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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

    Medicare Payment for COVID-19 Vaccine Increases!

    Posted by Carl Mays, ClaimCare President/CEO on Tue, Mar 16, 2021 @ 03:31 PM

    For COVID-19 vaccines administered on or after March 15, 2021, the national average payment rate for physicians, hospitals, pharmacies and other immunizers will be $40 per dose.

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    This represents an increase from approximately $28 to $40 for the administration of single-dose vaccines, and an increase from approximately $45 to $80 for the administration of COVID-19 vaccines requiring two doses.

    The exact payment rate for administration of each dose of a COVID-19 vaccine will depend on the type of entity that furnishes the service and will be geographically adjusted based on where the service is furnished.

    This new and higher payment rate will support important actions taken by providers that are designed to increase the number of vaccines they can furnish each day, including establishing new or growing existing vaccination sites, conducting patient outreach and education, and hiring additional staff.

    At a time when vaccine supply is growing, Centers for Medicare & Medicaid Services (CMS) is supporting provider efforts to expand capacity and ensure that all Americans can be vaccinated against COVID-19 as soon as possible.

    CMS is updating the set of toolkits for providers, states, and insurers to help the health care system swiftly administer the vaccine with these new Medicare payment rates. These resources are designed to increase the number of providers that can administer the vaccine, ensure adequate payment for administering the vaccine to Medicare beneficiaries, and make it clear that no beneficiary, whether covered by private insurance, Medicare or Medicaid, should pay cost-sharing for the administration of the COVID-19 vaccine.

    Coverage of COVID-19 Vaccines

    As a condition of receiving free COVID-19 vaccines from the federal government, vaccine providers are prohibited from charging patients any amount for administration of the vaccine. To ensure broad and consistent coverage across programs and payers, the toolkits have specific information for several programs, including:

    Medicare: Beneficiaries with Medicare pay nothing for COVID-19 vaccines and there is no applicable copayment, coinsurance or deductible. 

    Medicare Advantage (MA): For calendar years 2020 and 2021, Medicare will pay providers directly for the COVID-19 vaccine (if they do not receive it for free) and its administration for beneficiaries enrolled in MA plans. MA plans are not responsible for paying providers to administer the vaccine to MA enrollees during this time. Like beneficiaries in Original Medicare, Medicare Advantage enrollees also pay no cost-sharing for COVID-19 vaccines.

    Medicaid: State Medicaid and CHIP agencies must provide vaccine administration with no cost sharing for nearly all beneficiaries during the public health emergency (PHE) and at least one year after it ends. Through the American Rescue Plan Act signed by President Biden on March 11, 2021, the COVID-19 vaccine administration will be fully federally funded. The law also provides an expansion of individuals eligible for vaccine administration coverage. There will be more information provided in upcoming updates to the Medicaid toolkit at Toolkit.   

    Private Plans: CMS, along with the Departments of Labor and Treasury, is requiring that most private health plans and issuers cover the COVID-19 vaccine and its administration, both in-network and out-of-network, with no cost- sharing during the public health emergency (PHE). Current regulations provide that out-of-network rates must be reasonable, as compared to prevailing market rates, and reference the Medicare reimbursement rates as a potential guideline for insurance companies. In light of CMS’s increased Medicare payment rates, CMS will expect commercial carriers to continue to ensure that their rates are reasonable in comparison to prevailing market rates. 

    Uninsured: For individuals who are uninsured, providers may submit claims for reimbursement for administering the COVID-19 vaccine to individuals without insurance through the Provider Relief Fund, administered by the Health Resources and Services Administration (HRSA).

    More information on Medicare payment for COVID-19 vaccine administration – including a list of billing codes, payment allowances and effective dates – is available at Vaccine Shot Payment.

    More information regarding the Centers for Disease Control and Prevention (CDC) COVID-19 Vaccination Program Provider Requirements, and how the COVID-19 vaccine is provided at 100% no-cost to recipients is available at Provider Support.

    Information on the COVID-19 Claims Reimbursement to Health Care Providers and Facilities for Testing, Treatment, and Vaccine Administration for the Uninsured Program is available at Covid-19 Uninsured. 

    To view the complete Centers for Medicare & Medicaid Services (CMS) announcement, click Vaccine Payments. 

    To contact CMS Media Relations: (202) 690-6145 or CMS Media Inquiries.

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    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.

     

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    Tags: medical billing, medical billing process, COVID-19 Medical Reimbursement, COVID-19, COVID and the law

    What You Need to Know Before Hiring a Medical Billing Company

    Posted by Carl Mays on Tue, Jan 14, 2020 @ 11:00 AM

    What You Need to Know Before Hiring a Medical Billing CompanyClaimCare Medical Billing, 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.

    Finding the right medical billing company can be challenging for practices or facilities that are dissatisfied with their current billing situation - or for those just starting up new practices or facilities. At the same time, medical billing and coding remains one of the most important aspects of medical- provider organizations.

    It is a proven fact that has been documented by medical practices and facilities, and by various patient surveys, many patients will switch healthcare services due to their discontent with an in-house or outsourced billing staff. And, the discontented patients often go online to air their frustrations, as well as share their dissatisfaction with family and friends. Obviously, this proves to be very costly to medical providers.

