MEDICAL BILLING BLOG

What You Need To Know About COVID-19 Billing 

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:

 GUIDANCE 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.
• 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 20^th, 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

Any 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:

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.

ClaimCare 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.

Do 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:

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.

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.

According to a 2019 survey by the Kaiser Family Foundation (KFF), there are 478,463 Primary Care Physicians in the USA – and according to a 2019 survey by Statista, there are currently 525,439 Specialty Physicians. (Click on links to see categories and states.)

From these lists of physicians, some are succeeding well, others are struggling to break even, and still others are closing their offices. Meanwhile, incoming physicians are aspiring to establish their own practices.

One of the reasons why some practices have failed or are currently struggling to stay open is the lack of strategic planning. Such practices have failed to realize that establishing a private practice is not an easy endeavor and have not answered the questions that all practices face:

• What are the different measures you need to consider to ensure your practice will survive for several years prior to becoming soundly established?
• Can you handle the start-up challenges on your own, or do you need the help of another company?
• Does help from another company include obtaining the services of a professional medical billing company?

A current source that deals with the challenges of setting up your own medical practice is found in the online magazine, Business News Daily. The January 10, 2019 article is titled:

How to Open a Private Medical Practice, Step by Step

This article emphasizes that at the very least, anyone who intends to set up a medical practice should be prepared for the following:

• Equipment costs of no less than $100,000
• A line of credit with a minimum of $100,000
• Enough operating capital for several months
• Obtaining a medical practice tax ID
• Obtaining liability and malpractice insurance
• Obtaining insurance/payer credentialing
• Deciding on how to handle medical billing

Along with the basics of capitalization and the other fundamentals of opening a new medical practice, come important additional needs:

Choosing your staff

ClaimCare points to an online blog titled Manage My Practice, which covers descriptions of a dozen or more staff members, but begins with the absolute minimum number of staff required:

1. Front Desk Officer
2. Clinical Assistant

This minimum staff means that the front desk officer should be knowledgeable in many areas, including filing medical billing claims and processing your medical credentials. But what happens if the front desk officer can’t come to work? Who will handle her or his duties for the day or possibly longer, including the medical billing?

Also, rather than one clinical assistant, it is best to have two who can interchange schedules in case one of them becomes ill or is unavailable for work for some other reason.

The Manage My Practice Blog also responds to the following questions regarding staff:

1. Why do some offices need more staff and some need less?
2. What should you do if you can’t figure out if it’s taking too many people to do the work?

Returning to the Business News Daily article, other needs covered include:

Purchasing and installing your equipment

Eight pieces of equipment, with accompanying software, are detailed in this article and, importantly, the first three mentioned are extremely vital to your revenue cycle:

1. Electronic Health Record System
2. Practice Management System
3. Medical Billing System

Without someone to utilize these software systems effectively (doing the right thing) and efficiently (doing the thing right), you will experience a waste of time and a financial loss.

How a medical billing company helps your practice

A medical billing company has a pool of highly skilled medical billers and coders. These professionals have been trained to use various software systems including the above-mentioned. Thus, by working with a third party medical billing provider you are eliminating the burden of finding or training someone to utilize these systems to reach your optimal advantage. As a result, you can better focus on your core offerings and concentrate on further improving your medical services. This also gives you additional time to think of ways to further expand your patient outreach.

About ClaimCare

ClaimCare understands the needs of new medical practices. Thus, it provides services that aid you with credentialing and contracting. As needed, it also helps in training your front desk staff with all of these processes.

In all medical billing areas, ClaimCare:

· provides the top service level guarantee in the industry

· offers best-of-breed technology,

· is based 100% in the U.S.A.

· has an air-tight medical billing process

· provides actionable reporting and broad experience

· can work on its clients' medical billing systems.

Healthcare Tech Outlook named ClaimCare as one of the nation’s “Top 10 Medical Billing Companies” in 2019. This honor follows previous such honors, including being ranked in the “Top 5” by the online magazine, Money & Business.

