Medical billing is one area that represents constant change.  If it is not the insurance carriers, we have new provisions with Medicare to keep on top of, such as no consultation code with Medicare.  If you are providing medical billing services to clients, this meeting could be one you might want to put on your calendar.

It is coming up next month and will be held in the Washington DC area.  Listed below are some of the topics on the agenda to include the new HIPAA laws, which do including billing and business associates.

To learn more or register for the HBMA 2010 Compliance Conference, visit HBMA’s event page.

 Press Release:

Annual Event Will Help Medical Billing Professionals Develop and Assess Compliance Plans against the Backdrop of Federal Legislation and Regulatory Concerns

LAGUNA BEACH, Calif.–(BUSINESS WIRE)–The Healthcare Billing & Management Association (HBMA), a non-profit educational resource and advocacy group representing third-party medical billers and billing professionals, today announced details of the association’s 2010 Compliance Conference. Taking place at Hotel Monaco in Alexandria, Va., March 9-11, HBMA’s Compliance Conference will help participants to gain deeper understanding of many issues relating to compliance within the healthcare billing industry.

Andrea L. Treese Berlin, senior counsel for the U.S. Department of Health and Human Services, Office of the Counsel to the Inspector General, will be on hand to speak to attendees on OIG-specific compliance issues. Additional conference sessions will include discussions on such critical compliance areas as:

• HIPAA, HITECH and other federal regulations
• Billing company policies and procedures
• Effective monitoring and auditing
• Coding education and training
• Risk assessments
• Billing contracts and negotiation
• On Wednesday, March 10, the conference features a presentation by Attorney Mark Cunningham, titled, “How to ‘Date’ Your Client.” This session offers participants advice ranging from problem areas in client-billing company relations, to issues and recommendations for building a strong relationship with a client. A post-conference session called “Hot Topics in Compliance” will be held on Friday, March 12 and hosted by Louie; Karen Collier, Esquire; Jackie Willett, CHBME and Bob Burleigh, CHBME. This session will address major topical compliance concerns such as human resources, RAC, successful ALJ appeals, ICD-10, enforcement, coding, quality payments and several other industry topics of interest and concern to participants.Conference registration opens at 11:30 a.m. on Tuesday, March 9, and includes a comprehensive schedule of sessions, networking lunches, informal activities like “Compliance Jeopardy,” an evening reception, and a tour of the D.C. area. Bill Finerfrock, HBMA’s legislative consultant from Capitol Associates, will present his “Washington Update” in a Wednesday, March 10 session.

The full press release can be read at the link below:

http://www.businesswire.com/portal/site/home/permalink/?ndmViewId=news_view&newsId=20100208006133&newsLang=en

 A new committee has been formed by the HHS and US Attorney General that will also stand to strengthen the provisions that allow for whistle blowers to share in the recovered funds.  With the new laws going into effect, we could stand to see a higher level of lawsuits filed.

Durable medical equipment in the home has been the targeted area for fraud for many years.  If a hospital was overpaid by Medicare a few years back and did not repay the money, the could be liable, and this stands to go back a few years, so when analyzing any payments made, it may not be a bad idea to double check the number if in doubt.

Also as part of the package, the attorney general can delegate the authority to make civil investigative demands to lower level government lawyers, so less legal cost for government attorneys if it can be held at a local level in civil courts.  

In addition, there are some additional pending amendments that could or could not be added.

With scant money in the federal budget available to overhaul the way healthcare is provided and paid for in the U.S., the Obama administration and Democratic leaders in Congress would like their hands on tens of billions of Medicare and Medicaid dollars lost each year to fraud and abuse.
The government often relies on whistle-blowers and the False Claims Act to get at more complicated and subtle forms of fraud and abuse, and in healthcare allegations are often based on violations of the anti-kickback statute and the restrictions on physician self-referral known as the Stark Law. The Justice Department credits the False Claims Act with returning $14.3 billion to HHS since 1986, when Congress reinvigorated the Civil War-era statute.

Re-Enrollment has changed quite drastically from 27 months to 30 days, so something to be aware of.  Also, if a change of address or location is not made within 30 days, there’s the risk of being expelled for 2 years.  This comes at a time when many physicians are actually dropping many Medicare and Medicaid patients.  The changes must be registered with the Medicare contractor.

One large concern is the paper flow as a physician could go to work before the initial process is completed for enrollment.  The AMA is pushing to get the deadline extended for such changes to 90 days.  Practices are not holding off on purpose, it’s just that there’s some real big mountains of administrative work that pile up today.

If the contractor denies enrollment instead of rejecting there’s a 30 day window for the physician and contractor to rectify the initial errors, so this could also offer some relief.  Guidelines state that internet enrollments should be within 45 days, while 60 days is the expected time frame for those enrolling with paper.
Washington — Physician practices are anticipating major difficulties with Medicare enrollment rules that went into effect amid protests from doctors and practice managers. A wrong step by a practice could mean that it loses Medicare revenue or even gets kicked out of the program altogether.

http://www.ama-assn.org/amednews/2009/04/20/gvl10420.htm

May 12, 2008

Important Information from Medicare for Clarification for Identifying Secondary Providers

In accordance with the NPI final rule, when an identifier is reported on a paper or electronically submitted claim for ordering/referring /attending/operating/supervising/purchased service/other/service facility provider (in the x12N 837 claims transactions) , that identifier must be an NPI. For Medicare purposes, this requirement is effective May 23, 2008. If the entity to be identified as the ordering/referring/attending/operating/supervising/purchased service/other/service facility provider does not furnish an NPI at the time of the order/referral/purchase or time of service, the billing provider must attempt to obtain that NPI in order to use it in the claim. The billing provider may use the NPI Registry or may need to contact the ordering/referring/ attending/operating/supervising/purchased service/other/service facility in order to obtain the NPI.

• If unable to obtain the NPI of the entity to be identified in the service facility location loop, no identifier should be reported in that loop.
• If unable to obtain the NPI of the ordering/referring/attending/operating/supervising/purchased service/ the billing provider (in the X12N 837 transactions) or the service provider (in the NCPDP 5.1 transaction) shall use its own NPI to identify those secondary providers. Medicare will not pay these claims if these secondary providers are not identified by NPIs.

Go to http://www.cms.hhs.gov/ for additional NPI information.

CEDI
(Common Electronic Data Interchange)

National Government Services has been awarded the contract for the Common Electronic Data Interchange (CEDI). All four DMERC regions will submit claim files and receive reports from CEDI.

EZClaim has passed EDI Connectivity testing with CEDI.

REGISTRATION

• Current DMERC submitters will be able to use their current submitter ID#’s. No registration is required.
• New submitters will be required to register with CEDI. An Enrollment form is provided on the CEDI web site. http://www.ngscedi.com/
• Optional: Providers with multiple DMERC submitter ID#’s will be able to combine those numbers and receive one submitter ID number used for all 4 regions. A form is provided on the CEDI web site.
• Each region will continue to use their region specific Receiver ID, Receiver Code and Payer ID.

TRANSMISSION

• A Bulletin Board System (BBS) is used for transmitting files and a modem will be required to connect to CEDI

Contact CEDI for additional transmission information.

• Web address: http://www.ngscedi.com/