Thursday, May 16, 2013
treatment team in which all of its members participate in a coordinated effort to benefit the patient
and the patient’s significant others and caregivers. Interdisciplinary services, by definition, cannot
be provided by only one discipline. Though individual members of the interdisciplinary team work
within their own scopes of practice, each professional is also expected to coordinate his or her
efforts with team members of other specialties, as well as with the patient and the patient’s
significant others and caregivers. The purpose of the interdisciplinary team is to foster frequent,
structured, and documented communication among disciplines to establish, prioritize, and achieve
“MA Organization” means a public or private entity organized and licensed by a State as a riskbearing entity (with the exception of provider-sponsored organization receiving waivers) that is
certified by CMS as meeting the MA contract.
“Medicaid” is a joint Federal and State program that provides health coverage for selected
categories of people with low incomes. Its purpose is to improve the health of people who might
otherwise go without medical care for themselves. Medicaid is different in every state. In Florida,
the AHCA develops and carries out policies related to the Medicaid program.
“Medicaid Fiscal Agent” refers to the State Medicaid Program’s vendor contracted to serve as the
state’s fiscal agent. Some of the fiscal agent functions include: enroll non-institutional providers,
process Medicaid claims, serve as the enrollment broker for Medicaid recipients, and distribute
Medicaid forms and publications.
“Medical Director” means a physician contracted by the organization to provide consultation
regarding member policies and services.
“Medical Group” means a group of PCP and/or Specialist Physicians who:
(1) are formally organized as a partnership or professional corporation;
(2) provide for the diagnosis or direct care and treatment of a medical condition; and
(3) divide their income based on a specified, fixed formula.
“Medically Necessary” shall be determined by CarePlus’ Medical Director and shall include
consideration of whether services:
(1) are appropriate and necessary for the symptoms, diagnosis or treatment of a medical
(2) provide for the diagnosis or direct care and treatment of a medical condition; and
(3) are not primarily for the convenience of the Enrollee, the Enrollee’s attending or
consulting physician, or another healthcare provider.
“Participating Physician” means any physician licensed to practice in the State of Florida who
satisfies the participation criteria established by CAREPLUS and who has entered into a contractual
arrangement with, or is otherwise engaged by, CAREPLUS to provide physician services to
Friday, May 10, 2013
Medical billing basic terms, definitions - capitation fee, covered services, dependent, emergency Medical condition
assigned to Provider. The amount of the Capitation Fee is set forth in the PCP Agreement.
“Clean Claim” is a claim that has no defect or impropriety, including lack of required
substantiating documentation for non-contracted providers and suppliers, or particular circumstances
requiring special treatment that prevents timely payment from being made on the claim. A claim is
“clean” even if CarePlus refers it to a medical specialist for examination. If additional
documentation in the medical record involves a source outside CarePlus, the claim will not be
“Copayment” means the amount required to be paid by Member to Provider as additional payments
for Covered Services as are Medically Necessary and shall include fixed payments to be paid as well
as percentage amounts based on the cost of a service (i.e. “co-insurance”). Copayments will vary in
amount for Members, depending on benefit structure
“Covered Services” means those medical and hospital services that are expressly covered under
any Subscriber Certificate and are medically necessary as determined by CarePlus’ Medical
“Covering Provider” means a physician who will continue to render Covered Services to Members
during those times when Provider cannot provide these services as set forth in this Agreement, but is
doing so under the same terms of this Agreement
“Dependent” means a family member of a Subscriber who are eligible for coverage under the
Subscriber Certificate and who have been enrolled in CarePlus
“Emergency Medical Condition” means a medical condition manifesting itself by acute symptoms
of sufficient severity (including severe pain) such that a prudent layperson, with an average
knowledge of health and medicine, could reasonably expect the absence of immediate medical
attention to result in:
(1) Serious jeopardy to the health of the individual or, in the case of a pregnant woman,
the health of the woman or her unborn child;
(2) Serious impairment to bodily functions; or
(3) Serious dysfunction of any bodily organ or part.
“Emergency Services” means covered inpatient and outpatient services that are:
(1) Furnished by a provider qualified to furnish emergency services; and
(2) Needed to evaluate or stabilize an emergency medical condition.
