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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.


    Accelerated Payment and Advance for Providers

    Posted by Carl Mays, ClaimCare President/CEO on Tue, Mar 31, 2020 @ 08:03 PM

    Accelerated Payment and Advance for Providers:

    How to get it and what it means for your practiceiStock_CashFlow2

    CMS has notified providers about the Accelerated Payment and Advance program available to Part B providers. This is a portion of the legislative CARES Act (P.L. 116-136).  Each Medicare Administrative Contractor (MAC) is required under this regulation to consider advancing payments at the request of a provider.  As we will explain below, this is NOT a cash influx without consequences. It is NOT free money. This advance can represent 100% of the amount typically paid to a provider in a 3-month period.   However, if you want to, you can request less than the                                                                   CMS calculated amount.


    ClaimCare advises you to be cautious when requesting this advance.  We completely understand that numerous providers and practices have been hurt by this horrific COVID-19 Pandemic.  However, we encourage you to look at what this would mean for your practice on down the road.  increase-cash-flow-medical-practiceThe amount of money received is not the issue. The issue is that you must carefully consider how the advance will be recouped and reconciled beginning 120 days after you have received it. It is still in flux exactly over what timeframe MAC will reclaim the advance through recoupments. MAC may take a little from every payment over a large number of months, or they may take a lot back from every payment over a shorter timeframe. It appears NOVITAS will be recouping a small amount over many months. However, no matter the timeframe in which the money is recouped, ultimately your future payments will be reduced until the full amount of the advance is paid.

    After you receive an advance through this program, you will continue to be paid as usual for your claims submitted in the normal course of business for the next 120 days.  However, after 120 days following the advance, ANY Medicare claims submitted for payment will be processed against the advance.  This means that after 120 days you will NOT receive full payment for claims submitted to Medicare until your advance is paid in full.

     ClaimCare is not suggesting that you do not pursue the advance. We are only saying that if you do accept it, do so with a full appreciation for the impact it will have on your monthly collections in four months.

    All providers are struggling with trying to provide continuity of care by using telemedicine and videoconferencing. We understand that if your schedules are not full, it is difficult to pay the bills and keep the doors open. If you need these funds, please be sure and submit the appropriate form as quickly as possible to your regional MAC. The forms have either been sent to your primary Medicare contact – OR – you can find them on the MAC website for your region. You should receive the accelerated payment advance in 7 days after your appropriately submitted form is received. This accelerated payment opportunity is only available if the nation us under a National Emergency.  Once this designation is over, the advance will not be available to providers.


    To qualify, you must meet the following requirements:  

    • Have billed Medicare for claims within 180 days of the signature on the form
    • Not be in bankruptcy
    • Not under medical review or investigation
    • Cannot have any outstanding Medicare overpayments

    After 120 days from the date you receive the payment, you will have 210 days to repay the advance, which will be offset against claims submitted.  If you do not submit a sufficient volume of claims in that 210-day period to replay the advance, then you will be expected to make a payment directly to Medicare for the difference.

    We certainly hope you and your staff are staying safe and healthy during this crisis. We encourage you to share with everyone, staff and patients, that they can keep updated on the news and recommendations on the government’s Coronavirus.com website.


    About ClaimCare

    ClaimCare Medical Billing Company is a 100% USA-based HIPAA-Compliant Medical Billing Company

    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 additional information, contact sales@claimcare.net, or phone toll-free (855) 376-7631, or visit the ClaimCare Medical Billing website. We can assist your practice and/or facility in numerous ways.

    Tags: medical billing education, medical billing resources, COVID-19 Medical Reimbursement, Medicare Billing

    Why Your Practice May Need a Medical Billing Company

    Posted by Carl Mays on Thu, Nov 07, 2019 @ 02:00 PM

    Why You Need a Medical Billing Company for Your Upcoming Private Practice

    According to a 2019 survey by the Kaiser Family Foundation (KFF), there are 478,463 Primary Care Physicians in the USA – and according to a 2019 survey by Statista, there are currently 525,439 Specialty Physicians. (Click on links to see categories and states.)

    From these lists of physicians, some are succeeding well, others are struggling to break even, and still others are closing their offices. Meanwhile, incoming physicians are aspiring to establish their own practices.

