Some times patient may not be able to pay full payment of co-pay dues,
co-insurance dues, Deductible dues or any balance mentioned by insurance.
They would be ready to pay their dues in installments i.e. monthly fixed payments. Making the patient to come under Budget Payment System for paying their dues in installments is called as Budget Payment.
AR people have to discuss with their Supervisors and as per their discussion, they need to put the patient into monthly installment payment schemes.
They should clearly state that this arrangement to minimize the patient’s
burden and patient should not stop any monthly payments to the Doctors
Office.
We need to keep those patients in a separate Bill Cycle or in separate credit
status and a Control Log to be maintained all relevant patient details. If the patient does not pay their dues properly , then we need to inform the patient that their accounts would be moved to Collection Agency.
Moving Patients to Collection Agency
If the patient does not make any payment for his dues and not giving proper response for the calls, not attending calls, always stating that patient is not in the station and refusing to pay dues, then Billing office would be sending two bills to the patient and after 60 days, if there is no response, then thepatient account would be moved to Collection Agency.
After identifying the patient accounts which are to be moved to Collection agency, an excel spread should be prepared and sent to US office for approval. Once approval is received from US Office, then the patient account can be moved to internal collection agency or external collection
Agency. This process should be followed at the time of each and every patient is to be moved to collection agency.
There may be an internal collection agency or an external collection agency.
Their main function is to trace the patient and compel the patient to pay the dues or inform the patient that they may have to face legal action.
Internal Collection Agency would be setup by Billing office itself and they would send letters to patient requesting them to pay or there may be a legal action against them. There would not be any percentage or any share for the internal collection agency if they collect money from
patient. But in External Collection Agency, if they get payment from patient, then they would get approximately 35% of the collected money. The percentage is varies from collection agency to collection agency.
Normally Billing Office may not have their own Collection Agency. Because collection agency require more man power, need to spend more time, need to have people in various places and need to spend more money for searching patients, etc. So most of the billing offices hire the External Collection Agency and handover their accounts to them.
After handing over the accounts to Collection Agency, patients account balance would be changed as Zero and the balance would be moved to collection Account in the system. Once the payment is received then the balance would be retrieved in the patient account and payment would be
Applied.
Showing posts with label medical billing process. Show all posts
Showing posts with label medical billing process. Show all posts
Friday, January 15, 2010
Tuesday, December 22, 2009
Bill to medicaid patients - how and when
how and when to Bill medicaid patients
Bill patients only in the following situations:
The recipient's Medicaid eligibility status is pending . If you bill the recipient and they are found eligible for Medicaid with a retroactive date that includes the date of service, you must return the entire amount collected from the recipient and then bill Medicaid. For this reason, it is recommended that you hold claims until after eligibility is determined.
Medicaid does not cover the service and the recipient agrees to pay by completing a written, signed agreement that includes the date, type of service, cost, verification that the provider informed the recipient that Medicaid will not pay for the service, and recipient agreement to accept full responsibility for payment. This
agreement must be specific to each incident or arrangement for which the client accepts financial responsibility.
The TPL payment was made directly to the recipient or his/her parent or guardian. You may not bill for more than the TPL paid for services rendered.
The recipient fails to disclose Medicaid eligibility or TPL information. If a recipient does not disclose Medicaid eligibility or TPL information at the time of service or within Medicaid ’ s stale date period, the recipient assumes full responsibility for payment of services.
you cannot bill the patient for:
For co-payment indicated on a private insurance card
For the difference between the amount billed and the amount paid by Medicaid or a TPL
When Medicaid denies the claim because the provider failed to follow Medicaid policy
Medicaid is the payor of last resort and must be billed after all other payment sources.
Bill patients only in the following situations:
The recipient's Medicaid eligibility status is pending . If you bill the recipient and they are found eligible for Medicaid with a retroactive date that includes the date of service, you must return the entire amount collected from the recipient and then bill Medicaid. For this reason, it is recommended that you hold claims until after eligibility is determined.
