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David Brooks, at www.MNetNews.com, wrote an informative article recently about an update that could affect current Patient Privacy Policies for most physicians.  The FCC has stepped in and said that all medical debt collectors must have explicit, written constent from their patients if they may contact them on their mobile cell phones regarding medical billing debts. 

 

Th article goes on to state that a California hospital has been sued for violating a patients rights:

 

Last summer the rules that govern the collection of medical debt became tighter when the FCC gave voice to a ruling that made it more difficult to reach out to patients on their mobile devices without first providing express consent for such a call.

 

A hospital chain based in California has become one of the first healthcare providers in the country to be sued based upon that ruling made last July.  The focal point of the class-action lawsuit is Prospect Medical Group’s Southern California Hospital at Culver City.  The allegations set forth in the suit claim that an automated dialer was used by the hospital to contact the cell phone of a patient named Donna Ratliff to collect on a debt without having prior consent to call her mobile device.

 

The medical debt collection industry originally asked the FCC to give greater clarification on the Telephone Consumer Protection Act in the hopes that greater flexibility would be extended.  The medical debt collection industry was also hoping that the FCC could address more recently related issues such as consent to call, reaching wrong numbers and auto-dialing mobile devices.  But instead, the FCC pointedly asserted that collectors of medical debt must have prior consent before contacting a cellular phone, leaving few options for phone numbers that have been reassigned.

 

Prospect Medical issued a statement that makes it clear that they follow necessary protocols to obtain the proper consent to make contact with patients on mobile devices.  The statement said  “All of our patients are asked to sign an irrevocable authorization permitting our hospitals to contact them via telephone—including, specifically, via cellphone—in their efforts to collect outstanding debt."

 

Hospitals have previously enjoyed a measure of room to move when calling patients for the purpose of medical debt collection as a part of the medical encounter.  However, medical providers must ensure diligence about ensuring that the debt can be linked back to the medical encounter when the patient first provided the cell number to the provider.

“At this point, best practice for providers is to secure written consent during the initial intake process that very clearly states and obviously makes note of the fact that auto-dialers could be used and that mobile devices will be contacted if that is the number that the patient has provided to the facility” said Mnet Financial CEO David Hamilton.

Violations of TCPA are already quite active with lawsuits related to the TCPA increasing between 2010 and 2014 more than 560% based on data provided by the Association of Credit and Collection Professionals (ACA).  “With the FCC’s latest clarification, we are seeing an increase of these kinds of lawsuits and it isn’t likely to change in the near future” said Hamilton.  The penalties for such infractions can range from as little as $500 per phone call, up to as much as $1,500 for a willful violation.

 

The California case does deal with the matter of express consent but does not, however, broach the issue of what happens when a medical debt collector reaches out to someone erroneously.  The FCC does allow collectors of medical debt to call a wrong number once without threat of penalty, whether or not someone answers the call.  However, studies show that more than 100,000 mobile phone numbers are changed each and every day.  This situation has led to ACA International suing the FCC in challenge to the order issued last July.  

“It’s increasingly difficult for medical debt collectors to keep up with the risk involved” said Hamilton.  “It’s nearly impossible to confirm that the person you are reaching out to is going to actually be the person you are trying to reach.  It’s a very difficult situation.

 

Mr. Hamilton says that the best possible way for a provider to protect themselves is to create a very thorough process for obtaining consent from the patient and simply respecting the wishes of those who choose to opt out.

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Good news has been reported from HBMA (http://www.hbma.org/) regarding cutting Medicare physician fee schedule payments and implementing ICD-10.

 

The United States Senate has joined the House of Representatives and passed legislation to prevent a 24% cut in physician fee schedule payments from occurring April 1, 2014.  Instead, Medicare physician fee schedule payments will continue to be paid as they have been for the past 3 months.

 

On April 1, President Obama signed into law a bill to delay the planned ICD-10 implementation until Oct. 1, 2015. Specifically, the bill prohibits CMS from enforcing a mandate to switch from ICD-9 to ICD-10 until Oct. 1, 2015


The so-called SGR Patch approved by Congress will be in effect for 12 months, expiring on March 31, 2015.  Between now and then, Congress will have to enact a permanent fix or enact another patch to prevent a huge drop in Medicare Physician payments next April 1.
In addition to preventing the SGR related reduction, Congress approved language extending various other Medicare provisions slated to expire at Midnight tonight.  These include:


• Extends Medicare work Geographic Practice Cost Index (GPCI) floor for 1 year
• Extends Medicare therapy cap exception process for 1 year
• Extends Medicare ambulance add-on payments for 1 year
• Extends Medicare adjustment for Low-Volume hospitals for 1 year
• Extends Medicare-dependent Hospital (MDH) program for 1 year


In addition to these “extenders” Congress also approved a one-year delay in the effective date of the ICD-10 transition.  As you know, ICD-10 has been scheduled to take effect on October 1, 2014.  Due to Congressional intervention, the new effective date will be October 1, 2015.

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5010 Compliance Enforcement Deadline is June 30, 2012.  Are you ready?  If not, after July 1, 2012, all Medicare claims submitted in any other format than the ASC X12 v5010 and NCPDP D.0 will be rejected!  Call Advanced Billing Consultants, Inc. @ 888-222-2125 today to make sure you're 5010 compliant!

