Provider Based Billing And Coding For RHCs

1
Provider Based Billing And Coding For RHCs

• Presented by
• Deborah Holzmark, RN, MBA, CPHQ, MCS-P , CMPE
• Dixon Hughes PLLC
• [phone]

2
Agenda

• Types of Services - Covered and Non-Covered
• Providers of Service
• Specific Services
• Medical Record Requirements
• Changes for 2006
• AR Management

3

• Types of Services
• Covered and Non-Covered

4

• Types of Services - Covered and Non-Covered
• The services provided at a rural health center
  can be divided into four categories
• Face-to-face encounters (or "visits").
• RHC services incident to a face-to-face
  encounter. These services are not directly billed
  but are reimbursed through the cost report.
  Incidental services are typically provided by non
  practitioners under general physician/extender
  supervision, although practitioners (particularly
  therapists who are directly employed by the RHC)
  frequently also provide incidental services.

5

• Types of Services - Covered and Non-Covered

• Non RHC services. RHCs can provide Part B
  covered services that do not fall within their
  congressional mandate. Examples include physician
  services to hospital inpatients and physical
  therapy by contracted therapists. Non RHC
  services are not reimbursed under the all
  inclusive rate rather, they must be billed
  separately to the appropriate carrier.
• Non-covered services. Non-covered services may be
  provided and billed directly to RHC patients.
  However, in no instance can Medicare
  beneficiaries be billed for services that would
  be covered under Medicare.

6
Covered Services

• The services offered in a Rural Health Clinic
  (RHC) are the type of services that patients
  receive in a doctors office, an outpatient
  clinic or emergency room. Such services are
  physicians diagnostic, treatment or consultation
  services. In an RHC, the services may also be
  provided by a nurse practitioner, physicians
  assistant, certified nurse midwife, clinical
  psychologist or clinical social worker.

7
Covered Services

• Services are covered in an RHC if the following
  apply
• Medically reasonable and necessary.
• The service is provided by a physician, nurse
  practitioner, physician assistant, certified
  nurse midwife, clinical social worker or clinical
  psychologist who is employed by or receives
  compensation from the clinic.
• If not provided by a physician, the service is
  provided under the general supervision of the
  physician.

8
Covered Services

• The service is provided in accordance with the
  clinics policies, protocols, standing orders or
  any physicians medical orders for patient care
  and treatment.
• If not provided by a physician, the service is
  permitted by state law for the nurse
  practitioner, physician assistant, certified
  nurse midwife, clinical psychologist or clinical
  social worker to provide the service.
• If not provided by a physician, the service would
  be covered by Medicare if performed by a
  physician.

9
Non-covered Services

• Services not covered in an RHC as clinic services
  but may be covered under other Medicare benefits
  include
• Durable Medical Equipment (DME) (whether rented
  or sold) including iron lungs, hospital beds used
  in the patients home, wheelchairs, etc.
• Ambulance services.
• Prosthetic devices, which replace all or part of
  an internal body organ (including colostomy bags)
  and supplies directly related to colostomy care,
  and the replacement of such devices.

10
Non-covered Services

• Leg, arm, back and neck braces and artificial
  legs, arms, and eyes, including replacements if
  required, because of a change in the patients
  physical condition.
• Physical, speech or occupational therapy with a
  therapist not employed by the RHC.
• Screening mammography.
• Technical components of diagnostic tests.
• Contracted non-physician diagnostic or
  therapeutic services are also excluded from RHC
  coverage.

11
Non-covered Services

• No payment can be made under Medicare Part A or
  Part B for items and services with the following
  characteristics
• Not reasonable and necessary.
• No legal obligation to pay for or provide.
• Furnished or paid for by government
  instrumentalities.
• Not provided within the United States.
• Personal comfort.
• Routine services and appliances.
• Supportive devices for feet.

12
Non-covered Services

• Custodial care.
• Cosmetic surgery.
• Charges by immediate relatives or members of
  household.
• Dental services.
• Paid or expected to be paid under a Medicare
  Secondary Payer (MSP) provision.
• Or,
• Non-physician services provided to a hospital
  inpatient that were not provided directly or
  arranged for by the hospital.

