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Medical Claims Clearinghouses: A Guide

There are several important things to consider concerning using a claims clearinghouse for your practice. Here are some examples of what you need to know to make sure that you are armed with the right data to make good decisions. The Importance of Having the Right Medical Claims Clearinghouse Your office can benefit significantly from having effective claims clearinghouse these days. Here are a few reasons why this is the case. The Age of Digitization While it’s still common for offices to send paper bills for their services, the actual healthcare claims themselves are processing everything digitally more and more.

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Choosing a Medical Credentialing Service

Medical credentialing is a crucial and necessary step to having an operating practice. This process encompasses the actions required to review doctors’ qualifications and career history. Credentialing takes a close look at the education, training, residency, and licensing of a medical professional while also identifying any of the certificates one may have obtained. Because this step into the professional medical industry is so important, it is vital to have your credentialing performed by the right service. There are many different options out there in terms of credentialing, so it can be a little difficult to know for certain that you

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How to Read an EDI 837 File

837 File Format Guide Today’s technology innovations allow for the rapid exchange of data all over the globe. In offices that offer patient services, safeguarding patient privacy is of the utmost importance. The 837 or EDI file is a HIPAA form used by healthcare suppliers and professionals to transmit healthcare claims. Before delving deeper into the 837 form, it’s critical to understand what an EDI file is. EDI stands for the electronic data interchange. It’s the structured electronic process that all businesses, including the healthcare industry, use to transfer information to other companies electronically instead of using paper. A variety

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Starting a Physical Therapy Clinic

Starting a Physical Therapy Clinic: The Right Way How to Start a Physical Therapy Clinic Starting a physical therapy clinic doesn’t have to be stressful. With careful planning and preparation, you can operate a successful business that becomes a vital part of the local community. However, there is a right way to do things and a wrong way, but in the end owning a physical therapy clinic is a challenging, but immensely rewarding experience. Read on to learn how you can get started with your physical therapy clinic. Have a Plan No business succeeds without a plan and starting a

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Guide to Optometry Billing and Coding

How to Bill for Your Optometry Clinic According to the American Foundation for the Blind, there is a significant increase of severe eye defects found in older people. Unfortunately, a large number of these people are in their 60s. Also, most experts forecast that the rate of vision loss will double alongside the aging US population. Thus, within the next ten years, the employment of Optometrists will experience a sudden 18 percent increase. This rate is faster than most regular occupations in the US. This means the opportunities in this industry are vast and the potential for growth for both

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What percentage of submitted claims are rejected?

As reported by the AARP1, estimates from US Department of Labor say that around 14% of all submitted medical claims are rejected. That’s one claim in seven, which amounts to over 200 million denied claims a day. There are legitimate reasons that a claim can be denied, but it’s not unheard of for insurance companies will deny claims that patients have a right to. Here are a few of the reasons there are so many denied claims. Medical billing and processing errors There are estimates that between 40% to 80% of medical bills have errors 2. Some of them, such

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How Artificial Intelligence Is Increasing Medical Billing and Coding Efficiency

Medical billing and coding is an essential component of the health care industry, providing a standardized format for determining the costs of different treatments and procedures. However, while these procedures are necessary for providing fair prices to medical procedures, billing and coding is a practice rife with potential for error, which can affect patients, providers, and insurers alike. Considering the scope of medical billing and coding, it’s no surprise that mistakes are common. With over 70,000 ICD and CPT codes to work with, many of which refer to combinations of services and procedures, keeping all the different designations straight is

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How New Jersey Assembly Bill 2039 Aims to Curb “Surprise” Out-of-Network Charges

New Jersey Governor signed Assembly Bill 2039 into law at the beginning of June. The conditions set up by AB 2039 are meant to help reduce surprise out-of-network medical costs that many face due to their insurance policies. The law goes into effect at the end of August 2018. In-network and out-of-network medical services have long played a role in the selection of medical providers, as well as the cost of care. When a patient receives treatment from a healthcare provider that is outside the patient’s insurance network, the billing process differs. As the insurance company will cover less for

