Monday, August 4, 2014

Receipt Date - Medicare definition

The receipt date of a claim is the date the contractor receives the claim (provided the filing is in a format and contains data sufficiently complete so that the filing qualifies as a claim). The receipt date is used to: determine if the claim was timely filed , determine the “payment floor” for the claim , determine the “payment ceiling” on the claim  and, when applicable, to calculate interest payment due for a clean claim that is not timely processed, and to report to CMS statistical data on claims, such as in workload reports.

A paper claim that is received by 5:00 p.m. on a business day, or by closing time if the contractor routinely ends its public business day between 4:00 p.m. and 5:00 p.m., must be considered as received on that date, even if the contractor does not open the envelope which contains the claim or does not enter the claims data into the claims processing system until a later date. A paper claim that is received after 5:00 p.m., or after the contractor’s routine close of business between 4:00 p.m. and 5:00 p.m., is considered as received on the next business day.

A paper claim is considered as received if it is delivered to the contractor’s place of business by the U.S. Postal Service, picked up from a P.O. box, or is otherwise delivered to the contractor’s place of business by its routine close of business time. If the contractor uses a P.O. box for receipt of mailed claims, it must have its mail picked up from its box at least once per business day unless precluded on a particular day by the emergency closing of its place of business or that of its postal box site.

As electronic claim tapes and diskettes that may be submitted by providers or their agents to an FI are also subject to manual delivery, rather than direct electronic transmission, the paper claim receipt rule also applies to establish the date of receipt of claims submitted on such manually delivered tapes and diskettes.

Electronic claims transmitted directly to a contractor, or to a clearinghouse with which the contractor contracts as its representative for the receipt of its claims, by 5:00 p.m. in the contractor’s time zone, or by its closing time if it routinely closes between 4:00 p.m. and 5:00 p.m., must likewise be considered as received on that day even if the contractor does not upload or process the data until a later date. NOTE: The differentiation between HIPAA-compliant and HIPAA-non-compliant in § with respect to applying the payment floor, does not apply to establishing date of receipt. Use the methodology described above to establish the date of receipt for all electronic claims.

Paper and electronic claims that do not meet the basic legibility, format, or completion requirements are not considered as received for claims processing and may be rejected from the claims processing system. Rejected claims are not considered as received until resubmitted as corrected, complete claims. The contractor may not use the data entry date, the date of passage of front-end edits, the date the document control number is assigned, or any date other than the actual calendar date of receipt as described above to establish the official receipt date of a claim.

The following permissive exception applies to establishment of receipt date: Where its system or hours of operation permit, a contractor may, at its option, classify a paper or electronic claim received between its closing time and midnight, or on a Saturday, Sunday, holiday, or during an emergency closing period as received on the actual calendar date of delivery or receipt. Unless a contractor closes its place of business early in an isolated situation due to an emergency, the contractor’s cutoff time for establishing the receipt date may never be earlier than 4:00.

A contractor may not make system changes, extend its hours of operation, or incur significant additional costs solely to begin to accommodate late receipt of claims if not already equipped to do so.

The cutoff time for paper claims may not exceed the cutoff time for electronic claims. However, the cutoff time for electronic claims may exceed the cutoff time for paper claims and, indeed, carriers and FIs are encouraged to use this tool where their system and overnight batch run schedules permit. Likewise, at a carrier or FI’s option, it may consider electronic claims received on a weekend or holiday as received on the actual calendar date of receipt, even though paper claims received in a P.O. box on a weekend or holiday would not be considered received until the next business day.

Where a carrier or FI prepares bills for payment for purchased DME because the $50 tolerance is exceeded (see §40.4.1) it establishes any date consistent with its system processing requirements as the receipt date for the second and succeeding bills. It uses the date as close to its payment as possible

