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    Welcome to the ClaimCare Medical Billing Blog. We strive to provide content that improves the overall quality of medical billing efforts across the US. If you have any specific topics that you would like to see addressed in this medical billing blog please post the topic in the Medical Billing Questions & Answers Forum. If you have an article that you would like considered for publication in the medical billing blog then please email your article to resources@claimcare.net.

    MEDICAL BILLING BLOG

    The Rise and Fall of Offshore Medical Billers

    Posted by Carl Mays, ClaimCare President/CEO on Thu, Aug 13, 2020 @ 06:00 AM

    The Rise and Fall of Offshore Medical Billers

    A trend began several years ago for practices to move billing and coding offshore to save money, which has often led to crippling the practices rather than adding any advantage in terms of being more effective, efficient and productive. And money has often been lost rather than saved.

    A January 2019 “For The Record” article titled Is Offshore Coding Dead in the Water? tells of a two-year study involving six hospital systems. In an apples-to-apples comparison of USA coders and offshore coders, the offshore coders were less accurate and productive than the USA coders. There was a higher denial rate and lower reimbursement resulting from a lower case mix index. Additionally, offshore coders required longer onboarding.

    In the end, the savings realized from employing lower-wage offshore coders was lost to productivity issues and lower reimbursements. All variables considered, offshore coders cost hospitals $3.10 per hour more than their American counterparts.

    The study, which was presented in detail at the 2018 American Health Information Management Association (AHIMA) Convention was the first of its kind, and it appears the findings are the first solid numbers supporting a move away from offshore coding solutions. However, warnings from various sources existed long before the study was begun. Law firms, healthcare organizations, publications and IT groups were among those sounding alarms. 

    Offshore Medical Billing Poses Security, Legal Issues

    As far back as 2012, the Liles/Parker Law Firm, which specializes in Healthcare Law, warned of security and legal issues arising from the use of offshore groups in an article titled Overseas Outsourced Billing and Coding – Compliance Risks. The article opens with, “Thinking of sending your medical billing and coding functions out of the country? You better think twice. While overseas outsourced billing is growing in popularity for medical office functions, this practice represents a unique set of problems for both physician practices and 3rd party billers. And the news is just getting worse." Some points made in the article include:

    • You have no guarantees that a coding and billing business overseas is HIPAA compliant or even understands the law at all.
    • Providers are responsible not only for their practice, but also for the acts of their business associates and their respective subcontractors overseas.
    • Obtaining a judgment against an offshore entity is next to impossible, takes a substantial amount of time, and costs a lot of money.
    • Liles/Parker writes, "We had previously reported that the backlog for having a case heard in India was nearly 20 years. But recent estimates by the National Bar Association of India put that figure closer to 350 to 400 years."
    • Offshore workers have extorted providers over PHI records. In one case, an employee of a Pakistan billing company contacted the hospital on whose records she was working. She demanded a significant sum of money from the hospital or she would release the medical records on the Internet and anonymously contact United States authorities. Given the legal case backlog information above, the hospital had no option but to pay.

    Supreme Court Stepped In After Liles/Parker 2012 Article

    The 2013 HIPAA Omnibus Rule prevents medical providers from enforcing HIPAA laws in foreign countries. Providers are responsible for improper disclosures and breaches with business associates and their respective subcontractors overseas. Thus, if a provider offshores billing or EMR the provider is responsible for all HIPAA fines, which could be as much as $10,000 per violation. 

    There are some so-called "USA-based" medical billing companies that have home offices in America, but offshore the majority of their work. These companies are dependent upon their foreign workers, but as American companies they have to answer to their clients when problems arise offshore. 

    Publications Report Offshore Horror Stories 

    A 2013 "Fierce Healthcare" article titled 32,000 Patient Records Exposed On Contractor's Unsecured Website tells of a Tennessee-based hospitalist and intensivist group that contracted with an India company to transcribe care notes dictated by physicians. The contractor was supposed to store protected patient health information on a secure website, but its firewall was down between May 5 and June 24 before the Tennessee group discovered the problem.

    Health information on 32,000 patients across 48 states was exposed. Compromised patient information included patients' names, dates of birth, diagnosis description, treatment data, medical history and medical records numbers. According to U.S. Department of Health and Human Services records, it was the second HIPAA breach for the Tennessee group.

    The article reports that according to the Ponemon Institute, considered an eminent research center dedicated to privacy, data protection and information security policy, 94% of 80 participating healthcare organizations polled had experienced at least one data breach that they were aware of in the previous two years. Those breaches cost organizations a total of $6.78 billion annually.

    IT Companies Warn Against Overseas Medical Billers

    Scouring the Internet for multiple IT company remarks on offshore medical billing and coding, here are some summarized views:

