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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

    CMS Seeks Faster COVID-19 Lab Results

    Posted by Carl Mays, ClaimCare President/CEO on Fri, Oct 16, 2020 @ 01:03 PM

    CMS Seeks Faster COVID-19 Lab Results

    CMS is working to ensure that patients who test positive for the virus are alerted quickly so they can self-isolate and receive medical treatment. Thus, under President Trump’s leadership, the Centers for Medicare & Medicaid Services posted an October 15 announcement of new actions to pay for expedited COVID-19 test results.

    BLOG

    Back on April 15, CMS Administrator Seema Verma announced, “CMS has made a critical move to ensure adequate reimbursement for advanced technology that can process a large volume of COVID-19 tests rapidly and accurately.” At that time, Medicare payment to laboratories for high throughput COVID-19 diagnostic tests was increased from approximately $51 to $100 per test.

    Now, to encourage labs to increase the rapidity in receiving results, beginning January 1, 2021, Medicare will pay $100 only to laboratories that complete high throughput COVID-19 diagnostic tests within two calendar days of the specimen being collected. Medicare will pay a rate of $75 to laboratories that take longer than two days to complete these tests, effective also on January 1, 2021.

    “As America continues to grapple with the COVID-19 pandemic, prompt testing turnaround times are more important than ever,” said CMS Administrator Seema Verma. This updated payment announcement “supports faster high throughput testing, which will allow patients and physicians to act quickly and decisively with respect to treatment decisions, physical isolation, and contact tracing. President Trump continues to lead the most robust testing effort anywhere in the world.”

    Amended Administrative Ruling (CMS 2020-1-R2)

    This amended ruling, effective January 1, 2021, lowers the base payment amount for COVID-19 diagnostic tests run on high-throughput technology from $100 to $75 in accordance with CMS’s assessment of the resources needed to perform those tests.

    Then, Medicare will make an additional $25 add-on payment to laboratories for a COVID-19 diagnostic tests run on high-throughput technology if the laboratory: (1) completes the test in two calendar days or less, and (2) completes the majority of their COVID-19 diagnostic tests that use high throughput technology in two calendar days or less for all of their patients (not just their Medicare patients) in the previous month.

    HCPCS Code U0005

    CMS established these requirements to support faster high throughput COVID-19 diagnostic testing and to ensure all patients (not just Medicare patients) benefit from faster testing. These actions will be implemented under the amended Administrative Ruling (CMS-2020-1-R2) and coding instructions for the $25 add-on payment (HCPCS Code U0005) released October 15.

    According to CMS, “The new payment amounts effective January 1, 2021 ($100 and $75) reflect the resource costs laboratories face for completing COVID-19 diagnostics tests using high throughput technology in a timely fashion during the Public Health Emergency."

    Impact on Laboratories

    This CMS update may have an impact on laboratories’ logistics and/or sample collections beginning with dates of service from January 21, 2021, forward. Please note that the two-day clock starts when the sample is COLLECTED, not when it is received by the lab.

    It appears this updated policy is measured on a monthly basis. The two scenarios seem to be:

       1. In the prior month, the lab completes the majority of ALL COVID-19 tests (across all payers, not just Medicare) in 2 days or less from sample collection, and the two codes are billed: 
           a. COVID-19 test (U0004), which will pay $75
           b. Fast completion code (U0005), which will pay $25 

       2. In the prior month, the lab does not complete the majority of ALL COVID-19 tests (across all payers, not just Medicare) in 2 days or less from sample collection, and the one code is billed: 
           a. COVID-19 test (U0004), which will pay $75

    Questions Will Be Asked

    Undoubtedly, laboratories will have questions regarding this updated policy, and I feel sure additional information will be coming from CMS to answer such questions as:

    1. What does “majority” mean? Simple majority? Super majority?  
    1. Do both the test being billed AND the majority of tests from prior months need to be completed in two days or less? If you visit the CMS source, the text is not clear on this point.  
    1. What if the issue is with the sample source and not with the lab when it comes to missing the two-day mark?

     When ClaimCare uncovers more information regarding this updated policy, we will posting it via our blogs.

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    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 ClaimCare clients.

    ClaimCare has once again been named a “Top 10 Medical Billing and Coding Company.” The honor this time comes from MD Tech Review. image-png-1The 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: Medicaid billing, COVID-19 Medical Reimbursement, COVID-19, Medicare & Medicaid

    COVID-19 CPT Code Update

    Posted by Carl Mays, ClaimCare President/CEO on Fri, Sep 25, 2020 @ 06:00 AM

    Just in case you are not already aware, this memo is to inform you the American Medical Association (AMA) added Current Procedural Terminology (CPT) code 99072, effective September 8, 2020, and has updated information about this code and other codes, which was posted September 22, 2020, on the AMA website in an article titled COVID-19 Coding and Guidance.

    COVID-19 Update

    Coming rather late in the COVID-19 crisis, this code regards “Additional supplies, materials, and clinical staff time over and above those usually included in an office visit or other non-facility service when performed during a Public Health Emergency as defined by law due to respiratory-transmitted infectious disease.” 

    CPT Code 99072 Explained

    The earlier announcement explained Code 99072 is used to report additional practice expenses necessary in an office visit or other non-facility setting to mitigate the transmission of the respiratory disease for which the Public Health Emergency (PHE) was declared. These expenses include, but are not limited to, additional supplies such as face masks and cleaning supplies, as well as clinical staff time for activities such as pre-visit instructions and office arrival symptom checks that support the safe provision of evaluation, treatment or procedural services during the respiratory infection-focused PHE.

    Instructions state that when reporting 99072, report only once per in-person patient encounter per day, per provider identification number, regardless of the number of services rendered at that encounter. Code 99072 may be reported during a PHE when the additional clinical staff duties as described are performed by the physician or other qualified health care professional in lieu of clinical staff.

    Dollar Value To Be Established

    This new code does not yet have any dollar value associated with it, but efforts are underway to establish payment. 

    CPT Code 86413 Also Approved

    As explained in the update, the AMA also approved CPT code 86413, which regards “Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) antibody, quantitative," in response to the development of laboratory tests that provide quantitative measurements of SARS-CoV-2 antibodies.

    Per the standard early release delivery process for CPT codes, note that the code descriptor will need to be manually uploaded into electronic health record systems. In addition to the long descriptor, codes 99072 and 86413 have short and medium descriptors that can be accessed on the above mentioned AMA Website.

    For more detailed information on reporting codes 99072 and 86413, please refer to the September Update article on CPT Assistant, the official source for CPT coding guidance.

    _________________________

    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.

    image-png-1ClaimCare 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. 

    Tags: medical billing coding, COVID-19, COVID

    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.

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    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

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