Electronic Records Still unable to replace Paper Works in Healthcare Insurances

Likewise many of Healthcare Practices and hospitals which are still adopting the trend of Paper works, Healthcare Insurance Carriers are also still not updated with the Electronic Records.

Many of the Insurance Carriers claims that they’ve implemented all the processes electronically which in real words, I must say that they have been failed to do so.

In Insurance Carriers like Blue Cross Blue Shield and some others has most updated systems but still many of Insurance even having all electronic facilities are unable to be electronically updated. This is all because whether the staff within their organizations are still not ready to adopt the electronic trend or still they don’t want to leave the same old trend of processing information.

It has been identified that if there comes any errors/denials, some of Insurances re-process these claims in a most efficient manner without any hindrance electronically, but some of the insurances are still like they are working with the trade carts. While submitting these corrected claims is still a hectic for the providers and that leads to the loss of money for them.

When these providers are getting such responses that they are losing money, lots of companies comes up with their marketing ideas and they do over charging to the healthcare providers to clean their all such records with payments. In this case Healthcare providers lose money and pay a big money to the market for their recovery.

Here the problem is not of losing money but the problem is to promote Healthcare Providers to provide them with all facilities so they should be able to provide with 100% stress free services to their patients, while he should be confident that the insurance will pay for the benefits they are providing to their patients. Sometimes Insurance demands for such paper works, COB’s and all these things which delays or cancel the payments incurred from Insurance side, make upset to the Healthcare Providers, which sometimes leads to the issue to send long bills to the patients. Once the patients receive such bills they use to shout on Healthcare Providers, that why is it so happening. Result loss of Patients within their practices.

On other hand Provider Enrolment/Credentialing is a basic issue for these providers, which leads a massive loss to these Healthcare Providers. Enrolling themselves with different Insurances and sometimes Insurance rules and regulations get changed and all contracts get revised which results in lots of difficulties while providing Healthcare services to their patients.

I’ve raised here two basic issues for the Healthcare Provider Revenue; one is Electronic Submission/re-submission of bills to Insurance Carriers and another is of Provider Enrolment/Credentialing. For Electronic Records there should be a general body of every Insurance which take steps to make it sure that they are providing 100% Electronic Submission for the bills and for all other records, where for Credentialing there should be a central body like CMS who regulates not only all rules and regulations but also provider all-in-one enrolment to their Healthcare Providers.

Step from CAQH was a good start but still I feel it is not compatible with the problems of Healthcare Providers. Their should be more lenient way so that Healthcare Provider never thinks about these things. He should only be focused on their Patient’s health.

Please send your feedbacks, comments and suggestions on; help@healthinformatrix.com.

Tips to Become Medicare Participating Provider

The Centers for Medicare and Medicaid Services is always seeking medical providers to see patients. The application process for becoming a Medicare insurance provider is through the Internet-based Medicare Provider Enrollment, Chain and Ownership System (PECOS) or by mail. To receive reimbursement, you must enroll as a Medicare provider before rendering services to Medicare patients. Complete the application carefully to avoid delays in processing. Applying through PECOS is quicker than applying by mail.

Instructions

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   Online Submission

   
   
   
   
   • Make sure you have a National Plan and Provider Enumeration System (NPPES) user ID and password. PECOS is accessible with your NPPES ID and password. If you need an NPPES ID, call 800-465-3203, visit the NPPES application site (see Resources) or email customerservice@npienumerator.com for assistance.
   
   
   • Go to the Medicare PECOS website and log in with your NPPES User ID and password.
   
   
   • Complete the enrollment application online, following the directions on the website. Submit the application. Print the two-page Certification Statement that appears on the PECOS site.
   
   
   • Sign and date the Certification Statement and gather the required supporting documentation, as instructed on the PECOS site. Mail hard copies of the Certification Statement and supporting documents to your regional Medicare carrier within seven days of the electronic submission. To find your regional Medicare carrier, consult the list on the Centers for Medicare and Medicaid Services' website (see Resources). The carrier must have the signed Certification Statement prior to application review.
   
