Computer Upgrades and Mergers
Some of our newer clients and new physicians joining established practices are caught in the “computer upgrade” issue with some of the insurers. When these large insurers upgrade their computer systems, any additions or changes to the existing practice listings grind to a halt. We are seeing that happen right now with Independence Blue Cross in Pennsylvania and AmeriHealth in New Jersey.
As is our practice, we continue to coax & nudge the representatives to get all of the needed changes done in as timely a fashion as possible. However, when the behemoth computer system is upgraded, our usual successful approaches don’t work as well. We will continue to coax and nudge until the systems are updated. In most cases, we are able to obtain the effective date in advance of the system upgrade. This means that the physician can see patients for the insurer but the claims will have to be held until the systems are updated. As a small business, we certainly appreciate this cash flow issue & assure you that we are doing everything possible to get the work done!
The Aetna/ Coventry merger continues to be problematic for certain areas of the country. In some areas, Aetna and Coventry are still operating separately from each other while other areas are seeing the process to add a new practice or physician grind to a halt due to the merger. We recommend caution when seeing Coventry patients during the transition as the merger decisions are not consistent from state to state.
AddVal Can Help Before you Contract with a New Physician.
Hiring a new physician and want to check their background and avoid any surprises when the physician applies to hospitals? Primary Verification by AddVal is the answer. Consider hiring AddVal to help lessen you and your staff's burden. We will work with you to tailor a package specific to your needs.
Revalidations are Still Problematic….
We continue to receive 1 or 2 panic calls each week where a physician’s Medicare claims are on hold because the revalidation was not completed. Medicare sends revalidation request letters and follows up with phone calls if the revalidation is not returned. Please do NOT ignore these requests!
As many of you know by now, the State Medical Assistance programs are moving forward with mandatory revalidation in the coming years. Each State is defining their revalidation process with some States requiring yearly revalidation (Delaware), some requiring revalidation every two years (NV), etc. If you and your practice participate with Medical Assistance, it is VERY important to respond to any and ALL revalidation requests from your State’s Medical Assistance program.
The reimbursement rates vary for Medical Assistance but you certainly want to avoid denial of claim payment, no matter how small, due to a missed revalidation. As with Medicare, the revalidation cannot be done until it is requested of the physician or practice. It is crucial to recognize the importance of responding to all mailed requests from Medicare and Medical Assistance within the time frames listed.
The search for a scapegoat is the easiest of all hunting expeditions.
-- Dwight D. Eisenhower
If you need any help with Medicare credentialing or credentialing with any commercial insurers, or you are concerned about Medicare Revalidation please contact AddVal for assistance at 215-396-8972, firstname.lastname@example.org.