13
Non-covered Services

• Visits for the sole purpose of obtaining or
  renewing a prescription, in which the need was
  previously determined (so that no examination of
  the patient is performed), are not covered
  services.
• Time used in completion of claim forms.
• Care-plan oversight is not allowed by either Part
  A or Part B for RHC providers

14
Services Incident To

• Services and supplies incident to an RHC
  practitioners (physician, physician's assistant,
  nurse practitioner, nurse midwife and clinical
  psychologist) professional services are covered
  as RHC services as long as the services are
  supplies are
• Furnished as an incidental, although integral,
  part of an RHC Practitioners services.
• A type commonly furnished either without charge
  or included in the RHCs bill.
• A type commonly furnished in a physicians
  office.
• Services provided by clinic employees that are
  furnished under the direct and personal
  supervision of an RHC practitioner.
• Furnished by a member of the clinic or staff who
  is an employee of the clinic.

15
Supervision

• Coverage is limited to situations where there is
  direct supervision of the clinic staff performing
  the service. Direct and personal supervision does
  not mean that the RHC practitioner must be
  present in the same room. However, the
  practitioner must be on the premises and
  immediately available to provide assistance and
  direction throughout the time the clinical staff
  is performing services. In other words, if no
  mid-level or physician is on the premises
  auxiliary staff may not provide any medical
  services.

16
Services for Lab Tests

• Lab tests
• An encounter expressly for the purpose of
  obtaining blood for lab tests does not constitute
  a medically necessary face-to-face visit even if
  a face-to-face contact with the provider is made.
  To be considered as a face-to-face visit, there
  must be some additional medically necessary
  evaluation or management component.

17
Services without Visit Requirement

• For services that do not qualify as a billable
  visit, the usual charges for the services are
  added to those of the appropriate (generally
  previous) visit. RHCs/FQHCs use the date of the
  visit as the single date on the line item.

18
Medical Necessity

• Medical Necessity
• Thus there are situations in which the provider
  of the service (e.g. the person giving an
  injection) may be a qualified practitioner and
  the service (e.g. the injection) may be medically
  necessary but it is not medically necessary to
  have the practitioner re-examine the patient to
  deliver the service. In these cases it is the
  physician/extender services that are medically
  unnecessary using physician/extenders for
  services routinely performed by ancillary staff
  does not create additional reimbursable
  face-to-face encounters as Medicare is
  specifically prohibited from reimbursing
  medically unnecessary services

19
Services to Others

• Medicare and Others
• If you provide to others, must provide to
  Medicare beneficiaries
• Non Rural Health
• Cant move pt back and forth to get
  reimbursement- allergy injection example

20
Providers of Service
21
Providers of Service

• Physicians
• Non-physician practitioners

22
NP/PA Other Locations

• Full-time and part-time nurse practitioners,
  physician assistants (including nurse midwives)
  who are employees of an RHC or who are
  compensated by the clinic for providing services
  furnished to the clinic's patients in locations
  other than at the clinic, may furnish services to
  clinic patients at the clinic or in other
  locations, such as the patients home. These
  services are RHC services and are reimbursable
  only to the clinic. Clinic patients include
  individuals who receive services at the clinic
  facility or services provided elsewhere. These
  costs are included in the costs of the RHC.

23
Non-Physician Practitioners

• Clinical Psychologist
• Diagnostic and therapeutic services that the CP
  is legally authorized to perform in accordance
  with State law and regulation.
• Services and supplies furnished incident to a
  CPs services are covered if the requirements
  that apply to services incident to a physicians
  services, as described in 60, are met and they
  are furnished by an employee of the RHC or FQHC.
  To be covered, these services and supplies must
  be
• Mental health services that are commonly
  furnished in CPs' offices
• An integral, although incidental, part of
  professional services performed by the CP and
• Performed under the direct personal supervision
  of the CP, i.e., the CP must be physically
  present and immediately available.
• Appropriate State laws and regulations governing
  a CPs scope of practice must be considered.