Medicaid does not cover the service and the recipient agrees to pay by completing a written, signed agreement that includes the date, type of service, cost, verification that the provider informed the recipient that Medicaid will not pay for the service, and recipient agreement to accept full responsibility for payment. This
agreement must be specific to each incident or arrangement for which the client accepts financial responsibility.
The TPL payment was made directly to the recipient or his/her parent or guardian. You may not bill for more than the TPL paid for services rendered.
The recipient fails to disclose Medicaid eligibility or TPL information. If a recipient does not disclose Medicaid eligibility or TPL information at the time of service or within Medicaid ’ s stale date period, the recipient assumes full responsibility for payment of services.
you cannot bill the patient for:
For co-payment indicated on a private insurance card
For the difference between the amount billed and the amount paid by Medicaid or a TPL
When Medicaid denies the claim because the provider failed to follow Medicaid policy
Medicaid is the payor of last resort and must be billed after all other payment sources.
Monday, December 21, 2009
provider enrollment process
provider Enrollment process
Provider Enrollment is the crux of a proper billing setup. Before we send claims to insurance companies, we should ensure that all provider (doctors) are enrolled with the respective carriers, all providers are contracted.
The process is as follows:
For Federal carriers such as Medicare and Medicaid, we need the provider # to submit claims. Otherwise they would get denied. In order to get this; we need to act at the inception itself.
When a new provider has joined the group, we need to ensure the following:
1: Does the provider have all the credentials?
2: Does the provider have a State License? Without State License the doctor cannot perform in that State.
3: Does the provider have a contract with major carriers in the State? If so we can just write a letter to the carrier saying that this provider has joined the group and request them to merge the provider with the group.
Where the provider does not have a contract with a carrier, a fresh application for enrollment is required.
A Fresh application in Form 855 is filled and signed by the doctor and sent to the carrier. This form should be filled up with details such as the doctor’s name, his Social Security Number (SSN), his State License Number, the name and address of the facility in which he is or will be providing services, the name and address of the group of which he has become a member, the name of the owner of the group, the pay-to address of the group etc.
The carrier processes it and sends in intimation mentioning the provider #. This provider # becomes the individual provider # for that doctor and needs to be stated in Box 24K and Box 33-PIN # in the CMS.
Box 33 of the CMS also contains the Pay-to address where the checks and EOBs need to be sent by the carriers. But Medicare and Medicaid do not go by what is mentioned in this box with regard to pay-to address. Based on the pay-to address mentioned in Form 855 at the time of enrollment the carrier records it in its system. All checks and EOBs will be sent to this address. If there is a change of address, the carriers need to be notified in Form 855-C. Based on this, the carriers update this information in their system.
In this regard the following terms need to be understood:
Employer Identification Number (EIN): This is a tax identification (tax id) number of the group into which the doctor has joined. This number is allotted by the IRS for the purpose of submitting the tax returns. The group needs to show this number in all claim forms and correspondence with the carrier.
W-9 Form: This is a “Request for tax payer identification number and certification” form. This shows the provider’s individual tax id # (SSN) or the group tax id # (EIN) along with the pay-to address. This can be used for updating the tax id # and the pay-to address with the carriers. This should be signed by the provider.
EDI Enrollment:
EDI is Electronic Data Interchange. Certain carriers have the facility to accept claims electronically. For this purpose we need to enroll the providers with the EDI Department of the insurance carriers. This is mandatory requirement in the case of Federal Carriers such as Medicare and Medicaid. This is a separate process apart from the above Provider Enrollment process. We need to fill in a separate EDI enrollment form for providers and send them to the carrier. The carrier will then add the provider in the EDI database. Only then can we submit claims to that carrier for that provider electronically.
Provider Enrollment is the crux of a proper billing setup. Before we send claims to insurance companies, we should ensure that all provider (doctors) are enrolled with the respective carriers, all providers are contracted.