   
   • Track your enrollment application's status on the PECOS site. The average application processing time for Internet-based submissions is 45 days.
   
   
   
   

   Mail Submission

   
   
   
   
   • Open the Medicare enrollment application, Form CMS-855, from the Centers for Medicare and Medicaid Services' website. Review which 855 form is appropriate, as there are several based on the type of provider. Individual practitioners use CMS-855I.
   
   
   • Complete the enrollment application, a PDF document, on your computer or print the PDF to complete by hand. If you wish to complete the PDF on your computer, download the application, save the document to your computer and print it upon completion.
   
   
   • Mail the application and required supporting documents to your regional Medicare carrier. To find your regional Medicare carrier, consult the list on the Centers for Medicare and Medicaid Services' website (see Resources).
   
   
   • Wait for written confirmation of your acceptance or denial as a Medicare provider. The average application processing time for paper-based submissions is 60 days.
   
   
   
   

See also: Average Processing Days for Medicare 855 Application

Average Processing Days for Medicare 855 Application

In Provider Credentialing Process, Medicare Enrollment is one of the toughest way to process the application. If you are enrolling with Medicare you should be aware with all tools and all available resources to pursue for your provider enrollment before you process your application.

Medicare process the Application with the following Application Forms;

• CMS-855A


• CMS-855I


• CMS-460


• CMS-855B


• CMS-855R


• CMS-588

The above CMS forms defines that what form we need to submit for which insurance.

The duration to process the application are given as below;

Medicare Part A

	Initial Applications	Changes of Information	PECOS Web
Average Days to Process	51	43	17

Medicare Part B

	Initial Applications	Changes of Information	Reassignments	PECOS Web
Average Days to Process	103	92	111	22

In order to smoothen the Credentialing Process, Medicare also contracted with different Contractors to provide faster process for their applications. Each state is provided with different Medicare Fee for Service Contractors based on their territories. To see the List of Medicare Fee For Service Contractors Click here.

These Medicare Fee for Service Contractors provides help and support to enroll the provider or organization with Medicare.

If you are looking for more information about Medicare Credentialing Process please send us email at help@healthinformatrix.com.

See also: Tips to Become Medicare Participating Provider

Medicare Incentive Payments Are Not Just for Physicians Anymore

CMS incentive programs are not just for physicians anymore. Beginning this year, hospitals can participate in the Electronic Health Record (EHR) Incentive Program. Federal incentive payments will be available to doctors and hospitals when they adopt certified EHR technology and demonstrate its use in ways that can improve quality, safety and effectiveness of care.

End Stage Renal Disease (ESRD) facilities can participate in the ESRD Quality Incentive Program (QIP), which is designed to promote high-quality dialysis services at Medicare facilities by linking CMS payments directly to facility performance on quality measures.

Two new incentives for physicians this year are the Primary Care Incentive Payment Program for primary care providers and the Health Professional Shortage Area (HPSA) Surgical Incentive Payment Program designed for general surgeons.

TrailBlazer has developed a Web page dedicated to the various types of CMS incentive programs to ensure that you receive the latest information. Check out the Incentives Web page to see if your facility could benefit from the many opportunities available for additional revenue.

BCBS no more paying 99050, 99053 & 99058 to Urgent Cares

In past times BCBS used to pay Urgent Cares for 99050, 99053 & 99058. The payable amount was around $137.97.

Recently BCBS stopped paying against to these Add-on Codes to Urgent Cares. In addition BCBS raised paying E&M codes.

Also BCBS is no longer paying S9088 but they are still paying for S9083.

AMA launches coding mobile app

The American Medical Association unveiled a coding application for use on Apple iPhones, iPads and iPod Touches and also announced a contest to find "the next great medical app," according to a news release from the association.

