http://www.hmetalk.com/forum/blogs/andreastark/ HmeTalk Description en Thu, 09 Feb 2012 14:18:50 GMT vBulletin 60 http://hmetalk.com/forum/images/misc/rss.jpg http://www.hmetalk.com/forum/blogs/andreastark/ http://www.hmetalk.com/forum/blogs/andreastark/19-look-year-ahead-legal-reimbursement-changes-dme-2011.html Wed, 15 Dec 2010 16:42:10 GMT *Webinar: A Look at the Year Ahead: Legal and Reimbursement Changes for DME in 2011* DME consultant Andrea Stark of MiraVista and healthcare... Webinar: A Look at the Year Ahead: Legal and Reimbursement Changes for DME in 2011

DME consultant Andrea Stark of MiraVista and healthcare attorney Jeff Baird of Brown and Fortunato are teaming up to prepare suppliers for the legal and reimbursement changes ahead.

The two industry experts will be holding a joint webinar on January 11, 2011. Two time slots are available: 11am & 3pm EST.

On the agenda:

• The Power Wheelchair Purchase Option
• Operational and Regulatory Requirements in 2011
• Future DMEPOS (Re)Enrollment Changes
• Competitive Bidding Updates
• Andrea's Audit Outlook
• Legal Advice from Attorney Jeff Baird
• And Much More!

Educate your employees, remain profitable and avoid unforeseen potholes. Get prepared for the reimbursement and legal changes ahead by participating in this webcast!

Added Bonus: Take advantage of a live Q&A session with both presenters!

Seats are limited – Register Now!
Cost is $99 per conference line.
]]> AndreaStark http://www.hmetalk.com/forum/blogs/andreastark/19-look-year-ahead-legal-reimbursement-changes-dme-2011.html http://www.hmetalk.com/forum/blogs/andreastark/17-new-live-webinar-respiratory-updates-vital-your-business-oxygen-cpap-rad.html Wed, 15 Sep 2010 17:52:38 GMT Respiratory Updates Vital to Your Business: Oxygen, CPAP and RAD

Sep-Thu-30-2010
11:00am & 3:00pm EST

This webinar is co-hosted by:


2010 has been a year of change for oxygen, CPAP and RAD suppliers. With revised LCDs, special payment rules under Competitive Bidding, limited maintenance payments and increased audits, respiratory suppliers have had more than their fair share of changing reimbursement guidelines and new regulations. Have you kept up with them all?

Join Andrea Stark for this informative webinar and ensure your respiratory business is operating in compliance with the Medicare program.

Andrea will start the course by providing answers to some of the most frequently asked oxygen, PAP and RAD questions, including:

Oxygen
* When can I bill for maintenance payments, and what do I have to do to justify the claims?
* Which oxygen modalities/equipment qualifies for content payments, and when can I start billing for them?
* Which situations qualify for a new 36-month rental period?
* What are my obligations if an oxygen patient moves or travels outside of my service area?

CPAP & RAD
* Who can conduct the required re-evaluation of a CPAP or RAD patient?
* What is considered compliant usage of a CPAP or RAD, and how must compliance be documented?
* What are my options if a CPAP or RAD patient is not re-evaluated within 90-days of initiating therapy?
* What if the patient fails their second CPAP trial?

Andrea will conclude the session with the latest respiratory billing updates issued by CMS, including:

* Clarifications to Oxygen Maintenance Payment Regulations
* Proposed Changes to the 36-Month Oxygen Payment Rule
* New Documentation Requirements for CPAP to RAD Upgrades
* How Competitive Bidding will impact Oxygen, PAPs and RADs

Attendees will be able to submit questions throughout the course and time will be allotted to ask live questions at the end of the event.

Seats are limited. Online registration will be available until 11:59pm on 9/29/10 or until each session is full.

Cost is just $99 per conference line. To register, visit: Mira Vista. ]]> AndreaStark http://www.hmetalk.com/forum/blogs/andreastark/17-new-live-webinar-respiratory-updates-vital-your-business-oxygen-cpap-rad.html http://www.hmetalk.com/forum/blogs/andreastark/16-hme-news-tv-andrea-stark-speaks-preparing-audits.html Mon, 13 Sep 2010 19:21:04 GMT *Audits,...]]> HME News TV: Andrea Stark Speaks on Preparing for Audits

Audits, audits and more audits. They’re looking for any reason to deny your claim. Here’s how to protect yourself.


