Medical debt collectors frustrated by FCC cellphone ruling

By Beth Kutscher  | August 29, 2015

A new Federal Communications Commission ruling could challenge medical-debt collectors seeking to contact patients on their cellphones.

The FCC this summer issued an interpretive ruling on the decades-old Telephone Consumer Protection Act after a number of petitioners asked for clarity on issues including autodialing, consent to call and reaching wrong numbers, particularly for cellphones.

The petitioners wanted greater flexibility. But the FCC made it clear that the onus is on debt collectors to confirm express consent before autodialing a cellphone. The challenge, debt collectors say, is that the ruling leaves no leeway when a collection agency doesn't know they have the wrong number for someone.

The industrywide order provides some exceptions for appointment reminders and test results. But the FCC “was very explicit” that the exemptions did not extend to bill collection efforts, said Robert Föehl, general counsel at ACA International, the Association of Credit and Collection Professionals.

Medical-debt collectors say they're working quickly to comply with the changes. Penalties start at $500 and can swell to $1,500 for willful violations.

Hospitals need to be aware of the rule changes because they can be held liable even when it is their vendors who fail to comply with regulations, said George Buck, president of Frost-Arnett, a Nashville-based collections company. “The healthcare world is behind the curve when it comes to getting consent,” he said.

Providers must get express written consent to call patients on their cellphones about billing issues.

Despite record-high levels of insurance coverage, a number of health systems are reporting an increase in bad debt as more patients come in with high-deductible plans. Each year, that adds up to millions of calls from healthcare debt collectors.

Parallon Business Solutions, the revenue-cycle management company owned by HCA, has been trying to reduce the number of autodial calls it makes. “We find it makes no sense to dial someone 50 or 60 times,” said Leslie Newman, Parallon's managing counsel.

Still, she described the calls as “highly effective initially”—within the first 20 to 30 attempts.

Many of those unanswered calls go straight to an automated voicemail message that's little more than a recording of a phone number, without a name attached. And that's precisely the situation where debt collectors can now get into trouble.

The FCC allows debt collectors to mistakenly dial a number one time without penalty—but if that call goes to a generic voicemail message, debt collectors have no way of knowing that they're now on the hook for up to $500 per call going forward. “There's a practical problem,” Föehl said. “There's no way to be 100% compliant.”

ACA International immediately filed a lawsuit challenging the interpretive ruling, arguing that it is at odds with Congress' original intent. The group is hoping for a resolution within a year, but until then, the ruling stands, Föehl said.

The growing scrutiny on medical- debt collection practices extends far beyond the Telephone Consumer Protection Act, or TCPA. State and federal regulators have put the healthcare industry on watch, including the Consumer Financial Protection Board, which held a public hearing in December to address the “unnecessary and frustrating challenges” people face after they incur a medical bill.

A study by the board last year found that medical debt accounts for 52% of collection marks on credit reports. Moreover, consumer credit scores overstate the effect of medical debt, even when overdue bills are paid.

The number of TCPA-related lawsuits increased 560% between 2010 and 2014, according to ACA International, citing numbers from WebRecon, which helps debt collectors identify problematic phone numbers.

Medical debt was the reason for 14% of complaints filed with the Consumer Financial Protection Board last December, WebRecon found. And most complaints came from people pursued for debt they did not owe.

The ruling is likely to become increasingly relevant as cellphones replace landlines. Nearly 60% of households are primarily or exclusively wireless, according to a 2014 survey from the Centers for Disease Control and Prevention.

 

http://www.modernhealthcare.com/article/20150829/MAGAZINE/308299969/medical-debt-collectors-frustrated-by-fcc-cellphone-ruling

 

The ICD-10 Training Lab - NueMd

NueMD launched the ICD-10 Training Lab, an online tool that helps healthcare professionals get ready for the ICD-10 transition.
Here are five things to know:
1. The tool has a robust code search as well as numerous training games. The tool has an extensive list of common codes organized by specialty.
2. The tool was developed for medical billers and small healthcare practices, but is available for any healthcare professional looking to expand their ICD-10 knowledge.
3. Creators believe users will find the Code Search to be most beneficial, even after the Oct. 1 deadline. The search has results for both ICD-9 and ICD-10 codes.
4. Code Search additionally can help with difficult conversion scenarios where there is not a clear one-to-one solution.
5. NueMd plans to release new features and fine-tune the search algorithm in the near future.

http://icd10.nuemd.com/icd-10/games/memory   - Click this link and then the specialty of interest to play the memory game that helps you to be more familiar with the codes used in your practice.