The process is as follows:
For Federal carriers such as Medicare and Medicaid, we need the provider # to submit claims. Otherwise they would get denied. In order to get this; we need to act at the inception itself.
When a new provider has joined the group, we need to ensure the following:
1: Does the provider have all the credentials?
2: Does the provider have a State License? Without State License the doctor cannot perform in that State.
3: Does the provider have a contract with major carriers in the State? If so we can just write a letter to the carrier saying that this provider has joined the group and request them to merge the provider with the group.
Where the provider does not have a contract with a carrier, a fresh application for enrollment is required.
A Fresh application in Form 855 is filled and signed by the doctor and sent to the carrier. This form should be filled up with details such as the doctor’s name, his Social Security Number (SSN), his State License Number, the name and address of the facility in which he is or will be providing services, the name and address of the group of which he has become a member, the name of the owner of the group, the pay-to address of the group etc.
The carrier processes it and sends in intimation mentioning the provider #. This provider # becomes the individual provider # for that doctor and needs to be stated in Box 24K and Box 33-PIN # in the CMS.
Box 33 of the CMS also contains the Pay-to address where the checks and EOBs need to be sent by the carriers. But Medicare and Medicaid do not go by what is mentioned in this box with regard to pay-to address. Based on the pay-to address mentioned in Form 855 at the time of enrollment the carrier records it in its system. All checks and EOBs will be sent to this address. If there is a change of address, the carriers need to be notified in Form 855-C. Based on this, the carriers update this information in their system.
In this regard the following terms need to be understood:
Employer Identification Number (EIN): This is a tax identification (tax id) number of the group into which the doctor has joined. This number is allotted by the IRS for the purpose of submitting the tax returns. The group needs to show this number in all claim forms and correspondence with the carrier.
W-9 Form: This is a “Request for tax payer identification number and certification” form. This shows the provider’s individual tax id # (SSN) or the group tax id # (EIN) along with the pay-to address. This can be used for updating the tax id # and the pay-to address with the carriers. This should be signed by the provider.
EDI Enrollment:
EDI is Electronic Data Interchange. Certain carriers have the facility to accept claims electronically. For this purpose we need to enroll the providers with the EDI Department of the insurance carriers. This is mandatory requirement in the case of Federal Carriers such as Medicare and Medicaid. This is a separate process apart from the above Provider Enrollment process. We need to fill in a separate EDI enrollment form for providers and send them to the carrier. The carrier will then add the provider in the EDI database. Only then can we submit claims to that carrier for that provider electronically.
Friday, December 18, 2009
workers compensation in medical billing
Workers Compensation:
Workers compensation is a form of insurance that provides compensation medical care for employees who are injured or sick during the job.
1. Medical treatment and rehabilitation
2. Loss of wages (disability payments)
3. Permanent disability (payments in one sum or weekly or monthly payments)
4. Vocational rehabilitation
5. Compensation to the dependents of employees who are fatally injured (death benefits)
Claim is submitted on CMS 1500 though certain carrier but few required their own. but the basic information which insurance companies are required is
Employeer Information
Injury Date
and other information (normally used in claims)
and without above information, claim will not get paid.
The amount paid by the workers compensation carrier to the provider is in full and final settlement of the claims. Appeal can also be made if you are not agree with the payments. No account should the patient be billed for the balance after a workers compensation claim has been paid.
Workers compensation is a form of insurance that provides compensation medical care for employees who are injured or sick during the job.
1. Medical treatment and rehabilitation
2. Loss of wages (disability payments)
3. Permanent disability (payments in one sum or weekly or monthly payments)
4. Vocational rehabilitation
5. Compensation to the dependents of employees who are fatally injured (death benefits)
Claim is submitted on CMS 1500 though certain carrier but few required their own. but the basic information which insurance companies are required is
Employeer Information
Injury Date
and other information (normally used in claims)
and without above information, claim will not get paid.
The amount paid by the workers compensation carrier to the provider is in full and final settlement of the claims. Appeal can also be made if you are not agree with the payments. No account should the patient be billed for the balance after a workers compensation claim has been paid.