    • There are always dangers of HIPAA security breaches and violations of patient privacy, but these dangers are intensified with offshore contractors, and immediate fixes are less tenable.  
    • Many offshore companies utilize a “bait-and-switch” technique. Initial workers assigned to you are what the company considers as their “best.” Later, these “best” are replaced by the company’s lowest-paid, inexperienced workers who use the login of the original worker. Errors increase, productively drops, and security suffers.
    • Low-paid offshore workers are enticed to commandeer ePHI (as referenced in the Liles/Parker information above). Such tactics provide a much greater risk than any possible savings afforded by cheap offshore work.
    • Offshore contractors may present a basic package of service, but then charge extra for services that are already bundled in initial agreements by a truly 100% USA-based company like ClaimCare.
    • Turnover rate is much higher offshore because employees are always looking for higher-paying jobs, whereas ClaimCare emphasizes medical billing "careers" rather than jobs. One of the things that entices quality people to seek employment at ClaimCare is the emphasis on personal growth opportunities within a company that grows annually.
    • Surveys have shown that offshore workers are less experienced than USA-based workers and have little or no understanding of America's complex and everchanging federal and state laws regarding healthcare. 
    • In general, without taking into account Daylight Savings Time, the time in India (which has only one time zone) is 10.5 hours ahead of USA central time. (The half-hour aspect arose when the meridians for the Indian subcontinent were created. New Delhi was in between the two and India chose to be 30 minutes between the two time zones.) This time element, along with the language element, affects client and patient contacts to a large degree. It also limits real-time access to patient accounts and revenue cycle management reports.
    • Whereas ClaimCare can work on clients' systems or its own, offshore contractors often work only on their own, which leads to lack of transparency in reports and data such as payment posting, collection efforts, charges, third-party payer claims and more.

    Groups Push Congress to Delegitimize Offshoring  

    Some USA-based groups are pushing Congress to strengthen the HIPAA laws by making offshore medical billing illegal. One such letter to Senators and Representatives contains:  

    "A foreign workforce is not accountable to the HIPAA laws, and since the HIPAA laws cannot be enforced overseas, we ask that you protect us by keeping medical billing within the United States. In addition to the security that comes with a USA-based labor force being held accountable to HIPAA laws, this move would also keep medical billing jobs in America. We need your presence in Washington to create and pass legislation that safeguards our sensitive data and preserves the medical industry. Do not work so hard to create safeguards within HIPAA only to see them undermined by offshoring."

    ClaimCare Rescues Providers, Facilities from Offshoring  

    With deep knowledge of offshore billing issues, ClaimCare steps in with distinctive elements and nuances as a professional medical biller to solve the majority of problems that result from the offshore billing and coding model. In doing so, ClaimCare brings unique solutions that are designed to support effective communication, offer up-to-date healthcare intelligence and security, deliver the right information at the right time and fulfill our mission “To collect the maximum amount for your practice as fast as possible while helping to alleviate costs and hassle for your organization.”

    About ClaimCare ®                        

    ClaimCare has 30 years of medical billing experience. We have an established 100% USA-based medical billing team that has been assembled through a thorough pre-employment screening. All personnel participate in on-going training and strong process management to ensure they deliver only the highest quality medical billing services to clients.

    ClaimCare has once again been named a Top 10 Medical Billing and Coding Company. The honor this time comes from "MD Tech Review." The magazine’s Augmenting Medical Billing and Coding Operations article presents solid reasons why ClaimCare has been chosen for this 2019-2020 recognition.

    For more information, contact sales@claimcare.net, or phone toll-free at (855) 376-7631, or visit the ClaimCare Medical Billing Company website. We can assist your practice and/or facility in numerous ways, including complete certification processing.

    100% USA-Based HIPAA-Compliant Medical Billing Company

     

     

    Tags: ClaimCare News, medical billing coding, Reasons to outsource medical billing, Off Shore Billing

    Provider Relief Fund Deadline Extended to August 3

    Posted by Carl Mays, ClaimCare President/CEO on Mon, Jul 27, 2020 @ 06:30 AM

    Provider Relief Fund Deadline Extended to August 3

    covidimage

    It’s not too late to apply for financial emergency assistance from the Provider Relief Fund if you have not yet done so. The deadline to apply has been extended to Monday, August 3.

    For in-depth information from HHS about this extension, visit CARES Act. Included with the latest update on the application process is information about a webcast on Monday, July 27, 2020 at 3:00 p.m. ET.    

    You may also want to revisit an earlier ClaimCare blog concerning Four Options to Boost Your Practice’s Cash on Hand Balance.  

    Another site of interest in this matter is HealthCare Law Diagnosis.

    Meanwhile, we have discovered through our clients that some patients, especially senior adults, remain hesitant about going into a medical office or facility since COVID-19 is on the upswing in certain areas.

    Therefore, being proficient in telemedicine is still highly important. We have posted several earlier blogs regarding telemedicine, which include:

    Keep Revenue Flowing During Pandemic (03-27-20)

    Serving Patients Through Telemedicine (03-31-20)

    Update to Telemedicine (04-03-20)

    Also, regardless of the state in which you have your practice or facility, here is an informative and very extensive article by the Texas Medical Association about telemedicine and more.

     

    About ClaimCare ®                        

    ClaimCare has 30 years of medical billing experience. We have an established 100% USA-based medical billing team that has been assembled through a thorough pre-employment screening. All personnel participate in on-going training and strong process management to ensure they deliver only the highest quality medical billing services to clients.

    AwardclaimcareClaimCare has once again been named a “Top 10 Medical Billing and Coding Company.” The honor this time comes from MD Tech Review. The magazine’s Augmenting Medical Billing and Coding Operations article presents solid reasons why ClaimCare has been chosen for this 2019-2020 recognition.

    For more information, phone (855) 376-7631 toll-free, or contact sales@claimcare.net, or visit the ClaimCare Medical Billing Company website. We can assist your practice and/or facility in numerous ways, including complete certification processing

     

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    100% USA-Based HIPAA-Compliant Medical Billing Company

     

     

     

    Tags: HIPAA, best medical billing companies, telemedicine, CARES Act, Healthcare Cash Flow, Provider Relief Funds Extension

    Insurance Payers Moving at Snail-Like Pace

    Posted by Carl Mays, ClaimCare President/CEO on Thu, Jul 16, 2020 @ 03:45 PM

    snail-3901655__340We are posting this blog for ClaimCare clients and for other medical practices and facilities who have not yet become clients. During this continuing COVID-19 pandemic, we want to proactively explain to all in the healthcare industry why your Account Receivables may be behaving differently than anyone would expect.

