Email Newsletter #9 Coding and Billing Tips / Updates for 2000 June 12, 2000 Free and fast UPIN search for any state and/or specialty. Use the "AccuLibrary" for useful how-to information on billing and coding correctly for nearly all specialties. Hundreds of informative articles. Use e-mail link to request a user name and password-QUICK and EASY signup. Check it out FREE for 2 weeks! Just visit our website at - http://accuchecker.com to register! Click to view a list of the most useful MEDICAL REIMBURSEMENT BOOKS available in the market! To subscribe or unsubscribe to this service, please see instructions below. Medicare Participation and Group Practices/Questions and Answers Medifest 2000 Participant Handbook Q: My partner and I are currently participating providers and we have decided to form a group. Will our group participation status automatically reflect participating? A: No. A separate agreement must be filed on behalf of the group. The agreement binds all physicians with respect to any service billed by the group. Q: I was practicing with a group that was participating; however, I have decided to open an individual practice. Will I be considered participating or non-participating? A: You may choose whether or not to participate at your individual practice without regard to the participation status of the group. However, a contract must be filed for your individual practice if you choose to participate. Q: My professional association has decided to join the Medicare Part B participation program. Is it necessary to complete an agreement for each group member? A: No. Only one participation agreement is needed for the group. Q: My professional association has changed ownership. As a result, we have been issued a new group provider number. Is it necessary to complete a new agreement? A: Yes. If a participant receives a new provider number as a result of a change in ownership, it's necessary for the participant to file a participation agreement on behalf of the newly assigned provider number. Q: Can a provider withdraw from the Medicare program? A: One provision of the Balanced Budget Act (BBA) of 1997 allows physicians to enter into private contractual relationships with their beneficiaries. This allows physicians to bill and receive direct payments from their beneficiaries without having to follow Medicare guidelines. However, in doing so, the physician excludes himself from participation in the Medicare program for a two-year period of time. There are many associated rules related to this provision of the BBA. Should a physician wish to look further into this new arrangement, he/she should consult the summary of the private contract guidelines provided later in this chapter. USEFUL RELATED ISSUES Factors that Influence Efficiency Medifest 2000 Participant Handbook Medicare is a highly automated process when it comes to determination of reimbursement for submitted claims. Based on the claims information received (e.g., procedure code, diagnosis code, billed amount), Medicare's computers automatically make processing and reimbursement decisions for approximately 85 percent of all claims submitted. The remaining 15 percent suspend for personnel to review. To improve claim-filing efficiency, office staff should consider adopting processes that would allow claim information to be exchanged with the Medicare contractor in the swiftest and most accurate manner possible. Provided below is an overview of the tools available to accelerate the speed of transactions, minimize the occurrence of denials and track the claim efficiency of a practice. Electronic Funds Transfer (ERN) Medifest 2000 Participation Handbook Using the Electronic Remittance Notification (ERN) feature helps speed up the process of receiving payment information. This feature can also automatically post payment information to the existing accounts receivable system, thus minimizing the need for posting personnel and freeing time for them to handle other office tasks. To obtain electronic remittance notices, providers need to have software that supports this feature and complete the proper enrollment form. Send requests to your local Medicare Carrier.