medclaims-blog
REVENUE CYCLE MANAGEMENT
Please follow link for more information on Revenue Cycle Management.
CLOUD COMPUTING
Cloud Computing. December, 2012. Medclaims has entered into a strategic partnership with Data Strategies, Inc. (www.mdsuite.com) to offer Electronic Health Record (EHR) and Practice Management (PM) in a cloud computing environment. Both companies have been in a successful partnership for eight years, and mutually agreed to elevate the partnership to the next level to further leverage their knowledge in the ever evolving Health Care industry.
Under this partnership, clients will have full access to EHR functionality. Moreover, EHR and billing will seamlessly interact, giving clients visibility to billing activities and performance.
No software or maintenance costs are incurred by clients, since the partnership is based on a paid for performance business model. For further information and details, please click contact Medclaims.
HEALTH CARE REFORM AFTER THE ELECTION
HEALTH CARE REFORM AFTER THE ELECTION
With President Obama’s re-election and the Democrat Party maintaining control of the Senate, the implementation of the law has overcome its most significant roadblocks.
However, there are challenges ahead for the implementation, so inside this article we look at those challenges and identify what employers need to be doing now.
Aggressive Deadlines for Exchanges
Exchanges are required to be up and operational by January 1, 2014 with open enrollment by October 1, 2013. This is an aggressive timeline and if states are not operational in time, then the federal government will step in and run the exchange for them. Many states that have waited for the outcome of the election to begin are now facing a serious crunch time. Questions further abound about whether the federal government can accomplish its requirement to set up an exchange in time if the state does not. Any delays in exchange implementation will impact implementation of other parts of the law too. California’s Commissioner remains optimistic in this state, but multi state companies should keep watch.
The Fiscal Cliff
In the coming weeks we will be hearing a lot more about the so-called Fiscal Cliff. Triggered by the 2011 Debt Ceiling Deal,the Fiscal Cliff is short hand for automatic government spending cuts and tax increases that will occur on December 31, 2012. The Fiscal Cliff will likely get Democrats and Republicans negotiating and this may slow implementation of the law or reduce its subsidies. All is yet to be seen.
Agency Guidance
It will be important to stay current on regulations and guidance notices put out by agencies involved in the law. The Treasury Department, the DOL and HHS will soon be issuing regulatory guidance. Important expectations here are focused on how employer penalties will be applied and how they are precisely calculated.
What employers need to do now?
- Request a benefits planning meeting with your broker. Understand new plan options, exchange options and tax consequences of decisions.
- Provide Summary Plan Benefits Coverage ( SBC ) to your participants and beneficiaries by the first open enrollment period beginning after September 23, 2012.
- Provide Employee Notice of Exchanges by March 1, 2013. The HHS or your broker will soon have model notices available.
- Withhold Additional Medicare Tax for high wage workers. In 2013 employers will be required to withhold an additional 0.9% on wages over $200,000.
Source: William J. King & Associates
ICD-10 COMPLIANCE
HHS has announced the final rule that delays the ICD-10 compliance date from October 1, 2013 to October 1, 2014. Now is the time to prepare.
PALMETTO GBA LOSES MEDICARE MAC CONTRACT
Follow link for details. http://www.sbcms.org/article/palmetto-gba-loses-medicare-mac-contract
U.S. AUTHORITIES CHARGE 91 IN $430 MILLION MEDICARE FRAUD
Please follow link for details.
http://news.yahoo.com/authorities-charge-91-430-million-medicare-fraud-173905068.html
WELLNESS SCREENING PROGRAM AVAILABLE SOON
Starting in December 2012, a new wellness screening program will be available to your Cigna patients in select markets. Follow link for details. http://www.cigna.com/customer_care/healthcare_professional/newsletters/October_2012/Wellness-1012.html
EHR INCENTIVE PROGRAMS
“The Medicare and Medicaid EHR Incentive Programs provide incentive payments to eligible professionals, eligible hospitals and critical access hospitals (CAHs) as they adopt, implement, upgrade or demonstrate meaningful use of certified EHR technology. Eligible professionals can receive up to $44,000 through the Medicare EHR Incentive Program and up to $63,750 through the Medicaid EHR Incentive Program.”
