MEDICAL BILLING BLOG

Many significant coding and billing changes have been introduced in 2013 for cardiologists. The ClaimCare Medical Billing Company has created a 23 minute training video to bring cardiologists and cardiology practice staff members up to speed on the key 2013 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.

2013 Cardiology Coding and Billing Changes - (23 minutes)

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

You can download this presentation by visiting  the following page: 2013 Cardiology Coding Changes.

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 on 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.

Last spring, ClaimCare Medical Billing Company began notifying clients about inherent issues of the HIPAA 5010 mandate. We have continued working to guide clients through the standardized electronic requirements. Recently, many physicians with whom we have spoken have said they are only learning about these 5010 issues from ClaimCare. They are asking “Why isn’t there anything about these 5010 collections problems on the medical association sites?” It is understandable physicians ask this question. We have asked the question for almost a year. This is not an indictment against any state medical association, just an honest question.

The Texas Medical Association came on board February 1 to help distribute concerns, posting an article on its site about HIPAA 5010 potholes: Are Your Claims Being Rejected? Hopefully, other states that have not already done so will follow suit. This past December the Medical Group Management Association (MGMA) had issued a press release titled: Healthcare industry not ready for 5010; MGMA calls for 6-month contingency plan. Now, in a letter sent to U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius, MGMA President/CEO Dr. Susan Turney writes (click here for copy of the full letter):

“New federal standards designed to streamline electronic insurance claims are instead slowing them down, hurting physician cash flow and pushing some practices into financial distress... Many practices face significantly delayed revenue, operational difficulties, a reduced ability to treat patients, staff layoffs, or even the prospect of closing their practice."

Medscape.com posted an article on February 3 about the MGMA letter titled: Physician Groups Say 5010 Standards Hurt Cash Flow. This was preceded by the Physicians Practice “dire situation” article in December to which we referred in an earlier posting: New Year Comes with New Challenges in Healthcare Reimbursement.

As we re-emphasized in our December 19, 2011 update to clients, and then again in January, the 5010 is a format in which all clearinghouses, payers and providers must submit claims. Unfortunately, not all parties have complied in a timely manner. As a result, 5010 has hit some with the fury of a hurricane. Delays in claims acceptance and payments from Medicare and other payers such as BCBS and Cigna are occurring across the nation, and your practice is most likely experiencing decreased collections.

The ClaimCare EDI team continues to work diligently (and literally around the clock) to help resolve these issues and insure that all claims and claim files are received and confirmed at each level of the submission process. This is one of the reasons that our clients are not among the unfortunate groups that have had no Medicare payments since November 2011! Many of the delays, however, are 100% with the payers. These delays will continue until the payers correct the internal system issues that are leading to erroneous claim rejections and general processing delays. This payer-problem is one of the situations we anticipated and to which we referred in the 5010 communications we sent clients in December and January.   

We continue to communicate with our clients on “known issues” at payer (CMS, BCBS, etc.) and clearinghouse levels. Most issues are being resolved by the payers and clearinghouses.  Many other file transmission issues have been resolved through recent upgrading or patching we have performed for our clients and their practice management systems and/or via a plug-in that is designed to help translate the transmitted data into the corrected formats.

If you are not getting the information you need about the impact that 5010 is having on your practice and would like to learn what ClaimCare Medical Billing Company can do to help you, we invite you to contact us at (877) 440-3044. As far as HIPAA 5010 is concerned, we remain on the forefront of testing and successful transmission and believe for practices that are prepared to take advantage of the opportunity, relief is in sight.

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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.

Until recently physicians believed that they had until January 3, 2011 to comply with Medicare's PECOS enrollment requirement. This is no longer the case. In May Medicare announced that a new mandate from the health system reform law forced the deadline to be moved up by 6 months. Starting July 6, 2010 if the physicians that refer to your practice are not properly enrolled in the Provider Enrollment Chain and Ownership System (PECOS) then your cashflow will be interrupted. If a claim is submitted to Medicare after July 6^th with a referring physician that is not enrolled in PECOS, then Medicare can reject the claim. This means that your practice needs to work with your referring provider base and ensure that your referring providers are enrolled in PECOS. This is a much higher burden than the more typical medical billing situation where a provider only needs to ensure the he or she is enrolled with a payer.

