Saturday, December 7, 2013
Friday, November 29, 2013
Federal regulations require that Medicare fee-for-service contractors maintain payment responsibility for managed care enrollees who elect hospice. These regulations are found that Medicare Fee for Service retains payment responsibility for all hospice and non-hospice related claims beginning on the date of the hospice election.
A - Covered Services
While a hospice election is in effect, certain types of claims may be submitted by either a hospice provider, or a provider treating an illness not related to the terminal condition, to a fee-for-service contractor of CMS. These claims are subject to the usual Medicare rules of payment, but only for the following services:
1. Hospice services covered under the Medicare hospice benefit if billed by a Medicare hospice;
2. Services of the enrollee’s attending physician if the physician is not employed by or under contract to the enrollee’s hospice;
3. Services not related to the treatment of the terminal condition while the beneficiary has elected hospice; or
4. Services furnished after the revocation or expiration of the enrollee’s hospice election until the full monthly capitation payments begin again. Monthly capitation payments will begin on the first day of the month after the beneficiary has revoked their hospice election.
Sunday, November 24, 2013
For eligible recipients from birth through (18) years of age, vaccines and combination vaccines providing protection against the following diseases are available free to the VFC-enrolled provider through the VFC program:
Diphtheria, Tetanus and Pertussis (DTaP)
Haemophilus Influenzae Type b (HIB)
Hepatitis B (pediatric and adult)
Meningococcal Conjugate (MCV4)
Pneumococcal (PCV 7)
Measles, Mumps, and Rubella (MMR)
Tetanus and Diphtheria (Td) (Adult)
Human Papillomavirus (HPV)
The following vaccines are available by request or for high-risk areas only through the VFC program:
Diphtheria and Tetanus (DT) (Pediatric)
Pneumococcal Polysaccharide (PPV)
Meningococcal Polysaccharide (MPSV4)
Vaccines for Recipients (19) through (20) Years
For eligible recipients ages (19) through (20) years, vaccines and combination vaccines providing protection against the following diseases are reimbursable:
Human Papillomavirus (HPV)
Measles, Mumps, and Rubella (MMR)
Meningococcal Conjugate (MCV 4)
Meningococcal Polysaccharide (MPSV4)
Pneumococcal Polysaccharide (PPV)
Tetanus and Diphtheria (Td)
Administration Fee Reimbursement
Medicaid reimburses an administration fee to physicians, ARNPs and Pas providing free vaccines through the VFC Program to Medicaid eligible recipients from birth through (18) years of age
Medicaid reimbursement for providing vaccinations to Medicaid-eligible recipients (19-20) years of age includes the cost of the vaccine and an administration fee.
The provider must bill with the appropriate HCPCS procedure code assigned to the vaccine and a modifier HA when appropriate. CPT codes 90632, 90660, 90733, and 90746 do not require the HA modifier.
Monday, November 18, 2013
Child Health Check-Up (CHCUP) is available to every Medicaid-eligible child under age (21). It includes screening (or well-child check-ups), diagnosis and treatment.
To provide Child Health Check-Ups, a provider must be enrolled in Medicaid as a provider with a Category of Service (code 55) for Child Health Check-Ups.
As licensed health care professionals you are aware that performing a blood test is a federal requirement at specific intervals during the “Child Health Check-Up.” This note is to remind you how important it is to document the blood tests you are performing in compliance with this federal mandate. Failure to provide documentation can lead to a federal audit and the requirement to repay Medicaid for fees received.
The CHCUP schedule listed below is based on the American Academy of Pediatrics, ”Recommendations for Preventive Pediatric Health Care” and Florida Medicaid’s recommendation to include the (7) and (9) year old recipients.
The Child Health Check-Up schedule is:
Birth or neonatal examination
(2-4) days for newborns discharged in less than (48) hours after delivery
By (1) month
Once per year for (2) through (20) year olds*
The child may enter the periodicity schedule at any time. For example, if a child has an initial screening at age (4), then the next periodic screening is performed at age (5).
* Florida Medicaid recommends check-ups at (7) and (9) years of age for those children at risk.