    One of the reasons why some practices have failed or are currently struggling to stay open is the lack of strategic planning. Such practices have failed to realize that establishing a private practice is not an easy endeavor and have not answered the questions that all practices face:

    • What are the different measures you need to consider to ensure your practice will survive for several years prior to becoming soundly established?
    • Can you handle the start-up challenges on your own, or do you need the help of another company?
    • Does help from another company include obtaining the services of a professional medical billing company?

    A current source that deals with the challenges of setting up your own medical practice is found in the online magazine, Business News Daily. The January 10, 2019 article is titled:

    How to Open a Private Medical Practice, Step by Step

    This article emphasizes that at the very least, anyone who intends to set up a medical practice should be prepared for the following:

    • Equipment costs of no less than $100,000
    • A line of credit with a minimum of $100,000
    • Enough operating capital for several months
    • Obtaining a medical practice tax ID
    • Obtaining liability and malpractice insurance
    • Obtaining insurance/payer credentialing
    • Deciding on how to handle medical billing

    Along with the basics of capitalization and the other fundamentals of opening a new medical practice, come important additional needs:

    Choosing your staff

    ClaimCare points to an online blog titled Manage My Practice, which covers descriptions of a dozen or more staff members, but begins with the absolute minimum number of staff required:

    1. Front Desk Officer
    2. Clinical Assistant

    This minimum staff means that the front desk officer should be knowledgeable in many areas, including filing medical billing claims and processing your medical credentials. But what happens if the front desk officer can’t come to work? Who will handle her or his duties for the day or possibly longer, including the medical billing?

    Also, rather than one clinical assistant, it is best to have two who can interchange schedules in case one of them becomes ill or is unavailable for work for some other reason.

    The Manage My Practice Blog also responds to the following questions regarding staff:

    1. Why do some offices need more staff and some need less?
    2. What should you do if you can’t figure out if it’s taking too many people to do the work?

    Returning to the Business News Daily article, other needs covered include:

    Purchasing and installing your equipment

    Eight pieces of equipment, with accompanying software, are detailed in this article and, importantly, the first three mentioned are extremely vital to your revenue cycle:

    1. Electronic Health Record System
    2. Practice Management System
    3. Medical Billing System

    Without someone to utilize these software systems effectively (doing the right thing) and efficiently (doing the thing right), you will experience a waste of time and a financial loss.


    How a medical billing company helps your practice

    A medical billing company has a pool of highly skilled medical billers and coders. These professionals have been trained to use various software systems including the above-mentioned. Thus, by working with a third party medical billing provider you are eliminating the burden of finding or training someone to utilize these systems to reach your optimal advantage. As a result, you can better focus on your core offerings and concentrate on further improving your medical services. This also gives you additional time to think of ways to further expand your patient outreach.


    About ClaimCare

    ClaimCare understands the needs of new medical practices. Thus, it provides services that aid you with credentialing and contracting. As needed, it also helps in training your front desk staff with all of these processes.

    In all medical billing areas, ClaimCare:

    · provides the top service level guarantee in the industry

    · offers best-of-breed technology,

    · is based 100% in the U.S.A.

    · has an air-tight medical billing process

    · provides actionable reporting and broad experience

    · can work on its clients' medical billing systems.

    Healthcare Tech Outlook named ClaimCare as one of the nation’s “Top 10 Medical Billing Companies” in 2019. This honor follows previous such honors, including being ranked in the “Top 5” by the online magazine, Money & Business.

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

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

    Tags: medical billing services, medical billing resources

    New Medicare Card: MBI Transition Ends December 31, 2019

    Posted by Carl Mays on Thu, Oct 24, 2019 @ 10:30 AM


    On October 17, 2019, the Centers for Medicare & Medicaid Services (CMS) sent this reminder:

    New Medicare Card: MBI Transition Ends in Less Than 10 Weeks.

    ClaimCare posted a blog back on September 17, 2018, titled Top Three Impacts of Medicare ID Card Changes on Medical Billing Services. You can review the 2018 post and see that it covers several important points and then goes into some detail regarding:

    1. Eligibility Verification of the New Medicare ID Card

    2. Coordination of Benefits with the New Medicare ID Card

    3. Submission of Medical Claims Using the MBI

    Since the transition period that began April 1, 2018, CMS has posted quite a few notices dealing with clarifications and revisions to the initial announcement.

    Previous CMS announcements in 2019 include the following:

    September 26: New Medicare Card: More Questions about Using the MBI?

