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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

    5 Solutions to Common Medical Billing Errors

    Posted by Carl Mays on Thu, Jul 18, 2019 @ 02:01 PM

    5 Solutions to Your Common Medical Billing ErrorsDenial of claim is defined in the Health Insurance Glossary as “the refusal of an insurance company or carrier to honor a request by an individual (or his or her provider) to pay for health care services obtained from a health care professional.”

    This is one of the most pressing problems the healthcare industry is facing today, resulting in a reported loss of net patient revenue ranging from 1 to 5% for your practice, or around two to three million dollars yearly for an average 300-bed hospital.

    Although these denials can be appealed and reworked, physician practices spend approximately $25 cost per claim just for this to be completed. Sadly, the success rates for these appealed claims vary from 55% to 98% depending on the capability of a practice’s medical denial management team.

    A bird’s-eye view of just how much money can be lost by denied claims is posted in the chart below, supplied by the American Association of Family Physicians (AAFP):

    Screenshot 2019-07-18 20.06.49

    How to Fix Common Medical Billing Errors for Increased Revenue

    You can reduce the rate of your medical billing denials with these following recommendations:

    1. Complete all the necessary fields of your medical claim.

    61% of initial medical billing denials and 42% of denial write-offs are due to submitting a medical claim with missing or incorrect demographic information and incorrect plan code. Thus, it is important for your staff to perform due diligence when submitting your claims. This means verifying that all the information needed in the form is filled out properly.

    Do this faster and more efficiently with a scrubber that can check the coding, bundling, and procedure information on your claim prior to submitting it to the payer.

    2. Never resubmit claims on the same date.

    Resubmitting claims on the same date to the same provider for the same beneficiary, even if all entries are complete, is one of the biggest reasons for a Medicare Part B claim denial. Avoid this by encouraging your staff to double-check if a claim has already been submitted before filing another.

    Motivate them to practice this protocol by choosing software with a user-friendly interface. This makes it easier for them to track and check the status of your claims.

    3. Ensure your patients' insurance coverage information is updated.

    Some medical billing denials are a result of your staff's failure to check the details of a patient's insurance eligibility. Thus, you end up filing for a claim that is not covered by the payer.

    Regularly update a patient’s insurance eligibility, as well as his or her basic profile information to ensure you have the most updated information.

    4. Use an alert system to ensure all claims are filed on time.

    There is a limit to the number of days a medical claim can be submitted to a payer. Know the grace period for this, which includes the time you will take to rework any rejections.

    As needed, incorporate into your workflow an alert system that will notify your staff of any medical claim that is approaching the time limit.

    5. Choose the right billing codes.

    Some claims are considered reviewed but denied or reduced by the payer due to an incorrect choice of billing codes, which could either be:

    • Upcoding (assigning a bill to a more expensive medical procedure)
    • Undercoding (failure to include the services you've performed)
    • Insufficient code specificity

    The best solution for this is to have a comprehensive patient record. This includes the laterality, severity, and accompanying conditions of the service provided. This is most helpful to your medical billing staff when assigning the proper codes to it.

    About ClaimCare

    ClaimCare offers a complete medical billing solution for your practice. This includes an EMR, Instant Payment Program, an upfront insurance verification, and a patient collection tool to help improve your practice's revenue. Call us toll-free at (855) 376-7631 or Contact ClaimCare to see how we can improve your profits so you can focus on medicine instead of medical billing.

    Tags: medical billing, medical billing services, improving medical billing

    Outsourcing is Influencing the Revenue Cycle of the Healthcare Industry

    Posted by Carl Mays on Fri, Jun 07, 2019 @ 08:00 AM

    How Outsourcing is Influencing the Revenue Cycle of the Healthcare Industry"Approximately 98% of hospital leaders are determining whether to work with third-party vendors for cost-efficiencies in both clinical and nonclinical functions and allowing hospitals to focus on value-based programming."

    The above statement came from the results of a survey conducted by Black Book Market Research LLC in 2014. Today, third-party medical billing providers are still on the rise. A few have even heightened their bundled services in response to the various challenges of the healthcare industry.

    With various specialists and named by Health Tech Outlook as one of the nation’s “Top 10 Medical Billing Companies” in 2018, ClaimCare Medical Billing now provides full-service revenue cycle management, including: consulting, credentialing, compliance, coding assistance, AR collections, and other services that go beyond our basic medical billing focus.

    How exactly is outsourcing changing the revenue cycle of various practices?

    The Increased Valuation of Revenue Cycle Management Outsourcing

    Last July, The Market Reports projected that global healthcare RCM outsourcing is expected to reach $23,000 million by 2023, an increased Compound Annual Growth Rate (CAGR) of 11.9% from its previous valuation of $11,700 million in 2017.

    This boost is due to the increasing demand from healthcare providers for a perfect solution to their need of providing quality healthcare services at a lower price. Dough Brown, author of the Black Book Research LLC, stated:

    "... hospitals look for ways to reduce costs, outsourcing is a valid strategy to achieve a financially healthier organization."