The CPT coding app is free on iTunes and is designed to help physicians find appropriate evaluation and management billing codes—known as E/M codes—which apply to patient-physician encounters.

The AMA also launched the 2011 AMA App Challenge, which asks physicians, residents and medical students to develop innovative medical applications. Two winners—one a physician and one a resident, a fellow or a medical student—will receive $2,500 in cash and prizes and a trip to the AMA's annual meeting in November in New Orleans.

Health Care Fraud Takedown

111 Charged Nationwide

Twenty individuals, including three doctors, were charged in South Florida earlier this week for their alleged participation in a fraud scheme involving $200 million in Medicare billing for mental health services.

And that was just a precursor to today’s national federal health care fraud takedown involving charges against 111 defendants in nine cities in connection with their alleged participation in schemes to bilk Medicare out of an additional $225 million. More than 700 law enforcement personnel from the FBI and Health and Human Services-Office of Inspector General (HHS-OIG), multiple Medicaid fraud control units, and other state and local law enforcement agencies took part in today’s operation, which was announced at a press conference in Washington, D.C.

HEAT. The Florida case and the cases involved in today’s takedown were the result of the Department of Justice/HHS Health Care Fraud Prevention and Enforcement Action Team, or HEAT, initiative and its Medicare Fraud Strike Force operating in a number of U.S. cities. In addition to Baton Rouge, Brooklyn, Detroit, Houston, Los Angeles, Miami, and Tampa, Attorney General Eric Holder announced at today’s press conference the expansion of the strike force into two more cities—Chicago and Dallas.

Medicare Strike Force members include federal, state, and local investigators who use data analysis techniques to identify high-billing levels in health care fraud hot spots, targeting chronic fraud and emerging or migrating schemes by criminals masquerading as health care providers or suppliers.

In the Florida case, the indictment alleges that various defendants paid kickbacks to patient brokers and owners or operators of halfway houses and assisted living facilities for delivering patients to community mental health facilities owned by a particular corporation. The facilities would then submit claims to Medicare for services that weren’t medically necessary, or weren’t provided at all.

The defendants charged in today’s takedown are accused of various fraud-related crimes, including conspiracy to defraud Medicare, criminal false claims, violations of the anti-kickback statutes, money laundering, and aggravated identify theft. Some of the cases include:

• Nine charged in Houston for $8 million in fraudulent Medicare claims for physical therapy, durable medical equipment, home health care, and chiropractor services.


• Five charged in Los Angeles for a scheme to defraud Medicare of more than $28 million by submitting false claims for durable medical equipment and home health care.


• Eleven charged in Chicago for conspiracies to defraud Medicare of $6 million related to false billing for home health care, diagnostic testing, and prescription drugs.

In addition to our involvement with HEAT and the Medicare Fraud Strike Force, the FBI remains committed to working additional health care fraud investigations with our partners at HHS-OIG, individual state Medicare fraud offices, and investigative units from major private insurance companies. We also work jointly with the Drug Enforcement Administration, the Food and Drug Administration, and the Department of Homeland Security to address drug diversion, Internet pharmacies, prescription drug abuse, and other health care fraud threats.

We’re currently working more than 2,600 pending health care fraud investigations. During fiscal year 2010, cooperative efforts with our law enforcement partners led to charges against approximately 930 individuals and convictions of almost 750 subjects. But perhaps even more satisfying—we dismantled dozens of criminal enterprises engaged in widespread health care fraud.

Explore Medical Billing & Coding Tips within your Practice

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     Medical billing is an occupation that requires knowledge of coding and techniques for billing. In the ever-changing world of health care, a billing specialist works hard to keep up with coding requirements and changes. The billing process begins before the patient comes into the office, with verification and pre-approval from her insurance company, and continues long after she is gone.

