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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.

    MEDICAL BILLING BLOG

    3 Major Benefits of Outsourcing Your Medical Credentialing Process

    Posted by Carl Mays on Tue, Jun 18, 2019 @ 11:30 AM

    3 Major Benefits of Outsourcing Your Medical Credentialing ProcessIn dealing with the complexity of the medical credentialing process, some healthcare providers still rely on spreadsheets, checklists, and makeshift programs without an expert to verify these entries. This results in several enrollment errors and delays.

    Some practices have no dedicated team to handle the credentialing process. Thus, their staff is left juggling their intended responsibilities with other tasks, which only results in inefficiencies and delayed enrollments.

    Outsourcing your medical credentialing helps eliminate these problems while offering the following benefits:

    • Reduced operating and administrative costs
    • Reduced errors in the enrollment and credentialing process
    • More time to focus on building your practice

    Recent ClaimCare blogs provide in-depth information on why Proper Medical Credentialing is a Vital Necessity and How to Avoid Delays and Mishaps in the credentialing process of verifying your medical staff information regarding:

    • Education and certifications
    • Training and work experience
    • Other professional qualifications

    This is vital because unless a physician is enrolled your practice cannot file medical claims for the services he or she delivers. This means no revenue generated for your practice or facility.

    Medical Credentialing and the Rising Administrative Costs in the HealthCare Industry

    The administrative expense in the US accounts to 8% of healthcare costs. This includes activities related to planning, regulating, and managing health systems and services such as medical credentialing.

    Kevin Schulman, a professor of Medicine at Duke and co-author of the "Administrative Costs Associated with Physician Billing and Insurance-Related Activities at an Academic Health Care," shares the reason behind this in the following statement:

    "The extraordinary costs we see are not because of administrative slack or because healthcare leaders don’t try to economize. The high administrative costs are functions of the system’s complexity."

    One source of this complexity is the multiplicity of payers in the American health system. This includes private insurances and several public health programs such as Medicaid and Medicare.

    With the variety of processes required by these payers resulting in increased administrative costs, the healthcare industry needs to consider all the possible cost-reduction solutions for operational efficiency. This includes choosing a third-party provider to handle your medical credentialing process.

    Medical Credentialing Outsourcing for Reduced Administrative Costs and Better Patient Care

    Below are three ways on how medical credentialing outsourcing can benefit your practice:

    1. Reduced Operational and Administrative Costs through Medical Credentialing Outsourcing

    In an article published in the Harvard Journal of Medicine, David Cutler Ph.D, Elizabeth Wikler B.A., and Peter Basch, M.D. shared that streamlining your electronic transactions, standardizing your reporting requirements and provider enrollment, and the credentialing system is one of the best solutions to your cost concerns.

    How much savings are we talking about? It is estimated to be $29,000 per physician in a year.

    2. Reduced Errors Resulting in a Faster Medical Credentialing Process

    With a third-party provider, you are working with expert medical staffers who are skilled and knowledgeable regarding all the recent updates on the medical credentialing process. This ensures your enrollment submission has minimal to zero errors.

    As a result, you have a faster enrollment process that allows your practice to earn more revenue.

    3. More Time to Focus on Building Your Practice

    On average, a U.S. physician spends an average of 43 minutes each day on health plan administrative functions. This is equivalent to 261 hours of saved time in a year (365 days).

    Now you can say goodbye to these administrative functions because an outsourced medical credentialing provider will do it for you. Your time can be used to focus on building your practice while delivering better services to your patients.

    About ClaimCare

    ClaimCare is one of the largest medical billing and medical credentialing providers in the United States. Its medical credentialing staff is thoroughly screened, well trained, and provided with the best tools and proper incentives to ensure you are given the best services. For more information about the services we deliver, phone us at (855) 376-7631 or subscribe to our Medical Billing Blog.

    Tags: medical billing operations, credentialing, medical credentialing

    Meet the Two Culprits Behind Your Medical Billing Mistakes

    Posted by Carl Mays on Tue, May 07, 2019 @ 11:03 AM

    Meet the Two Culprits Behind Your Medical Billing Mistakes According to a Healthcare Business and Technology report, almost 80% of medical bills contain errors. This results in approximately $125 billion of profit loss for U.S. practices. If you have in-house billing, it is important to identify these mistakes and the reasons behind them in order to fix and avoid them in the future.