24
Non-Physician Practitioners

• CSW
• RHC services include the services provided by a
  clinical social worker. A clinical social worker
  is an individual who
• Possesses a master or doctors degree in social
  work.
• Has performed at least two years of supervised
  clinical social work and, is either licensed or
  certified as a clinical social worker by the
  state in which the services are performed.
• Or,
• In the case of an individual in a state that does
  not provide for licensure or certification, has
  completed at least two years or 3,000 hours of
  post masters degree supervised clinical social
  work practice under the supervision of a masters
  level social worker in an appropriate setting
  such as a hospital, Skilled Nursing Facility
  (SNF) or clinic.

25
Nutrition/Dietician

• Two services never should be billed as face to
  face visits. Medical nutritional therapy, in
  accordance with BIPA 105, must be provided by a
  registered dietician or nutrition professional
  it is therefore an "incident to" service for
  which costs are reported but no visit. Diabetes
  self management (DSM) represents a similar
  situation. PM-A-00-30 identifies DSM as an RHC
  service, but MIM 3619 specifies that G0108/9
  codes are not payable for beneficiaries receiving
  services in an RHC. Although DSM (as defined in
  Section 4105 of the BBA of 1997) must be
  certified as medically necessary by a
  physician/extender, the actual educational
  intervention is usually provided by other
  professionals, typically nurses. A face-to-face
  service beyond that which occurred when the
  intervention was ordered (certified) is not
  medically necessary. Therefore it too is an
  "incident to" service for which costs may be
  reported but no visit reported. Lacking technical
  components, neither of these services would
  generate Carrier claims either.

26
Billing
27
RHC Billing and Reimbursement

• Provider Based billing to FI servicing the main
  provider
• Billing on CMS 1450 (UB-92 or electronic
  equivalent)
• Services billed at your set charges, not expected
  reimbursement (exception Medicaid in some
  states)

28
RHC Billing and Reimbursement

• Third Party Reimbursement
• All inclusive rate current upper payment limit
• Exceptions in provider based with less than 50
  beds
• Other exceptions
• Patient Portion
• Deductibles
• Based on incurred- your billed charge
• Co-Pays
• 20 co-insurance based on incurred- your billed
  charge

29
2007 Deductible

• The amounts indicated below represent the
  deductible and coinsurance applicable to services
  provided in Rural Health Clinics.
• Deductible 131 per calendar year.
• Coinsurance Twenty percent (20) of covered
  Medicare services.

30
RHC Billing and Reimbursement

• Bill Types
• RHC Bill Type 71X
• Third digit
• 710 non payment/zero
• 711 Admit through DC
• 717 Replacement
• 718 Void/cancel

31
RHC Billing and Reimbursement

• Revenue Codes
• CPT Codes
• Effective with dates of service on or after April
  1, 2005 FQHC/RHCs are no longer required to use
  HCPCS codes when billing for RHC/FQHC services.
  Charges only are entered on the revenue code
  line. Medicare Claims Processing Manual Chapter
  9

32
RHC Billing and Reimbursement

• 0521 Clinic visit by member to RHC/FQHC
• 0522 Home visit by RHC/FQHC practitioner
• 0524 Visit by RHC/FQHC practitioner to a member
  in a covered Part A stay at the SNF
• 0525 Visit by RHC/FQHC practitioner to a member
  in a SNF (not in a covered Part A stay) or NF or
  ICF MR or other residential facility
• 0527 RHC/FQHC Visiting Nurse Service(s) to a
  members home when in a home health shortage area
  
• 0528 Visit by RHC/FQHC practitioner to other non
  RHC/FQHC site (e.g., scene of accident) Charges
  for the interpretation of diagnostic tests
  performed by RHC staff (physician or midlevel)
  are included with the charges for the encounter
  under revenue code 52X.

33
RHC Billing and Reimbursement

• Dates of Service
• A single date should be reported on a line item,
  not a range
• Reporting Units
• Non-visit day services
• For services that do not qualify as a billable
  encounter, the usual charge for the services are
  added to those of the appropriate (previous or
  subsequent) encounter.