    September 19: New Medicare Card: Why Use the MBI?

    August 08: New Medicare Card: Will Your Claims Reject?

    July 25: New Medicare Card: Questions about Using the MBI?

    June 20: New Medicare Card: 75% of Claims Submitted with MBI

    March 28: New Medicare Card and MBI Adoption: How Do You Compare?

    March 06: MBI Look-Up Tool Can Be Used With Medicare Advantage Plans (PDF)

    January 10: New Medicare Card: Transition Period Ends December 31

    If you review these announcements, you will see that the majority of practices and facilities have already made the necessary changes, with many tweaking things along the way. Some, after having claims rejected, are learning more about the process. Others have assisted their patients in making sure they have the new cards and have educated them on why the change in cards became necessary.

    If you still need help with the transition in any way during these final weeks prior to the mandated deadline of January 1, 2020, ClaimCare can provide that help.

    In all medical billing areas, ClaimCare:

    · provides the top service level guarantee in the industry

    · offers best-of-breed technology,

    · is based 100% in the U.S.A.

    · has an air-tight medical billing process

    · provides actionable reporting and broad experience

    · can work on its clients' medical billing systems.

    Healthcare Tech Outlook named ClaimCare as one of the nation’s “Top 10 Medical Billing Companies” in 2019. This honor follows previous such honors, including being ranked in the “Top 5” by the online magazine, Money & Business. ClaimCare has a proven track record of increasing client collections by 10 to 20 percent.

    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: medical billing services, medical billing resources

    3 Data Analytics that Should Always Be Included in Your Medical Billing Report

    Posted by Carl Mays on Wed, Sep 11, 2019 @ 03:00 PM

    3 Data Analytics that Should Always Be Included in Your Medical Billing ReportMedical billing reports are important in evaluating the efficiency of your practice. Thus, reports should show the performance of your organization in full details. This will greatly help in improving your revenue cycle.




    Some of the questions reports should be able to answer include:

    • Referring physician profitability
    • Front desk employee effectiveness
    • Payer contractual compliance
    • Provider productivity
    • Coding profiles

    How is this possible? Read on to know the different data analytics that should be present in your medical billing report.

    1. Accounts Receivable Aging Report

    This report contains any accounts receivable (A/R) that remain to be paid by the insurance companies. It also reveals how long A/R has been unpaid and the average time a claim needs before it is paid by the insurance provider.

    As an example, for CIGNA HealthCard holders, Cigna says they do their best to process medical claims within 5 days after filing.

    Five days may not be possible, but medical claims should be paid in less than 45 days. Thus, any claim that extends beyond 45 days to be paid should immediately be monitored. If this reaches 90 days, then it is a red sign that you should urgently take action with it.

    As a friendly note, you should also consider the type of claim you are requesting. Generally, the following claims take longer to be processed:

    • Workers compensation
    • Car accident claims
    • Out-of-state claims

    Thus, it is best to be mindful of any healthcare services provided under this category.

    2. The Key Performance Indicators (KPI) Report

    Just like any business, your practice should know the most profitable procedures in your organization. Thus, your key performance indicator report should be able to track the following:

    • Frequency a procedure is performed
    • Sum charges and collection
    • Total adjustments
    • Outstanding A/R

    This should be neatly presented in a document so you can easily compare results on a per-date basis. Any sudden surge or leap in weeks or days should be carefully noted so you can monitor these dates more meticulously.

    3. The Insurance Analysis Report

    This lists the top payers and insurance companies contributing to your practice, based on the collection per Total Relative Value Unit (RVU).

    But what exactly is an RVU?

    This represents the following components:

    • Physician work expenses: 52%
    • Practice expenses (staff, facilities, overhead): 44%
    • Malpractice expenses: 4%

    It is further influenced by the area of the country in which the service is provided. This, together with the above components, comprises the total RVU of a particular service.

    Why is this important for your practice?

    Knowing the collection per total RVU of your procedures gives you the leverage to negotiate for better pricing with various insurance companies.

    How do you know if you are making a smart negotiation?

    Ideally, the collection per Total Relative Value Unit should be higher than the current Medicare Conversion Factor, which is $36.04. If this is lower, then you are not collecting the right amount for your services.

    Check who among your payers are paying less and start talking to them about it. If they will not settle with an agreement, then it may be better to drop them and add another carrier that pays better. However, be extra careful before dropping one of your carriers because it may have an impact on your practice.

