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    Welcome to the ClaimCare Medical Billing Blog. We strive to provide content that improves the overall quality of medical billing efforts across the US. If you have any specific topics that you would like to see addressed in this medical billing blog please post the topic in the Medical Billing Questions & Answers Forum. If you have an article that you would like considered for publication in the medical billing blog then please email your article to resources@claimcare.net.


    Three Reasons You Should Outsource Your Medical Billing Services

    Posted by Carl Mays on Wed, Sep 26, 2018 @ 04:03 PM

    3 reason to outsource your medical billingThe majority of the chief financial officers (CFOs) involved in the 2018 CFO Outlook Performance Management Trends and Priorities in Healthcare listed cost reduction as their no. 1 priority.

    Among them, 50% expressed the desire for easier report creation, better dashboards and visuals, and enhanced ability to understand the report and data statistics. Also, a staggering 90% have shown their concern over the online payment security of their accounts. How can outsourcing your medical billing services address these concerns? Is this even possible?

    How Outsourcing Your Medical Billing Service Can Help Your Practice

    Outsourcing your medical billing services can bring numerous benefits to your practice including:

    Increased Revenues and Reduced Labor Costs

    Approximately, 8% to 10% of medical collections are spent on the medical billing process. However, with an outsourced medical billing, you can:

    • Reduce overhead costs
    • Increase reimbursements
    • Decrease claim denials and rejections

    In an orthopedic billing case study, the group reported a 73% increase with their billing revenue within six to eight months. This was due to the improved contracting and exiting unprofitable procedure lines implemented in their medical billing process.

    In most instances, physicians and office medical managers even realize a 96% claim payment upon the first submission in less than 45 days. All because they have moved their medical billing services to a third party provider.

    Easy to Read Dashboard Reports and Data Statistics

    Now you can focus more on your patients rather than spending long hours analyzing and interpreting your medical billing reports, with the help of an outsourced medical billing provider.

    Third party providers have medical billing online dashboards that easily show the issues with your medical account at a glance. Also, the data can be tracked on a weekly, monthly, or annual basis according to:

    • Patient volumes
    • Procedure mixes
    • Collections
    • Days in AR

    This makes it easier for your staff to handle your patients’ financial matters and results in a less time-consuming experience for them.

    Safe and Secured Data Infrastructure

    Last year, DataBreaches.net shared a data compilation revealing that 477 healthcare breaches affecting 5.579 million patient records were reported to the US Department of Health and Human Services (HHS).

    Choosing the services of a well established third party medical billing company can protect your patient records through 100% secure medical billing processes. These HIPAA-compliant providers offer a secure and transparent billing process that ensures your data remains confidential at all times.

    Now you can say goodbye to those unwanted cyber hack attacks without having to pay extra for cyber-security protection. These are all taken care of by your third-party provider. All you need is to find a medical billing third-party provider who can deliver the medical billing services you require.

    Why Choose ClaimCare for Your Medical Billing Services?

    ClaimCare has more than 25 years of experience in medical billing. It has a proven track record of increased customer collection reaching all the way up to 25% (the average increase is approximately 5%) and days in AR under 40 for your collectibles.

    Let's talk. Complete our online form or call us toll-free on (855) 376-7631, today.

    Tags: general medical billing questions, medical billing operations, medical billing education, medical billing companies, medical billing services, medical billing resources, Reasons to outsource medical billing

    Buyer Beware: EHR System Vendor Agreements & Its Impact on Your Billing

    Posted by ClaimCare Resources on Thu, Sep 20, 2018 @ 05:06 AM

    Medical Billing Services


    Have you ever experienced signing an EHR vendor system agreement only to later realize you also transferred your medical billing tasks to the vendor? How about the nightmare of migrating your data from the previous system vendor to the new one? 

    This was experienced by Daniel Goodman, MD of Atlanta. He is a solo internist who had to pay approximately $10,000 to $12,000 just to get his data from the previous vendor into the new one. This is not to mention the 50% disruption of usual workload from his practice for an entire week.

    Learn the importance of thoroughly reading your EHR system vendor agreement before signing up to avoid these scenarios, surprises, and inconveniences.