Monday, July 21, 2014

Procedure codes with modifier 22

An internal system processing issue has caused some surgical procedure codes billed with modifier 22 processed on/after January 1, 2014, to not allow any additional money above the fee schedule. First Coast Service Options (First Coast) is currently identifying the impacted claims and will begin to initiate adjustment action on all impacted claims within the next two weeks. Note: only claims previously reviewed by our medical staff having met medical necessity requirements to allow above the fee schedule will be adjusted. Providers are asked not to file appeals or call the First Coast call center regarding this internal issue. First Coast apologizes for any inconvenience this issue has caused.
An internal system processing issue has caused some surgical procedure codes billed with modifier 22 processed on/after January 1, 2014, to not allow any additional money above the fee schedule.
First Coast is currently identifying the impacted claims and will begin to initiate adjustments on all impacted claims within the next two weeks. Claims having met medical necessity requirements will be changed to an unlisted surgical procedure code (modifier 22 will be appended to the related unlisted surgical procedure) to allow payment above the Medicare physician fee schedule. First Coast began utilizing this process July 11, 2014, for all surgical procedure billed with the 22 modifier that met medical necessity requirements for additional payment.

Wednesday, July 9, 2014

Electronic vs. Paper Billing - basic overview from Molina insurance

Medicaid  claims  that  are  secondary  to  insurance  or  Medicare  coverage,  including  Medicare HMOs, may be billed electronically either through electronic vendors or through Molina’s web portal.  Contact the EDI Help Desk for access to submitting claims on the web portal.

Medicare Primary Claims 

Many Medicare primary claims crossover to Medicaid automatically from the Medicare Part A and Part B carriers through the Coordination of Benefits Agreement (COBA), but some do not.  Claims that do not crossover, and therefore must be billed separately by providers include:

*** Outpatient claims from Part A Medicare carriers (such as NGS)
*** Long Term Care (LTC) claims from Part A Medicare carriers
*** Anesthesia claims from Part B Medicare carriers (on crossover, these are rejected because
claims are billed in “minutes” not “units”)
*** Claims processed by Medicare HMOs.

All of these types of claims may be billed electronically to Medicaid.  Medicare paid amounts, deductible amounts, and coinsurance amounts are required for Medicare approved services and Medicare Action Codes are required for services denied by Medicare.  This information is re-quired at the claim line level for professional services billed on the 837P format and at the head-er level for institutional services billed on the 837I format.  

***  Allowed amount, paid amount, deductible, and co-insurance information must be billed in the Medicare segments, not the TPL segments, or the claim will not process correctly.  

***  Medicare HMO co-pay amounts are to be billed as deductible.  ***  Claims denied by Medicare HMOs may be billed electronically if the denial is a HIPAA com-pliant denial code or Medicare Action Code (MAC).

***  Denied claims that are not denied with a MAC must be billed on paper with copy of EOMB including the denial reason in addition to the denial code.  

***  All Medicare HMO claims billed on paper must have “Medicare HMO” written on the EOMB to assure correct processing .

Third Party Liability—TPL Primary claims 

Providers must seek reimbursement from private insurance prior to billing Medicaid.  These sec-ondary claims may be billed electronically if the insurance carrier approved the service. Claims that were denied by the primary carrier, or contain denied claim lines, must be billed on paper with a copy of the EOB that includes a description of the denial in addition to the denial codes.

Medicare and TPL Claims 
If a member has Medicare and TPL coverage, claims may be billed electronically if both carriers made payments for the service.

Wednesday, June 25, 2014

Important update from PUP

ALL CMS PUP patient would be moved Medicare from June 1. We could submit the claim to Medicare and get paid See the below notice form PUP.

Wednesday, May 28, 2014

HIPAA - some important website resources

Look to the AMA and website resources for updates. 

The HIPAA Privacy, Security and Breach Notification rules continue to be revised, and technological
change continues to impact the application of those rules. Physician practices must ensure they stay on
top of these changes to protect their patients’ rights, maintain compliance and avoid the potentially
draconian penalties for violations.

American Medical Association HIPAA information 
AMA provides a host of information designed to help physicians comply with the HIPAA Privacy,
Security and Breach Notification Rules.

US Department of Health and Human Services (DHHS) Office of Civil Rights (OCR) 
The HHS OCR website contains a wealth of information on the HIPAA Privacy and Security Rules,
including a list serv and a link to the Transaction and Code Sets information posted by CMS.

Centers for Medicare and Medicaid Services (CMS) 
This link to the CMS website includes information on the Transaction and Code Sets Rule.

Workgroup for Electronic Data Interchange (WEDI) 
This is the WEDI website which includes information on EDI in the health care industry, lists of
conferences, implementation information and the availability of resources for standard transactions.