Claim status calling process
Calling Insurance for claim status
How to call for claim status
A/R callers either take status from IVR or from Insurnace representative , for both IVR or respresentative, A/r caller need to provide below things in order to verify him.
1. Provider name
2. provider ID
3. provider tax id
4. provider NPI
Then you will be able to take claim status and for that you need
1. Patient id #,
2. Patient Name
3. Date of Birth
4. Date of Service
5. Billed amnount on claim
Then representative will let you know
Claim would either not on file, in process, approved to pay , Paid or Denied
If it is paid, You will come to know
1. Allowed amount
2. Patient Responsibility
3. Paid Amount
4. Check Number
5. Check Date
and if there is any Denial, then it will let you know denial reason.
If its not on file, you need to check wheather the claim is submitted or not, and if yes, do check mailing address.
If its in process, then you can ask process days and wait for the process to complete
If its approve for payment, you can payment details.
How to call for claim status
A/R callers either take status from IVR or from Insurnace representative , for both IVR or respresentative, A/r caller need to provide below things in order to verify him.
1. Provider name
2. provider ID
3. provider tax id
4. provider NPI
Then you will be able to take claim status and for that you need
1. Patient id #,
2. Patient Name
3. Date of Birth
4. Date of Service
5. Billed amnount on claim
Then representative will let you know
Claim would either not on file, in process, approved to pay , Paid or Denied
If it is paid, You will come to know
1. Allowed amount
2. Patient Responsibility
3. Paid Amount
4. Check Number
5. Check Date
and if there is any Denial, then it will let you know denial reason.
If its not on file, you need to check wheather the claim is submitted or not, and if yes, do check mailing address.
If its in process, then you can ask process days and wait for the process to complete
If its approve for payment, you can payment details.
Accounts Recievable management Process
Management of Accounts recievable in medical billing is responsible to maximize the collections and brining down the accounts recievable , it monitors all the activity related to accounts recievable in such a way to maximize the collection which is a core objective for any billing company.
For the above responsibilities, medical billing company have A/R analyst.
Responsibility of A/R analyst:
- maximize the collection
- Bringing Down the Acconts Recievable
- Reporting related to Accounts Recievable
- meet the Accounts recievable targets
- Keeping track of Electronic and paper Claims
- keeping track of rejection and denials so that further action can be taken on them.
- Keep himself and other departments updated with latest updates in billing
- Cordinate with call center agents (Follow up department) to get the issues solved
In order to bringing down the recivables, get the outstanding claims to be processed completely and for that , one should know about the outstanding claims.
- Claim not in System
- Claim pending
- Claim is in Process
- Claim denied
Claim not in system:
Claim not in system means that claim is not yet recieved by insurance , it can be because of many reason, either The mailing address or information on claim is not correct or the claim is in transit.
Claim pending:
It means that insurance have recieved claim but it is pending because of the information required from provider or patient.
Claim is in process:
it means insurance have recieved claim but it is in process as it take few days to process and the processing time of insurance is different to each other which we will also discuss in next article
Claim denied:
Claim is denied because of defined rules and regulation are not followed , insurance processed them and send EOB which will explain the denial reason.
Medical Billing Process summary
Charge Entry Process
Payment Posting Process
What is EOB (Explaination of Benefit)
For the above responsibilities, medical billing company have A/R analyst.
Responsibility of A/R analyst:
- maximize the collection
- Bringing Down the Acconts Recievable
- Reporting related to Accounts Recievable
- meet the Accounts recievable targets
- Keeping track of Electronic and paper Claims
- keeping track of rejection and denials so that further action can be taken on them.
- Keep himself and other departments updated with latest updates in billing
- Cordinate with call center agents (Follow up department) to get the issues solved
In order to bringing down the recivables, get the outstanding claims to be processed completely and for that , one should know about the outstanding claims.
