Monday, 16 January 2017


CMS has a number of policies that limit payment when multiple procedures are furnished on the same day. Under the American Taxpayer Relief Act, the multiple procedure payment reduction has been increased to 50 percent for therapy services furnished on or after April 1, 2013.


The time frame in which CMS may recoup over payments made for items and services was lengthened from 3 years to 5. Under this provision, providers are deemed to be “without fault” for any over payments “subsequent to the fifth year following the year in which notice was sent” as to the amount paid.


Two programs specifically for low-income Medicaid beneficiaries have also been extended through 2013. State Medicaid plans will provide assistance to those with dual eligibility in the form of premium support for Part B services for qualifying Medicare beneficiaries that have incomes between 120% and 135% of the poverty level. 

The Transitional Medical Assistance Program provides low-income families with the ability to continue Medicaid coverage on a temporary basis once they become employed and collect earnings that otherwise disqualify them from eligibility. There is an increase in the amount allocated to the program in 2013, with $485 million available for the period from January 1, 2013, to September 30, 2013, and $300 million available for the period from October 1, 2013, to December 31, 2013.


The Medicare Program provides a percentage increase for each payment to certain qualifying low- volume hospitals. Due to the substantially broadened eligibility criteria, many more hospitals qualify for these additional payments.


Medicare-Dependent Hospitals (MDHs) are typically small rural hospitals with a substantial Medicare patient population that rely significantly on Medicare payments. They will continue to receive the increased Medicare payments through October 1, 2013. CMS has indicated that it will issue instructions to hospitals that forfeited or lost this status effective October 1, 2012, on how to regain MDH status.


The Geographic Practice Cost Index (GPCI) floor of “1.0” for the work component of physician payment rates will continue through 2013. Medicare adjusts payments to physicians through the GPCI to reflect the varying cost of delivering physician services in different locations. 

These GPCIs are applied to the three calculation components of a procedure’s relative value unit: work, practice expense, and malpractice. The “floor” of 1.0 for the work component of the formula means that physician payments would not be reduced in a geographic area just because the relative cost of physician work fell below the national average.


There is an annual per-Medicare-beneficiary cap of $1,500 for outpatient therapy services (physical and speech therapy combined, and separately to occupational therapy. In 2006, an exceptions process whereby Medicare beneficiaries can request and be granted an exception to the caps, and receive an unlimited amount of therapy services to the extent deemed medically necessary by Medicare was established. The exceptions process, which effectively suspends the cap has been extended through December 31, 2013.

Additional protection to beneficiaries affected by this cap has been added to protect Medicare beneficiaries from liability for items and services furnished to them if the Medicare beneficiary and the provider did not know, and could not have been reasonably expected to know, that the item or service would be non-covered.

Medical Office Workflow Step 6: Accounts Receivables

If you followed the advice given in the previous articles, you have properly identified the patient benefits, obtained the necessary authorizations, and carefully produced clean claims.  

If you missed the blogs discussing these important steps, follow these links:  Step 2, Step 3, Step 4. clean claimsEach one of these steps is an integral part to keeping a “young” Accounts Receivables (ARs) balance.  They ensure the quickest turn-around time for your claim payments which keeps your cash flow smooth and predictable.

You may wonder why I use the reference “young” when speaking of ARs.  One of the most common ways to evaluate your practice cash flow situation is by analyzing the open balances by their aging.  

The aging is most often broken down into “buckets” of 30 day increments: 0-30 days, 31-60 days, 61-90 days, 91-120 days, 121-150 days and 151 days and over.  As the aging increases, the balances should decrease with the highest amounts, hopefully, always in the 0-60 days’ categories.

No comments:

Post a Comment

Popular Posts