The Value of ICD-10

http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_050729.pdf

Think Productively

2016 - ICD-10 CM guidelines

https://www.cms.gov/Medicare/Coding/ICD10/Downloads/2016-ICD-10-CM-Guidelines.pdf

OSHA - Worker's Rights

https://www.osha.gov/Publications/osha3021.pdf

HIPAA--Know your compliance requirements.

Look to the AMA and Website Resources for Updates

http://www.ama-assn.org/ama/pub/dab/hipaa-toolkit-abstract.page
Know your compliance requirements.
HIPAA: Who Must Comply?
Physicians who conduct any of the below named transactions electronically are required to
comply with HIPAA:

 Health Care Claim: Professional
 Health Care Claim Payment/Remittance Advice
 Health Care Claim Status Response
 Health Care Eligibility Benefit Inquiry
 Health Care Services Review Information - Review
 Health Care Services Review Information - Response
Health Care Claim: Professional


2 Accredited Standards Committee
3 Standards for the Additional Information to Support a Health Care Claim or Encounter have
not yet been adopted.

Physicians can also use a tool developed by the U.S. Department of Health & Human Services
(HHS) if
they are unclear whether or not they are a covered entity under HIPAA.

How to “HIPAA” 2.0-Tip # 3: Prioritize Your Compliance Activities
............................................................
Prioritize your compliance requirements.
Understanding targets for compliance
. Federal law
. State law
. Regulatory changes and guidance
. Practice changes

Evaluate current office practices by conducting a gap analysis/risk assessment
. Compliance official – Has someone been given primary responsibility for HIPAA compliance –
including the privacy, security and breach notification requirements?

. Policies and procedures – Do your HIPAA policies and procedures reflect the realities of your
current practice and meet the requirements of current law?

. Patient requests – Is there a documented policy and procedure to handle:
. Medical Record Access, inspection and copy requests – wdhen a patient asks you to
provide the opportunity to review or obtain a copy of the patient’s medical records,
especially requests for electronic PHI copies?
. Disclosure restriction requests – when a patient asks you to limit sharing their medical
information with other covered entities?
. Amendment requests – when a patient asks you to make a change to the information in
the patient’s medical record?
. Accounting of disclosure requests – when a patient asks for a list of everyone who has
come in contact with the patient’s record?
. Confidential communication channel requests – when a patient requests to receive
information in a specific way or at a specific location; for example they request to not be
called at home for an appointment reminder?
. Notice of Privacy Practices (NPPs) – Does your practice maintain and share with your
patients a Notice of Privacy Practices that clearly details how your practice will use and
disclose PHI and your patients’ rights, including their rights to prohibit the sale of their PHI or
its use for marketing purposes, to request privacy protections and amendments to their PHI,
to access their PHI, to receive notice of any breach and to obtain an accounting of
disclosures? If your practice maintains a physical site (as opposed, for example, to being
hospital-based), do you post the Notice of Privacy Practices in a prominent location? If your
practice maintains a website, is your Notice of Privacy Practices posted on the website (also
in a prominent location)? Read more about NPPs in the next section.
. Training – Has all of your staff been trained to comply with your HIPAA policies and
procedures?

Do you periodically provide HIPAA Security training reminders?

AMA provides a host of information designed to help physicians comply with the HIPAA Privacy,
Security and Breach Notification Rules.
http://www.ama-assn.org/go/HIPAA

US Department of Health and Human Services (DHHS) Office of Civil Rights (OCR)
The HHS OCR website contains a wealth of information on the HIPAA Privacy and Security Rules,
including a list serv and a link to the Transaction and Code Sets information posted by CMS.
http://www.hhs.gov/ocr/privacy/index.html

Centers for Medicare and Medicaid Services (CMS)
This link to the CMS website includes information on the Transaction and Code Sets Rule.
http://www.cms.gov/Regulations-and-Guidance/Regulations-and-Guidance.html

