounters. (As opposed to the automated charting functions of EMR).

R.A.C. Audit: Recovery Audit Contractor ‐ The RAC Program’s purpose is to reduce improper Medicare payments and implement actions to prevent future improper payments. The demonstration program in 3 states started in 2005. 3 more states were added and by 2008, $1.03 billion were recovered from improper payments.

Role Based: Used to describe a type of training strategy that focuses the amount and type of training on job classification rather than general training for an entire group. In this context for example, you should consider a different level of training for your physicians (documentation training) than for your coding staff (full ICD‐10‐CM training).

Sequela: An aftereffect of a disease, condition or injury. Also called a “late effect.”

Specificity: In this context, “specificity” is a term used to describe choosing the diagnosis code that is the most descriptive possible given the available provider documentation.

V.5010: An electronic data reporting format scheduled replacing V.4010 on Jan. 1, 2012. Electronic testing of transactions using V.5010 commenced on Jan. 1, 2011. This new data format is required because the new ICD‐10‐CM codes are comprised of up to 7 alpha numeric characters and the old data format currently in use (v.4010) is unable to accommodate ICD‐10‐CM. (On Nov 17, 2011 CMS announced a 90‐Day period of enforcement discretion.)

W.E.D.I.: Comprised of a cross section of the health care industry, the Workgroup for Electronic Data Interchange (WEDI) is the leading authority on the use of Health IT to improve healthcare information exchange in order to enhance the quality of care, improve efficiency and to reduce costs of the American healthcare system. Formed in 1991 by the Secretary of Health and Human Services (HHS), WEDI was named in the 1996 HIPAA legislation as an advisor to HHS and continues to fulfill that role today.

WHO: World Health Organization is made up of representatives from numerous
countries that create policy and develop health programs to be adopted on a
world‐wide basis. The WHO developed ICD‐10.

2013 Accounting Tip #10

March 12, 2013

There are many ways to get organized for taxes. Each person needs to find the way that works for them to ensure that they will stay consistent and current. We will provide you some tips at getting started, you may even find a tip that you like better than your current way of doing things.

Deposit your receipts timely.  Depending on your volume, this should be done either daily, every other day or at minimum once a week.  It is best that you deposit your receipts each day in order to reduce the risk of money being lost or stolen, and checks not clearing by the time they are deposited.  If your business does not have a lot of cash receipts, you should at least deposit your receipts every week. All checks, money orders and cash items received should be deposited intact without any deductions for expenses or advances. Use your petty cash fund to pay expenses or advances that require currency.  Better yet, write a check to reimburse the person for the expense so that you have tracking on that expense and it is accounted for.  It is not recommended that you keep large quantities of cash at your place of business.  Have a specific cash amount that you keep on hand in a petty cash fund for those instances when you need to make change.

2013 Accounting Tip #9

March 5, 2013

There are many ways to get organized for taxes. Each person needs to find the way that works for them to ensure that they will stay consistent and current. We will provide you some tips at getting started, you may even find a tip that you like better than your current way of doing things.

Consider working with a Professional. Accountants have been trusted and respected allies to small business owners for many years. Their intimate knowledge of the profession as well as tax laws in their jurisdiction will save you money almost every time. I know how tempting it can be to save a buck and do it yourself, but it’s almost never more cost-efficient in the end. An accountant will almost always find more deductions and keep you penalty-free. On that note, the cleaner your records, the fewer billable hours you’ll have to pay, so make sure you’re organized year-round. But when things get technical or taxes are due, save yourself the money, time and headaches and call in a trusted professional.

2013 Accounting Tip #8

February 26, 2013

There are many ways to get organized for taxes. Each person needs to find the way that works for them to ensure that they will stay consistent and current. We will provide you some tips at getting started, you may even find a tip that you like better than your current way of doing things.

Make sure you pay yourself a living wage.  Many business owners are just trying to get their gig off the ground.  In doing so, their focus is on creating sales and running the day-to-day operation without having a plan on what they are going to pay themselves.  Don’t buy into the myth that all owners make a large salary from the get go.  Remember that as your business grows you will likely achieve a higher rate of pay, but this is not always true.  Many business owners consequently just draw out money whenever they feel like it or need it to not have their personal checking account bounce.  Don’t do this.  Have a plan.  Decide in advance how much of a draw you need to make a living and pay your personal expenses.  Once you have determined what is a decent wage for yourself, schedule this draw on a regular basis realizing that it may not be a wage that you want it to be, and may have to be adjusted as you work at building your business.  Make sure you follow the tax strategy for paying yourself depending on if you are a Sole Proprietor, S-Corp, C-Corp or LLC.  Seek the advice of a Tax Professional if you need additional input.

