Member Reimbursement Assistance

The Idaho Medical Association provides its members’ a broad range of benefits and services to assist with third party payer issues. To access the services described in detail below, contact one of these Reimbursement staff members:

Suzan Belzer, Reimbursement Director
Phone (208) 344-7888
Fax (208) 344-7903
E-mail: sbelzer@idmed.org

Judy Bailey, CPC, Reimbursement & Policy Analyst
Phone (208) 344-7888
Fax (208) 344-7903
E-mail: jbailey@idmed.org

Margy Leach, Reimbursement & Policy Assistant
Phone (208) 344-7888
Fax (208) 344-7903
E-mail: mleach@idmed.org

Third party payer/reimbursement assistance is available in these areas:

Consultation on insurance billing and coding: The IMA provides assistance with preparation and submission of electronic and paper claims and assistance in coding unusual services. IMA reimbursement staff assists physicians in resolving denied claims and those not paid fully or correctly.

Workshops and seminars: IMA educational programs address ICD-9-CM and CPT coding, current coding issues and payer/carrier requirements. These programs target the needs of physicians and staff members at all levels of expertise, with separate offerings for novice, intermediate, and experienced coders.

(The Calendar Section of the IMA Web Site lists seminars that are currently scheduled. Click here to view those offerings. For members’ convenience, the IMA links Calendar seminar offerings to a downloadable registration form. Just print, fill out and fax to speed your reservation!)

Practice Management Consulting Services
The IMA offers two new fee-for-service programs for members. Coding and documentation review includes chart auditing reviews with a written analysis of findings and recommendations as appropriate. Fees are $20/record for E/M only, $25/record for E/M and Procedure (minor surgury) and $75/record for major surgery.

The second new service is compliance plan auditing, which provides a physicians or practice with a coding compliance report to assist in meeting an office's self-audit compliance requirements. Program options include baseline results, quarterly or semi-annual follow-up reviews and on-site education. Charges vary.

Direct interface with third party payers on members' behalf when issues/problems arise.
Audit consultation: The IMA provides immediate consultative assistance to members involved in audits by Idaho insurance carriers, assisting physicians and their legal counsel in preparing appropriate responses to audit findings.

Reimbursement assistance is available for the following payers:

• Medicare (Part B and DMERC, Railroad Medicare)
• Idaho Medicaid
• Blue Cross of Idaho
• Regence BlueShield of Idaho
• TRICARE/TriWest (formerly Champus)
• Workers' Compensation
• Other private payers

Reimbursement References

IMA members may purchase the following references through the IMA:

National Correct Coding Policy Manual - Correct Coding Initiative (CCI)

This reference contains Medicare bundled code edits, including both comprehensive and mutually exclusive edits. The CCI is usually updated quarterly by the National Technical Information Service and made available to IMA members at a per-update cost. To order, call the IMA at (208) 344-7888 for an order form or print an order form from the IMA Web Site (click here). The WHAT’S NEW area of this site announces the availability and pricing of each new CCI release.

Medicare Physician Fee Schedule Data Base (MPFSDB)

The IMA has created a user-friendly version of the MPFSDB and makes it available to members annually. This valuable billing tool includes the RVUs for each Medicare-covered service plus valuable information on surgery coding policies, including follow-up days and information regarding multiple surgery, bilateral surgery, co-surgery, and assist at surgery. Those who purchase the IMA MPFSDB also automatically receive updates as issued by the Centers for Medicare and Medicaid Services (usually quarterly). Click here to download an order form for the current data base (MPFSDB price information is available under WHAT’S NEW or call the IMA at (208) 344-7888 for details).

Mastering Modifiers Audio/Visual CD

A coding refresher for basic and intermediate coders. Or, use this convenient tool to educate new staff on CPT and HCPCS modifiers - a great addition to your training library! Computers with Windows 98 (second edition or later) can run the presentation with or without PowerPoint. You will need a CD player, sound card and speakers. CD $65.00 IMA members, CD $150 Nonmembers. Visit "What's New" section on this website for ordering information.

Medicare Preventive Medicine Packet and Initial Preventive Physical Exam Template

2005 Medicare changes include coverage of preventive medicine, including an initial preventive physical examination (IPPE) for newly qualified Medicare patients. The preventative medicine pacet and four-page template for billing the new services are FREE if you order the Preventive Medicine Billing Tools Alone Available only to IMA Members -- CD $25.00. Visit "What's New" section on this website for ordering information.

INSight Newsletter

The IMA continuously monitors third party payer policies and activities to keep members informed of changes and new billing requirements. The Association publishes INSight each month to alert members to the activities of Medicare and other payers. Click here to read the current newsletter and/or review archived issues of the publication.