    For better results, seek the advice of experts in the field of medical billing and coding to help you make an assessment of your current medical billing reports.

    Do you wish to know more about medical billing and coding practices? Subscribe to our blog for more helpful insights or complete our online form so we can schedule an appointment with you. You may also contact us at (855) 376-7631.

    About ClaimCare

    ClaimCare delivers medical billing and coding reports with detailed information for you to fully understand the state of your practice. This helps your organization to create action plans that can help improve your performance. It also comes with an easy-to-use dashboard reporting system, which easily presents critical information in a comprehensive manner.


    Tags: medical billing, medical billing resources

    Rejected Medical Claims vs Denied Medical Claims: What's the Difference?

    Posted by Carl Mays on Tue, Sep 10, 2019 @ 03:20 PM

    Rejected Medical Claims vs Denied Medical Claims_ Whats the DifferenceLooking back, to look ahead: With ICD-11 on the horizon for 2022, Centers for Medicare & Medicaid Services (CMS) reported in 2015 that claims were processed with fewer rejected and denied claims after the transition from ICD-9 to ICD-10. Rejections and denials are projected to decrease even more when ICD-11 takes effect.

    Meanwhile, while dealing with ICD-10, many providers are confused on how to differentiate “rejected” medical claims from “denied” medical claims. This article discusses how you can distinguish the two from one another and steps on how to avoid both.

    What are rejected medical claims?

    These medical claims are considered unpayable and are sent back by the payer due to:

    • Incorrect information
    • Failure to meet specific data requirements
    • Non-adherence to the required formatting

    Due to these reasons, rejected medical claims are not even entered into the computer systems of payers. Thus, they cannot be processed.

    Once the error has been fixed, rejected claims can be submitted for approval. Thus, it is important for your medical biller to properly code and complete the information required by the payer.

    How are denied medical claims different from rejected medical claims?

    Unlike rejected medical claims, denied claims have been received and processed by the payer, but considered unpayable. Although these claims can be resubmitted, it should be done with a reconsideration request or appropriate appeal. Otherwise, it will just be denied once again costing your practice or facility more time and money.

    What causes a medical claim to be denied?

    Several factors can result in a denied medical claim. This includes:

    • Incorrect patient identifier information
    • Termination of medical insurance coverage
    • Requirement of prior authorization or precertification
    • Excluded or non-covered services
    • Requires supplementary medical records
    • Auto or work-related incident
    • Invalid CPT or HCPCS codes
    • Lapse of the filing date
    • Lack of referral on file

    Thus, make sure your medical billers and coders are knowledgeable regarding the latest medical coding updates and are skilled in properly preparing your medical claims. Otherwise, you’ll have instances of medical claims being denied and rejected by the payers.

    How can you improve your practice’s claim rejections and denial rates?

    There are several ways to improve your claim rejections and denial rates:

    1. Analyze and track your payer denial and rejection trends

    Review the most common types of mistakes and coding errors committed by your medical billing team. Create routine chart audits for documentation and data quality. Based on this information, create a course of action that will minimize, if not eliminate, these errors.

    2. Educating your medical billing and coding staff

    Invest in training your staff. Provide training on how to handle claim denials and rejections appropriately.

    Otherwise, consider outsourcing your medical billing to an “Experienced” and ”Knowledgeable” medical billing company. In this manner, you are guaranteed that the team handling your medical billing is well equipped, skilled, and knowledgeable in completing these tasks.

    3. Discuss your concerns with payers

    Schedule an appointment with your payers. Discuss, revise, or eliminate contract requirements resulting in denied claims, which eventually get overturned after an appeal. This helps to clarify the requirements in order to avoid future medical claim rejections.

    Are you having problems with your medical claim submissions? Do you need help processing these claims? Subscribe to our blog for more tips and updates.

    About ClaimCare

    ClaimCare has more than 25 years of experience in providing medical billing and coding services to various practices. Throughout these years, they have helped numerous organizations increase their revenue cycle by eliminating medical claim rejections and denials. Complete our online form or call us toll-free at (855) 376-7631 to learn more about the services we deliver.