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

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

On October 17, 2019, the Centers for Medicare & Medicaid Services (CMS) sent this reminder:

New Medicare Card: MBI Transition Ends in Less Than 10 Weeks.

ClaimCare posted a blog back on September 17, 2018, titled Top Three Impacts of Medicare ID Card Changes on Medical Billing Services. You can review the 2018 post and see that it covers several important points and then goes into some detail regarding:

1. Eligibility Verification of the New Medicare ID Card

2. Coordination of Benefits with the New Medicare ID Card

3. Submission of Medical Claims Using the MBI

Since the transition period that began April 1, 2018, CMS has posted quite a few notices dealing with clarifications and revisions to the initial announcement.

Previous CMS announcements in 2019 include the following:

September 26: New Medicare Card: More Questions about Using the MBI?

September 19: New Medicare Card: Why Use the MBI?

August 08: New Medicare Card: Will Your Claims Reject?

July 25: New Medicare Card: Questions about Using the MBI?

June 20: New Medicare Card: 75% of Claims Submitted with MBI

March 28: New Medicare Card and MBI Adoption: How Do You Compare?

March 06: MBI Look-Up Tool Can Be Used With Medicare Advantage Plans (PDF)

January 10: New Medicare Card: Transition Period Ends December 31

If you review these announcements, you will see that the majority of practices and facilities have already made the necessary changes, with many tweaking things along the way. Some, after having claims rejected, are learning more about the process. Others have assisted their patients in making sure they have the new cards and have educated them on why the change in cards became necessary.

If you still need help with the transition in any way during these final weeks prior to the mandated deadline of January 1, 2020, ClaimCare can provide that help.

In all medical billing areas, ClaimCare:

· provides the top service level guarantee in the industry

· offers best-of-breed technology,

· is based 100% in the U.S.A.

· has an air-tight medical billing process

· provides actionable reporting and broad experience

· can work on its clients' medical billing systems.

Healthcare Tech Outlook named ClaimCare as one of the nation’s “Top 10 Medical Billing Companies” in 2019. This honor follows previous such honors, including being ranked in the “Top 5” by the online magazine, Money & Business. ClaimCare has a proven track record of increasing client collections by 10 to 20 percent.

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

Medical billing reports are important in evaluating the efficiency of your practice. Thus, reports should show the performance of your organization in full details. This will greatly help in improving your revenue cycle.

Some of the questions reports should be able to answer include:

• Referring physician profitability
• Front desk employee effectiveness
• Payer contractual compliance
• Provider productivity
• Coding profiles

How is this possible? Read on to know the different data analytics that should be present in your medical billing report.

1. Accounts Receivable Aging Report

This report contains any accounts receivable (A/R) that remain to be paid by the insurance companies. It also reveals how long A/R has been unpaid and the average time a claim needs before it is paid by the insurance provider.

As an example, for CIGNA HealthCard holders, Cigna says they do their best to process medical claims within 5 days after filing.

Five days may not be possible, but medical claims should be paid in less than 45 days. Thus, any claim that extends beyond 45 days to be paid should immediately be monitored. If this reaches 90 days, then it is a red sign that you should urgently take action with it.

As a friendly note, you should also consider the type of claim you are requesting. Generally, the following claims take longer to be processed:

• Workers compensation
• Car accident claims
• Out-of-state claims

Thus, it is best to be mindful of any healthcare services provided under this category.

2. The Key Performance Indicators (KPI) Report

Just like any business, your practice should know the most profitable procedures in your organization. Thus, your key performance indicator report should be able to track the following:

• Frequency a procedure is performed
• Sum charges and collection
• Total adjustments
• Outstanding A/R

This should be neatly presented in a document so you can easily compare results on a per-date basis. Any sudden surge or leap in weeks or days should be carefully noted so you can monitor these dates more meticulously.