Workgroup for Electronic Data Interchange (WEDI)
This is the WEDI website which includes information on EDI in the health care industry, lists of
conferences, implementation information and the availability of resources for standard
transactions. http://www.wedi.org

National Committee on Vital and Health Statistics (NCVHS)
This is the NCVHS website. NCVHS is the Advisory Body to the Department of Health and Human
Services responsible for the HIPAA Transaction and Code Set Rule. Information on membership,
how to contact the committee, announcements and agendas for past and future public hearings is
also available. http://www.ncvhs.hhs.gov

Medicare This is the Medicare EDI Web page. Here you will find information regarding Medicare EDI, advantages to using Medicare EDI, Medicare EDI formats and instructions, news and events, frequently asked questions about Medicare EDI, and information regarding Medicare paper forms and instructions.
http://www.cms.gov/Medicare/Billing/ElectronicBillingEDITrans/index.html

Fraud Prevention Fact Sheet -CMS link

http://www.cms.gov/Medicare-Medicaid-Coordination/Fraud-Prevention/Medicaid-Integrity-Education/Downloads/ehr-providerfactsheet.pdf


A list of EHR challenges addressed in the above link which provides a list of many other links associated with this important topic.

E/M Documentation Guidelines from the Medicare Learning Network

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/eval_mgmt_serv_guide-ICN006764.pdf

Evaluation and Management Services Guide

Denial Management –A Review of the Reasons Given and the Steps Taken To Obtain Reimbursement.

 E/M Denial Management

Was the consult code billed either denied or changed to lower E/M level?

 What Documentation Is Required?

In order for an E/M service to be considered a consultation, the following criteria must be met and documented:

A request for a consultation, along with the reason for a consultation, must be documented by the consultant in the patient's medical record and included in the patient's medical record of the referring practitioner.

An opinion is rendered by the consulting practitioner. This opinion, along with any other service provided, is documented in the patient's health record.

A written report of the consultant's findings and opinion or recommendation is communicated back to the requesting practitioner. This report is known to include a thank-you letter for the consultation request and state exactly what the consultant's opinion is concerning the patient's medical problem.

CPT Assistant, July 2007 indicates that “there may be circumstances when a consultation is initiated by sources other than a physician, such as a physician assistant, nurse practitioner, doctor of chiropractic, … social worker, lawyer, or insurance company.” This helps to explain who can be considered another provider or healthcare entity. Reporting a consultation would be appropriate if the service was at the request of one of these professionals. -

Documentation is the key to getting paid for the consult done.

 It is a lack of proper documentation that leads to a carrier determination to downcode consultation codes to a lower E/M level of service or completely deny payment.

If you documented a consult properly and still received a downcode, appeal it immediately and attach the report made out to the referring physician.
Don't settle for the downcode amount when a consultation has been performed. Appeals that show full proof of the consultation performed will be reconsidered by the insurance carrier for the full payment due.

 

Spotting denial patterns can be an effective way of managing the denial issues that have affected reimbursement.

 Additional information was not sent in as requested from the carrier. Electronic submission of claims expedites the processing of payments for bills submitted in this format, however, certain codes will need to be submitted with clinical documentation records for carrier review. If the insurance carrier doesn’t receive the information requested within their allowable time frame, your claim remains denied. Review policy guidelines to know the time frames.

Some insurance carriers have a software program that are unable to recognize modifier usage.  If you have billed for another service during a post op surgical time frame, denials are issued because the carrier software program doesn’t recognize the modifier placed on your line charge. Often an online appeal or telephone appeal can clear this up. Should the insurance carrier request a written appeal for payment reconsideration, have a form prepared that you can easily type in the information or fill in. Fax or mail it out immediately.  

 High Deductible Amounts: More insurance plans are placing greater financial responsibility on the patient. This denial is more common. Advising the patient ahead of time can bring awareness to the patient and the opportunity to set up a payment plan. 

 Incorrect modifier usage- Depending on the carrier, some modifiers may or may not be acceptable when placed on a charge line submitted electronically. Check with the guidelines of the insurance carrier regarding claim submissions with modifiers. Also, the line charge on your submitted claim may have been missing a modifier. Review the billing and send in a corrected claim with the modifier attached to the denied charge.

