Unprecedented changes in health care in 2014   Leave a comment

We are preparing now! And we have concerns!

ICD-10 and ACA, the Affordable Care Act, are bringing

a whirlwind of change. While we see humor in the October

2014 move from ICD-9 (13,600 codes) to ICD-10

(69,000 codes), the billers preparation

for these changes is serious business.

The humor is pretty obvious: So

many new codes exist in the new

ICD-10 system that the granularity of

the diagnoses brings coding such

as: W6133XA (pecked by a chicken,

initial encounter) and V95-42XA,

(spacecraft crash injury to occupant,

initial encounter).

We have begun the preparation for ICD-10 compliance

on the Centricity system, and will be starting shortly on

the ambulance system, well before the October 1, 2014


Here is our chief concern with ICD-10: It arrives October

1, 2014 with no pre-testing before, and no grace period

after. All billers will have to carefully monitor claims

submitted after October 1, 2014, to discover and fix electronic

glitches. Our technology partners and our clearinghouses

will certainly have their chance to shine!

The other big change in 2014: With the Affordable

Care Act comes an influx of 30 million new health insurance

policy-holders. This will cause a significant up-trend in

co-pays, co-insurances, and deductibles. This trend is already

underway, according to a 2013 study by the Trans

Union credit scoring agency, which reported that the average

deductible a consumer pays increased this year by

more than 154 percent, from $405 to $1,032. And the

average copay went from $65 to $117.

Here is our chief concern with the Affordable Care Act:

providers must be ready for the continuing rise in co-pays,

co-insurances and deductibles.

We have helped our clients through many changes

over the past 23 years. The huge change to ANSI 5010 in

2012 disrupted many providers’ collections. We prepared,

upgraded our systems, and protected our clients, who experienced

no disruptions. We will help our clients through

these changes in 2014. That is our absolute commitment.

NGS (National Government Services) takes over as Medicare contractor in New England and New York   Leave a comment

For many medical practices and also for many ambulance companies, Medicare is a very significant payer in the payer mix.  Thus, when the Medicare contractor changes in a region, it is very, very important to submit claims successfully to the new payer.  In fact. it is prudent to take the payers up on their offer to provide “early boarding.”  With this procedure, the claims are sent before the changeover to the new payer, even though they are not in place yet.  The new payer (new Medicare contractor) then relays the claims to the old payer which has not stopped work yet.

This is a very good test for any medical practice or ambulance company.  In the case of New England and New York, NGS is now receiving claims from ‘early boarders’ and relaying them to NHIC, soon to be the old payer.

We help our clients by testing the new Medicare connections for them as we pass claims through to the new payer (then relayed to the old Medicare contractor still on the job until the changeover October 25th. 

Why not test your claims submission to National Government Services (NGS) now?

Curt Anderson

More Hard Work in the Trenches of Medical Billing in 2012   Leave a comment

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, now delayed),

2. and the ANSI 5010 electronic claims filing changes (with the grace period now extended to June 30th, 2012), and, if you can believe this,

3. Medicare contractor revalidations of all of the active physicians submitting claims for services to Medicare beneficiaries. 

This is way too much hassle pressed onto the medical claims reimbursement arena in 2012. 

All of us in this business- providers and suppliers- should contact our Senators and Representatives in Washington to tell them to temporarily stop these changes while the medical community gets ready.  Just click on www.senate.gov and www.house.gov and then click on Find Your Senators or Find Your Representatives and call them or email them.

It’s very important that we make ourselves heard right now!

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

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.

(continued from our homepage)
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!   Leave a comment

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   Leave a comment

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…   Leave a comment

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.   Leave a comment

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…   Leave a comment

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…   Leave a comment

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.