Ask A Medical Biller

Microsoft Office Training Videos

noreply@blogger.com (SLC - Utah) — Fri, 28 May 2010 15:51:00 +0000

These are the best Microsoft Office Training Packages. They are all completed by a Certified Microsoft Office Trainer who is certified in Microsoft Applications. Get these highly detailed training for you and your medical office.

Use Word to create Letters, Patient Documents, Templates, Fax Sheets, Mailing Labels, and patient forms.

Use Excel to manage Accounts Receivable, create graphs, track business numbers.

Use Powerpoint to create marketing materials and presentations for conferences, talks, and onsite visits. It's also a powerful tool for medical billing services that are presenting their services and skills to new clients.

Professional Liability Errors and Omissions Insurance for Medical Billing Services

noreply@blogger.com (SLC - Utah) — Wed, 06 May 2009 15:52:00 +0000

Do medical billing services, individual medical billers and certified coders require Professional Liability Errors and Omissions Insurance coverage to perform their job duties?

Professional Liability Errors and Omissions Insurance coverage helps to protect your business or company services from claims submitted by your clients.

Let's say you are a medical billing service and the doctor sends you $120,000 worth of Aetna medical claims. You are required to bill a clean CMS 1500 claim to Aetna within 90 days from the date of service (per doctors contract with Aetna) and you have issues getting a clean CMS 1500 medical claim sent through the electronic medical claim clearinghouse software. Your medical billing staff didn't realize they could drop the claims to a CMS 1500 form and bill it by paper so the claims sit their denied at the medical claim clearinghouse, waiting for someone to fix the issue.

95 days later you finally get the medical claim clearinghouse working and all CMS 1500 electronic claims are submitted to the carrier and denied for untimely filing. Your billing service can't appeal (although it doesn't hurt to try) because you can't prove you sent Aetna Health Insurance a clean CMS 1500 medical claim in the timely filing period.

Now let's say the doctor was expecting to collect about $73,000.00 from Aetna on the $120,000 worth of medical claims. The doctor is mad when he finds out that he just lost $73,000.00 in business and decides to sue you for this loss.

The Professional Liability Errors and Omissions Insurance Coverage can potentially protect you from most of these fees including court, attorney and lawsuit settlement fees.

Does a Medical Billing Service require Professional Liability Errors and Omissions Insurance - no but would it help out to cover the costs of protecting your business in the case of being sued by a doctor? Yes.

Who needs Professional Liability Errors and Omission Insurance in the medical industry? Anyone who performs "services" to a client. Services can be anything from billing, coding, doing work in a "timely" matter.

General Liability Insurance does not protect your business for errors, contract performance disputes, or any other professional liability issues which is why they have Error and Omission insurance.

Other Medical Insurance Policies

Medical Malpractice & Medical Liability Insurance covers providers and other professionals in the medical industry for liability claims arising from their treatment of patients. Pricing varies by the rendering providers specialty, location and state.
Some states do not require providers to have Medical Malpractice Insurance although most doctors do have Medical Malpractice Insurance.

Employment Practices Liability Insurance or EPLI insurance is insurance policies to protect employers from employees, former employees or "potential" employees. If employees feel discriminated against for their age, sex, race, disabilities, sexual harassment or wrongful termination you may find the need for EPLI insurance.

Keywords: Medical Billing Insurance, Certified Coders insurance, Insurance polices for medical offices, insurance policies for medical billing services, when to buy, do I need to buy, purchase, insurance policies, medical industry, medical billing companies, corporations, businesses, employed, employer, small businesses, health care, providers, doctors, nurses, assistants, biller, collector, collecting, collections, doctor error, erroneous,

How does a Medical Office gain insight into what their Medical Billing Service is doing with Medical Claims?

noreply@blogger.com (SLC - Utah) — Mon, 16 Feb 2009 18:39:00 +0000

A medical office is outsourcing their claim billing to a medical billing service. The medical office has no transparency into what is happening with their medical claims and they were asking me what steps they should take to gain access to the billing services electronic medical claim clearinghouse Office Ally.

The Medical Office's concerns are the lack of insight into all electronic claims, which claims are getting submitted, are any kicking out, if they are getting claim denials what are the reasons, how often is the medical billing service actually billing their medical claims, and what percentage of claims are getting passed on to the health insurance carrier? Because of these concerns they want access to the electronic claims clearinghouse.

Let's first review how the medical claims clearinghouse Office Ally works?

All data is entered into the Practice Management/Billing Software

A claim file is generated

The claim file is downloaded to the desktop

The user logs into Office Ally
The user uploads the claim file from the desktop into Office Ally Clearinghouse Software
The user submits these claims electronically through Office Ally after it passes through certain claim edits
Any denied claims will be received in a report format, the medical billing service should be fixing the issues in both the claim clearinghouse software and in their Practice Management Software
The medical billing service should be permanently deleting the Claim File from their desktop to remain HIPAA compliant

If the medical billing service has the contract with Office Ally Clearinghouse and you are the medical office contacting them to gain access they will most likely forward you on to your medical billing service to get a user name/password. Office Ally Medical Claim Clearinghouses contract is with the billing service and not you.

If you are not on speaking terms with your medical billing service or you would rather they not know you are trying to log into Office Ally Clearinghouse than you will need to work this through another angle.

Your other option and one that you have more control over if you cannot get a user name and password into Office Ally's Clearinghouse.

The doctor has access to setting up user names/passwords with all health insurance carriers they are contracted with including BCBS, Cigna, Aetna, UHC, Humana and many more. This is the same place that you might use to check patient eligibility online but instead of clicking on the eligibility click on the claim status section.

Side Note: If the billing service has registered the doctors on these websites you will need to ask them to give you user names/passwords to access. If they ask why you need access (and they shouldn't but if they do) explain the doctor would like to monitor new coding updates, releases, fee schedules and that the front office needs access to check patients eligibility and pre-authorizations. Notify the billing service that you would like them to keep you updated with the most current user names/passwords for each health insurance carrier.

How to use your Health Insurance Carriers websites to track what your billing service is doing?

Use the online claim status screens to track your patients and identify how long it takes from the time you give the claims, medical records information to your billing service until it gets accepted by your health insurance carrier. Plus you can check for denials etc. If the patients claims are not on file with the health insurance carrier than it means that the billing service is having issues submitting claims through Office Ally (they are kicked out because information is being sent incorrectly so they do not send on to the Health Insurance Carrier).

For a list of additional Articles I have written please check out this website and scroll down until you get to the Electronic Medical Billing Clearinghouses section.

Medical Billing and Coding Keyword Tags: medical billings and claims, medical billings claims, medical claims electronic billing, claim billing software, electronic medical claim billing, medical billing software, web based medical billing, electronic medical billing, electronic medical billing software, medical billing education, medical insurance billing software, medical billing and coding course, medical billing software company, learn medical billing, insurance billing software, medical billing and coding software, medical billing class, medical billing and coding online, medical billing systems, medical billing system, electronic medical claim billing, chiropractic practice management software, medical practice management system, medical practice management software, medical practice management services, practice management software, medical billing practice, Aetna Health, health insurance, Auto insurance, Commercial Insurance Quote, lytec medical, lytec, chiropractic software, web based medical billing software, medical billing software,

Medicaid of Illinois is requiring doctors to register NPI numbers

noreply@blogger.com (SLC - Utah) — Fri, 16 Jan 2009 16:05:00 +0000

Medicaid of Illinois Health Insurance currently requires providers to report a one digit payee code in the Billing or Pay-To-Provider Loops. This one digit payee code designates the appropriate Pay-To-Provider.

Illinois Medicaid is now requiring medical providers to register their NPI numbers associated with their designated Payee ID's. They will soon be transferring their software to accept the NPI number in lieu of the 1 digit payee code.

If you are a medical provider and bill to Medicaid of Illinois Health Insurance you should immediately register your NPI number for each designated payee number. You can register the NPI number at either website:

myhfs.illinois.gov
illinoisnpi.com

After the NPI information is registered with the HFS, the Payee NPI can be reported in the 837 (electronic medical claims) and DDE transactions. Also, after the NPI number has been registered you can start billing your medical claims using the NPI number and the 1 digit Payee ID will no longer be required.

The deadline for registering and using the NPI number is March 1, 2009. Any claims submitted electronically not using the NPI number will be rejected.

Register now to prepare for these changes by March 1, 2009.

Medical Billing and Coding Tags: Medical Health Insurance, Medicaid of Illinois Health Insurance, Medicaid NPI updates, Medicaid Payee one digit updates, New change over, New Medicaid of Illinois deadlines, Electronic Claim Denials for invaid NPI number, update, switch over, electronic

Oregon Medicaid MMIS Updates on Claim and ERA issues

noreply@blogger.com (SLC - Utah) — Fri, 16 Jan 2009 15:54:00 +0000

Oregon Medicaid Health Insurance was recently converted to a new MMIS system and the bugs have already started to reveal themselves. Oregon Medicaid Health Insurance has identified issues with the Electronic Remittance Advice and some claim processing issues.

Some medical offices and hospitals are experiencing problems with inconsistent denial codes, medical claims dropping out of the system, missing electronic remittance advice and problems with weekly electronic funds transfers.