“Enrollee” means a Subscriber or Dependent who is enrolled in CarePlus. An enrollee is also
referred to as a “Member”. “Medicare Enrollee” means an Enrollee who is entitled to medical and
hospital benefits under Title XVIII of the Social Security Act, as amended
Monday, May 6, 2013
I have contacted different Medicaid provider phone numbers, but I have not received any response back.
Claims for recipients in MediPass are billed just like any other Medicaid claim. Please consult the appropriate billing handbook Florida Medicaid Provider Reimbursement Handbook, CMS-1500, Florida Medicaid Provider Reimbursement Handbook, UB-04; etc. Or contact Provider Support with the Medicaid Fiscal Agent.
You will find the contact information for the fiscal agent, HP Enterprise Services, at: https://portal.flmmis.com/FLPublic/Portals/0/StaticContent/Public/Training/032409%20Complete%20General%20Information.pdf . The claims addresses are in the center of the page. The Medicaid Area Office for your county can also assist.
Is the NPI# the authorization number for MediPass kids? I have some pediatricians who write their NPI# as authorization and others who put their Medicaid #.
No. The National Provider Identifier (NPI) number cannot be used to replace the MediPass authorization number. Providers who are not sure what to use as the MediPass authorization number should contact their Medicaid Area Office. NPI numbers are 10 digits while the MediPass authorization numbers will be 9 digits.
Do MediPass patients have dental benefits?
Dental services do not require prior approval or referral by the MediPass primary care provider, except in an area with the Prepaid Dental Plan. Some Medicaid HMOs cover dental services. If the HMO does not cover dental services, they may be covered by a Prepaid Dental Plan. Such plans currently operate in Miami-Dade, and they will expand statewide starting in 2012. If the person is not in a prepaid dental plan, the person would be covered under the fee-for-service Dental Services for Children or Dental Services for Adults. Note that the services for adults are very limited. Currently the following health plans cover optional (State Plan) dental services in all of their non-Reform counties of operation: JMH, Healthy Palm Beaches, Integral, Sunshine, and Molina. Beginning on January 1, 2012, only the following health plans will cover optional (State Plan) dental services: Healthy Palm Beaches, Integral, and Molina. Please be careful to request service authorization and to bill accordingly. Information on the implementation of the Statewide Prepaid Dental Health Plan program is available at the following website: www.AHCA.MyFlorida.com/MedicaidPDHP
Tuesday, April 30, 2013
You can obtain a call reference number through the AVRS. If you use the Web Portal you may choose to save a copy of the screen print or print out a hardcopy. If you use a MEVS vendor you will receive hard copy when you verify eligibility that you can save.
To show proof that we verified eligibility, we use a spreadsheet with recipient name, Medicaid number, date checked and comment box. Is this enough to show or document verification of eligibility? We verify eligibility using the web portal.
Many providers print out or save a screen shot of the page when they look up the eligibility and put it with the recipient’s file. If there is ever a discrepancy at a later time with the recipient’s eligibility it will show what the provider saw at the time the provider checked the eligibility
It is the provider’s responsibility to verify a patient’s Medicaid eligibility prior to providing any Medicaid reimbursable services.” If a recipient is not eligible for the month of September until the 15th of the month (and then eligibility is retroactive for the entire month), but services were provided earlier in September… will those services be billable once the recipient becomes eligible for the month?
Yes, once the recipient has eligibility for the date of service. Keep in mind that if you provide services for a person who is not eligible, you should not expect Medicaid payment. The recipient must be informed and agree to receive services that may not be covered by Medicaid. See Page “1-7” in Chapter 1 of the Florida Medicaid Provider General Handbook. All Medicaid handbooks, fee schedules, forms, provider notices, and other important Medicaid information are available on the Medicaid fiscal agent’s Web Portal at: http://mymedicaid-florida.com/
Will the system’s speed ever be improved? We have 60+ individuals to verify eligibility on. This process currently takes hours and hours to complete because the system response is so slow.
You may want to look into submitting batch transmissions. These can be done on the web portal or with most of the eligibility vendors. You can contact the fiscal agent for assistance with the web portal at www.mymedicaid-florida.com.