34
Specific Services
35
Technical Components

• Technical services/components associated with
  professional services/components performed by
  provider-based RHCs or FQHCs are billed by the
  base-provider on the TOB for the base-provider
  and submitted to the FI

36
Specific Services

• Lab Services
• UA
• Hemoglobin or Hematocrit
• Blood Sugar
• Stool for occult blood
• Pregnancy
• Primary culturing for transmittal to certified
  lab

37
Lab Follow-up Clinics

• Lab Follow-up Clinics
• Visits to lipid clinics, prothrombin (Coumadin)
  clinics and other lab-based follow-up clinics
  generally do not demonstrate a need for
  physician/extender face-to-face discussion of
  results other than in the two or three visits
  following diagnosis. Exceptions are expected to
  demonstrate a well-documented and unique need for
  the face to face interaction. The routine use of
  a visit to discuss lab results is clearly not
  medically necessary medical necessity for this
  is discussed above.

38
Preventive Services

• Preventive Services
• Unless specifically covered by statute, primary
  preventive services are not covered and are
  additionally not considered to be medically
  necessary for the diagnosis or treatment of
  disease. Screening tests are not medically
  necessary for diagnosis when used for screening
  they are only considered medically necessary when
  used in the diagnosis or exclusion of suspected
  disease.

39
Preventive Services

• Preventive services therefore include
• medical social services,
• most nutritional assessments,
• preventive health education,
• prenatal and postpartum care,
• routine physicals (including well child care),
• immunizations,
• eye and ear screening,
• family planning,
• routine screening procedures (urine dipstick,
  stool guaiac, serum cholesterol, weight and BP),
• risk assessment (including undirected history
  taking and physical exam to ascertain risks), and
  
• thyroid screening, among others

40
Preventive Services Exception!

• Welcome to Medicare Physical
• The specific guidance regarding RHC billing is as
  follows
• RHCs and FQHCs should follow normal billing
  procedures for RHC/FQHC services.
• Encounters with more than one health professional
  and multiple encounters with the same health
  professionals that take place on the same day and
  at the same location constitutes a single visit.

41
Preventive Services

• Welcome to Medicare Physical
• The technical component of the EKG performed at a
  provider-based RHC/FQHC is billed on the
  applicable TOB (Table 3) and submitted to the FI
  using the base provider number and billing
  instructions.
• RHCs and FQHCs use revenue code 052X. Effective
  April 1, 2005, RHCs and FQHCs will no longer have
  to report additional line items when billing for
  preventive and screening services on TOBs 71x.
  Except for telehealth originating site facility
  fees reported using revenue code 0780, all
  charges for RHC services must be reported on the
  revenue code line for the encounter, 052x, or
  0900.

42
Pneumococcal and Influenza

• Influenza/Flu and Pneumonia Vaccines should not
  be submitted to Riverbend GBA on a UB-92 claim
  form. Instead, when submitting your year end cost
  report , include a listing of those vaccines
  administered to your Medicare patients. The
  listing should include the following information
• 1) The patients Name and Medicare number.
• 2) The date of service.
• 3) The type and cost of each immunization.
• DO NOT, however, include vaccines administered
  to patients covered under the new Medicare
  Advantage plans on your listing to Palmetto GBA.
  You should bill each respective Medicare plan for
  those services.

43
Injections

• Injections
• A visit solely to receive an injection does not
  constitute a medically necessary face-to-face
  visit if the need for the injection was
  previously determined. This is true even if a
  face-to-face contact is made. CMS Pub 100-4,
  12-200, RHC 27-406, CMS Pub 100-4, 17-20, PIM
  83-2.4.3.1

44
Allergy Shots

• Allergy shots
• A visit solely to receive an allergy shot does
  not constitute a medically necessary face-to-face
  visit even if a face-to-face contact is made. The
  allergy shot is generally administered by
  ancillary personnel and represents a service that
  is incident to a prior physician visit. However,
  if the patient has an adverse reaction that
  necessitates a physician/extender evaluation (and
  that examination, assessment and plan is
  appropriately documented), the encounter may then
  be appropriately billed as a face-to-face visit.

