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September - October 2012 •
Volume 17, Issue 5
Beyond "Denial"
Message from the President
Don Rodden, CPA, CHBME
We usually associate denials with payers who are challenging claims, but there is another form of denial that may be much more serious to us in the billing community. Click for more

SPOTLIGHT ON! Gail Sunshine, CMP
ISAM Staff Profile
By Billing Editors
As the conference director, my responsibilities run the full gamut of meeting management functions for HBMA in-person meetings, from the site selection process through the production and execution of the events. Click for more

Pros and Cons of Cold Calling for New Clients
SOUND OFF!
By Billing Editors
HBMA Members SOUND OFF! on important issues in the healthcare billing and management industry. Click for more

HBMA 2012 Fall Conference Program Highlight
Get a sneak preview from five of our speakers!
Conference Speakers
HBMA has elevated to a greater level of recognition by decision makers in Washington. The conference is preceded by a day on Capitol Hill for members to meet with their representatives, senators, or staff. The Keynote Speaker will be former Speaker of the House of Representatives and presidential candidate, Newt Gingrich. Click for more

A Look at CMS' Proposed Rule on Reporting and Returning Overpayments
Feature Story
By Connie S. Ditto, Esq
In addition to the well-known provision of the Patient Protection and Affordable Care Act (PPACA) that requires individuals to obtain health insurance, a lesser-known provision requires health care providers to "report and return" overpayments within 60 days of their identification or face severe penalties. This provision is one more factor in the government's ever-increasing commitment to reducing "fraud, waste, and abuse in the Medicare program." Click for more

Succeeding in an Evolving Industry
A Look at the Most Influential Trends in Healthcare Payments
By Bill Marvin
The latest trends in the healthcare industry are driving change in the payments process for billing services. These include the rise of consumerism, increasing pressure on administrative costs, and ongoing reform mandates. In order to maximize performance for their clients in this evolving environment, billing services must be aware of how the industry is changing, acutely understand the challenges, and focus on specific areas of their services and solutions to improve performance and ultimately succeed and thrive in this new climate. Click for more

New Operating Rules for Claims Processing are Fast Approaching
Claims
By Renae D. Price, CHBME, CMPE, CHFP, CPA
Deep within the Affordable Care Act (ACA) are technical provisions that most of the press have ignored. They are directed squarely at the administrative burden faced by providers in the reimbursement process. Specifically, in section 1104(b)(2) of the ACA, Congress required the adoption of operating rules for the healthcare industry and directed the Secretary of Health and Human Services to "adopt a single set of operating rules for each transaction1 with the goal of creating as much uniformity in the implementation of the electronic standards as possible." Click for more

Does the Discharge Summary Comply with Documentation Guidelines?
Feature Story
By Meera Mohanakrishnan, MSc, CPC, CPC-H, CPC-P
Good documentation is imperative in the healthcare setting. All documentation, regardless of its form, must be understandable, accurate, and legible. An accurate inpatient discharge summary is especially important since it provides the foundation for ongoing patient care. Discharge planning classically commences at the point of admission. After physicians and the hospital staff manage a patient's medical condition, the physicians capture the discharge details by reporting discharge day management codes 99238 or 99239. Click for more

Do I Have to Transition to ICD-10?
Five Essential Qualities
By Shelly Guffey and Dawn Duchek
The comment period on the proposed rule to delay ICD-10 closed on May 17, and the Department of Health and Human Services (HHS) is still in the process of reviewing those comments and deciding how the industry will proceed. Providers are uncertain about the ICD-10 starting date and whether they should continue moving forward with their preparations. Click for more

Managed Care Contracting Webinar Series Helps Physicians Navigate New Payment and Delivery Systems
AMA Perspective
Published with permission of the American Medical Association (AMA)
Now, in a post-healthcare reform world where managed care organizations are rapidly and permanently changing the way they pay and otherwise do business with physicians, it is imperative that physicians are able to negotiate and conduct business in a way that preserves their rights and maximizes their ability to reach your short- and long-term goals. The American Medical Association's (AMA) series of webinars will empower physicians and practice staff to do just that. Click for more

Data Visualization
Let Data Lead Your Marketing
By Marc Oestreich
"Data is what distinguishes the dilettante from the artist." Those sage words from George Higgins are true in nearly every profession in this world, but are often forgotten where they are needed most. In business-to-business marketing, data drives the sale more than advertising, glossy leave-behinds, or nifty websites could ever do. However, in a world popping at the seams with data – and a health profession well past that – if you cannot make that data talk, you cannot win sales. Click for more

Expense Report Embezzlement
How Employees Pull It Off
By Kit Powell, CFE, MSA
If you are concerned that fraud may be occurring in your place of business, a good first place to check is in the area of employee expense reimbursement. Employees who state false information on their expense reports may be committing some other type of fraud. There are four main types of expense reimbursement fraud: mischaracterized expenses, overstated expenses, fictitious expenses, and multiple reimbursements. Click for more

American Medical Association's "Heal the Claims Process"™ Campaign Transforms Healthcare
AMA Perspective
Published with permission of the American Medical Association (AMA)
The AMA is leading the charge for physicians against administrative waste by replacing burdensome, manual processes with seamless, automated solutions. We can reduce health care costs and eliminate hassles at the same time – letting doctors be doctors. Click for more

"Incident To" Services
Coding Corner
By Jackie Miller, RHIA, CCS-P, CPC, PCS
In certain circumstances, Medicare will pay for services performed by a physician's staff "incident to" the physician's service. The rules for "incident to" services are often misunderstood and have landed many physician practices in hot water. In this column, we will briefly review the Medicare requirements for these services, though keep in mind that other payors may have different requirements. Also, it is important to remember that all services must comply with each state's scope of practice regulations in addition to Medicare's rules. Click for more

Advanced Table Features
Software
By Nate Moore, CPA, MBA, CMPE
The May–June 2012 issue of Billing introduced tables in Excel, a powerful tool to sort, filter, and organize data. The July–August 2012 issue of Billing added table design tricks, the totals row, and how to add rows and columns to a table. Now that you are familiar with the basic features of tables, this article adds several advanced features to your repertoire. Click for more

One Step at a Time
Helping Your Clients with a Clinical End of Day Process
By Ron Sterling
At the end of each working day, practices generally reconcile fee tickets and receipts to ensure that all charges and payments have been properly posted and applied to their medical billing systems. Such an effort assures the integrity and accuracy of the financial records and is a key service of many third party billing organizations. A similar process is needed to maintain and ensure the integrity of EHR-based patient information. Click for more

How to Market Your Medical Billing Services, Part 2
From the Road
By Dave Jakielo, CHBME
In the last issue of Billing, I shared 15 sales and marketing strategies that will help you grow your company. Here are 15 more proven ideas. Why is marketing necessary? Because today's medical billing marketplace is more competitive than ever, and if you are not proactively marketing your services, you may find your clients slowly slipping away. For the first time in the billing industry, companies are losing clients even when they are doing a stellar job. Click for more

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