In order to mitigate any risk to your practice's cashflow you need to:

• Generate a report of your top referring providers,
• Call and check the PECOS system to confirm that your practice's key referrers are properly enrolled (you will need basic information about the providers such as name, tax ID or provider ID),
• Contact any referring providers that are not properly enrolled with PECOS and make certain they know: 1) they are not enrolled with PECOS, 2) why it is critical that they enroll with PECOS, and 3) how to quickly enroll with PECOS (to eliminate any delays on their part in finalizing their enrollment), and
• Send thank you notes to all of the providers that are enrolled with PECOS (this is a great way of showing them how much you value their referrals).

With all of the healthcare bills and Medicare cuts taking up mind share and discussion time, it would be easy to miss the critical PECOS medical billing deadline and find that the 21% Medicare fee cut is one of two big reimbursement problems. Take action TODAY to ensure your practice's cashflow.

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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.

Physicians continue to see their collections, cashflow and emotions whipped around like a rag doll in the mouth of a rottweiler. Congress failed to act before the June 1, 2010 deadline. Once again physicians are "officially" under a new Medicare fee schedule that has an average reduction of over 21%. In reaction, Medicare will once more hold claims for the first 10 business days of the month (for June dates of service).

Physicians are being told that this 10 business day hold will have a minimal impact on their collections. This is not accurate, however, since Medicare is not holding the payments for 10 business days; rather they are holding the processing of the claims for 10 business days. It makes sense to hold the processing since if Congress negates the 21% pay cut then Medicare would need to reprocess the claims. This approach means, however, that at the end of the ten business day hold, Medicare will drop the full amount of held claims into the processing hopper and then the normal time line will begin (in other words, do not expect a big Medicare check on June 15th - which is the 11th business day of June). The bottom line is that unless Congress acts swiftly and thus Medicare begins to swiftly process claims, most physicians will see a big dip in their Medicare collections in June (since the payments typically seen in the last two weeks of a month are from dates of service in the first part of the month).

Here is the full text of the Medicare announcement (from the Trailblazer Website):

"The Continuing Extension Act of 2010, enacted April 15, 2010, extended the zero percent update to the 2010 Medicare Physician Fee Schedule (MPFS) through May 31, 2010. CMS believes Congress is working to avert the negative update scheduled to take effect June 1, 2010. To avoid disruption in the delivery of health care services to beneficiaries and payment of claims for physicians, non-physician practitioners and other providers of services paid under the MPFS, CMS has instructed its contractors to hold claims containing services paid under the MPFS (including anesthesia services) for the first 10 business days of June. This hold will only affect MPFS claims with dates of service on or after June 1, 2010.   This hold should have minimum impact on provider cash flow because, under the current law, clean electronic claims are not paid any sooner than 14 calendar days (29 for paper claims) after the date of receipt.   Be on the alert for more information about the 2010 MPFS update."

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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.

You may be faced with multiple fee options if you are considering seeking help with your old AR clean-up and denial management. Many medical billing companies will charge a very high percentage of what they collect (over 35%). Others may offer a fixed fee approach. Which is best for your practice?

As is so often the case, the best answer lies between these two options. One of the weaknesses of a high percentage of collections with no fixed fee is that the medical billing company doing the old AR clean-up has no incentive to pursue smaller claims. It will cost well over $20 for each old claim worked by the medical billing company. This means that any claim under $100 will not provide much profit for the company and will likely be ignored. This is an issue because many of the older AR claims are these smaller claims.

The fixed fee option, however, has its own problems. The problem with a pure fixed fee pricing model is that the medical billing company has no real incentive to collect as much money as it can. The company is being paid a flat fee; if it can write off a claim it will cost the company less but, of course, cost the medical practice more in lost revnue. In addition, under a fixed fee model, the medical billing company has an incentive to take a long time to work the old AR - the longer they work, the more they make.

A hybrid model of a moderate fixed fee and a moderate percentage of collections provides the best of both worlds. The fixed fee component makes it economical for the medical billing company to pursue smaller claims. The percentage of collection means the medical billing company will profit from collecting every dollar that it can (and thus does not have an incentive to just write-off claims).

Proper alignment of incentives between the practice and the medical billing company cleaning up your Old AR is critical. A mixed pricing model provides the alignment of incentives that is required for the best overall results for the practice.

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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.