New Affordable Care Act measure gives patients more rights and help with their health insurance and health choices, but what does this newly expanded provision mean to healthcare providers?

The Affordable Health Care Act was signed into law in March of this year. It seems to be as rough a draft as the ARRA stimulus provisions in that they are continuing to be expanded and defined as they go. The new features expanded/added last week (see the official July 22 News Release) involve a desire to put patients more in charge of their healthcare and to give them better protection by giving them rights of appeal in claim and procedure denials. Per the news release: “Consumers in NEW health plans in every State will have the right to appeal decisions, including claims denials and rescissions, made by their health plans.” The plan is that there will be a set of standards and “defined and impartial” appeals method for your patients allowing them access and help with knowledge and protocols to be able to ask and work options for both internal and external appeals processes. This new, expanded provision also grants, by application, $30 million for Consumer Assistance Programs to create or strengthen existing offices to help your patients appeal decisions made by their insurance companies as well as to help them decide on appropriate health plans and insurance options for them. The appeals standard looks to have come from the National Association of Insurance Commissioners (NAIC) and per the Fact Sheet (listed below) States are “encouraged” to adopt the NAIC external appeals laws as their State appeals laws before July 1, 2011. The combined effect of these enhanced patient protections and the NAIC appeals laws are roughly listed next.

Office Financial Policies: Do you have one?

Management Corner
By Kathleen Wrolbel-Erlich CMOM, CPC

Office Financial Policies:  Do you have one?  How about some pointers to get you started?

Create a financial policy.  Have the doctor agree that this is his/her expectation of the patient.  Then have all of your patients sign a copy as they come in for visits.  You can also post copies by the front desk to remind patients if they forget. It is extremely important that the doctor, staff, and patients all have an understanding of your office’s financial policy.  Adjusting off money, because of a misunderstanding with a patient, is frustrating for both you and the patient.

Genius Focus Group- Warren (with goodies)

By Penny H, Genius blogster, news editor, & Focus Group participant

Wow, it was a whirlwind week last week.  It took me the entire weekend for my head to come back to earth and settle down.  Warren was a lot of fun!  The dynamic was a bit different in Warren because we had so many more people.  We also tried a different room setup, instead of rows of chairs and tables we were able to try a giant horseshoe of chairs and tables so that everyone could see each other and we could see them.  I think I can safely say that all of those who presented really liked it, and the comments coming back from you were that the layout was equally well-liked by you.  It seemed odd at first, having a giant space in the middle, but it really was much easier for all of us, to well, see all of us.   I just wanted to give a quick review with some tips for those that were there (or were not able to be there).  I'll also be giving you a link to download the printed materials we gave out (.pdf) so you can have it on your computer, or be able to print out more copies if needed.

Genius Fall Training Schedule Posted

The Fall Training Schedule has been posted, please choose your classes, then download and return the form to us.  If you have questions on any of the classes, please e-mail training2009@geniussolutions.com or contact Training at 586-751-9080 / 800-645-0955

Genius Focus Group- Mt. Pleasant

Yeah, we had our first Focus Group meeting yesterday.  Sherri and I (aka me, Penny, Genius blogster) were out in Mt. Pleasant yesterday.  We would like to give a shout out to everyone who came out the Mt.Pleasant Focus Group yesterday.  It was a great group, with a very relaxed atmosphere at the golf resort; they made us feel very welcome and very comfortable.  We hope we did the same for them. 

Medicare Pay Cuts Extension Through December 1st 2010

HR 4213 finally bombed out of the Senate late Thursday (6/24) after a couple of attempts to dump chunks of the overstuffed bill failed to get the significant passing votes to pass (57-41 yea, but they needed 60 Senate votes to pass).  There will be many jobless Americans wondering what will happen to them now (although a stripped down version with just the jobless extensions has been relabeled for just itself and it back on the docket.  No significant action seems to be expected on it until the House and the Senate both return from the 4th of July holiday.)  It failed to pass the additional Medicaid aide for states, dumped Cobra help extensions, etc.  Not only was the cost of this jumbo bill very high, but it was promoting a significant tax increase.  So, it being busted is not necessarily a bad thing, now maybe they will weigh each portion separately for cost and merit as should have been done from the beginning.

What does this mean for Doctors and your Medicare cut? 

Important: Your Medicare Payments

Beginning today, you may start to see Medicare checks in your mailbox.  These will be payments that Medicare had been holding off on processing, hoping that Washington D.C. would pass the next reprieve for the Medicare pay cut.  The month-to-month wait was finally going into a 19 month reprieve, but the resolution to do it, H.R.4213, is currently stalled in debate on the Senate floor.  Again, the problem isn't giving you doctors a break on the pay cut, the problem is that your pay cut is tied in with an extension on jobless benefits, Medicaid, and a bunch of other stuff.  Stuff that would best be served on individual bills, rather than as one mega-conglomerate bill.

June News Flash!: The Summer of E-Statement Love

As we boldly move forward into the future with you, we are in the process of combining our production facilities into one.  Click here for more of the June 2010 e-mail News Flash.

Update your THOMAS, d and e

If you aren’t up-to-date, don’t wait, update! If you are an active, current Genius client office, the update is FREE; there is no charge for updates to the program if you are a current SoftCare subscriber.  Here is more on the "whys" and "how to-s".

On the Dockets/Chopping Block Again:Medicare Pay Cut

The Medicare physician pay cut exists as part of the of the Balanced Budget Act of 1997, which says that the Medicare payment dollars paid out to doctors will be cut automatically when the cost out paces inflation. These automatic cuts have been delayed repeatedly by Congress since 2003, which is why there is such a large pay cut currently being faced by doctors.  For physicians, if passed, H.R.4213 would extend the currently scheduled 21.2% cut in Medicare reimbursement until January 2012.  This would eliminate the current month-to-month wonder of what, if any, payment they are going to receive from Medicare for 19 months.

EHR: Plan the Implement, Implement the Plan.

Promoting Use of Health IT: Why Be a Meaningful User? I read a great article, succinct, to the point, and extremely thought worthy. I can't really say it any better, so I'm recommending that you take a minute to look it over, go ahead, it's from Dr. David Blumenthal, the National Coordinator for Health Information Technology, and his article is posted over at the government's HHS-HIT web site: Click here for the Blumenthal article. After that, come back here for some suggestions on how you can begin your journey into the wild lands of Meaningful Use.  Click here for suggestions on what you can do to prepare for EHR in your office.

Michigan BCBSM edits: NewsFlash

Attention Michigan Clients:

Per BCBSM please be aware of the following claim edits:

"Date: 05/12/10     End date: 05/26/10
To: Professional and Institutional electronic submitters
Subject: UPDATE Blue Care Network claims - edit codes P407 and F224

Earlier today we communicated an issue with BCN front-end edits P407 and F224.  We have determined that claims sent between 6:00 AM on 5/11/10 and 10:00 AM on 5/12/10 were erroneously edited.  Please do not resubmit, as these edited claims are being re-cycled back into the processing system.  All claims should be reprocessed by Friday, 5/16/10. "