    Tags: medical billing, medical billing services, medical billing resources, clean claims

    4 Steps to Painless Physician Credentialing

    Posted by Carl Mays on Thu, Sep 05, 2019 @ 10:00 AM

    4 Steps to a Painless Physician CredentialingThe famous Chinese philosopher Confucius once said, "A man who does not plan long ahead will find trouble at his door." This is true, especially with healthcare providers in the U.S. and their physician credentialing process.

    In a study conducted and published by the Beckers Hospital Review, it has been revealed that a one month delay in physician credentialing can result in a $30,000 loss in revenue. This amount further increases for higher billing specialties such as cardiothoracic surgery and orthopedics. Thus, it is important for healthcare providers to plan properly for their physician credentialing procedure to ensure their cash flow will run smoothly in 2019.

    These steps will help you organize your physician credentialing process:

    Step 1: Start Early

    Physicians Practice, an online publication, said that most physician credentialing can be done within 50 to 90 days, but it is best to give your practice a 120-day leeway. This is because the internal timeline of the payer who processes the application varies, differing from one payer to another.

    Given this timeframe, it is best to start your physician credentialing process earlier, preferably prior to hiring.

    Step 2: Pay Attention to Detail

    Perform the necessary due diligence when submitting your application.

    Many physician credentialing delays are caused by incomplete and incorrect information. This is a simple mistake that can cost you a huge sum of money. Thus, it is important for your team handling the physician credentialing process to pay close attention to all of the required information.

    Double check to see if all of the entries have been properly filled out. In doing so, you'll have a more efficient physician credentialing process, which means completing it within 50 to 90 days. Plus, you avoid going through the process of re-applying.

    Step 3: Remain Updated with the Coalition for Affordable Quality Healthcare (CAQH)

    In December 2018, CAQH announced new functionality for Verifide ™, This automated solution verifies the accuracy and completeness of credentialing information submitted by healthcare providers to health plans.

    This will now become the primary source verification (PSV) as it offers real-time visibility into your credentialing application status. As a result, your practice will have an easier time knowing the reason behind your physician credentialing rejection or denial.

    Thus, you should always be in the loop with the latest updates provided by CAQH.

    Step 4: Be Knowledgeable with State Regulations

    State regulations vary from one another. For some states, a physician credentialed by Provider A in another state may be streamlined in their states; others may allow a physician to avoid the full credentialing process again when moving from one practice to another within the same state.

    Just take a look at Texas. A credential verification organization has been launched through the collaboration of Texas Medical Association and 19 Medicaid health insurance plans. The organization’s goal is to reduce paperwork for Texas physicians.

    Amanda Hudgens, director of special projects for The Texas Credentialing Alliance (TAHP), stated:

    "We want to simplify the credentialing process for physicians here in Texas and we're focusing on Medicaid providers because we understand they have a lot of paperwork burdens and administrative requirements to become a Medicaid provider."

    Thus, it is important for the one handling your physician credentialing to know all about these varying state regulations.


    The physician credentialing process remains a tedious process if you do not have all the information you need up front. Following the above recommendations will help speed up this process while eliminating inefficiencies.

    Subscribe to our blog for more tips related to medical billing or call us toll-free at (855) 376-7631 for your queries and concerns.

    About ClaimCare

    ClaimCare helps new medical practices and existing organizations with their physician credentialing process. They even assist in training your front desk office staff for a more efficient medical billing process. Learn more.

    Tags: medical billing resources, credentialing, medical credentialing

    There Is A Significant Difference Between General Billing & Medical Billing

    Posted by Carl Mays on Tue, Jul 02, 2019 @ 11:00 AM

    Final-puzzle-piece (003)We recently discovered that a new client had just hired an office worker who had a good knowledge of general billing but no experience whatsoever with medical billing. This posed a problem that we solved by meeting with the office worker and explaining some medical billing specifics.

    Following the meeting, we sent her links to six of our blogs to help guide her in comprehending more fully the medical billing process. These links will continue to help her handle more smoothly the front-end billing procedures and assist us in handling the back-end billing operations.

    Since this is not the first time we have encountered such a situation in our 30-year history, we think it is a good idea to share these six links with all of our current clients and potential clients.


    Link 1. Medical Billing Allowables: Why Charge More Than You Expect To Collect?

    In most businesses, if you bill $100 you expect to collect $100. In the healthcare business, a bill for $100 is often sent out with the expectation that only $50, $30 or even less will be collected. Why? This article answers the question and delves into (1) Revenue Enhancement (2) Comparability and (3) Compliance.