The transition to the new MMIS system happened in Mid-December. If this is happening to you please be aware that Medicaid is aware of most problems and are working to resolve these issues. If you feel your issue is new please contact Medicaid and notify them of the problem.

Medical Tags: Clearinghouse, Medicaid of Oregon, Health insurance claims billing issues, Electronic Remittance Advice issues, medical claims billing and coding issues

Will United States of America ever get Universal Health Care?

noreply@blogger.com (SLC - Utah) — Fri, 09 Jan 2009 22:35:00 +0000

Universal Health Care is how the government likes to describe a Socialist environment where all Americans would get FREE Health care including illegal aliens. (Oh I forgot Illegal Aliens already get free health care).

The media loves the concept of Free Health Care and anytime a democrat talks about free health care they rave and talk it up in hopes to gain favor amongst the Americans. However States have tried this on several attempts and not one has ever worked (TennCare (bankrupted hospitals, doctor practices and the state of Tennessee, Hillary Clintons Single-Payer plan (pilot was TennCare), Hawaii Universal Health Care for all children lasted 7 months due to unsufficient funds, San Francisco Medicare for All program was voted down even by democrats because they knew it would bankrupt the City). It's mainly the democrats who attempt to push this jargon on the Amercians with the dream of getting free health insurance. What they don't tell you is that since the government would own the doctors they would also own the right of who got to see them.

Of course something else the democrats don't tell you is that the government can't actually afford to pay the doctors equal or more of what they are currently earning so the middle tier and BEST doctors will leave their practice and do something else.

I found this hilarious You Tube video about what the world would look like if America were to socialize the medical industry. All I can say is thank goodness for Google.

If the video didn't make it clear to you try thinking back to your days at Public High School. How many teachers did you feel were actually qualified to cross-teach you. And of those teachers how many did you actually like listening to. Now think about this with doctors. How many doctors on Government Pay Scales do you think will be good at their jobs?

Let me know what you think about Socializing Health Care or I mean Universal Health Care. As a medical biller how do you think this would affect your job? Do you think you would even have a job as a biller if the government ran the medical industry?

Medical Tags: Socializing Health Care, Doctors, Providers, Physicians, Universal Health Care, Single Payer, Mandated Insurance, Hospitals, Health Care Insurance,

Utah Health Information Network (UHIN) to raise electronic fees

noreply@blogger.com (SLC - Utah) — Wed, 24 Dec 2008 01:41:00 +0000

If you are a medical billing service or are a medical provider in the state of Utah and you are credentialed with UHIN (Utah Health Information Network) please be advised that they are raising their per transaction surcharge from $0.12 to $0.168 effective January 1, 2009.

If you submit claims using RelayHealth please be aware that they will pass this fee onto the providers as it is currently in place at this time.

The health insurance carriers that this affects:

CPID 1536 Altius Health Plan
CPID 4726 Altius Health Plan
CPID 4728 Deseret Mutual Benefits Association
CPID 4410 Educators's Mutual Insurance Association
CPID 4480 SelectHealth
CPID 4727 Public Employee Health Program (PEHP)
CPID 1529 Utah Blue Cross
CPID 1530 Utah Blue Cross FEP
CPID 2412 Utah Blue Shield
CPID 2788 Utah Blue Shield FEP
CPID 1486 Utah Medicaid
Please be aware of these changes when you are looking at your 2009 invoices.

Medical Billing Tags: medical billing claims, claim coding, health insurance carriers, medical claims processing, medical claims clearinghouse, medical claim billing and coding, medical billing and coding, new updates, Electronic modifications, new changes to electronic claims submission, aware of New Years updates

Aetna Health Insurance Electronic Remittance Advice Updates

noreply@blogger.com (SLC - Utah) — Wed, 24 Dec 2008 00:42:00 +0000

For all medical offices that bill to Aetna Health Insurance please be aware of their new announcement regarding electronic remittance advice.

Starting March 30, 2009 Aetna will not send Electronic Remittance Advice (ERA's) to providers subject to the National Provider Identifier regulations when

1. A billing provider NPI is not sent on the claim and

2. we have not been notified of a specific override NPI to use on ERA's and

3. the payee does not have a default NPI recorded in Aetna's health insurance providers records

If Aetna Health Insurance does not have a NPI or they adjudicate or reprocess a claim that was submitted without a Billing Provider NPI you will receive the explanation of benefits by paper.

At this time your medical office or billing service maybe submitting medical claims without submitting the NPI number. Right now Aetna health insurance will send your Explanation of Benefits using the Electronic Remittance Advice if it is currently enabled. But on March 30, 2009 those same medical claims will no longer be eligible for electronic remittance advice until you submit the Billing Provider NPI.

If you would like to ask Aetna Health Insurance to continue to receive the payee NPI loaded in to the Aetna Health Insurance system you may send Aetna a email request to their dedicated mailbox aetnanpiera@aetna.com.

Aetna health insurance will be looking for NPI's at the Payee ID source, Group ID source and/or the Rendering Provider ID Source.

The TIN and provider business group (PBG) will always be sent to identify the taxpayer ID that will be used for IRS reporting and the provider business area handling remittances for the claim.

If you have access to Aetna Health Insurance's Secure Provider Website you can access the NPI's assigned to your provider if you have registered for the ERA/EFT feature.

Please be aware of these new updates and confirm that you are submitting the NPI numbers now so you will not see a issue with your Explanation of Benefits. Waiting on paper EOB's can become extra work for any billing department when identifying paid/unpaid claims and the status of such.

For those who bill using RelayHealth: Aetna Health Insurance CPID#'s are 4500 and 6400. If you are new to billing or are interested in learning more about medical claims reports please visit: Medical Claims Clearinghouse Reports

Medical Billing Tags: medical claims clearinghouse, electronic medical claims clearinghouse, medical billing and coding, new ERA updates, new changes, reviews, reporting, Health Insurances, medical billing, medical billing, claims coding and billing, medical claims, claim submission, claim billing, healthy medical claims, clean claims submission, faster payments on insurance claims, health insurance billing and coding

Oregon Medicaid MMIS Updates

noreply@blogger.com (SLC - Utah) — Tue, 23 Dec 2008 17:15:00 +0000

On December 11, 2008 RelayHealth, a medical claims clearinghouse, began submitting electronic claims to Oregon Medicaid Health Insurance Carrier (CPID#1481 and 5517).

RelayHealth, a medical claims clearinghouse, is adding new claim edits that you should be aware of if you bill to Oregon Medicaid Health Insurance.

The following apply for Professional CPID 1481:

Professional claims are CMS-1500 formatted claims to indicate the providers services:
HU 0019C:INVALID BILLING PROVIDER ID QUAL - IN LOOP 2010AA, NM108 MUST BE SENT AND MUST BE EQUAL TO XX
HU 0022C:INVALID CLAIM REND PRV ID QUAL - IN LOOP 2310B(PROF)/2310C(INST), NM108 MUST BE SENT AND MUST BE EQUAL TO XX
HU 0028D:INVALID SRV LINE REND PRV ID QUAL - IN LOOP 2420A(PROF)/2420C(INST), NM108 MUST BE SENT AND MUST BE EQUAL TO XX
HU 0031D:INVALID SRV LINE SUP PROV ID QUAL - IN LOOP 2420D(PROF), WHEN NM108 IS SENT IT MUST BE EQUAL TO XX
HU 0043C:INVALID CLAIM REF PROV ID QUAL - IN LOOP 2310A(PROF) NM108 MUST BE SENT & MUST BE EQUAL TO XX

The following apply for Institutional CPID 5517:

Institutional Claims are UB-04 and indicate facility charges
HU 0019C:INVALID BILLING PROVIDER ID QUAL - IN LOOP 2010AA, NM108 MUST BE SENT AND MUST BE EQUAL TO XX
HU 0020C:INVALID PAY-TO PROVIDER ID QUAL - WHEN LOOP 2010AB IS SENT, NM108 MUST BE SENT AND MUST BE EQUAL TO XX
HU 0022C:INVALID CLAIM REND PRV ID QUAL - INVALID CLAIM REND PRV ID QUAL: IN LOOP 2310B(PROF)/2310C(INST), NM108 MUST BE SENT AND MUST BE EQUAL TO XX
HU 0024C:INVALID CLAIM SRV FAC ID QUAL - IN LOOP 2310D(PROF)/2310E(INST), WHEN NM108 IS SENT IT MUST BE EQUAL TO XX
HU 0026C:INVALID CLAIM ATTEND PHY ID QUAL - IN LOOP 2310A(INST), NM108 MUST BE EQUAL TO XX
HU 0027C:INVALID CLAIM OPERATE PHY ID QUAL - IN LOOP 2310B(INST), NM108 MUST BE EQUAL TO XX
HU 0034C:INVALID SRV LINE ATTND PHY ID QUAL - IN LOOP 2420A(INST), NM108 MUST BE EQUAL TO XX

Please be aware of the NPI updates when billing electronic medical claims.

Want to read additional information on Medical Claims Clearinghouse?

