All of us in the billing arena for medical providers need to stand up and say what we know to be the truth at this time: the government is pressing too many changes on our complex healthcare system right now.  The three biggest changes are: 1. the ICD-10 transition (originally scheduled for October 1, 2012, [...]

The change from the old standard for HIPAA transactions (ANSI 4010) to the new standard (ANSI 5010) took effect January 1, 2012 (with a grace period until March 31, 2012). This change requires all medical providers to abruptly upgrade or change their practice management software immediately.  As the American Medical Association says on their site [...]

Why do the insurance companies and Medicare and Medicaid hold back your payments?  It’s obviously in their best interests to withhold payments when there are complications on claims. But, sometimes… there’s no justification for holding back payments. If you have the documentation, and you’ve gone to the claims department supervisors, and still no satisfaction on [...]

The other day another medical practice asked us about the  guaranty we offer on our billing work for medical practices.  Seems risky?  Well, we can offer our unique 6% cash flow increase guaranty because we have been taking on the billing responsibilities for medical providers for the past 20 years and our experience has customarily [...]

We have discussed the cost of the billing function with many, many medical practices.  We even use a spreadsheet to compare the cost of outsourced billing, which often runs between 5% and 8% of collected funds, billed monthly.  The spreadsheet approach shows that an internal billing department can cost 10% to 11% of collected funds [...]

Uh-oh, here comes the transition to a new billing team.  Over and over again we have helped physician practices make the transition to our billing team.  Orderly, process-driven work  will make this transition easy. Patient encounter forms merely shift destinations, from the medical practice billing department to the billing company. The encounters may be on [...]

Billing snafus caused by provider enrollment issues?  We’ve seen ‘em!  Practices large and small, all over the country are forced to enroll their physicians with many, many insurance payers. The payers often have enrollment forms that are filled out physically and faxed or emailed or FedExed or filled out online.  You need an Excel spreadsheet [...]

Here are two rules of thumb pertaining to a practice’s billing function: We are  often asked about whether a billing company’s services should be used by a medical practice.  We recommend rules of thumb that can help a practice manager decide whether to outsource the billing function to a billing company.  Rule 1- If the [...]

by: MBM Inc, Topsfield, MA This really bothers us.  It just does not seem right, but you have to do this sometimes.  This seems so wrong.  Sometimes Medicare refuses to credential a provider (“Provider Enrollment”) on the correct date.  Medicare selects a date for claims to begin being payable (the “effective date”).But the doctor began [...]

Wow, we took a long shot on this doctor’s problem with United Healthcare.  When a prominent eye doctor in Rhode Island could not get a provider enrollment agreement for many months from United  Healthcare, we FedExed a letter to the President of United in her Hartford, CT office. Amazingly, she asked her staff to research [...]