    Link 2. Medical Billing Allowables: How To Set A Practice’s Fee Schedules

    This article focuses on setting the overall fee schedule for your practice once you know your allowables, emphasizing: (1) Be consistent (2) Don’t leave money uncollected and (3) Don’t scare away patients. This has been ClaimCare’s highest-viewed article overall.

    Link 3. Medical Billing Allowables: How They Affect EOBs and Medical Billing Reports

    This article focuses on how your allowables and fee schedules shape the EOBs and the reports you will see every day, emphasizing: (1) The main impact you will see on your EOBs is from contractual adjustments and (2) You will see two main impacts on your reports due to the interaction of your fee schedules and your allowables.

    Link 4. Medical Billing Allowables: Understanding Your AR With Medical Billing Yields

    This article deals with how to use the knowledge gained through the first three links to understand better the true value of a practice’s AR. Understanding the concept of “yield” is the key behind understanding the value of a practice’s AR.

    Link 5. Medical Billing Allowables: Predicting Expected Medical Billing Collections

    After having read and absorbed the previous four articles, you are ready to learn how to predict your practice’s month-to-month cash flow. In its simplest form, predicting collections can be done by taking your practice’s average charges per month over the last year and multiplying by your weighted average practice yield. However, in this article you will also gain insight into how to deal with month-to-month variations to get a better handle on your cash flow situation.

    Link 6. Addendum: Allowables and Medical Billing Yields – A Few Additional Thoughts

    The previous article in the series of five outlined why yields are important and how to calculate them. This article follows up with seven tactical points concerning medical billing yields. Yields are a critical component of medical billing and practice management. These seven tactical points should help you become a “power user” when it comes to medical billing yields.

    To receive ongoing information regarding medical billing and to view previously-posted articles: Subscribe to our blog. To learn more about what ClaimCare can do for you, visit ClaimCare – The Medical Billing Professionals, or you may phone us at (855) 376-7631.

    Our mission statement: “To collect the maximum revenue for your practice as fast as possible while helping to alleviate costs and hassle for your organization.”

    About ClaimCare

    Healthcare Tech Outlook named ClaimCare as one of the nation’s “Top 10 Medical Billing Companies” in 2018. This honor follows previous such honors, including being ranked in the “Top 5” by the online magazine, Money & Business. We have a proven track record of increasing client collections by 10 to 20 percent.

    Tags: medical billing services, medical billing resources

    Avoid Medical Credentialing and Provider Enrollment Delays and Mishaps

    Posted by Carl Mays on Tue, May 21, 2019 @ 10:00 AM

    Competence_in_dictionaryNo enrollment means no payment.

    When a new physician joins your practice, it is of utmost importance for your practice to expedite his or her medical credentialing and enrollment process. Credentialing specialists at ClaimCare can help you do this effectively (doing the right thing) and cost efficiently (doing the thing right).

    Having a fast and reliable medical credentialing process is important.

    As you are probably aware, only after a health plan has awarded your new hire with an "effective date of participation" can this physician’s claims be properly submitted for payment.

    How much are you losing?

    A disrupted cash flow for your practice occurs when an “uncredentialed” physician cannot receive payments for claims while waiting for the practitioner to be enrolled with patients’ health plans.

    According to various reports, approximately $30,000 in lost revenue happens to an average primary care physician with just a month of credentialing delays. This amount increases substantially for higher billing specialties such as cardiothoracic surgery and orthopedics.

    3 reasons to outsource your medical credentialing and enrollment process:

    1. It helps reduce costs while safeguarding stored data.

    Allowing a third party medical credentialing provider to handle the enrollment and credentialing process lowers your expenses. It allows you to utilize top-rated hosting and security technology without the need to pay for the installation, implementation, and maintenance of servers and data encryption software.

    2. It brings better efficiency through robust Key Performance Indicators.

    Third party medical credentialing providers give your practice efficient tracking, trending and reporting data. This includes the following:

    • In-process charges
    • Department processing times
    • Provider process times
    • Days in Enrollment (DIE)
    • Quality measurements for updating payer follow-up notes

    This data allows you to easily establish performance baselines that can help improve your practice. This results in an expedited enrollment and medical credentialing process.