Medical Billing Tags: Electronic Medical Claims, Medical Claims billing, billing electronic claims, electronic claim submission, medical claims clearinghouse, electronic claims clearinghouse, how to bill claims electronically, why bill claims electronically, supporting electronic claims, asking, ask, transmit, rebill, bill, excluded, denied, denials, exclusions, denial edits, how to fix, how to work, how to bill electronic claims through a clearinghouse,

Harrington Benefit Services of OK new claims processing center

noreply@blogger.com (SLC - Utah) — Tue, 23 Dec 2008 16:55:00 +0000

the Medical Claims Processing for Health Choice, Department of Rehab Services (DRS) and the Department of Corrections (DOC) providers are being transitioned over to a new medical claims processor effective January 1, 2009.

If you are a medical provider and you are currently submitting electronic claims to your medical claims clearinghouse please be aware of the new payor ID 22521.

Payor ID# 59142 has been deleted as of December 23, 2008 which correlates to RelayHealth's medical claims clearinghouse CPID#'s:
CPID# 1751 Harrington Benefit Services of Oklahoma Professional CMS-1500 Claims CPID# 2554 Harrington Benefit Services of Oklahoma Institutional UB-04 claims

If you use RelayHealth as your medical claims clearinghouse has not identified the new CPID# that they will use to accept electronic medical claims. They are asking that medical providers hold their medical health insurance claims until the new payor ID is created.

Another reminder is that Health Choice providers will need to send their medical practice location in loop 2010AA REF01 with the LU qualifier. The practice location code is a 6 digit code which is assigned by the HealthChoice Provider Relations Division and they can be called at 800-543-6044.

Read more articles on Medical billing and Coding

Medical Billing Tags: Harrington Benefit Services of OK, medical claims clearinghouse, medical claims processing, medical billing, medical health insurance claims, claim billing, medical coding and billing, asking, ask, choosing, selecting, using, billing, health care, health insurance, processing, producing, electronic claims billing, electronic health,

RelayHealth Medical Claims Clearinghouse has Report Update

noreply@blogger.com (SLC - Utah) — Tue, 23 Dec 2008 16:25:00 +0000

RelayHealth a Medical Claims Clearinghouse has announced that on January 8 2008 they will be modifying the way you look at their medical claims clearinghouse reports.

Health Insurance Carriers return two reports to RelayHealth, medical claims clearinghouse. One report is the Print Image File also known as Availity Electronic Batch Report and the second report is the Data File or Availity Data File. Both of these reports contain duplicate data but the report formats are different.

RelayHealth is trying to streamline the data the their clients get so on January 8th 2008 they will no longer be parsing the Data File (Availity Data File) to clients.

You will still have access to the Payor Claim Data Report (SR), Payor Claim Rejections Report (SE), and Payor Report Data File (SF).

These changes will affect health insurance carriers like:
CPID 1403 Oklahoma Blue Shield
CPID 1405 Illinois Blue Shield
CPID 1406 Texas Blue Shield
CPID 1414 Florida Blue Shield
CPID 1514 Oklahoma Blue Cross
CPID 1563 Illinois Medicaid
CPID 1997 Washington Regence Blue Cross
CPID 2404 Oregon Blue Shield
CPID 2440 Ohio Choicecare HMO
CPID 2449 Humana
CPID 2488 Illinois Medicaid
CPID 3417 Florida Healthy Options HMO
CPID 3517 Florida Blue Cross
CPID 3540 Idaho Blue Shield Regence
CPID 3561 Florida Health Options
CPID 3890 Humana Encounters
CPID 4544 Humana
CPID 5501 Texas Blue Cross
CPID 5508 Illinois Blue Cross
CPID 5516 Oregon Blue Cross
CPID 5565 New Mexico Blue Cross
CPID 7403 New Mexico Blue Shield
CPID 7426 Idaho Blue Shield Regence
CPID 7451 Washington Regence Blue Shield
and more...

If you use RelayHealth as your electronic medical claims clearinghouse please be aware of these new changes. Tell the medical billers in your office that on January 8 2008 the Data File report will no longer be available for the majority of health insurance carriers but since this report contained duplicate content you should just notice less reports to have to sort through.

Happy Billing!

Read here for additional medical claims exclusion articles Medical Claims Clearinghouse

Medical Billing Tags: Medical claims clearinghouse processing center, medical claims processing, electronic medical claims, medical billing and claims, billing and coding, medical claims clearinghouse updates, reports, news, features, help, what's new, what to expect, changes in the industry, features, health insurance carriers, medical claims,

CDPHP Health Insurance Carrier offers new claim exclusion reasons

noreply@blogger.com (SLC - Utah) — Tue, 23 Dec 2008 16:06:00 +0000

As of December 19th 2008 RelayHealth a medical claims clearinghouse facility will be implementing new claim exclusion edits for CPID#'s 3786 and 2987 because the NPI is now required from the health insurance carrier.

CAPITAL DISTRICT PHYSICIANS HEALTH PLAN (CDPHP)

The following payor edits are for institutional or UB-92 / UB04 facility billing

CPID 2987 - CDPHP:
HU:0019C:

INVALID BILLING PROVIDER ID QUAL - IN LOOP 2010AA, NM108 MUST BE SENT AND MUST BE EQUAL TO XX
HU0020C:

INVALID PAY-TO PROVIDER NPI - IN LOOP 2010AB, NM108 MUST BE SENT AND MUST BE EQUAL TO XX
HU0026C:

INVALID CLAIM ATTENDING PHY NPI - IN LOOP 2310A(INST), NM108 MUST BE SENT AND MUST BE EQUAL TO XX

The following payor edits are for professional CPID 3786 or CMS-1500 provider services CDPHP:
HU:0019C:

INVALID BILLING PROVIDER ID QUAL - IN LOOP 2010AA, NM108 MUST BE SENT AND MUST BE EQUAL TO XX
HU0020C:

INVALID PAY-TO PROVIDER NPI - IN LOOP 2010AB, NM108 MUST BE SENT AND MUST BE EQUAL TO XX
HU0022C:

INVALID CLAIM RENDERING PROVIDER NPI - IN LOOP 2310B(PROF), NM108 MUST BE SENT AND MUST BE EQUAL TO XX
HU0021C:

IN LOOP 2310A(PROF), WHEN NM108 IS SENT IT MUST BE EQUAL TO 'XX'

To fix if you get any of these medical claim exclusions is to add the correct NPI number in the appropriate field before submitting medical claims electronically.

To read additional posts on medical billing please see: Asking a Medical Biller

Medical Billing Tags: asking, ask, search, medical billing and coding questions, how to get electronic claims submitted, medical billings, billing and coding, NPI required, how to fix exclusions, edits, medical claims denials, medical claims billing, health care industry, health care insurance, medical claims, health insurance claims, health insurance billing, electronic claim submission, electronic claim denials, electronic claim how to fix, electronic claim how to bill correctly, billing industry, billing help, tips, tricks, ideas, suggestions, identify, educate, simplify,

How to use Medicare Part B Electronic Data Interchange (EDI) Hotline

noreply@blogger.com (SLC - Utah) — Sat, 13 Dec 2008 22:40:00 +0000

A few years ago Medicare Health Insurance began requesting medical offices to submit all Medicare Health Insurance claims electronically to save processing costs. In order to handle the connection of software products to Medicare they created a department called the Electronic Data Interchange or EDI.

The EDI department has the right to kick out a claim before it comes through their claim processing system. If a medical claim is kicked out at the EDI level it is like the insurance carrier never received the medical claim in the first place.

If you have issues where you are sending Medicare Health Insurance claims and they are not appearing in the IVR or in the support line it means one of two things:

1. Your clearinghouse kicked out the claim for issues
2. The Medicare EDI department kicked out the claim for issues

I would first recommend viewing your EDI reports for the patient that Medicare Support was not able to find on file. Now that you have the report read the exclusion reason...

If you don't understand the denial reason you have 3 different options depending on how you are submitting the claim:

1. If you use a Practice Management software that is integrated with the medical claims clearinghouse you might want to contact them first to see how to resolve the issue.
2. If you use a Practice Management Software that is not integrated with the medical claims clearinghouse and you can contact your medical claims clearinghouse do so now. Ask them to pull the file and see why they can identify the claim is getting kicked out.
3. If you have a direct connection with Medicare Health Insurance follow the EDI Hotline Rules

To make a phone call to the EDI Hotline please have this information handy:
1. Submitter ID number. It can also be called Sender ID, User ID and/or Billing Location Code for providers sending to Medicare Health Insurance through Blue Cross of Michigan.

2. NPI number (National Provider Identifier) and can be found in the NPPES directory

3. Date you submitted the claim

4. Processed Date if report states "deleted"

Do not call Medicare's EDI Hotline until you have prepared all of this information. They are usually very nice in the EDI department but they are in a hurry so they need this information quickly.

EDI Hotline for Medicare Part Health Insurance Carriers: 877-567-7261

To read more about Medicare updates including Billing Health Insurance Information check out Medicare Medical Coding and Billing Courses

Medical Billing Insurance Tags: Medicare Health Insurance, Health Insurance Claims processing, Medical Claims Billing, Medical Health Insurance Claims, Electronic Claim Submission, EDI Hotline for Medicare Part B, How to fix denials for Medicare, Deleted Files on EDI Reports, How to work EDI Denial Reports, EDI Denial options, Medical Billing, Medical Billing and Coding, Medical Coding,

Sagamore Health Network moves to new location

noreply@blogger.com (SLC - Utah) — Sat, 13 Dec 2008 22:29:00 +0000

RelayHealth was updated with a new physical address for Sagamore Health Network.

