A recent study published by Health Affairs has proven what we all know to be true: Fee-for-service Medicaid is the most difficult insurer to bill. The study, conducted by economists, revealed a claim denial rate 17.8% higher than other insurers. The result is an increase in administrative and labor costs, but also a situation that creates problems for providers. Medicaid has long been plagued by billing problems, and there doesn’t seem to be an end in sight. Number Crunching Fee-for- service Medicaid claims are denied at a rate of 18%, 10.7% higher than Medicare denials. For private insurers, Medicaid claim
Zika virus is spread by infected mosquitoes, and a vaccine has not yet been developed to treat it completely. Symptoms often mimic those of other ailments and diseases, so it can be difficult formedical professionals to diagnose. The virus is especially dangerous when infected insects sting pregnant women and mothers pass the virus on to their unborn child. Infection during pregnancy can cause birth defects. Healthcare providers not only face the challenge of treating patients who show symptoms, they also must adhere to regulations for coding and reporting. What Is the Zika Virus? The Zika virus was first discovered in
A Navicure survey reveals even though more than half of patients prefer electronic medical bills, 77 percent of providers still send bills through the mail. Researchers also found while only 28 percent of providers keep a patient’s credit card on file to make paying easier, the number of patients who would be willing to use such methods is much higher. Electronic medical billing is a faster, easier way to deal with medical billing. Computerizing medical bills and billing records have many benefits that affect healthcare providers and patients. Eliminates Hassle Paper medical billing creates a large amount of hassle for
The American Hospital Association (AHA) reports hospitals and healthcare providers spend more than $39 billion annually on tasks related to compliance issues. Investing in technology, training, and staff allows them to keep up with demands, but causes them to feel overworked and pressured to meet continually rising requirements. Just last year, providers saw 629 changes in nine domains related to reporting, meaningful use, billing and other administrative tasks. There are 4 groups involved in creating legislation: CMS, OIG, OCR, and ONC. Centers for Medicare & Medicaid Services (CMS) The Centers for Medicare & Medicaid Services (CMS) is a part of
The government mandated adoption of electronic health records (EHR) systems claims the change improves patient care and reduces costs for healthcare providers. Healthcare providers adopted systems in stages to meet the requirement, hoping costly implementation would eventually pay off. Many facilities aren’t seeing the benefits they’d hoped for. The results are leaving many providers skeptical of the claim that EHR truly lowers administrative costs. What Are Electronic Health Records? Electronic Health Records (EHRs) are digital versions of a doctor or hospital patient’s paper chart. The goal of EHRs is to remove the need for physical documents to keep track of
Healthcare is a hotly contested subject within government, and the conversation has been shifting for decades. The last few years change has rapidly accelerated with new legislation, changes to the way insurance provides payment, fresh hope for chronic disease and a rapidly evolving approach to patient care. Let’s take a brief look at what happened last year to create such sweeping change and discover what patients and providers can expect in 2018. The Opioid Crisis Takes Center Stage Opioid overdoses have quadrupled since 2000, making the opioid crisis a key focus for government and healthcare officials in the year ahead.
There’s a lot more to running a medical practice than just treating patients. Physicians and administrators balance human resources and ever-changing regulations. They make daily decisions that involve vendor relationships and revenue streams. Technology can make many aspects of healthcare easier with claims processing software and systems that coordinate aspects of patient care. However, many physicians find themselves juggling different systems for scheduling, reporting and billing, and it bogs down office processes. Find out how medical practice management software can help, how it relates to your clearinghouse and how to choose the best for your facility. What Is Medical Practice
One of the most significant traits of claims processing is how fast it can all happen. If a claim is processed quickly it can be less expensive and your customer satisfaction will skyrocket. Find out why speed is so important and how to make sure you don’t lose a second when it comes to receiving payment. The Claims Process It should be so simple. Your practice provides a patient with treatment. They give you their insurance information. You supply the insurance company with a request for payment. It seems reasonable that they should process and approve your claim. However, each
No one likes receiving medical bills, because they often contain unwelcome surprises. If your billing department receives frequent phone calls for overbilling, your practice might be guilty of one – or more – of these behaviors that lead to customer dissatisfaction and decreased billing productivity. Medical claims processing is a critical part of a practice, and claims processing software can help keep patients happy and ensure there are no delays in clearing the medical billing clearinghouse. Make your billing department run smoothly by avoiding these mistakes. How Big a Problem Are Medical Errors? The Department of Health and Human Services
There are many reasons that a patient might report to a physician and leave the office without a diagnosis – maybe the symptoms are nonspecific, or maybe the patient requires a referral to a specialist better suited to make the correct diagnosis. No matter what the reason, coding and billing these cases can be pretty tricky. Medical claims processing is often a complicated and difficult task, and when no diagnosis is reached, properly coding these cases presents a unique challenge. Coding a claim incorrectly can be costly for both your practice and for the patient. Few things lead to irate
Is Federal Action Needed to Stop Surprise Medical Bills? There is a national crisis brewing in medical claims processing, but the federal government has yet to intervene. Surprise medical billing occurs when a patient gets a bill from an out-of-network provider, despite receiving treatment from a facility that’s within a patient’s health care plan. The provider, which is usually employed by a third party, holds the patient responsible for charges that the insurer won’t cover. The corrupt practice occurs in every state, but only one has been actively keeping track of it and taking measures to stop it.
What the FDA Says About Marijuana Claims When California becomes the eighth state to legalize recreational marijuana in 2018, the pressure will be high for the Food and Drug Administration to start enforcing some regulatory practices – despite its use being a federal crime. More states around the nation are expected to approve cannabis for recreational and medicinal use, which will likely transform medical claims processing for marijuana pharmacies. Though many users and doctors who prescribe medical marijuana are concerned about the FDA’s interference, it may be good news when it comes to getting insurance to cover such
You are diligent in making sure your medical claims are clean and correct before sending them to the payer. You have dependable medical billing software to help ensure casual mistakes caught early on. You may have heard medical claims clearinghouses benefit healthcare providers, but wonder what they might offer that you don’t already provide. Is it worth the additional expense or something your practice can do without? Here are some of the reasons your office can benefit from choosing a medical claims clearinghouse. Records Are Increasingly Electronic Most likely you still send paper bills, but healthcare claims are increasingly processed
You’ve made the decision that using a medical claims clearinghouse is the right avenue to take. Now you have the decision of choosing the right clearinghouse. Where do you start and how do you decide what is the best value for your practice? Here’s how to choose the best option for your facility. Understand How a Medical Clearinghouse Works When healthcare facilities install medical billing software, each claim becomes a file known as an ANSI-X12- 837. Software uploads the file to your medical claims clearinghouse where it is checked for errors, then transmitted electronically to the payer. Each transmission takes
Medical billing is a complex task where many things can go wrong. It takes a seamless, highly efficient system to conduct medical claims processing without critical errors. Even minor mistakes can spell trouble for healthcare providers, insurance companies, and patients. One of the best ways to prevent billing mistakes and payer audits is with regular self-audits. Self- auditing the right way could save your office. Common Billing Errors in Medical Claims Processing To understand the value of self-auditing, first explore the many errors that could harm a physician’s office. Billing in the medical field requires innumerable charts, codes, and communications