National Committee on Vital and Health Statistics (NCVHS) 
This is the NCVHS website. NCVHS is the Advisory Body to the Department of Health and Human
Services responsible for the HIPAA Transaction and Code Set Rule. Information on membership, how
to contact the committee, announcements and agendas for past and future public hearings is also

This is the Medicare EDI Web page. Here you will find information regarding Medicare EDI, advantages
to using Medicare EDI, Medicare EDI formats and instructions, news and events, frequently asked
questions about Medicare EDI, and information regarding Medicare paper forms and instructions.


Saturday, May 24, 2014

HIPAA Understand the basics.

HIPAA is the acronym for the Health Insurance Portability and Accountability Act. Although HIPAA covers many things, physicians typically are most concerned with HIPAA’s Administrative Simplification provisions, and particularly the Privacy, Security and Breach Notification requirements. Since it was originally enacted, HIPAA has been amended and expanded several times as a result of new laws and regulations. The most sweeping change resulted from the Health Information Technology for Economic and Clinical Health Act (HITECH), enacted as part of the American Recovery and Reinvestment Act of 2009 (ARRA).

This toolkit provides an overview of the HIPAA Privacy, Security and Breach Notification Rules with which almost all physicians must comply. At their core, these rules simply implement longstanding physician commitments to protect the confidentiality of their patients’ medical information and maintain open physician-patient communications. However, the specificity of the requirements goes well beyond traditional, self-evident obligations, and violations can result in serious penalties. Thus, physicians need to understand these rules and participate in a formal compliance plan designed to ensure all the requirements are met.   Physicians should also note that HIPAA is considered a “floor,” meaning, states may have requirements that go above and beyond what the federal government requires.  This toolkit is focused on the federal mandates.

In a nutshell, these three core compliance areas include:  

1.  The Privacy Rule 
The Privacy Rule restricts covered entities’ and business associates’ use and disclosure of an individual’s "protected health information" (PHI). Physicians who transmit PHI electronically in a HIPAA Standard Transaction, such as by filing electronic claims or checking eligibility electronically even if they are using a third party such as a billing service or a clearinghouse, are “covered entities,” and bound by HIPAA.  “Business associates” include those persons and companies that physicians hire to help their practice and that have access to their patients’ PHI, such as billing services, attorneys, accountants and consultants. "Protected health information" means individually identifiable information that is held or transmitted by a covered entity or business associate in any form or media—whether electronic, paper,
or oral, that relates to the past, present, or future physical or mental health of an individual, health care services, or payment for health care. The Privacy Rule also provides for “individual rights” such as a patient’s right to access their PHI, restrict disclosures, request amendments or an accounting of disclosures and their right to complain without retaliation.

2.  The Security Rule 
The Security Rule requires covered physician practices to implement a number of what are known as “administrative, technical, and physical safeguards” (described further on page 14) to ensure the confidentiality, integrity, and availability of electronic PHI. "Electronic PHI or ePHI" refers to all individually identifiable health information a covered entity or business associate creates, receives, maintains or transmits in electronic form. The Security Rule does not apply to PHI transmitted orally or in paper form.

3.  The Breach Notification Rule 
The Breach Notification Rule requires covered physician practices to notify affected individuals, the Secretary of the U.S. Department of Health & Human Services (HHS) and, in some cases, the media when they discover a breach of a patient’s unsecured PHI.

Friday, May 16, 2014

Medicare and Medicaid cross over claim - with different NPI

 If a claim is submitted to Medicare and 3 lines pay and 2 deny--will the two denied lines crossover on that claim? 
 If a provider bills multiple lines to Medicare and Medicare pays one or more lines but denies the others, the paid line(s) (as long as there are PRs) will be crossed over to Medicaid and the provider must resubmit the crossover payment as an adjustment to Medicaid to add the additional lines.

What if the deductible causes the claim to be zero paid by Medicare? 
The claim will still be crossed over and the deductible will be paid by Medicaid.

 Are Medicare Part C or Part D claims part of the crossover process? 
No, Part C and Part D claims will not be part of the crossover process.