45
Injections

• Vitamin B12. The IM administration of B12 may be
  transiently necessary in any B12 deficiency state
  but is only medically necessary chronically
  following a definitive diagnosis of pernicious
  anemia (Schilling test, radiolabeled B12 uptake
  and/or other standard diagnostic criteria).
  However, even when appropriately administered, a
  face to face encounter is not medically necessary
  with each injection. In the setting of newly
  diagnosed B12 deficiency with symptoms, patient
  evaluations may be required weekly times four and
  then monthly times twelve. In the absence of
  symptoms attributable to B12 deficiency, two or
  three visits within the first six months may be
  necessary for patient education and re-evaluation
  . Following this initial period, annual visits
  may be necessary (whether or not the patient is
  continuing injections) if the patient is not
  being otherwise seen for chronic problems. More
  frequent physician/extender encounters are not
  medically necessary due to the slow rate of
  relapse following B12 repletion.
• Flu shots and vaccinations (influenza, hepatitis
  B and pneumonia vaccines) do not necessitate a
  face to face visit.

46
Injections

• Other injections (such as epogen) also usually
  represent incidental services when the need for
  the injection is previously established, even if
  the physician/extender specifies a change in
  dosage. This is because the physician/extender is
  merely responding to a lab test a re-evaluation
  of the patient is not indicated with each
  adjustment. Conversely, a face to face encounter
  is medically necessary when it is the accepted
  standard of practice in physician offices and
  outpatient clinics, generally because a clinical
  re-evaluation of the patient is also indicated
  (e.g. 24 hours after an initial dose of IM
  antibiotics but not routinely after each
  subsequent dose).

47
Dressing Changes

• Dressing changes
• There may be instances when a caretaker is unable
  to adequately perform dressing changes or where
  the level of complexity of the care requires the
  skills of a nurse. These dressing changes do not
  constitute medically necessary face to face
  visits solely because the service was provided by
  a physician/extender if similar services could be
  provided by nurses or other designated office
  staff. Except in the special case of visiting
  nurse services, medical necessity for a face to
  face encounter is based on
• The need for a physician/extender to monitor the
  underlying wound at a frequency that does not
  differ from the usual patterns of utilization in
  an office or outpatient clinic OR
• An exacerbation or complication that would
  trigger an examination in those environments OR
• Sharp debridement requiring the skills of a
  physician/extender.

48
Prescription Services

• Prescription Services
• Writing or refilling prescriptions and services
  such as intermittently dispensing medications
  (oral or injectable) to psychiatric patients or
  drug abusers and counting/filling pill dispensers
  for disabled or demented beneficiaries do not
  require a face to face evaluations in the typical
  outpatient setting. Thus the need for a
  prescription refill or medication disbursement
  will not contribute to establishing medical
  necessity for the face to face encounter. These
  are covered services, but are incidental to the
  underlying physician/extender examination and
  treatment.

49
Pain Management

• Pain management is a covered RHC service but the
  enabling of a drug addiction (either within or
  outside of a drug rehabilitation program) is not.
  Frequent medication refills for narcotics do not
  represent medically necessary face to face
  encounters, but they nonetheless indicate a
  potential quality of care issue and the overall
  pain management strategy should be well
  documented in the chart. Visits for the injection
  of narcotics usually require an evaluation and
  thus a face to face visit, but they should also
  be part of a well documented pain management
  strategy that includes diagnostic investigations
  and/or pain specialty consultations that attempt
  to minimize addiction and maximize patient well
  being. A pattern of over-utilization of the RHC
  for multiple patients in the absence of pain
  management strategies is not medically necessary
  and additionally may be an indicator of more
  serious problems.