    In a previous blog I shared how ClaimCare spent significant time, energy and money putting in place a fully-tested, HIPAA-compliant work-from-home option several years ago following a flu season that hit ClaimCare and the nation hard. 

    Thus, we are one of the relatively few companies with no interruption or slowdown whatsoever in serving our clients in a timely and responsible manner. This cannot be said about many insurance payers.

    Even though ClaimCare has been working our clients’ ARs consistently and hard throughout the COVID-19 pandemic, we are not getting the results these efforts would normally yield. This is because many payers entered the crisis unprepared and are now woefully understaffed.

    Anything that requires “human intervention” in order to resolve appeals and other forms of claims reprocessing is taking much longer than normal. Some of our clients’ ARs have not decreased over the past three months as much as we normally are accustomed to seeing due to bottlenecks caused by payers. For example:

    • With one very large payer that we can normally call and have a claim put back into reprocess on the same day, we now have difficulty in even conversing with a human.
    • Medicare appeals normally take about 30 days to resolve, but now we have claims in appeals from March that still have not processed due to Medicare staff shortages.
    • We left multiple messages for the Supervisor of one Medicare Advantage group, and when she finally returned our call she said, “We are doing the best we can, but we can’t give you an update yet on your appeals.”

    ClaimCare continues to be very aggressive with these payers within the constraints of an unprecedented event limiting their staffing. We have found chains of command to be very thin and the Insurance Commissioner unable to get involved with pandemic-related slowdowns. We will eventually obtain what is due to our clients because we feel our 100% USA-based team is the best, most professional and most prepared to get the job done.

    If anyone reading this blog post – client or non-client – has any specific questions or concerns regarding this current situation, please don’t hesitate to contact us. We in the healthcare industry are all in this together, working to achieve the best for patients, practices, facilities and America.

    About ClaimCare ®                        

    ClaimCare has 30 years of medical billing experience. We have an established 100% USA-based medical billing team that has been assembled through a thorough pre-employment screening. All personnel participate in on-going training and strong process management to ensure they deliver only the highest quality medical billing services to clients.

    ClaimCare has once again been named a “Top 10 Medical Billing and Coding Company.” The honor this time comes from MD Tech Review. The magazine’s Augmenting Medical Billing and Coding Operations article presents solid reasons why ClaimCare has been chosen for this 2019-2020 recognition.

    For more information, contact sales@claimcare.net, or phone toll-free at (855) 376-7631, or visit the ClaimCare Medical Billing Company website. We can assist your practice and/or facility in numerous ways, including complete certification processing.

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    Tags: 2010 medical billing changes, medical billing compensation, Medicaid billing, medical billing coding, Insurance Payers

    Let’s Take A Look At Medicare Allowables

    Posted by Carl Mays, ClaimCare President/CEO on Wed, Jun 17, 2020 @ 06:30 AM

    Medicare-stamp-small

    A new healthcare provider of medical appliances who turned to ClaimCare for billing and other matters was confused about Medicare Allowables. The primary question this provider had was, "What will I collect from Medicare for my services?" 

    This provider was confused because sources had been saying that Medicare only pays 80% of the published rate. In a way, this is true. However, as more established healthcare providers know, it's not the whole story. 

    Original Medicare publishes the allowable amounts for a given Current Procedural Terminology (CPT) code. How much of that specific procedure Original Medicare pays depends on where a patient is in meeting his or her deductible for the year. According to the Center for Medicare and Medicaid Services (CMS), the annual deductible for all Medicare Part B beneficiaries in 2020 is $198.

    If a patient has Original Medicare only (with no additional Medicare-related plan, which we’ll cover later on in this post) and has not met any of the deducible, the patient is responsible for that $198 plus the remaining 20% of the procedure cost. As you can imagine, with such a small deductible, Medicare patients tend to meet it early in the year.

    Once an Original Medicare patient has met the deductible, the patient will owe 20% of the allowed amount and Medicare will pay the other 80% of the allowed amount. For example, if you billed a code that would allow $100 and the patient had met the deductible, you would get a payment of $80 from Medicare and be told to bill the patient for the other $20.

    ClaimCare would then send the patient a bill. If not duly paid, ClaimCare would follow up with a call and, if needed, a collection letter. I imagine your next question would be, ”How much of the patient’s balance will we likely collect?” The answer is, “It depends.” Assuming the patient has only Original Medicare, it depends on some following factors:

    1. Patient-population Demographics.

      1. If you are in a financial area with a middle-class population or higher, we would expect to collect around 85% to 90% of the patient balances owed. This demographic tends to pay bills and to be concerned about credit scores.
      2. At the other end of the spectrum, offices with many Medicare patients who have Medicaid as a secondary insurance will result in almost no patient payments. This is because when Medicaid is secondary to Medicare they will tell us that Medicare has already paid more than Medicaid would allow. Thus, Medicaid will not pay the balance and you cannot bill the patient. This also applies to patients who have Medicaid as the primary insurance. You must accept only what Medicaid allows for these patients. You cannot bill a Medicaid patient.
      3. As I am sure you can see, the more you trend away from the regions described in category (a) above and toward category (b), the less your patient collections yield will be. If you are providing the patient with something that costs you, such as some appliance or test, you could consider requiring the patient to provide you a credit card number when the appliance or test is ordered. You could charge the expected amount the patient will owe before you provide the extra appliance or test. If you are a ClaimCare client, we could help you update your form with the info needed to do this. If it ends up the patient owes less than charged, then you could refund what was overpaid. If too little was paid, you could charge the credit card for the rest. We could help with this in our patient services area. However, keep in mind: You cannot do this for Medicaid patients. 

