ED. NOTE: Nancy Beckley enchanted Monitor Monday listeners recently with her “Post Cards on the Edge,” in which she tersely, albeit affectionately describes her travails in the realm of inpatient rehabilitation compliance.
Well by now you have received your Medicare mailing called “Medicare and the New Health Care Law – What it Means for You.”
Page one has a message from Kathleen Sebelius, the Secretary of Health & Human Services, and it is all about the Affordable Care Act passed recently. The centerfold contains information about improvements in Medicare that you will see right away, including more affordable prescription drugs, the wellness benefit, and improvements to Medicare Advantage. It also includes improvements beyond Medicare that you and all of us in our family can count on, according to Secretary Sebelius. For example, it improves long-term care choices, helps early retirees, helps people with pre-existing conditions, and expands health coverage for young people. I hope you had a chance to read through all of this.
The back page has information of interest to consultants like me. You know that I work in rehabilitation, but sometimes explaining what I do as a consultant, rather than as a therapist, has been hard. Well, read page four. This is about how the new law will preserve and strengthen Medicare. It provides for new tools to fight fraud and protect your Medicare benefits.
For example the new law contains important new tools to help crack down on criminals seeking to scam seniors and steal taxpayer dollars. It reduces payment errors, waste, fraud and abuse to make Medicare more efficient and return savings to the Trust Fund to strengthen Medicare for years to come. It also advises you that you are an important resource in the fight against fraud. Be vigilant and rely only on your trusted sources of information about your Medicare benefits. It also gives you a number to call if you have any questions or want to report something that seems like fraud.
Well, you see Mom, this new law is creating more work for all providers. While there are reports on sham operations that are just billing the Medicare fund and not providing services or goods, there are also very aggressive and diligent efforts to review the billings and records of all your trusted medical providers, including your hospital and the clinic across the street and the doctor that you have been going to for years.
I hope you had a good Memorial Day. I am on the road again this week and one of the hospitals I am working with has been getting reviewed by one of Medicare’s fraud police. Yup, they got napped. They provided the service, but they didn’t realize that the code that was billed could only be billed one time per day. It is called an untimed code. Normally, they don’t bill for this code more than one time per patient, per day, but they have a new employee and she didn’t know that was the rule. Their billing sheet didn’t identify that it could only be billed once, and the people in the billing department didn’t know it could only be billed once, and the software that was supposed to check for these types of billing errors wasn’t programmed for this particular code. All and all it was a good day onsite with this provider, and I enjoyed a glass of local chardonnay with dinner.
I’m on the road again and with another hospital this week. Traveling isn’t much fun, but the people I work with are happy to have someone help them appealing Medicare claims. They are really good therapists at this hospital, they just didn’t know that the contractor who pays their claims on behalf of Medicare has changed the rules several times over the past several years on payment for certain procedures. I showed them how to create a scrapbook of the rules. (I have even published an article called Scrapbooking Your Way to Success in a RAC World). These folks are now having to spend time and effort to appeal, have been denied on the first level, and are seeing a bit of success at the second level. It is so important for providers to know when the rules are effective, including the timing.
I am back home again this week and will be on a Webinar with other professionals discussing some of Medicare’s policing efforts and how providers can prepare themselves for retrospective audits, and how they can change the way things are done to prepare for the future. Sometimes it is all about good penmanship, as Medicare just clarified their rules about legible signatures. Oh, and thank you for sending me to Catholic Schools, where we got penmanship grades every quarter, and I was the Sophomore Penman of the year. I don’t write in charts anymore, but you would be proud to know that I would pass the signature rule.
About the Author
Nancy Beckley is a co-founder and president of Bloomingdale Consulting Group, Inc., providing consulting services to the rehab professional. Nancy is certified in healthcare compliance by the Healthcare Compliance Board, and serves on the Part A and Part B Provider Outreach Education and Advisory Panel for First Coast Services Options (Florida Medicare). She previously served on the CMS Professional Expert Technical Panel for Comprehensive Outpatient Rehabilitation Facilities.
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