Written by Dan Loch of EZClaim – As with most people at this time of the year, I like to reflect a short time on the year gone by before I make plans for the next year. Each year is filled with experiences that shape who we are and where we are going next.
This was a very exciting year for EZClaim and for me in my first year as the VP of Sales, Marketing, and BD. I used this year to truly understand who EZClaim was, is today, and help to guide EZClaim into the future. EZClaim, as many of you know, has been around for over 22 years. We are a firm that values our customers and the support we give them over everything else. We are a support firm that sells software as we like to say.
This year we decided to announce that support would be ending at the end of 2020 for one of our most popular products, EZClaim Advanced. This does not mean people have to stop using a product they love. We want to make sure we can continue to offer great products on the latest technology so it is time for us to move on.
This year we hosted our very first User Group Meeting in our home town of Rochester, Michigan. It was an excellent opportunity to meet face to face with the people we support on a regular basis while making some new friends that are considering our solution. During this meeting, we interviewed some current customers along with many of the EZClaim staff. Please take a couple of minutes and watch some excerpts that talk about EZClaim’s history, support focus, and family focus that forms who we are from our interview with the EZClaim Founder and President, Al Nagy.
We started a Blog this year and for the first time added a Facebook page to go along with our LinkedIn profile. Our plan is to communicate about industry topics on the blog and these social channels to assist our vast customer and prospect network. We have a lot of knowledge built up over the long history of EZClaim and it is time we share it. The blog will feature topics from our partners as well. Please be sure to watch for posts every few days in 2020 and beyond. Please let us know if there are any specific topics you want us to hit as well. We are always looking for feedback.
We added some new partners in 2019 that nicely complement our solution and have the same drive for customer support we do. Live Compliance for all your HIPAA compliance needs, Elation Health EMR for “The Quarterbacks of Healthcare” as they like to say, and Alpha II for claim scrubbing. All the vendors we work with are listed on our partners page.
As we go into 2020, EZClaim will focus on EZClaim Online, another Premier platform product due out in quarter four. This expansion of our Premier platform offers additional flexibility in how our clients interact with our billing and scheduling platform. In addition to Online, we will continue to enhance Premier by introducing new features such as Claim Status Inquiry (CSI) and more.
Thank you for being part of the EZClaim family and taking the time to reflect on 2019 with me and think about an exciting 2020. Please take a moment of your time and watch the message from Al Nagy.
Please have a safe and joyful holiday with your friends and family.
Need help getting your To-Do list done? We have you covered!
With 2019 nearing its close, now is a great time to evaluate your revenue cycle management
and look for areas of improvement in the coming new year. Make 2020 the year you put the
focus back on your patients by automating your revenue cycle and improving your bottom line.
The best place to start is by ensuring you get your To-Do list done early!
Making the list is just like a New Year’s resolution: Easy to do but hard to complete without a
partner there to support you. The right solutions should be at the root of your strategy. EZClaim
and TriZetto Provider Solutions (TPS), a Cognizant Company, have the tools and support to
make a difference in your practice and can help you get through the list:
Go digital – Check!
Improve denials management – Check!
Get paid faster – Check!
If these challenges are at the top of your 2020 To-Do list, get in touch with our revenue
cycle experts now to find out how we can help you check them off your list and make sure you
are ready to recoup all that you are owed in the coming new year.
In the meantime, download our infographic with the details of the financial and operational
benefits of getting your To-Do list done early this year.
Don’t run off, Electronic Data Interchange or EDI is quite simply a standardized method for businesses to transfer documents electronically. Some typical business uses for EDI are purchase orders, invoices, shipping notices – types of transactions where the pertinent data can be separated from the regular communication related to negotiations, business deals, vendor contracts, etc. Why are we talking about it here? Easy. A set of standards for the healthcare industry has been adopted and make your life easier.
EDI creates efficiency and helps to automate data entry that is often performed manually. Before HIPAA, there were more than 400 different process forms in paper format. Thanks to the research of the Workgroup for Electronic Data Interchange (WEDI) to explore ways to control skyrocketing healthcare costs and patient privacy protections and the subsequent enactment of HIPAA, EDI is available for use in the healthcare landscape.
Just like EDI used in business, Healthcare EDI functions by exchanging information via transaction sets created as standards by organizations like the American National Standards Institute (ANSI). When HIPAA-covered healthcare providers electronically exchange any of the information covered in the list below, the transaction requires the use of adopted standards.
Claims and encounters information
Payment and remittance advice
Enrollment and disenrollment
Referrals and authorizations
Coordination of benefits
Why is this important? – Efficiencies created in the entry and transference of data reduce errors, saves time and, in turn, saves money. These efficiencies have been adopted for the healthcare industry as they apply so readily to patient and claims data, eligibility, and security.
The EDI Benefits
Standardization: The elimination of proprietary formats creates consistency, reduces errors and the need for translation.
Efficiency: Data does not require manual entry. This reduces errors and speeds up the process as it becomes more automated.
Accuracy: Automated data entry means a reduction of errors, which translates to a savings of both time and money.
Cost savings: Digital transactions reduce paper usage, storage solutions and time used for manually completing paperwork.
Greater security: Since only authorized parties can access the data, patient data is better protected and the risks of HIPAA violations are significantly decreased.