     
     
   
   
   
   

   Pre-Approval

   
   
   
   
   • When a patient sets up an appointment, it is important to get his payment or insurance information up front. If the patient is paying cash, it is unnecessary to do anything else, but if the patient has insurance, verification and pre-approval are important. This consists of calling the insurance company and requesting the patient's policy information, as well as asking if he requires any further authorization or a referral before he can be treated. In addition, the insurance company will tell you the amount of the co-pay or deductible the patient is required to pay during his visit.
   
   
   
   

   Coding

   
   
   
   
   • Correct coding and use of the Current Procedural Technology (CPT) codes that an insurance company uses to pay claims is important. If the correct code is not listed on the form, the insurance company will return the claim with no payment. This can delay payment because the form will have to be corrected and refiled as a "corrected claim." This slows down the billing process.
   
   
   
   

   Patient Billing

   
   
   
   
   • An insurance company and a physician may have an agreement for an accepted price on a procedure. After the insurance company pays and the physician takes the adjustment, a patient may be required to pay. If a procedure is not covered or the patient owes a balance after the insurance company pays its share, the balance is billed to the patient. Send a statement to the patient as soon as you receive payment from the insurance company. This allows the patient ample time to contact the billing department or insurance company with any questions she may have.
   
   
   
   

   Collections

   
   
   
   
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     If a patient fails to pay the amount due, the next step is collections. Collections involves working with the patient to set up payments or using other means such as a collection agency or wage garnishment to receive payment. Start by contacting the patient by telephone to make sure there is not a misunderstanding (i.e., the bill was lost in the mail). Offer to set up a payment plan to enable the patient to take care of the bill. If this doesn't work, send the patient a certified letter demanding payment. If you still have no response from the patient, you may turn the bill over to a collection agency.

     
     
   
   
   
   

Challenges in Medical Billing Industry

Do you know the reason that why Healthcare Providers face challenges with Medical Billing?

Here are some important reasons;

TIME CONSTRAINTS:

Day-to-day business operations at a practitioner's site represent a bustling and eventful array of healthcare services. But most medical offices are very limited on administrative time as their primary focus is healthcare operations. As such, a conversion to a new system will require a significant effort and expense for the practice, a move that they are reluctant to make.

BUDGET CONSTRAINTS:

As with any successful business, one of the keys is to keep overhead costs to a minimum and to extend the useful life of all capital assets. To process claims electronically, the practice will need to acquire additional software, perhaps additional hardware, and spend a large dollar amount for training on the conversion.

On-going costs are also high. Due to the high employee turnover in medical clinics, doctors constantly hire and train new staff. Maintaining a computer system means paying for constant annual upgrades, training and support contracts.

STRICT PROCESSING GUIDELINES:

Healthcare providers are required to adhere to strict processing guidelines established by insurance companies and government agencies. Failure to comply with these strict guidelines results in claims being rejected, which in turn has an adverse effect on cash flow. Healthcare providers seldom are willing to take this chance. Additionally, when they process claims, they are required to batch claims which may result in a delay in processing, thus forfeiting one of the key benefits of electronic claims processing.

LIMITED EXPOSURE TO THE BENEFITS OF ECP:

Most healthcare providers are familiar with electronic claims processing but are unsure how the process may impact them specifically. With limited exposure, they do not have the ability to recognize the tremendous potential in cost savings, efficiency and improved cash flow that electronic claims processing can provide.

MOST DOCTORS ARE NOT TRAINED FOR BUSINESS:

Healthcare providers spend 10-15 years in medical studies. Even while they are practicing medicine, they have to stay active in medical research and development. Most doctors are not experienced in running a business. They rely heavily on professionals to take care of their business.

Medical Insurance - Protection Against Sickness

Medical insurance is one of the first things that you should purchase as soon as you start earning. Your family's health is the most important for you and you may be ready to do anything to ensure that they are well protected. However, if you do not have adequate resources to secure yourself against any major medical expense in the future then there would not be much that you can do. Our health is the most important asset and for that reason it is necessary to do everything possible to assure good health throughout the life. With the costs of medical expenses hitting the roof, getting a policy that provides ample cover is the easiest and the most appropriate way of dealing with any medical emergencies in the future.