    The Two Most Common Reasons Behind Medical Billing Errors:

     

    1. The Complexity of the Medical Coding System

    The International Classification of Diseases, currently in its 10th Revision (ICD-10), will present ICD-11 at the World Health Assembly in May 2019, which will come into effect on January 1, 2022. “A key principle in this revision was to simplify the coding structure and electronic tooling – this will allow health care professionals to more easily and completely record conditions,” says Dr Robert Jakob, Team Leader, Classifications Terminologies and Standards, WHO.

    Meanwhile, it is important to keep up to date on ICD-10, which has constant updates and changes, as exemplified on ClaimCare’s post: Impact of Medicare 2019 E&M code changes on a physician compensation package based on RVU.

    ICD was originally adopted by the U.S. to provide better data for research, a more efficient healthcare system, and quality, safety, and efficacy measurement of services - believing that it could reduce medical billing errors because of the specificity of services listed on each code.

    However, this has resulted in more errors for practices that have struggled to learn and remain updated with the coding system.

    Insurance companies have also become stricter with their medical billing and coding practices. The smallest mistake easily becomes a reason for your medical billing claim to be rejected.

    This results in a longer medical billing cycle, which may lead to several months of waiting before payment for services are released.

    2. Failure to Remain Updated with the Latest Medical Billing Rules and Regulations

    Another challenge facing medical practices is how to cope with the aforementioned constantly changing rules and regulations in the medical billing industry.

    The release of the Medicare 2019 E&M Code Changes meant another set of codes had to be remembered for your medical billing staff/personnel. The question arises, “Did your organization have the time and skill set to read and implement the changes?

    Kyle Haubrich, JD shared the following insights in his article, How the MIPS proposed rule could affect your practice:

    "Physicians are frustrated and are becoming burned out with all the regulations they currently have to comply with, so opting in might just be more frustration for them, and not worth the hassle."

    Are you feeling the same thing?

    Here's how you can get rid of these medical billing problems.

    Incorrectly, medical billing outsourcing may seem expensive to some practices and facilities that have never tried an efficient and effective medical billing company. However, the numerous benefits, including the reduced profit loss, will prove to be more beneficial than previously imagined for the practices and facilities that are hesitant to outsource.

    Teaming up with a medical billing company erases a need to worry about:

    • Changing medical rules and regulations
    • Medical claim submission and approval
    • Medical coding updates

    Most importantly, you don't need to spend on personnel:

    • Salary
    • Benefits
    • Taxes
    • Compensation

    You don't even need to think about turnover, training, and staff familiarization over billing software, procedures, and coding.

    With Medical billing outsourcing, you gain access to trained professionals, who only make money when you do.

    Reduce your profit loss. Consider your options and choose a medical billing company who can help you reduce these mistakes.

    Learn more tips and suggestions on how you can improve your medical billing process. Subscribe to our blog or call us toll-free at (855) 376-7631.

    About ClaimCare

    ClaimCare has over 80 years of combined medical billing experience in providing medical billing services to various specialties and states. This includes process engineering, information technology, accounting, and business management. Let's talk. Send us a message.

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

    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

    3 Types of Medical Billing Companies to Fit Your Needs

    Posted by Carl Mays on Fri, Apr 26, 2019 @ 11:01 AM

    3 Types of Medical Billing Company to Fit Your NeedsThe AMGA 2017 Medical Group Operations and Finance Survey reported that operating costs losses per physician jumped from a 10 percent loss of net revenue in 2016 to a 17.5 percent loss a year later. Thus, the total losses per physician during this two-year period went from $95,138 to $140,856.

    With these increasing revenue losses, to help reduce operational costs more and more healthcare providers are choosing to outsource their medical billing rather than keeping it in-house.

    If you are considering a move to outsource your billing, it behooves you to understand the 3 types of medical billing companies. This basic knowledge will help you decide which type best fits your needs, allowing you to focus on your core operations.

    Medical billing companies vary with the services they offer, and are categorized as such:

    1. Light Service Medical Billing Companies

    These are billing software vendors. Their services include handling of coding validation and working rejections due to authorizations, eligibility, and patient demographics.