    Medical billing and coding is an ever-changing and always demanding job that requires highly-knowledgeable and laser-focused professionals. This is why ClaimCare rises above the basics of medical billing and coding with a mission statement that reads: “To collect the maximum for your practice as fast as possible while helping to alleviate costs and hassle for your organization.”

    Regardless of whether you currently have in-house or outsourced medical billing, it is vital to ensure your service contains the absolute basics needed to please the government, keep the patients content and the cash flow coming. If you do choose to outsource your service to any medical billing company, we recommend you pay attention to these 4 tips:

    Tip No.1: Check to see if the company is HIPAA compliant

    “If you think compliance is expensive, try non-compliance.”

    There is a good reason why the Government sets rules of compliance for various organizations. This is to protect consumers from unreliable service providers, including medical billing companies that have an unsecured online infrastructure.

    Thus, it is important to check to see if the medical biller you are dealing with, or want to deal with, is HIPAA compliant. If not, then it is best to look for someone that is compliant to the HIPAA rules and regulations.

    Tip No 2: Consider the company’s medical billing experience

    “Claiming is one thing, but proving is another thing.”

    Any company can easily say they offer the best services. But how can you know if they do?

    Their years of service in the industry says a lot about their work. After all, an organization cannot last long unless they deliver exceptional medical billing services to their clients. Thus, it is extremely important to know how long they have been in the industry.

    Tip No. 3: Ask about the company’s reporting system

    “All technologies are not equal.”

    One thing that sets medical billing companies apart from one another is the additional features they deliver, such as their reporting system.

    While some companies may just give you log-in details so you can process your medical bills, others will include a monthly, weekly, or real-time dashboard report. Thus, it is best to choose a company that can give everything you need to make your practice more efficient. This includes:

    • 24/7 access to your medical billing data
    • Automated insurance verification
    • Easy to use dashboard reports
    • Electronic medical record software
    • Practice analytics and recommendations
    • Practice management system
    • Scheduler

    Tip No. 4: Confirm the company’s client reviews

    Reviews are a gold mine when looking for the best medical billers. However, don’t simply believe everything you read online or hear from the company.

    Do some investigation. Contact these clients to inquire personally about the services provided to them by their medical billers. This ensures you choose an honest and reliable medical billing company.

     

    Conclusion

    There are other factors you will need to consider when choosing the right medical billing company for your practice or facility. This includes the cost, staff, and contract issues you will need to clarify with them. However, it is vital that you begin by considering these 4 tips as the first step to help you decide if the medical biller will fit your needs.

    Do you need to learn more about medical billing? Subscribe to our blog to receive regular updates, tips, and recommendations.

    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 a proven track record of increasing client collections by 10 to 20 percent.

    For more information, contact sales@claimcare.net, or phone toll-free at (855) 376-7631, or visit the ClaimCare Medical Billing Company website.

    Tags: medical billing, best medical billing companies, medical billing process

    4 Medical Billing Errors Preventing a Healthy Patient-Provider Relationship

    Posted by Carl Mays on Thu, Dec 19, 2019 @ 02:00 PM

    4 Medical Billing Errors Preventing a Healthy Patient-Provider RelationshipDo you know that “surveys consistently demonstrate that patients prioritize both the interpersonal attributes of their providers and their individual relationships with providers above all else?” This is the statement made by Kurt Strange, an expert in family and health systems in one of the articles published in Harvard Business Review.

    This video from Advent Health Florida further elaborates on this:

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    Source

    A healthy patient-provider relationship that develops in the office can quickly be affected negatively if after the treatment the patient receives a medical bill that contains errors.To avoid this from happening, it is important that physicians and staff keep in mind the following common errors in medical bills that can hurt a good office-developed relationship.

    1. Medical Code Mismatch

    Any mismatch with your codes can cause rejection or denial of your patient’s medical claim. Healthcare in America reveals just how much these medical billing errors cost:

    “Most patient billing errors happen due to technology or a staff member entering an incorrect diagnostic code onto the bill. This becomes more common on bills that total more than $10,000 or more. According to credit agency Equifax, those bills often come with errors totaling more than $1300.”

    With a discrepancy amounting to more than $1300, there is no wonder your patient becomes dissatisfied. Thus, it is essential that your medical billers enter the right codes. Otherwise, be prepared to face the fury of your patient or the patient’s relatives.

    2. Duplicate Medical Billing

    As of July 2, 2018, all CMS-1500 hard copy claims should not have any duplicate ICD-10-CM diagnosis code within item 21. This is the directive issued by Medicare. Thus, any claims containing duplicate diagnosis codes will be returned as unprocessed by the Medicare Administrative Contractors (MACs) and the Durable Medical Equipment (DME).

    With this being implemented, the frequency of duplicate medical billing is expected to decrease, if not eliminated. The outcome is a more satisfying patient experience.

    3. Upcoding

    In 2018, Prime Healthcare Services was charged $65 million to settle a federal whistleblower lawsuit that accused the fast-growing California hospital chain of engineering a wide-ranging Medicare fraud scheme. Included in this lawsuit is the issue of upcoding, a medical billing error wherein services are added to the patient’s medical bill even if these services are not executed.

