Huge Changes Ahead for Medical Billing

Something has been developing in the world of medical billing that is going to change the whole process of submitting medical insurance claims to the insurance companies in a big way. We who are immersed in the field are used to changes. Codes are always changing. We all had to get used to obtaining and the correct use of NPI numbers. Now insurance companies are telling us that we will be required to use taxonomy codes. Universal credentialing is now required by many insurance companies. But these are all small in comparison to what we will soon be seeing.

As technology develops changes are unavoidable. Often it seems as if the new technology only makes things more complicated and more expensive. Changes such as NPI numbers require new software updates which can be quite costly. As it is, a good medical billing software package can cost thousands or tens of thousands of dollars for the initial purchase. Generally a new version comes out every year requiring the additional expense of updating the software. For a small doctor’s office or a new medical billing service this expense can be out of the question. This is one of the reasons we see so many doctors joining groups directly out of school instead of opening their own practices. It is just too costly to set up their own offices.

Now we see a change coming which can turn the world upside down for the small medical office and medical billing services. SaaS technology has brought about the ability for the little guy to compete with the big boys at not only an affordable price, but a money saving plan.

The development of web based medical billing software over recent years has really changed the work flow process in the offices that could afford it. One advantage of web based software is that it has added features which eliminate the tedious work of running aging reports. Claim status can be checked automatically on a daily basis with problem claims being routed to a queue. Payments of insurance claims can be posted electronically eliminating hours of tedious data entry. And these are just two of many major time saving advantages. The big disadvantage was the cost. Web based software is generally extremely expensive. But that was before SaaS.

Software as a service (SaaS) has allowed a company to emerge which offers the same benefits of web based software for a fraction of the cost. Now for $99 a month per seat a doctor’s office can enjoy the benefits of web based software with no up front costs. The cost to a medical billing service with unlimited providers is $149 per month per user. This is much less than the cost to most offices of updating their server based software and paying for support.

The benefits of web based software are obvious but up until now the cost wasn’t justified. Now, due to SaaS, any office can enjoy all the benefits at a fraction of the cost of other web based software. For more information on Xena Health and the SaaS technology, you can contact Alice or Michele at 1-800-490-4299.

Did You Think Web Based Software Was Too Expensive?

There have been a lot of changes in Medical Billing Software, in the last few years, but one of the biggest changes is the popularity of web based software. There are so many advantages over the traditional practice management systems that many offices are changing over. In the past the biggest problem with the web based programs was the expense.

But now instead of spending thousands or tens of thousands of dollars on a web based system, there is a company introducing an advanced system at a very low subscription cost.

The company is called Xena Health and they are currently looking for some input and possibly even people for the beta testing of the software. If you are interested in finding out more, please complete this short survey and Maggs or Rob will explain more about it.

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What’s Happening at Medicare?

We used to hear others complain about Medicare and how they would not pay the claims right and how slow they could be and all these other problems they had with Medicare and we always disagreed. We always found Medicare to be quite straight forward and predictable.
That was until Sept 1, 2008 when it seems many Medicare offices changed carriers. We offer credentialing services to medical providers, so we are dealing with Medicare offices all over the country and have found a few areas where this transition didn’t go smoothly at all and our local carrier is one of them.
Under our old Medicare carrier you knew exactly what to expect. If you submitted claims electronically, payment would come in 14 days, 28 days on paper. When something was denied you would call customer service and they would explain to you exactly what was wrong and what you had to do to correct it. Now claims get “hung up in the system” for unexplainable reasons and for indefinite periods of time. Now when we get a denial that is completely wrong or unexplainable, we call customer service and they can’t answer any questions. They only refer you to the remit.
Now when claims are not paid on time or are denied incorrectly, there is little recourse for the provider. We expected things to get better over time but it has been five months since the transition and things are still completely tumultuous. We feel that it is time to contact our local congressman.

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3 Key Things to do When a Dr Changes Practices

Many problems that we see practices or providers run into is when a doctor decides to change practices. They don’t realize what needs to be done to make sure payment for their services is made to the new practice. There are 3 key things that need to be done when doctors switch practices.

First, all insurance carriers need to be contacted to make the necessary changes. If the provider is leaving a practice where all of the benefits for their services were assigned (or paid) to the group they belonged to then they need to notify the insurance carriers that they are leaving that group.