2013 Accounting Tip #6

February 12, 2013

There are many ways to get organized for taxes. Each person needs to find the way that works for them to ensure that they will stay consistent and current. We will provide you some tips at getting started, you may even find a tip that you like better than your current way of doing things.

When you’re looking for insights into your business spending, don’t forget to properly track what is likely one of your biggest expenses: labor. Whether you’re paying for full-time staff, part-time staff or you’re the only one on the payroll, make sure you’re tracking the costs of wages, benefits, overtime and any other costs associated with labor. By tracking your spending on labor, perks and benefits, you may find you have more money to incentivize your employees — or that you’re outspending your budget.

Either way, doing the math now can help you make better decisions later.  Knowing what it costs you to have employees doing work for you, is part of the picture as to whether you are able to grow your business further with your current people or if you will need more people.  It is provides a picture as to the profit of your business venture when you know what it costs you to produce in man time hours.

2013 Accounting Tip #5

February 5, 2013

There are many ways to get organized for taxes. Each person needs to find the way that works for them to ensure that they will stay consistent and current. We will provide you some tips at getting started, you may even find a tip that you like better than your current way of doing things.

Finally, don’t forget to get paid for the services or products you provide.  You might think that this one seems pretty obvious, but in reality you would be shocked at how many small business owners don’t properly track invoices and customer payments. You need to have a method at keeping track of your services and/or product so that you can invoice your customers timely.  If you’re not keeping proper records on what your customers or clients owe you with the information in a format that you can make sense of at a glance, it could be months before you realize you have outstanding invoices. You could be charging late fees if your customers are not making payments timely.  If you don’t know if a customer has an outstanding balance, you could be collecting payments late or missing some altogether. Make sure you’re properly tracking all payments due and recording when each invoice is paid, how long customers generally take to pay, and which customers you have had difficulties collecting payments from in the past.  This will help you stay on top of all business revenue and is the first step at Cash Flow Management.

2013 Accounting Tip #4

January 28, 2013

There are many ways to get organized for taxes. Each person needs to find the way that works for them to ensure that they will stay consistent and current. We will provide you some tips at getting started, you may even find a tip that you like better than your current way of doing things.

Start a folder for Charitable Deductions for each Calendar year.  As you make the deductions, make sure to put a copy of the receipt in the folder so that you have them all in once place when you file your tax return the next year.

In order to deduct your charitable contributions on your tax return, you will need to have the backup records to support this.  This means that no matter how the transaction occurred whether it was by Cash, Check, Money Order, Credit Card, or donation of goods, your records need to include all paperwork regarding the transaction that includes a receipt from the Charitable Organization or your bank record if you were not given a receipt.

2013 Accounting Tip #3

January 22, 2013

2013 Accounting Tip #2

January 15, 2013

There are many ways to get organized for taxes. Each person needs to find the way that works for them to ensure that they will stay consistent and current. We will provide you some tips at getting started, you may even find a tip that you like better than your current way of doing things.

Those new shoes aren’t a business expense, but your business credit card was handy so you used it. Sure, you can pay back your business for a personal expenditure, or the other way around.  However, when you do this, things get complicated fast, and you don’t need that headache. By keeping separate bank and credit card accounts for business and personal, you’ll save yourself hours of work and make it easy to keep track of deductible expenses in one place. It also makes it clear when you are reviewing your Profit & Loss Reports pertaining to Income and Expenses for the year. If you are mixing business and personal expenses, you are never going to have a true picture of what your business is doing and the bottom line.  We recommend handling business and personal finances as independently as possible, besides the fact that the IRS states it is required otherwise they consider those transactions as a co-mingling of funds.

Do yourself a favor and start the year out with a clean slate even if you did things differently last year.

CMS Medicaid Payment Rule

January 10, 2013

CMS held a call on the Medicaid PCP payment rule on Wednesday, December 12, 2012.  The following summary of that call.

Administrative:

They will issue more guidance within a month as Q/As at Medicaid.gov

Physician Self-Certification:

To qualify for payment physician has to self certify, indeed, but responsive to the many questions they received on this issue (and most of the questions they received were on this singular issue), CMS explained they view the requirement as a two step process. First one must self-attest but then (as the second step) one has to support the self-attestation. So they suggest that they are not really defining it as ‘self-certification’ in a conventional sense. Further, no one can attest on behalf of the physician – physicians are required to do that on their own.