     2. Typical size of the balance you will be owed.

    It is best that the balance owed by a patient not be too big or too small. You want it to be in the Goldilocks Zone (just right). Balances that are really small (less than $10) can be a problem because people don’t want the hassle of making a call or writing a check to pay such a small balance, and most folks know that balances this small will not impact their credit report. On the other hand, if you get balances that are in the hundreds-of-dollars range, patients may be trying to avoid paying simply because they cannot afford such a big balance. 

    Of course, ClaimCare creatively presents payment plans to these patients with large balances, empathizing with them, but emphasizing the importance of making payments at a rate they can afford. Balances in the $10 to $200 zone are in the Goldilocks Zone. I am not saying ClaimCare will not collect payments outside this range. I am just saying the yield is best in the Goldilocks Zone.


    1. Will they even owe money?

      The additional Medicare-related plans to which I referred earlier will sometimes cover 100% rather than just 80% of the bill. They will also sometimes cover things that traditional Medicare will not pay. This is why getting into these plans is important. The percentage of people who have these plans has continued to grow exponentially, especially among patients in category (a) under the Patient-population Demographics above. Most practitioners and facilities are already familiar with such plans, but for the sake of information for newer providers, and review for experienced providers, here are some at-your-fingertips links to give insights into the various plans and terminologies:  

    Medicare Advantage Plans

     Medigap Plans 

     Medicare Supplement Insurance

     

    About ClaimCare ®                          

    ClaimCare has 30 years of medical billing experience. We have an established 100% USA-based medical billing team that has been assembled through a thorough pre-employment screening. All personnel participate in on-going training and strong process management to ensure they deliver only the highest quality medical billing services to clients.

    ClaimCare has once again been named a “Top 10 Medical Billing and Coding Company.” The honor this time comes from MD Tech Review. The magazine’s Augmenting Medical Billing and Coding Operations article presents solid reasons why ClaimCare has been chosen for this 2019-2020 recognition.

    For more information, contact sales@claimcare.net, or phone toll-free at (855) 376-7631, or visit the ClaimCare Medical Billing Company website. We can assist your practice and/or facility in numerous ways, including complete certification processing.

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    100% USA-Based HIPAA-Compliant Medical Billing Company

     

     

    Tags: Medicare Allowables

    April 3, 2020 Update to Medicare Telemedicine Notification

    Posted by Carl Mays, ClaimCare President/CEO on Fri, Apr 03, 2020 @ 06:29 PM

    April 3, 2020 Update to Medicare Telemedicine Notification

    telehealthmedicareAt 2:45 this afternoon, CMS notified all providers via Special Edition Message that CMS has made yet another change in the coding requirements for Telemedicine/Telehealth services. Pointed out below are the most critical changes, which pertain to place of service and modifier utilization. Here is the original April 1 Telemedicine Blog Post  that contains the earlier CMS information to which we are now referring. Comparing the April 1 blog to this updated blog will make things less confusing to you. 

    04-03-20 Revised Special Edition Telemedicine Message from CMS

    Building on prior action to expand reimbursement for telehealth services to Medicare beneficiaries, CMS will now allow for more than 80 additional services to be furnished via telehealth. We will notify you when those services are clearly identified.

    For professional claims for all telehealth services with dates of services on or after March 1, 2020, and for the duration of the Public Health Emergency (PHE), telehealth claims need to be billed with:

    checklist

    • Place of Service (POS) equal to what it would have been had the service been furnished in-person. This means you no longer use the 02 Place of Service.
    • Modifier 95, indicating that the service rendered was actually performed via telehealth.
    • As a reminder, CMS is not requiring the CR modifier on telehealth services.

    For telemedicine claims already billed with the “02 Place of Service,” medical billers actively monitoring these claims should show them as having been received and in process.  So, it appears this updated change will only impact claims from today forward. Your medical biller should notify you if they find any problems with older or new telemedicine claims. 

    ClaimCare remains on top of all things that impact practices and will continue to monitor these updates.  You may have numerous resources sending information to you. Make sure your medical biller vets every piece of information that is sent to you to ensure its validity.  

    We certainly hope you and your staff are staying safe and healthy during this crisis. We encourage you to share with everyone, staff and patients alike, that they can keep updated on the news and recommendations on the government’s Coronavirus.com website.

     

    About ClaimCare

    ClaimCare is a 100% USA-based HIPAA-Compliant Medical Billing Company

    ClaimCare has once again been named a “Top 10 Medical Billing and Coding Company.” The honor this time comes from MD Tech Review. The magazine’s Augmenting Medical Billing and Coding Operations article presents solid reasons why ClaimCare has been chosen for this 2019-2020 recognition.

    For additional information, contact sales@claimcare.net, or phone toll-free (855) 376-7631, or visit the ClaimCare Medical Billing website. We can assist your practice and/or facility in numerous ways.

    Tags: medical billing coding, COVID-19 Medical Reimbursement, Medicare Billing, Telehealth, CMS Update, Practice Cash Flow

    Practice Cashflow Update April 1, 2020

    Posted by Carl Mays, ClaimCare President/CEO on Thu, Apr 02, 2020 @ 08:00 AM

    Four Options to Quickly Boost Your Practice’s Cash on Hand Balance

    CashFlow

    As patient volumes have fallen, many practices are worried about keeping their doors open through this national COVID-19 crisis. With that in mind, the goal of this update is to outline four options at your disposal to quickly increase your available cash balances. These have all been made available or made easier to pursue by recent government changes in reaction to the economic turmoil being caused by COVID-19 and the related “shelter in place” orders around the country. These are listed in the order from fastest to slowest in terms of increasing your available cash on hand. 