The new location is:
Sagamore Health Network
11595 North Meridian Street
Ste #600
Carmel, IN 46032
800-933-3466

Sagamore Health Network will have the servers down during this transition and will not be able to process electronic claims during Friday December 12th 2008 - Monday December 15th 2008. RelayHealth will submit files to Sagamore Health Network up to December 11th 2008 and resubmit to Sagamore on December 15th 2008 after 8:00 am ET.

Clients do not need to stop submitting claims to RelayHealth as RelayHealth will just hold the Sagamore claims and process them the next week to Sagamore. Please be aware of the delay for claims submission and claims reporting.

Also please update your records with the new physical location.

Medical Billing Tags: Indiana, Sagamore Health Network, Medical Billing, Medical Billing and Collections, Medical billings, Medical Health Insurance claim filling,

Present on Admission (POA) for Institutional Medical Claims (UB-04)

noreply@blogger.com (SLC - Utah) — Sat, 13 Dec 2008 22:18:00 +0000

Starting December 30, 2008 RelayHealth medical claims clearinghouse will print the Present on Admission (POA) indicator for institutional paper claims that are submitted through RelayHealth (electronic file sent to RelayHealth and RelayHealth drops claim to paper).

CMS was the first to require the POA but RelayHealth wants to open this up and make it available for institutional medical claims to submit these to other insurance carriers as needed.

When dropping Institutional Claims to Paper through RelayHealth please use these CPID#'s:
4350 ~ Commercial
4352 ~ Medicaid
4353 ~ Blue Shield
4354 ~ Commercial Carrier Direct
Reporting Options to indicate POA (Present on Admission)
Y = Yes, was present at the time of inpatient admission
N = No, was not present at the time of inpatient admission
U = Unknown, documentation is insufficient to determine if condition is present on admission
W = Clinically undetermined provider is unable to clinically determine whether condition was present on admission or not
Unreported/Not used (exempt from POA reporting)

Medical Billing Tag Words: Medical Billing Health Insurance Claims, Medical Billing Hospital Facilities, Medical billing and Coding, Medical Billing and Collections, Coding, Reporting, Present on Admission, POA, ICD-9 codes, when to use POA, updates to POA

Ask a Medical Biller Index

noreply@blogger.com (SLC - Utah) — Mon, 08 Dec 2008 20:54:00 +0000

Sometimes accessing blog articles can be difficult for the user. I am creating a Master Page or SiteMap for ease of navigating to over 258 articles in specific categories.

You are visiting this Website URL: http://www.askamedicalbiller.blogspot.com/

These are additional blog posts that you can read while on Ask A Medical Biller.

Medical Billing and Coding Courses Information

Telehealth Online Medical Billing and Coding Courses
Present on Admission for medical claims clearinghouse
Medical Billing and Coding for Evaluation and Management
Ophthalmology medical billing
Modifier Billing
Anesthesia Medical Billing and Coding
Electronic Medical Claims Secondary
Medical Billing Coding for Allergies and Sinuses
Medical Billing Taxonomy Code text
Wisconsin Physician Service Website update
Medical Billing Place of Service
Electronic Medical Billing for Claim Adjustment Reason Codes
Medical Claim Billing with Patient Information
Electronic Claim Clearinghouse RelayHealth
Billing for Group Practices
CMS 1500 Medical Billing Claims
Medical Providers NPI Validation
Referring Providers NPI validation test
Claim Billing for Providers without a NPI
Medical Billing for CLIA waived Tests
Flu Shots
2008 deleted Procedure Codes for Medical Coding
Medical Coding updates of 2008 deleted Procedure Codes
Medical Billing and Coding Tips
Billing Medical Claims with Procedure Code 99354
Pediatrician Medical Billing
Aetna Health Care Insurance Medical Claims Billing
Aetna Health Care Insurance Dermabrasion Medical Billing
Think Green when Medical Billing and Coding
Medicaid Requires NPI
Health Alliance Medicaid and NPI updates
Electronic Claim Billing Oklahoma BCBS claim Exclusions
Maryland Medicaid and NPI updates for Medical Billing
Electronic Claim Billing Exclusions for missing NPI issues
Louisiana Medicaid NPI updates for Medical Billing
Missouri Medicaid NPI updates for Medical Billing
Electronic Certificate of Medical Necessity Forms for Medical Billing
Certified Medical Coding Trainer
Billing Medical Claims J0725 to Aetna Health Insurance
MediCal Modifier Update for Medical Billing Claims
Health and Human Services releases info on ICD-10
How to send a patient to outside collection agency
Billing 90669 and 90471 including screenshots of claim coding software
Aetna Health Insurance Medical Billing Claims Update on Attachments
Information on SCCIPA

Medicare Billing and Coding Course Information
Medicare Electronic Data Interchange Hotline
Proper Billing Steps when Medicare is the Secondary Insurance Carrier
How to resolve Overpayment issues with Medicare correctly
Waived CLIA Tests for Medicare
Resolve Podiatry Medical Billing Claim Issues
When Medicare can withhold the doctor’s insurance payment
Payment fees for Laboratory Travel Codes
2009 Medical Billing and Coding books available for purchase
Doctors can’t appeal Medicare Allowable Fee Schedules
Crossover Explanation of Benefits sent with incorrect rejections
Proper steps for emailing Medicare Health Insurance
How to Refund Medicare Health Insurance
Medicare Payments may look small
Electronic Claims Medicare Secondary Billing
Medical Billing and Coding using GA Modifiers
Medicare Secondary Payer MSP billing and coding situations
Electronic Claim Remittance Advice Remark Codes
Medicare Electronic Claims Crossover
MSP for Billing Medical CMS-1500 Claims
Medicare Remittance Advice Remark Codes Crosswalk
Submitting Electronic Claims as Secondary
Medicare Provider Bonus
Medicare Bonus Registration
Physician Quality Reporting Initiative PQRI
Medicare Billing for Smoking Cessation
Medical Billing Insurance Phone Calls with Medicare - IVR
Understanding the PTAN number
What Medicare IVR is
Checking Claim Status through IVR
IVR phone numbers by State
IVR Medicare Tip

Top 10 Medical Billing Calls to Medicare
Medicare Provider Enrollment Telephone Numbers
Electronic Medicare Claims for Secondary Payers
Electronic Claim Payment Reason Codes
NPI Medicare Website
Medical Billing NPI Registry
NPI Registration Questions
National Plan and Provider Enumeration System
Medicare Billing and Clearinghouses
Medicare PTAN
Medicare Billing and Coding Training Software
Medicare Training Courses
Medicare Claim Billing Rules for No Shows or Missed Visits
Deleted Electronic Claims Billing Issues
Medicare Electronic Claim Denial M codes
Medicare Electronic Claims Billing using CR modifier
Cardiovascular screen Blood Tests text
Medicare Electronic Claims require NPI
NPI required when Billing Medicare Electronic Claims
Register or Update NPI for Medical Billing Providers
Medicare Medical Claim exclusion H21084
Durable Medical Equipment Billing
Medicare Illinois Locality Fees
Q4097 Injection Code
Medicare ABN form updated
How to Call Medicare steps
Medical Billing Claims use of Modifier 59
Medical Billing for Active Duty in Armed Forces
National Drug Codes Claim Billing
Billing Medical Claims for Nursing Facility Service
Supporting Documentation for Medical Billing Claims
Diagnostic Laboratory Medical Billing
Medical Billing and Coding for Prolonged services
How to bill Paper Medical Claims to Medicare
Medical Billing Secondary Insurance Claim Denials
Medicare Holidays
Medicare NPI
Medicare Refund Forms Updated
Inpatient Hospital Medical Billing for Payment
Out of Country Address on Medical Claims
Medicare Medical Claim Billing for HCT or HGB values
Medicare NPI Exclusion Edits for Medical Billing and Coding
Phone Call Preparation
Highmark Medicare Services Website

Medical Billing Software
Microsoft Computer Training
Microsoft Office Online Training Videos
Medical Billing Software
Medical Billing Scanners
Medisoft Billing Software Data Export
Medical Claims Billing Software CollaborateMD
Medical Billing Software with NPI issues
Microsoft Office Training Videos
Customized Training Videos for your internal staff
Patient Eligibility Searches for Medical Billing Software
Online Eligibility for Medical Billing software

Electronic Medical Billing Clearinghouses
How to track what a Billing Service is doing through the Clearinghouse
How to identify what Clearinghouse to use Example
How to read RelayHealth Clearinghouse Payor Claim Data Reports
Save money by sending medical billing claims electronically
Claim Denials because of Medical Billing Clearinghouses
Medical Billing Clearinghouse Claim Status Reports
Electronic Billing Clearinghouse Reports Simplified

