Our Medical Billing Service Package

Our Medical Billing Service: Offers!!

Medical Billing company can be surely termed as the backbone of the financial stream of any Doctor’s practice. Medical Billers obviously act as the care-takers of the revenue cycle of the physicians. We, e24 Technologies take pleasure in serving the Doctors, who has dedicated their lives & career to the healthcare cause of the mankind. We are also dedicated to serve the Physicians by maintaining a healthy revenue cycle for them. In order to substantiate this, and to make our Physicians even more happier, we have simplified our billing, and have added value to our services. Please read further to have a look at our simplified service of our Medical Billing:-

1) e24 MedComprehensive – which takes care of the end-end process of Medical Billing(this includes first 30 days free trial).

2) e24 MedCoding – which takes care of your Medical coding(includes 15 days free trial)

3) e24 MedEntry – which takes care of your charge entry, and cash entry(includes 15 days free trial)

4) e24 MedAR – which takes care of your Accounts Receivables(includes 30 days free trial)

5) e24 MedCustomize – this depends on your choice as to which area of billing to choose. This includes one or more packages (includes 15-30 days free trial).

We have divided Medical Billing into several areas just to simplify your choice, and to serve you even better. To let us know your opinion on this, and to know more about our services, please email us at medical.billing@e24tech.com

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Modifier Code in Medical Billing

                Modifiers are codes that are used to “ENHANCE OR ALTER THE DESCRIPTION OF A SERVICE OR SUPPLY” UNDER CERTAIN CIRCUMSTANCES. A modifier provides the means by which the reporting physician can indicate that a service or procedure that has been performed has been altered by some specific circumstance but has not changed in its definition or code. The judicious application of modifiers obviates the necessity for separate procedure listings that may describe the modifying circumstance.

Modifiers may be used under the following circumstances:-

· A service or procedure has both a professional and technical component.

· A service or procedure was performed by more than one physician and/or in more than one location.

· A service or procedure has been increased or reduced.

· Only part of a service was performed.

· An adjunctive service was performed.

· A bilateral procedure was performed.

· A service or procedure was provided more than once.

· Unusual events occurred.

The following are the most commonly used modifiers:

• Professional Component 26
• Technical Component 76
• Bilateral Procedure 50
• Right side of body RT
• Left side of body LT
• Distinct Procedural Service 59

For inquires / comments please email us at medical.billing@e24tech.com

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Claim Adjudication in Medical Billing

The claim is be defined as a request or an appeal made by the entity or organization (on behalf of the provider) for proper reimbursement to the provider for the service rendered.

‘Claim Adjudication’ is defined as the claim submission and its subsequent settlement made by the insurance company. Claim adjudication ensures that all program requirements have been met (provider and facility in-network, a PCP referral has been made, notification requirements have been met, etc). Claims editing helps spot and correct problems faster before claims are sent to payers. Ensures accurate adjudication, prevents payment for unauthorized or inappropriate services, and manages coverage limitations by automatically administering all the provisions of each product line.

Fact-finding is the basic criterion on which the process of claim adjudication is built up. The various type of facts, which influence the claim adjudication are, Obtaining of facts, Recording of facts, Recording the absence of fact of any claim that has been filed for reimbursement.

The other factors, which contribute to claim adjudication are:

• Implementation of medical policy
• Prior-Authorization
• Post-Service Claims Edits
• Highly specific coverage criteria implemented on case-by-case basis
• Obtaining additional information from physician if necessary.
• Plan considers time and cost of implementing coverage restrictions
• Look at claims experience to gauge appropriateness of use
• Level of payment for new service
• Based on cost
• Based on comparable service

The standard forms often used by billing companies for submitting claims are:

Form 1: HCFA 1500

Form 2: UB 92

HCFA 1500:

HCFA stands for health care financing administration. It consists of 33 blocks giving information about the patient, insurance, provider, and facility details. This form is mainly used for outpatient details.

UB 92:

UB stands for uniform billing. It consists of 86 blocks giving information about patient, insurance, provider, and employer details. This form is mainly used for inpatient details.

For inquires/comments please email us at medical.billing@e24tech.com

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Eligibility Verfication in Medical Billing

Eligibility Verification is a department in the Billing Company, which functions exclusively for the verification of a patient’s active coverage with the Insurance company, and also to check if he/she has an eligible benefit for the procedure to which he/she is scheduled in the facility/Doctor’s office/Ambulatory Surgical Center, and finally ensuring that the patient that is about to walk-in for the procedure is thoroughly eligible for that service from the Insurance Company’s perspective.