     

    • Apply for Medicare’s Accelerated Payment and Advance Program
    • Apply for the Paycheck Protection Program as soon as it is open for applications
    • Aggressively pursue telemedicine
    • Apply for a Small Business Administration (SBA) Economic Injury Disaster Loan                            

    Details and key links for these options

    1.  Apply for Medicare’s Accelerated Payment and Advance Program.
          This program will advance you up to three months of your normal monthly Medicare payments.      

          Key elements of the program:

      • You will have the money within seven business days from when you apply.
      • You will not owe anything on this money for the first 120 days, AND your claims being sent to Medicare during this time will still pay as normal.
      • You will begin having the advance recouped after 120 days.
      • Please see this blog on ClaimCare’s website for more detailed information about the program: Medicare Accelerated Payment and Advance for Providers.  

    CMS_expands_financial_relief_for_Medicare_Providers_pic___3.31.20du___virus_4970581_1920___Pixabay.5e835a4f8b198

    2.  Apply for the Paycheck Protection Program 

          Key elements of the program:

    • It should be live for applications by Friday, April 3rd.
    • The money should be in your account in two weeks or less.
    •  It will be administered by banks and not the SBA.
      • You can receive a loan of up to 2.5 times your monthly payroll.
      • No payments are owed for the first 6 months, and no payments will be owed at all if you meet the guidelines for full loan forgiveness.
      • For the loan to be forgiven you need to use it within the eight weeks after the funds are received to pay for employee salaries, rent, utilities and other similar expenses. You also need to maintain your payroll and not significantly reduce it through layoffs or wage reductions.
      • Here is a link to more information about the program: SBA Paycheck Protection Program.

    3.  Aggressively pursue telemedicine.

    We have released multiple updates on this. The bottom line is that the reimbursements have increased, while the amount of required paperwork and other requirements have decreased; and the scope of what can be done with telemedicine has expanded. Please follow these links to see our latest updates on the ClaimCare Blog:

    4.  Apply for a Small Business Administration Economic Injury Disaster Loan.

    These loans are available because a state of emergency has been declared. These loans will take longer to result in cash on hand than the first three options outlined, but they also allow for a loan amount of up to $2 million. These are different than normal SBA loans and the lending rules are more lenient.

         Key elements of the program: 

    SBA-Loan-1030x687
    • These loans are administered by the SBA.
      • You can borrow up to $2 million.
      • You can receive an almost immediate advance of $10,000.
      • All businesses in all states are now eligible for these loans.
      • The loan proceeds can be used for expenses that cannot be paid because of the COVID-19 economic disaster.
      • The interest rate will be 3.75%.
      • You will have up to 30 years to repay the loan.
      • None of this loan is forgivable.
      • Here is a link to the SBA Economic Disaster Loan Application.

    As you can see, you have four great options to quickly improve your current cash position and help sustain you through this economic crisis. Rest assured that ClaimCare, with our fully HIPPA-compliant 100% USA-based  work from home team, is focusing on every lever at our disposal to quickly bring money in from our clients' existing and new claims.

    We encourage you to reach out to your practice’s banker to get more information about the loans outlined above. Please let ClaimCare know if you are in need of a professional medical billing company to become your partner and help you during this COVID-19 crisis - and beyond. Our mission statement is "To collect the maximum revenue for your practice as fast as possible while helping to alleviate costs and hassle for your organization" 

     

    About ClaimCare

    ClaimCare is a 100% USA-based HIPAA-Compliant Medical Billing Company

    ClaimCare has once again been named a “Top 10 Medical Billing and Coding Company.”  The honor this time comes from MD Tech Review.  The magazine’s Augmenting Medical Billing and Coding Operations article presents solid reasons why ClaimCare has been chosen for this 2019-2020 recognition.

    For additional information, contact sales@claimcare.net, or phone toll-free (855) 376-7631, or visit the ClaimCare Medical Billing website.  We can assist your practice and/or facility in numerous ways.

    Tags: Physician Reimbursement, COVID-19 Medical Reimbursement, telemedicine, SBA Loan, Practice Cash Flow

    March 31, 2020 - Latest  Telehealth CMS Update Provides More  Relief For Providers Serving Patients Through Telemedicine

    Posted by Carl Mays, ClaimCare President/CEO on Wed, Apr 01, 2020 @ 06:05 PM

    telehealth-2CMS released another important update to the ever-evolving emergency telemedicine rules. As ClaimCare has explained in earlier posts during the COVID-19 crisis, one thing is certain: “As we learn more, more things change.” This stands true with the eligibility, coding and claims processing for telemedicine.  ClaimCare has highlighted some key points for you that include the latest changes from today’s CMS update. The current CMS    report titled Physicians and Other Clinicians: CMS Flexibilities to Fight COVID-19 lists all the CPT codes that CMS is now allowing due to the National Health Disaster.