- Claim not in System
- Claim pending
- Claim is in Process
- Claim denied
Claim not in system:
Claim not in system means that claim is not yet recieved by insurance , it can be because of many reason, either The mailing address or information on claim is not correct or the claim is in transit.
Claim pending:
It means that insurance have recieved claim but it is pending because of the information required from provider or patient.
Claim is in process:
it means insurance have recieved claim but it is in process as it take few days to process and the processing time of insurance is different to each other which we will also discuss in next article
Claim denied:
Claim is denied because of defined rules and regulation are not followed , insurance processed them and send EOB which will explain the denial reason.
Medical Billing Process summary
Charge Entry Process
Payment Posting Process
What is EOB (Explaination of Benefit)
Thursday, December 17, 2009
Payment Posting Process
Before Reading this article , it is advised you to read about EOB (Explaination of Benefit) First.
Once the claims reach the carriers and they complete processing, they issue a check and prepare an Explanation of Benefits (EOB). The checks and the EOBs would be sent to the pay-to address with the carrier or in the HCFA. Pay-to address is the common address that the provider has set up to receive checks and EOBs from carriers and patients. This is most likely a PO Box address set up in arrangement with the bank where the provider has an account. The checks and EOBs are received on all working days. The bank deposits the checks every day into the provider’s account, prepares a deposit statement and sends the statement, EOBs and copies of checks every day to the provider. The provider forwards them to the billing office for posting.
The Basic Formulae used in Payment Posting is:
Allowed Amount = Paid Amount + Pt. Responsibility
Patient Resp. = Copay + Co Ins. + Deductible
Information can be found on EOB , Billed amount will be found with every CPT , Insurance will allow some amount and paid, and some can go for patient responsibility also , Information on EOB then entered into the claim keeping in view the above formulae. Reason Codes are very important which should be read and entered into the claim.
Its not an end of payment Posting, its not an Data Entry Job , all the claims are not paid, sometime it denied and sometime amount applied for patient responsibility , which can be understand by reading reason code and if there is patient responsibility, then balance should applied on patient Account and if there is a payment on insurance and not processed properly or some mistake , then it should be re-submit to Insurance or transfer to the concern department for furthur review.
Payments can be entered through different methods:
EOB POSTING
LINE ITEM POSTING
ACCOUNT POSTING
etc
Terms which is needed to understand for Payment Posting:
Allowed Amount:
This is the amount allowed by the carrier. Not all carriers and in all circumstances allow the entire amount billed. Certain carriers have fee schedules based on which they make payments. These fee schedules determine the allowed amount. A Fee Schedule is a list of reimbursement amount for each procedure. These vary according to various localities. This allowed amount is the maximum that a carrier will pay for a particular procedure.
Co-Insurance:
This is a part of the allowed amount, which the carrier has determined that the supplementary insurance or the patient is responsible to pay. This will be mentioned clearly in the EOB and should be billed to the secondary carrier or to the patient.
Deductible:
This is an amount that the patient owes the carrier every year apart from the premium. The patient has to pay this amount before insurnace started to pay.
Write Off:
This is an amount that the provider has to remove from his books. There are two types of write off: One is contractual write off and the other one is adjustments. Contractual write off are those wherein the excess of billed amount over the carrier’s allowed amount is written off. The fee schedules of each carrier will be loaded in the billing system. When you are posting the EOBs these fee schedules in the system also called system allowed amount would pop up. The difference between the billed amount and the system allowed amount will be the write off.Adjustments are amounts such as discounts, professional courtesy and other special items that are identified by the provider as those that need not be collected or collected at a lower rate.
Once the claims reach the carriers and they complete processing, they issue a check and prepare an Explanation of Benefits (EOB). The checks and the EOBs would be sent to the pay-to address with the carrier or in the HCFA. Pay-to address is the common address that the provider has set up to receive checks and EOBs from carriers and patients. This is most likely a PO Box address set up in arrangement with the bank where the provider has an account. The checks and EOBs are received on all working days. The bank deposits the checks every day into the provider’s account, prepares a deposit statement and sends the statement, EOBs and copies of checks every day to the provider. The provider forwards them to the billing office for posting.