    With value-based care reforms putting more pressure on hospitals to decrease inpatient volumes while providing cost-effective care, the need to balance patient satisfaction and cash inflow becomes even more inevitable.

    How does your practice respond to these challenges?

    Braving the Challenges through Revenue Cycle Management Outsourcing

    Knowing these challenges, third-party providers like ClaimCare have introduced a simplified front-end to back-end revenue cycle management that can help cut the administrative costs of your practice. This includes:

    • Assisting with medical coding
    • Qualifying patients for Medicaid
    • Processing the medical credentialing of your physicians
    • Documenting, reviewing, and collecting patient records and receivables
    • Scrubbing and submitting medical claims and enrollments

    Some are even providing bundled services that are relevant to inpatient groups and hospitals such as clinical services, cyber security, IT, health facilities management, and analytics. Others have decided to focus on servicing healthcare clients alone.

    The practices and facilities who have chosen to outsource their revenue cycle management function, which includes their medical billing processes, have experienced significant improvements in:

    • Revenue
    • Collection rates
    • Patient satisfaction rates
    • Denial resolution efficiency

    Does this mean you should also implement the same for your practice?

    It is tempting to join the bandwagon and choose a third-party provider to handle your medical billing process. However, before you get excited about establishing a relationship with one, here are some factors that can influence your decision to outsource your medical billing process:

    • Cultural fit between organizations
    • Start-up costs and maintenance
    • Accountability and autonomy in operation
    • Performance goals and improvement expectations
    • Patient satisfaction regarding your employee population

    Consider these factors before transferring your medical billing services to a third-party provider. Perform the necessary due diligence to determine whether or not they can deliver on your practice's unique requirements. Subscribe to our blog or call us toll-free on (855) 376-7631 to learn more about revenue cycle management outsourcing.

    About ClaimCare

    ClaimCare offers the best-of-breed technology, delivering a comprehensive revenue cycle denial management system to various healthcare providers. This includes software databases that track, quantify, and report all denials of your payers. We provide an airtight medical billing process with actionable reporting. To learn more about our services, complete our online form.

    Tags: medical billing, medical billing services, Reasons to outsource medical billing

    3 Medical Billing Tips Guaranteed to Maximize Your Revenue

    Posted by Carl Mays on Sat, Jun 01, 2019 @ 08:00 AM

    3 Physician Billing Tips Guaranteed to Maximize Your RevenueAccording to a Healthcare & Business Technology report regarding medical billing, almost $125 billion in uncollected revenue happens each year due to:

    1. medical billing errors, and

    2. failure to stay up-to-date on medical billing rules and regulations.

    This becomes even more alarming when realizing that a Modern Healthcare article stated nearly 80% of patients owe more than $500 to their healthcare providers while 51% owe more than $1,000.

    With this data to consider, maybe you should take a closer look at your medical billing situation to see if you have a mission statement similar to the one we have at ClaimCare Medical Billing, Inc.: “To collect the maximum revenue for your practice as fast as possible while helping to alleviate costs and hassle for your organization.”

    As you strategize to maximize revenue and alleviate costs and hassle, here are 3 medical billing tips that can help your billing process become more efficient.

    1. Create a clear billing and collection process

    Improve your revenue cycles through an established step-by-step billing and collection process. Do this by:

    • Establishing clear terms with your patients, which includes getting their permission to leave voicemail messages regarding billing matters, reminding them about co-pays, and discussing their different payment options.
    • Gathering and verifying patient information, which includes their phone number, email, workplace, and billing address. If you are not already doing so, require them to bring a photo ID to accompany their insurance card at their initial visit. This can be very helpful in case their bill has to go to a collection agency in the future.
    • Drafting a sequence of letters to remind them about their bills, which includes when their bill is due, when it will be overdue, and when it will be turned over to a collection agency.

    With these 3 bullet points above in place, you can experience a more efficient physician billing process with less delinquent payments.

    2. Properly manage your claims

    HealthCare & Business Technology revealed that almost 80% of all medical billing contains errors. When errors occur, the result is a longer cycle revenue for your claim collection process, which undergoes an initial submission, rejection, editing, and resubmission.

    Why go through this longer cycle if it can be done more efficiently by inputting the correct information and double-checking the claims before submitting them the first time?

    Ensure you double-check the following before submitting your claims:

    • Patient information
    • Provider information
    • Standardized medical codes
    • Insurance information
    • Duplicate billings
    • Documentations

    What if you still get a denied claim after verifying the above information? How do you handle this?

    Denied claims are often provided with claim number references or denial codes, together with an attached Explanation of Benefits (EOB). If you don’t receive these, it is best to contact the representative of the company to request the items. If they can't be provided, you may directly clarify the errors with them to ensure your claim will be accepted the second time around.

    3. Track pending accounts payable and identify problem accounts

    Aside from doing due diligence in performing tips no. 1 and 2, it is also important for your practice to track the following:

    • Pending account receivables
    • Problem accounts

    Why is this important?