Go here to see the video interview: http://www.hmenews.com/video.php?cat_id=2&v_id=175. ]]> AndreaStark http://www.hmetalk.com/forum/blogs/andreastark/16-hme-news-tv-andrea-stark-speaks-preparing-audits.html http://www.hmetalk.com/forum/blogs/andreastark/15-cms-implements-restrictive-enrollment-regulations-business-hours-location-operatio.html Mon, 13 Sep 2010 19:17:31 GMT Effective *September 27, 2010* DMEPOS suppliers looking to enroll or re-enroll in the Medicare program will face enhanced scrutiny from the NSC and... Effective September 27, 2010 DMEPOS suppliers looking to enroll or re-enroll in the Medicare program will face enhanced scrutiny from the NSC and CMS officials. On top of surety bond and accreditation requirements, CMS has issued a Final Rule, which implements several additional licensure and business operation requirements.


Some of the new requirements in the rule include:

• Suppliers of products that require a license in their state must have a certified W-2 employee on staff. (There are two exceptions to this rule.)
• Suppliers must maintain a physical facility on an “appropriate site” (as defined in the Final Rule) with access to the public.
• Suppliers may not use a cell phone, beeper or pager as their primary business phone.

Additional regulations within the rule also limit which vendors oxygen suppliers may use to obtain oxygen and restrict the circumstances under which a supplier may contact a patient.

DMEPOS consultant Andrea Stark has reviewed all of the regulations in the Final Rule and will be holding a detailed webinar to clearly explain what suppliers can expect on October 8, 2010 at 2:00pm EST. For more information, or to register for the event, visit the Seminars/Webinars page of our website. ]]> AndreaStark http://www.hmetalk.com/forum/blogs/andreastark/15-cms-implements-restrictive-enrollment-regulations-business-hours-location-operatio.html http://www.hmetalk.com/forum/blogs/andreastark/13-claravista-asks-cms-convert-pecos-pdf-excel-problem-solved.html Mon, 28 Jun 2010 15:05:23 GMT *ClaraVista Asks CMS to Convert PECOS PDF to Excel – Problem Solved!* (http://www.miravistallc.com/blog) “All I had to do was ask. After a bit... ClaraVista Asks CMS to Convert PECOS PDF to Excel – Problem Solved!

“All I had to do was ask. After a bit of back and forth, they put the PECOS physician list in a CSV format for everyone to download.” - Maureen Bacon, Controller, ClaraVista.

That’s right. Problem solved! CMS has finally uploaded a list of PECOS enrolled physicians in a useable CSV format. Unlike the previous PDF version, the CSV file will open in Excel or Notepad and can be easily imported into Access. This allows users to quickly sort, filter and search the data with a click of the mouse.

“This is a huge breakthrough,” said Bacon, “We tried to convert the massive PDF to a CSV file on our own, but even with dual core processors and a T3 internet connection, it proved to be painfully slow and my computer system all but grinded to a halt during the process.”

Bacon said the final straw came after she converted 3,700 of the 13-some-odd-thousand PDF pages, and then lost it all to a system error.

”I waited 3 hours to get less than a third of the way through and then lost everything,” said Bacon. “I knew I wasn’t the only one having this problem, and I wanted to find a solution that would help us, our billing clients and anyone else who needed a better way to search for physicians in PECOS.”

Thanks to Google and a bit of ingenuity, Bacon located an early transmittal issued by CMS that parsed out responsibilities for implementing the PECOS edits.

“I found a release that contained the names and e-mail address of two of the people put in charge of creating the PECOS file,” said Bacon. “I sent them an e-mail explaining the problems I was having with the PDF and asked them if they could convert the file into a more user friendly spreadsheet.”

Believe it or not, Bacon received a response just thirty minutes later.

Initially, Bacon was advised to independently convert the PDF to text or use the search function to look up the physician’s NPI.

“It was clear to me that they didn’t fully understand how long it takes to search 13,000 pages for hundreds of physicians in a PDF file,” said Bacon. “So I gave them an NPI from the last page and asked them to start at page one and search for it; just so they could see how long it takes for themselves.”

