MEDICAL BILLING BLOG

Many significant coding and billing changes have been introduced in 2012 for cardiologists, particularly electrophysiologists (EPs). The ClaimCare Medical Billing Company has created a 30 minute training video to bring cardiologists and cardiology practice staff members up to speed on the key 2012 Cardiology Coding and Billing Changes they need to understand to insure they have no compliance, billing or collection issues as a result of these new rules.

2012 Cardiology Coding and Billing Changes - Part 1 (13 minutes)

2012 Cardiology Coding and Billing Changes - Part 2 (15 minutes)

 

For more insights concerning cardiology billing, please check out the following collection of articles: Cardiology Billing Articles

About ClaimCare, Inc.

ClaimCare Medical Billing Services stands out from the crowd of medical billing companies. ClaimCare offers a complete medical billing solution, has the only service level guarantee in the industry, offers best-of-breed technology, an air tight medical billing process, actionable reporting and broad experience and can work its clients' medical billing systems.  For more information contact ClaimCare Medical Billing Services by email at sales@claimcare.net , by phone at (877) 440-3044 or visit the ClaimCare Medical Billing Company website.

In kicking-off 2012, Money & Business, the online magazine that provides comprehensive coverage of business and personal financial matters, named the ClaimCare Medical Billing Company among the top five online medical billing companies. Independent researcher/writer Michele Wyan, listing the top five companies in alphabetical order, was impressed with ClaimCare’s track record, extensive experience and proven ability to serve all medical specialties nationwide.

The researcher, mirroring ClaimCare’s mission “To collect the maximum revenue for your practice as fast as possible while helping to alleviate costs and hassle for your organization,” spotlighted a couple of ClaimCare’s many positive attributes:

1. A guarantee that 85% of charges will be resolved within 60 days and that 95% of charges will be resolved within 120 days.
2. The submission of claims within one weekday of receiving documentation of a patient encounter. If ClaimCare misses a claim submission deadline, the client is reimbursed for the missed claim.

ClaimCare’s CEO/President Carl Mays II says, “This recognition is greatly appreciated because it reflects the dedicated hard work and the consistent, conscientious attention to detail that ClaimCare employees provide in order to serve our clients and to accomplish our mission. We are also quite proud of the fact that we have the ability to work on all major medical billing systems such as Centricity, eCW, NextGen, eMDs, Sage, Greenway, Misys, etc.”

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Copyright 2010 by ClaimCare Inc. The author, Greg Weremowicz, is VP of Sales for ClaimCare Medical Billing Service, one of the largest medical billing companies in the United States.

If you accept Texas Medicaid then please note the following Texas medical billing changes that have begun as of August 2011. The Texas Health & Human Services Commission will be sending out new plastic Medicaid Cards to all eligible Medicaid Recipients.  The new plastic card will replace the monthly paper cards (Form 3087) to which you are accustomed. This is being done as part of the initiative to increase providers utilization of Texas Medicaid Web Resources for coverage verification and to cut down on the amount of paper that is sent to Texas Medicaid participants.

Many practices utilize the paper Medicaid cards to assist them with verification of benefits and to determine eligibility.  Please note, that in conjucntion with the move towards plastic cards, Texas Medicaid is now providing real-time; live eligibility and PCP information through their on-line tool at www.YourTexasBenefitsCard.com.

ClaimCare Medical Billing highly recommends that each Medicaid patients’ eligibility and PCP be verified with each provider visit.  If you are currently scanning traditional insurance cards into your system or EHR, we encourage you to now scan the Medicaid Plastic Cards for the Medicaid and CHIP patients that you serve.

Here is the relevant excerpt from the August 2011 Texas Medicaid Bulletin: "This week, HHSC is beginning to mail new plastic Your Texas Benefit Medicaid cards to 3.4 million Texans covered by Medicaid. The new cards will replace the paper Medicaid ID (Form 3087) Medicaid clients receive in the mail each month. Texans with Medicaid coverage should receive their new plastic cards by the end of August. They will also get one last paper Medicaid ID in a separate August mailing. The new plastic card will be the client's everyday Medicaid card and will only be replaced if the client changes health plans or the card is damaged or lost. Medicaid providers can now go to www.YourTexasBenefitscard.com and begin using the site for up-to-date information on a patient's eligibility and other services."

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Copyright 2011 by ClaimCare Inc. The author is Susan Price, Austin Office Manager of ClaimCare Medical Billing Service, one of the largest medical billing companies in the United States.

Mark Twain is attributed with saying, “The reports of my death are greatly exaggerated.” We at ClaimCare can now relate to how he must have felt! A small company by the name of Claim Care that helped patients with denied claims (and not associated with us in any way) closed their doors in September 2010. We were not even aware of the group until someone phoned us this week to see if we were still in business. Be assured – ClaimCare is alive and well – and going strong!