     

    Key Points that Make Telemedicine Easier and Better

    • Removes barriers for physicians, nurses and other clinicians to be readily hired from the community or from other states so the healthcare system can rapidly expand its workforce.
    • Increase access to telehealth in Medicare to ensure patients have access to physicians and other clinicians while keeping patients safe at home.
    • Puts patient care FIRST before paperwork to give temporary relief from the many reporting and auditing requirements, allowing providers, healthcare facilities, Medicare Advance and Part D plans and States to focus on providing needed care to Medicare and Medicaid beneficiaries affected by COVID-19.
    • Allows clinicians to now provide these services to established and new patients.
    • Allows ANY kind of telemedicine service (see attached list of CPT codes to use).
    • Removes Frequency guidelines.
    • Where a face-to-face visit was required in the past, those guidelines do not apply during the national health emergency.
    • Supervision requirements will not apply during the crisis, but Supervision where previously required will be allowed via teleconference with the Supervising Provider.
    • Postpones ALL re-validation requirements.

     

    Very importantly, CPT Codes have changed and expanded (again)!  There are numerous codes that can now be billed via Telehealth that could not previously be billed. It is imperative when documenting in your systems you notify medical billers that you provided these services via telemedicine.  Medical billers are required to use the appropriate place of service as well as the correct modifiers. 

     

    ClaimCare recommends you indicate in the visit type that (1) it is a telehealth visit (2) you have obtained verbal consent from the patient and (3) consent is documented in the chart. Virtual-Doctor Although the current CMS report articulates the suspension of audits, we encourage you to complete the documentation that you normally would and are ABLE to complete in the chart during the telemedicine visit.

     

    About ClaimCare

    ClaimCare is a 100% USA-based HIPAA-Compliant Medical Billing Company

    new

    ClaimCare has once again been named a “Top 10 Medical Billing and Coding Company.” The honor this time comes from MD Tech Review. The magazine’s Augmenting Medical Billing and Coding Operations article presents solid reasons why ClaimCare has been chosen for this 2019-2020 recognition.claimtag

    For additional information, contact sales@claimcare.net, or phone toll-free (855) 376-7631, or visit the ClaimCare Medical Billing website. We can assist your practice and/or facility in numerous ways.

    Tags: Telehealth, CMS Update

    Accelerated Payment and Advance for Providers

    Posted by Carl Mays, ClaimCare President/CEO on Tue, Mar 31, 2020 @ 08:03 PM

    Accelerated Payment and Advance for Providers:

    How to get it and what it means for your practiceiStock_CashFlow2

    CMS has notified providers about the Accelerated Payment and Advance program available to Part B providers. This is a portion of the legislative CARES Act (P.L. 116-136).  Each Medicare Administrative Contractor (MAC) is required under this regulation to consider advancing payments at the request of a provider.  As we will explain below, this is NOT a cash influx without consequences. It is NOT free money. This advance can represent 100% of the amount typically paid to a provider in a 3-month period.   However, if you want to, you can request less than the                                                                   CMS calculated amount.

     

    ClaimCare advises you to be cautious when requesting this advance.  We completely understand that numerous providers and practices have been hurt by this horrific COVID-19 Pandemic.  However, we encourage you to look at what this would mean for your practice on down the road.  increase-cash-flow-medical-practiceThe amount of money received is not the issue. The issue is that you must carefully consider how the advance will be recouped and reconciled beginning 120 days after you have received it. It is still in flux exactly over what timeframe MAC will reclaim the advance through recoupments. MAC may take a little from every payment over a large number of months, or they may take a lot back from every payment over a shorter timeframe. It appears NOVITAS will be recouping a small amount over many months. However, no matter the timeframe in which the money is recouped, ultimately your future payments will be reduced until the full amount of the advance is paid.

    After you receive an advance through this program, you will continue to be paid as usual for your claims submitted in the normal course of business for the next 120 days.  However, after 120 days following the advance, ANY Medicare claims submitted for payment will be processed against the advance.  This means that after 120 days you will NOT receive full payment for claims submitted to Medicare until your advance is paid in full.

     ClaimCare is not suggesting that you do not pursue the advance. We are only saying that if you do accept it, do so with a full appreciation for the impact it will have on your monthly collections in four months.

    All providers are struggling with trying to provide continuity of care by using telemedicine and videoconferencing. We understand that if your schedules are not full, it is difficult to pay the bills and keep the doors open. If you need these funds, please be sure and submit the appropriate form as quickly as possible to your regional MAC. The forms have either been sent to your primary Medicare contact – OR – you can find them on the MAC website for your region. You should receive the accelerated payment advance in 7 days after your appropriately submitted form is received. This accelerated payment opportunity is only available if the nation us under a National Emergency.  Once this designation is over, the advance will not be available to providers.

     

    To qualify, you must meet the following requirements:  

    • Have billed Medicare for claims within 180 days of the signature on the form
    • Not be in bankruptcy
    • Not under medical review or investigation
    • Cannot have any outstanding Medicare overpayments

    After 120 days from the date you receive the payment, you will have 210 days to repay the advance, which will be offset against claims submitted.  If you do not submit a sufficient volume of claims in that 210-day period to replay the advance, then you will be expected to make a payment directly to Medicare for the difference.

    We certainly hope you and your staff are staying safe and healthy during this crisis. We encourage you to share with everyone, staff and patients, that they can keep updated on the news and recommendations on the government’s Coronavirus.com website.

     

    About ClaimCare

    ClaimCare Medical Billing Company is a 100% USA-based HIPAA-Compliant Medical Billing Company

    ClaimCare has once again been named a “Top 10 Medical Billing and Coding Company.” The honor this time comes from MD Tech Review. The magazine’s Augmenting Medical Billing and Coding Operations article presents solid reasons why ClaimCare has been chosen for this 2019-2020 recognition.

    For additional information, contact sales@claimcare.net, or phone toll-free (855) 376-7631, or visit the ClaimCare Medical Billing website. We can assist your practice and/or facility in numerous ways.