E&M Codes Identified in the NPRM:

Final rule now clarifies that states are not required to provide payments for codes in that range that are not otherwise eligible for payment under their state plan. Also clarifies that the 2009 base payment amount for codes added to the E&M range since 2009 and currently reimbursed by the state will be zero. Additionally recognizes that some states allow providers to bill using local codes – higher payment will be available for services billed using these codes if the state as part of the required state plan provides a crosswalk of those codes to the specified E&M codes (so they can continue to use the local codes, but they have to provide a crosswalk that will be approved or rejected by CMS as part of the SPA approval process).

Additional Parameters of Payment:

Final rule defines 2009 base Medicaid state plan rate as excluding performance based supplemental payments such as bonus, Pay for Performance, and incentive payments since they are not part of the fee schedule payments. However, it makes clear that volume based payments such as those made to physicians associated with certain academic medical centers must be acknowledged as part of the base rate. As required by statue, the final rule continues to provide for 100% FMAP on the differential between the 2009 Medicaid state plan rate and the applicable 2013 and 2014 Medicare rates. States that have lowered their rates since 2009 will receive federal match at the regular FMAP for the difference between the 2009 rate and the existing lower state plan rate. There are no waivers or exceptions possible.

Identification of the 2013/ 2014 Medicare Fee Schedule Amount:

CMS just published the final rule establishing the Medicare rates for CY 2013. Under current law, the Medicare conversion factor is expected to be $25 unless Congress intervenes to adjust the conversion factor upward. The conversion factor currently is $34. In 2009, the conversion factor was $36, therefore it appears that states will be expected to pay rates in 2013 for codes identified in the final rule that are developed using the 2009 conversion factor and 2013 RVUs.

The final rule no longer requires that states make all Medicare service and locality adjustments although they can do so if they wish. States can choose to pay all services as the Medicare office rate (non facility rate) as opposed to paying at facility rate when service is provided in a hospital setting. Can also choose to pay each E&M code at a rate that represents the Medicare mean over all counties rather than pay the Medicare rate applicable to specific geographic location. Continues to permit state flexibility in determining whether to and how often to update rates to conform to changes in Medicare physician fee schedule. Rule also clarifies that higher payment may be made as adjustments to rates or if in a lump sum basis – no less frequently than quarterly and these additional reconciling amounts methodologies will be specified to the state plan. Rule continues to require payment for codes not reimbursed by Medicare using a CMS developed fee schedule that will be based on the recommended RVUs and the CMS published conversion factor.

SPAs:

Final rule continues to require that states submit SPAs to implement the payment increase but now indicates that CMS will provide a template. The rule now indicates that SPAs will be required to specify (1) whether the state will make a site-of-service adjustment or reimburse all codes at the Medicare rate applicable to the office setting, (2) whether the state will make all Medicare locality adjustments or use a statewide rate per code that reflects the mean value over all counties of the Medicare rates (3) the manner in which states will make higher payment (whether as a fee schedule or aggregate supplemental payment ) and (4) the codes which will be paid by the state at the higher rate and the codes that have been added to the fee schedule since 2009. If the state does not use HIP AA compliant codes, the SPA must provide a crosswalk to the covered E&M codes.

The final rule confirms that the State plan requirement applies – meaning the SPA may be effective of the first day of the calendar quarter in which it is submitted, so states will have until March 31, 2013 to submit their SPAs Then CMS will have 90 days to review the SPAs and approve, deny or request additional information. 100% FFP will not be available for eligible primary care vaccine administration until the SPA is approved. CMS will work with states to expedite approval of the SPA. CMS will also provide a template to facilitate this requirement. No payment will be dispersed until the SPA is approved but, again, CMS believes the template will greatly expedite the development of the SPAs. MDES (the system that states report Medicaid expenditures) has been modified so that it has separate lines to report services eligible for the 100% match. There is also separate reporting for FFS payment and managed care payment.

Program Evaluation:

Rule requires that states submit to CMS at such time/in such form that CMS specifies information relating to participation by eligible physicians and use of E&M codes described in regulation as of 7/1/09 and for CY 2013. This data will help evaluate the impact of the rule on access to services.