If they are joining a new group, or forming their own practice they need to notify the insurance carrier of that as well. They want to make sure their services are going to be paid to the appropriate practice.

Each carrier has different requirements or forms that they need completed in order to do this. It is important that the correct paperwork is done. You can’t just send out a blanket letter and expect that to work.

For example, a provider called me the other day to say that he had recently started his own practice but he wasn’t getting any payments from Medicare. I asked if they had notified Medicare of his change. He said he had sent a letter. Well that doesn’t work for Medicare. You must complete a CMS 855I form to make changes to an individual provider number. Even if you just move to another suite in the same building.

Bottom line, the first thing you need to do is to make sure your services are going to be paid to the correct place.

Second, you need to make sure that your practice address is updated. This is usually done at the same time you are updating the payment information. The forms required to be submitted also ask for the new practice address and other info (phone, fax, etc.). It is important though that you make sure the address the insurance carrier has on file for you is accurate.

Third, you need to contact NPPES and update your information on the NPI enumerator’s system. If you have your login information you can simply log in and make the changes yourself. If you don’t you will want to call NPPES and get your login info so that you have access to it. You will want to keep your information associated with your NPI number current.

So, if a provider is planning on changing practices and they want to ensure a smooth transition, they will have a better chance if they make sure these 3 things are done prior to the change, or at least as soon as possible

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Counting Keystrokes

I’ve been noticing something lately that I hadn’t really considered much in the past. I’ve been counting keystrokes. Why would anyone in their right mind count keystrokes? Well, we have really been working diligently lately at getting systems in place that improve our efficiency and counting keystrokes became an issue.

We’ve used Lytec software for 15 years now and found it to be very user friendly and capable. We are billing for 60 providers with it. Last summer we started looking at web based software to see what all the excitement is about. I guess what really got us interested in the web based software was when we had an account that wanted to hire us if we used a web based software. They asked us to call if we ever change over to a web based software.

What’s that got to do with counting keystrokes? Plenty.

When we looked into web based medical billing software, we realized how much more efficient billing can be than the way we have been doing it for 15 years. The advantages of some web based programs are so great that they could cut our data entry time in half.

Here is an example. Years ago we used to print each claim that was going to go out on paper as we entered the claim. Then we would send the electronic claims. One day Michele had a stroke of brilliance and realized how many keystrokes it saved to change the process. If we sent the electronic claims first and then printed the rest of the claims it saved literally hundreds of keystrokes on an average account. Instead of printing each claim individually, she printed the batch with the same number of keystrokes that it took to send a single claim. To print a claim in Lytec (or a batch of claims) we go through as many as five screens and use eight keystrokes. When you multiply that times maybe 25 paper claims you see the wasted effort.

Then in our search for an affordable web based software we found a company that could make processes such as printing much simpler. Many activities that took several steps with other software were combined into one simple click to accomplish. These simple changes made a tremendous difference in our productivity and efficiency. We would advise anyone looking into purchasing a new practice management system to consider looking at a web based system. Many are extremely costly, especially for a medical billing service, but the one we found is not only affordable but has much more advanced capabilities than most of the others. For more information, complete this short survey and Maggs or Rob will give you more information.

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To visit our forum to view questions, post questions, or answer questions on medical billing visit Medical Billing Live

Medicare problems

I wonder if other billers are running into the same problems we are with Medicare. For the fifteen years we have been doing medical billing we found Medicare to be one of the most straightforward reliable insurance payors. They have their rules to follow, but if you followed them, the rest was easy. On September 1, 2008 many Medicare offices changed carriers and that’s when our problems started.

It wasn’t just our local Medicare either. One of our services is obtaining Medicare credentialing for other providers so we are contacting different Medicare carriers all over the country. In September we found that we couldn’t even get through on the phone to many carriers. We could continually hit redial or wait on hold with music playing all day and never get to a representative. It took us days to get the mailing address for one Medicare carrier just to mail in the application.

Some providers are calling us looking for help as they applied for Medicare credentialing months ago and still haven’t heard anything. We worked with one provider for over two weeks trying to help him find the status of his application and neither one of us was ever able to get through to a representative. We don’t know if he ever did learn if he was credentialed or not.