RelayHealth Clearinghouse Claim Billing, Edits, Exclusions, and Updates

Mississippi Medicaid to stop accepting Secondary Medical Billing Claims
Medical Billing Claim Edits for NDC
anchor text
New Medical Claim Exclusions for CDPHP
Medical Claims Clearinghouse Reports
Managed Care of Memphis Medical Billing Claims alert
Medicare Electronic Claim of 4 states reporting issues
RelayHealth Electronic Claims to Paper using Wrong CPID format
Medical Health Insurance Carriers Address Information
Direct connection with Gateway Health Insurance
Blue Medicare PPO how to fix Exclusions
New Jersey Medicare using Highmark Medicare Services for Electronic Claims Billing
Kaiser of Georgia has new Report updates
Electronic Claim Billing Exclusion Edit: F1 0001C and how to fix
Mcare Medical Health Insurance can be billed through Blue Care Network HMO
Medical Claim Exclusions for invalid zip code
Another Insurance Carrier can’t accept electronic secondary claims
Aetna Health Insurance requesting Secondary Claims to come electronically
Electronic Claim Exclusion PA the Claim Adjudication Date
RelayHealth Terminated Insurance Carriers Update
Medicaid Electronic Claims Update
Medicare DME new claim edit
Medicare Montana claim exclusion edit
Fixing Edit Exclusion CH 64
835 files deadline for BCBS of Florida
Wisconsin ForwardHealth update
Insurance Carriers dropping Claim Status Reports from Clearinghouse
EDI updates for Michigan Medicaid
Kaiser Permanente Electronic Claims filing
Care Choice Electronic Claims CPID update
Iowa and South Dakota BCBS medical billing updates on NPI
RelayHealth Additional Processing time for Electronic Claims Billing
Cigna Health Insurance Exclusion Report
First Choice Health Network Electronic Claim Edit updates
Direct Connection with Humana Veterans Healthcare Services
RelayHealth EDI Reports Update
Kansas, Nebraska and Western Missouri Medicare Electronic Claim Billing Updates
EDI report changes for DME MAC Dubuque and Chicago
DME MAC CPID for electronic claim billing updates
Billing Claims to Wisconsin Medicaid look for these changes
Priority Health of Michigan adding new EDI reports for electronic claim billing
SAMBA will be consolidated under Cigna Health Insurance
Insurance Carrier EDI Reports issues
Indiana University Medical Group and Electronic Claims Billing
HealthComp Electronic Claims Medical Billing updates
New York Empire Medicare system issues
New Jersey Medicare transferring to Highmark updates
Texas First Health Plan through RelayHealth updates
Oregon Medicaid Electronic Claims Billing updates
Direct connection with Kaiser Mid Atlantic
Insurance Carriers are requesting no more hand written EDI Agreements
EDI error BO13 and how to fix
Illinois BCBS Insurance Claim NPI updates
Electronic Claim Edits for New York Preferred Care HMO Billing Insurance
RelayHealth Clearinghouse
Ohio Medicare Electronic Remittance Advice Issues
Blue Shield NPI Medical Claim Exclusion Edits
RelayHealth connected to Office Ally
Palmetto GBA EDI Conversions
Illinois Medicaid Exclusion Codes when Medical billing
EDISS NPI Updates for Electronic Medical Billing
Amerigroup exclusion on Electronic Medical Billing Claims
LA Medicaid has new Payer Edits for Electronic Claims Billing
Oklahoma Medicaid Requires Taxonomy Code on Electronic Medical Claims
Direct Connection with Magellan for Electronic Claims Billing
Health Administrative Services changes Name to Trisurant
Avmed Inc Electroni Claim Exclusions
Electronic Claims Medical Billing updates for Golden Rule Health Insurance
Benefit Plan Management Inc Electronic Claims Billing update
DME electronic claims medical billing updates
Medicare Claim Exclusion 90496 on electronic claim submission
Electronic claims for National Association of Letter Carriers update
Electronic Claim Billing PHP Tenncare updates
Electronic Claim Billing IHC is now SelectHealth
Electronic Medical Billing for Oklahoma Medicaid has new EDI exclusions
New Mexico and Oklahoma Medicare Electronic Claim Submission updates
Electronic Remittance Advice Batching Options
Electronic Medical Billing Claim Exclusions for Tricare South Region
Nevada and Hawaii require new EDI agreements
Medicare and Nevada electronic claims denied for no EDI agreement on file
Wellcare new Electronic Claim Exclusion edits for Medical Billing
Florida Medicaid Rejection Electronic Medical Billing Claims missing NPI numbers
Florida Medicaid Updates for Electronic Medical Billing
New Jersey Insurance Claim Exclusions for Medical Billing
New Payor Batch Reports
Electronic Claims Exclusions for Florida Medicaid updates
Capital Blue Cross of Pennsylvania requires new EDI agreements with RelayHealth
RelayHealth enhancing Medical Billing Clearinghouse software
Amerigroup Electronic Claims Billing Exclusions
New Mexico Medicaid Electronic Claims Billing Exclusion Edits
Memorial Hermann Insurance Electronic Claim Denials
Northern and Southern California updating to Palmetto for Electronic Claim Billing
Community Health Plan of Washington Electronic Claim Billing Edits
Blue Medicare PPO Electronic Claim Edits for Medical Billing Services
Humana Electronic Claim Billing Exclusions
Indiana Medicaid Electronic Claim denials
Electronic Claim Billing to North American Medical Management of Illinois
Athens Area Health Plan edit updates for Electronic Medical Billing Claims

Dental Billing
Electronic Dental Medical Claims
Orthodontist in Utah

Medical Services Website
Doctors and Dentist Websites

Medical Billing Schools and Online Courses
Ease of Medical Billing and coding

Chiropractic Medical Billing
Chiropractic Medical Billing Office Software
98940 Electronic Claims Medicare update

Health Insurance Quotes, Online Auto Insurance Quotes, Property Insurance Quotes
Health Insurance Quotes
Life Insurance Quotes
Online Auto Insurance Quotes

Medical Billing and Coding Colleges
When to attend Medical Coding Colleges

Medical Business Suggestions
Marketing Campaign
Viewing your Medical Office through the eyes of your patients

Medical Billing and Coding Keyword Tags: medical billings and claims, medical billings claims, medical claims electronic billing, claim billing software, electronic medical claim billing, lytec medical billing software, medical billing schools, medical coding and billing schools, medical billing schools online, medical coding and billing schools online, medical billing classes online, online medical billing school, medical billing and coding courses online, courses online, medical billing classes, chiropractic software, online courses medical billing, medical office billing software, medical coding schools, medical coding courses, on line medical billing, medical billing programs, Medicare billing software, medical billing software, medisoft medical billing software, web based medical billing, degree medical billing, electronic medical billing, electronic medical billing software, medical billing education, medical insurance billing software, medical billing and coding course, medical billing online course, medical billing software company, learn medical billing, insurance billing software, medical assistant school, medical billing course, medical billing program, medical billing and coding software, medical billing school, medical billing class, medical billing and coding online, medical billing certificate, medical billing systems, medical billing system, electronic medical claim billing, chiropractic practice management software, medical practice management system, medical practice management software, EMR practice management software, medical practice management services, practice management software, medical billing practice, Aetna Health, health insurance, Auto insurance, Auto Insurance Quotes, Auto insurance quote, Car Insurance Quotes, Commercial Insurance Quote, Car Insurance Quote, Car Insurance Quote, Employers Liability, Employers Liability insurance, Auto Insurance Companies, Property Insurance Quote, Car Insurance Companies, Auto Cheap Insurance, Accident Claim, Liability Insurance Quote, Employer Liability Insurance, Public Liability Insurance, lytec medical, lytec, chiropractic software, web based medical billing software, medical billing software, medical billing systems, Auto Insurance Quotes, Online Auto Insurance Quotes, Health Insurance Quotes, Online Health Insurance Quotes, Property Insurance Quotes, Auto Attorneys, Auto Medical Liens

New Claim Edits for New York Preferred Care HMO

noreply@blogger.com (SLC - Utah) — Sat, 06 Dec 2008 02:27:00 +0000

New York Preferred Care HMO CPID# 7434 has new NPI requirements. Because of these changes RelayHealth will be implmenting a new electronic claim exclusion on December 5th 2008 for all claims submitted to CPID# 7434.

EDIT: HU 0021 INVALID CLAIM REF PROV ID QUAL? IN LOOP 2310A(PROF), WHEN NM108 IS SENT MUST BE EQUAL TO XX

Please understand that the NPI is now required when submitting claims through RelayHealth for New York Preferred Care HMO health insurance.

