Wouldn't you like to avoid denials? Let's look at Claim Scrubbers and how they function to optimize reimbursement of medical claims. The best medical billing software will have a built in scrubber that analyzes the procedure codes on the claim for any conflicts to the NCCI edits. If the scrubber finds no conflicts, then you can proceed with …
Infrastructure is Key in Medical Billing Systems Software
Are you looking for new medical billing software, but do not want to buy a bunch of new hardware? Do you need have an Apple computer and require Mac medical billing software? Do you want to get rid of that clunky server under your desk? Do you want access to your billing system online from anywhere, even home, day or night? Is …
Reviewing Commercial Carrier Medical Policies/Clinical Guidelines
Commercial Insurance Carriers develop Medical Coverage Policies/Clinical Guidelines as a basis for the reimbursement for medical procedures. Since many are updated at varying intervals, it is important to regularly review as many of your Commercial Insurance Carrier's Medical Policies/Clinical Guidelines as possible for important changes. The Carrier's websites typically allow you to search for this information by procedure name and/or …
Understanding Medicare Fiscal Intermediaries LCD’s and How They Affect You
Each Fiscal Intermediary (FI) has the authority to produce their own “Local Coverage Determination” (LCD), based on national guidelines. The LCD basically defines under which circumstances a particular procedure is covered under the patient's Medicare benefits. As new procedures are developed, the FI will then set out to create an LCD. The FI will also review existing LCDs to see …
Why are Internal Chart Audits Important?
Many people are intimidated by the word “audit” and run in the other direction. Why should every practice do chart audits? It is important to inspect and verify your charts and billing practices before an insurance company calls for medical records. Doing regular chart audits sets you up for a sense of calm when the auditors do come knocking. Audits …
Knowing the difference between global, professional, and technical charges
Medical practices are almost as diverse as people in regards to the arrangements and agreements that exist between physicians and facilities. The existence of different fiscal arrangements requires that medical entities bill their charges based on the specific level of service that the entity is providing to the patient. CMS has created billing rules to accommodate these different scopes of …
What is Real-Time Eligibility?
Historically, when a patient with insurance came into a medical office, the staff obtained a copy of the insurance card and, if there was time, they made a call to the insurance company for eligibility status, benefits, and stop-loss information. Today, medical technology is all about networking with other systems in order to save time and increase billing success. Real-time …
Taking control through self-audit
A medical business should always be making steps toward improvement. That is how we retain clients in all businesses. Have you ever thought, “Every worker is busy. The appointment calendar is full. The piles of work get bigger, but the money is shrinking. It feels like everything is out of control.” These are common thoughts for many executives and employees …
I have received claims denials, now what?
Read more on our Biller's Blog.
I have received claims denials, now what?
Set aside a specific amount of time to work the denials received. The practice will be better off for this approach, because consistent data entry problems or billing errors can begin to show a pattern in poor workflow or training needs. Insurance companies also have time limits on adjusting and reviewing appealed claims, so time is of the essence. When …