Insurance Can Allow You to Get the Best Medical Treatment

Those who do not have medical insurance and suddenly face an illness because of which they need medical treatment would soon realize how expensive medical services are. Those who do not have enough resources and are not financially strong will have to rely on low grade public health services where the lines are never ending and the quality of health care provided is low. If you want to get the best possible health care facilities and treatment then good doctors and well known hospitals would be the only choice. However, these can be immensely expensive. With the help of an insurance plan you would not have to think about the cost of treatment before the health of your family members.

Also, in many cases there may be a medical emergency. During such situations you would need immediate medical care and treatment and you would not have ample time to arrange for finances. A policy can ensure that you will have the necessary finances when you need them to take care of these expenses.

Protection Against Large and Small Ailments

Medical insurance will also provide you protection against ailments of all kinds, large and small. There may be a few policies that would not cover critical ailments. Normally, expenses that would be incurred for medication, personal visitation fees of doctors and hospital expenses would all be covered by the policy. There are also several different types of policies available today so that you can find something that suits your current needs perfectly. More people today are becoming aware about health issues and are eager to get the best possible facilities in medical treatment and care. The help provided by an insurance company can be very valuable at such times. Medical insurance can definitely provide you protection and the peace of mind that you need.

Medical Billing Companies Can Handle Billing Updates to Simplify Your Insurance Claims

Nowadays, documents are deemed very important. These documents may be just pieces of information scribbled in ordinary papers; but the value it carries can be equivalent to the value you have as a person and more so, as a citizen.

When you make transactions with just about any company most especially financial institutions, you are required to show a billing update. On the other hand, obtaining your insurance claims also requires your billing update. If for any reason, you fail to show proof of your billing update, then chances are you will never succeed in getting your insurance claims.

This does not only apply when you are processing your insurance claims. Remember that at your initial application, you were required by your chosen health insurance provider to present an update of some finance-related information. Failure to provide these updates would mean failure to be recognized as a member or failure to obtain insurance claims for already recognized members.

The American Hospital Association releases project reports with the goal of providing patient friendly billing updates and other financial communications to help patients. With this project, it would be easy for health systems and hospitals to report the patient's financial matters such as billing. These reports are not just patient -friendly but clear and concise as well.

The American Hospital Association also taps physicians and aids them in dealing with their patients by helping them generate patient friendly billing. Such reports also improve physicians' revenue-cycle management. This project provides convenience to the patients but to the hospitals and physicians, they need to have state of the art IT systems to make this possible.

Since health care providers and physicians do not have any understanding of how to get fast and efficient payment, the billing companies are capable of facilitating this need. These companies assist you in claiming insurance provided that you maintain proper billing updates.

What these medical billing companies do is submit insurance claims to insurance companies on behalf of the health care providers. But first, the health care provider visits the patient and suggests medication. The physician then updates the patient's medical record taking in to account the service provided.

Afterwards, medical billing companies analyze and relate the data using their database of numerical codes for insurance companies. They are the ones who'll bear the burden of processing the diagnoses and procedure codes. Overall, this is the process of generating patient friendly update for the patient's needs.

George Edmondson is an accomplished writer on medical billing updates, tips, and advice.

Pain Management post operative Anesthesia billing codes

Pain Management Consultation

Evaluation and management services for postoperative pain control on the day of surgery are considered part of the usual anesthetic services and are not separately reportable. When medically necessary and requested by the attending physician, hospital visits or consultative services are reportable by the anesthesiologist during the postoperative period. However, normal
postoperative pain management, including management of intravenous patient controlled analgesia, is considered part of the surgical global package and should not be separately reported.