3. The Insurance Analysis Report

This lists the top payers and insurance companies contributing to your practice, based on the collection per Total Relative Value Unit (RVU).

But what exactly is an RVU?

This represents the following components:

• Physician work expenses: 52%
• Practice expenses (staff, facilities, overhead): 44%
• Malpractice expenses: 4%

It is further influenced by the area of the country in which the service is provided. This, together with the above components, comprises the total RVU of a particular service.

Why is this important for your practice?

Knowing the collection per total RVU of your procedures gives you the leverage to negotiate for better pricing with various insurance companies.

How do you know if you are making a smart negotiation?

Ideally, the collection per Total Relative Value Unit should be higher than the current Medicare Conversion Factor, which is $36.04. If this is lower, then you are not collecting the right amount for your services.

Check who among your payers are paying less and start talking to them about it. If they will not settle with an agreement, then it may be better to drop them and add another carrier that pays better. However, be extra careful before dropping one of your carriers because it may have an impact on your practice.

For better results, seek the advice of experts in the field of medical billing and coding to help you make an assessment of your current medical billing reports.

Do you wish to know more about medical billing and coding practices? Subscribe to our blog for more helpful insights or complete our online form so we can schedule an appointment with you. You may also contact us at (855) 376-7631.

About ClaimCare

ClaimCare delivers medical billing and coding reports with detailed information for you to fully understand the state of your practice. This helps your organization to create action plans that can help improve your performance. It also comes with an easy-to-use dashboard reporting system, which easily presents critical information in a comprehensive manner.

Looking back, to look ahead: With ICD-11 on the horizon for 2022, Centers for Medicare & Medicaid Services (CMS) reported in 2015 that claims were processed with fewer rejected and denied claims after the transition from ICD-9 to ICD-10. Rejections and denials are projected to decrease even more when ICD-11 takes effect.

Meanwhile, while dealing with ICD-10, many providers are confused on how to differentiate “rejected” medical claims from “denied” medical claims. This article discusses how you can distinguish the two from one another and steps on how to avoid both.

What are rejected medical claims?

These medical claims are considered unpayable and are sent back by the payer due to:

• Incorrect information
• Failure to meet specific data requirements
• Non-adherence to the required formatting

Due to these reasons, rejected medical claims are not even entered into the computer systems of payers. Thus, they cannot be processed.

Once the error has been fixed, rejected claims can be submitted for approval. Thus, it is important for your medical biller to properly code and complete the information required by the payer.

How are denied medical claims different from rejected medical claims?

Unlike rejected medical claims, denied claims have been received and processed by the payer, but considered unpayable. Although these claims can be resubmitted, it should be done with a reconsideration request or appropriate appeal. Otherwise, it will just be denied once again costing your practice or facility more time and money.

What causes a medical claim to be denied?

Several factors can result in a denied medical claim. This includes:

• Incorrect patient identifier information
• Termination of medical insurance coverage
• Requirement of prior authorization or precertification
• Excluded or non-covered services
• Requires supplementary medical records
• Auto or work-related incident
• Invalid CPT or HCPCS codes
• Lapse of the filing date
• Lack of referral on file

Thus, make sure your medical billers and coders are knowledgeable regarding the latest medical coding updates and are skilled in properly preparing your medical claims. Otherwise, you’ll have instances of medical claims being denied and rejected by the payers.

How can you improve your practice’s claim rejections and denial rates?

There are several ways to improve your claim rejections and denial rates:

1. Analyze and track your payer denial and rejection trends

Review the most common types of mistakes and coding errors committed by your medical billing team. Create routine chart audits for documentation and data quality. Based on this information, create a course of action that will minimize, if not eliminate, these errors.

2. Educating your medical billing and coding staff

Invest in training your staff. Provide training on how to handle claim denials and rejections appropriately.