Tuesday, April 23, 2013
How do we find out which network provider to call?
If you check eligibility through the web portal, look for this information in the Managed Care section of the recipient’s eligibility screen. You will find the name, type and phone number of the HMO, PSN or other managed care plan.
Is the network provider the one who is going to give us the authorization for the services?
No, you would get the authorization from the Health Plan. The only time you will get authorization from a provider is for a person managed under MediPass.
Referring to Slide 50: If recipients don’t have managed care, will it be blank or will it state FL Medicaid? If the recipient does not have managed care, the Web Portal screen will show ***No rows found***.
A patient will come in with a Medicare managed plan yet also show us a Medicaid card. The Medicaid eligibility will show full Medicaid benefits but does not show the Medicare Advantage plan yet we do call and verify eligibility with the Medicare HMO. Does Medicaid pay as a secondary in this case?
Medicaid is not currently paying crossover claims for beneficiaries in Medicare HMOs (Part C plans), but there are changes in the works that may take place as soon as the end of the year. Please watch for any upcoming provider alerts on this subject. You may also contact your Local Medicaid Area Office for questions on this topic. You can find a list of the Medicaid Area Offices and contact information on the Medicaid fiscal agent’s Web Portal at: http://mymedicaid-florida.com/
If I have a situation where our claims are being underpaid with our HMO contract and we have sent several requests, spreadsheets and calls to get this rectified; what other recourse do we have as a provider?
The Medicaid contract requires that the provider address any claims/billing disputes through the provider complaint system of the individual Health Plan. Language from the contract is provided below. If the provider is unable to resolve this with the Health Plan, they are able to access an outside claims arbitrator, Maximus, which deals with claims disputes between Health Plans and providers. Application forms and instructions on how to file claims are available from Maximus.
How can I check for eligibility for a specific service by a managed care plan?
You may ask the recipient’s managed care plan when you contact them for authorization.
If you do not have a specific recipient, you may contact the managed care plan for general information. Your Area Medicaid office may be able to provide the contact telephone numbers for the managed care plans in your county.
Wednesday, April 17, 2013
If a recipient has other insurance coverage through a third party source, such as Medicare, TRICARE, insurance plans, AARP plans, or automobile coverage, we refer to that as Third Party Liability (TPL). As you know, these other sources must be billed prior to billing Medicaid. Florida Medicaid currently contracts with Affiliated Computer Systems (ACS) to manage TPL operations. Providers who have questions or problems concerning third party insurance can contact the Medicaid third party contractor:
* By telephone at 877-357-3268 (FL-RECOV),
* By fax at 866- 443- 5559,
* Through the website at http://www.FLMedicaidTPLRecovery.com,
* By e-mail at FLMedicaidTPLRecovery@acs-inc.com,
* Or in writing to:
ACS; Florida TPL Recovery Unit; 230; Killearn Center Blvd., Bldg A1; Tallahassee, Florida 32309
The TPL contractor can make the necessary corrections to the information on the recipients’ files.
How do we handle patients with FULL MEDICAID who also have an individual plan (ex. BCBS) and they refuse to acknowledge the individual coverage. BCBS makes it a patient responsibility/deduct and then Medicaid paid for the service. What do I do?
Medicaid is always the payer of last resort. Other insurance, including Medicare, must be billed prior to requesting Medicaid payment. Florida Medicaid currently contracts with Affiliated Computer Systems (ACS) to manage Third Party Liability (TPL) operations. Providers who have problems concerning third party insurance information can contact ACS, and they will make the necessary corrections to the information on the recipients’ files. If the TPL approves the service, but does not make a payment because it is applied to the patient’s deductible the provider can bill to Medicaid with the TPL EOB and is entitled to received payment for the service up to the Medicaid fee.
Tuesday, April 9, 2013
A Medically Needy recipient is an individual who would qualify for Medicaid, except that the individual’s income or resources exceed Medicaid's income or resource limits. A Medically Needy recipient becomes eligible on the day that the recipient incurs allowable medical expenses that equal or exceed the amount by which his income exceeds the Medicaid income standard (share of cost).