Postoperative Pain Control Procedures

When provided principally for postoperative pain control, peripheral nerve injections and neuraxial (spinal, epidural) injections can be separately reported on the day of surgery using the appropriate CPT procedure with modifier -59 (Distinct Procedural Service) and 1 unit of service.

Examples of such procedures include:

62310-62319 Epidural or subarchnoid injections
64415-64416 Brachial plexus injection, single or continuous
64445-64448 Sciatic or femoral injections, single or continuous
64449 Lumbar plexus injections, continuous

These services should not be reported on the day of surgery if they constitute the surgical anesthetic technique.

NOTE: Modifier 59 requires that the medical record substantiate that the procedure or service was a distinct or separate services performed on the same day.

Daily Management of Continuous Pain Control Techniques

Daily hospital management of continuous epidural or subarachnoid drug administration is reported using CPT code 01996 (1 unit of service daily). This code may be reported on the first and subsequent postoperative days as medically necessary.

When continuous block codes 64416, 64446, 64448, or 64449 are reported on the day of surgery, no additional reporting of daily management is permitted during the following ten days (10 day global period). When these injections procedures constitute the main surgical anesthetic and are therefore not separately reported on the day of surgery, subsequent days’ hospital management is reported using the appropriate hospital visit code (99231-99233).

Coding Pain Management

Transforaminal epidural injection: 64479-64484
Transforaminal epidural injection is given at the nerve root in to the spidural space(64479-64484). The injection is passed through the foramen to reach the nerve root. These are unilateral codes and require 50 modifier for bilateral injections. The physician injects at the nerve root like L4 or between the vertebral interspaces like L4-L5.

Interlaminar injections: 62310-62311
Interlaminar injections are given in to epidiral or subarahnoid space through lamina without passing through the foramin. The injection goes directly into the lamina unlike previous one which has to go through foramen and then lamina. These are nonneurolytic injections for dianostic or therapeutic purposes inlcuding anesthetic, steroid, opoid or other substances. These injections also includes contrast if given.

Facet jont injections: 64422-64427
Code Range 64470-64472 is for injection of steroid and/or an anesthetic.
If any other type of substance is injected may be nondistructive or pulsed radiofrequency use 64999. Facet joint injection codes are unilateral and modifier 50 should be used for bilateral procedures. If a Neurolytic is injected for destruction, code range is 62280-62284.

Trigger point injection: 20550-20553
CPT codes 20552-20553 are reported only once per session. CPT code 20551 should be reported one time for multiple or single injections to a single tendon origin or tendon insertion performed. Injections to multiple tendon origins or tendon insertions are reported one time for each injection. For dry needling technique use unlisted procedure code 20999. Imaging guidance is reported sepertely like 77002 for fluoroscopic, 76942 for ultrasound, and 77021 for MR.

Tips for Modifiers use in an Ambulatory Surgery Center

Modifiers have had reporting relevance since the implementation of the Centers for Medicare & Medicaid Services (CMS) payment methodology for procedures performed in ambulatory surgery centers (ASCs), and hospital-based ASCs. On the basis of approval by the National Uniform Billing Committee, CMS instructed its Medicare fiscal intermediaries to accept those approved CPT (HCPCS Level I) and HCPCS (HCPCS Level II) modifiers applicable to outpatient reporting.

A modifier provides the means by which a reporting facility can indicate that the service or procedure represented by a specific code does not exactly meet the standards for that code. A procedural circumstance requires an alteration of the code’s meaning. The individual circumstance depicted by each modifier has reimbursement or tracking relevance to the carrier, and for payment to the provider. The use of the modifier enables the insurance carriers to appropriately pay for the procedure and any associated postoperative services performed within or subsequent to the global period (same day for ASCs). In addition, it allows the carrier to differentiate instances in which duplicate billing or duplicate services may have been reported.

The facility should apply the CMS-endorsed coding policy/instructions when outpatient services are billed, and these should apply to all payers, unless other carrier-specific directives have been received.