    Tracking your pending account receivables helps you properly evaluate the efficacy of your collection procedure, while identifying problem accounts can help you create a better approach in handling their non-compliance to your billing schedules. As needed, you may either increase the billing reminders for these patients or choose an outsourced collector to handle the collection for you.

    About ClaimCare:

    ClaimCare is one of the largest medical billing companies in the United States. We offer a complete medical billing solution using the best-of-breed technology, actionable reporting, and airtight medical billing process to ensure you have increased revenue for your practice. For more information contact us by phone at (855) 376-7631 or subscribe to our Medical Billing Blog.

    Tags: medical billing education, medical billing, medical billing services

    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

    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

    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

    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

    Cardiology Billing: 2013 Cardiology Coding Changes

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

    Cardiology Billing CodingMany significant coding and billing changes have been introduced in 2013 for cardiologists. The ClaimCare Medical Billing Company has created a 23 minute training video to bring cardiologists and cardiology practice staff members up to speed on the key 2013 Cardiology Coding and Billing Changes they need to understand to insure they have no compliance, billing or collection issues as a result of these new rules.

    2013 Cardiology Coding and Billing Changes - (23 minutes)

    For more insights concerning cardiology billing, please check out the following collection of articles: Cardiology Billing Articles.

    You can download this presentation by visiting  the following page: 2013 Cardiology Coding Changes.

    About ClaimCare, Inc.

    ClaimCare Medical Billing Services stands out from the crowd of medical billing companies. ClaimCare offers a complete medical billing solution, has the only service level guarantee in the industry, offers best-of-breed technology, an air tight medical billing process, actionable reporting and broad experience and can work on its clients' medical billing systems. For more information contact ClaimCare Medical Billing Services by email at sales@claimcare.net , by phone at (877) 440-3044 or visit the ClaimCare Medical Billing Company website.

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

    Medical Billing Update: 5010 Issues Are Affecting Your Collections!

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

    5010 medical billing issuesLast spring, ClaimCare Medical Billing Company began notifying clients about inherent issues of the HIPAA 5010 mandate. We have continued working to guide clients through the standardized electronic requirements. Recently, many physicians with whom we have spoken have said they are only learning about these 5010 issues from ClaimCare. They are asking “Why isn’t there anything about these 5010 collections problems on the medical association sites?” It is understandable physicians ask this question. We have asked the question for almost a year. This is not an indictment against any state medical association, just an honest question.

    The Texas Medical Association came on board February 1 to help distribute concerns, posting an article on its site about HIPAA 5010 potholes: Are Your Claims Being Rejected? Hopefully, other states that have not already done so will follow suit. This past December the Medical Group Management Association (MGMA) had issued a press release titled: Healthcare industry not ready for 5010; MGMA calls for 6-month contingency plan. Now, in a letter sent to U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius, MGMA President/CEO Dr. Susan Turney writes (click here for copy of the full letter):

    “New federal standards designed to streamline electronic insurance claims are instead slowing them down, hurting physician cash flow and pushing some practices into financial distress... Many practices face significantly delayed revenue, operational difficulties, a reduced ability to treat patients, staff layoffs, or even the prospect of closing their practice."

    Medscape.com posted an article on February 3 about the MGMA letter titled: Physician Groups Say 5010 Standards Hurt Cash Flow. This was preceded by the Physicians Practice “dire situation” article in December to which we referred in an earlier posting: New Year Comes with New Challenges in Healthcare Reimbursement.

    As we re-emphasized in our December 19, 2011 update to clients, and then again in January, the 5010 is a format in which all clearinghouses, payers and providers must submit claims. Unfortunately, not all parties have complied in a timely manner. As a result, 5010 has hit some with the fury of a hurricane. Delays in claims acceptance and payments from Medicare and other payers such as BCBS and Cigna are occurring across the nation, and your practice is most likely experiencing decreased collections.

    The ClaimCare EDI team continues to work diligently (and literally around the clock) to help resolve these issues and insure that all claims and claim files are received and confirmed at each level of the submission process. This is one of the reasons that our clients are not among the unfortunate groups that have had no Medicare payments since November 2011! Many of the delays, however, are 100% with the payers. These delays will continue until the payers correct the internal system issues that are leading to erroneous claim rejections and general processing delays. This payer-problem is one of the situations we anticipated and to which we referred in the 5010 communications we sent clients in December and January.   

    We continue to communicate with our clients on “known issues” at payer (CMS, BCBS, etc.) and clearinghouse levels. Most issues are being resolved by the payers and clearinghouses.  Many other file transmission issues have been resolved through recent upgrading or patching we have performed for our clients and their practice management systems and/or via a plug-in that is designed to help translate the transmitted data into the corrected formats.

    If you are not getting the information you need about the impact that 5010 is having on your practice and would like to learn what ClaimCare Medical Billing Company can do to help you, we invite you to contact us at (877) 440-3044. As far as HIPAA 5010 is concerned, we remain on the forefront of testing and successful transmission and believe for practices that are prepared to take advantage of the opportunity, relief is in sight.

    *     *     *

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

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

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