Recipients with a Share of Cost should be treated as private pay patients until they meet the Share of Cost amount. They should be informed that they will be responsible for the charges if they do not incur enough medical expenses to meet the Share of Cost. Information on the Share of Cost amount can be provided by the recipient or the Department of Children and Families (DCF).
Is DCF the only agency that determines share of cost?
Yes. Enrollment in the Medically Needy program only happens with DCF determinations. There is no similar program for SSI determinations through the Social Security Administration. Their applicants are either eligible for full coverage or not at all.
What is “Share of Cost” Medicaid?
When eligibility for Medicaid is determined, some people will meet all the technical requirements except that their income or the value of their assets (resources) is too high. These people can be enrolled in the Medically Needy program. The difference between the person’s income and the qualifying limit for full Medicaid is their “Share of Cost” (SOC).
For example, if the income limit for a person to get full Medicaid is $350/month and the person makes $500/month, this person’s SOC would be $150. Any month that this person’s medical expenses are more than $150, the person will get Medicaid coverage. Coverage will begin on the day the SOC is met and continues to the end of the month. Persons enrolled in Medically Needy will not be listed when you try to verify eligibility unless medical bills or other proof of medical expenses have been sent to the appropriate DCF office. DCF uses the bills to establish the date when the person is Medicaid eligible. Please contact your Area Medicaid Office for information on sending bills to DCF for tracking. You can find a list of the Medicaid Area Offices and contact information on the Medicaid fiscal agent’s Web Portal at:
Do we bill for share cost monthly or wait until monthly bills are submitted?
You can bill at any time after the person’s eligibility is established for the month
How do we check how much a recipient has already met or needs to meet before being considered eligible for full Medicaid?
If the recipient cannot give you the information on his/her Share of Cost, you will need to get the information from DCF. You can use the DCF Provider View link from the secure area of http://mymedicaid-florida.com . You can also contact the DCF call center at: 1-866-762-2237 or send a written request at this web site: https://www.dcf.state.fl.us/contact/contact_email.shtml?recv=ACCESS.
Wednesday, April 3, 2013
If you are referring to persons who only have coverage as Special Low Income Medicare Beneficiaries (SLMB) or as Qualifying Individuals I (QI1), this would be correct, but note that it is possible for a person to be eligible for both SLMB and a full Medicaid coverage program at the same time. Crossover claims policy would apply for those persons. More information can be found in the Florida Medicaid Provider General Handbook
Patients that are enrolled in a Medicare Advantage Plan still think that they have Medicaid second. What can we do to help us and them?
Florida Medicaid covers the Medicare Part C deductible and coinsurance up to the Medicaid fee, less any amounts paid by Medicare. If this amount is negative, no Medicaid payment is made. If this amount is positive, Medicaid pays the coinsurance and deductible up to the billed or allowed amount, whichever is less. The Florida Medicaid system is in the process of being programmed to comply with the state’s policy governing Medicare Advantage plan copayments. The system changes will be retroactive to January 1, 2010
Slide 38 of the presentation states that full Medicaid over-rules lower programs. Then, on slide 61 it states that as the recipient is QMB along with full Medicaid, the provider can bill for level of care (Medicare coinsurance). Could you please clarify this issue?
The QMB coverage means that the person has Medicare (another payer) in addition to the Medicaid coverage. The “level of care” refers to Nursing Facilities. Even though this person does not have the Long Term Care Medicaid, they have Medicare that could pay for Nursing Facility days (up to a limit). In this case the facility can bill Medicaid for part A coinsurance only – level of care =X. Of course, during the process of verifying eligibility, you would have already seen the Medicare coverage information.
SLMB: What is the definition of a Medicare Premium?
The Medicare premium is the amount that a person with Medicare Part A and/or Medicare Part B pays to Medicare to receive coverage.
Can you go over reimbursement for Share of Cost Medicaid patients? Is Medicaid now paying the full 20% after Medicare pays 80% of their allowed amount?
Information on Medicaid reimbursement for persons with both Medicare and Medicaid (dual eligibles) can be found in Chapter 4 of the Florida Medicaid Provider General Handbook. Claims with Medicare as the primary payer are called crossover claims. In the section labeled “Medicaid Program Limits,” you will find the information on how Medicaid reimburses crossover claims. If the Medicare payment is greater than the Medicaid payment for the same procedure, you must accept the Medicare payment as “payment in full.” You cannot “Balance Bill” or require any additional payment from the recipient.