One of the problems we encountered with our local Medicare was denials on claims for bogus reasons. We would call and ask what this was all about and were told that it is an internal problem they are working on. Well here it is, almost the beginning of February and we still are having trouble getting some of these claims paid. They still haven’t worked out their internal problems. If our internal problems lasted this long, we wouldn’t have any clients left.

Our most recent problem with Medicare claims are for a specialty where the patient is returning regularly for the same service. Now Medicare is paying at a much lower rate. When we called to inquire, no one could give us an answer. They could not answer one question. It was like they took people off the street and told them to answer phones with absolutely no training. We were told to call ‘telephone reopening’. When we asked why we were asking for the claim to be reopened, they couldn’t tell us. They couldn’t even say if telephone reopening would reprocess the claim. So is this provider just supposed to accept this lower rate now?

What happened to our old reliable Medicare?

I hope not Gone Forever!

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To visit our forum to view questions, post questions, or answer questions on medical billing visit Medical Billing Live

Looking for work as a medical biller

I got an email this weekend from someone asking how to find a job in medical billing now that she has finished school and graduated with honors.  I told her that I would give her the same advice I just gave my grandson who is looking for a new job.

Yes, it’s a tough economy now.  Many businesses are laying off.  But there are a few jobs available.  There are new doctors getting started who need help.  There are people retiring in doctors offices.  There are offices expanding.  There are a few jobs out there.  There may be ten people looking for one job (or even more than ten) but one person will be hired for the job.  Make sure you present yourself as that person.  Be the person that doctor or hospital wants to hire.  Get your resumes’ out there.  Call the employers and check to make sure they got the resume and ask if they will consider you for a job.  Make sure your resume is good.  Get help if you need it.  Call all the billing services in your area and ask if they are hiring.  Keep your ears open to any news from any doctor’s offices about anyone leaving.  Be serious about looking for the job.  Your job while you are looking is to look for a job every day.

It is a tough economy right now. We are all being touched by it. We would much rather be enjoying a healthy, growing economy, but that’s not the reality now.

Filing Secondary and Tertiary Insurance Claims

When we first started our medical billing business in 1994 I had no previous experience at billing any medical claims, let alone secondary and tertiary. (You mean some people have 3 insurances?) I knew nothing. In fourteen years of billing I’ve learned quite a bit and I see from questions in our forum that many beginners do not understand secondary and tertiary claims billing at all.

First of all, how does anyone get two or three policies and which is determined primary? If a husband and a wife both work (who doesn’t?) and they are both covered by health insurance by their employers, they may both have family policies so they are both covered under each others plan. One would be primary and the other secondary. Now if one of this couple (a few years ago we would have assumed that it would only be the husband) had previous military experience and carried over their Tricare military insurance, that would be the third payor (if there was a balance left).

Which company is primary and which one is secondary is determined by one of a couple different methods. First of all, if a person is working and they carry insurance, that insurance is primary (unless they have Medicare and their employer has less than 100 employees). If a person is retired and has Medicare but the spouse works and carries a family policy, then the spouse’s plan would be primary and the Medicare would be secondary.

There is no way to cover every scenario but basically whether or not the person or the spouse is working can determine the order. For dependants (usually children) some go by the “birthday rule” meaning that whichever parents birthday falls first in the year is primary. Of course with all of the divorce out there sometimes the order of insurance is determined by a court order.

When a patient is seen by a provider the claim is sent on a CMS 1500 form to the primary insurance carrier either electronically or on paper. Electronically it can be sent either directly to the insurance carrier by special software or through a service or through a clearing house. When sent on paper it simple means the claim is printed to a paper CMS 1500 form and sent through the mail. Whatever the case is, it is important that you know the order of the policies.

Once the primary insurance carrier pays their share of the claim it is then submitted to the secondary insurance company if the patient has one. Secondary claims can also be sent electronically and on paper. Medicare is mandating electronic submissions even on secondary claims. When submitted electronically all the information from the eob (explanation of benefits) is entered into the claim information and submitted to the secondary insurance carrier.