    Basic Things to Consider Before Signing an EHR System Vendor Agreement

    Titus Schleyer, DMD, PhD, the director of the Center for Biomedical Informatics at the Regenstrief Institute in Indianapolis, Indiana gave a very interesting comment for anyone who wishes to sign a new EHR system vendor agreement.

    “Switching to a new system is a big investment, and you’re impacting practice viability if you’re laying out hundreds of thousands of dollars every few years for a new system. So, you need to be very careful and prepare for your switch well.”  

    You definitely need to do your homework before making that switch. To ensure you are making the right choice, include the following questions to your potential EHR system vendor:

    1. How will the data be migrated to the new EHR system?

    Migrating data from your current EHR to a new EHR system is a huge task.

    As Daniel experienced, he had to focus on manually encoding the data on the system for an entire week just to ensure it was accurately transferred. That meant temporarily closing his practice during that time.

    To prevent this from happening, properly plan for your data migration. Seek answers to the following questions in the EHR system vendor agreement:

    • How long will it take to complete the migration? Can the data be migrated in stages?
    • How does the system ensure that the data has been migrated correctly into the new vendor system?
    • Does the vendor have the capacity to integrate data from the billing system, LIS, RIS, PACS, and medical devices?

    If the answers are not clearly stated in the agreement, then it is best to clarify these questions directly with the vendor.

    1. How will the billing be done using the new system?

    A billing system is the heart of any practice. If it gets disorganized or disrupted, your entire operation may be in jeopardy. Thus, it is very important to know if the following items are clearly discussed in the agreement:

    • Billing capabilities
    • Training procedure
    • Data integration

    Software training and data integration are key factors in effectively using a new vendor system for your practice. If not provided, additional outside help from a software consultant may be necessary just to integrate the new EHR system and the medical billing system. This means more expenses for your practice.

    Think twice! Carefully read your vendor system agreement because...

    Some system vendors automatically assume the responsibility of handling the billing system of your organization after you have shifted to their service. Should you wish this to be handled by a different provider, immediately inform them upfront about it and amend the agreement stating such.

    What can ClaimCare do for your practice?

    ClaimCare provides various medical billing services. ClaimCare can work on yoru current Billing system or provide you with one if needed. For more information and how you can benefit from ClaimCare Medical Billing Services, contact us.

    Tags: general medical billing questions, medical billing operations, medical billing education, medical billing, selection process

    Top Three Impacts of Medicare ID Card Changes on Medical Billing Services

    Posted by Carl Mays on Mon, Sep 17, 2018 @ 07:05 PM

    ClaimCare Medical Billing LightsIn the interest of improving security, Medicare has released new cards meant to prevent identity theft among its users.

    The Centers for Medicare & Medicaid Services (CMS) have given physicians and medical billing companies 21 months to fully implement the necessary changes to their medical credentialing and medical billing services. The announcement was made to allow companies the chance to fully comply with the newly implemented Medicare ID card requirements.

    The question is, what kind of impact will these new changes have on your billing system and services? What would be the best way to go about this transition? Let’s start by understanding the major changes with the new Medicare ID card...

    There are three primary differences in the new Medicare ID card that should be taken note of:

    • The removal of the Social Security Number (SSN)
    • The replacement of the Health Insurance Claim Number (HICN)
    • The use of the Medicare Beneficiary Identifier (MBI)

    What’s the major difference between the Medicare Beneficiary Identifier (MBI) and the Health Insurance Claim Number (HICN)?

    Previous Medicare cards used to have the SSN based Health Insurance Claim Number (HICN) and used it as a primary identifier for card holders. However, due to rising incidence of identity theft and fraud risks, the Medicare Access and CHIP Reauthorization Act required the CMS to remove the HICN.

    Instead, Medicare cardholders will now be provided with a NEW Medicare Beneficiary Identifier (MBI) that features an 11-character-long combination of numbers and uppercase letters (except for S, L, O, I, B and Z), separated by dashes.

    It is a unique, non-intelligent and randomly generated sequence of numbers and letters that do not have any special meaning whatsoever.

    How will this impact doctors and medical office managers in billing and compliance services?

    Currently, the new Medicare cards are already being mailed and distributed to recipients. This means that cardholders will soon be visiting medical offices with their new cards, asking for further clarification about the changes, and seeking assistance for its use. It’s important,  therefore, that you are fully prepared to address their concerns, inquiries, and demands.