Friday, March 29, 2013
What is CPT?
CPT was developed by the American Medical Association (AMA) in 1966. The AMA revises and publishes CPT each year to keep pace with changes in medical practice. They delete obsolete procedures, modify existing procedures, and add newly developed procedures.
Your physicians’ office should make it a policy to order the current book from the AMA each year. Begin using the new CPT codes on January 1.
• listing of descriptive terms and five-digit, numeric codes for reporting medical services and procedures performed by physicians.
• provides a uniform language to accurately designate medical, surgical and diagnostic services.
• serves as an effective means of reliable nationwide communication between physicians, patients and third-party payers.
Each time you submit a claim, identify the service provided by using one of these five-digit CPT codes, plus a two-digit modifier when appropriate.
HCPCS Levels of Codes
HCPCS is the acronym for the Healthcare Common Procedure Coding System. This system is a uniform method for health care providers and medical suppliers to report professional services, procedures, and supplies.
There are three levels of codes within the HCPCS system:
Level I. Level I is the largest component, made up of five-digit numeric CPT codes and two-digit modifiers. Both CPT codes and modifiers have descriptive terms for reporting services performed by health care providers. The first edition of CPT was published by the American Medical Association (AMA) in 1966 and it continues to release updates each year.
Example: 10060 * Incision and drainage of abscess
Level II. These national codes, created by The Centers for Medicare and Medicaid Services (CMS), were developed to cover services not specifically reported in CPT. Level II HCPCS codes consist of one alpha character (A through V), followed by four numbers. Level II HCPCS modifiers are two-digit codes which can be used with any level of codes. Level II codes are grouped by the type of service or supply they represent and are updated annually by CMS with input from private insurance companies.
Example: A4580 Cast supplies
Level III. Level III codes are used to report services and supplies that may be covered but not listed in the other two levels of HCPCS. These codes begin with a letter (W - Z) followed by four numeric digits. Wellmark has eliminated all Level III codes in accordance with HIPPA (Health Insurance Portability and Accountability Act of 1996) requirements.
• CPT* provides a uniform language to accurately designate medical, surgical and diagnos-tic services.
• CPT and HCPCS are updated annually to reflect medical practice changes.
• The AMA is responsible for revising CPT and CMS updates HCPCS Level II codes.
• CPT is used to report the medical services and procedures performed by physicians to insurance carriers.
• To assure that correct CPT codes are used for all procedures, a new CPT book should be purchased annually.
• Choose a procedure code that accurately identifies the service performed. Do not choose an approximate code (use an unlisted code if none exists to accurately describe it).
Friday, March 22, 2013
What is the overall Billing process?
The physician doesn’t get paid for his services immediately after they are rendered. Majority of the patients have insurance coverage and details of such coverage are provided to the physician before treatment. It is the responsibility of the physician to submit claims to the insurance company and get paid for his services. Submitting Claims and getting paid is a lengthy process and involves a lot of rules and regulatory systems and is very complicated. The physician needs to adhere to all these rules before submitting claims. This is the concept of Medical Billing. Sometimes the physician cannot provide his entire attention to this activity. He entrusts this activity to Billing Companies. This is a process of the physician providing rights to Billing Companies to bill Medical Insurance claims in order to save his time energy, and money.
After the provider renders services to the patient, the billing company will submit bills to the insurance company/ payer, using the insurance information that was last provided, as well as information about the reason for the examination, and the exact type of procedure performed.
Medical coding is the process of converting Medical terms to numeric code and it required Medical knowledge skills.
Medical billing is the process of submitting the claims and get paid behalf of provider.I have listed the important process in Medical Billing. Each process is very important.
1. Insurance verification.
2. Demo and Charge entry process.
3. Claim submission.
4. Payment posting.
5. Action on denials or Denial management or Account receivables.
Process started from here and usually front desk people are doing this process. Its a process of verifying the patients insurance details by calling insurance or through online verification. If this department works well, we could resolve more problem. We have to do this even before patient appointment.
