MBM INC. Topsfield, MA www.Medical-Billings.com

2012 Brings Disruptive Changes to the Physician and Ambulance Medical Billing Arenas:

Medical Billing Massachusetts — Tue, 07 Feb 2012 18:35:04 +0000

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 (www.ama-assn.org), “…many practices have not had their practice management system software upgraded by their vendor and have not been able to conduct testing with key trading partners…” This has caused medical billing problems for many, many medical providers.

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These disruptions are unnecessary now. They are causing hardship in many, many medical provider practices across the U.S. in 2012. If a medical practice’s claims submission system is not now updated to the new ANSI 5010 standard, their claims sent to Medicare and other payers will be denied, unless the claims are “upconverted” by a claims clearinghouse (e.g. General Electric IDX, McKesson, Capario). This ANSI 5010 standard should have been delayed by at least 6 months to allow all medical practice software vendors and medical practices to test the new software upgrades with all trading partners. Some software upgrades were not available until the Fall of 2011, so practices and software vendors had insufficient time to test and install upgrades. This caused unnecessary chaos in the medical practice management field. Shame on the U.S. Department of Health and Human Services and CMS (Centers for Medicare and Medicaid Services) for causing this chaos.

Another unnecessary disruption for medical practices in 2012: “Revalidations” CMS/Medicare is demanding that 1.4 million physicans, ambulance companies and other medical providers go through the revalidation process by re-submitting many of their enrollment records (g.g. medical license renewal dates, medical school graduation dates, DEA license data, etc.). This is a new requirement of the healthcare reform law passed in 2010. Even though CMS agreed in November 2011 to delay the revalidation deadline 2 years, from 2013 to 2015, this disruptive revalidation process in now underway; medical practices are receiving notices that their Medicare enrollments have been suspended. Why has CMS ignored the law extending the revalidation deadline to 2015? MBM has registered a complaint with both Senator Scott Brown in Massachusetts and Senator Sheldon Whitehouse in Rhode Island.

This revalidation process is designed to reduce fraud and abuse. But since physicians have proven to be much lower risks for fraud than medical equipment and other non-physician providers, CMS was asked by the AMA to exempt phyaicians from the revalidation deadline. CMS refused this request.

This revalidation adventure will continue through 2015 and beyond; it will take a long, long time for 1.4 million medical providers in the U.S to be fully revalidated, in addition to the 27,000 new enrollments and more than 30,000 billing reassignments that must be processed each month by Medicare contractors like our NHIC contractor in Hingham, MA.

All of us at MBM are dedicated to helping our medical provider clients move smoothly through the ANSI 5010 compliance requirements and the revalidation requirements. In the Fall of 2011 and Winter of 2012 we have invested $49,000 in ANSI 5010-compliant software and hardware to protect our clients, and many hours of time in revalidation documentation for our clients.

The battle is waged every day by MBM to protect its clients! Stay tuned.

Don’t let the payers unfairly hold back your reimbursements!

Medical Billing Massachusetts — Mon, 15 Aug 2011 22:17:50 +0000

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 an unfairly denied claim…

You can overnight a letter to the president of the insurance company. You’ll get a response, whether it’s a giant payer like United Healthcare or a small health insurance company. We’ve had successes with United, Blue Cross and other payers, getting claims finally paid.

You can contact CMS (Centers for Medicare and Medicaid Services) New England regional headquarters in Boston. These folks oversee the service provided by New England Medicare contractor NHIC in Hingham, MA. If CMS decides to help you, they can ask NHIC to pay your denied claims.

You can contact your U.S. Senators’ offices and email or fax a description of your unfairly denied claims. If your case is accepted by the Senators’ staffs, they will contact the CMS Regional office, who will ask for an immediate review by NHIC, leading to payment if you are correct in your assertions that the claims should have been paid.

We are experiencing another breakthrough for a client whose claims are unfairly withheld because of physician enrollment problems caused by the Medicare system in New England. That situation should be resolved this month and we’ll post another blog comment.

