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This Months Newsletter
Health Net will continue to process claims submitted
under the old and new ID number. However, to avoid problems in the
future, we recommend that you take the following actions:
• Request and verify the member ID Card at each and every
office visit.
• Update the patient’s files to include the new ID number.
• Notify your billing agent (if you use one) about this change.
• Update your Practice Management System to include the new
ID number (make sure it will accept alphabetical letters in teh
ID field)
• Use the number from the member’s ID card for all eligibility
verification and claims submission.
Physicians in New Jersey are struggling to meet the
ever-rising costs of practice at a time when revenues are either
static or in decline. The current regulations of the State Board
of Medical Examiners require that physicians make records available
for a charge of $10 for a record of 10 pages or less and then for
an additional $1 per page thereafter up to 100 pages. If a record
exceeds 100 pages, no additional charges are permitted. The reimbursement
has been the same since the original enactment of the regulation
many years ago. Dr. Peter Blumenthal of Essex County submitted a
resolution to the Board of Trustees requesting that those charges
be increased.
The retrieval and copying of records is labor intensive and the
Board of Trustees believes that the allowed fee should be increased.
The President of MSNJ will send a letter to the State Board of Medical
Examiners suggesting that they consider a revision that raises the
permitted charge to $50 for records up to 50 pages with an additional
$1 being allowed for all pages thereafter with no other limitation.
As far-flung Medicare fraud schemes go, a conviction
from the northern district of New York could be the farthest yet.
U.S. Attorney Glenn Suddaby announced the sentencing April 21 of
Ukraine native Konstantyn Pekerman, who allegedly managed to con
more than $2 million from Medicare — without ever setting
foot in the U.S.
Pekerman was hit with a 77-month prison sentence for his alleged
role in a three-year scheme that submitted more than $7 million
in false claims to Medicare carriers across the U.S.
Pekerman and others working for him admittedly used beneficiary
and provider identifiers — some of which were from deceased
individuals — to file claims, then directed the fraudulent
reimbursement to commercial mailboxes. According to Suddaby, couriers
were hired from Mexico to pick up and deposit the checks so that
funds could be withdrawn at ATMs in Russia, Ukraine, Mexico, southern
California, and New York, or be wired to Ukraine, Latvia and Cypress.
MEDICARE AFFIRMS 6.6-PERCENT REIMBURSEMENT HIKE
The good news keeps getting better for Medicare Advantage plans.
The Centers for Medicare & Medicaid Services announced May 10
that MA plans will receive a 6.6-percent increase in reimbursement
in 2005. That’s in accordance with what CMS was expecting
back in March when it released an early estimate.
Though opponents of Medicare reform say the government is overpaying
private plans, health plans are glad that they’re finally
receiving a sustainable rate and are optimistic for the future of
managed Medicare. There are now 4.6 million beneficiaries enrolled
in Medicare Advantage, CMS says.
• Are your expenses increasing?
• Are your denials & non-payments increasing?
• Is your staff spending more & more time on insurance
follow up?
• What does it actually cost you to run your billing operation?
Outsourcing medical billing is a good option in today’s highly
competitive healthcare industry. Source One Medical Management is
an established player in the outsourcing arena. Substantial investments
have been made in technology, resources and people. Our staff has
gained expertise thru ongoing training in all aspects of medical
billing. We can help you obtain a competitive edge and save on your
current related expenditures.
Give us a call today to discuss your options!
Contact Ruth Harris @ 609-895-9700 ext. 219 (Or) Email rharris@source1med.com
• Computer Consulting/Sales
• System Design and Maintenance
• Custom Programming
• Computer Hardware and Software Troubleshooting
• PC and Printer Repair/Upgrade
• CD-Rom Creation/Replication
For more information regarding Source One System
Solutions, contact Ruth Harris at (609) 895-9700, extension 248.
If you think you’re too small to make
a difference, you haven’t been in bed with a mosquito.
-Anita Roddick
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