<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.


    Insurance Payers Moving at Snail-Like Pace

    Posted by Carl Mays, ClaimCare President/CEO on Thu, Jul 16, 2020 @ 03:45 PM

    snail-3901655__340We are posting this blog for ClaimCare clients and for other medical practices and facilities who have not yet become clients. During this continuing COVID-19 pandemic, we want to proactively explain to all in the healthcare industry why your Account Receivables may be behaving differently than anyone would expect.

    In a previous blog I shared how ClaimCare spent significant time, energy and money putting in place a fully-tested, HIPAA-compliant work-from-home option several years ago following a flu season that hit ClaimCare and the nation hard. 

    Thus, we are one of the relatively few companies with no interruption or slowdown whatsoever in serving our clients in a timely and responsible manner. This cannot be said about many insurance payers.

    Even though ClaimCare has been working our clients’ ARs consistently and hard throughout the COVID-19 pandemic, we are not getting the results these efforts would normally yield. This is because many payers entered the crisis unprepared and are now woefully understaffed.

    Anything that requires “human intervention” in order to resolve appeals and other forms of claims reprocessing is taking much longer than normal. Some of our clients’ ARs have not decreased over the past three months as much as we normally are accustomed to seeing due to bottlenecks caused by payers. For example:

    • With one very large payer that we can normally call and have a claim put back into reprocess on the same day, we now have difficulty in even conversing with a human.
    • Medicare appeals normally take about 30 days to resolve, but now we have claims in appeals from March that still have not processed due to Medicare staff shortages.
    • We left multiple messages for the Supervisor of one Medicare Advantage group, and when she finally returned our call she said, “We are doing the best we can, but we can’t give you an update yet on your appeals.”

    ClaimCare continues to be very aggressive with these payers within the constraints of an unprecedented event limiting their staffing. We have found chains of command to be very thin and the Insurance Commissioner unable to get involved with pandemic-related slowdowns. We will eventually obtain what is due to our clients because we feel our 100% USA-based team is the best, most professional and most prepared to get the job done.

    If anyone reading this blog post – client or non-client – has any specific questions or concerns regarding this current situation, please don’t hesitate to contact us. We in the healthcare industry are all in this together, working to achieve the best for patients, practices, facilities and America.

    About ClaimCare ®                        

    ClaimCare has 30 years of medical billing experience. We have an established 100% USA-based medical billing team that has been assembled through a thorough pre-employment screening. All personnel participate in on-going training and strong process management to ensure they deliver only the highest quality medical billing services to clients.

    ClaimCare has once again been named a “Top 10 Medical Billing and Coding Company.” The honor this time comes from MD Tech Review. The magazine’s Augmenting Medical Billing and Coding Operations article presents solid reasons why ClaimCare has been chosen for this 2019-2020 recognition.

    For more information, contact sales@claimcare.net, or phone toll-free at (855) 376-7631, or visit the ClaimCare Medical Billing Company website. We can assist your practice and/or facility in numerous ways, including complete certification processing.



    Tags: 2010 medical billing changes, medical billing compensation, Medicaid billing, medical billing coding, Insurance Payers

    Key Elements of a Good Medical Billing Bonus System

    Posted by Carl Mays on Fri, Jan 23, 2009 @ 07:33 PM

    medical billing bonusI have had several questions submitted about how to design a good medical billing bonus system. To help folks that are considering implementing such a system I thought I would share a few key elements of any good billing bonus system. An effective medical billing bonus system is...

    • Significant enough that people care about whether they achieve the bonus (a good bonus system will increase the base pay by between 15 and 20% for outstanding performers);
    • Paid monthly - less frequently than that and people tend to discount the value;
    • Differentiates between up front processes (getting claims out clean) and back end follow-up (dealing with claims that have denied);
    • Based upon objective and not subjective measures;
    • Outcome driven and not effort driven (i.e., based upon how many claims resolved within 60 days not how quickly claims are submitted);
    • OIG compliant (primarily gives no incentive for up coding);
    • Not easily gamed through tactics such as writing off hard to collect claims; and
    • Balances the individual and the team. Success in medical billing is a team effort that includes the front desk, the data entry people, the insurance follow-up people and the patient follow-up people. Not everyone on the team, however, typically contributes equally. The bonus should reward the team but reward the stars a bit more than the rest.

    A well designed bonus system for a medical billing department can be a challenge to design and implement, but it can pay huge dividends in terms of employee motivation and aligning their incentives with those of the practice.

    Copyright 2009 by Carl Mays II, President, ClaimCare Inc

    Tags: medical billing operations, improving medical billing, medical billing compensation

    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