Medicare requires that you complete specific forms put out by CMS when applying to become a Medicare provider. Sounds easy enough but have you seen the list of forms that they have? How are you suppose to know the correct form to complete and once you figure that out, what fields on the form do you need to fill out?

If you are a solo provider, can you bill under a tax ID number (EIN number) or do you have to use your social security number? Is it necessary if you use a tax ID number to apply for a group Medicare number? And why would you need to reassign benefits to yourself?

Well it's really not as complicated as it seems. If you are a solo provider and you are using your social security number for your tax ID number then you need to complete an 855I, 588 EFT, and a CMS 460. The CMS 460 is the participating provider agreement. You only need to complete this if you choose to be a participating Medicare provider. The 588 EFT is the Electronic Funds Transfer form. Medicare requires that you accept EFT and they will transfer your payments directly into your bank account. The 855I is the individual provider application.

If you are a solo provider who is going to bill under a tax ID number but you are a sole proprietor you also would need to complete the 855I, 588 EFT and the CMS 460.

When applying for a group, you will need to complete an 855B, an 855I for each provider in the group, an 855R for each provider in the group, a 588 EFT, and a CMS 460. The 855B is the group application and the 855R is to reassign the benefits of each provider to the group. If you are a solo provider but you have formed a corporation, you need to apply for a group application for the corporation.

The forms are available on the internet. You must complete the appropriate forms and send them in to the Medicare carrier for your area. It is crucial that you complete the forms correctly to avoid delays. If your application is not completed completely or correctly the carrier will request the additional or corrected information from you. If you do not respond or respond timely your application may be closed.



Article Source: http://EzineArticles.com/?expert=Michele_Redmond

Tomorrow I am going to one of our new practices. It is an Urgent Care facility. I have a couple of tasks to perform and look forward to the time I will be there.

My first task is to discuss the S9083 Urgent Care Global code. When we took over this practice we found a lot of EOBs rejecting the code and a good many with other anomalies regarding the use of S9083. The medical billing personnel handling the claims before we took over, did not have a grasp for this type of facility. Primarily, for this practice, Aetna is the only company using the global code although they have contracts that state otherwise. When a patient came into the practice and utilized several services, their medical billing would use a line item for each service. For example, say the patient had lower back pain, so along with the E&M code they did a urinalysis and a lower back x-ray.

Now for a regular office visit we would have three separate charge items, the E&M 9XXXX, the urinalysis 8XXXX, and the x-ray 7XXXX and that works fine. What the billing had done was to use the old strategy but replace the above three codes with S9083 and they created three line items of S9083. Unfortunately they charged different amounts for the same code. For the office visit they charged $100.00, for the urinalysis they charged $20.00 and for the x-ray they charged $75.00. Well insurance companies being insurance companies, naturally they paid for the $20.00 charge and claimed the other items are duplicate charges which from the standpoint of the procedure codes, they do appear to be.

The practice should have only charge the SXXXX code in place of the E&M (9XXXX) code and utilized the other codes as they were represented in the CPT list. They would have at least gotten the $100.00 allowed and likely had the CPT codes rejected. Unfortunately, they are now out $80.00 with little chance of recouping the difference. The filing limit has passed. It would be okay if this was an isolated incident but it was ongoing. At the least we will put an end to the loss from that standpoint.

In addition to the S9083 code there is an S9088 add on code. Although most companies may not recognize this code and pay it, at least we should be asking for it. If we don't ask we will not get. So for those companies that accept the CPT codes rather than the HCPCS global code we will attempt to get some additional revenues by using the add on code. In addition, the practice needs input on when to refer the patient to ER and when to keep the patient in-house. Remember, the S9083 code is only generating $100.00 in practice revenues. It cannot therefore afford to spend a lot of its resources on patients that need greater services. These should be considered emergent care and not urgent care. There is a difference!

I am looking forward to helping this practice get a handle on the coding process and generate positive revenues.



Article Source: http://EzineArticles.com/?expert=Nat_Wynn

Have you ever fully assessed the total cost of what it takes for you to get your medical billing done? Likely as not you haven't. Most practices simply think that those costs comprise just the cost of the labor to key in the data. On the surface that could seem correct but nothing could be further from the truth.