    Tags: medical billing education, medical billing resources, COVID-19 Medical Reimbursement, Medicare Billing

    Keeping Your Practice Revenue Flowing During the Coronavirus Pandemic

    Posted by Carl Mays on Fri, Mar 27, 2020 @ 03:02 PM

    What You Need To Know About COVID-19 Billing 

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    Many ClaimCare clients have reached out to us with numerous questions regarding billing during the COVID-19 crisis. They have also asked what other services we can provide to help them during this time. As a 100% USA-based medical billing and coding company, we feel it is the right thing to do to assist other medical practices and facilities in navigating rough waters during this flood of change. 

    Here is the most recent key point ClaimCare has shared with clients: Medicare has made it much easier to bill for telemedicine (see below for details) – AND –  Medicare has indicated that telemedicine payments will now be the same as the normal E&M visits.

    As you are aware, information seemingly changes hourly regarding the Coronavirus. Therefore, we would like to update you on changes that have been implemented by the Federal Government to enable providers to care for patients, keep your doors open (even if virtually), and get paid for your efforts during the next several weeks or months. ClaimCare has also reminded clients they should not feel any immediate financial difficulties for the next few weeks, because the payments coming in now are from last month’s services and old AR work.

    It is evident that practices must be available to patients to ensure continuity of care, as well as to ensure the financial health of the practices.  Therefore, ClaimCare has assured clients we are in this together.  We have assured clients we are partners in Revenue Cycle Management, but we can go much further than that. At the request of numerous clients, we are expanding our services to help those who may be finding themselves short-staffed or with a staff that has been quarantined and unable to work. But first, let’s look at telemedicine:

     

     telemedicineimageGUIDANCE FOR GETTING STARTED WITH TELEMEDICINE

    • How do I get started with providing telemedicine? The basic answer is that you pick up the phone. You do not have to be approved to provide this service, and you certainly do not have to change anything in your office. Just have access to your systems.
    • We recommend you start with patients ALREADY on your schedule. Have your staff contact those  patients and inform them that rather than coming into the office, they will be receiving a call from the provider. When that happens, you are doing telemedicine.
    • If you have patients calling into your office requesting to be seen or to speak with a provider, schedule them in your appointment scheduler as you normally would. This will help you keep track of the patients you are billing for the service, and will also help you keep track of anyone who needs a call back or anyone who did not answer when you called earlier in the day.
    • Your patients will appreciate the fact that you can still help them even though they cannot come into the office.
    • You must obtain a verbal authorization from the patient at the beginning of the conversation.
    • You should document the start and stop times of the call.
    • When at all possible, we recommend you have an appointment type named “Telemedicine,” which is critical due to the similarity in coding as you will see below.
    • You should review symptoms, review systems and conduct medication reconciliation as you would do if the patient was in the office.
    • Be prepared for the need to refer patients for any kind of radiology, lab testing or COVID-19 testing. This includes telling them where to go, what to expect, and when they should receive results.
    • Encourage the patients to sign up for your portal if they have not already done so. This will ensure that you can communicate with your patients even if it is just questions, test results and other capabilities that each system portal allows between the patient and the practice.
    • Go ahead and schedule a follow-up for your patient. Explain that in these uncertain times it may be an office visit, or if the crisis is not over, you will call the patient again.Coronavirus 5
    • Allow the patient to ask you questions. Don’t rush too much.  The patient may be feeling anxious due to being confined to home and needs the reassurance that you and your staff care.
    • If you have staff who can get on the phone and do some of these steps prior to the provider getting on the phone, we encourage you to do that. This will allow you to have your staff screening calls and placing them on hold while waiting for the doctor, just as if they were in your office.
    • Remember, you can bill for your services! This is not providing services for free!
    • As of March 20th, Medicare and other private sector payers are accepting traditional E&M codes for services rendered. The only difference in the CPT codes or E&M Codes will be the modifier that has to accompany the CPT Code, along with the Place of Service.  Medicare has indicated the modifiers will NOT lower the payment of this visit. Phone visits pay at the same level as in-office visits. The ClaimCare team has worked to get phone visits added to our clients’ systems.  
    • You no longer need to divide videoconferencing from Telephonic visits. ALL will be processed by the payer, using the standard E&M codes 99212-99215.
    • Keep in mind, you are not expected to be perfect! More than likely, this will be the FIRST time most patients have had a “virtual” visit.  So, just breathe. Remember… to the patient you are the voice of reason and comfort!

     

    WHAT CLAIMCARE CAN DO TO HELP

    Several years ago, as a result of ClaimCare employees coming to work with the flu and infecting others, we spent significant time, energy and money to put into place a fully-tested, HIPAA-compliant, 100% USA-based work-from-home infrastructure. Doing that back then, has allowed us to seamlessly go fully remote as soon as the COVID-19 crisis was announced, continuing to serve clients in a timely and responsible manner.

    We admire the USA industries that are currently making changes by re-engineering their services and factories to help address the COVID-19 needs of the country.  As a proud 100% USA-based company, we are in a great position to adjust to address these same needs!  Thus, along with medical billing and coding, we are offering some new services to assist our clients during the current crisis. We can:

    • Contact your patients to alert those who are not on your scheduler that telemedicine is now an option.
    • Assist with scheduling new telemedicine visits if your scheduling staff cannot make it into the office.
    • Take over insurance verification and preauthorizations.
    • Step up to the plate for clients who have asked us only to perform clean-up projects, but now realize they can’t keep up with the current billing and follow-up!