Don’t give up; fight for your money. Go over the claims department personnel’s heads to higher authorities. It’s your money!

6% Cash Flow Increase Guaranty

Medical Billing Massachusetts — Mon, 15 Aug 2011 20:10:15 +0000

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 been that we provide a substantial lift to the practice cash flow. This cash flow increase comes from three sources:

1. Personnel/payroll savings (It costs less to employ a billing company than to hire a billing staff and manager. See “Why Outsource” Page)

2. Our billing specialists have deeper experience than most billing personnel in pursuing payments on denied claims.

3. Our clients can use the management time savings (not supervising a billing team) to build their practices and further increase the cash flow.

We’re always happy to discuss this with a medical practice.

It’s All In The Spreadsheets…

Medical Billing Massachusetts — Mon, 15 Aug 2011 20:04:34 +0000

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 each month. We’re happy to share the spreadsheets and billing rate charts with medical practices, with no obligation to use our services. You can email us at info@medical-billings.com and we’ll send you the spreadsheets.

The Easy Transition….. Painless.

Medical Billing Massachusetts — Mon, 15 Aug 2011 20:02:28 +0000

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 paper and sent by mail or UPS, or the encounters may be transferred electronically, from the practice EMR system or scheduling system, or the encounters may be scanned and e-mailed to the billing company. In any case, the creation of the claims merely changes locations, and the work flow goes on. Please click our “Testimonials” button on our Home Page to see video testimonials of our clients describing how easy the transition to our services was, whether from another billing company to MBM, or from an internal billing operation to MBM.

Payer Enrollment Issues…

Medical Billing Massachusetts — Mon, 15 Aug 2011 20:00:19 +0000

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 to track the payer enrollment issues. We don’t think anyone can enroll physicians quickly without tracking the progress with a spreadsheet.

Outsouced Billing Is a Good Idea…

Medical Billing Massachusetts — Mon, 15 Aug 2011 19:50:26 +0000

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 medical practice employs 1 to 6 doctors, it is often less expensive to employ a billing company. Rule 2- With more than 6 physicians in a practice, the practice can have the option of either employing the billing team within the practice, or outsourcing the billing function. With the practice revenue volume provided by more than 6 doctors, there are sufficient financial resources to fund a billing manager and deep enough staff to accommodate billing employee turnover, training, vacations and illnesses, without damaging the practice cash flow.

Outsourcing gives the practice freedom from managing the billing personnel, so the focus can be on growing the practice. Keeping the billing function in house can give the providers control and oversight on the critical billing function.

Medicare enrollment problems delay doctors’ cash flow unfairly. Uh-oh-

Medical Billing Massachusetts — Wed, 27 Jul 2011 15:33:52 +0000

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 seeing Medicare beneficiaries months before this date. So, the practice loses tens of thousands of dollars.

On a few occasions, we have had to enlist the support of Senator Scott Brown’s
office, and before that, Senator Ted Kennedy’s office. They will look at a case of Medicare making the wrong decisions, and ask for a review by CMS regional managers.

This free, very valuable process, is open to all medical practices across the U.S. If Medicare mistreats you, go to your elected representatives to protect your practice’s cash flow. Or, call us and we will help you find the elected official to help you.

MBM Cuts Through the Red Tape…

Medical Billing Massachusetts — Wed, 27 Jul 2011 15:24:31 +0000

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 the provider enrollment problem and fix the problem as appropriate.

Result: the doctor got his claims paid back to the October date he launched his new practice.

Thousands of dollars in claims that had been denied were paid. The long shot paid off. This has worked for us and our physicians with Blue Cross, also, where we faxed a letter to the president of Blue Cross, citing unfair treatment of an eye surgeon by the Blue Cross provider contracting team.

Result: amazingly, the contract was issued by Blue Cross with the corrected start date within 2 days.