 Data entry errors made by the insurance carriers for the codes billed and submitted by your practice. This happens more often than you think. And with ICD-10 in mind, this may become a more common denial on both the biller’s end and the carrier’s end since the codes are longer and contain both letters and numbers. Review the written denial carefully line by line for the codes submitted and compare it with the denial explanation sent to you and sometimes it is a simple data entry error that caused the denial.

 Provider not credentialed: If there were new physicians added to your practice but they are not yet credentialed or participating with the same insurance plans your practice is part of, contact your credentialing department to resolve this issue.

Certain codes cannot be billed to specific carriers. One example of this is the consultation codes. Check all your insurance company guidelines and let your billers know what insurance carriers do not accept consult codes.

 Claim Not On File

Send in your proof of a submitted claim to the carrier and call them as well. Get the names of the representatives you spoke to, advise them you are sending proof of submission which can be in the form of a copy of your electronic submission report of the claim and this time send it signed return receipt to the carrier for the claim. Document all “claim activity follow up” in a log regarding all actions to get this claim paid. Follow up with the carrier once your signed return receipt card is back on file with you. Most of the time this is enough proof to have the denied claim paid but sometimes it isn’t and then it becomes a matter that can be addressed with your state insurance department. Send in copies of your call log activity that includes the names of the people you spoke to at the insurance company and your proof of claim submission for all the times the claim was submitted. The State Insurance Department can be of great assistance with this kind of issue as well as other issues if a claim is unfairly denied.

 

No Coverage – Your office staff verified active coverage for the patient prior to medical services rendered but the denial states “no coverage”. This denial happens when the premium has not been paid by the patient. It is now patient responsibility.

 Build a bridge where you can and establish a good rapport with the insurance company representatives.

Phone communications go along with payment review considerations. If an appeal has been sent to the insurance carrier on their website or mailed in, there should be phone contact to follow up and make sure your paperwork was received. Good communications often lead to good results. Get to know the claim representatives name and contact number. Establishing contacts and building relationships with representatives at the companies you contact, can help expedite the appeal process of your claims.

 Claim Tracking Reports

 Your medical billing software program should be able to run reports on specific codes or for insurance carriers to see why you aren’t being properly reimbursed for the medical services provided. A dedicated staff in your billing department should be able to help identify and address the denials that come in.  All denial management actions should be documented and addressed with the carrier as soon as possible because of time frame limitations set within the policies of the insurance companies. Most denials can be turned around if the denial reasons are understood and acted upon immediately. Delay leads to more delay so one of the keys to obtaining reimbursement after a denial is issued is to act fast when it is known why the denial was placed on your claim.

 

Julie Pisacane, CCA, CPMA, CEMC            7/16/15

 

 

 

 

 

Road to 10 - What Is Different

http://www.roadto10.org/whats-different/


Click link for full article .

Important Changes to Note in ICD-10-CM:

• Importance of Anatomy: Injuries are grouped by anatomical site rather than by type of injury
• Incorporation of E and V Codes: The codes corresponding to ICD-9-CM V codes (Factors Influencing Health Status and Contact with Health Services) and E codes (External Causes of Injury and Poisoning) are incorporated into the main classification rather than separated into supplementary classifications as they were in ICD-9-CM
• New Definitions: In some instances, new code definitions are provided reflecting modern medical practice (e.g., definition of acute myocardial infarction is now 4 weeks rather than 8 weeks)
• Restructuring and Reorganization: Category restructuring and code reorganization have occurred in a number of ICD-10-CM chapters, resulting in the classification of certain diseases and disorders that are different from ICD-9-CM
• Reclassification: Certain diseases have been reclassified to different chapters or sections in order to reflect current medical knowledge

OIG Healthcare Compliance Plan -Seven Components - Federal Register

http://oig.hhs.gov/authorities/docs/physician.pdf

Self-Audits Are Worth the Effort

Self-Audits Are Worth the Effort

by Peggy Stilley, CPC, CPC-I, COBGC
Conducting a baseline audit of your practice—and taking proactive action to correct and prevent coding, billing, and other compliance shortfalls—does require a considerable effort. But however painful that process may be, it almost certainly will be less stressful and costly than finding yourself under the microscope of a payer audit, unprepared and unsure of what the audit may turn up.
Peace of mind has tremendous value. Audits verify that the provider’s documentation meets applicable guidelines, and that he or she is reporting the appropriate level of service for services provided. When a provider understands E/M documentation guidelines and practices compliant documentation there will be less risk for error and concern.
Audits look for a medical record to be complete and compliant for patient care. If the standards of care are not documented, it could leave the practice vulnerable. To ensure the records are complete and compliant, determine:

