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
eligibility testing allows to submit clean claims to healthcare
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
eligibility verification is the method of checking the insurance
of a patient in terms of :
➢ Active or Inactive status
➣ Eligibility status
this information, healthcare services will be interrupted.
necessary as it is directly linked to claim denials or payment delays
of any healthcare
The claim denial and payment delays occurs when eligibility checking
is not done correctly and efficiently. Checking
or insurance eligibility
remains important to medical practice income and productivity and
also saves time and money.
explained below will give you some insights about the importance of
patients insurance eligibility checking in Medical
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.
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
where insurance has expired or plans do not cover the programs,
checking eligibility in advance
protects the procedure.
and benefits of a patient can change at any time. Lack of follow up
prior to a patient visit may lead to rise in claim denials and a
substantial loss of a revenue. Patients insurance
checking plays a major role in a healthcare
facility’s claims denial management program. Every successful
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
is very vital and plays a very effective role in medical billing.
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.
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.
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
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
Tips to improve
patient collections in medical billing: –
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
- Check your
patients’ coverage before the consultation – Remind patients who are on
- 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.
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 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.
is a catastrophic plan?
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.
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.
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.