Every day you key your own data, your software gets more obsolete. At some point it has to be replaced. That cost has to be incorporated into the formula. The same is true for your hardware. It has to be replaced and before it is replaced there are costs associated with maintaining it and with repairing it during its useful life. The office area set aside to operate your medical billing is also part of that overhead as well as your matching costs for social security, Medicare, unemployment insurance, and other general employee benefits which include but are not limited to vacation time, sick leave, and more. In addition, you have clearing house fees, ongoing software fees, postage for claims and patient statements, envelopes, cost of HCFAs and more. If you have a medical billing person, you are probably paying at least $10.00 per hour. That fee over a month's time equals $1720.00 based on the average of 4.3 weeks in a month. Add to that the matching benefits listed above and that almost equals another $170.00 for a total of $1890.00 per month just for the employee. Again this does not include any of the other overheads mentioned, but all of those figures pale in comparison to the true losses incurred by the practice during the month.

If you have a small practice that collects only $30,000.00 per month, odds are great that at least 10% of your revenues are being written off without your knowledge. That's $3000.00 per month--$36,000.00 per year! And that is in addition to the fees listed above. Your costs are now up to $4890.00 per month still not counting all of those other costs. In addition, you have paid up front for that employee.

If you had a medical billing company doing that work for you and they collected that same $30,000.00 at an average rate of 8%, your out of pocket would only be $2400.00! That is half of what you are paying now. And I guarantee that a competent medical billing company will be collecting that other $3000.00 your office failed to collect because they want that extra $240.00 and even after considering that it comes out as if they are actually paying you $460.00 just for the privilege of collecting your money for you. Your net revenues doing the work yourself was $28,110.00 and after farming it out it goes up to $30,360.00. A net increase of $2,250.00 not to mention the other associated costs and the stress on you of trying to see that the work gets done. Do yourself a favor and do the math.



Article Source: http://EzineArticles.com/?expert=Nat_Wynn

How do most of your health claims travel? Are they still going by paper? How can you track that system? With few exceptions, our claims all go by an electronic method. Most go directly from us to the payer, but a few filter through a clearing house.

Early this week, WellCare alleged that some 27 claims that were dropped out of our system on September 2nd were not on file in their system. Had we sent those claims by paper there would be little we could do. These are recent claims so if they had gone by paper, we could get them back out the door. Fortunately for us though they did not go on paper. Wednesday I had my IT pull the report for that day's drop (it is transmitted back to us the next day). When we reviewed the report, low and behold, all 27 claims were listed as accepted by WellCare and gave a batch number for the claims as well as a tracking number for each claim. The review itself is just as easy. Once the file is located, a quick easy search using the software looking for that specific provider instantly located the claims in 29 pages of report. These tools simply are not available using paper.

Regardless of the outcome, we are able to demonstrate that the claims were sent, and that WellCare received our claims. The medical billing people have done their job.

How good is your office about tracking claims? If you do not have a system in place for keeping up with when the claims went out, when they were received and who got them, you are wasting valuable resources. Take advantage of all the resources available to you. Teach your staff to work smarter, learn to use the system to your advantage rather than allow the insurance company to hoodwink you.


Article Source: http://EzineArticles.com/?expert=Nat_Wynn

A well designed medical billing process does not allow errors to propagate. This design tenant results in less effort required to collect payments and payments arriving much faster. One of the most important manifestations of this concept is insuring that claims are clean before they are submitted to payers.

Implementing a process that submits clean claims can lead to days in AR of less than 45.

If claims are indeed submitted clean, then over 90% can be paid after the first submission. This leaves a much smaller number of "real" issues for the medical billing staff to pursue. By eliminating avoidable errors, collections accelerate and increase (since in many billing offices there is no time to perform basic tasks like no response calls). A key tool in realizing these improvements is a claim scrubber. These scrubbers, which are used by all leading medical billing services, compare claims to the rules utilized by payers to decide if a claim will be paid. These scrubbers include:

* A Basic Demographic scrubber. Such a scrubber insures that the basic elements of the claims are in place (for example, a 9 digit social security number that is not composed of repeating numbers, a valid date of birth, etc),
* Coding and Diagnosis Scrubber. This scrubber looks for ICD-9/CPT mismatches based upon Medicare and CCI rules. The rules not only identify sources of denials, but also identify overlooked CPTs.

