PrecisionHCC Blog

How Do I get paid for Flu Shots from Medicare?

Vanessa Best — Fri, 02 Dec 2011 14:25:35 +0000

Why am I not getting paid for Medicare Flu Shots?

Many practices and medical billers have seen that flu shot CPT code 90658 is no longer being paid. Claims are being rejected. “Why am I not getting paid for Flu Shots from Medicare?” What changes to medical billing and coding have been made by CMS (Center for Medicare and Medicaid Services) ?

There are now five separate HCPCS codes that must be used to appropriately bill Medicare. To receive reimbursement these codes must be used in your medical billing .

The New Medicare Flu Vaccine Codes:

Q2035 Afluria Vaccine:

Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Afluria)

Q2036 Flulaval Vaccine:

Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Flulaval)

Q2037 Fluvirin Vaccine:

Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Fluvirin)

Q2038 Fluzone Vaccine:

Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Fluzone)

Q2039 NOS (Not Otherwise Specified) Vaccine

Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Not Otherwise Specified)

Still Use HCPCS Administration Code G0008

Read the full article from CMS MLN Matters

Should Your Office Out Source Your Medical Billing?

Vanessa Best — Thu, 01 Dec 2011 15:22:03 +0000

Should we Outsource Medical Billing

Managing a medical practice has never been more difficult. Between the highly competitive environment and increasingly tight margins, revenue management has become acutely important. Profitability – even survival – requires that practices are run in an efficient, business-like manner. And management decisions need to enhance both health outcomes and business operations.

Industry trends show an increasing number of practices are making the switch to outsourcing their medical billing rather than maintaining in-house billing departments. For many practices, partnering with a professional medical billing company can be a very cost-effective investment. But practice managers must decide on a case-by-case basis whether outsourcing or internal billing makes the most sense.

Medical billing is becoming increasingly complex.

Assuming the medical side of the practice is performing at peak efficiency, the primary way to generate more income, faster, is by improving the medical billing process. But efforts to streamline must take into account the rapidly changing medical billing landscape.

The trend is toward greater bundling of services and billing codes and, in many cases, lower reimbursements. Vast, sweeping changes related to instituting ICD-10 are just two years away.

Demand for electronic health records is growing. Government and some private payers are requiring stronger linkage between financials and patient data. In fact, documentation is becoming so important that failure to provide fully up-to-date information may soon result in denied claims or possibly even fines.

Increasing patient responsibility is creating new and different billing and collections issues.

Meanwhile, daily operations costs continue to escalate, emphasizing the need for greater control.

The only certainty is that more changes are on the way.

In-house medical billing provides total control.

There’s no question that an in-house billing department enables practice managers to design and control every detail of the billing process. But creating and maintaining efficiencies requires sophisticated, specialized billing technology to accommodate current and future coding and regulatory requirements, payer policies and internal processes.

Investing in technology can reduce mistakes, enhance productivity and efficiency, and provide useful reporting information. But upgrading hardware and software can be expensive. Complex technology can require more highly specialized staff and increased training.

Because of the complexities, in-house medical billing is often considered more cost-effective for larger practices or medical centers.

Outsourced medical billing offers distinct advantages.

A professional medical billing service offers many benefits. Outsourcing can save money by decreasing the need for staffing and training, eliminating the need for expensive and recurring technology and reducing overhead.

The practice can benefit from the latest tools and techniques and knowledgeable, experienced billing staff without the out-of-pocket investment. That expertise virtually eliminates mistakes, resulting in shorter procedure-to-reimbursement time with fewer denials or collections problems. Expert billing service staff can also provide individually targeted advice to help the practice better manage the entire revenue cycle.

Outsourcing medical billing enables practice personnel to focus on what they do best – delivering the best possible patient care.

Either way, measure practice performance.

It’s useful to compare practice statistics to industry standards. Determining key performance indicators (KPIs) and monitoring and analyzing that data provides insight into where the practice is performing well and uncovers existing and potential problems.

“A professional medical billing service can help identify the most valuable KPIs for any size and type of practice.”

By fully understanding the ramifications of medical billing statistics, practice managers can effectively evaluate the benefits of outsourcing. For many practices, integrating and streamlining business operations can be a cost-effective solution to ensure long-term ability to remain competitive and prosper in a tough and rapidly changing environment.

Countdown to HIPAA 5010 – Five Things You Should Know To Avoid Claims Denials

Vanessa Best — Wed, 30 Nov 2011 17:08:57 +0000

HIPAA 5010

What is 5010 compliance?

If your practice doesn’t know or you haven’t begun to prepare for this critical change, please read on. In less than 80 days new HIPAA 5010 standards will go into effect. The United States Department of Health and Human Services (HHS) has mandated that all providers, clearinghouses and healthplans use a new standard in electronic transactions called HIPAA 5010 or ANSI 5010. Electronic transactions include but are not limited to electronic claims, eligibility requests, electronic remittances, and electronic referrals.

#1. What is HIPAA 5010 or ANSI 5010 and why not ANSI 4010?
The goal of the federal government is to have one healthcare uniform industry standard platform for all transactions. It will create better accuracy and efficiency than the current ANSI 4010.

