When submitting professional claims to Medicare part B, there are some things that Medicare requires that differ from other insurance carriers. If you do not follow these guidelines or rules, you will find that your claims will be rejected.

First of all, most Medicare carriers are requiring that claims be submitted electronically, even if Medicare is secondary. If you are not capable of submitting your claims electronically you can apply for a waiver. An office with less than 10 full time employees can obtain a waiver granting them permission to file on paper. The CMS requires you to obtain a waiver certificate "demonstrating extraordinary circumstances". If accepted by Medicare, they can then file claims on paper. If you do not qualify for the waiver then you must find a method to submit your claims electronically.

If your software is not capable of electronic billing, which in this day and age would be unusual, or if you just do not want to go thru the expense or trouble, you can get a free software from your Medicare carrier. The biggest problem with using the free software is that it many times is cumbersome to use, and it requires double entry of the claims. However, if you do not submit a lot of Medicare claims it can be a viable option.

Another little quirk with Medicare is that they require you to enter the word "none" in box 11 (or the equivalent of box 11 if submitting electronically) on the CMS 1500 form. We have had many providers over the years contact us because "Medicare won't pay!" when it was all just because they didn't have the "none" in box 11.

Whenever we train a new employee that is one of the things we try to drill into their head! "Don't forget the 'NONE'!" There is nothing more annoying to me than getting a rejection to find that the only problem is that 'none' was missing. We are working with a company who is building a rules engine to prevent problems like this from getting thru. The claims scrubber will alert you to the missing word before you submit the claims!

Then of course there are the modifiers required only by Medicare such as the AT modifier for chiropractors or the GP modifier for physical therapists. These modifiers are not used by any of the other carriers, but without them Medicare will not pay.

Another thing Medicare requires is referring dr name and NPI number for simple in office services such as EKG's. So if one of my doctors decides to do an EKG on one of his patients, I have to put HIS name and NPI number in as the referring doctor, even though he provided the service. Seems kind of ridiculous to submit a claim for Dr. Smith doing an EKG where Dr. Smith referred the patient to himself. But if I don't put it in, the EKG is denied.

Another Medicare quirk is that many Medicare carriers (maybe all) require that you do not put the NPI number in box 24J if you are filing a claim for an individual provider who bills using just their individual NPI number. When the NPI number is in 24J for an individual provider, the claims are rejected. However, if you are filing a claim for a group, the individual NPI # must be listed in 24J and the group NPI# must be listed in box 33A.

When a claim is denied by Medicare or any other carrier, it is important to identify why the claim, or service, was denied. If the denial on the eob is not clear, call to get an explanation. If you do not agree with the reason for the denial ask what the process for appealing the denial is. If the claim was denied for something simple that you can fix easily, make the correction and resubmit the claim. If you do not understand the denial even after getting an explanation from a customer service rep, you can always Google it, or post a question on a good medical billing forum. The important thing is to take care of the denial and not to ignore it.





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

Recently the state of Minnesota mandated that all medical claims are sent electronically by July 15, 2009. If you are not from Minnesota, you may not feel that this affects you, but it does. It affects us all.

Costs are definitely cut down with electronic billing. Both insurance companies and the government would like to see all claims sent electronically. If Minnesota is effective with instituting the electronic mandate, you can be sure that other states will follow. It is just a matter of time.

A very small percentage of medical offices or billing services are capable of sending all their claims electronically. Many small insurance carriers are not yet capable of accepting claims electronically. So how will we accomplish this major undertaking? The real question is how will this affect the individual providers and billing services.

The providers in the state of Minnesota will have to at the very least have a computer with internet access in the office or they will have to hire someone who can submit the claims on their behalf. Don't laugh! We still find offices that don't have a computer. They won't have to purchase an expensive practice management system if they don't want to. They may have a good way of tracking their claims on paper but hopefully they are tracking claims. Anyone who has been in this business for any length of time knows of the office that looses thousands of dollars or tens of thousands of dollars by not tracking claims to make sure they are paid.

The Trade Association of State HMO's (The Minnesota Council of Health Plans) has contracted with an independent company who is building the software that will be available to medical offices and billing services in the state of Mn. to submit the claims online. The biller will go to the site and enter the claim information and send it to the insurance company. The only problem with this is that the information will have to be entered again for tracking purposes. If the office has a practice management system, any claims that had to be sent through this new system will also have to be entered into the practice management system.

We don't know how this affects the smaller insurance companies in Minnesota who were not yet capable of receiving electronic claims submissions. I presume they are scrambling to get ready. Not only has Minnesota mandated that medical insurance claims be submitted electronically, but they have also mandated that all insurance carriers use ERAs or electronic remittance advices (electronic eobs). This is huge too. Electronic remittances make posting payments much quicker and easier if you have the means to post them automatically.

At any rate, it will be very interesting to see how this all works out. All eyes are on Minnesota. We would be interested in hearing from anyone in Minnesota and how it is affecting them.



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

Traditionally, young chiropractors have three options when they enter the chiropractic profession. They can associate with another doctor in hopes of learning how to run their own practice; they can independent-contract (that is rent office space from another chiropractor and use their office staff while they try to build a practice); or they can try to open their own office upon graduation from chiropractic school. The overwhelming majority of young doctors will choose to associate for a time because they lack the knowledge and skills in the areas of billing, compliance, and record-keeping. Chiropractic schools do a good job of preparing young chiropractors on how to provide quality care for their patients, but unfortunately they do not teach the students on how to run a profitable practice.

What many new chiropractors do not realize is that they can open their own practice immediately because there is very useful billing and practice management software available that makes billing, compliance, and record-keeping a snap. The software is designed by chiropractors to make the transition from school into practice as smooth as possible. Chiropractic billing software will guide the new doctor through the entire process. It's like having a practice management group and a billing department in your office as soon as you open your doors.

The software allows you to: finish SOAP notes before the patient gets off the table, perform electronic scheduling and monitor missed patient visits, bill insurance companies at each visit, and use the most recent compliance information to help avoid insurance audits. And new doctors especially, are susceptible to accidental insurance fraud because they are still learning the process. Billing software helps eliminate this concern because it is the new "gold-standard" in transparency. Off-site billing companies are using web based systems that allow the doctor to enter claims directly into the system at the end of each patient visit. These paperless systems allow the doctor to track claims and see how the insurance company is handling the claims as they are being processed. This results in total transparency and eliminates confusing monthly or bi-monthly reports. Thus, the doctor can provide outstanding patient care to build the foundation for the practice of their dreams without the headaches of paperwork and collections.

Unfortunately, many young chiropractors think that their only option is to go and work for another doctor until they "learn the ropes" of the profession. This is simply not true anymore. With the arrival of chiropractic billing systems, doors for recent grads are being opened like never before. Why learn the hard way when there are systems out there that can help you avoid all of the bumps in the road that were previously inevitable?




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