The Basic Formulae used in Payment Posting is:
Allowed Amount = Paid Amount + Pt. Responsibility
Patient Resp. = Copay + Co Ins. + Deductible
Information can be found on EOB , Billed amount will be found with every CPT , Insurance will allow some amount and paid, and some can go for patient responsibility also , Information on EOB then entered into the claim keeping in view the above formulae. Reason Codes are very important which should be read and entered into the claim.
Its not an end of payment Posting, its not an Data Entry Job , all the claims are not paid, sometime it denied and sometime amount applied for patient responsibility , which can be understand by reading reason code and if there is patient responsibility, then balance should applied on patient Account and if there is a payment on insurance and not processed properly or some mistake , then it should be re-submit to Insurance or transfer to the concern department for furthur review.
Payments can be entered through different methods:
EOB POSTING
LINE ITEM POSTING
ACCOUNT POSTING
etc
Terms which is needed to understand for Payment Posting:
Allowed Amount:
This is the amount allowed by the carrier. Not all carriers and in all circumstances allow the entire amount billed. Certain carriers have fee schedules based on which they make payments. These fee schedules determine the allowed amount. A Fee Schedule is a list of reimbursement amount for each procedure. These vary according to various localities. This allowed amount is the maximum that a carrier will pay for a particular procedure.
Co-Insurance:
This is a part of the allowed amount, which the carrier has determined that the supplementary insurance or the patient is responsible to pay. This will be mentioned clearly in the EOB and should be billed to the secondary carrier or to the patient.
Deductible:
This is an amount that the patient owes the carrier every year apart from the premium. The patient has to pay this amount before insurnace started to pay.
Write Off:
This is an amount that the provider has to remove from his books. There are two types of write off: One is contractual write off and the other one is adjustments. Contractual write off are those wherein the excess of billed amount over the carrier’s allowed amount is written off. The fee schedules of each carrier will be loaded in the billing system. When you are posting the EOBs these fee schedules in the system also called system allowed amount would pop up. The difference between the billed amount and the system allowed amount will be the write off.Adjustments are amounts such as discounts, professional courtesy and other special items that are identified by the provider as those that need not be collected or collected at a lower rate.
Clearing House Definition - Benfits and Services
It plays an important role in medical billing process
What exactly does a clearinghouse do? Well, for one thing, they check claims for accuracy. But, the biggest thing they do is re-format the data you send to them to a format that a given carrier can read.
How Clearinghouse Works
The billing software creates the electronic file (the electronic claim), which is then sent to your clearinghouse account thorugh software. The clearinghouse then scrubs the claim checking it for errors and then once the claim is accepted, the clearinghouse securely transmits the electronic file to the specified payer with which it has already established a secure connection that meets the strict standards laid down by a HIPAA.
At this stage, the claim is either accepted or rejected, but either way, a status message is sent back to the clearing house which updates the claim's status in your account. It then alert's you that you have an accepted or rejected claim. If rejected, you have a chance to make the needed corrections and then re-submit the claim. Ultimately assuming there are no other corrections needed and the patient's insurance is valid, you'll receive a reimbursement check along with an explanation of benefits (EOB), all very simple. Not
The same sort of activity takes place every night within the federal banking system as our checks and banking activities are sent electronically from local banks to central ACH repositories (Automated Clearing Houses) and then on to banks of origin across the country, and then back to local banks -- all done electronically, and somewhat instantly.
Thus today, you have dozens of regional medical clearinghouses throughout the country all serving the same role; that of scrubbing claims and then transmitting the claim information securely to insurance carriers electronically.
The best clearinghouses offer added features that provide a whole new level of claim intelligence for revenue cycle management that makes their services extremely compelling from a financial perspective, and as well, highly desirable from an office-staff efficiency point of view.
