Patients insurance eligibility

Why Checking Patients Insurance Eligibility Is So Important In Medical Billing

The current healthcare space has created confusions not only among healthcare providers but also among the patients. Many of the patients are unaware about how healthcare insurance works. In today’s healthcare environment, insurance eligibility screening is crucial and must be done before the patient is ever seen by the doctor in order to minimize the risk of services being refused.

Running an eligibility testing allows to submit clean claims to healthcare providers.

It prevents re-submission of claims, decreases rejections and denials related to demographic or eligibility, enhances upfront collections, leading to increased patient satisfaction.

Importance Of Insurance Eligibility Checking In Medical Billing

Insurance eligibility verification is the method of checking the insurance of a patient in terms of :

➣ Coverage status
➢ Active or Inactive status
➣ Eligibility status

Without this information, healthcare services will be interrupted. Verification of insurance eligibility is necessary as it is directly linked to claim denials or payment delays of any healthcare services. The claim denial and payment delays occurs when eligibility checking is not done correctly and efficiently. Checking patient eligibility or insurance eligibility remains important to medical practice income and productivity and also saves time and money.

The steps explained below will give you some insights about the importance of patients insurance eligibility checking in Medical Billing Services

  • The advance checking of patient’s insurance eligibility helps to estimate the total patient responsibility for payment. When patients are notified of their approximate sum before appointments they are much more likely to come to the appointment prepared to pay or make payment plans.
  • Knowledge about insurance can be very confusing and it changes rapidly. A large number of patients aren’t aware about their coverage, and also they do not know that their deductible have changed. A good protocol is to notify the patients as soon as possible so that they can budget in the extra costs or work with the practice to create a schedule of their payment.
  • The majority of patients want their bills to be paid on time. This eligibility checking procedure helps the patients to access all the data they needed so that they are not blindsided by high bills.
  • In situations where insurance has expired or plans do not cover the programs, checking eligibility in advance protects the procedure.

The eligibility and benefits of a patient can change at any time. Lack of follow up with insurance carriers prior to a patient visit may lead to rise in claim denials and a substantial loss of a revenue. Patients insurance eligibility checking plays a major role in a healthcare facility’s claims denial management program. Every successful Medical Billing Services depends solely on the success of eligibility verification. Having a detailed checking of eligibility verification at healthcare desk eliminates hours on phone or using several websites to check the eligibility details. Therefore, Patients insurance eligibility is very vital and plays a very effective role in medical billing. iMedWare expedite every of your claim quickly and completely with confidence. We are one among the leading Medical Billing companies in Syracuse and we can simplify your ever changing billing needs.

Medical billing service

Coding and Billing for Coronavirus immunizations

The American Medical Association (AMA) has published an update to the CPT code set that includes new vaccine-specific codes to report immunizations for the new coronavirus (SARS-CoV-2).  CDC has approved a unique CPT code for each of two coronavirus vaccines as well as administration codes unique to each such vaccine. These CPT codes are available prior to the public availability of the vaccines to facilitate swift updating of health care medical billing systems across the country.

New vaccine administration codes and billing guidelines have been published by CMS that are distinct to each coronavirus vaccine as well as to the specific dose in the required schedule. This helps to track the vaccine usage even when it is administered for free to the patients. Toolkits have been prepared for providers, states and insurers to easily accommodate the changes in the coding and medical billing of the vaccination program. It allows the smooth administration of the vaccine once it is available. Medical billing with these codes ensures adequate reimbursement for administering the vaccine in Medicare. The resources clearly explain to the private insurers and Medicaid programs their liability to cover the vaccine at no charge to recipients.

The CMS guidelines state that providers should administer a COVID-19 vaccine irrespective of an individual’s ability to pay or their coverage status. Also, they cannot seek any reimbursement from a vaccine recipient through patient billing. People lacking health insurance or whose insurance does not provide coverage of the vaccine can also get COVID-19 vaccine at no cost. In such cases providers can request remittance for the vaccine administration through the Provider Relief Fund.

Why drug-drug allergy and disease interaction checking is important in eRx ?

Why drug-drug allergy and disease interaction checking is important in eRx ?

From the good olden days to this point of time, things and events are constantly been evolved to break down human labor. Ideas, methodologies and solutions are been stormed at each and every field to make the process much effective and simple.

In the US, the field of medicine introduced e-Rx or E-Prescription. E-prescribing reduces the risks associated with traditional prescription and this resulted in high demand of electronic prescription software. E-prescribing aims to connect the patient’s to the team of health care professionals by exchanging medical prescription information to promote knowledgeable decision-making.

What are drug interactions ?

Every time you take more than one medication or a pill and you mix it with certain drugs, you are at the risk of drug interaction. Most of the drug interactions are not serious but a few of them can be harmful to your body. So it is important to know your drug interactions.

  • Drug-drug interactions – These are the most common type of interactions. These interactions happen if you consume more than one medication, there will be a chance for your drug to interact with another drugs and could result in various unexpected side effects or even increases the blood pressure as well.
  • Drug-disease interactions – These interactions occurs when certain drugs related to cure the disease for which a drug intended for healing purpose could turn out to be harmful for the body. Your current medical condition may also impact the way a drug works too. In short drugs that are helpful in one disease are harmful to another disorder.

What does disease interaction checking do?