 What will happen if I bill Medicare with a different NPI than I use to bill Medicaid? 
The NPI that is used on your Medicare claim must be enrolled with NY Medicaid.  Your crossover claims will not be processed if the NPI on your Medicare claim is not enrolled with NY Medicaid. In this case, Medicaid will reject the cross over claim back to Medicare and Medicare will send a notification letter of the rejection to the provider

How do I enroll my NPI with NY Medicaid to take advantage of payments of crossover deductibles and coinsurance? 
Enrollments application can be found on this website under Provider Enrollment. Questions about the enrollment process may be directed to the eMedNY Call Center at 1-800-343-9000.

 Will I be able to submit adjustments and voids to crossover claims? 
You will be able to submit adjustments directly to Medicaid for crossover claims.  The adjustments will be submitted the same as any other adjustment.  Voids must be submitted to Medicare. Medicare will void the claim and crossover over the voided transaction to Medicaid.

 Will the Medicaid remittance distinguish between a void submitted from Medicare as a cross over and a provider submitted void directly to Medicaid? 

There is no indication on the Medicaid remittance that the void was submitted by Medicare or the provider.

 What if I submit a claim directly to Medicaid for a patient who also has Medicare?
If the crossover claim from Medicare is processed first, the provider submitted claim will be denied as a duplicate claim. If the provider submitted claim is processed prior to the Medicare crossover claim, the provider submitted claim will be paid as it is today if zero fill indicator is included on the claim.  When the crossover claim is received it will also be paid. The eMedNY system will then automatically void the provider submitted claim.

 I submit Hospital Inpatient claims and many patients have Part B coverage only (No Part A).  Will the Part B coverage during an Inpatient stay be part of the crossover? 
Part B only claims are excluded from the crossover process and should be submitted to Medicaid as they are today.

Friday, May 9, 2014

Will Medicare cross over claims with no patient responsibilities? Clinic pricing, how much payment for crossed over claims?

 How does the Medicare Crossover process affect my Medicaid billing? 
You will no longer need to submit claims directly to Medicaid for those Medicaid patients who have both Medicare (Parts A &/or B) and Medicaid.

Will Medicare Crossover process affect my Medicare billing? 

In most instances, there are no changes to how you bill Medicare however Institutional providers who submit with rate codes are encouraged to include the Medicaid rate code on their claim to Medicare if they submit on the 837I . (See the next FAQ on how to  bill with a rate code)

 I receive enhanced Clinic pricing on my claims, will that payment methodology continue? 
The enhanced pricing will continue only if the claim submitted to Medicare contains your Medicaid rate code. If the claim submitted to Medicare does not have your Medicaid rate code the crossover payment will be only the deductible, coinsurance or co-pay due.  Send your claim to Medicare with the Medicaid rate code in Loop 2300 in the HI Value Information segment in data element HI01.

(visit eMedNY.org for more information at www.emedny.org/hipaa/FAQs/Rate_Codes.html) Rate codes are sent to Medicaid as 4-digit (numeric) values. If submitting the rate code to Medicare, the following amount format should be used: (NN.NN). N=number and the decimal must be included.

If you do not send the Medicaid rate code on your claim to Medicare, you will need to resubmit an adjustment to Medicaid with the correct rate code on the claim in order to receive the enhanced Clinic payment.

 If I am submitting the rate code on my Medicare claim, is there a special format? 
Send your claim to Medicare with the Medicaid rate code in Loop 2300 in the HI Value Information segment in data element HI01.  The following amount format should be used: (NN.NN). N=number and the decimal must be included.

 What amount will Medicaid reimburse on the crossover claims? 
The amount paid by Medicaid will be the deductible/coinsurance or co-pay amounts as indicated on the crossover claim from Medicare.

Will Medicare cross over claims with no patient responsibilities? 

No, only claims with PRs will be part of the automatic crossover system.

 Will I still need to do Medicaid Eligibility verification for claims I send to Medicare?
Yes, providers will still need to verify Medicaid eligibility with eMedNY as you do today.  Send  your claim to Medicare, and your claim will be automatically crossed over to Medicaid if the client is eligible for Medicaid.

Monday, April 28, 2014

How can we know Medicare crossed over the claims to Medicaid?

1.  What is meant by the crossover payment?

When Medicaid providers submit claims to Medicare for Medicare/Medicaid beneficiaries, Medicare will pay the claim, apply a deductible/coinsurance or co-pay amount and then automatically forward the claim to Medicaid. Providers will NO longer need to bill Medicaid separately for the Medicare deductible, coinsurance or co-pay amounts.

