How to Avoid CMS Audits

September 11, 2015 Posted on Categories CMS, Documentation

by Michelle Tohill

No matter how confident you are in how you run your business, the phrase “you’re being audited” can strike fear into everyone. The idea of having a comprehensive analysis of your system is bad enough, but it’s even worse to think of the time that may be required to comply with the requirements of the audit process. Thus, although audits are very necessary parts of our healthcare reimbursement system, they are definitely considered a significant disruption.


Here are four ways you can avoid audits in the first place. Taking these steps will also ensure that you are fully prepared in case you ever do fall under the watchful eyes of CMS.


1. Verify eligibility up-front for every patient.

The ability to verify payment eligibility up-front, before you file a claim, is critical in maximizing your reimbursement rates and avoiding future audits. Additionally, if you went through the process of verifying eligibility, you have now created a paper trail documenting your system that will be helpful if you are audited. The right software system can make this easier by providing instant eligibility checks.


2. Review documentation to ensure proper ICD9/ICD10 & HCPC coding.

Before you ever file a billing claim, you should make sure that you have the proper coding. This is a time-consuming but necessary step to ensure that you are reimbursed appropriately for the services and products rendered. It will be a red flag if your coding is consistently off, as CMS may interpret that level of inconsistency as a part of how you do business.


3. Keep/scan your supporting documentation so that it is available if needed for an audit.

Always ensure that proper documents are being scanned and provided to the billing department. Dated screen shots provide a good source of documentation, but whatever your system, make sure your record-keeping is meticulous so that if there are any individual questions it doesn’t spark questions for CMS and lead to an audit.


4. Educate your staff on required documentation to meet medical necessity requirements.

No matter how great you are as an individual, or how knowledgeable you are of how to avoid audit, at the end of the day your staff could be the main weakness in your business if they aren’t fully aware of the documentation and coding requirements. Talk with them regularly and monitor their execution of your standards to ensure they are taking the steps necessary to avoid audit.


Michelle Tohill is Director of Revenue Cycle Management of Bonafide Management Systems and oversees all billing programs and processes. Her specialty is conducting AR audits to expose inefficient billing practices that fail to fully reimburse physicians for their work. She conducts AR audits and provides Bonafide customers with training and consulting on how to improve every aspect of billing and practice management to maximize revenue.

What DME Retailers Need to Know About EMV

August 27, 2015 Posted on Categories Cash Flow, DME, EMV

This blog post is also available as an infographic here.

The EMV transition is scheduled to go into effect Oct. 1, 2015. This switch will require all DME retailers to get a new POS machine and access upgraded EMV processing technology.

What is EMV?
EMV is a global payment system that entails putting a microprocessor chip into debit and credit cards, making them less vulnerable to fraud for in-person transactions. Because EMV uses better data security, this standard is being adopted in the United States with a deadline of Oct. 1.

Why EMV?
EMV cards have been proven to dramatically reduce credit card fraud. The United States has lagged behind other countries that have already improved credit card security using EMV. Although the U.S. accounts for just 25% of the world’s credit card transactions, more than 50% of all fraudulent transactions happen here. EMV technology makes it virtually impossible for thieves to duplicate cards.

How Will EMV Work?
Unlike a magnetic stripe card, EMV cards have a chip in them that can send unique data with each transaction. The EMV chip transmits a variable algorithm with each transaction, making the data more secure than static data, which is what magnetic stripes offer. Only EMV-enabled terminals can read and decode EMV cards.

When Will EMV Go Into Effect?
Your customers are receiving new EMV-compliant credit cards right now, and all major credit card companies will have distributed EMV cards by Oct. 1. The U.S. is set to transition more than 1.2 billion payment cards this year.

Meanwhile, all retailers need to upgrade to an EMV-compliant terminal and payment processing software system in place by Oct. 1. The U.S. is estimated to transition more than 8 million point-of-sale (POS) terminals to meet EMV requirements.

Bonafide has partnered with AxiaMed to provide its DME clients with EMV-compliant customer payment transactions that are fast, efficient and secure. For more information, please contact Kristina Akerberg at (805) 906-1698.