Drug-disease interaction checking enables a healthcare provider or doctors to check whether the medications are harmful to the patients or infected. This dedicated checking in e-Rx pop up a screen showing whether the medicine is suitable to patients or not. If he/she is allergic to a particular medicine a notification or popup will appear showing the complete details and history of the medicine claiming whether the medicine is harmful to the patient or what will happens if he/she consumes the medicines. Checking for a drug interaction before it occurs will drastically lower the risk of a problem and eliminates every chance of risk of drug-drug interactions and drug-disease interactions

It is necessary to check the status of drug interactions with each new drug, because most of the people do not know whether two or more drugs will interact and it can effect adversely even death can happen. Therefore, disease interaction checking is very important as it is a lifesaver for all those who consumes two or more medicines.

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Medical Billing USA

Medical billing – Patient Collections

Healthcare system in United States is under going drastic changes which are leading to new challenges for both providers and patients. Patients with financial difficulties have tough time paying their medical bills. Patient copays account for about 20% of a provider’s office revenue.

Patient collections are not something that can be ignored in medical billing.

Reminding patients defaulting payments need to be done regularly without harassing them.

Tips to improve patient collections in medical billing: –

  • Standard payment policy – Practice should have clear payment policy that is informed to patients in advance.
  • More payment options – Patients should be able to pay by cash, check, credit card or through an online payment portal.
  • Inform patients about prices – Patients should be aware of procedure costs beforehand.
  • Check your patients’ coverage before the consultation – Remind patients who are on high-deductible plans.
  • Use a Medical billing software system – Medical billing software can track patient collections process by looking up past due bills, automatically check patient insurance eligibility and has system integrated payment processing method.
  • Regular reminders – Send out patient statements on a regular basis.
  • Using a collection agency – Notification from a third-party agency prompts patients to pay their dues.

With so much work and attention to detail required for successful medical billing and ensuring proper payment from patients it is good to outsource medical billing to a reputable company. This enables providers to focus more on patient care rather than on getting reimbursed.     

Medical Billing and Telemedicine

Medical Billing and Telemedicine

Telemedicine refers to a category of services that are provided to a patient without any actual patient contact. Services are provided via a telephone, web portal or via email interactions between the patient and provider.

The Corona virus crisis has created billing requirement with telemedicine a significant issue. The guidelines for billing telemedicine are not only changing apace but also differ from payer to payer.  All the major private insurances pay telemedicine. Private insurance companies and Medicare are streamlining telemedicine policies virtually on a daily basis. Now Medicare allows telemedicine visits for new patients as well.

Simple pointers to consider when billing telemedicine:-

• Confirm that the patient’s insurance covers telemedicine. Always call and verify coverage with the patient’s insurance before their initial telemedicine visit
• Knowledge of the telemedicine guidelines for each payer. Rules and regulations differ from payer to payer and also area vice.
• Claims for covered telehealth services provided at the distant site need to be submitted using the applicable CPT or HCPCS code.
Documentation necessities for a telemedicine service are the similar as for face-to-face services. As telemedicine becomes more efficient and improves patient outcomes, more services are likely to be approved for reimbursement. In the present situation as more payers reimburse telehealth services, payment policies and criteria will be regularly amended, hence constant observation and updation is required on the telemedicine billing services.

medical billing and credentialing services

Medical Billing – Medical Credentialing a Necessity

Medical Credentialing consists of verifying the qualifications of licensed medical practitioners and assessing their background and legitimacy. Credentials are documented evidence of license, education, training, experience, or other qualifications.

Not obtaining proper credentialing can lead to lost revenues. This results to loss in medical bills for various services provided by the uncredentialed professionals. Medical credentialing process also validate a medical provider’s regulatory compliance record and malpractice history before allowing that provider to participate in a network or treat patients at a hospital or medical facility.

Medical credentialing is a vital part of the Medical Billing process without which it cannot even be completed.

Steps to follow for efficient Medical Credentialing process:

  • Confirm all documents are up to date
  • Provide adequate references
  • Begin early and pay attention to details
  • Have knowledge about the State’s Credentialing specifications.

An efficient workflow will help overcome medical credentialing problems and thus avoid money loss in handling appeals and reimbursements. SpectraMedi Medical Service Organisation provides simple and cost effective Credentialing service. Our service help Providers handle the burdensome procedures of enrollment and credentialing at a competitive price.


Medical Billing to a COVID-19 World

Catastrophic Plans in Medical Billing

What is a catastrophic plan?

Designed to have low premiums but still protect its enrollee’s from substantial medical debt if they suffer a catastrophic illness. These plans have a major role in Covid-19 crisis.

In medical billing, diagnosis and treatment of COVID-19 can be filed under catastrophic plans. These plans must cover essential health benefits (EHB) as required by the Patient Protection and Affordable Care Act (PPACA) but are typically subject to limitations. Health issuer can amend their catastrophic plans to provide pre-deductible coverage for services related to the diagnosis and treatment of COVID-19. 

Catastrophic plans help patients who can’t afford more comprehensive plans. Though expanded catastrophic plan maybe harder on medical billing systems, reimbursements to hospitals and providers will likely remain the same.

RPA in Medical Billing

Robotic Process automation (RPA) with its cost savings, speed and efficiency is slowly making its way into all industries and all types of business processes. Enterprises and service providers are adopting more tools that aid automation. RPA enhances accuracy.

Robotic Process Automation (RPA) has the perfect solution to transform revenue cycle management. It unites an organization’s systems, including electronic health records, billing, patient payment portals, and credit card processing applications. Automation in data entry and insurance claim processing results in fast and precise process completion.

Robots connect to the payer website, handle insurance aging and resubmit claims without human intervention – saving significant time and resources.RPA can help medical billing organizations when processing information as physician credentialing and enrollment as well as checking patient eligibility.

RPA is complementary to existing systems and processes, enabling health care organizations to address gaps in existing processes. Additionally, it creates a 24/7 work force which is more efficient and quicker resulting in improved collections.