When you talk about eligibility, it is all about checking if the patient has an active medical/dental (depending on the service) policy with the insurance company, and also verifying the patient’s name, ID #, DOB, Subscriber of the policy, Group # are appropriate, and matching with what has been updated by the patient to us. Also, the policy effective date, type of policy and the insurance company functioning as primary/secondary/tertiary, claims mailing address need to be checked.

On benefits, it is the area of coverage, which the subscriber and the dependents are entitled to, by having an active policy with an insurance company. In other words, the procedures which are covered, and being authorized by the insurance company for payment are the benefits of the policy. It also covers ascertaining of the insurance company’s % of coverage of payment on a particular procedure, patient’s responsibility through co-pay/co-ins on that procedure.

In Eligibility Verification department, the other information to be ascertained is on the requirement of a Referral, and or Prior-authorization. So that once the procedure is over, a copy of the Referral/Prior-authorization should be submitted along with the claim with the insurance company for the claim to be paid. One other responsibility of the pre-certification department is to check if the Provider is participating with the insurance company as there are different levels of benefits for in-network/out-of-network Providers from the insurance company.

The Eligibility Verification department department minimizes the denial of the claims to the maximum extent by checking out the eligibility, and benefits of the patient before hand ie., before the service is being rendered to the patient. Less number of denials is equal to more number of clean claims, which means a healthy collections, and higher inflow of payment.

                                 > Denials = < Clean claims

                                 > AR = < Collections

            [ ie more money to the Doctor, & the Billing office]

Ultimately, the Eligibility-Verification department plays a vital role is curbing the denial of the claims, and bringing in more money to the Doctor’s office, and Billing office as well.

For inquires / comments please email us at medical.billing@e24tech.com

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Claim Paid to Wrong Address – Medical Billing

Claims are created, filed with the insurance company, and the insurance company processes the claim, and pays on it as a clean claim. Where does this payment go? It should go to the correct pay-to-address of the provider, only then it serves the final purpose of Medical Billing.

Now, imagine what will happen if the insurance company has a wrong pay-to-address for the provider. All the checks will be wrongly directed to an address, which does not belong to the provider, and gets accumulated there. This is not a big problem if identified earlier else if it is being plotted after quite a period of time, it becomes a great disaster.

Usually in these cases, the insurance company representative confirms the Doctor’s address with the person, who calls up the insurance company, and if it is the same address, which she has in her system, and if the check would have been sent to the wrong address, she will put a stop-payment on the previously issued check, and generates a new check to be mailed out to the Doctor’s correct pay-to-address.

If the address, which she has in her system for that particular provider is not the same as it has been told by the Doctor’s office, she asks the concerned person from the Doctor’s office to fill up a W9 form (a form which is used by the insurance companies to update the Physician’s information) in which the correct pay-to-address of the Provider should be mentioned, and send it back to the insurance company. The insurance company reviews the form and updates the Doctor’s pay-to-address in their system accordingly.

Now-a-days these problems do not arise often as the insurance companies have started paying the Doctors through EFT[Electronic Fund Transfer]. They have a Payer ID for every provider, and dispatch the payment through this mode of EFT. Thanks to the Electronic revolution!!!

For questions / comments email us at medical.billing@e24tech.com

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Importance of Dx Code in Medical Billing

            As we discussed earlier, coding is the numerical representation of diseases and their corresponding treatment. The coder reads the medical transcript carefully and finds out the disease and the treatment done on a particular patient. After reading this, he assigns the relevant codes for both the disease and the procedure, and enters these in the claim form. In addition to the CPT procedure/service code, physicians must describe the reasons for their services. It has a major contribution in getting the claim paid. That is why coding is considered as one of the most significant departments in Medical Billing.

The coder should see to it that the codes, which he/she assigns should be accurate and both the Dx and the CPT codes must be compatible to each other. If they are not matching with each other, the entire claim becomes unprocessed, and gets denied by the insurance company.

While coding for the disease or the ailment, the coder should look into the transcript carefully and find out exactly the disease or the diagnosis of the patient, and should assign the exact Dx code taking from the ICD 9 CM manual (Sample) . While coding for the disease, the coder should always assign the Dx code, which should be of highest level of specificity.

For example, if the coder has to code for the disease Acute Bronchospasm, it should be with the code “519.11”. In this the code 519 is for the disease, and 11 after the decimal point is the level of specificity of the disease. Coding Dx codes with the highest level of specificity is one of the imperatives in getting the claim paid, and medical documents should be attached wherever necessary.

For questions / comments please email us at medical.billing@e24tech.com

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Denial Reason in Medical Billing – Patient Not Found in System

                 “Patient Not Found or Patient Not in System” is one of the common denials found in Medical Billing. It may be due to some incomplete information in the claim form or due to some errors. In Medical Billing errors are inevitable. They are a fact of medical billing, even with the advent of electronic medical records (EMRs). Usually Medical Billing companies deal with a lot of Medical Practices, Hospitals, Doctors etc, and it should comply with each one of their process of filing claims. This is one of the key reasons for errors occurring in Medical Billing.