Demo and Charge entry process
Demographic entry is nothing but capturing all the information of patients. It should be error free.
Charge-entry is one of the key departments in Medical Billing. Key department?? Yes, that's true. It is the keying-in department in Medical Billing. After receiving the super bills from the Doctor's office, it gets passed through the coding department, and then comes to the charge-entry department.
A Charge-entry person also has one other vital role to perform. That is, to look-up the codes entered in the claim, and to assign the relevant charges for those codes.
Claim submission Process
The next step after demographics and charge entry is claim generation. Claims may be paper claims or electronic claims. There are various types of forms for paper claims. The most widely used form is Health Care Finance Admin-1500 designed by the Health Care Financing Administration.
Electronic transmission of claims is the modern way of sending claims with less paper work. The most common means of transmission are through internet . The claim information is directly loaded into the insurance company's computer system or to the clearing house.
Payment Posting Process
Once the claims reach the carriers and they complete processing, they issue a check and prepare an Explanation of Benefits . The checks and the Explanation of Benefits would be sent to the pay-to address with the carrier or in the Health Care Finance Administrators.
In this processing we have accounted the money into the account as per the Explanation of Benefits. Now a days we are using Electronic payment posting also.
Action on denials or Denial management or Account Receivables
This is a most important function in the process flow of data. Unless this is taken care of, insurance balance will only be on an upward trend.
Problem in Medical Billing
•Inaccurate or lack of coding
• Incomplete claims
• Lack of supporting documentation
• Poor communication with the payer
• Not billing for services rendered
* Not being follow up AR balance claims
The person who is doing this process will be called Medical billing specialist.
Who is Medical Billing Specialist.
Medical billing Specialist is the one who is handling the below process and having well knowledge in each and every process.
* Insurance verification process
* Patient demographic and charge entry process.
* Submitting the claims by electronic as well as paper method. Tracking various claim submission report.
* Payments posting process for insurance as well as patient.
* Denial management.
* Insurance followup management.
* Insurance appeal process.
* Handling patient billing inquiries.
* Patient statement process.
* Preparing monthly reports such as revenue report and account receivable report and as per the provider requirement.
Medical Billing Specialists are in charge of reviewing patient charts and documents. They prepare and review all medical insurance claims based on the rules and regulations of insurance companies. Medical Billing Specialists also review insurance communications, payment and rejection notices to properly track all claims and payments.
Medical Billing specialist Professional
If a person is computer literate he is a fit enough candidate to take up the profession of medical billing and medical coding. However he will need to be trained and be aware of a lot of new information before he can start working effectively. He has to learn about the medical billing software and must be familiar with and master the various commands used while working with it.
Who are medical coders and how is it related to medical billing? Medical billing is a sub specialty of medical coding. Medical coding is the first step in the billing process. All patient records are maintained using the ICD-9 index system so that it is compliant with the federal rules.
A medical Biller’s most important skill includes filling up of the various medical forms correctly without any mistakes what so ever. All information required should be complete without any mistake at all. And the work will be include the following
Patient demographic entry
Billing and reconciling of accounts
Scheduling and rescheduling
Account receivable follow-ups and collections
Is it worth taking a medical billing program?
Usually don't spend too much cost on Medical billing program because the program will not do anything with real experience. What you learn from these kind of program will not be going to match with when you are working in the real environment. Hence just use as the start kind of program and get the real time experience even in small salary and later you can come up with more demanding one.
Problem of In House Processing of Medical Claims
Medical claims are generally very complex and have long extended details. While processing medical claims, one has to be highly critical and do efficient follow-up in order to get results. The process requires a lot of time and effort. And even after all this, there can be cases where files get lost or a small error can ruin the entire lot and everything has to be re-submitted again. Usually practice staff can be held up with lot of current work rather than submitting the claim and resubmitting the corrected claim hence it will lead to time delay on payment flow and it will affect all the relationship with in the practice. Even cost wise is also not effective when compare to outsourcing.
Advantage of Medical Billing Outsource
Medical Billing Company helps you in managing all your billing requirements proficiently. By choosing right medical billing company, you can get benefit such as improved financial strength.