    With this in mind, here are the top three concerns or challenges that you need to take note of given this new policy:

    1. Eligibility Verification of the New Medicare ID Card

    With the new card, one of the primary concerns that you will have to face will be verifying its authenticity and validity. 


    The new card shares the same white, blue and red color like the previous one. However, take note of the new Medicare Number and how it is comprised of uppercase letters and numbers alone. Thus, it is most important for doctors and medical office managers to learn how to identify a valid Medicare ID card from a fraudulent one.

    This sounds simple, right? But wait a minute. This is just the tip of the iceberg. There is more information pertaining to the patient’s screening process that has to be verified. This includes:

    • Effective dates
    • Benefits and calculations
    • Administration, follow-up and plan execution

    Should there be a need to verify the validity of the card, doctors and medical office managers can check and verify using Medicare Administrative Contractors (MAC's) secure portal, beginning June 2018.

    2. Coordination of Benefits with the New Medicare ID card

    The major change happening with the new Medicare ID card is the use of the MBI number. CMS is not expecting any other major changes aside from this, unless there are disputes on an individual's account.

    Another issue you may encounter is your patients not being able to receive their new Medicare ID cards due to a change of address. How should you handle this if they visit your office and continue to hand over the old Medicare ID card?

    To that end, doctors and medical office managers should be proactive and update their records. This is to easily and quickly claim their payments while avoiding unwanted mishandling of client records in the future.

    3. Submission of medical claims using the MBI

    The issuance of new cards was driven by a need to protect users from potential identity theft and fraud. This basically means that the new Medicare IDs will still require doctors and medical office managers to thoroughly process claims. It’s important, therefore, to ensure that the process and submission of these medical claims are accurate, otherwise you will leave yourself vulnerable to payment delays.

    Bottom line…

    To help you with this transition, you need to have an efficient system set up that can handle new information, securely handle data, and manage operational efficiencies easily.

    ClaimCare provides doctors and medical office managers a complete medical billing solution to manage this transition.

    Claim Care:

    • provides the top service level guarantee in the industry
    • offers best-of-breed technology
    • is based 100% in the USA
    • an air tight medical billing process
    • provides actionable reporting and broad experience
    • 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 (855) 376-7631 or visit the ClaimCare Medical Billing Company website.

    Tags: general medical billing questions, medical billing operations, medical billing education, medical billing services, medical billing resources

    Medical Billing Benchmarks: Yield

    Posted by ClaimCare Resources on Wed, Jun 04, 2014 @ 06:54 PM

    PrMedical Billing Benchmarksactices and physician's constantly struggle with understanding how well their billing is working. This can be difficult to do because reliable medical billing benchmarks that can be easily applied are difficult to find. A great solution to this is the use of a Theoretical Yield (i.e., the amount you should collect for every dollar billed if your billing is working perfectly).

    Understanding the concept of yield is the key behind assessing the billing performance using medical billing benchmarks.  From a medical billing standpoint, yield is the amount of a claim that should actually result in a payment versus a contractual adjustment. In other words, if your yield is 50%, then on a $100 claim you should received $50 in payments and will write-off the rest to contractual adjustments. In the first article in the series on allowables I discussed why you should set your fee schedule higher than your contractual allowables. Having fees higher than allowables is what results in yields that are less than 100%.

    Calculating your practice's yield is straightforward. At its simplest level you take the allowable for a CPT and divide by the fee you charge for that CPT. Using the example above, if your fee for a given CPT is $100 and your allowable for that fee is $50, then your yield is $50 (what you should collect)/$100 (what you charge) = 50%.

    This is a straightforward calculation. The complication arises because of the various payer contracts for a practice and the fact that the yield for a specific payer often varies by CPT (i.e., with BCBS you may have a yield of 50% for one CPT and 60% for another CPT).

    This means that calculating your yield requires you to understand your procedure mix. To get a close estimate of your yield for a specific payer you can:

    1. Take your top 20 CPT codes and calculate the yield for each of these codes; and then
    2. Calculate a weighted average for the overall yield based upon the frequency of each of your CPTs;

    To move from a close estimate to a more precise estimate your repeat the above procedure but instead of only using your top 20 CPT codes, you use as many as is required to cover at least 90% of your charge volume with each payer. Typically, however, the top 20 CPTs provide an accurate answer.