• Did the patient sign all the necessary forms and consents?
• Did the physician document risks and benefits of recommended treatments?
• Did the service need an order?
• Is the procedure note adequately documented?
• Did the physician sign the record?
• Did the patient sign an ABN (advanced beneficiary notice)?

Auditing may uncover services billed but not documented in the patient record. Documentation that lacks pertinent information and is inadequate for services billed is indefensible. On the positive side, comparing documentation in the medical record to the billing ticket could identify services performed that weren’t charged; avoiding lost revenue.

Whatever issues are identified, you’ll want to educate providers and staff, and to develop protocols to prevent future errors. This is far more productive than sitting back, waiting for a payer audit to result in mandatory action.

Business Associates Under the HIPAA Privacy Regulations

http://library.ahima.org/xpedio/groups/public/documents/ahima/bok3_005270.hcsp?dDocName=bok3_005270

Click above link for full article.

Identifying Your Business Associates Under the HIPAA Privacy Regulations by Michael C. Roach, JD The HIPAA privacy regulations require that covered entities have written agreements in place before disclosing protected health information (PHI) to business associates.1 The regulations also require specified provisions be included in business associate agreements (BAAs).2 Most likely none of your existing BAAs satisfy all of the requirements of the regulations. Consequently, you need to locate all of your existing agreements with business associates and start amending those agreements. It is important to understand who is and who is not a business associate, because only BAAs need to be amended. A business associate is an entity that on your behalf, performs or assists in the performance of: (1) any of the following, if it involves use or disclosure of PHI: • Claims processing or administration; • Data analysis; • Processing or administration; • Utilization review; • Quality assurance; • Billing; • Benefit management; • Practice management; or • Repricing;

World Health Organization ICD10 Online Training Tool

http://apps.who.int/classifications/apps/icd/ICD10Training/

Orthopedics Powerpoint presentation for ICD-10 Coding for surgery and fracture care

http://www.powershow.com/view/7e1d2-ZWEyY/Orthopedics_powerpoint_ppt_presentation

Coding Topic - Consult Downcoded to a lower E/M level ?

http://nfclaims.blogspot.com/2013/10/coding-tip-consult-downcoded-to-lower.html

Coding Topic - Consult Downcoded to a lower E/M level ?

What Documentation Is Required?

In order for an E/M service to be considered a consultation, the following criteria must be met and documented:

• A request for a consultation, along with the reason  for a consultation, must be documented by the consultant in the patient's medical record and included in the patient's medical record of the referring practitioner.
• An opinion is rendered by the consulting practitioner. This opinion, along with any other service provided, is documented in the patient's health record.
• A written report of the consultant's findings and opinion or recommendation is communicated back to the requesting practitioner. This report is known to  include a thank-you letter for the consultation request and state exactly what the consultant's opinion is concerning the patient's medical problem.

CPT Assistant, July 2007 indicates that “there may be circumstances when a consultation is initiated by sources other than a physician, such as a physician assistant, nurse practitioner, doctor of chiropractic, … social worker, lawyer, or insurance company.” This helps to explain who can be considered another provider or healthcare entity. Reporting a consultation would be appropriate if the service was at the request of one of these professionals. -

Documentation is the key to getting paid for the consult done.

 It is a lack of proper documentation that leads to a carrier  determination  to downcode  consultation codes to a lower E/M level of service.

If you documented a consult properly and still received a downcode, appeal it immediately and attach the report made out to the referring physician.  Point out to the carrier the referring physician requesting the consultation, the report on record and the rendered opinion given from the physician performing the consultation.

Don't settle for the downcode amount when a consultation has been performed.Appeals that show full proof of the consultation performed will be reconsidered by the insurance carrier for the full payment due.



