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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 Reasons Your Medical Claims Are Being Denied

    Posted by Carl Mays on Tue, Sep 03, 2019 @ 10:00 AM

    5 Reasons Your Medical Claims Are Being DeniedSome of the crucial elements in the medical claims process happen during the medical coding and medical billing procedures.

    This article discusses how these two procedures are essential in filing medical claims and why your medical claims are being denied.

    How Medical Coding and Medical Billing Influence Medical Claims Approval

    Medical coding is the process of accurately encoding written documents (e.g., a medical prescription or diagnosis) made by medical experts into a numeric or alphanumeric one. On the other hand, medical billing is the process of assigning a corresponding bill for the insurance or healthcare provider.

    Any incorrect or incomplete coding and billing can result in a denied claim for the following reasons:

    1. The coded information lacks detail or is not clearly rendered by the coder

    There are codes for specific medical terms. It is important for the coder not to overlook even the tiniest bit of information contained therein. The code must be complete. If the coder neglects to input one number or includes an irrelevant one, the code is invalid.

    For example, k35 is acute appendicitis while k35.80 is an unspecified acute appendicitis. Failing to indicate the right type of appendicitis of the patient may be the cause for a denial. Thus, it is important that medical coders and billers be very knowledgeable about these codes.

    2. Mistakes due to outdated coding

    The coder must have an up-to-date book of codes. Documents coded using an outdated set of codes will only lead to an inaccurate output. The coder must be well informed regarding any changes in the coding system.

    3. The claim forwarded to the insurance company is missing relevant information

    Insurance companies are very meticulous. They review all the information required in the claim forms. Any missing information such as date of diagnosis, date of the accident, and any other relevant dates may be the reason for a claim denial. Thus, you should carefully review and ensure all the required information is properly incorporated in the claim forms.

    4. Delayed filing of the claim

    Submission of claims must be made within twelve months from the start date for Medicare. The start date can either be the date the medical service was performed or the date written on the “from” part of the claim form. The claimant may not be granted reimbursement if the filing is not made in a timely manner.

    5. The patient’s personal information is incorrect

    Your medical claims may also be denied if the personal information input into the system is erroneous. Name, age, sex, and other personal details of the patient must be correct.

    Other relevant information such as the insurance company where the reimbursement is requested from and the policy number should also be valid. If the patient is not the insured himself/herself, be sure to state the relationship between the insured and the patient for the claim to be considered. Furthermore, the procedure performed on the patient must correspond correctly to the coded documentation prepared by the coder.

    Are you interested in learning more medical billing tips? Subscribe to our blog to remain posted. You may contact us online for any of your medical billing problems and concerns.

    About ClaimCare

    ClaimCare has years of industry experience in delivering high quality and affordable medical billing services in the U.S. We assist in collecting the maximum revenue for your practice while helping alleviate the medical billing costs and hassle for your organization.

    Tags: medical billing, medical billing services, Medical Reimbursement

    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

    Medical Billing News: CMS Releases 2013 Incentive Payments

    Posted by ClaimCare Resources on Thu, Oct 16, 2014 @ 06:22 PM

    Medical ReimbursementsCMS announced on October 1st that the 2013 PQRS (Physician Quality Reporting System) and eRx (e-prescribing) incentive payments are now available for eligible professionals and group practices that successfully submitted data for these respective Medicare Part B programs.  The payments will be paid based on services rendered and reported between Jan. 1, 2013 and Dec. 31, 2013. 

    The incentive payments will be issued by MAC’s (Medicare Administrative Contractors) with remittance advices and identified as separate payments under these programs. MACs will use the indicator of LE ("Levy") to indicate federally mandated payments.

    LE will appear in the PLB-03-1 segment of the 835 electronic remittance advice. In an effort to further clarify the type of incentive payment issued, LE will appear on the remittance, along with a 4-digit code to indicate the type of incentive and reporting year.

    As medical billing reimbursement shrinks across the industry it is critical for practices to take advantage of the opportunity to participate in any of the CMS incentive programs.  It does take a great deal of effort, but the reward can be a great healing injection to your cash flow!

    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.

    Copyright 2014, Carl Mays II and the ClaimCare Medical Billing Company

     

    Tags: medical billing resources, Physician Reimbursement, Medical Reimbursement

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