    Due to the limited services such companies deliver, which include processing the front end billing process and processing your claims, they are designed for practices that have an expert in-house medical billing staff in place.

    2. Full Service Medical Billing Companies

    These are the traditional medical billing companies that initiate their services during the earlier stages of your revenue cycle. They are equipped and skilled to:

    • Provide your practice with technology tools and training for demographics, card issuance information, and eligibility verification, which is most helpful during the check-in process
    • Work with rejected claims and assist you on how to avoid this from happening in the future
    • Communicate with practices regarding how to manage rejections.

    They have the capacity to handle all of your medical billing concerns. This makes them the ideal choice for medium to large practices aiming to focus on their core operations.

    3. Boutique Medical Billing Companies

    Sometimes what’s required is a medical billing company that can provide more specific assistance to your specialized practice. This is where boutique types of medical billing companies are extremely valuable.

    Boutique medical billing companies can deliver customized services to specialized practices and facilities that wish to go beyond the common simple payment postings, claims submissions, and account receivables follow-up. However, this also means a higher service fee because of their unique customized approach to medical billing.

    Which type of medical billing company would best suit your practice or facility?

    It depends on your requirements. If you have a limited in-house billing staff, choosing a full-service or a boutique billing company would be ideal. However, if you have the resources to handle most of this on your own and only require a software to assist you, then a light service medical billing company could help you achieve your goals.

    About ClaimCare

    ClaimCare has over 17 years of medical billing experience with all employees being 100% U.S.A.-based. Our services include denial management, electronic medical record implementation, fixing of broken medical billing processes, and expedited billing service. Subscribe to our blog or call us toll-free at (855) 376-7631 for any of your medical billing queries and concerns.

    Tags: medical billing operations, best medical billing companies, improving medical billing, medical billing resources, Medicaid 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

    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. 

    New-Medicare-Card-Banner-Image

    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 News: You Are Probably Your Own Worst Enemy!

    Posted by ClaimCare Resources on Wed, Mar 27, 2013 @ 11:44 AM

    Denial ManagementMedicare has over 200 reason and remark codes they use daily in the process of adjudicating claims. They have recently released the top reasons for medical billing denials and rejections.  Most practices may think the majority of medical billing denials and rejections are based on how the doctor or certified CPT coder chooses to code. This is incorrect. Of course, sometimes it is the case – but most times it is not.

    You may be surprised to learn that the top denial and rejection reasons are caused by failures within the work flow of the practice’s office. It is easy enough to want to point fingers at Medicare in frustration, but quite often it is the little things that prevent a practice from being paid in as few as 15 days from submission.  So, if you are experiencing delays in receiving Medicare payments, the culprit may well be one of the issues listed below. Fixing these problems can dramatically speed up your payments from Medicare (and other payers). After all, the best medical billing denial management process is avoding denials in the first place.

    2013 top 10 reasons for Denials and Rejections:

                    1.   Claim submitted to the Wrong Payer/Contractor

                                    a.  New Medicare Advantage programs

                                    b.  Should be sent to Railroad Medicare instead of Traditional

                    2.   Patient ID Number is Invalid

                    3.   Patient DOB does not match Medicare Record

                    4.   Patient Name does not match Medicare Beneficiary

                    5.   Other insurance primary

                    6.   Coordination of Benefits of the primary payer is out of balance

                    7.   No Part B coverage (or Part A coverage only)

                    8.   Zip Code of place of service invalid (requires 4 check-digit code)

                    9.   NPI is invalid for the referring physician

                   10.  Invalid Procedure Code for date of service.   

    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: medical billing operations, medical billing education, cardiology billing, orthopedic billing, medical billing, improving medical billing, denial management

    Texas Medical Billing News for Medicaid Coverage Verifications

    Posted by ClaimCare Resources on Mon, Aug 29, 2011 @ 05:19 PM

    Texas Medical BillingIf 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."

                                     _________

    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.

    Tags: medical billing operations, medical billing education, payer compliance, improving medical billing, medical billing resources, 2011 medical billing changes, Medicaid billing

    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."

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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.

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

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