<img alt="" src="http://www.poiuy12.com/102832.png" style="display:none;">
    Welcome to the ClaimCare Medical Billing Blog. We strive to provide content that improves the overall quality of medical billing efforts across the US. If you have any specific topics that you would like to see addressed in this medical billing blog please post the topic in the Medical Billing Questions & Answers Forum. If you have an article that you would like considered for publication in the medical billing blog then please email your article to resources@claimcare.net.

    MEDICAL BILLING BLOG

    10 Tips on How You Can Ensure Your Medical Billing Company is HIPAA Compliant

    Posted by Carl Mays on Thu, Jan 23, 2020 @ 10:30 AM

    10 Tips on How You Can Ensure Your Medical Billing Company is HIPAA CompliantAny 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:

    image1-1

    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.

     

     

     

    Tags: HIPAA, medical billing companies

    5 Factors to Consider When Choosing a Medical Billing Company

    Posted by Carl Mays on Wed, Sep 04, 2019 @ 10:00 AM

    5 Factors to Consider When Choosing a Medical Billing Company_On December 15, 2015, Jason Adam Townsend, owner of a medical billing company, was indicted on healthcare fraud and aggravated identity theft charges by the Charlotte Grand Jury.

    Don't fall victim to these fraudulent medical billing companies. Know how you can select a reliable medical billing company for your medical billing needs.

    When looking for a medical billing company, it is important to consider the following factors:

    1. Service Level of the Medical Billing Provider

    What are the services provided by your medical billing company? Does this include:

    • Pursuing denied claims
    • Billing follow-up
    • Complying with industry regulations
    • Reporting and analysis

    Ensure you discuss these matters with the company before signing up for any of their packages. Doing so will confirm if they are the right service provider for you.

    2. Years of Experience in the Industry

    How long has the medical billing service provider been in the industry? On what medical specialties do they focus?

    These are important questions to consider when choosing a medical billing service provider because it shows if they are knowledgeable in the following areas:

    • Current medical coding system and medical terminology
    • Insurance claims and billing, which includes the appeals and denial process, as well as fraud and abuse detection
    • Information and web technology
    • Reimbursement practices

    3. Knowledge with the Use of Technology

    One of the aims of medical billing is to accomplish more tasks with less time. This is done through the use of sophisticated billing software. But, it does not mean having to work on an entirely new system altogether.

    While most medical billing companies have their own billing system, very few have the capacity to work with the existing system used by an organization. Thus, you are forced to migrate your data into their own. However, this makes the transition process longer and more complicated.

    Rather than migrate your data into a new one, you may prefer a medical billing company  like ClaimCare that can work in your current billing system. In this manner, you don't have to worry about your data being transferred into a new system.

    Thus, it is important to ask them the following questions:

    • Are they willing to work in your current system?
    • How knowledgeable are they with other billing systems?
    • How long will it take to integrate with your billing system?

    4. Security and Compliance

    According to the National Healthcare Anti-Fraud Association NHAA, approximately tens of billions of dollars are lost to health care fraud. This makes it one of the most challenging problems among medical providers.

    Avoid being a victim. Carefully select your medical billing company by inquiring if they perform one or more of the following safety precautions:

    • Annual background checks on their employees
    • Monthly annual checks with the OIG for excluded employees
    • Anonymous methods on how to report employee violations
    • Health Insurance Portability and Accountability Act (HIPAA) training
    • Dedicated compliance officer to ensure your data remains protected

    This will help you assess how much these medical billing companies value the confidentiality of all your records.

    5. Medical Billing Service Efficiency

    Check the performance of the medical billing companies you’re considering. Identify how much of the denied claims and fee collection they are able to deliver by asking for the following data:

    • How many of their current clients match your specialization?
    • How many claims do they process each year?

    It is also helpful to know the following information:

    • Percentage of reduced payment delays
    • Increased revenues they deliver to their existing clients
    • Average number of days in A/R by specialty percentage

    Utilize all of this information when choosing a medical billing company. Remain updated with the current medical billing trends and issues. Subscribe to our blog or call us at (855) 376-7631 for any of your medical billing concerns.

    About Claimcare

    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.

    Tags: medical billing, medical billing companies, medical billing services

    3 Ways to Reduce Administrative Burdens of Your Practice

    Posted by Carl Mays on Wed, May 01, 2019 @ 08:00 AM

    3 Ways to Reduce the Administrative Burden of Your PracticeAn American College of Physicians (ACP) paper titled "Putting Patients First by Reducing Administrative Tasks in Health Care” estimated the annual costs for excessive administrative tasks total $40,069 per full-time equivalent (FTE) physician.

    The administrative tasks addressed include:

    • 2 hours for every hour a physician speaks with a patient
    • 3 to 5 hours of billing and insurance-related (BIR) activities
    • 6.5 hours per week on EHR documentation.

