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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

    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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    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 

    coronavirus 2

    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

    solutions logo medical billing and coding_Page_1

     

    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:

    image1-1

    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

    What You Need to Know Before Hiring a Medical Billing Company

    Posted by Carl Mays on Tue, Jan 14, 2020 @ 11:00 AM

    What You Need to Know Before Hiring a Medical Billing CompanyClaimCare Medical Billing, 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.

    Finding the right medical billing company can be challenging for practices or facilities that are dissatisfied with their current billing situation - or for those just starting up new practices or facilities. At the same time, medical billing and coding remains one of the most important aspects of medical- provider organizations.

    It is a proven fact that has been documented by medical practices and facilities, and by various patient surveys, many patients will switch healthcare services due to their discontent with an in-house or outsourced billing staff. And, the discontented patients often go online to air their frustrations, as well as share their dissatisfaction with family and friends. Obviously, this proves to be very costly to medical providers.

    Medical billing and coding is an ever-changing and always demanding job that requires highly-knowledgeable and laser-focused professionals. This is why ClaimCare rises above the basics of medical billing and coding with a mission statement that reads: “To collect the maximum for your practice as fast as possible while helping to alleviate costs and hassle for your organization.”

    Regardless of whether you currently have in-house or outsourced medical billing, it is vital to ensure your service contains the absolute basics needed to please the government, keep the patients content and the cash flow coming. If you do choose to outsource your service to any medical billing company, we recommend you pay attention to these 4 tips:

    Tip No.1: Check to see if the company is HIPAA compliant

    “If you think compliance is expensive, try non-compliance.”

    There is a good reason why the Government sets rules of compliance for various organizations. This is to protect consumers from unreliable service providers, including medical billing companies that have an unsecured online infrastructure.

    Thus, it is important to check to see if the medical biller you are dealing with, or want to deal with, is HIPAA compliant. If not, then it is best to look for someone that is compliant to the HIPAA rules and regulations.

    Tip No 2: Consider the company’s medical billing experience

    “Claiming is one thing, but proving is another thing.”

    Any company can easily say they offer the best services. But how can you know if they do?

    Their years of service in the industry says a lot about their work. After all, an organization cannot last long unless they deliver exceptional medical billing services to their clients. Thus, it is extremely important to know how long they have been in the industry.

    Tip No. 3: Ask about the company’s reporting system

    “All technologies are not equal.”

    One thing that sets medical billing companies apart from one another is the additional features they deliver, such as their reporting system.

    While some companies may just give you log-in details so you can process your medical bills, others will include a monthly, weekly, or real-time dashboard report. Thus, it is best to choose a company that can give everything you need to make your practice more efficient. This includes:

    • 24/7 access to your medical billing data
    • Automated insurance verification
    • Easy to use dashboard reports
    • Electronic medical record software
    • Practice analytics and recommendations
    • Practice management system
    • Scheduler

    Tip No. 4: Confirm the company’s client reviews

    Reviews are a gold mine when looking for the best medical billers. However, don’t simply believe everything you read online or hear from the company.

    Do some investigation. Contact these clients to inquire personally about the services provided to them by their medical billers. This ensures you choose an honest and reliable medical billing company.

     

    Conclusion

    There are other factors you will need to consider when choosing the right medical billing company for your practice or facility. This includes the cost, staff, and contract issues you will need to clarify with them. However, it is vital that you begin by considering these 4 tips as the first step to help you decide if the medical biller will fit your needs.

    Do you need to learn more about medical billing? Subscribe to our blog to receive regular updates, tips, and recommendations.

    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 a proven track record of increasing client collections by 10 to 20 percent.

    For more information, contact sales@claimcare.net, or phone toll-free at (855) 376-7631, or visit the ClaimCare Medical Billing Company website.

    Tags: medical billing, best medical billing companies, medical billing process

    4 Medical Billing Errors Preventing a Healthy Patient-Provider Relationship

    Posted by Carl Mays on Thu, Dec 19, 2019 @ 02:00 PM

    4 Medical Billing Errors Preventing a Healthy Patient-Provider RelationshipDo you know that “surveys consistently demonstrate that patients prioritize both the interpersonal attributes of their providers and their individual relationships with providers above all else?” This is the statement made by Kurt Strange, an expert in family and health systems in one of the articles published in Harvard Business Review.

    This video from Advent Health Florida further elaborates on this:

    image1

    Source

    A healthy patient-provider relationship that develops in the office can quickly be affected negatively if after the treatment the patient receives a medical bill that contains errors.To avoid this from happening, it is important that physicians and staff keep in mind the following common errors in medical bills that can hurt a good office-developed relationship.

    1. Medical Code Mismatch

    Any mismatch with your codes can cause rejection or denial of your patient’s medical claim. Healthcare in America reveals just how much these medical billing errors cost:

    “Most patient billing errors happen due to technology or a staff member entering an incorrect diagnostic code onto the bill. This becomes more common on bills that total more than $10,000 or more. According to credit agency Equifax, those bills often come with errors totaling more than $1300.”

    With a discrepancy amounting to more than $1300, there is no wonder your patient becomes dissatisfied. Thus, it is essential that your medical billers enter the right codes. Otherwise, be prepared to face the fury of your patient or the patient’s relatives.

    2. Duplicate Medical Billing

    As of July 2, 2018, all CMS-1500 hard copy claims should not have any duplicate ICD-10-CM diagnosis code within item 21. This is the directive issued by Medicare. Thus, any claims containing duplicate diagnosis codes will be returned as unprocessed by the Medicare Administrative Contractors (MACs) and the Durable Medical Equipment (DME).

