COMPATIBILITY IS THE NAME OF THE GAME IN INSURANCE BILLING Have you ever wondered what happens to your claim once it has been sent, either electronically or by mail? An electronic claim is sent directly to the insurance company's computer system to begin a series of compatibility checks. A paper claim is always scanned first and may be manually entered into …
Billing Claims to Secondary Insurers
After those payments come in from primary health insurers, it is imperative to have a reliable system for billing secondary insurers. Staying on track with sending secondary claims can be a challenge. Consider that using a manual process to bill secondary payers requires pulling patient charts, making copies of primary Explanations of Benefits(EOB), generating secondary claims, attaching all the required …
EHR Reimbursement Deadline Rapidly Approaching
Through the course of time, we have seen advancements in electronic claim submission, responses, and reimbursements. Now comes Electronic Health Records (EHR). Medicare, Medicaid, and other insurance companies first required electronic transmissions in the big move in ‘going paperless’. As more providers enabled their claims transmission capabilities, the question became how to handle the exceptions as well as provide …
Getting Patients to Pay
There are many patient collection styles in the medical industry, ranging from passive to extremely aggressive. The office attitude about collecting money from patients often reflects the physician’s own feelings about money and the empathy they have toward their patients. Patients usually understand that they will be paying for some or all of their medical care, but few will offer …
Getting Your Claims Off The Ground
In almost all businesses that carry accounts receivables, there is an ongoing, continual problem with slow-pay and non-pay customers. In the medical industry, accounts receivables include a variety of insurance agencies among the customer base. When the government is so heavily involved in mandating the payment process, which includes timeliness, one would think that the insurance claims aging would be …
Establishing Rapport With Insurance Customer Service Representatives
Facing the required phone calls often necessary to insurance companies may be the worst part of the day for medical office staff. It is time-consuming and can be very frustrating at times. Being prepared and remembering a few tips while on the phone can save time and sanity. Gather the patient information including the chart, claims and Explanation of Benefits. …
Primary Care Teams For Medicare Beneficiaries At Home
New legislation authorized by Section 3024 of the Affordable Care Act will bring primary care teams into the homes of certain Medicare beneficiaries. Physicians and nurse practitioner teams will be testing a new service delivery model starting in 2012 that enables chronically ill patients to remain in their homes and receive services. For more information on the Independence at Home …
Suspension of Updates to ICD-9 Coding
The new 5010 version of data interchange and ICD-10 Level II being tested and implemented by Medicare and Medicaid has caused the ICD-9-CM Coordination & Maintenance Committee to partially suspend any further updates to code sets. ICD-9-CM and ICD-10 codes are usually updated annually. October 1, 2011 marks the last full update to ICD-9 code sets. On October 1, …
All Aboard For EDI & Coding Changes
New health care electronic transaction standardized requirements are coming up fast. Testing for the new 5010 version of data interchange and ICD-10 Level II compliance begins January 1, 2011. The current version, 4010A will be accepted through December 31, 2011 but the new version 5010 will also be accepted by the Medicare & Medicaid systems. January 1, 2012 is the …
Submitting A Clean Claim
What is this exactly? Technically speaking, it is the process of submitting fees for medical services to private, commercial, and government insurers for payment of such services, by completing a universal medical insurance claim, known as the HCFA1500. As you can imagine, billing these types of services to regulated entities can get quite confusing. It can either flow like a …