    Here are three strategies to help make these tasks more efficient:

    Strategy 1: Use a Cloud-Based Electronic Health Record (EHR) System Handled by Competent Staff

    According to the Center for Disease Control and Prevention (CDC), 78% of office-based physicians are using EHR systems. However, the efficiency in using these systems varies widely among practices and facilities.

    According to the National Center for Health Statistics (CDC-NCHS), it takes an average of 4,000 total mouse clicks or 43% of physician time just to document patient records and charting functions.

    You can reduce IT problems, increase efficiency, and speed-up your medical claim process through the use of a cloud-based EHR system handled by a competent administrative staff.

    Strategy 2: Outsource Your Medical Billing Tasks

    Outsourcing your medical billing is a great way to:

    • Reduce overhead costs
    • Expedite the medical claims process and increase net revenue
    • Focus on your core services

    Choosing a quality medical billing company with a proven track record of reducing administrative tasks, along with increasing your net revenue, allows you to focus on your core services and improve the quality of those services.

    Strategy 3: Prioritize and Delegate Tasks

    Emphasize individual and team responsibilities. NBA Hall of Fame coach Phil Jackson said, "The strength of the team is each member. The strength of each member is the team.” This aptly applies to your administrative staff.

    Know the skill set of your staff. Identify their strengths and weaknesses. Based on these qualities, assign the roles that will make them most effective. If needed, enlist the help of your medical billing company to assist in devising a strategic plan to improve your team's efficiency.

    Erase the idea of procrastination. Work as a team by choosing someone who will monitor the assigned tasks of each member. Strictly implement guidelines to insure tasks that should be done today will not be left undone until tomorrow.

    Challenge your excuses and act today on these tips and recommendations to help improve your medical billing process. Subscribe to our blog to receive more medical billing tips, news, and insights, or complete our online form to leave us a message.

    About ClaimCare

    ClaimCare aids you with your medical billing tasks through its complete medical billing solution. We offer the best-of-breed technology, including HIPAA compliant EHR System, and an airtight medical billing process with actionable reporting. For more information, email us at sales@claimcare.net or call (855) 376-7631.

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

    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

    Orthopedics Billing: 2013 Orthopedic Coding Changes

    Posted by ClaimCare Resources on Fri, Mar 29, 2013 @ 03:11 AM

    Orthopedic Billing and CodingMany significant coding and billing changes have been introduced in 2013 for orthopedics. The ClaimCare Medical Billing Company has created a 13 minute training video to bring orthopedic providers and practice staff members up to speed on the key 2013 Orthopedic 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 Orthopedic Coding and Billing Changes - (13 minutes)

    For more insights concerning orthopedic billing, please check out the following collection of articles: Orthopedic 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 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: coding questions, medical billing education, orthopedic billing, 2013 medical billing changes, medical billing companies, medical billing resources, Medicaid billing

    Cardiology Billing: 2013 Cardiology Coding Changes

    Posted by ClaimCare Resources on Tue, Mar 26, 2013 @ 03:51 PM

    Cardiology Billing CodingMany 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.

    Tags: coding questions, medical billing education, cardiology billing, 2013 medical billing changes, medical billing, medical billing companies, medical billing services, improving medical billing

    Medical Billing Update: 5010 Issues Are Affecting Your Collections!

    Posted by ClaimCare Resources on Thu, Feb 09, 2012 @ 09:41 PM

    5010 medical billing issuesLast 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.

    *     *     *

    Copyright 2012 by Carl Mays II, CEO/President of ClaimCare Medical Billing Services, one of the largest medical billing companies located 100% in the United States. In 2012, Money & Business, the online magazine that provides comprehensive coverage of financial matters, named the ClaimCare Medical Billing Company among the top five online medical billing companies.

    Tags: medical billing education, 2012 medical billing changes, medical billing, medical billing companies, medical billing resources, HIPAA 5010 Medical Billing Issues

    ClaimCare Named One of the Nation's Top 5 Medical Billing Companies

    Posted by ClaimCare Resources on Wed, Jan 25, 2012 @ 10:41 PM

    best medical billing companiesIn 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.”

                                                            *      *       *

    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.

    Tags: medical billing, medical billing companies, ClaimCare News, medical billing services, selection process, best medical billing companies, improving medical billing

    ClaimCare is Alive and Well

    Posted by ClaimCare Resources on Tue, Jan 25, 2011 @ 11:14 PM

    ClaimCare Medical Billing CompanyMark 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!

                                     _________

    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: medical billing companies, ClaimCare News, medical billing services

    What is the best medical billing fee structure for old AR clean-up?

    Posted by Carl Mays on Thu, May 27, 2010 @ 01:25 AM

    old AR clean-up, denial managementYou 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.

    _____________

    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: medical billing companies, denial management, AR clean-up

    Subscribe by Email

    Most Popular

    Browse the Medical Billing Blog by Tag

    Medical Billing Blog Requests

    If you have  specific topic or question you would like to see covered in this blog then please post the question on the Medical Billing Question & Answer Forum.

    If you have a question about ClaimCare's Medical Billing Services please utilize the form below.

    Contact Us