    Upcoding may happen for two reasons: accidentally or intentionally. Whatever reason it may be, any patient who sees unnecessary treatments included in their medical bill will most definitely direct anger towards your billing staff.

    Therefore, always perform due diligence before issuing a medical bill. Double check the codes you have entered.

    4. Incorrect Entry of Patient Information

    Sometimes, it’s the small things that can be so annoying, such as a misspelled last name or incorrect policy ID number. These could have been easily checked to avoid any claim rejection or denial.

    So, be extra careful and meticulously check all the information you’ve entered into your system. Not only will this save your practice time and money, but it will also free you from heaps of frustration due to increasing patient complaints.

    Conclusion

    Billing errors should hurt the provider-patient relationship. Ensure patients are well treated during and after check-in. Do so by handling their medical bills more efficiently through a skilled and reliable medical billing company. Learn more tips and advice related to medical billing and claims processing. Subscribe to our blog, today.

    About ClaimCare

    ClaimCare has more than 29 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 a proven track record of increasing client collections by 10 to 20 percent.

    Healthcare Tech Outlook named ClaimCare as one of the nation’s"Top 10 Medical Billing Companies" in 2019. For more information, contact sales@claimcare.net, or phone toll-free at (855) 376-7631, or visit the ClaimCare Medical Billing Company website.

     

     

     

     

    Tags: medical billing, medical billing process

    Untangling Knots in Medical Billing Process

    Posted by Carl Mays on Fri, Nov 15, 2019 @ 10:00 AM

    Untangling the Knots of the Medical Billing Process

    Medical billing is the process of submitting and following up on claims with health insurance companies in order to receive payment for services rendered by a healthcare provider.

     

     

     

     

    This task involves several individuals, including:

    • Office administrators
    • Receptionists
    • Medical billers
    • Medical coders

    It is important for any medical practice to know how the medical billing process works in order to avoid facing several problems related to the process.

    Six Steps Involved in the Medical Billing Process

    Effectively (doing the right thing) and efficiently (doing the thing right) while handling the following steps in the medical billing process is crucial for the success of your revenue cycle.

    Step 1: Patient Check-In

    The medical billing process starts the moment the patient requests an appointment with the physician. From here, the receptionist or front desk officer gathers patient information, which includes the following:

    • Name
    • Address
    • Birthdate
    • Contact number
    • Reason for visit
    • Insurance provider
    • Policy number

    It is important to accurately encode this information into the EHR system. Any wrong data encoded may be a cause for a denied or rejected claim in the future.

    Step 2: Confirming Insurance Eligibility of the Patient

    After recording or updating the initial information, the patient’s insurance coverage should be verified by the office administrator. This includes identifying the list of services covered in the patient’s current insurance policy. The administrator should also be aware of the different billing procedures required by a provider, such as the need for pre-authorization prior to billing.

    Once these things have been clarified, the office administrator needs to inform the patient if he or she needs to pay out of pocket for certain services.

    Step 3: Handling the Patient Check-Out

    All services rendered for the patient must be recorded and placed into the patient’s medical record. This means translating all the diagnoses and medical procedures into medical codes. This is where medical coders enter the picture.

    Medical coders determine the diagnoses of the treatments that have been administered to the patient. This is then translated using the ICD or CPT code and encoded into the patient’s ledger.

    Here, the patient’s bills, including previous balances (if any) and new charges, are input in relation to any payments the patient or patient’s provider may have paid, all of which are printed and given to the patient in the form of a receipt.

    Step 4: Accurately Transmitting the Medical Claim

    Now that the diagnoses and treatment services have been properly coded, it is time for the billers to transmit the medical claim to the insurance provider. However, before this is transmitted, it needs to be reviewed internally. This means adhering to written standards and procedures designed by your organization to reduce erroneous claims and fraudulent activity.

    This ensures all data has been accurately entered electronically into provider’s system through a clearinghouse or directly to the provider, such as Medicaid.

    Step 5: Receiving the Payment

    Once the medical claim is received by the insurer, it is reviewed and evaluated. The insurer determines if the entire or just a portion of the bill should be paid, or if it should be denied. All of this depends on the policy and the contract the patient signed with the insurer.

    Step 6: Billing the Patient

    There are instances wherein the patient needs to pay for the remaining bill not covered by the provider. This is the reason why some insurers and healthcare providers implement a co-payment policy.

    If the patient fails to pay the bill accordingly, it is the responsibility of the healthcare provider to followup with the patient through a collection process. Thus, it is important to explain to the patient upfront about the entire medical billing process.

    Learn more medical billing tips. Subscribe and follow our blog today.

     

    About ClaimCare

    ClaimCare provides a complete solution for all your medical billing concerns. This includes claim submission and follow-up processing, practice analytics and recommendations, instant payment program, automated insurance verification, and patient checkout tool. Learn more about the services we deliver. Complete our online form to schedule an appointment with us.

     

     

    Tags: medical billing, medical billing services, medical billing process

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