#2. Does HIPAA 5010 or ANSI 5010 relate to ICD 10? What is ICD10?
The new 5010 standards are phase I and serve as a foundation to support the soon to be implemented ICD-10 CM and PCS diagnosis code set. ICD 10 compliance is October 1, 2013. The current ICD 9 diagnosis coding system will expand from 17,000 to 140,000 codes with ICD10. Our billing and coding specialist Vanessa Best has received certification and credentialing through AHIMA Academy for ICD-10 and has received the designation from AHIMA(American Health Information Management Association) as ICD-10-CM/PCS Trainer. Check Events at www.precisionhcc.com for 5010 seminars to prepare for ICD 10.

#3. Can my clearinghouse map or upgrade my claims from ANSI 4010 to ANSI 5010?
There are new field requirements that can’t be upgraded. If your current medical billing software does not have these fields, you will have to manually log onto a clearinghouse portal and manually edit each and every claim submitted!

#4. What changes do I need in my medical billing software or medical billing service?
Your practice must use the current ANSI 5010 complaint version. As an example, let us examine the medical billing software program by McKesson – Medisoft Version 17. Medisoft medical billing software incorporates the following new fields:
a. Patient Race
b. Patient Ethnicity
c. Patient Language
If you are using an older version of your medical billing software, for example Medisoft Version 16 medical billing software the key fields do not exist so your claim file will not be complaint. There are many other new fields that are required for 5010 compliance.

#5. What Do I Do Now to Ensure 5010 Compliance and Prepare?

Test Your ANSI 5010 Transaction Sets. Learn More.

Attend Our Next Webinar and Receive 2.5 CEU thru AAPC . Learn from our medical billing specialist and Certified ICD-10 CM/PCS AHIMA Trainer Vanessa Best CCS-P, CPC. Click Here for Upcoming 5010 Coding Seminars.

Achieve 5010 Compliance today!

How to Jumpstart A Medical Billing Business

Vanessa Best — Tue, 29 Nov 2011 16:06:38 +0000

Jumpstart Medical Billing

Thinking about starting a business? Wish you were self-employed? The medical billing industry needs you.

What is medical billing?

Just as with any business, keeping accounts straight and up-to-date, from the time a patient is treated through receipt of payment, brings in the money to keep things going. Medical billing specialists “bird-dog” the process from start to finish, to ensure claims are complete and accurate, submitted quickly and payments are collected on time.

It’s a significant aspect of running any medical office, clinic, hospital or health insurance company.

1. Consider the opportunity.

This is detailed work. Each diagnosis and procedure is part of a vast numerical coding system on which billing is based. Medical professionals don’t have time to do this, let alone keep up with ongoing coding and billing changes.

It’s far more cost-effective for them to outsource this important work to skilled medical billing specialists. Demand is high because healthcare is one of the country’s top growth industries. People will always get sick or injured, and our population is aging. Industry watchers report annual spending could rise to $4 trillion by 2015, twice as much as in 2006.

This is definitely not a “tapped out” field.

Armed with proper tools, knowledge and desire, you can become a medical billing specialist, creating a significant small business and the success to control your financial future.

2. Consider the benefits.

You can:

Work from home, setting your own hours and saving save time and money on commuting. Work can be ongoing or project-based according to your time commitment and earnings needs.
Or work within a larger established organization.
Save on overhead, with just a quiet space, computer and special medical billing software.
Learn quickly – even online — to get started, then take advantage of continuing education to get a degree or certification to enhance earning potential.
As the nation moves toward a more technologically advanced health care system, the Office of the National Coordinator for Health Information Technology (ONC) has funded the Health IT Workforce Development Program. Read More…

Medical billing is less physically demanding that many healthcare jobs, but you’re still helping patients as well as providers.

3. Take action.

If you’re serious about starting a new career and you like challenging work with a real purpose, medical billing could be the future you’ve dreamed about.

This is the real deal. It’s not easy money, but it’s a genuine opportunity to start a needed business in a growing segment of our economy, where the potential is limited only by your desire to succeed. You do the work, and you will enjoy the rewards.

“Get the Free Video – 5 Things You Need to Do To Start A Medical Billing Business”

Get The E-Book

First Women in Business Summit: Making Dollars and Sense

Vanessa Best — Fri, 21 Oct 2011 14:50:49 +0000

The future of healthcare is changing and doctors need skilled professionals help navigate the business of ANSI 5010, ICD 10, Electronic Health Records, E-Prescribing. Vanessa Best, Principal of Precision was invited to participate in the 1st Annual Women in Business Economic Empowerment Summit in NYC.

Precision Chosen By Allscripts as Select Partner

Vanessa Best — Thu, 16 Jun 2011 12:35:53 +0000

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Precision Selected as Part of Senator Gillibrand Small Business Working Group

Vanessa Best — Tue, 22 Mar 2011 10:10:59 +0000

Vanessa Best, CEO of Precision HealthCare Consultants was invited to a meeting of Senator Kirsten Gillibrand’s Small Business Working Group. “To have been invited twice was amazing! I had the privilege of meeting Small Business Owners from NYC and Long Island from all sectors including finance, security services, transportation services, fine art galleries, tutoring services, the food industry, eco cleaning services and health care. The last meeting on March 15, 2011, included representatives from the IRS, SBA and several Chamber of Commerce Center’s”

The US SBA Regional Advocate was the guest speaker and legislative updates were provided and items such as the Small Business Jobs Act Implementation was discussed.

Invited members of the group were very willing to share their experiences and challenges of growing their business in New York. The Chair of Sen. Kirsten Gillibrand’s Small Business Working Group and The Director of Economic Development and Transportation, Office of Sen. Kirsten Gillibrand were very interested in working on solutions to continue to help small businesses in New York.