Not only are we alive and well – we are continuing to keep on the cutting edge of information and key technologies to collect the maximum allowable revenue for our clients while alleviating costs and hassles for their offices. We look forward to continuing to serve all of our existing and new clients in 2011 – and beyond!

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Copyright 2010 by Carl Mays II. Carl is President and CEO of ClaimCare Medical Billing Service, one of the largest medical billing companies in the United States.

ClaimCare, Inc - June 15, 2010 - According to various media reports from Washington, action will come too late regarding the June 6 Senate announcement that it is ready to initiate a 19-month Medicare "doc fix." This means cash-flow problems will affect doctors across the country. Senator Charles Schumer (D-N.Y.) said at a press conference that the Senate is expected to have 60 votes to pass the bill "early next week (week of June 14)." But even if the votes come then, more than likely it will take several days for the bill to be passed by the House and signed into law by the President.

On Monday, June 14^th Medicare responded to this continued delay by Congress by deciding that it will extend its freeze on processing claims with June dates of service until Friday, June 18^th. It is possible that Congress will reverse the massive Medicare fee reduction by that date. Given, however, the time line outlined by Senator Schumer, it is unlikely the fix will be completed by that time.

So, on Monday, June 21^st, Medicare may well begin processing June 2010 claims using the 21.3% fee reduction that went into effect on June 1. However, it appears highly likely that within two weeks Congress will retroactively reverse the fee cut. This will result in Medicare claims being reprocessed, causing new "make-up payment" problems for providers. It is a situation that leaves providers to ask some important questions - and to make some important medical billing decisions.  

Question/Decision #1:  Should your medical billing department continue submitting your Medicare claims as usual - or should you hold them until Congress eliminates the 21.3% fee reduction?

If you submit your claims as usual, then you will receive payments as usual - but at the reduced fee rate. When Congress does eliminate the fee reduction, you will have a lot of work to do when Medicare reprocesses your claims. This work includes auditing to ensure Medicare has indeed made all of the make-up payments they should. It also includes responding to patients' questions and concerns about receiving two Explanation of Benefits (EOBs) from Medicare regarding their charges. The situation will be exacerbated when Medicare automatically crosses these lower-paid claims to secondary insurance payers. EOBs and payments involving secondary (and possibly tertiary) insurance payers will cause further confusion and complications for your office - and  for your patients.

If you hold your Medicare patient claims and then submit them after Congress passes the "doc fix" bill, you will not get hit with the 21.3% cut - but you will get paid later than usual. You also will have a much simpler time in terms of ensuring all payments are correct from both Medicare and secondary payers. Also, patients will receive only a single EOB for the dates of service during this "waiting" time period.

Question/Decision #2:  Should you collect co-insurance from Medicare patients under the fee schedule that was in place prior to June 1, 2010 - or under the significantly reduced fee schedule?

If you collect patients' 20% Medicare co-insurance under the reduced fee schedule and the reduction is reversed by Congress, then under Medicare rules you will need to bill patients for any extra amount they owe over $5.00. (You are not forced to try and collect balances that will cost more to pursue than will be yielded in revenue). This will lead to additional expense and patient confusion.

On the other hand, if you collect co-insurance amounts in accordance with the pre-June 1 fee schedule and Congress does not reverse the fee reduction, then you will need to reimburse patients any overpayments greater than $5.00. (The same financially reasonable principle applies to patient refunds.) Since it is unlikely that the fee reduction will stand, this is an unlikely outcome.

Question/Decision #3:  Most likely, you have already filed some June 2010 Medicare patient claims. These will start being processed on Tuesday and will generate many of the issues mentioned above. (The decisions you make now regard being able to minimize the complications rather than being able to avoid them completely.)  These already-filed claims force you to ask and decide: Should you bill patients and secondary insurance payers for the June 1 to June 14 dates of service you submitted (and for which Medicare will begin receiving payment over the coming days) or should you wait for these claims to be reprocessed and paid correctly after Congress reverses the 21.3% Medicare fee cut?

The pros and cons outlined for the questions/decisions in #1 and #2 also apply to #3. If you proceed with billing patients (and secondary insurances that do not automatically cross over), you will have confused patients who receive an initial statement from you and then receive a second statement from you for additional money after Congress retroactively reverses the fee cut.   

On the other hand, not billing patients and secondary insurances until after Congress acts will delay your collections - but will lead to much less patient and office confusion.