Julie Pisacane, CCA, CEMC

Member of AHIMA and AAPC

http://news.aapc.com/aapc-certification-matters-to-me/

AAPC Certification Matters to Me

• By Renee Dustman
• In Healthcare Business Monthly Archive
• April 1, 2015        

by Julie Pisacane, CPMA, CEMC

I’ve never been more confident in the work I do.
My career in the healthcare office began many years ago, working for an orthopedist while I was in high school. I liked working there; and to this day, it’s my home away from home. I now work for a growing multi-specialty practice in a supervisory position. I’m accountable for reviewing claims before they are submitted, checking documentation against billed charges, and collecting on aging delayed or denied claims.
Education Is Key
Times are changing and it’s becoming more difficult to obtain reimbursement from insurance carriers that deny claims for so many different reasons. A few years ago, I wanted to know if an insurance carrier was correct in down-coding an evaluation and management (E/M) visit. I was told by a supervisor to just use my judgment. Well, “my judgment” told me to get educated on the matter so I would have confidence in making such determinations. Lucky for me, an AAPC-certified coworker pointed me in the right direction.
AAPC has been an extremely helpful resource for my coding, compliance, auditing, and revenue management needs. My AAPC certifications have put me in a much better position to help other billers and supervisors review claims that need a little more attention.
Learn Proper Billing
for Success and Confidence
I earned two certifications over the past two years: Certified Professional Medical Auditor (CPMA^®) and Certified Evaluation and Management Coder (CEMC™).
I had to take the CEMC™ exam twice, but it was worth it. My appeals on improper payments and denied claims are successful because I learned what I needed to know about modifiers and E/M levels. I have a better understanding of the system in place for proper E/M coding, which seems like a gray area at times. Earning my CPMA^® taught me rules, regulations, and knowing exactly what to look for when auditing a medical record.
Now, when others turn to me with billing or auditing questions, I can readily provide an answer with confidence.
Next Stop Is ICD-10
I’m preparing for the ICD-10 proficiency exam. I have no doubt AAPC’s materials, webinars, and resources will help me to better understand ICD-10 and pass the exam.

---

Julie Pisacane, CPMA, CEMC, is employed as the collections team leader of the No Fault Department at Orlin & Cohen Orthopedic Group, and is a member of the Nassau County, New York, local Chapter.

Two Words

Two Words

 

Specificity and Necessity

2015 brings new changes to the billing practices of private healthcare offices and hospitals throughout the nation.  Two words now commonly heard and addressed at professional medical conferences are specificity and necessity. They are the key words closely linked with education and implementation of ICD-10.   Most practices should have helped to prepare their staff with training and books by now to learn more about these upcoming changes, but it doesn’t end there. Individuals who believe the training began and ended with a few meetings and a little reading on the subject may find themselves overwhelmed and unprepared if they do not continue to educate on their own time taking the additional steps needed to understand why ICD-10 is being implemented.

 

Changes and Challenges

Changes and challenges open up the doors to education and growth. Both can be met with positive action. All departments have staff that can be motivated to contribute their knowledge, skills and talents so that all can embrace the changes that are right around the corner.

Challenges can be embraced by those who understand the important changes ICD-10 brings to the areas of billing and documentation requirements.  Just about every department of the medical practice plays an important role in reimbursement. Staff at the front desk handling referrals and authorizations need to have an awareness of the upcoming changes. Billers and coders should already be prepared with the new way the ICD-10 book is designed for code look up and how conditions are billed.

 Before and After

Now is the time to open up communications to make sure everyone understands what is needed as of October 1, 2015. Specificity and necessity must be established in billing and clinical documentation. Medical managers can cultivate a more positive outcome for proper reimbursement of all submitted medical claims if they are motivating their staff to be more knowledgeable and supportive of the upcoming changes.  Working hard before ICD-10 is implemented will pay off after October 1, 2015 for those who took the necessary steps to understand that this new coding system is more than just updating record templates and software.

 

Two Questions

1.      Who is still in need of training regarding anatomy and clinical documentation at your practice?

2.      Is the financial health of your healthcare organization at risk due to a lack of preparedness?

These are  two questions that should lead to more questions in any professional health care setting and answered   as soon as possible so that the road to compliance and proper reimbursement will be a well paved one for your practice.

The final two words that we have often heard before many critical situations- Be Prepared.