Vaccines for Children
The Centers for Disease Control and Prevention (CDC), which provides Vaccines for Children (VFC) funding, has developed strict accountability requirements from the state, local health jurisdictions, and individual providers. Molina Healthcare Providers should be enrolled in the VFC program through their
local health department. State supplied vaccines are provided at no cost to enrolled providers through the local health department. Florida is a “universal vaccine distribution” state. This means no fees can be charged to patients for the vaccines themselves and no child should be denied state supplied vaccines for inability
to pay an administration fee or office visit.
Molina Healthcare follows AHCA billing guidelines for reimbursing a provider’s administration costs. We reimburse per Florida’s fee schedule. Providers must bill state-supplied vaccines with the appropriate procedure codes.
Wednesday, October 30, 2013
Providers (as defined in 1861(u) of the Act, and institutional suppliers such as RHCs) that undergo a change in their ownership structure are required to notify CMS concerning the identity of the old and new owners. They are also required to inform CMS on how they will organize the new entity and when the change will take place. A terminating cost report will be required from the seller owner in all CHOWs for certification purposes. There are five types of changes that can occur:
1. A CHOW in accordance with 42 CFR 489.18;
2. Changes in the ownership structure to an existing provider that do not constitute a CHOW;
3. A new owner who purchases a participating provider but elects not to accept the automatic assignment of the existing provider agreement, thus avoiding the old owner’s Medicare liabilities;
4. An existing provider who acquires another existing provider (acquisition/merger); and
5. Two or more existing providers who are totally reorganizing and becoming a new provider (consolidation).
Providers that undergo a change of ownership will usually continue with the same FI that served the previous owner. However, if the prospective owner does not wish to accept the automatic assignment of the existing provider agreement, this means that the existing provider agreement is terminated effective with the CHOW date. The regional office must be notified in writing of the CHOW per instructions contained in section 3210.5 of the State Operations Manual. The prospective owner provides a notice 45 -days in advance of the CHOW to the CMS/RO to allow for the orderly transfer of any beneficiaries that are patients of the provider. All reasonable steps must be taken to ensure that beneficiaries under the care of the provider are aware of the prospective termination of the agreement. There may be a period when the facility is not participating and beneficiaries must have sufficient time and opportunity to make other arrangement for care prior to the CHOW date.
After the CHOW has taken place, the RO acknowledges the refusal to accept assignment in a letter to the new owner, with copies to the State Agency (SA) and the FI. The RO completes a form CMS-2007 with the date the agreement is no longer in effect, noting that the termination is due to the new owner’s refusal to accept assignment of the provider agreement.
If the new owner refuses to accept assignment and also wishes to participate in the Medicare program, the RO will first process the refusal as indicated above and then treat the new owner as it would any new applicant to the program. The RO will obtain and process the application documents, have the SA perform an initial survey and if all the requirements for participation are met, assign an effective date of participation. The earliest possible effective date for the applicant is the date that the RO determines that all Federal requirements are met. Once this is completed, a new provider agreement with a new provider number will be issued to the new owner. The provider will be assigned to the local FI.
Wednesday, October 23, 2013
Section 202(n) of the Social Security Act (the Act), requires the termination of Title II benefits upon deportation. Moreover, Sections 226 and 226(A) of the Act provide that no payments may be made for benefits under Part A of Title XVIII of the Act if there is no monthly benefit payable under Title II. Section 1836 of the Act limits Part B benefits to those who are either entitled to Part A benefits or who are age 65 and a United States (U.S.) resident, U.S. citizen, or a lawfully admitted alien residing permanently in the U.S. Given that, a deported beneficiary is not allowed to enter the U.S. and cannot be lawfully present in the United States to receive Medicare-covered services, Medicare payment cannot be made for Part B Benefits.
An audit of Medicare payments by the Office of Inspector General identified a vulnerability for the Medicare trust fund with respect to this issue. The study identified improper payments for beneficiaries, who, on the date of service on the claim, had been deported. To address this vulnerability, CMS is establishing claim level editing using data from the Social Security Administration (SSA). Specifically, the data contains the name and Health Insurance Claim (HIC) of the Medicare beneficiary and the month the deportation is effective. CWF will reject claims where the effective date on the Master Beneficiary Record is equal to or greater than the date of service on the claim. All claims rejected by CWF shall be denied by the respective Carrier, DMERC, RHHI or intermediary that submitted the claim to CWF.