Clearing House Premium services includes:
- Eligibility Verification
- Electronic Remittance
- Claim Status Reports (Know the status of a claim at all times)
- Rejection Analysis
- Online Access
- Printed Claims - Have non-par claims automatically dropped to paper but
still be able to track them electronically.
- Patient Statement Services
- Support
Main Clearing House Benefits
Here are the main benefits of using a electronic claims clearinghouse
Using an electronic clearinghouse to send claims:
Allows you to catch and fix errors in minutes rather than days or weeks
Results in significantly higher claim success --fewer rejected claims.
Allows you to catch and fix errors in minutes rather than days or weeks.
Results in significantly higher claim success --fewer rejected claims.
Rapid claims processing: Submitting claims electronically can reduce your reimbursement times to under ten days.
Eliminates the need to prepare claims and manually re-key transaction data over and over for each payer.
Submit all your electronic claims in batch all at once, rather than submitting separately to each individual payer.
It provides a single location to manage all your electronic claims
Avoid long hours of being on-hold with Medicare and Blue Cross inquiring about claim errors.
Vastly improve vender relationships with insurance carriers.
If you subscribe to a good clearinghouse, you'll be speaking with a knowledgeable support person within just a few rings.
Shorter payment cycles lead to more accurate revenue forecasts.
Reduce or eliminate need for paper forms, envelopes and stamps.
Plain and simple, using a clearing-house will greatly simplify your claims processing.
Charge Entry Process can be found here
Steps ingvolved in Medical Billing and Coding Process
What exactly does a clearinghouse do? Well, for one thing, they check claims for accuracy. But, the biggest thing they do is re-format the data you send to them to a format that a given carrier can read.
How Clearinghouse Works
The billing software creates the electronic file (the electronic claim), which is then sent to your clearinghouse account thorugh software. The clearinghouse then scrubs the claim checking it for errors and then once the claim is accepted, the clearinghouse securely transmits the electronic file to the specified payer with which it has already established a secure connection that meets the strict standards laid down by a HIPAA.
At this stage, the claim is either accepted or rejected, but either way, a status message is sent back to the clearing house which updates the claim's status in your account. It then alert's you that you have an accepted or rejected claim. If rejected, you have a chance to make the needed corrections and then re-submit the claim. Ultimately assuming there are no other corrections needed and the patient's insurance is valid, you'll receive a reimbursement check along with an explanation of benefits (EOB), all very simple. Not
The same sort of activity takes place every night within the federal banking system as our checks and banking activities are sent electronically from local banks to central ACH repositories (Automated Clearing Houses) and then on to banks of origin across the country, and then back to local banks -- all done electronically, and somewhat instantly.
Thus today, you have dozens of regional medical clearinghouses throughout the country all serving the same role; that of scrubbing claims and then transmitting the claim information securely to insurance carriers electronically.
The best clearinghouses offer added features that provide a whole new level of claim intelligence for revenue cycle management that makes their services extremely compelling from a financial perspective, and as well, highly desirable from an office-staff efficiency point of view.
Clearing House Premium services includes:
- Eligibility Verification
- Electronic Remittance
- Claim Status Reports (Know the status of a claim at all times)
- Rejection Analysis
- Online Access
- Printed Claims - Have non-par claims automatically dropped to paper but
still be able to track them electronically.
- Patient Statement Services
- Support
Main Clearing House Benefits
Here are the main benefits of using a electronic claims clearinghouse
Using an electronic clearinghouse to send claims:
Allows you to catch and fix errors in minutes rather than days or weeks
Results in significantly higher claim success --fewer rejected claims.
Allows you to catch and fix errors in minutes rather than days or weeks.
Results in significantly higher claim success --fewer rejected claims.
Rapid claims processing: Submitting claims electronically can reduce your reimbursement times to under ten days.
Eliminates the need to prepare claims and manually re-key transaction data over and over for each payer.
Submit all your electronic claims in batch all at once, rather than submitting separately to each individual payer.
It provides a single location to manage all your electronic claims
Avoid long hours of being on-hold with Medicare and Blue Cross inquiring about claim errors.