50
Paperwork

• Paperwork
• The paperwork involved in maintaining records,
  documenting encounters for third parties and
  completing forms for patients is an incidental
  part of medical practice. These services (when
  provided in support of an activity not otherwise
  excluded from coverage, such as disability
  examinations) are reimbursed by Medicare through
  the cost report as services incidental to the
  covered encounter. A period of time spent solely
  in record keeping cannot be considered as a face
  to face visit. An actual face to face encounter
  solely for the purpose of creating or filling out
  paperwork is not a medically necessary visit the
  visit must be justified by a medically necessary
  evaluation or treatment.

51
Recurrent Services

• Blood Pressure Measurement Follow-up visits to
  monitor blood pressure which include
  physician/extender evaluation and management
  services are appropriately identified as
  encounters. The documentation should reflect the
  performance of these services over and above the
  simple measurement of a blood pressure.
• The frequency of follow-up is medically necessary
  when consistent with the recommendations of The
  Sixth Report of the Joint National Committee on
  Prevention, Detection, Evaluation and Treatment
  of High Blood Pressure.
• http//www.nhlbi.nih.gov/guidelines/hypertension/
  jncintro.htm

52
Recurrent Services

• Specific medical necessity must be clearly
  documented to support frequencies greater than
• New diagnosis (first 6 months) lifestyle
  modification monthly (q 30 days)
• New diagnosis (first 6 months) pharmacological
  management monthly (q 30 days)
• Established diagnosis lifestyle modification
  controlled quarterly (q 90 days)
• Established diagnosis pharmacological
  management uncontrolled monthly as long as at
  least every other visit supports active
  intervention (change in therapy)
• Established diagnosis pharmacological
  management controlled quarterly (q 90 days)

53
Recurrent Services

• Accelerated or unstable hypertension with a need
  for rapid control of pressure medically
  necessary as long as each visit supports ongoing
  direct and active intervention (change in
  therapy) during the period of frequent
  follow-up.Visits solely to obtain BP
  measurements are incidental to the primary EM
  visit, and any follow-up at a frequency that is
  not supported by current standards of care is not
  medically necessary.

54
Hospice

• Services related to the terminal illness of a
  hospice patient cannot be billed as RHC services.
  If the RHC physician is the hospice patients
  attending physician, these hospice-related
  services can be reimbursed by the hospice service
  to the physician. RHC physicians and
  practitioners can bill, as an RHC, only the
  services that are not related to the terminal
  condition of a hospice patient

55
Mental Health

• The beneficiary is responsible for at least 37.5
  percent of the all-inclusive rate for psychiatric
  therapy services. Additionally, the beneficiary
  is responsible for the coinsurance and any unmet
  deductible (for RHCs only) that is based on the
  remaining 62.5 percent of the reasonable charges.

56
Mental Health

• Part 1 - 62.5 limitation
• 1. Multiply the charges for revenue code 0900 by
  37.5.
• Part 2 - Deductible and coinsurance calculation
• 1. Multiply charges for revenue code 0900 by
  62.5 to calculate recognized charges.
• 2. For RHCs, apply any portion of recognized
  charges necessary toward the deductible, if it is
  applicable and has not yet been fully satisfied.
  For FQHCs, there is no deductible obligation
  therefore, this step is not applicable.
• 3. Multiply remaining recognized charges by 20
  to calculate coinsurance.
• Total beneficiary liability for RHCs is 37.5
  percent of revenue code 0900 charges plus 20
  percent of recognized charges (coinsurance) plus
  any unmet deductible (as calculated from
  recognized charges.)

57
Therapy Services

• Face to face therapy encounters that are
  uncharacteristically shorter or less intensive
  than their traditional ancillary service
  counterparts (i.e. typically less than 30
  minutes) will be denied as not medically
  necessary
• Group therapy sessions are not consistent with a
  traditional physician-patient visit, are
  appropriately treated as incidental (cost report
  reimbursable) services, and are not medically
  necessary for the physician/extender level of
  expertise.
• Only one-on-one therapy sessions may be treated
  as face to face visits group sessions are
  covered RHC services and are reimbursed through
  the cost report.

