Four Reasons Why Cash Feels Tighter Than Usual

The surprise start to 2020 is beginning to negatively impact cash flow for many practices. Below are four reasons why cash is tightening and three recommendations to address that.

1. Surprise January 2nd CMS Coding Changes

Practices are just now noticing lower reimbursements from early January Medicare visits.

  • As of 1/2/20, Therapeutic Activities, 97530 is no longer paid during an eval visit.
  • Manual Therapy, 97140, isn’t paid when billed during the evaluation unless the code is properly defended, and the appropriate modifier is added.

Many practices did not hear about these changes so two of their most widely used CPT codes are not being paid for Medicare evals.

Since January 4th, Systems 4PT’s HardStop™ technology has blocked non-payable codes and guided therapists toward full payment for 2020 Medicare evaluations.

2. Poor Communication and Widespread Confusion

The collective response to the above is “NO! THE CMS REVERSED THIS DECISION!”

  • Yes, on 1/20/20, the CMS announced they would reverse the ban on these codes. Because of this, many therapists went back to charging 97530 during eval visits, but NO!

“Announcements” don’t make codes payable; the MACS need time to update their computers

  • On Feb. 7th the APTA announced “It’s official: Medicare Administrative Contractors for CMS have been notified of the agency’s decision to reverse [the 97530 ban on evals]…”
  • Again, the words “MACS have been notified” DO NOT SAY that the MACs have updated their computers.

Because of this, from January 1st through today,

many practices have been paid dramatically less for their Medicare evaluations.

Systems4PT HardStop™ technology will allow therapists to charge 97530 on the eval, as soon as the MACS have updated their adjudication.

3. Deductible Nightmare

For many practices, patient deductibles are more than one-third of January and February revenue.

  • Their EMR does not communicate patient deductible balances during intake. When a patient’s deductible balance is $539, that web based EMR shows that patient owes $0.00.
  • These practices are doing everything right, but because billing is in a separate database from their EMR and scheduling, they’re losing out on more than $10,000 in patient payments that should be collected.

Systems 4PT integrates scheduling, EMR, and billing into a single database. Front Desk Staff see that $539 is due during patient check in and collects as much of it as possible!

4. EMR Error

  • Clinicians using another EMR have told us that, as of January 1, their EMR attempted to auto-remove 97530 from their Medicare evaluations. Instead, that EMR erroneously removed the eval code instead of removing the 97530. A nightmare for those practice owners!

Recommended Solutions

1. Glance Through Your Medicare ERAs

  • Look for visits with an eval code.
    • Are 97140 codes denied because they lack the necessary defense and modifier?
    • Was 97530 submitted during Medicare eval visits? If so, were they denied?
  • If you find either scenario:
    • Audit all 2020 Medicare evaluations.
    • Wait for news that your MAC has updated their eval coding rules.
    • Then rebill all mis paid/unpaid dates of service.

2. Look at Patient Self-Pay Balances by Month

  • Key in on the “30 day” and “60 day” columns.
    • If those balances are high, something is wrong.
  • If 30-day self pay balances are rising, re-address your deductible collection protocols.
    • If billing isn’t integrated, your staff may need to calculate balance’s due manually.

3. Upgrade to a Trustworthy EMR

  • For 18 years Systems 4PT has delivered the fastest compliance response times and the highest first pass claim acceptance rate in outpatient rehab.

Systems 4PT enables you to focus on using your expertise to restore your patients

to their full potential!

Ask about our Stress-Free Installation™

Treat More, Type Less™

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