Learn more about Electronic Medical Billing and Coding at this site medical billings and health insurance claims

Medical Billing Keywords: medical claims clearinghouse, claims clearinghouse, clearinghouse, software clearinghouse, national clearinghouse, direct electronic claims, medical claims electronic billing,medical practice management software, EMR practice management software, medical practice management services, practice management software, medical billing practice, Aetna Health, health insurance, Auto insurance, Auto Insurance Quotes, Auto insurance quote, Car Insurance Quotes, Commercial Insurance Quote, Car Insurance Quote, Car Insurance Quote, Employers Liability, Employers Liability insurance, Auto Insurance Companies, Property Insurance Quote, Car Insurance Companies, Auto Cheap Insurance, Accident Claim, Liability Insurance Quote, Employer Liability Insurance, Public Liability Insurance, lytec medical, lytec, web based medical billing software, medical billing software, medical billing systems electronic claim medical billing, electronic claim billing, medical electronic claim, electronic insurance claims, electronic claim processing, electronic claim filing, electronic claim submission, electronic claims submission, physician billing, medical billing, hospital billing, claim billing, doctor billing, billing services

Illinois Blue Cross Blue Shield Insurance Claims

noreply@blogger.com (SLC - Utah) — Sat, 06 Dec 2008 01:45:00 +0000

Blue Cross Blue Shield of Illinois has required medical offices to bill using a Rendering NPI number. If you use RelayHealth as your electronic insurance claim filing clearinghouse you will get specific denials relating to this issue.

BA7: NPI is not valid as rendering

If you receive this exclusion it means that "The NPI submitted on the claim to identify who provided the services is identified in our files as a billing entity, not a rendering provider." To rectify the above error message, the NPI of the provider who rendered the services should be populated in Loop 2310B - Data Element NM109, which is equivalent to Box 24J on the CMS-1500 claim form.

NOTE: You must continue to include the Billing NPI in Loop 2010AA - Data Element NM109. This Data Element is equivalent to Box 33A in the CMS-1500 Form.

If receiving Warning message: BAJ - Rendering Provider Loop (2310B) is Missing
Please be advised that this Warning message alerts you that "If the NPI billing provider record is NOT established as 'valid as rendering,' then the claim rendering provider loop (2310B) is required." In this situation, you must include the rendering provider's NPI in Loop 2310B - Data Element NM109. This Data Element is equivalent to Box 24J on the CMS-1500 claim form.

When filing claims, it is imperative, to include the rendering NPI (Type 1) in the rendering field (2310B Loop) and the billing NPI (Type 2) in the billing field (2010AA). The appropriate billing and rendering NPI must be entered properly to avoid claim rejection(s) and ensure proper payment.

Questions on Electronic Medical Billing and Claims then view medical claims electronic billing

Medical Billing Tags: Blue Cross Tonic, Blue Cross Blue Shield nm, Blue Cross health insurance, blue cross blue shield OK, blue cross health, insurance quote, blue cros, blue shield health insurance, Blue Cross and Blue Shield Medical Insurance, Blue Cross medical plans, blue cross medical insurance, blue shield, blue cross medical insurance, cross blue shield medical insurance, blue cross medical plans, medical billing claims, how to get claims paid on, medical debt collection, medical billing collection, medical billing and collection, medical collections, insurance, health insurance, health plan, management, physician, doctors, health care, providers, facility, hospital billing, national student loan clearinghouse, medical claims clearinghouse, claims clearinghouse, software clearinghouse, clearinghouse information, national clearinghouse, medical billings and claims, medical billings claims, medical claims electronic billing, claim billing software, electronic medical claim billing, lytec medical billing software, medical billing schools, medical coding and billing schools, medical billing schools online, medical coding and billing schools online, medical billing classes online, online medical billing school, medical billing and coding courses online, courses online, medical billing classes, chiropractic software, online courses medical billing, medical office billing software, medical coding schools, medical coding courses, on line medical billing, medical billing programs, Medicare billing software, medical billing software, medisoft medical billing software, web based medical billing, degree medical billing, electronic medical billing, electronic medical billing software, medical billing education, medical insurance billing software, medical billing and coding course,

Electronic Claims EDI error BO13 Prov Phone 1

noreply@blogger.com (SLC - Utah) — Mon, 01 Dec 2008 16:13:00 +0000

For those medical offices billing through RelayHealth to insurance carriers CPID#1405 Illinois Blue Shield, CPID# 1406 Texas Blue Shield, CPID# 7403 New Mexico Blue Shield and/or CPID# 1403 Oklahoma Blue Shield you may have noticed a EDI Denial: B013 PROV PHONE 1 on November 14th 2008.

The invalid rejections have all been corrected and forwarded on to the correct payors. Please be aware of this fix.

Confused by Electronic Medical Claim Billing by clicking here electronic medical claim billing

Medical Billing Tag words: RelayHealth, Clearinghouse, McKessons, EDI edits, EDI errors, claim errors, claim issues, how to fix B013 PROV phone 1, how to resolve, how to understand how to read edit, edited, corrected, affected, forwarded, claims fixed, resolved, understanding, Reporting issues, medical billing, billing services, physician billing, doctors, providers, physicians, health care providers, claims, electronic transmission, claim submission, CMS-1500, HCFA, UB04, UB92, Institutional, Professional, medical industry, medical facility, hospital, specialty, pediatricians, podiatry, surgery, mental health, chiropractic, general, medical billings and claims, medical billings claims, medical claims electronic billing, claim billing software, electronic medical claim billing, lytec medical billing software, medical billing schools, medical coding and billing schools, medical billing schools online, medical coding and billing schools online, medical billing classes online, online medical billing school, medical billing and coding courses online, courses online, medical billing classes, chiropractic software, online courses medical billing, medical office billing software, medical coding schools, medical coding courses, on line medical billing, medical billing programs, Medicare billing software, medical billing software, medisoft medical billing software, web based medical billing, degree medical billing, electronic medical billing, electronic medical billing software, medical billing education, medical insurance billing software, medical billing and coding course,

Seeing your Medical Office through the eyes of your patients

noreply@blogger.com (SLC - Utah) — Sun, 30 Nov 2008 00:06:00 +0000

After a few years of running a medical business doctors find themselves in a rut. I suggest taking a few minutes out on a slow day to look at your business from a new perspective. Take a pad of paper and pen and begin by starting from the parking lot.

Take in a few breathes, close your eyes and when you open your eyes look at things like a new patient might see them. Study your surroundings, scrutinize what you see and see how patients might feel when they see the same things.

Starting from the parking lot does your building have any curve appeal?
- repaint the building
- add flowers or trees
- add art
- new doors
- well lit outside if you work in the evenings

Walking into the building
- how does it smell
- does the place need new tile, paint, carpet cleaning

Restrooms
- Is it clean
- Is it functional

Opening Doors to your office
- What does it smell like
- What does it look like
- What does the front office desks look like
- Is their enough seating room

Front Office
- Do girls eat lunch at desks
- How do they answer the phones
- Is everyone well groomed
- Is everyone smiling to greet the patient
- Do they call the patient by their first name
- Are they pleasant when collecting the co-payment and outstanding balances

Walking down the hall to doctors office
- How are the carpets or tile
- Is everything dusty
- Is everything sanitized
- Are their scuffs on the walls (does it need to be repainted?)

Doctor Bedside Manners
- Is the doctor exercising and keeping fit
- Breathe check
- Clothing attire (over-dressed, under-dressed or just right?)
- Hand shake
- Eye Contact
- Understanding when to nod the head and when not to
- Listening skills

Doctors Office
- Office Equipment well maintained, no rips, no holes, no stains
- Chairs for patent's family
- Reading Materials
- Any smells

Taking this small 30 minute test every few years will help you identify if the building is looking drab, if the office is getting lazy in it's neatness and if their are areas that can be improved on. Fix the issues that you can now and make a list of things that you want to change over the next few months. I have learned that it's the simple things that can have the biggest impact on retaining patients for the next 50 years.

To view over 250 articles on Medical Billing and Coding information please check out Medical Billing and Coding Articles

Medical Tags - medical offices, how to evaluate front office staff, medical practices, patients, family friendly doctors offices, facilities, clean environment, aura, backdrop, background, circumstances, climate, conditions, context, domain, element, entourage, habitat, hood, jungle, locale, medium, neighborhood, scene, scenery, setting, situation, status, stomping ground, surroundings, terrain, territory, turf, uncluttered, blank, bright, cleansed, clear, delicate, dirt less, well-kept, white, washed, unspotted, unsoiled, unsmudged, trim, tidy, simple, shining, sanitary, neat as a button, neat as a pin, orderly, pure, elegant, faultless, flawless, fresh, graceful, hygienic, immaculate, laundered, commentary, examination, grasp, impression, paraphrase, review, scrutiny, study, treatment, understanding,medical billing classes, chiropractic software, online courses medical billing, medical office billing software, medical coding schools, medical coding courses, on line medical billing, medical billing programs, Medicare billing software, medical billing software, medisoft medical billing software, web based medical billing, degree medical billing, electronic medical billing, electronic medical billing software, medical billing education, medical insurance billing software, medical billing and coding course, medical billing online course, medical billing software company, learn medical billing, insurance billing software, medical assistant school, medical billing course, medical billing program, medical billing and coding software, medical billing school, medical billing class, medical billing and coding online, medical billing certificate, medical billing systems, medical billing system, electronic medical claim billing, chiropractic practice management software, medical practice management system, medical practice management software, version,

Running a Successful Medical Practice

noreply@blogger.com (SLC - Utah) — Sat, 29 Nov 2008 22:39:00 +0000

Doctors go to College to learn how to be a doctor not on how to run a profitable Medical Practice Business. For every doctor you hear about that is making 6 figure salaries each month their are 50 other providers just trying to stay afloat.