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How Blockchain Will Affect the Medical Billing Industry

The term blockchain has steadily worked its way into the modern lexicon thanks to the growing popularity of cryptocurrencies. But managing digital money isn’t all that blockchain is capable of, and industries of every shape and size have started to work on ways to implement blockchain into their work. The medical industry is no exception, and there are some intriguing applications of blockchain to the processes of medical billing and coding. What Is Blockchain? Blockchain got its start for use in managing bitcoin and other cryptocurrencies, providing a third- party database management system. In terms of those cryptocurrencies, it keeps

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FWC Urogynecology Pays $1.7 Million to Resolve False Claims Case

The settlement of a lawsuit against a Florida urogynecology network ended in FWC Urogynecology agreeing to pay $1.7 million. The lawsuit took place in the United States District Court for the Middle District of Florida and centered on allegations that FWC Urogynecology had violated the False Claims Act by conducting improper billing practices. U.S. Attorney Maria Chapa Lopez led the lawsuit, which alleged that FWC Urogynecology had knowingly used billing modifier 25 in cases where they did not provide the proper amount of services. As a result, the network received payment from the U.S. government for medical treatments to patients

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How the Medical Billing Outsourcing Market Is Going to Expand

Hospitals and independent practitioners, much as they may deny it, usually run as businesses. Even if their end goals aren’t the same as other private enterprise, private practice operates in much the same way as other private sector industries. What this means, of course, is that the billing department is the lifeline for healthcare. More and more, however, hospitals and doctors are outsourcing their billing to third-party companies. Despite the importance of finance to healthcare providers, hospitals may receive as little as 10% reimbursement for healthcare procedures. In an industry where turning away non-paying customers is rare, this means that

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7 Medical Procedures for Which You Cannot File Claims

Health insurance is an extremely complicated process, and very much a hot topic these days. Even if you’ve read your enrollment brochure cover-to-cover, it’s still possible to miss some of the details of your coverage. With so many plans, exceptions, restrictions, and limits, it’s easy for your insurance to catch you off guard when it refuses to cover a procedure. Most procedures are covered by most plans – emergency care being the most obvious. A general rule of thumb is that insurance companies tend to restrict coverage to those situations they deem “medically necessary” or life-threatening emergencies. That said, there

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6 Most Important Medical Billing Reports

Ensuring that your practice is functioning efficiently involves investigating many things. One of the parts of your practice that needs to be working smoothly is your billing process. Medical billing reports are an important way to learn about this. They can give you vital information about claims, payments, and a variety of other aspects of your practice. Though there is a wide array of reports you should be checking for your practice, some should take priority over others. Following are 6 of the most important medical billing reports that your practice should check frequently. The Accounts Receivable Aging Report The

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UnitedHealthcare Accused of Wrongfully Denying Over $11 Million in Claims

NYC Health + Hospitals and UnitedHealthcare are set to enter arbitration regarding $11.5 million in denied inpatient medical claims. These claims are all related to patients who sought emergency department treatment between July 2014 and December 2017. The patients were covered by UnitedHealthcare’s Medicaid and Medicare programs. Their claims through Medicare and Medicaid for emergency treatment were denied, leading to NYC Health + Hospitals’ arbitration pursuit. None of the denied claims werefor cases of ambulatory care, behavioral health, or other services. NYC Health + Hospitals believes that the claims were wrongfully denied. Since the claims were all related to emergency

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What You Need to Know About Claims Scrubbing

The speed at which medical claims are processed is a vital part of the medical billing process in the United States. If the claim goes through quickly, it can save the patient, provider, and insurer time, money, and frustration. This is where we enter claims scrubbing into the equation. Thorough claims scrubbing is a significant step that will determine whether the claim goes through the first time or not. Whether you are seeking or providing healthcare, it is important to understand what claims scrubbing is and how it factors into the medical billing process. What Is Claims Scrubbing? Many steps

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