My Recommendation:  Every practice must make its own decision about these issues, but a decision must indeed be made. If you can handle the temporary cash flow reduction, then my recommendation is:

1. Hold your claims until Congress retroactively reverses the Medicare fee cut;
2. Collect patient co-insurance under the pre-June 2010 fee schedule;
3. Do not bill patients or secondary insurance for the June 1, 2010 to June 18, 2010 dates of service for which you will start receiving payments over the coming days. Instead, bill the patients and secondary insurances after these dates of service are reprocessed when Congress reverses the Medicare fee cut.

This approach will minimize confusion in the practice and among your patients. It will also minimize the chance you are underpaid for your claims.

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Copyright 2010 by Carl Mays II. Carl is President and CEO of ClaimCare Medical Billing Service, one of the largest medical billing companies in the United States.

Everyone in the medical billing field is hopeful that Congress will act to defer (and ultimately eliminate) the proposed 21% fee reduction for Medicare.  Keep in mind, however, that March 2010 collections will likely suffer a delay even if the fee cut is deferred.  The coming months will be a challenging time for medical practices and medical billing companies.

In January 2010 Medicare had a 2 to 3 week delay in processing claims because they needed to update their system after Congress deferred the 21% Medicare fee reduction.  As of today, Medicare is still catching up in their claims processing (a fact that have not officially acknowledged).  ClaimCare found that as of February 23, 2010, Medicare was still at least a week behind in their typical claim processing time frame.  And this level of a delay happened when Medicare had plenty of advance warning concerning the deferral, so you can imagine what delays could result when they have less advance notice.  In addition to this delay, Medicare had a system problem that resulted in multiple weeks worth of secondary claims not crossing over properly.  This Medicare system problem has compounded the delay in collections.

There is every reason to expect another delay in Medicare payments in March 2010 if Congress issues a last-minute deferral of the 21% fee reduction.  Based upon past evidence and experience, if Congress does issue a deferment, we anticipate a 2 to 3 week delay in the Medicare claims processing and payments.  Therefore, when thinking about your cash flow for March 2010, you should plan for at least an additional 2 to 3 week delay for Medicare payments.

If Congress decides to delay the fee reduction for only 30 to 45 days (as they are considering), then this problem will be repeated and exacerbated in April if they pass yet another last-minute deferral.  Practices and medical billing companies need to plan on Medicare collections being less predicable and fairly erratic over the next few months.  As I stated earlier, this is a challenging time to be a medical practice or a medical billing company.

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Copyright 2010 by Carl Mays II. Carl is President and CEO of ClaimCare Medical Billing Service, one of the largest medical billing companies in the United States.

   Former University of Florida quarterback Tim Tebow became a hot discussion topic when Denver Broncos coach Josh McDaniels selected him in the NFL draft. Many of the comments have been of a very sarcastic, critical nature, such as one sportswriter demanding, "Fire Josh McDaniels for drafting a team chaplain in the first round." Only time will reveal the outcome of the selection, but the entire situation led me to think about hearing the late Dallas Cowboys coach Tom Landry say, "We're looking for character, not characters."

Regardless of any other talents and qualities one may possess, character often means the difference between life and death - of an organization or a person. I recall a "character segment" from the classic Lawrence of Arabia film. T.E. Lawrence, a British Army lieutenant during World War I, is leading a group of men across the Nefud Desert, considered impassable even by the Bedouins. Traveling day and night during the final stretch to reach water, they find an oasis. As the men celebrate and splash in the water, Lawrence discovers a riderless camel. The man apparently had fallen off during the night.

   Lawrence says, "We must go back and find him." But no one agrees to join Lawrence. They plead with him not to go, saying it is God's will he did not make it, that his fate was written by God. "We must not interfere," they declare.

   Lawrence climbs on a camel and heads back into the desert alone. The men shake their heads and say, "Now we have lost him, too." Two days later, a shimmering image emerges from the heat wave stretched across the sand dunes. The men stare, wipe their eyes, and stare again. Finally, someone yells, "It's Lawrence! He has found him!" They run toward Lawrence. He hands the unconscious survivor to them, looks into their faces and hoarsely whispers, "Remember this: Nothing ‘is written' unless you write it."    

   Has today's whole economic, social and political turmoil slapped you down? Is it now trying to "write you off?"

   J.C. Penney is a name well-known to most of us. He launched his chain of "The Golden Rule" department stores in 1907. His first wife died in 1910. He incorporated as the J.C. Penney Company in 1913. His second wife died giving birth to a son in 1923. The stock market crashed in 1929, and he lost $40 million.

   By 1932, J.C. Penney had to sell out to satisfy creditors, leaving him virtually broke. His spirit was crushed from his losses and his health began to fail. He ended up in a sanitarium. One morning while there, he heard the distant singing of employees who gathered to start the day with a chapel service. The words were, "Be not dismayed, whatever betide, God will take care of you. Beneath His wings of love abide, God will take care of you....."