HIPAA Compliance – Healthcare EDI transactions are more secure than paper methods of transmitting information. Only authorized users have access to transactions, which is in keeping with healthcare data management practices. That being the case, EDI helps to enable secure data transmissions that comply as HIPAA mandates.
So, why isn’t everybody using EDI? – The use of EDI for data entry and transfer requires both parties to be technologically equipped to handle the transaction. For many smaller businesses, these initial costs can be prohibitive. In many instances, the standards to use between provider and payers are not defined or agreed upon; this results in paper documents being used a fallback.
Looking forward – In addition to the advancements in mobile and smartphones, we now have many types of wearable tech that can be used to track all types of health data. The advancements of mobile EDI can empower patients and practitioners alike to not only ease the portability of patient data, but also mobilize patient health information, track health trends, diagnose potential or emerging health issues, and simplify billing. While technology marches ahead, we will all need to keep in mind the methods for enabling data transfer and keeping compliant for security, safety, and privacy.
EZClaim Premier can generate, parse and display ANSI Healthcare EDI transaction sets as well as clearinghouse formats. This means you are ready to start processing claims using HIPAA-compliant EDI methodology right away with the end-to-end simplicity, compliance, and the peace of mind that comes with ease of data entry, assurance of data free from errors to produce clean claims and, with that, fewer rejections. We continually update our software to keep pace with any changes that may occur in the EDI space.
The cloud is still a mystery to many and when it comes to cloud security regarding Health Insurance Portability and Accountability (HIPAA) compliance and your patients’ protected health information (PHI), the unanswered questions you may have can lead to a lot of stress. We’re here to help make your life easier, so we’ll put this in plain and simple terms. Here are the necessities that make for HIPAA compliant secure hosting and cloud storage solutions. Making sure your hosting and/or cloud storage provider ticks these boxes ensures adherence to the security standards that are required to keep your patients’ PHI, your practice, and your reputation safe.
Business Associate Agreement (BAA)
Private hosting environment
SSAE 18 Certification
Cloud computing is an impossible-to-ignore convenience and EZClaim Cloud provides the best of both worlds – the ability to work wherever you want and the peace of mind that comes with knowing your practice and patient data are protected on secure servers with nightly backups. EZClaim Cloud uses Netgain, the industry standard for secure and scalable HIPAA compliant for hosting and secure cloud storage. Rest assured EZClaim Cloud has the security of you and your patients’ PHI covered in every respect.
Not to mention EZClaim Cloud gives you these additional benefits:
Data Permissions Control
Less onsite technical support
Works on all Operating Systems
If you would like to dig deeper to get extensive information regarding HIPAA compliance and the cloud computing environment, visit the U.S. Department of Health and Human Services (HHS) for their Guidance on HIPAA and Cloud Computing.
If you like the sound of the outstanding benefits that EZClaim Cloud provides backed by Netgain, a leader in secure cloud-based hosting and storage, we invite you to learn more or upgrade your account today.
We hope you enjoyed the “Security – Keep Your Head In The Clouds” blog article. Click here to see our full blog page to see all of our most recent posts!
We often find that the reason behind declining medical practice revenues doesn’t have to be uncovered – it’s right there in plain sight in your payer contracts.
Practices that don’t track their payer contract rates are reimbursed on average 4 percent less. (1)
Payers make inaccurate payments on one out of every 14 healthcare claims. (7.1%) (2)
A recent study showed that physicians billed $5.15 below their contracted fee schedule per code. (3)
While working with healthcare groups across the country, we have seen payers reduce their fee schedules by 5 to 12%.
Fortunately, longstanding patterns of poor attention to contracts can be broken by analyzing and monitoring your payer contracts. You’ll be more informed and in a much better position to compete and thrive.
Updating Your Charge Fee Schedule
Making yearly updates to your charge fee schedule is one of the most important things a provider can do to ensure the collection of an appropriate amount for services.
Rates change over the years due to Amendments, Proprietary Market Fee Schedules, or CY Medicare-Based Fee Schedules.
Payer Reimbursement Pitfalls
Most contracts contain an evergreen clause, which is a fancy way of saying that the contract goes on and on until something triggers renegotiation and/or termination. The contract is automatically renewed unless one or both of the parties modify or terminate it.
% of Billed Charges (BC)
Contracts that are primarily based on a percentage of billed charges (BC) will be devastating if, for example, your charges are at 150% of CY Medicare and the Agreement pays 50% of billed charges – you are getting paid 75% of CY Medicare.
Oftentimes an agreement will state that the payer has the right to amend the contract without prior written notice. Reject any language which gives the payer unilateral amendment rights.
If the agreement requires the payer to provide notice of the amendment, remember, usually; “Following (30) days written notice. Failure to object constitutes agreement.”
“Lesser of” Language
All too often, practices have certain codes that fall below contract rates and almost all contracts have a “lesser of billed charges (BC) or contract rate” provision. Meaning, if your contract rate is $100 and your charge is $50 – you just lost $50 and cannot get it back!
The primary mission of CodeToolz is to help medical providers increase their revenue. It’s as simple as that.
Texas Medical Association, 2019
American Medical Association’s National Health Insurer Report Card, June 2019
Medscape Physician Compensation Report 2019
We hope you enjoyed this article about the Payer Reimbursement Pitfalls. Click here to visit our main blog page to read more interesting and useful articles from EZClaim!
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