Medical Billing task is very tedious and time consuming. However, billing must require more accuracy and special attention to strengthen the financial condition of clinical or hospital. You can do this task at own or assign to clinical staff but you have to be pleased with low patients satisfaction. Medical billing company can help you in supportive task. By efficient medical service, you will get highly satisfied patients.
A Medical Billing service can improve the efficiency of your billing system, reduce denials, cut down operating costs, boost reimbursements and save valuable time that can be devoted to patient care. These services are better equipped to adapt to continuously changing billing codes and industry requirements.
* Prince is low compare to doing it in house
* Dedicated Highly Skilled Professionals
* No need to maintain the hardware . Ability to perform Medical Billing remotely, using the software of your choice
* Usually Maximum reimbursements and fewer denials
* Accuracy is high when compare
* Faster transaction
Question need to ask when Medical Billing Outsourcing
1. Check with their referral and how long they are doing this business.
2. Are they HIPAA compliance
3. Where they are doing their work. If possible just visit there.
4. Data security.
5. Compare the price with others.
6. what are the reports they will provide
7. Your specialty wise question
8. Their software skills.
Services and process involved in Medical Billing
* Coding ( CPT, ICD-9, and HCPCS)
* Patient Demographics Entry
* Charge Entry – All specialties
* Payment Posting (Manual and Electronic)
* Payment Reconciliation
* Denials/rejections analysis, re-billing
* Accounts Receivable Follow-up
* Systemic A/R projects, re-billing
* Collection Agency Reporting
Medical Billing Salary Range
Depending on the education qualification, the hourly rate varies from $12-$15. Another most important factor that affects billing pay is how long someone has worked in the field. Medical specialist with experience of 1 year earns around $12 per hour. Those who have more experience in billing earn up to $16 per hour. However, the geographic location also plays a role in pay scale. For instance, areas where cost of living is high, the pay will be more. Billers who work in New York City, Houston, Chicago and California are able to pull a good amount of salary. Work locations such as hospital, billing company or private practice will also affect the salary. Since there are lots of factors which affect the salary of billing, it is really not easy to predict the pay scale. Studies have shown that 50% of people earned around $35,000-$45,000 annually.
Most of the medical Billers are paid hourly, rather than annually. While Biller who is experienced can earn around $40,000 a year as an independent contractor working from home, a billing and coding specialist who runs his own firm can earn $100,000 a year. However, people who are searching for home based job should be very careful. There is lots of fraud going on in this field. These spammers charge hundred to thousand dollars and in exchange they claim they will help to get a placement in billing. They also promise that medical billing job can earn a substantial amount of money and no experience required. But in reality, those who paid to get a job end up with no job, no money. Billing is a very competitive field, so without experience or training in medical billing field, it is almost impossible to get a job.
Selecting Medical Billing Software - 10 things to consider
1. The first step is to evaluate your needs. And when evaluating different systems look for a package that goes one step ahead of billing. Choose a medical practice management system MPP. This will handle considerably more that just medical billing.
2. Determine whether the system handles electronic transmission of claims, direct billing for patients, co-pays, co-insurance, and expenses not covered by insurance.
3. Weigh the pros and cons of different medical billing systems and ask to see a system in operations. Always check out the references yourself.
4. Look for a medical billing management system that is user friendly. When a vendor demonstrates get your office staff to be present. This way you will be able to check how the software functions. Any software must be easy to use to be productive. The system should be fool proof.
5. Ask whether the medical billing software is a traditional system, one that will work on your office computers or an application service provider system (ASP), one that will process data at the software company’s data center.
6. Always get quotes from at least three medical billing software providers.
7. Ask whether they are offering an evaluation period or trial. This will enable you to know in actuality whether the system works or not.
8. Find out about training your office people, up-gradation of system, and whether the software is compatible with your office computer systems
.9. Find out whether the system will handle appointment scheduling, maintenance of records and so on apart from electronic medical records, SOAP notes, and billing. Choose a system that is comprehensive.
10. An ideal Medical Billing software system must include aspects like payment posting, reconciliation; follow up, secondary submission, and patient billing.Choose a transparent billing system that enhances your office efficiency. Install a system that you can use not one that will lead to frustration and problems.Medical billing systems must free your time and that of your office staff not make you run in circles. Choose a system with care.
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