   J.C. Penney followed the music to its source and slipped into a back row. He left a short time later a changed man, his health and spirit renewed, ready to start the long climb back at age fifty-six. By 1951, there was a J.C. Penney store in every state, and for the first time sales surpassed $1 billion a year.

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About our guest Blogger:

© Carl Mays, father of ClaimCare CEO Carl Mays II, is an author and speaker at over 3,500 events.  Contact Carl at carlmays@carlmays.com or 865-436-7478.  His motivational speaking and book information can be found on http://www.carlmays.com/.  The Student Mentoring site MyMerlin.Net for students and others is based on his book and program, "A Strategy For Winning."

There are many items that are confusing in the world of medical billing. One of the most confusing areas for individuals that are new to the business side of medicine is the idea of medical billing allowables. There are not many businesses where a bill is sent out for much more than one would expect to collect. In most business if you bill $100 then you expect to collect $100. In the business of medicine a bill for $100 is often sent out with the expectation that only $50, $30 or even less will be collected. Why?

This is primarily done for four reasons:

1. Simplicity. Not all payers pay the same amount for a medical procedure. If a practice tried to bill each insurer and each patient exactly what they expected to collect it would become an all consuming task to maintain the multiple fee schedules. The practice could easily end up with more than 25 fee schedules. In addition, all of the fee schedules would need on-going updating since many plans change the amount they will pay annually (and they change their fee schedules at different times throughout the year).
2. Revenue Enhancement. Medical practices will often see patients with insurance plans for which the provider is out of network. Some of these plans pay a percentage of billed charges. So, you do not want to set fees too low because for the plans that pay a percentage of billed charges the practice would leave money on the table that they could be collecting.
3. Comparability. If a practice continually changes it fee schedules (see point 1 above) then comparing charge volumes across months and years becomes less meaningful. For example, does the fact that charges are up 10% this June versus last mean more patients are being seen or that the fee schedule has changed? There are other measures that are easily decoupled from charge volume, such as patient encounters, but charge volume is the fastest and easiest metric for most billing software and departments to produce.
4. Compliance. It is illegal for a medical practice that accepts Medicare to charge any other entity a lower fee than they charge Medicare. They can always give discounts, but the fee charged must not be lower. By charging all plans and individuals the same amount, the risk of unintentionally running afoul of this rule is eliminated.

Now that you understand why fees are set higher than expected collections it is time to explore other elements of allowables:

• How are fee levels determined (or at least what is the best practice for determining fee levels)?
• How do allowables impact the reports and explanation of benefits that are seen daily?
• How can you use your understanding of allowables to better understand the meaning of your AR numbers?
• How can you use your understanding of allowables to better predict practice cash flow and expected collections?

These topics will be the subjects of upcoming blog entries.

2009 copyright by Carl Mays II and the ClaimCare Medical Billing Company

One of the most important things in billing is to create and follow a very structured plan that can be measured each step of the way. Remember, if it cannot be measured and monitored it cannot be improved!

Clean claim submission can reduce average days in AR to less than 45 days

The leading medical billing services operations utilize scrubbers that ensure your claims are clean before they are submitted to payers. These scrubs accelerate the speed of collections by avoiding denials and delays. They also increase collections by minimizing the volume of "re-work" and allowing billing staff to focus their efforts on pursuing true collections improvement opportunities and not simply resubmitting claims that should have been paid the first time. As a result of these scrubbers, over 90% of claims submitted are paid upon first submission. These "scrubbers" include:

• Basic mechanical scrubber that assures that all claim fields have been properly filled with formatted data (social security number with 9 digits, date of birth etc), the NPI is in a proper field, there is a referring physician if needed, etc.
• Scrubber that checks coding, bundling, and procedure information versus local Medicare and CCI rules. This scrub assures better coding, identifies overlooked procedures or codes.

The truly great medical billing specialists can rely on medical billing specific know-how and business intelligence created over time through work with many medical practices and facilities in the given payer relevant geographic area.

• Dynamic Proprietary Rule scrubber that checks for optimal coding and documentation versus the particular payer or plan's rules. This scrub assures that each claim is optimized for clean submission. When the payer or plan's rules change or when the billing office detects a systemic issue they can update the scrubber to filter and fix problems before claims go out. These specialized scrubbers can make a significant collections difference.

At ClaimCare Medical Billing Services we have found that these actions can decrease the medical practice's collections cycle by up to 40-50 days. This is why you need to insure this critical step is being completed no matter who is doing your Medical Billing.

Copyright 2008 by Carl Mays II