When the secondary is submitted on paper, the claim is printed out again on a cms form and a photocopy of the eob is attached. If other patients are listed on the eob, their personal information should be hidden. Many offices use black markers (we call them smelly pens) to draw through the unwanted information. I’ve set up a bunch of various width strips of white cardboard that we slide into clear report covers to cover the unwanted information before we photocopy. We only do this with companies that are not yet accepting electronic submissions.

If there is still a balance after the secondary insurance carrier pays their share, the claim is sent on to the third carrier. It is printed out again on a cms form and copies of the eobs of both the primary and the secondary insurance carriers are attached.

Whenever you send secondary and tertiary claims on paper, make sure the photocopies you attach are clear, easy to read, and for the correct date of service. Many insurance carriers scan the eobs which lightens them a little. If the copy you submitted was already light, by the time the claim is processed it may be sent back to you as unreadable. It takes a lot more time to find the original eob and resubmit a claim than it does to get it right the first time.

Secondary and tertiary claims can sometimes seem like a pain to get paid – especially because they can be for a very small amount of money. It is still important to file and track these claims to keep your receivables under control. It may not seem like a lot of money but it adds up. If you have a system for submitting them it really isn’t that bad.

Here are more articles we’ve written about various aspects of medical billing.

Taxonomy Codes – Why They Are Important

What the heck is a taxonomy code and why is it important? Taxonomy Codes are an administrative code set for identifying the provider type and area of specialization for health care providers. They are alphanumeric and are ten characters in length. Taxonomy codes allow providers to identify their specialty. A provider can have more than one taxonomy code.

Taxonomy Codes have 3 distinct levels. Level I is the provider type which is a
major grouping of health care providers. For example: Dentists, Osteopathic Physicians, and Chiropractors.

Level II is Classification or a more specific service or occupation related to the provider type.

Level III is the Area of Specialization. This is a more specialized area of the classification in which a provider chooses to practice or make services available. This is usually based upon the sub-specialty certificate.

Taxonomy Codes allow the provider to identify their specialty at the claim level so this can directly affect your reimbursement from insurance companies. If you have an inaccurate taxonomy code linked to your NPI number then your services may be paid at a lower reimbursement rate, or outright denied by an insurance company.

For Example: If you are a Pediatric Surgeon and you pick a taxonomy code for just straight Pediatrics, your services may be denied. You would need to pick the more specific code of Pediatric Surgeon (at Level III) in order to ensure proper reimbursement for your services.

If you have more than one specialty you can pick more than one taxonomy code. In the NPI system if you have more than one taxonomy code you do have to indicate which one is primary.

Insurance carriers are going to start to request (then require) that you have the taxonomy code on claims when they are submitted. They are going to be in box 33b on the CMS 1500 form. If a provider has more than one specialty it will be important that they put the appropriate taxonomy code for the service they are billing for on the claim.

For Example: I have a provider who is a DO and does osteopathic manipulation. He is also certified for treating drug addiction. This may seem like a strange combination, but it is actually genius. People who are addicted to Oxycodone were prescribed the drug due to pain. Now they are addicted and need to be treated for the addiction, but many still have the pain. He can treat their drug addiction, and also relieve their pain with osteopathic manipulation.

Ok, I got a little off track. The point is, if he is billing for services that are treating the drug addiction, then he should have the taxonomy code for the addiction medicine on the claim. If he is billing for the osteopathic services, then the taxonomy code for osteopathic medicine should be on the claim.

Picking the correct taxonomy code is extremely important because it can directly affect your reimbursement by insurance companies. If you are not sure the correct taxonomy code is on file with NPPES (NPI system) then you should double check it. Better safe than sorry.

Here is a link to a web site that has a listing of taxonomy codes.

Free Medical Billing Newsletter Topics

We’re getting ready to release the January issue of our free monthly medical billing newsletter and here are the topics we are covering this month.

Billing at the Workers Comp Fee Schedule
Medical Billing as a Career
Filing Secondary and Tertiary Claims
What Are Taxonomy Codes and Why Are They Important

You will also find our forum question of the month and a helpful website listing the names and addresses of many many insurance companies. (I hate to say all insurance companies because they may have missed some, but it’s a great resource.)

You can sign up for our free monthly newsletter at Medical Billing Live.

You can also find many articles on medical billing on our informational website at Solutions Medical Billing.

Alice