2.  How will the crossover process work? 

New York State Medicaid will receive Medicare crossover claims from the Coordination of Benefits Contractor (COBC), Group Health Inc. (GHI).  The various Medicare payers across the State will all transmit paid claims for Medicare/Medicaid beneficiaries to GHI. GHI will transmit the claims to eMedNY.

How will I know if my Medicare claims were crossed over to Medicaid? 

Your Medicare remittance will have an indicator that will show the claim was an automatic cross over to Medicaid. When the indicator appears on the Medicare remittance you will not bill Medicaid for those clients

Will Medicare release the Medicare EOMB to the providers before the claim is crossed over to eMedNY? 

The crossover will occur at the same time the Medicare EOMB is released.  Therefore the provider will see the Medicare EOMB before they see the Medicaid remittance or the crossover payments from eMedNY.

 What will be the indicator on the Medicare paper remittance? 

The Medicare Remittance will include a Remittance Remark Code of MA18 indicating the claim has been forwarded to a supplemental payer and will name NY Medicaid as that payer

What is the loop and segment for the Medicare indicator on the electronic 835 remittance? 

There will be no changes to the content of the Medicaid paper remittance or the Medicaid electronic 835 remittance.

I get my  Will the crossover affect how electronic 835 remittances? 
Your Medicaid 835 remittance will be generated to that Electronic Transmitter ID Number (ETIN) that is designated by you as your default ETIN.  If no ETIN has been designated as a default ETIN then the remittance will be produced as a paper remittance.

 How can I designate an ETIN as my default ETIN?
To indicate an ETIN as a default ETIN, the provider must complete a Default ETIN Selection Form available on emedny.org.

Thursday, April 10, 2014

Medicaid Coverage of Medicare Beneficiaries (Dual Eligibles) at a Glance - Part 3

See the First and second part for better understanding.

Qualifying Individual (QI)

A QI is an individual who:
 ■ is entitled to Part A;
 ■ has income that is at least 120 percent of the
 ■ FPL, but less than 135 percent of the FPL;
 ■ has resources that do not exceed three times the Supplemental Security Income (SSI) limit, adjusted annually for inflation.

A QI is similar to an SLMB in that the only benefit available is Medicaid payment of the Medicare Part B premium; however, expenditures for any QI are 100 percent federally funded and the total expenditures are limited by statute.

Full Benefit Dual Eligible (FBDE)

An FBDE is an individual who:

 ■ is eligible for Medicaid either categorically or through optional coverage groups, such as Medically Needy or special income levels for institutionalized or home
and community-based waivers; and
 ■ does not meet the income or resource criteria for a QMB or an SLMB.

Qualified  Disabled and Working Individual (QDWI)

A QDWI is an individual who:

 ■ lost Medicare Part A benefits due to returning to work, but is eligible to enroll in and purchase Medicare Part A;
 ■ does not have an income that exceeds 200 percent of the FPL;
 ■ has resource that do not exceed three times the Supplemental Security Income (SSI) limit, adjusted annually for inflation; and
 ■ may not be otherwise eligible for Medicaid.

A QDWI is only eligible for Medicaid payment of Part A premiums.

Balance Billing a QMB

For a QMB, Medicaid is responsible for deductible, coinsurance, and copayment amounts for Medicare Part A and Part B covered services. Providers may not bill a QMB for either the balance of the Medicare rate or the provider’s customary charges for Part A or Part B services. The QMB is protected from liability for Part A and Part B charges, even when the amounts the provider receives from Medicare and Medicaid are less than the Medicare rate or less than the provider’s customary charges, as specified in the Balanced Budget Act of 1997 (BBA). Providers who bill a QMB for amounts above the Medicare and Medicaid payments (even when Medicaid pays nothing) are subject to sanctions. Providers may not accept QMB patients as “private pay” in order to bill the patient directly, and providers must accept Medicare assignment for all Medicaid patients, including QMBs.

Medical Billing

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.

Insurance verification

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

Insurance enrollment

Charge entry

Insurance verification

Billing and reconciling of accounts

Payment posting

Insurance authorization

Medical coding

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

* Refunds

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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