Vastly improve vender relationships with insurance carriers.
If you subscribe to a good clearinghouse, you'll be speaking with a knowledgeable support person within just a few rings.
Shorter payment cycles lead to more accurate revenue forecasts.
Reduce or eliminate need for paper forms, envelopes and stamps.
Plain and simple, using a clearing-house will greatly simplify your claims processing.
Charge Entry Process can be found here
Steps ingvolved in Medical Billing and Coding Process
Charge Entry Process in Medical Billing
Summary: This article would help you to understand the required field and procedure of Charge entry:
The document which used for charge entry process is Super-Bill which give basic information of ICD and CPT codes required for Charge Entry.
Fields which required in Charge Entry
1: Patient Account No. (Which is assigned to patient at the time of registration)
2: Facility ID or Hospital ID
3: Doctor ID or Provider ID
4: PCP ID - optional
5: POS (place of service)
6: DOS (Date of service)
7: Member ID
8: Dignostic Codes (ICD codes)
9: Procedure codes (CPT Codes)
10: Modifiers
11: Units
12: Billed Amount - (Billed amount is entered against every procedure code).
Enter all above fields in a claim and amount against every procedure codes and make sure that the tree created between ICD and CPT codes should be correct and enter modifier with procedure code when it is required.
Above were the steps and field involved in charge entry process and claim creation
More Information:
understand the process of Patient Demographic
Complete Medical Billing process
The document which used for charge entry process is Super-Bill which give basic information of ICD and CPT codes required for Charge Entry.
Fields which required in Charge Entry
1: Patient Account No. (Which is assigned to patient at the time of registration)
2: Facility ID or Hospital ID
3: Doctor ID or Provider ID
4: PCP ID - optional
5: POS (place of service)
6: DOS (Date of service)
7: Member ID
8: Dignostic Codes (ICD codes)
9: Procedure codes (CPT Codes)
10: Modifiers
11: Units
12: Billed Amount - (Billed amount is entered against every procedure code).
Enter all above fields in a claim and amount against every procedure codes and make sure that the tree created between ICD and CPT codes should be correct and enter modifier with procedure code when it is required.
Above were the steps and field involved in charge entry process and claim creation
More Information:
understand the process of Patient Demographic
Complete Medical Billing process
Steps Involved in Medical Billing and Coding Cycle
Below are the medical Billing and coding steps and every step have its own importance which cant be neglect and Quality assurance should involve in each step.
steps involved in medical billing:
- Entry of patient Demographics
- Medical Coding
- medical Billing
- Charge Entry
- Claim submission to insurance
- Payments Posting
- Accounts recievable Management and follow-up
- Denial Management
- Management Reporting
steps involved in medical billing:
- Entry of patient Demographics
- Medical Coding
- medical Billing
- Charge Entry
- Claim submission to insurance
- Payments Posting
- Accounts recievable Management and follow-up
- Denial Management
- Management Reporting
Wednesday, December 16, 2009
Medical Demographic Entry process in outsourcing companies
Medical Demographic Entry process in Outsourcing Industry
Demographic Entry capabilities includes:
• Ability to work off scanned images as well as Electronically Submitted Demographic Entry Sheets
• Ability to correctly process insurance Information (selecting appropriate PO Box etc) as necessary including HMOs, PPOs, IPAs
Demographic Entry process steps include:
Demographic Entry capabilities includes:
• Ability to work off scanned images as well as Electronically Submitted Demographic Entry Sheets
• Ability to correctly process insurance Information (selecting appropriate PO Box etc) as necessary including HMOs, PPOs, IPAs
Demographic Entry process steps include:
1: Demographic information scanned and send through email, fax or directly copy on servers
2: Information then directly entered into software.
3: Internal Quality Assurance performed at three different levels:
- Individual
- Team
- Independent Audit Team
Medical Billing Process
Medical billing process Steps
To Get detail information about these steps, you can check out different articles divided in different categories.
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