    Once you have completed the above exercise for one payer, you need to repeat this for each of your top payers (you should do this for the payers that represent at least 80% of your payment volume). Once you have done this you can then get an overall yield for your practice by creating a weighted average yield for the practice based upon your charge volume (not payment volume) for the practice. The idea of a weighted average yield of the practice works well as long as your procedure mix and payer mix are stable.  If either changes significantly, then you need to recalculate your yields.

    With a weighted average practice yield (or Theoretical Yield) in hand you can easily get an initial understanding of how well you medical billing is performing. This medical billing benchmark will provide significant insight into your true performance. If your practice theoretical yield is 50% and your actual performance is 42% - then you are leaving a lot of money uncollected (up to 8% of every dollar billed). There are a number of items that will keep you from achieving your full Theoretical Yield, but you certainly would expect to be within a few percentage points.

    Although developing yields can be tedious work, it is critical to know your practice's yield and use this medical billing benchmark to understand if your medical billing is working well.

    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.

    Copyright 2009, Carl Mays II and the ClaimCare Medical Billing Company

    Tags: general medical billing questions, improving medical billing, Medical Billing Benchmarks

    HIPAA Compliance: Are you Ready for September 23rd?

    Posted by ClaimCare Resources on Wed, Sep 18, 2013 @ 02:03 PM

    HIPAA complianceGuess what day it is? No, it’s not hump day….it is HIPAA Day! Some providers are taken by surprise! Some practices are under the false impression that they are HIPAA Compliant.  Sadly, we are finding more and more that this is not the case.

    September 23rd is the deadline to ensure that your practice is prepared for the finalized MEGA RULE and HI-TECH Regulations. Numerous updates and changes are required of covered entities. Have you updated your manuals,
    the NPP (Notice of Privacy Practices), and all BAA’s (Business Associate Agreements)? Are you aware that the rules governing notifications for marketing and fundraising requirements have changed?  Are you ready? Did you know that if you are found to be NON-compliant, there are strict fines and penalties? 

    Are you ready to start the requirement for reporting disclosures to HHS? Do you know what limitations have been applied to that ruling? The HIPAA HITECH, Mega Rule comes with more audits, hefty fines and penalties and not only will it impact YOUR practice, but the impact reaches to all of your business associates. Do your providers use mobile devices such as laptops, I-phones, tablets, or other access that is considered remote access? Think about it!  September 23rd is just around the
    corner. So many questions!  Do you have the answers? If you do not feel prepared for the September 23rd deadline or the new, stricter HIPAA rules, there are many resources available to help you get where you need to be. If you have questions or need assistance, let us know. We have a team that can help get you HIPAA compliant quickly.

    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.


    Tags: general medical billing questions, HIPAA, Compliance, medical billing resources

    2012 Cardiology Coding and Billing Changes

    Posted by ClaimCare Resources on Fri, Jan 27, 2012 @ 12:42 PM

    cardiology billingMany 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.

    Tags: coding questions, general medical billing questions, medical billing education, payer compliance, cardiology billing, 2012 medical billing changes, medical billing, medical billing resources

    Medical Billing Update: Hold Medicare Claims or Submit Them?

    Posted by ClaimCare Resources on Tue, Jun 15, 2010 @ 11:24 PM

    medical billing medicareClaimCare, 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 14th 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 18th. 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 21st, 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.


    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.

    Tags: general medical billing questions, 2010 medical billing changes, medical billing, medical billing resources

    Medical Billing Update: July 6 PECOS catastrophe fast approaching

    Posted by Carl Mays on Fri, Jun 11, 2010 @ 06:44 PM

    medical billing pecosUntil 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 6th 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.


    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.

    Tags: general medical billing questions, 2010 medical billing changes, credentialing

    The June 1 Medicare Fee Cut - The Medical Billing Dance Continues

    Posted by Carl Mays on Tue, Jun 01, 2010 @ 01:00 PM

    Medicare Fee cutPhysicians 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."


    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.

    Tags: general medical billing questions, medical billing operations, medical billing education, 2010 medical billing changes, medical billing

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