Medicare payment shall not be made for an item or service furnished to an individual that has been deported from the United States.
Appeals: A party to a claim denied in whole or in part under this policy may appeal the initial determination on the basis of the deportation status at the time the item or service was furnished.
Thursday, October 17, 2013
If the specimen is drawn or received by an independent laboratory approved under the Medicare program that performs a covered test, but the lab refers the specimen to another laboratory in a different carrier jurisdiction for additional tests, the carrier servicing the referring laboratory retains jurisdiction for services performed by the other laboratory.
Examples of Independent Laboratory Jurisdiction
An independent laboratory located in Oregon performs laboratory services for physicians whose offices are located in several neighboring States. A physician from Nevada sends specimens to the Oregon laboratory. If the laboratory sends the results to the physician and accepts assignment, the carrier in Oregon has jurisdiction.
American Laboratories, Inc., is an independent laboratory company with branch laboratories located in Philadelphia, Pennsylvania, and Wilmington, Delaware, as well as regional laboratories located in Millville, New Jersey, and Boston, Massachusetts.
The Philadelphia laboratory receives a blood sample from a patient whose physician ordered a complete blood count, an SMAC T-4, and a B12 and folate. The Philadelphia lab performs the complete blood count, but the SMAC T-4 is performed at the Millville lab, while the B12 and folate is performed at the Boston Lab. The Pennsylvania carrier retains jurisdiction for processing the claims if they have certification information and the appropriate fee schedule allowance in house. Otherwise, the local carrier servicing Boston and/or Millville has jurisdiction for processing their claims.
The Wilmington laboratory draws a blood specimen from a patient whose physician has ordered a blood culture. The Wilmington lab then sends the specimen to the Boston laboratory, which performs the required test. American Laboratories accepts an assignment for the service.
If the Delaware carrier has the capability of comparing the Wilmington lab’s charge for the blood culture against the appropriate reasonable charge screens for the Boston lab, the Delaware carrier will retain jurisdiction for processing the claim. If the Delaware carrier does not have this capability, the claim should be transferred to the Massachusetts carrier for processing.
Friday, August 23, 2013
Our clinical philosophy is to provide the most appropriate member/practitioner match and the least restrictive treatment intervention for each member's needs across the life cycle. Our clinical orientation is a biopsychosocial approach with emphasis on wellness, early intervention, and integration of behavioral and medical healthcare. Excellent outcomes are maximized by good partnerships and a clinical consultation approach with all clinicians that deliver services to our members.
Psychcare makes decisions whether to approve or not approve payment for services based only on the appropriateness of the care or service, and what the member’s benefit plan covers.
The Medical Director oversees all triage and referral decisions. The Medical Director is available 24 hours per day; 7 days per week, to consult on initial clinical review decisions, and conduct peer clinical review.
The Vice President of Clinical Operations supervises nonurgent pre-service processes, and initial clinical review processes. The Vice President of Clinical Operations is available 24 hours per day, 7 days per week, to consult with Case Managers on initial clinical review decisions
In the event a patient is experiencing a behavioral health emergency in your office, or contacts you in crisis, call the police. If your patient can be safely transported with support, route the member to the nearest emergency room. After ensuring that the patient is safe, call Psychcare 24 hours per day, 7 days a week at (800) 221-5487 so that we can obtain the clinical information and begin managing the case.
If you call after hours or on the weekend, please inform the answering service that you have an emergency and the on-call case manager, a licensed clinician, will return your call within 30 minutes of the initial call. The on-call case manager arranges hospital admissions, crisis stabilization, and other required emergency services.
Initial Referral Process
Psychcare preauthorizes, and coordinates initial evaluations with our network psychiatrists and clinicians.
During the course of your patients’ medical treatment, you may determine that the patient could benefit from accessing their behavioral healthcare benefits when, for instance:
** the member requires an assessment of their current psychotropic medication(s), or an evaluation to determine the need for psychotropic medication
** the member is experiencing an acute crisis and needs to be evaluated by a psychiatrist
** the member is experiencing stressors that could possibly be reduced through psychotherapy
When callers request routine outpatient referrals, the calls are handled by our intake coordinators. The intake coordinator verifies the member’s eligibility and demographic information. They conduct a brief screening using an approved screening tool. During the screening, if, as indicated per the screening tool, the call requires clinical expertise, the intake coordinator transfers the call to a case manager. Once the intake coordinator completes the
screening, the member is given the names of network practitioners who meet their geographic, language, and cultural preferences. The member selects the practitioner they wish to see and the intake coordinator authorizes the members’ outpatient visit.