And it looks like that did the trick!

Less than 24 hours after her last correspondence with CMS officials, a new ZIP file was posted for download at:
http://www.cms.gov/MedicareProviderSupEnroll/06_MedicareOrderingandReferring.asp.

The ZIP contains a CSV version of the PECOS file, which lists all 687,819 physicians currently enrolled in the system.

But Bacon doesn’t credit herself alone for the breakthrough.

“I didn’t do this one on my own,” said Bacon. “There have been many people before me, including Medicare contractors and industry organizations, who have asked CMS to put the PDF in a better format. I guess I just happened to contact the right people at the right time.”

Lucky us.

We’d like to offer a special thanks to CMS for listening to our concerns and being so responsive on this issue. ]]> AndreaStark http://www.hmetalk.com/forum/blogs/andreastark/13-claravista-asks-cms-convert-pecos-pdf-excel-problem-solved.html http://www.hmetalk.com/forum/blogs/andreastark/12-using-excel-harness-power-data-management-revitalize-your-ar.html Thu, 17 Jun 2010 18:47:04 GMT As a consultant working in the reimbursement sector of the DME industry, I routinely visit clients to perform assessments of their accounts... As a consultant working in the reimbursement sector of the DME industry, I routinely visit clients to perform assessments of their accounts receivable (AR) departments. Like most business owners, these DME suppliers are looking for ways to create a more targeted workflow and improve billing efficiencies. While each case is unique and each client faces their own individual challenges, the one thing I’ve consistently found is that the majority of DME suppliers are underutilizing a valuable tool almost every one of them has at their disposal: Microsoft Excel.

I can’t tell you how many times I’ve met with a client frustrated with the limitations of their current billing software. True, most commercially available software can create standard AR reports (i.e. an Accounts Receivable By Payor report), which aggregate tens-of-thousands of records and provide an agreeable snapshot of current AR standings. However, these reports give little guidance on the type of information many business owners and billing managers base decisions on, such as quality of sales, effectiveness of collections or the cause of recurring problems. But with Microsoft Excel, this is exactly the type of information you can extract.

With a little know-how, suppliers can use Excel to: export and manipulate large quantities of raw data, analyze data to evaluate performance and problem areas, and easily map information that would otherwise have to be manually looked up and entered.

In just a moment, I will provide a few examples of how our DME billing company, ClaraVista, utilizes Excel to produce targeted results with little effort. However, I know it will not do any good if you are unable to take this information and apply it to your own business. That’s why we’d like to go beyond just telling you what you should be doing and actually show you how to do it.

On Wednesday, June 23, 2010, MiraVista will be holding a live Excel webinar tutorial, entitled: Maximizing AR Efficiencies through Excel: Your Receptionist or Delivery Tech Could be Your Best Data Analysts and we encourage you to come!

During our Excel Webinar, Derrick Stark CPA, CVA,will use sample reports relevant to the DME industry to show you how to fully utilize the program to strategically analyze, sort and format data in your own sales, collections and AR reports. Attendance is being offered at a discounted rate of just $49 and seats are limited to the first 50 participants. More information and registration is available at: http://www.miravistallc.com/recent_services.php.

With that said, let’s move on to some examples of how we use Excel at ClaraVista:

Average Age of Claims By Procedure Code
As our account managers are combing through vast amounts of AR data, it is helpful for them to analyze collection trends in regards to certain procedure codes. For example, if we see average times increasing, it may indicate: a problem with a specific client’s procedures for providing the service, a processing issue with a specific insurance company, or an increased level of scrutiny by the payor. We also use this analysis as a monitoring component to our own quality control protocol.

We start, by exporting our data to Excel and sorting it by procedure code. We then use Excel to quickly calculate the average age of claims by each procedure code. By running this query over subsequent months and comparing the results, we are able to identify the trends which our staff should focus on to perpetually improve collection results.

Mapping
Another great feature of Excel is that it allows you to easily map information that would otherwise have to be manually looked up and entered. For example, based on standard prefixes associated with Blue Cross/Blue Shield policy numbers, Excel can determine the appropriate Blue payor (e.g. Blue Cross of Alabama, Blue Shield, etc).

