Archive for April, 2017

My answer is both. While auto-post is a definite time saver, it is to be used with respect. The allowed amount should be correct based on your contract. If you don’t already know this information, do yourself a favor–study your contracts and make sure the correct allowable is entered in your system.

If the allowable is less than your contracted amount, your system should flag the entry for follow up. In a timely manner, contact the payer to have the line item reprocessed for the correct amount.

As easy as it is to use auto-post, the payment report still must be reviewed.

Whether it’s a denial or an incorrect payment amount, this is one step you really can’t ignore or put on the back burner, as most payers have timely filing deadlines for denials or adjustments.

Provider Stability Act First of its Kind in the U.S.

NASHVILLE – Tennessee doctors are praising a new state law that adds much-needed financial predictability in contracts between health plans and healthcare providers. The Provider Stability Act passed unanimously in both chambers of the Tennessee General Assembly and was signed by Governor Haslam on April 5.

Senate Bill 437/House Bill 498 was sponsored by Sen. Bo Watson (R-Hixson) and Rep. Cameron Sexton (R-Crossville). It requires health insurance companies to give a 60-day notice to a healthcare provider when reimbursement rates change, if such changes are a result of a policy change at the sole discretion of the payer. It also limits fee schedule changes to once in a 12-month period, and requires a 90-day notice of those changes.

The Tennessee Medical Association, which represents more than 9,000 Tennessee physicians, has pushed the measure since 2014.

No other state currently has these types of provisions in place.

“This is a huge win for physicians and all healthcare providers in Tennessee,” said TMA President Keith G. Anderson, MD of Memphis. “TMA listened and has responded to members’ growing frustrations by bringing some stability and predictability to the marketplace.”  Medical practices, hospitals, health systems and other healthcare providers enter into contracts with health plans to spell out exactly what will the insurer will pay for healthcare services provided to patients covered by that health insurance plan. The contracts are routinely written to allow insurers to lower payment at any time, for any reason.

“The intent of the Provider Stability Act from the very beginning was to have health plans honor network contract provisions and stop the one-sided, ‘take-it-or-leave-it’ rate cuts that threaten physicians’ financial stability, and disrupt patient care,” said Dr. Anderson. “When doctors cannot afford to incur an unexpected change in reimbursement from a health plan they may be forced to stop providing a procedure or drop out of the network altogether. Patients suffer by having to pay higher “out-of-network” fees for the same service if they want to continue seeing their doctor, or find another doctor who is in their insurer’s network. The new law will reduce these scenarios and help protect the important patient-physician relationship.

TMA said passage of the Provider Stability Act was made possible by member physicians, medical practice administrators and others who made calls, wrote letters and emails and visited Capitol Hill to speak directly with legislators about the issue. Several other organizations also supported the effort, including the Tennessee Hospital Association, Tennessee Medical Group Management Association, Tennessee Radiological Society, Tennessee Chiropractic Association, Tennessee Orthopaedic Society, Tennessee teaching hospitals, practice administrators and nurses.

Learn more about TMA’s legislative efforts at tnmed.org/legislative.

About the Tennessee Medical Association
TMA is the state’s largest professional association for physicians, serving more than 9,000 members. We improve the health of Tennessee by bringing all physicians together in efforts to continually improve effectiveness of physician care and ensure proper policy to serve the best interests of patients and the profession. tnmed.org

CONTACT:     Dave Chaney
Tennessee Medical Association
615.460.1671 | dave.chaney@tnmed.org

Don’t see patients until you know enrollment in their network is complete. Physicians are notorious for seeing patients at a new location, opening a new practice or performing new procedures without checking with the billing department first. I recently heard of a physician who started seeing patients in a new state, and then submitted charges to the billing department. You can imagine the shock and surprise when they received the billing tickets. To say things were kicked up in to high gear is an understatement!

You should allow a minimum of 3 -4 months to get all the credentialing in order, and you must be prepared to face some delays. In some instances, you will need to credential your group and then link individual providers to that group. Make sure you have qualified personnel or outsource this project because credentialing is not for the faint of heart.