Otherwise, consider outsourcing your medical billing to an “Experienced” and ”Knowledgeable” medical billing company. In this manner, you are guaranteed that the team handling your medical billing is well equipped, skilled, and knowledgeable in completing these tasks.

3. Discuss your concerns with payers

Schedule an appointment with your payers. Discuss, revise, or eliminate contract requirements resulting in denied claims, which eventually get overturned after an appeal. This helps to clarify the requirements in order to avoid future medical claim rejections.

Are you having problems with your medical claim submissions? Do you need help processing these claims? Subscribe to our blog for more tips and updates.

About ClaimCare

ClaimCare has more than 25 years of experience in providing medical billing and coding services to various practices. Throughout these years, they have helped numerous organizations increase their revenue cycle by eliminating medical claim rejections and denials. Complete our online form or call us toll-free at (855) 376-7631 to learn more about the services we deliver.

The famous Chinese philosopher Confucius once said, "A man who does not plan long ahead will find trouble at his door." This is true, especially with healthcare providers in the U.S. and their physician credentialing process.

In a study conducted and published by the Beckers Hospital Review, it has been revealed that a one month delay in physician credentialing can result in a $30,000 loss in revenue. This amount further increases for higher billing specialties such as cardiothoracic surgery and orthopedics. Thus, it is important for healthcare providers to plan properly for their physician credentialing procedure to ensure their cash flow will run smoothly in 2019.

These steps will help you organize your physician credentialing process:

Step 1: Start Early

Physicians Practice, an online publication, said that most physician credentialing can be done within 50 to 90 days, but it is best to give your practice a 120-day leeway. This is because the internal timeline of the payer who processes the application varies, differing from one payer to another.

Given this timeframe, it is best to start your physician credentialing process earlier, preferably prior to hiring.

Step 2: Pay Attention to Detail

Perform the necessary due diligence when submitting your application.

Many physician credentialing delays are caused by incomplete and incorrect information. This is a simple mistake that can cost you a huge sum of money. Thus, it is important for your team handling the physician credentialing process to pay close attention to all of the required information.

Double check to see if all of the entries have been properly filled out. In doing so, you'll have a more efficient physician credentialing process, which means completing it within 50 to 90 days. Plus, you avoid going through the process of re-applying.

Step 3: Remain Updated with the Coalition for Affordable Quality Healthcare (CAQH)

In December 2018, CAQH announced new functionality for Verifide ™, This automated solution verifies the accuracy and completeness of credentialing information submitted by healthcare providers to health plans.

This will now become the primary source verification (PSV) as it offers real-time visibility into your credentialing application status. As a result, your practice will have an easier time knowing the reason behind your physician credentialing rejection or denial.

Thus, you should always be in the loop with the latest updates provided by CAQH.

Step 4: Be Knowledgeable with State Regulations

State regulations vary from one another. For some states, a physician credentialed by Provider A in another state may be streamlined in their states; others may allow a physician to avoid the full credentialing process again when moving from one practice to another within the same state.

Just take a look at Texas. A credential verification organization has been launched through the collaboration of Texas Medical Association and 19 Medicaid health insurance plans. The organization’s goal is to reduce paperwork for Texas physicians.

Amanda Hudgens, director of special projects for The Texas Credentialing Alliance (TAHP), stated:

"We want to simplify the credentialing process for physicians here in Texas and we're focusing on Medicaid providers because we understand they have a lot of paperwork burdens and administrative requirements to become a Medicaid provider."

Thus, it is important for the one handling your physician credentialing to know all about these varying state regulations.

Conclusion

The physician credentialing process remains a tedious process if you do not have all the information you need up front. Following the above recommendations will help speed up this process while eliminating inefficiencies.

Subscribe to our blog for more tips related to medical billing or call us toll-free at (855) 376-7631 for your queries and concerns.

About ClaimCare

ClaimCare helps new medical practices and existing organizations with their physician credentialing process. They even assist in training your front desk office staff for a more efficient medical billing process. Learn more.