At ClaraVista, we maintain a spreadsheet in Excel that correlates standard policy number prefixes to specific payors, and input all of our transactional data, including policy numbers, in a separate spreadsheet. We then have Excel lookup the proper payor based on our Prefixes spreadsheet and identify any records where an incorrect payor is being billed (based on the policy number). The results allow our billing staff to quickly identify any claims that are not paying due to data entry errors related to the payor information.

Missing/Expired Authorization Analysis
We also use Excel is to avoid denials related to missing or expired authorizations. Through a series of simple formulas, we can quickly create custom reports that identify those patients for which there is no authorization at all or the expiration date expires within the next 90 days. This data allows us to generate quick work lists for maintaining current authorizations.

You Too Can Benefit From Excel!
With fee schedule cuts across the board, tighter payment regulations and ever changing policies, you have to maximize your resources and harness the power of data management. All billing software programs are built on database platforms, and most allow for some level of data export. By understanding how to organize exported raw data and manipulate it in Excel, you can produce strong returns on a modest effort. ]]> AndreaStark http://www.hmetalk.com/forum/blogs/andreastark/12-using-excel-harness-power-data-management-revitalize-your-ar.html http://www.hmetalk.com/forum/blogs/andreastark/11-live-dme-webinars-signature-requrements-ar-efficiencies.html Tue, 15 Jun 2010 14:08:29 GMT

Time is running out to attend these events!

]]> AndreaStark http://www.hmetalk.com/forum/blogs/andreastark/11-live-dme-webinars-signature-requrements-ar-efficiencies.html http://www.hmetalk.com/forum/blogs/andreastark/9-cms-implements-12-month-timely-filing-limit-effective-january-1-2010.html Tue, 11 May 2010 20:41:54 GMT May 11th, 2010
If you are one of the suppliers who attended Andrea’s The Impact of H.R. 3590 on DME: How the New Healthcare Bill Affects You! webinar, or you’ve subscribed to our RSS feed and are a regular reader of MiraVista's blog, then this news will come as no surprise to you. If you’re not… then listen up!

On May 7, 2010, CMS released MLN Matters® MM6960, which reduces the timely filing limit for all Medicare claims (including all DMEPOS) to 12-months from the date of service. The 12-month timely filing limit is being implemented in accordance with provisions in H.R. 3590, the recently signed Patient Protection and Affordable Care Act (PPACA), and is effective retroactive to January 1, 2010.

The new 12-month time limit and retroactive effective date are important to DME suppliers for two reasons:
1. Claims with dates of service from October 1, 2009 through December 31, 2009 will be denied as past timely filing if received after December 31, 2010.
2. Claims with dates of service on or after January 1, 2010 will be denied as past timely filing if received more than 12-months after the service date.

In other words, you only have until the end of this year to submit any claims dated back through October of last year, and your claims for January 2010 and beyond will start denying as past timely filing within 12-months of their service dates… starting January of next year!

Because CMS has stated that claims must be “received” within 12-months, rather than submitted, you must be sure to submit your claims early enough for them to be delivered (either electronically or via postal mail) within the 12-month deadline. Per CMS, contractors will generally use a claim’s “From” date as its date of service. In cases where claims require service dates for each line item, the line item’s date will be considered the date of service.

Currently, CMS has only specified one circumstance or “exception” to the timely filing rule. In the event that a Medicare contractor, agent or employee makes an “error or misrepresentation” when handling your claim that causes it to be received late, it will not be denied for timely filing.

The PPACA does grant CMS the authority to specify additional exceptions to the 12-month filing deadline; however we do not expect there to be many, if any at all. ]]> AndreaStark http://www.hmetalk.com/forum/blogs/andreastark/9-cms-implements-12-month-timely-filing-limit-effective-january-1-2010.html http://www.hmetalk.com/forum/blogs/andreastark/8-pecos-npi-updates-complete-rejections-expected-decline.html Mon, 18 Jan 2010 18:49:56 GMT By: Andrea Stark, DME Consultant and Reimbursement Specialist - MiraVista, LLC (http://www.miravistallc.com) Finally! There’s good news for... By: Andrea Stark, DME Consultant and Reimbursement Specialist - MiraVista, LLC

Finally! There’s good news for providers worried about the number of PECOS warning messages on their GenResponse Reports. In a statement released today, CMS announced that they have completed a systematic update of the PECOS system, in which NPIs have been added to the enrollment records of all physicians / non-physician practitioners.