If you would like refer a patient to Psychcare for mental health or substance abuse treatment, simply fax a referral to Psychcare to (800) 370-1116, or call us to coordinate the referral at (800) 221-5487 during business hours, Monday through Friday 8:30 AM to 5:30 PM EST. Please include all pertinent clinical information and member contact information.
All urgent care and continued treatment are reviewed by case managers. Case Managers are, at a minimum, Masters’ Level Licensed Clinicians, or Registered Nurses, with a minimum of 5 years experience post master and/or previous experience in providing direct patient care, crisis intervention and discharge planning. The case managers review the continued treatment at pre-determined intervals with the psychiatrist, clinician, hospital, or program. Ongoing authorization is based on, as applicable to the individual status of the member, Psychcare
Mental Health Level of Care Clinical Criteria, Psychcare Substance Abuse Level of Care Criteria or Florida Medicaid Level of Care Guidelines and the member’s benefit coverage.
In particular, cases, care may be required outside of the usual parameters set forth by the member’s benefit plan. In such cases, the Medical Director and the Vice President of Clinical Operations may work with the case manager and the practitioner to develop an appropriate treatment care plan.
Specialized Services Requirements
The following services are authorized only when they are determined to be medically necessary, and inclusive in the member’s benefit coverage. The case manager consults with the Medical Director when the following services are requested, and covered under the member’s benefit plan:
** psychological testing
** electroconvulsive therapy (ECT)
The following services are typically not covered under a typical benefit plan:
** marital counseling
** testing for educational placement
** neuropsychological testing
Sunday, August 18, 2013
A: ICD-10 is the International Classification of Diseases, version 10. (ICD is the international standard for diagnostic classifications.) The current version, ICD-9, was adopted in 1979.
2. Q: What changes are occurring in the ICD-10 version?
A: The changes will impact ICD-9-CM diagnosis codes and ICD-9-CM procedure codes. The changes are as follows:
** The diagnosis codes (ICD-9) are currently three to five digits that are alphanumeric in nature and combine to make around 14,000 unique diagnosis codes being used today. For ICD-10, the diagnosis codes will be seven digits that are alphanumeric in nature and combine to make around 68,000 unique diagnosis codes
** Currently, ICD-9 procedure codes are three to four digits that are numeric in nature and combine to make about 4,000 unique procedure codes. For ICD-10-PC S (inpatient), the procedure codes will be 7 alphanumeric in nature and combine to make around 72,000 unique procedure codes.
3. Q: What is the primary purpose of this change?
A: The primary purpose of the change to ICD-10 is to improve clinical communication. It allows for the capture of data about signs, symptoms, risk factors and comorbidities and better describes the clinical issues overall. It will also enable the United States to exchange information across country borders.
4. Q: What is CarePlus’ plan for ICD-10 acceptance?
A: CarePlus will accept ICD-9 codes on claims w/ date of service (DOS), or discharge dates of September 30, 2014 or prior. CarePlus will accept ICD-10 codes on claims w/ DOS, or discharge dates of October 1, 2014 or after.
5. Q: Do you plan to be ready to process ICD-10 codes submitted on claims forms by Oct 1, 2013?
A: CarePlus will go live with the ICD-10 codes effective October 1, 2014.
6. Q: How long will support for both ICD-9 and ICD-10 coding be provided?
A: CarePlus will process correctly coded transactions within the date ranges specified in the answers above until the volume of ICD-9 submissions is diminished.
7. Q: When will CarePlus begin testing transactions?
A: CarePlus will begin testing ICD-10 transactions in the second quarter of 2014.
8. Q: Do you have a communication plan and schedule for customers to keep them informed?
A: The ICD-10 Program team is currently working on a communication plan and schedule with testing partners, trading partners, providers and internal departments.
9. Q: Will your claims adjudication processing vary by contract type (e.g., hospital, professional provider, and/or ancillary services)?