Most doctors think they need to treat more patients a day to make more money but usually when you look at the aging reports you soon see it's not about treating more patients it's about collecting on the patients already treated.

Ask yourself these questions:

~Are you billing for ALL services you treated the patient for?
~Are charges getting entered and billed the same day as treatment?
~Are charts sitting around in different locations of your office waiting on forms to be completed?
~Is your billing department educated with your allowable fee schedules so they know they are collecting 100% of what is owed to you by procedure code? Are they going after the insurance carrier for claims that were underpaid?
~Are charges getting adjusted off just because the insurance carrier denies them?
~Does anyone work claims denied for timely filing, invalid procedure codes, invalid diagnosis codes, missing information, invalid modifiers, missing paperwork etc?
~Are patient balances getting adjusted off instead of being billed?
~Are medical liens being signed by attorneys and patients, workers compensation forms completed, Documentation attached to claims
~Are you sending claims electronically for all insurance carriers that you are credentialed with?
~Are you reading your EDI reports from the clearinghouse and working the denied claims?
~Are you re-billing claims that were denied or just fixing them and letting them sit in your A/R?
~Is someone checking claim status on everything that is 25+ days old?
~Are patients getting statements within the first month of treatment ensuring they will pay out almost 100% of the time?

Is it time for a change in the way you do business? Do you desire a profitable medical practice that actually helps patients? If you need help please leave a comment with your contact information and we will contact you or visit our www.medicalbillingsoftwarepro.com for PM vendor reviews, and www.videotrainingpro.com for online training videos. You can contact us through any of these websites for assistance on bettering your medical office flow to increase your monthly profits.

Practice Management Software Reviews

Medical Clearinghouse Reviews

To read more about Medicare updates including Health Billing Insurance Information check out Medicare Medical Coding and Billing Courses

Medical Practice Tags: medical billing, medical collections, how to run a successful medical practice, medical business, making money as a doctor, running a medical, doctors, providers, physicians, medical offices, hospitals, medical facilities, health care professionals, investors, brokers, specialized medical business, billing and collections, information, communications, human resources, growing financial assets, enhancing medical practices, electronic claims, marketing, business setup, start a viable medical office, business services, business plans, medical clinic business plan, highly profitable family medical practice, acquisition, advancement, advantage, benefit, bottom line, cleanup, earnings, goods, gross, harvest, income, interest, lucre, net, percentage, proceeds, product, receipt, revenue, savings, split, skim, surplus, take, takings, turnout, use, value, yield, winning, accomplish, achievement, advance, benefit, boom, do well, easy street, fortune, gain, good luck, good times, happiness, profit, triumph, victory,

Medical Providers find Money in sending claims Electronically

noreply@blogger.com (SLC - Utah) — Sat, 29 Nov 2008 21:48:00 +0000

Back in the day (12+ years ago) medical claims were completed by hand or type writer. I remember putting the claim in upside down, and rolling it up so that I could add in the patients information, subscriber information and the CPT, Modifiers, ICD-9, and charge amount. It was so tedious. The doctor would treat between 8-14 patients a day and we would complete the forms and mail everything out on Friday.

About 30-45 days later (varied by insurance carrier) we would get an Explanation of Benefit back explaining if the claim was approved or denied. We used to keep a paper ledger of our patients to track any claims not paid (like I said this was 12 years ago and our doctor was old fashioned. We begged for a computer).

12 years ago it wasn't a priority to go electronic because not all insurance carriers were accepting claims electronically but now it's a NECESSITY and any doctor that is still processing paper claims is outdated and actually losing money. Let me show you what I mean:

Medical offices that are sending claims by paper have to wait until they are first received at the insurance carrier. So, if we billed claims every Friday and it took 2 days for the post office to deliver the claims + 1 day for the insurance carrier to scan the claims into their software we are now 3 days out. It takes the insurance carrier 15-25 days to process the claim and then another 3-5 days to process the check and mail everything back to the doctors office.

With good insurance carriers and if all things in the universe go right you will get your Explanation of Benefits with a check and a list of all patients that were denied along with those reason. Medical offices usually have collectors working on any past due or outstanding accounts that are 35+, 45+, 60+, 90+ and 120+ days old. Patients receive statements 35, 45, 65, 90 and sometimes over 180 days after treatment for co-payments, coinsurance and deductible balances. Mainly patients refuse to pay because they don't remember being treated, don't feel like they owe on such a old balance etc.

Doctors would have to adjust off patient balances and old insurance claims not including denials for untimely filing issues.

Now let's fast forward to the new era and how to collect your insurance carrier money faster -

1. The charges are entered the same day the patient is treated
2. Charges are scrubbed by medical coding software within minutes notifying the biller of any possible denial issues
3. If patient information is missing or incomplete the claim will not be transmitted to the insurance carrier alerting the biller of these issues
4. All claims get fixed the "same day" and billed to the clearinghouse
5. Clearinghouse scrubs the claims and send any back that do not meet the insurance carriers requirements per their contract with the insurance carrier
6. Within 24 hours those issues are fixed and the denied claims are rebilled
7. The insurance carrier sends a notification of status of claims within 72 hours indicating those that were approved vs. denied
8. Within 5 days of the patients treatment we have notification of the check # the claim will be processed towards
9. Within 10 business days from the date the insurance carrier receives the claim electronically we have an Electronic Remittance Advice along with the date the check will either be mailed to the provider or direct deposited into the providers checking account
10. Patients get a statement normally within 15-20 days of being treated and they pay almost 100% of the time because they actually remember the office visit, they remember what it was for and they realize they have a co-payment, coinsurance or deductible that is owed.

If you are a medical practice and not receiving insurance payments within 25 days of treatment for carriers like Aetna, UHC, Cigna, BCBS, Federal, Medicare, Medicaid, Medi-Cal, Humana or other insurance carriers that accept electronic claims then you need to look for a new billing service, a new Practice Management software or a new clearinghouse based on your results.
Practice Management Software Reviews
Medical Clearinghouse Reviews

1 step to increasing your monthly revenue is to take your billing electronically using a robust clearinghouse that processes eClaims, secondary claims electronically and Electronic Remittance Advice. For more information on how a clearinghouse can help your medical office please check out:

How to read EDI clearinghouse reports

Clearinghouse EDI Reports

Clearinghouse Online Claim Status EDI Reports

Confused by Electronic Medical Claim Billing click here for additional articles on this subject and so much more: electronic medical claim billing

Medical Billing Tags: clearinghouses, practice management software reviews, selecting a practice management software that will make you money, efficient billing strategies, efficient medical billing services, how to be a medical biller, understanding the medical industry and new technologies, medical billing, medical collections, collecting on medical insurance claims, getting faster payments, receiving money faster, sending patient statements quicker, collection letters, reading EDI reports, understanding clearinghouse reports, RelayHealth, McKesson, Faster claims processing, providers, physicians, doctors, medical offices, hospital facilities, claims processing speeds, electronic claims, paper claims, CMS-1500, HCFA 1500, UB-92, UB-04, Institiutional, Professional claims, EDI program edits, minimize the impact, ease of use, reduction of payment errors, data entry errors, pre-edits, scrubbing of claims, claim coding software, medical billing from home, learn how to bill online from anywhere in the world, medical billings and claims, medical billings claims, medical claims electronic billing, claim billing software, electronic medical claim billing, lytec medical billing software, medical billing schools, medical coding and billing schools, medical billing schools online, medical coding and billing schools online, medical billing classes online, online medical billing school, medical billing and coding courses online, courses online, medical billing classes, chiropractic software, online courses medical billing, medical office billing software, medical coding schools, medical coding courses, on line medical billing, medical billing programs, Medicare billing software, medical billing software, medisoft medical billing software, web based medical billing, degree medical billing, electronic medical billing, electronic medical billing software, medical billing education, medical insurance billing software, medical billing and coding course, medical billing online course, medical billing software company, learn medical billing, insurance billing software, medical assistant school, medical billing course, medical billing program, medical billing and coding software, medical billing school, medical billing class, medical billing and coding online, medical billing certificate, medical billing systems, medical billing system, electronic medical claim billing, chiropractic practice management software, medical practice management system, medical practice management software, EMR practice management software, medical practice management services, practice management software, medical billing practice, Aetna Health, health insurance, Auto insurance, Auto Insurance Quotes, Auto insurance quote, Car Insurance Quotes, Commercial Insurance Quote, Car Insurance Quote, Car Insurance Quote, Employers Liability, Employers Liability insurance, Auto Insurance Companies, Property Insurance Quote, Car Insurance Companies, Auto Cheap Insurance, Accident Claim, Liability Insurance Quote, Employer Liability Insurance, Public Liability Insurance, lytec medical, lytec, web based medical billing software, medical billing software, medical billing systems

Move away from handwriting EDI Agreements

noreply@blogger.com (SLC - Utah) — Sat, 29 Nov 2008 21:39:00 +0000

More and more insurance carriers are getting away from handwriting and requiring EDI agreements for clearinghouses get completed electronically. Either type writing them (does anyone own a typewriter any more???) or by electronically completing the forms.

