Referrals from physicians and allied health partners is the absolute best way to ensure a viable practice. It is not only the most cost effective method in obtaining new patients, the patients already arrive mostly pre-qualified for both symptoms and insurance. I am frequently told, however, that lunch-and-learns and similar processes have not worked in […]
Timely – Applies to More than Claims Submission
What exactly is Timely? In the medical world this word is thrown around quite a bit. The definition of timely is done or occurring at a favorable or useful time; opportune.This can relate to a patient’s planned treatment, the creation of a chart note, the transfer of records to another physician, or it can refer […]
Novitas Claims Processing
Another brief note on a payer making unilateral or non-notified changes. Novitas’ current yet confusing policy notes that ancillary veins and perforators may be treated. What they do not spell out is how many ablations will be allowed per patient. The claims payment edits in Novitas currently allow only four ablations – even if they […]
Anthem Rate Changes
Like many payer contracts, Anthem’s has a clause that allows them to do a unilateral amendment to the agreement with proper notice. They have been exercising that clause to amend a number of contractual items recently. Of significant note has been ablation specific/targeted reimbursement rates. Needless to say the rates do not constitute an increase. […]
Sustainable Growth Rate Repealed, ICD-10 Coming
At the eleventh hour the senate passed the Medicare Access and CHIP reauthorization bill which repealed the almost twenty year old Sustainable Growth Rate formula. The bill has been placed on President Obama’s desk for final signature which is expected. Medicare will begin processing held Medicare claims today, April 15th, and some of these claims […]
Where X and Y Meet
I am frequently asked at what level of activity a practice will be profitable. Bruce Sanders, Executive Director of the ACP and I had this conversation at the AVF just recently. While this is a bit of a loaded question because I typically have no idea what a practice’s expenses are, I do have a […]
Documentation Scrutiny Comes With New Technology
With the advent of new treatment options being approved by the FDA, practices are finding their documentation under more scrutiny than previously experienced. This has caused some unforeseen and sometimes surprising results. When sending claims for an unlisted procedure code for a service that has no defined guidelines, some internal protocols should be implemented. Knowing […]
Experiences With Varithena
Recent experiences with Varithena claims have produced results we felt would be interesting to the venous community, so we thought we would share. As noted in a previous article by AJ Riviezzo, the claims have paid with some inconsistencies. We have since submitted a larger sample of claims and here are our findings. There have […]
PQRS Quick Information for Phlebology Practices
In order to participate for calendar year 2014 you must register by 01/30/15 and report by 02/15/15. If you qualify for one of the Measures Groups you must report on at least 20 patients. However, if you do not meet one of the 25 Groups (and most Phlebologists do not) then you must report on […]
Medicaid as a Payer?
With the cuts in reimbursement, increasing preauthorization requirements, and various government hoops to jump through; do you really want another payer with ‘hoops’ and poor reimbursement? The answer is a definite maybe. If your practice is already experiencing a wait time for treatment, then the answer is most assuredly a no on Medicaid. However, if […]