    And, considering our solid position during these disturbing times, you may want to contact us regarding a need that is not on the above list. We will listen and will look for creative, innovative solutions.

    ClaimCare has the resources, the manpower, and the experience to assist you in many ways.  We realize that many practices are considering layoffs or even closing until this is over.  We hope to help you avoid those options. Keep in mind that since the ClaimCare team is not seeing a disruption during this crisis, we are still getting our clients’ claims to the payers and collecting money for clients.

     

    Important: With a Reuters Poll reporting on March 24, “India’s already-slowing economy weakened to at least an eight-year low this quarter and will slow even more sharply in the next six months due to the global coronavirus pandemic,” and Prime Minister Narendra Modi announcing a nationwide lockdown, ClaimCare is positioned to serve those who have been dependent upon India’s medical billers.

     

    About ClaimCare

    ClaimCare is a 100% USA-based HIPAA-Compliant Medical Billing Company

    ClaimCare has once again been named a “Top 10 Medical Billing and Coding Company.” The honor this time comes from MD Tech Review. The magazine’s Augmenting Medical Billing and Coding Operations article presents solid reasons why ClaimCare has been chosen for this 2019-2020 recognition.

    For additional information, contact sales@claimcare.net, or phone toll-free (855) 376-7631, or visit the ClaimCare Medical Billing website. We can assist your practice and/or facility in numerous ways.

     

    Tags: medical billing companies, coronavirus, COVID-19, telemedicine

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    10 Tips on How You Can Ensure Your Medical Billing Company is HIPAA Compliant

    Posted by Carl Mays on Thu, Jan 23, 2020 @ 10:30 AM

    10 Tips on How You Can Ensure Your Medical Billing Company is HIPAA CompliantAny medical billing company offering multiple services, combined with Merit-based Incentive Payment System (MIPS) consultation, should be Health Insurance Portability and Accountability Act (HIPAA) compliant, especially when handling patient records and Protective Health Information (PHI). This is a must, as Electronic Health Records (EHRs) contain sensitive data that requires protection.

    This article will showcase the importance of PHI and how HIPAA can help in protecting it, highlighting the need to find a medical billing company that is HIPAA certified.

    Understanding the Importance of PHI

    PHI includes:

    • Demographic information
    • Test and laboratory results
    • Medical history
    • Insurance information
    • Mental health conditions
    • Other relevant information needed for appropriate health care treatment

    This explains in detail the information pertaining to an individual such as birthdate, health insurance claims, and medical conditions. It is sensitive patient information, which needs to be safeguarded.

    The Role of HIPAA in Securing and Protecting the PHI

    The moment an individual is born, or even during conception, his or her PHI is already entered into the EHR system. This refers to the following:

    • Length
    • Weight
    • Body temperature
    • Complications

    As a person ages, this data keeps on accumulating in the EHR system.

    The HIPAA oversees the use of this important information. It limits access to these details and regulates those who can have access to these files. Therefore, no one is allowed to sell the PHI unless it is for:

    • Research and treatment
    • Public health activities
    • Merger or acquisition of a HIPAA covered entity.

    Why Choose a HIPAA Compliant Medical Billing Company?

    Choosing a HIPAA compliant medical billing company guarantees that your PHI is always protected because they are legally bound to handle your data according to the HIPAA Privacy and Security Rules. They are also subject to HIPAA audits conducted by agencies such as the US Department of Health and Human Services.

    Failure to comply with HIPAA rules entails losing thousands, if not millions of dollars. Watch this video to learn more about HIPAA compliance:

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    Source

    How to Know if a Medical Billing Company is HIPAA Compliant?

    Medical billing companies that are HIPAA compliant have a physical network and process security measures in place. This means having technical and nontechnical safeguards that ensure an individual's EHR/electronic PHI is protected.

    Tips in Knowing if Your Medical Billing Company is HIPAA Compliant

    Medical billing companies who are compliant have the following:

    1. Regular training with their medical billing and coders to ensure everyone knows how to protect patient privacy.
    2. Medical billing software systems are well guarded against ransomware attacks and other online hacks.
    3. Follow HIPAA protocol on online information transfer that limits the patient information shared from one department to another.
    4. Limited facility access and control with authorized access in place.
    5. Established policies regarding the use and access of electronic media and workstations.
    6. Restrictions when disposing of, transferring, removing, and even re-using electronic media and ePHI.
    7. Unique user credentials, automatic log-off, encryption and decryption mechanisms, and emergency access procedures.
    8. Regular audit reports and tracking logs that are securely recorded on their hardware and software systems.
    9. Privacy policy notices in strategic locations of their office.
    10. Conduct the Mandatory Annual HIPAA Security Risk Assessment.

    For additional guarantee, ask them for HIPAA certification. Keep following our blog to learn more tips and updates regarding HIPAA compliance, as well as the latest trends and updates in the field of medical billing and credentialing.

    About ClaimCare

    ClaimCare is a HIPAA compliant medical billing company.

    ClaimCare, 100% USA-based, has once again been named a “Top 10 Medical Billing and Coding Company.” The honor this time comes from MD Tech Review. The magazine’s ‘Augmenting Medical Billing and Coding Operations’ article presents solid reasons why ClaimCare has been chosen for this recognition.

    For additional information, contact sales@claimcare.net, or phone toll-free at (855) 376-7631, or visit the ClaimCare Medical Billing website. We can assist your practice and/or facility in becoming HIPAA compliant. This includes improving your coding compliance and accuracy, as well as your documentation process.

     

     

     

    Tags: HIPAA, medical billing companies

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