RelayHealth offers a online Collaboration Compass to complete EDI Agreements electronically. For medical offices that use clearinghouses it's wise to use the Clearinghouses software to complete all EDI agreements for electronic claims and electronic remittance advice to prevent any kick outs from insurance carriers.

The following list of insurance carriers are requiring electronic completion of forms and will no longer accept handwriting (except where the providers signature is required)

CPID 1455 Alaska Medicare
CPID 1456 Arizona Medicare
CPID 1459 Oregon Medicare
CPID 1462 Washington Medicare
CPID 1469 Iowa Medicaid
CPID 1523 North Dakota Medicare
CPID 1527 Utah Medicare
CPID 2411 North Dakota Blue Shield
CPID 2453 North Dakota Medicare
CPID 2454 South Dakota Medicare
CPID 2458 Utah Medicare
CPID 2466 Wyoming Medicare
CPID 2571 Iowa Medicaid
CPID 3521 Minnesota Medicare
CPID 3583 Wyoming Medicare
CPID 3584 Wyoming Blue Cross
CPID 5515 Oregon Medicare
CPID 5521 Washington/Alaska Medicare
CPID 5546 Arizona Medicare
CPID 5581 Idaho Medicare
CPID 5589 South Dakota Medicare
CPID 7400 Montana Medicare
CPID 7489 Wyoming Blue Shield

For more information on EDI's:
How to read EDI clearinghouse reports
Clearinghouse EDI Reports
Clearinghouse Online Claim Status EDI Reports
Practice Management Software Reviews
Medical Clearinghouse Reviews

Interested in Medical Billing and Coding read more articles on Medical Coding and Billing Courses

Medical Billing Tags: Medical Billing, Medical Claims, Implementation of EDI Agreements, EDI forms, Electronic Data Interchange forms, completion of medical forms online to prevent denials, CMS-1500 electronic claim filing, Clearinghouses, Medical offices, providers, physicians, hospital facilities, billing services, Medicaid, Medicare, Blue Cross, Blue Shield, States, Insurance carriers, new rules for completing EDI agreements, Understanding clearinghouses, clearinghouse connections, how to bill insurance claims through a clearinghouse, education, training, teaching, skills, medical billing understanding, how to bill insurance claims electronically, how to be a medical biller from home, understanding simple processes, Electronic Remittance Advice, Electronic Explanation of Benefits, EOB's, physician billing, doctors, chiropractors, podiatry, surgery, pediatrician, speciality services, collections, web based medical billing, degree medical billing, electronic medical billing, electronic medical billing software, medical billing education, medical insurance billing software, medical billing and coding course, medical billing online course, medical billing software company, learn medical billing, insurance billing software, medical assistant school, medical billing course, medical billing program, medical billing and coding software, medical billing school, medical billing class, medical billing and coding online, medical billing certificate, medical billing systems, medical billing system, electronic medical claim billing, chiropractic practice management software, medical practice management system, medical practice management software, EMR practice management software, medical practice management services, practice management software, medical billing practice, Aetna Health, health insurance, Auto insurance, Auto Insurance Quotes, Auto insurance quote, Car Insurance Quotes, Commercial Insurance Quote, Car Insurance Quote, Car Insurance Quote, Employers Liability, Employers Liability insurance, Auto Insurance Companies, Property Insurance Quote, Car Insurance Companies, Auto Cheap Insurance, Accident Claim, Liability Insurance Quote, Employer Liability Insurance, Public Liability Insurance, lytec medical, lytec, web based medical billing software, medical billing software, medical billing systems

RelayHealth offers direct connection with Kaiser Mid Atlantic

noreply@blogger.com (SLC - Utah) — Sat, 29 Nov 2008 19:07:00 +0000

Starting November 19th 2008 RelayHealth is offering a direct connection to bill electornic claims and Remittance to Kaiser mid Atlantic for Professional (CMS-1500) and Institutional (UB-04) claims.

This is an exciting new direct connction for medical offices that use RelayHealth/McKesson as their clearinghouse.

The CPIDs included in this new connection are:
CPID 2819 Kaiser Mid Atlantic / Professional (CMS-1500)
CPID 7506 Kaiser Mid Atlantic /Institutional (UB-04)

You will not need to complete EDI Agreements (YEAH) for these direct connections either just enter the CPID# in the correct place for your PM vendor or Clearinghouse and transmit immediately.

The following payor reports will be available:
Unsolicited 277U
RelayHealth Standardized Payor reports for the above payors) will be available as soon as possible after November 20, 2008.

The following payor edits will be required by Kaiser Mid Atlantic:
Edit 01 version 0098 ? IN LOOP 2010BA, NM109 CAN NOT BE MORE THAN 10 CHARACTERS.
Edit HU version 0019 - IN LOOP 2010AA, NM108 MUST BE SENT AND MUST BE EQUAL TO 'XX'
Edit HU version 0020 - WHENI LOOP 2010AB IS SENT, NM108 MUST BE SENT AND MUST BE EQUAL TO 'XX'
Edit HU version 0022 - IN LOOP 2310B(PROF)/2310C(INST), NM108 MUST BE SENT AND MUST BE EQUAL TO 'XX'

If you have questions on EDI Reports please check out these earlier Blogs:
How to read EDI clearinghouse reports

Clearinghouse EDI Reports

Clearinghouse Online Claim Status EDI Reports

Or to read more about Medicare updates including Health Billing Insurance Information check out Medicare Medical Coding and Billing Courses

Medical Billing Tags: Kaiser, Kaiser Mid Atlantic, Professional Claims, Institutional Claims, CMS-1500 forms, HCFA forms, UB-04, UB92, Medical billing, billing insurance claims, claim filing, health insurance claim processing, new direct connection with McKesson Clearinghouse House through RelayHealth, 277 Reports, 277 EDI reports, how to read EDI reports, Claim edits, claim collections, claim submission, physician billing, health care provider billing, providers, medical office, billing service, understanding RelayHealth, how to process claims, how to post claims, how to bill claims, how to work insurance carriers, new direct connection with electronic claims processing, saving money in the medical industry, how to save money by billing claims electronically, medical coding and billing schools, medical billing schools online, medical coding and billing schools online, medical billing classes online, online medical billing school, medical billing and coding courses online, courses online, medical billing classes, chiropractic software, online courses medical billing, medical office billing software, medical coding schools, medical coding courses, on line medical billing, medical billing programs, Medicare billing software, medical billing software, medisoft medical billing software, web based medical billing, degree medical billing, electronic medical billing, electronic medical billing software, medical billing education

Oregon Medicaid transferring to a new MMIS system

noreply@blogger.com (SLC - Utah) — Sat, 29 Nov 2008 18:48:00 +0000

The replacement of Medicaid Management Information System (MMIS) is going live December 9th 2008. This new change will have an effect on how claims are submitted and how doctors are paid on medical claims. They have also added additional tools to speed things up and make it easier on all parties (medical offices, billing services, clearinghouses etc).

For clients that use RelayHealth as your clearinghouse to submit claims electronically to CPID#s 1481 & 5517 for Oregon Medicaid please be aware of these new updates:

RelayHealth is submitting the last electronic file to Oregon Medicaids current sysetm up to November 28th 2008
Claims will be held by RelayHealth if submitted between November 28th - December 8th 2008
On December 9th 2008 RelayHealth will send their first file to the NEW Oregon Medicaid MMIS claim processing system

Providers already approved with EDI Agreements thankfully do not need to re-register; however any new providers do require completed EDI Agreements in order to transmit claims electronically.

Providers that want to be setup with Electronic Remittance Advice (ERA) are required to complete a EDI Agreement for eRemittance. Anyone currently setup with ERA through RelayHealth will not be required to re-credential for this feature.

Please take a few minutes to register with MMIS training which is available online and can be found by visiting www.oregon.gov/DHS/mmis/training-info.shtml

A web-based provider eCourse is available through the DHS learning Center (select course C00818)

My recommendations is to watch claims closely for the first month. With anything this major in changing software be ready for Bugs. Be patient but also be ready to drop claims to paper if their are any issues with electronic claims files.

Another idea is to hold on to all claims from November 28th - December 15th and then submit. This will give both parties (RelayHealth and MMIS) to identify any bugs and fix them. This also means you won't have your claims involved with any mishaps.

If they do have problems with transmissions do not be afraid to press the Rebill button.

Happy Billing and Collecting!

Confused by Electronic Medical Claim billing then read these articles on Billing Health Insurance medical claims

Tag Words: Oregon, Ontario, Pendleton, Redmond, Eugene, beaverton, Roseburg, White City (medford), Coos Bay, Salem, Grants Pass, Tillamook, Hillsboro, Salem, Portland, Tualatin, MMIS, DHS, OHP clients, Web-based MMIS provider eCourse, Course information, Registration information, extended 2008 training schedule, professional, dental, institutional providers, pharmacy providers, POS/PBM training for pharmacies, physician claim billing, electronic claim billing, medical claim billing, medical office claim billing, billing service claim billing for Oregon Medicaid, eClaims, Electronic Claims submission, transmission stop and start dates, new claims filing features, functions, functionality, update to claims transmission for Medicaid of Oregon, Clearinghouse, RelayHealth, McKesson,