2023 update from Your Billing Buddy!

Will Getting Paid be Business As Usual in 2023?

Breaking News!!!

After decades of exclusion, ALL master-level clinicians WILL BE ELIGIBLE TO BE INDEPENDENT MEDICARE CLINICIANS ON JANUARY 1, 2024.

Are you kidding me?!?

It's a done deal, included in the 4,155 page Omnibus Appropriations bill passed last week.

As of January 1, 2024, licensed counselors and marriage & family therapists will be able to receive direct payment from Medicare as enrolled Medicare providers. No longer are “supervision” and “incident-to” billing going to be required.

There's no additional info at the moment. However, I will keep you informed and help you get ready for Medicare enrollment & billing as 2023 gets underway.

Take a moment to visit us online and Stay Connected! by signing up for our mailing list.

Do you have lose money every January because of Those Darn Deductibles? Check out my brand-new blog for helpful, practical tips to ensure your income stays stable this year!

Medicare telehealth flexibilities extended!

No Surprises - No News is GOOD news for us!

Anthem & Beacon are coming together: Watch Out!

Medicare rate reduction battle ends in compromise.

Who is Your Billing Buddy?

Have you ever wished for a biller who wouldn't charge you a percentage of EVERY dollar you make? Someone you could count on when you get stuck? That's me.

Susan Frager, Your Billing Buddy. I've spent 25 years as a mental health biller for practices in 23 states - I can help YOU, too!

You CAN bill and manage your practice on your own...with a little help.

I can help you get paid in 2023!

Let's start with two webinars on January 20 & 27, 2023.

To register, click the pictures to the right.

Special savings on registrations for both sessions prior to January 16th!

January 20: Benefit Verification Without Pain!

11 am - 1 pm Pacific / 12 pm - 2 pm Mountain

1 pm - 3 pm Central / 2 - 4 pm Eastern time

How do you find out what your client will owe without spending literally hours and still getting the wrong answer?

What does all that crazy terminology tell you about what your client will owe?

How to discuss money and benefits with your clients proactively, to prevent unpaid bills.

And lots of time for your questions! Let's find solutions that will work in your practice!

January 27: Deciphering Insurance Cards & Simplify Benefit Verification!

11 am - 1 pm Pacific / 12 pm - 2 pm Mountain

1 pm - 3 pm Central / 2 - 4 pm Eastern time

Find out what those acronyms & symbols on the cards mean in terms of YOU GETTING PAID.

How to use the card as a shortcut to getting benefits - no fussing with Availity, no sitting on hold!

What information on the card can help you proactively avoid denials?

And lots of time for your questions! We'll discover solutions for your practice!

Stay Informed! Join Your Billing Buddy’s Mailing List.

As soon as CMS issues more directives, I will give you the crucial information: what you need to do to get paid, in clear and understandable terms.

Medicare Telehealth flexibilities have been extended for an additional two years, until December 31, 2024.

What does this mean?

Didn't Medicare always cover telehealth?

Yes, but only in limited circumstances. The client had to qualify with either of the following criteria:

Live in an area at a certain geographic distance from the provider.
Homebound

Furthermore, there was a reduction in the reimbursement rate for telehealth vs. an in-person visit.

That all changed due to the COVID-19 pandemic. The "flexibility" refers to Medicare covering telehealth regardless of distance or circumstance, and at the in-person rate.

I don’t have a crystal ball, but to me it seems unlikely that Medicare telehealth coverage and payment policy will revert to the pre-COVID limitations. Generally, once you give people something, it’s hard to take it away later.

Will I still code telehealth as office Place of Service + Modifier 95?

No Surprises Act / Good Faith Estimates

When the NSA was passed in 2021, the government stated that many of the requirements for Good Faith Estimates (GFE) would be waived until 2023, because the operational rules & details still needed to be hammered out.

Well…a year later ... we’re still waiting. And we now have another year’s reprieve! CMS announced on December 2, 2022:

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Anthem & Beacon Merger is finalizing!

If you are a BCBS provider in one of these states, pay attention!

California / Colorado / Connecticut / Georgia / Indiana / Kentucky / Maine / Missouri (other than Kansas City) / Nevada /

New Hampshire / New York (Empire BCBS) / Ohio / Virginia / Wisconsin

Anthem BCBS (who has now rebranded itself as “Elevance”) acquired Beacon Health (who has now rebranded itself as “Carelon”) in March 2020, an event overshadowed by that “other” big news story.

Typically, corporate acquisitions in healthcare take about 2-3 years to shake down to the level of the ordinary provider and client. This summer, the Anthem/Elevance transition to Beacon/Carelon began to make itself felt. Providers in some (not all) Anthem states have received packages with new contracts, informing them that their contract would be held by Beacon/Carelon as of a certain date (varies by state). The contracts included several rate schedules – some of which have since been modified for 2023.

I can’t stress enough: READ YOUR CONTRACT AND RATE SCHEDULES when you receive them. Compare the listed rates with what you are receiving now. I noticed in one contract, buried on page 70-something, that there was a rate schedule for a small subset of plans that was significantly LOWER than what the provider was currently being paid.

Typically, you have a window of time to request modifications to your rates when you receive a contract update – TAKE ADVANTAGE OF IT! Don’t wait. There will never be a better time to receive rate increases from insurers than right now!

Click here for an e-reference manual on requesting and receiving rate increases!

Read the rest here!

ANYTHING YOU RECEIVE….READ CAREFULLY.

Contact me if you need help, or if you get nowhere by calling Anthem or Beacon.

I'm being vague on numbers, because the formula for Medicare reimbursement would challenge a rocket scientist.

Congress tends to give money with one hand and then take it away with the other. There are a lot of acronyms for pieces of previous legislation and unfamiliar terms like conversion factors, sequestrations, RVU’s, and complex formulas.

If you’re seriously interested in researching it, you can email me and I’ll send you a few headache-inducing references.

The Yearly Medicare Pay Cut Drama...

Ended in a compromise this year with the passage of the Omnibus Appropriations Act.

Prior to the last-minute legislation, a Medicare reimbursement rate cut of about 4.5% was scheduled.

It has now been reduced to a decrease of about 2.xx%.

I have some helpful suggestions:

WAIT to submit January claims. Typically, Medicare contractors take at least 15 working days after January 1 to update to the most current fee schedule, during which time they hold any claims submitted.

To find out exactly how much you’ll be paid, go here.

Continued...

Need help with a denied claim? Credentialing?

Or how to structure your practice to achieve maximum revenue?

Get help from your Buddy!

1420 Marvin Rd NE # C464

Lacey, WA 98516

(360) 628-8612