A: CarePlus does not foresee any issues with claims processing with the change to ICD-10. Testing will begin in early 2013 to mitigate any such issues.
10. Q: Will CarePlus purchase any new technology as part of its preparation for ICD-10 implementation?
A: CarePlus is remediating the systems that are currently in place for claims reimbursement.
11. Q: Will CarePlus be using GEMS as part of its process, or for creating files coming in or out?
A: CarePlus will process transactions in its “native” format and will not be using GEMS to crosswalk ICD-9 codes and ICD-10 codes for inbound or outbound v5010A1 transactions.
12. Q: Will there be any changes in payment with the change to ICD-10?
A: CarePlus’ plan is to be reimbursement neutral. There should be no change to the way a claim is paid with ICD-10 and ICD-9 codes unless an MS-DRG change has taken place or a contract has been rewritten to incorporate a change of reimbursement.
13. Q: What claim-processing issues does CarePlus anticipate with the preparation for ICD-10?
A: CarePlus is investing in remediation of systems and processes to support the ICD-10 requirements. CarePlus does not foresee any issues with claims processing with the change to ICD-10, although rejection due to misuse of new codes is possible. Testing will begin in early 2013 to mitigate any such issues.
14. Q: What key information should providers to keep in mind as they develop their own ICD-
10 implementation plans?
A: CarePlus suggests that providers stay up-to-date on any changes by CMS regarding the ICD-10 implementation. This can be done by monitoring the CMS website. If providers have questions or concerns, they may contact their CarePlus provider associate.
Websites offering additional information on 5010 and ICD 10 are:
Monday, August 12, 2013
1. Q: What is 5010?
A: HIPAA mandates certain transaction types for electronically submitted claims. The current format is ANSI (American National Standards Institute) X12 version 4010. HIPAA has mandated the industry move to the next version, X12 5010, by January 1, 2012.
Following are the ANSI X12 transactions used by the health care industry:
** The claims transaction known as 837 contains three transaction types: 837P - Professional, 837I - Institutional and 837D - Dental
** The remittance advice for the 837 (claim) is the 835 transaction
** The claim status request and response are 276/277
** The eligibility request and response are 270/271
** Referrals and authorizations are transmitted by 278
** Enrollment uses the 834
** Premium payments are made with the 820
** There are other transactions known as acknowledgements, which are used to confirm the receipt of the above transactions. These include the 997, 824 and the negative 277.
2. Q: Why is this change needed?
A: The move to the 5010 format is needed to support the introduction of the new ICD-10 code set and other current and future needs of the industry.
3. Q: Is there anything changing besides the accommodation of the ICD-10 codes?
A: There are a number of changes in versioning. This includes deletions of data previously reported on the 4010 and the introduction of the new data, which are newly available or required to be submitted in version 5010. Working with your practice management system representative will facilitate a smooth transition to the 5010 version.
4. Q: What is CarePlus doing to prepare for version 5010?
A: CarePlus is working closely with the clearinghouses and other trading partners to confirm readiness for the new format. CarePlus began testing the new format in the fourth quarter of 2010 and continues to test. Be on the lookout for information from clearinghouses about changes in the processes that may impact your practice.
5. Q: How will providers register in order to conduct testing for 5010 transactions?
A: CarePlus’ transition to version 5010A1 is transparent to providers submitting transactions through a clearinghouse. Contact your clearinghouse for information regarding its lead-time for transition to v5010A1. Remember that you should be conducting testing with your clearinghouses to ensure compliance.
6. Q: When will detailed instructions for submission under the new version be available?
A: CarePlus receives HIPAA version 5010 (v5010) transactions through Availity and Emdeon and will not have specific instructions for submission. Please contact your clearinghouse to validate its ability for passing v5010 formatted transactions to these clearinghouses.
7. Q: Will CarePlus’ systems be able to support both 4010 and 5010 transaction sets concurrently?
A: CarePlus will process v5010A1 transactions only after January 1, 2012.
8. Q: Will users have the capability to select one version over the other?
A: No. CarePlus will process v5010A1 transactions only after January 1, 2012.
9. Q: How long will support for both the 4010 and the 5010 transaction sets be provided?
A: CarePlus will process v5010A1 transactions only after January 1, 2012. 4010 transactions will no longer be supported after that date.
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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