Managed Care (Camille Dobson, Senior Policy Advisor for MMC):

For states that use a managed care delivery system, CMS revised section 438804 from the NPRM to require states to submit and receive approval from CMS for two methodologies (1) for identifying the 2009 base line rate for primary care services that were in capitation payments at that time and the differential in capitation rates between that amount and what they are paying in 2013 or 2014 that is eligible for 100% FFP. CMS made this revision because they determined, after receiving comments, that it was important to have a separate explanation of the 2009 base year rate for primary services since there are states that had populations or services that were not in managed care in 2009. In order to better evaluate the amount of difference in the payments that were eligible for 100% of FFP, they are now working with states on how to do this – as well as with Deloitte, which whom they have contracted for technical assistance.

The second change from NPRM is that the timeline is extended for submitting those methodologies and receiving CMS approval – thru end of first quarter of 2013 (original deadline was 1/1/13). This also synchs-up with the timeframe for submission of the SPA. CMS staff in regional offices will review and approve both of those methodologies to ensure states are using the most accurate and reasonable data available to accurately identify the amount eligible for the 100% federal match. Once those methods are approved, CMS will follow rapidly (hopefully) with approval of managed care contract amendments and rate setting documentation that reflect those managed care methodologies. Once states receive approval of contracts AND rates, payments will be made retroactively to 1/1/13 to the health plans. CMS gave flexibility to the states on how to disseminate payments to primary care providers, recognizing the number of different delivery systems that exit in managed care plans but they are clear that the benefit of the increased payment must go to the provider. Much like FFS: documentation must be provided by the plans to the state that the requirements of the rule are carried out. CMS is not specifying how that documentation or reporting must occur but states are required to specify that in their health plan contracts to substantiate that the primary care rate was delivered to eligible providers. Plans must also make available to the state for verification of payments for any audits or reconciliation processes and also for the evaluation component.

Vaccines

Section 1202 of ACA specifically identifies vaccines as being included in the payment increase – they are an integral part of the practice of primary care providers. More importantly, the inclusion aligns payment structure for vaccines and will hopefully result in increased provider participation and access to pediatric vaccines for children in Medicaid. Payments will be made at the lesser of the VFC regional vaccine for children or the Medicare physician fee schedule rate. Because the coding change for vaccines took place in 2009, states will have compute the vaccine administration code value – the formula to do this was included in the final rule. However, if states can show to state plan what was paid for vaccine administration codes on 7/1/09 – states can use that rate and will not have to develop another. The SPA template includes a section on vaccine administration and each state mush complete this template before it can receive increased payments. Coding change also added a code for additional components in a combination vaccine. The VFC program only allows a single payment for each shot administered and so the VFC doesn’t pay for this additional code. Here, the VFC rules also apply to the final rule.

The final rule also included an updated fee schedule for the VFC program. It has not been updated since 1994. There were no other changes to VFC program, so states continue to have the flexibility to determine their state’s regional maximum fee.

Questions:

Any additional questions should be directed to CMCSPPACAquestions@cms.hhs.gov

2013 Accounting Tip #1

January 8, 2013

There are many ways to get organized for taxes. Each person needs to find the way that works for them to ensure that they will stay consistent and current. We will provide you some tips at getting started, you may even find a tip that you like better than your current way of doing things.

You will need to keep track of your receipts each year. Depending on your volume of receipts, number of bank accounts, credit cards, and cash purchases will determine what method is the best for you. You will need to consider how often you reference your receipts and depending on how many of them you have, how you want to search for what you need when the time comes.

One option is to create envelopes labeled for each month and year [example: January 2013] and put all receipts in the envelope in date order, with most current in front. Another option is to staple or paperclip the receipts that match and attach them to each bank account and credit card statement for each closing period. If you don’t have many receipts, just putting them in a file folder may work for you.

Your CPA or Accountant is not going to be fond of you bringing your receipts all in a wad or stuffed in a shoe box. Take the time to create a little bit of organization and you will make their job a lot easier!

Reminder to Immunize your Children

August 30, 2012

According to the American Medical Association, vaccinations are available for 20 infectious diseases. Vaccines against 10 deadly diseases are recommended for all U.S. children to protect the child and the community where they live.

Read the full article here.

Poll: Did you go to College?

May 18, 2012

We would like your participation in a Poll that we are doing.  If you wish to participate, please email me.

Did you take any College courses following High School?  If so, what type of courses?  How long were your courses?  Did you complete the term?  If you were at the same spot in life as you were then, making that decision to take additional schooling, would take the course again given what you know now?  Are you in the field you went to school for?  If so, how long have you been?

We would appreciate your participation in this questionnaire!  If you would like to email us your story, we will publish it on our blog.