Many physicians were added to PECOS prior to May 2008, when the NPI became a mandatory identifier. Because the new claim edits look for a physician’s NPI first, these incomplete records have been firing warning messages identical to the problem physicians who had no PECOS record at all. Until now, providers had no way of telling whether a flagged physician just needed to update their information or go through the entire PECOS enrollment process, based on the warnings alone.

Now that the NPI update is complete, suppliers should see a definite decrease in the number of C200, C201 and C202 warning messages on their GenReports. However, this does not negate the need for action. Unless there is an uncorrected spelling or NPI error in your billing software, these physicians must be educated on the PECOS edits and complete enrollment prior to April 5, 2010, or your claims will result in rejections.

CMS has also promised to release an internet-based tool that will allow providers to scrub a physician’s NPI against those listed in the PECOS database. The tool will be made available prior to the start of rejections (currently scheduled for April 5, 2010); however no specific release date has been provided. ]]> AndreaStark http://www.hmetalk.com/forum/blogs/andreastark/8-pecos-npi-updates-complete-rejections-expected-decline.html http://www.hmetalk.com/forum/blogs/andreastark/6-bill-eliminate-competitive-bidding-gains-sponsors.html Wed, 06 Jan 2010 20:51:43 GMT H.R. 3790, a bill to eliminate the Competitive Bidding program now has 118 co-sponsors. H.R. 3790 was introduced by Rep. Meek (D-FL) on October... H.R. 3790, a bill to eliminate the Competitive Bidding program now has 118 co-sponsors.

H.R. 3790 was introduced by Rep. Meek (D-FL) on October 13, 2009 and has been dubbed the Meek Bill. If passed, the bill would effectively repeal the Competitive Bidding program and terminate the contracts of any bid winners.

To keep itself budget neutral, H.R. 3790 proposes two separate cuts in the consumer price index. The first cut of -0.25% would affect all DME except for Group 3 complex wheelchairs from 2010-2012. A second cut of -0.5% would then occur in 2015 (Group 3 wheelchairs would again be exempt).

MiraVista, LLC
PO Box 11544
Columbia, SC 29211
Phone: 803.462.9959 ext.252
Fax: 803.758.2450
Mira Vista

For outsourced DME billing, try ClaraVista, LLC.
Mira Vista ]]> AndreaStark http://www.hmetalk.com/forum/blogs/andreastark/6-bill-eliminate-competitive-bidding-gains-sponsors.html http://www.hmetalk.com/forum/blogs/andreastark/5-cms-changes-mind-billing-not-retroactive-voluntary-termination.html Wed, 06 Jan 2010 20:37:47 GMT DME suppliers who did not meet surety bond or accreditation deadlines were advised to voluntarily terminate their billing numbers to prevent being... DME suppliers who did not meet surety bond or accreditation deadlines were advised to voluntarily terminate their billing numbers to prevent being suspended from the Medicare program for a period of one year. Those suppliers who submitted a voluntary termination request did so with the understanding that billing privileges would be reinstated once they met all Medicare billing requirements and billing would be retroactive to the date of accreditation.

However, CMS recently threw a serious monkey wrench into the mix when they stated that suppliers would NOT in fact be able to bill retroactive to their date of accreditation, as previously thought. Instead, suppliers must now wait until their CMS-855S applications have been processed by the NSC to begin billing Medicare and will only be able to bill for services performed on or after the date their number is reactivated.

Several organizations, including AAHomecare, MAMES and the NSCAC are working towards a reversal of this policy. You can count on MiraVista to keep you posted on any changes.

MiraVista, LLC
PO Box 11544
Columbia, SC 29211
Phone: 803.462.9959 ext.252
Fax: 803.758.2450
Mira Vista

For outsourced DME billing, try ClaraVista, LLC.
Mira Vista ]]> AndreaStark http://www.hmetalk.com/forum/blogs/andreastark/5-cms-changes-mind-billing-not-retroactive-voluntary-termination.html