“Patient Not found” denial occurs due to one of the following reasons:

1) Incorrect insurance information furnished by the patient in the Doctor’s office.

2) Incomplete information given in the claim form by the Medical Biller, like incomplete ID #, incorrect patient name etc.,

3) Insurance policy of the patient would have been terminated long before, and the insurance company would have lost track on the patient’s information.

4) Patient would have been not included in the policy as a member (this occurs incase of dependent members).

5) The Medical Billing Company files the claim with a wrong insurance company.

Once this denial has occurred, it could be overcome by calling the Patient and checking the appropriateness of his/her insurance policy, and re-filing a new claim with the correct information. Else if the patient does not have a valid insurance coverage at the time of the treatment, the entire bill should be directed to the patient.

This denial could be avoided by getting the accurate insurance information from the patient at the first visit itself, and then checking the eligibility and benefits verification of the patient’s policy by calling the insurance company, and also by concentrating more on minimizing the errors, and filing a clean claim with the insurance company.

For questions / comments please email us at medical.billing@e24tech.com

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Claim Denied for Untimely Filing – Medical Billing

                  This is one of the fatal denials in Medical Billing. This one is considered fatal because usually the insurance company’s ends up without paying on the claim if it denies it for this reason. This normally happens due to the ignorance or negligence of the Medical Billing Company.

Usually every insurance company fixes up a time frame for the Doctor or the Billing Company to file their bill with the insurance company. Normally it ranges from 90 days to 1 year from the date on which the service was rendered. This limit is termed as the filing limit. When one files his bills/claims crossing this filing limit, the insurance company does not process this claim, and denies it as “Claim denied for untimely filing”.

This denial normally occurs when the Billing Company files the claim with the insurance company being ignorant of it’s filing limit else due to the heavy work-load or high pressure, there are chances for the billing company to miss out some claims to file it within the filing limit of their respective carriers.

Usually when the claim has been denied correctly for this reason, there is no other way than taking a write-off on this claim else if it is an incorrect denial, there is always an option to appeal on the denial with “Proof of timely filing”, and make the insurance company to process the claim, and make the payment on it.

For questions/comments please email us at medical.billing@e24tech.com

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AR Calling in Medical Billing

                   The call-center function in co-ordination with the AR Analyst is the most important function in Medical Billing. They are the persons who actually speak with the other parties in billing follow-up, the insurance Carrier, and the patient. Calling can be generally classified into three types. They are 1) Doctor calling 2) Insurance Calling and 3) Patient Calling.

1) Doctor Calling: It is calling the Doctor’s office by the caller for any patient’s information, procedure information etc..

2) Insurance Calling: In this, the caller reviews completely the work-order given by the AR Analyst, and starts calling-up the insurance carrier to check the status of claims filed with them, the payment issued on each claim, the denial reason if the claims are outstanding, the appropriateness of the patient information etc.. And documents the conversation in the work-order what he had on the call, so that the analyst, when reviewing them will understand what to do on that particular claim. In short, he calls the insurance company, gets the information on what happened on that particular claim, and conveys it to the AR Analyst to take action on it.

3) Patient Calling: In this, the caller calls up the patient for various reasons. Some of the common reasons on which the caller calls up the patient are:

i) To follow-up on the bills sent to the patient, when there is no response from the patient.

ii) To check the appropriateness of the insurance information given by the patient if it is inadequate or unclear.

iii) To check the insurance information incase of self-pay patients.

iv) To get clarification on insurance coverage in cases, where information provided by the hospital or Doctor’s office is insufficient.

v) To get information for which claims are pended by the insurance company.

In this way the AR Analysis, and the AR Calling department work hand-in-hand, and make the claims paid. It is the co-ordination between these two departments that makes the carrier to discharge the payments faster. The major criteria for assessing a billing office’s performance are high collections and low AR, and this could be attained only by the Accounts Receivables department – the back bone of Medical Billing

For question/comments please email us at medical.billing@e24tech.com

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Health 2.0: Do it yourself health care

Do you think the $2 trillion dinosaur Health-care system is getting changing in the new epidemic of Health 2.0? This article from Business 2.0 is talking about the new epidemic: Do-it-yourself health care.

Interesting thoughts on how the health-care industry is changing and how consumers (patients) will begin taking charge of their own health care using the Web 2.0 or Health 2.0 web model.

Share your thoughts on how this will impact the health-care system? Leave your feedback..

Technorati Tags: medical-billing, medical billing, medical billing services, doctors, doctor, healthcare, healthcare service, Medical Coding