58
Therapy Services

• Cardiac and Pulmonary rehabilitation (CR/PR) are
  NOT therapies In accordance with the Medicare
  benefit structure, these services must be
  provided incident to physician services in the
  outpatient environment, making them cost report
  reimbursable for the RHC. Based on utilization
  patterns in other outpatient environments, up to
  three physician contacts ("face-to-face visits")
  will be considered medically appropriate to
  monitor the course of cardiac or pulmonary
  rehab. 

59
Chiropractic Services

• Chiropractic clinics
• Coverage of chiropractic services is specifically
  limited to treatment by means of manual
  manipulation of the spine for the purpose of
  correcting a subluxation that has been
  demonstrated by x-ray or physical examination.
• The patient must have a significant health
  problem (neuromusculoskeletal condition)
  necessitating treatment,
• must have a direct therapeutic relationship to
  the patients condition and provide reasonable
  expectation of recovery or improvement.
• Once the functional status has remained stable
  for a given condition, further manipulative
  treatment is considered maintenance therapy and
  is not covered.
• chiropractic care must augment (not replace) the
  primary care nature of the RHC.

60
Off Site/Other Services

• Nursing Facilities
• Home Visits
• Domiciliary Visits
• Hospital Visits
• Hospice Visits
• Visiting Nurse Services
• Telehealth Services
• Family Consultations

61
Medical Record Requirements
62
Medical Record Requirements

• Each page of the medical record must be
  assignable to a specific patient by some form of
  identification, either a complete patient name or
  a unique medical record number.
• Each face to face encounter documented in the
  medical record must include the date on which the
  encounter occurred or, in the case of multiple
  visits on a single day, the date and time of the
  visits.
• Each face to face encounter documented in the
  medical record must end with the signature of the
  provider who personally performed the face to
  face visit.
• The provider signature may be appended to the
  medical record in any of several formats, but in
  all cases must be sufficiently unique to allow
  both the provider and Riverbend to determine
  unequivocally at a later date that the provider
  personally affixed the signature

63
AR Management
64
AR Issues

• Common Billing Errors
• Diagnosis Code (ICD-9) problem
• Beneficiary Name/HIC/Sex are incorrect on claim
• MSP issue
• Dates
• Timely filing

65
Billing and Collection Processes

• Tracking all visits
• Tracking all services
• Patient collection activities
• Monitoring payments
• Appealing denials
• Non RHC service AR management

66
AR Management Tips

• Start from the beginning
• Entering demographic info- track errors and
  provide feedback
• Charge entry- check and re-check, trained
  individuals must do this
• Claims submission- daily duties, follow-up on
  electronic submissions
• Daily/Monthly AR follow-up routine

67
AR Management Tips

• Set production goals/minimum expectations for
  working accounts
• Review documentation, meet weekly with team to
  discuss payor issues, errors, new policies
• Track denials, review logs, pinpoint issues
• Automate your processes as much a possible
  maximize that software!

68
AR Management Tips

• Create a system where staff understands these
  concepts and is able to identify issues
• Create a simple system where you can produce
  statistics easily
• Report data in a manner that they can easily
  digest
• Set realistic goals with staff involved

69
AR Management Tips

• Establish monthly meetings with AR staff
• Include front desk representative
• Encourage staff to develop their own solutions
• Reward success

70
AR Management Tips

• Double check demographic data entry
• Review claims prior to submission
• Close the loop with payors
• Verify eligibility and benefits both pre visit
  and retroactively if appropriate
• Submit claims receive payments electronically

71
AR Management Tips

• Talk about AR issues on a routine basis with
  staff and providers
• Ensure that training is occurring appropriately
• Involve the front desk in AR performance
• Collect patient responsibility before they see
  the provider
• Hire the cream of the crop for your AR team
  keep them happy (but do not make anyone
  indispensable)
• Employ written policies and procedures
• Outsource tasks when it makes sense

72
Thank You!

• For further information or questions
• Deborah Holzmark
• Senior Manager
• Dixon Hughes PLLC
• [phone]
• dholzmark_at_dixon-hughes.com