These scrubbers will lead to a marked improvement versus a billing process with no scrubbing; they are, however, not a complete scrubbing solution. A full solution requires a scrubber that can have a customized rule set that takes the knowledge of the billing company or medical practices and codifies it so that it can be applied to every claim before submission. This scrubber is:

* Knowledge Management Scrubbers that allow the medical billing operation to continually reevaluate the adjudication rules of each payer and update the rules accordingly. The proper implementation of the scrubber requires a clear feedback loop from the follow-up department to the scrubber so that the lessons learned from denied claims can be quickly incorporated in to the scrubber. Any top notch medical billing service utilizes a scrubber like this.

Medical Practices will see a significant improvement in both the speed and the magnitude of collections if the begin using the scrubbers outlined above. With all of the technology payers employ to minimize the amount they pay to providers, it is difficult to survive without utilizing these scrubbers.



Article Source: http://EzineArticles.com/?expert=Carl_Mays_II

In September, the Chiropractic Office Billing Precision Index (BPI) gained 2 points above its August mark. Overall, September BPI reached 21.2 under-performing the national average of 17.7 by 3.5, and 5.7 points away from its best record of 15.5 in March of 2008.

Keeping one hundred percent of its August membership unchanged, three members of the September index, changed positions. Specifically, while BCBS Illinois and CIGNA retained their top first and second positions respectively, Medicare Illinois and Blue Cross Blue Shield New Jersey each upgraded their positions, pushing United Healthcare down two levels to the fifth position.

Billing Precision Index 21.2 - September 2008

1. Blue Cross Blue Shield Illinois 7
2. CIGNA 13.6
3. Medicare Illinois 13.8 (up from #4)
4. Blue Cross Blue Shield New Jersey 14.6 (up from #5)
5. United Healthcare 16.27 (dropped from #3)
6. Aetna 22.1
7. Medicare New Jersey 28.9
8. Blue Cross Blue Shield South Carolina 40
9. Medicare South Carolina 49
10. Medicare Indiana 62

BPI = 21.2 means that the average of ten top performing payers, used by the patients of Billing Precision providers, reached 21.2% of Accounts Receivable beyond 120 days.

Note that an insurer can turn a profit even if the cost of administration and insurance claims exceeds the premiums it collects. It does so by investing income on the float in stocks and bonds between the time when a client pays a premium and the time when the client needs payment for his or her medical expenses. For instance, Aetna (number six on BPI of September 2008), taking advantage of the float, earned about 7% net interest income on the premiums, bringing its total profit margin to around 14% (ignoring taxes and other revenue sources).

BPI is one of the few important billing performance characteristics because it approximates the proportion of claims that are never paid. It is also a key billing transparency instrument, which allows the practice owner to see both the big picture of office billing and its position within the national average.


Article Source: http://EzineArticles.com/?expert=Yuval_Lirov

How efficient are you in your claims processing. How many providers are in your office? How many billing clerks do you have?

In our office we know that one medical billing clerk can easily handle the paper work of up to ten providers. If you have three billing clerks, do you have thirty providers? If your ratio is not as good, likely as not you are buried in bureaucracy. I go into office after office and see it. The management (physicians) is led to believe the work just cannot be done with any less employees. The truth is a completely different story. The more employees the less efficient the office will be.

The adage that if you have one person in an office you have one interruption an hour and if you have two people in an office you have four interruptions an hour and three you have nine interruptions really holds true in the medical profession. You have to wonder what work is keeping them so busy. I see billing clerks with their desks piled high and it stays that way; day after day, week after week.

We set them up to scan documents to us. Everything is automatic. They simply load fifteen or twenty sheets into the document feeder, push the little green button and the machine does all the rest yet they do not seem to even have time to do that. When questioned, there is a litany of excuses as to why, but none seem to be related to assigned tasks.

In so many cases it is the socialization that stands in the way. Do yourself a favor, exam your staff and cut out the dead weight. If you have someone who is really busy, they can get the work done but if you have someone who does not stay busy, they are never able to even keep up.



Article Source: http://EzineArticles.com/?expert=Nat_Wynn