American College of Physicians: Internal Medicine — Doctors for Adults ®

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Computer-based training and Y2K help from Medicare

From the September 1999 ACP-ASIM Observer, copyright 1999 by the American College of Physicians-American Society of Internal Medicine.

By Brett Baker

Q: What types of training programs are available to help physicians improve Medicare billing and coding?

A: HCFA offers a billing and coding education and testing plan called the Southern Consortium Provider Education and Testing Pilot (SCPETP). The plan focuses on four areas: training for residents, computer-based training, fraud and abuse education, and reducing duplicate claims.

  1. The SCPETP resident training program provides on-site training to familiarize housestaff with Medicare benefits and billing issues, such as how to select a third-party billing company. The program's goal is to help young physicians make good business decisions when they enter practice.
  2. SCPETP computer-based training courses are available on the Web at www.medicaretraining.com. Click on "courses" to view a list of lessons, and you will receive instructions for downloading the course. The courses, which are intended for both beginners and advanced students and can be completed in about an hour, address the following topics:
    • HCFA-1500 form. Offers information required to properly complete the HCFA-1500 claim form for Medicare Part B.
    • Home health regulations. Focuses on guidelines that providers must follow when dealing with home health agencies.
    • HCFA-1450 (UB-92) form. Reviews essential information required to properly complete the HCFA-1450 claim form for Medicare Part A.
    • Fraud and abuse issues. Focuses on prevention and early detection of Medicare fraud and abuse in a practice setting.
    • ICD-9-CM diagnosis coding. Explains how to use the ICD-9-CM manual to correctly code Medicare diagnoses.
    • Medicare secondary payer. Provides basic information about the Medicare secondary payer program.
    • Front office management. Reviews essential knowledge and skills needed for checking in Medicare patients.
    • Introduction to Medicare.Provides basic information about the Medicare program.
  3. SCPETP's fraud and abuse education program is intended to raise physician awareness regarding Medicare waste, fraud and abuse. It includes tips on how to safeguard medical practices from problems, as well as information from HCFA, such as lists of areas the agency believes are susceptible to abuse.
  4. The SCPETP duplicate-claims reduction program is a non-punitive project designed to reduce the number of duplicate claims filed by physicians. In Florida, for example, the regional carrier compiles a list of the 250 providers who submitted the most duplicate claims in a single month and notifies those practitioners.

    SCPETP currently operates in 13 Southern states, but physicians from anywhere in the country can access the computer-based billing and coding training courses. HCFA also recently announced that it plans to expand the program nationwide.

Q: Will Medicare help me check whether my computer systems are ready for the year 2000 so that I can avoid claims-processing disruptions?

A: HCFA requires all Medicare carriers to allow physicians to test their claims data exchange systems for Y2K compliance. HCFA urges physicians to contact their Medicare carrier as soon as possible to arrange testing.

When a physician submits a claim to be tested for Y2K compliance, the carrier runs it through its standard claims processing computer system and returns the edited transaction to the physician. The testing is intended to provide assurance to both physicians and HCFA that provider claims processing/data exchange systems are ready for year 2000 operations. (For more on how to prepare your practice to handle Y2K issues, see "Five last-minute strategies to head off Y2K woes")

Brett Baker is a third-party payment specialist in the College's Washington Office. If you have questions on third-party payment or coding issues, call him at 202-261-4533, send a fax to 202-835-0441 or send an e-mail to bbaker@acponline.org.

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