Please follow link below for more information. http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/index.html?redirect=/EHRIncentivePrograms/
5 TIPS TO IMPROVE MEDICAL BILLING
by Erin Palmer, US News University Directory
In this challenging economy, families still need medical care but may not have the means to pay for it when the bill comes due. This can prove challenging for medical billing agencies. In such a climate, medical billing services need to increase their effectiveness and efficiency in order to get the best results for their physician and medical facility clients. Consider these tips to improve medical billing practices:
1. USE TECHNOLOGY AS AN ADVANTAGE.
Medical billing services that strive for effectiveness and efficiency may find technology advantageous. By utilizing up-to-date software for medical billing, organizations have the opportunity to quickly determine whether claims are likely to be accepted or denied based on the ever-evolving changes in billing rules for insurance plans, Medicare and Medicaid. The highest quality software automatically updates as rules change, helping medical billing professionals determine new trends in denials and work toward increasing the amount they can collect for clients.
2. DEVELOP AND UTILIZE A FORMAL SERVICE CONTRACT.
Running a medical billing business is just that: a business. It is critical to have all parties involved – the medical facility or physician and the medical billing agency – sign a contract that delineates exactly which parties are responsible for each task, how payment will be made and terms for ending the contract. Having a billing contract emphasizes professionalism and helps protect the physicians and medical billing company.
3. USE BUSINESS INTELLIGENCE TO IDENTIFY AREAS FOR IMPROVEMENT.
Accurate data mining is one of the best ways for medical billing agencies to improve their level of service and collection. With the innovations in medical billing software, unique reports can be run that provide specific information to assist in decision making and implementing improvements. Most of today’s billing software does offer the option to create custom reports. Once reports have been completed, they can assist medical billing management with increasing staff productivity, adjusting staffing requirements, as well as quickly identifying payment errors.
4. COMMUNICATE WISELY WITH PATIENTS.
Medical billing professionals can assist medical staff by encouraging the posting of all billing information in an obvious location in the patient check in area. By having the terms of payment easily visible for patients, there is no confusion about billing practices of the medical service. This information should include insurance requirements, upfront payments, co-payments and billing procedures.
5. COLLECT FULL INFORMATION.
One of the best ways to help a medical billing agency increase efficiency is to make sure patient information is accurate and complete. Having a patient’s address, full name, birth date, work information and multiple phone numbers is a critical part of the data collection process that will be used both with insurance companies and as part of the collection process, should requests for payment be ignored. Additionally, asking patients for their Social Security number is an excellent practice that can be extremely helpful when cases of non-payment are turned over to a collection agency.
Clearly, there are many ways for a medical billing practice to become more efficient and effective. Acquiring accurate patient information, using a comprehensive contract with physicians and medical services as well as utilizing cutting-edge software are all steps to optimize the organization. Incorporate these steps today to see a medical billing agency grow more profitable.
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This post was provided by Erin Palmer.
Erin writes about online healthcare training programs and allied health careersfor US News University Directory. For more information please visithttp://www.usnewsuniversitydirectory.com
AETNA ACCEPTS ELECTRONIC CLAIMS FOR MEDICARE PART A AND B
You no longer have to send us your Medicare claims on paper. We now accept both Medicare Part A and B claims electronically.
To save time:
- Don’t send us a claim – Medicare pays its share first. In most cases, it then automatically forwards claims information and any remaining balance to us.
- Look for the “MA18” or “N89” codes on your Medicare Explanation of Payment. That means Medicare automatically sent us your claim.
- Check the status with our online Claim Status Inquiry transaction.
- Make a note that Aetna is reviewing your claim:
- Wait 30 days before billing us. Medicare carriers send claims every seven days, and we pay clean claims promptly; or
- Create a paper claim if your system can’t suppress billing, but don’t mail it.
- Follow up with us in 30 days, if needed.
For more information on Medicare crossover claims, visit our Coordination of Benefits (COB) page.
Aetna OfficeLink Updates
September 2012
Issue Number 3
Volume 9