DME Client Checklist: 5 Steps to Prepare for ICD-10

July 28, 2015 Posted on Categories ICD-10

Your Bonafide team has been working hard to prepare for the upcoming ICD-10 transition, which is scheduled to go into effect Oct. 1, 2015. ICD-10 will expand the number of diagnosis codes from 18,000 to 140, The Invisible Guest film online now


We will do everything we can on our end to help ease the transition for our customers. Here is a checklist of what you should be doing to prepare your business for this change. Click here for a visual infographic of this Fifty Shades Darker 2017 movie


1. Assess Your Current Situation
Each DME provider will have a different level of complexity in transitioning to ICD-10. Conduct a charge summary by primary diagnosis code. This will allow you to see how challenging ICD-10 will be for your particular business.

Next, identify all systems and work processes that will be affected by ICD-10. This will likely include documentation, encounter forms, superbills, contracts, and more.

Finally, consider your referring physicians. Remember that the largest challenge you may face as a DME provider is poor coding on their behalf. If they fail to use the correct ICD-10 code, it will be up to your team to find the correct code, which will require additional time.


2. Make a Plan
Once you know how seriously ICD-10 will impact your business, you should create an implementation plan. The countdown starts now, with full implementation going live Oct. 1.

Your plan should map out exactly how you are going to train your staff, prepare your providers, and conduct billing under the new system. Your plan should also evaluate the costs involved in the ICD-10 transition. In addition to training and implementation costs, you should also create a financial cushion to cover cash flow shortages that you may experience during the transition.


3. Communicate
Your implementation plan should include communication strategies for all of the parties with which you interact. In addition to referring physicians, customers and payors, you will also want to consider how you will communicate with your staff, delivery service, billing service, and wholesale suppliers.

Remember that the biggest challenge for DME providers during the transition will be cash flow shortages. This will not always be under your control, and thus you should expect significant hiccups along the way. By preparing communication strategies in advance, you can avoid major problems.


4. Get Started
Your plan should outline how to get started, but definitely don’t wait to begin training your staff. Another key action is to start becoming familiar with the most commonly used code or codes in ICD-10 in your business. You can also start obtaining ICD-10 codes from referring providers.

Depending on how you manage your billing, you will want to talk to Bonafide about how and when we are conducting any system tests. You should also familiarize your staff with the ICD-10 crosswalk mapping.


5. Get Help if You Need it
At Bonafide, we know how stressful ICD-10 is for our customers. We are developing training materials and programs for everyone. If you would like us to conduct a complimentary assessment of your frequently-used codes to let you know how seriously ICD-10 will impact you, then contact us right away. We will also be providing custom consulting, training and crosswalk mapping for a small fee. Please contact us if you have questions!

5 Things Physicians Need to Know About ICD-10

July 20, 2015 Posted on Categories ICD-10

The new ICD-10 requirements will be updated as of October 1, 2015, which will bring the current number of diagnostic codes from 14,500 to 69,700, an increase of 55,200 new codes.

This change will greatly impact your practice efficiency and billing revenue for several months. To minimize the impact, you should educate yourself and your staff today to make the transition smoother in October.

Check out this infographic about ICD-10, and feel free to call Bonafide for a customized ICD-10 analysis, plan and support.


5 Things Physicians Need to Know About ICD-10


1. More Codes

ICD-10 will bring the number of diagnostic codes from 14,500 to 69,700, an increase of 55,200 new codes. This massive increase is mainly due to individual codes being multiplied to increase the detail The Shack movie


2. Laterality Codes

Laterality is a major theme in the expansion of codes under ICD-10. For example, instead of simply coding for a cyst on the eyelid, under ICD-10 providers need to specify the location of the cyst: left, right or bilateral.


3. Anatomical Location Codes

In addition to laterality, providers will be required to specify detail in terms of location of an injury or condition. For example, an arm fracture will now need specific details such as which arm (left or right), precisely where on the arm, and additional anatomical location details.


4. Combination Codes

ICD-10 includes hundreds of combination codes that link symptoms, manifestations and/or complications with a diagnosis. For example, rheumatologists may document the relationship between two conditions using language such as “due to,” exacerbated by,” “with,” or “in” to demonstrate condition severity.


5. Encounter Type Codes

Providers will need to specify whether the encounter is initial (patient receives initial active treatment), subsequent (patient receives routine care during the healing or recovery phase) or sequela (patient receives treatment for complications or conditions that arise as a direct result of a condition).



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