    With this being implemented, the frequency of duplicate medical billing is expected to decrease, if not eliminated. The outcome is a more satisfying patient experience.

    3. Upcoding

    In 2018, Prime Healthcare Services was charged $65 million to settle a federal whistleblower lawsuit that accused the fast-growing California hospital chain of engineering a wide-ranging Medicare fraud scheme. Included in this lawsuit is the issue of upcoding, a medical billing error wherein services are added to the patient’s medical bill even if these services are not executed.

    Upcoding may happen for two reasons: accidentally or intentionally. Whatever reason it may be, any patient who sees unnecessary treatments included in their medical bill will most definitely direct anger towards your billing staff.

    Therefore, always perform due diligence before issuing a medical bill. Double check the codes you have entered.

    4. Incorrect Entry of Patient Information

    Sometimes, it’s the small things that can be so annoying, such as a misspelled last name or incorrect policy ID number. These could have been easily checked to avoid any claim rejection or denial.

    So, be extra careful and meticulously check all the information you’ve entered into your system. Not only will this save your practice time and money, but it will also free you from heaps of frustration due to increasing patient complaints.

    Conclusion

    Billing errors should hurt the provider-patient relationship. Ensure patients are well treated during and after check-in. Do so by handling their medical bills more efficiently through a skilled and reliable medical billing company. Learn more tips and advice related to medical billing and claims processing. Subscribe to our blog, today.

    About ClaimCare

    ClaimCare has more than 29 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 a proven track record of increasing client collections by 10 to 20 percent.

    Healthcare Tech Outlook named ClaimCare as one of the nation’s"Top 10 Medical Billing Companies" in 2019. For more information, contact sales@claimcare.net, or phone toll-free at (855) 376-7631, or visit the ClaimCare Medical Billing Company website.

     

     

     

     

    Tags: medical billing, medical billing process

    Untangling Knots in Medical Billing Process

    Posted by Carl Mays on Fri, Nov 15, 2019 @ 10:00 AM

    Untangling the Knots of the Medical Billing Process

    Medical billing is the process of submitting and following up on claims with health insurance companies in order to receive payment for services rendered by a healthcare provider.

     

     

     

     

    This task involves several individuals, including:

    • Office administrators
    • Receptionists
    • Medical billers
    • Medical coders

    It is important for any medical practice to know how the medical billing process works in order to avoid facing several problems related to the process.

    Six Steps Involved in the Medical Billing Process

    Effectively (doing the right thing) and efficiently (doing the thing right) while handling the following steps in the medical billing process is crucial for the success of your revenue cycle.

    Step 1: Patient Check-In

    The medical billing process starts the moment the patient requests an appointment with the physician. From here, the receptionist or front desk officer gathers patient information, which includes the following:

    • Name
    • Address
    • Birthdate
    • Contact number
    • Reason for visit
    • Insurance provider
    • Policy number

    It is important to accurately encode this information into the EHR system. Any wrong data encoded may be a cause for a denied or rejected claim in the future.

    Step 2: Confirming Insurance Eligibility of the Patient

    After recording or updating the initial information, the patient’s insurance coverage should be verified by the office administrator. This includes identifying the list of services covered in the patient’s current insurance policy. The administrator should also be aware of the different billing procedures required by a provider, such as the need for pre-authorization prior to billing.

    Once these things have been clarified, the office administrator needs to inform the patient if he or she needs to pay out of pocket for certain services.

    Step 3: Handling the Patient Check-Out

    All services rendered for the patient must be recorded and placed into the patient’s medical record. This means translating all the diagnoses and medical procedures into medical codes. This is where medical coders enter the picture.

    Medical coders determine the diagnoses of the treatments that have been administered to the patient. This is then translated using the ICD or CPT code and encoded into the patient’s ledger.

    Here, the patient’s bills, including previous balances (if any) and new charges, are input in relation to any payments the patient or patient’s provider may have paid, all of which are printed and given to the patient in the form of a receipt.

    Step 4: Accurately Transmitting the Medical Claim

    Now that the diagnoses and treatment services have been properly coded, it is time for the billers to transmit the medical claim to the insurance provider. However, before this is transmitted, it needs to be reviewed internally. This means adhering to written standards and procedures designed by your organization to reduce erroneous claims and fraudulent activity.

    This ensures all data has been accurately entered electronically into provider’s system through a clearinghouse or directly to the provider, such as Medicaid.

    Step 5: Receiving the Payment

    Once the medical claim is received by the insurer, it is reviewed and evaluated. The insurer determines if the entire or just a portion of the bill should be paid, or if it should be denied. All of this depends on the policy and the contract the patient signed with the insurer.

    Step 6: Billing the Patient

    There are instances wherein the patient needs to pay for the remaining bill not covered by the provider. This is the reason why some insurers and healthcare providers implement a co-payment policy.

    If the patient fails to pay the bill accordingly, it is the responsibility of the healthcare provider to followup with the patient through a collection process. Thus, it is important to explain to the patient upfront about the entire medical billing process.

    Learn more medical billing tips. Subscribe and follow our blog today.

     

    About ClaimCare

    ClaimCare provides a complete solution for all your medical billing concerns. This includes claim submission and follow-up processing, practice analytics and recommendations, instant payment program, automated insurance verification, and patient checkout tool. Learn more about the services we deliver. Complete our online form to schedule an appointment with us.

     

     

    Tags: medical billing, medical billing services, medical billing process

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