    3. It reduces medical credentialing and provider enrollment errors.

    Third party providers put the credentialing process into a single team that handles the centralized verification office. They are composed of trained, highly skilled, and knowledgeable individuals who are experts in completing your credentialing and enrollment process. This reduces the errors for your practice.

    The bulk credentialing approach of third-party providers also makes it easier for your organization to gain a "delegated status". Once acknowledged, you'll have an even faster enrollment and reimbursement process for your practice.

    So why continue to wait for 60 to 120 days before your credentialing process is completed if it can be done faster and more efficiently? Subscribe to our blog or call us at (855) 376-7631 to learn more about the medical credentialing process.

    About ClaimCare

    Healthcare Tech Outlook named ClaimCare as one of the nation’s “Top 10 Medical Billing Companies” in 2018. This honor follows previous such honors, including being ranked in the “Top 5” by the online magazine, Money & Business. We have a proven track record of increasing client collections by 10 to 20 percent. Talk to us to learn more about our medical credentialing services.

    Tags: medical billing, medical billing services, medical billing resources, credentialing, medical credentialing

    3 Ways to Maximize Your Practice's Reimbursements

    Posted by Carl Mays on Mon, May 13, 2019 @ 03:00 PM

    3 Ways to Maximize Your Practice's ReimbursementsAre medical claims reimbursements getting more challenging for your practice? You are not alone. There are other practices that have suffered the same in past years, and are still struggling with this problem.

    "83 percent of Physician Practices with under five practitioners said the slow payment of high-deductible plan patients are their top collection challenge, followed by the difficulties that practice staff have at communicating patient payment accountability (81 percent)."

    Here are some tips and recommendations on how to avoid this problem and improve your medical reimbursements.

    1. Get to Know More About Your Patients’ Health Plans

    Not all health plans are the same.

    Your patients may be presenting you an ID card with the same logo or from the same healthcare provider, but it doesn't necessarily imply they share the same health plan. Plans may vary regarding:

    • Filing requirements
    • Rates
    • Benefits

    Thus, it is important for the front desk staff to familiarize themselves with each patient's plan.

    How is this possible?

    Ensure your current office staff are kept updated regarding the various plans provided by your payers. Or, hire the services of a highly knowledgeable medical billing company familiar with the varying coverage and benefit mandates of healthcare providers.

    2. Understand Your Market

    You will most likely coordinate with three or more insurance companies each year. Thus, it is best to develop a strong foundational knowledge of their industry practices and trends. This includes the following:

    Identifying the major payers of your practice

    Prepare a record of your prevalent employers, unions, and providers that work with your practice. Compile the plans, networks, and payers of these patients. Familiarize yourself with these to manage their accounts efficiently.

    Learn more about your managed care contracts

    You may have provided several discounts to certain payers because of the number of patients they have endorsed to your organization. However, be cautious of how these discounts will impact your revenue.

    Are these discounts providing enough revenue to your practice? If not, data can show you how much revenue these payers are adding to your practice. This will give you leverage when negotiating discounts with these payers.

    Never fail to verify

    This may sound elementary, but verifying your patients’ benefits, plan requirements, and eligibility is very important to any practice.

    Conduct due diligence. Invest in a system that allows you to easily track and monitor the medical claim reimbursement efficiency of these payers. In doing so, you will know who among these payers are making medical reimbursements more difficult.

    3. Be knowledgeable about the current trends associated with your practice

    Medical practices vary depending on specialization. This makes it important for your practice to remain updated concerning the different trends happening in your practice.

    This includes:

    Bundled Payments

    It is relatively common for some payers to combine the rates of facility and professional reimbursement, radiology, lab, and anesthesia into one payment scheme. Your medical billing team should be aware of how these should be handled.

    Price Transparency

    As more patients are demanding enhanced transparency on medical fees, practices are under added pressure regarding how their medical service fees are to be quoted. Know the various billing laws related to this matter to avoid encountering patient conflicts.

    Stay informed regarding the latest developments, changes, and challenges facing the medical billing and coding industry. Subscribe to our blog or complete our online form for any of your queries and concerns.

    About ClaimCare

    ClaimCare is composed of an incredible team of professionals, including: certified coders, practice managers, medical providers, credentialing experts, and experienced business professionals. We aim to make your medical billing more effective and efficient. Call us at (855) 376-7631 if you need help with any of your medical billing needs.


    Tags: medical billing, medical billing services, medical billing resources, Medical Reimbursement

    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

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