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Department of Health and Human Services (HHS) Secretary Kathleen Sebelius today announced a proposed rule that would establish a unique health plan identifier under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The proposed rule would implement several administrative simplification provisions of the Affordable Care Act.

The proposed changes would save health care providers and health plans up to $4.6 billion over the next ten years, according to estimates released by the HHS today. The estimates were included in a proposed rule that cuts red tape and simplifies administrative processes for doctors, hospitals and health insurance plans.

“The new health care law is cutting red tape, making our health care system more efficient and saving money,” Secretary Sebelius said. “These important simplifications will mean doctors can spend less time filling out forms and more time seeing patients.”

Currently, when health plans and entities like third party administrators bill providers, they are identified using a wide range of different identifiers that do not have a standard length or format. As a result, health care providers run into a number of time-consuming problems, such as misrouting of transactions, rejection of transactions due to insurance identification errors, and difficulty determining patient eligibility.

The rule simplifies the administrative process for providers by proposing that health plans have a unique identifier of a standard length and format to facilitate routine use in computer systems.  This will allow provider offices to automate and simplify their processes, particularly when processing bills and other transactions.

The proposed rule also delays required compliance by one year– from Oct. 1, 2013, to Oct. 1, 2014– for new codes used to classify diseases and health problems. These codes, known as the International Classification of Diseases, 10th Edition diagnosis and procedure codes, or ICD-10, will include new procedures and diagnoses and improve the quality of information available for quality improvement and payment purposes.

Many provider groups have expressed serious concerns about their ability to meet the Oct. 1, 2013, compliance date. The proposed change in the compliance date for ICD-10 would give providers and other covered entities more time to prepare and fully test their systems to ensure a smooth and coordinated transition to these new code sets.
The proposed rule announced today is the third in a series of administrative simplification rules in the new health care law. HHS released the first in July of 2011 and the second in January of 2012, and plans to announce more in the coming months.

More information on the proposed rule is available on fact sheets (4/9/12) athttp://www.cms.gov/apps/media/fact_sheets.asp.

The proposed rule may be viewed at www.ofr.gov/inspection.aspx. Comments are due 30 days after publication in the Federal Register.

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HAS YOUR PRACTICE BEEN AFFECTED BY THE LACK OF MEDICARE AND COMMERCIAL INSURANCE PAYMENTS?

Like most practices and physicians throughout the country, you are not alone.  The root of the problem seems to be the result of the federally mandated transition to HIPAA Version 5010, enacted on January 1, 2012.  As a nation-wide medical billing company, we see all the medical insurance claims that get sent, rejected and processed to a large variety of insurance companies throughout the United States for our clients.  What we started to notice after HIPAA Version 5010 was enacted, was that Medicare, TRICARE, and a select few of local Blue insurance carriers have halted processing medical insurance claims.  When we first started noticing a lack of payment from these insurance carriers, we inquired with the insurance carriers as to where the money was; they returned with little, to no information as to if the claim was on file or not.  We then consulted our clearinghouses about the issue, who then told us the claims were  forwarded to the insurance companies.  Thousands of dollars in unpaid medical insurance claims are just floating in the clouds with little to no information as to why.

On Feburary 1, 2012, Susan Turney, MD, MS, FACP, FACMPE, Medical Group Management Association's president and CEO sent The Honorable Secertary Kathleen Sebelius of the Department of Health and Human Services a letter asking the government to take "immediate action to address the payment disruption issues that have occured as a result to the federally mandated transition to HIPAA Version 5010 electronic transactions on Jan.1".  Ms. Turney goes on to warn, "Should the government not take necessary steps, many practices face significantly delayed revenue, operational difficulties, a reduced ability to treat patients, staff layoffs, or even the prospect of closing their practice".

To read the full letter MGMA sent to HHS, please visit MGMA's website:http://www.mgma.com/WorkArea/DownloadAsset.aspx?id=1369699

So, What can you do?

Make sure your practice is monitoring any increase in claim rejections and denials by reviewing payer or vendor/clearing house reports.  Make sure you understand the requirements of HIPAA Version 5010 that can commonly affect claims:

  • Use NPI Numbers: Social Security and employer identification  numbers are no longer accepted as primary identifiers
  • Billing address Vs. Pay-to address: HIPAA Version 5010 requires a physical address in the billing field.  If a P.O. Box is used for payments, the address should be entered in the pay-to address field
  • Use a nine digit zip code: Five digit zip codes are no longer accepted
  • Drug reporting requirements: HIPAA Version 5010 requires a drug quanity and unit of measurement whenever a National Drug Code is listed on the claim
  • Both primary and secondary claims MUST have a Medicare Secondary Payer indicator if Medicare is the secondary pay

We at Advanced Billing Consultants, Inc. are also strongly recommending that you call and contact your local Congressman/woman and inform them of this dire issue.  You can find them here: http://www.house.gov/.  We have also drafted a letter (requires MS Word, click enable editing -- let us know if you'd like another format), http://www.advancedbillingconsultants.com/fixhipaa5010.docx, to either help you with talking points with your Congressman/woman or to send on the behalf of the physician, the physician’s employee, and the insured patient.  We recommend you call, instead of email, and have a short conversation to make sure they are aware of how this issue is affecting the healthcare industry and the people of the United States.