Jun 15, 2021 | Claims, Credit Card Processing, Medical Billing Customer Service, Medical Billing Software Blog
Are you or your staff having to enter every patient into your EHR program and then again into EZClaim? There is an easier way! Integrating your programs will put an end to duplicate data entry, saving your practice time and money!
So, what exactly is an interface and how does it work? An interface is a way for two programs to share information. For EZClaim clients, the interface can be set up to share data from your EHR program to EZClaim. Your EHR can give you specifics on how to send the data to EZClaim.
In EZClaim you will have an opportunity to review the file prior to saving the data. When you complete the import process, your claims will be created, and libraries will be updated. In addition to creating your claims for each visit, an interface can also create Physician/Facility library entries, as well as Payer library entries, and create new or update existing patient accounts.
If you are working with one of our partner EHRs (Visit our Partner List) the integration between programs can be set up quickly and easily. Since the process varies slightly depending on the EHR you are using, time to complete the integration request will vary.
If you are not using a partner EHR, you may still be able to integrate with EZClaim.
Following are some options:
- In our Online Help File the format types and specifications are available for you to share with your EHR vendor. If they can provide a file in one of the required formats you will be able to import your data.
- You may consider using a third party to write a custom interface for you. If you would like more information on this, contact EZClaim and we will be happy to provide information on consultants who are familiar with the EZClaim platform.
If you have questions, please submit them via email to support@ezclaim.com so a technician can review them and get back with you.
May 11, 2021 | Features, Medical Billing Software Blog
Can you add up the number of hours your billing team spent during any given week or month waiting on-hold with insurance companies to get patient billing information? Does your staff invest hours of their valuable time seeking out the smallest of details to get paid? Are you aware that integrated eligibility, through EZClaim’s medical billing software, can reduce that time on-hold to a fraction of the total?
It is estimated that the average biller can spend up to 2-hours on-hold just to get an insurance company on the phone. Add to that an average of 10 – 15 minutes to talk through a patient and most companies will only address one or two patients at a time. To add to it often there are multiple insurance companies to call. As you can tell you quickly have a considerable amount of time lost making phone calls. Instead of spending hours on the phone with insurance companies, make best use of your staff’s time by checking to see if you have the integrated eligibility feature in your billing software.
Getting started is as easy as getting set up with a clearinghouse (EZClaim clearinghouse partners). Once you are signed up with a clearinghouse for the electronic claim submission program, they will have an integrated eligibility feature that is integrated into EZClaim. Once you sign up with this feature, you can send a batch request of 50 patients at one time and if needed, send multiple requests in a day. Do this by selecting an active patient list collectively or send them individually in smaller amounts. Either way the time savings will be exponential.
Eligibility response reports often come back within seconds making the process nearly real-time. When a response comes back you have the real-time eligibility information. You will get details on if they are covered or not, their active dates, deductibles, co-insurances, co-pays, and what amounts they are subject to and what will be deducted. With EZClaim eligibility integration built in you save valuable time. To learn more contact EZClaim’s website, email, or call 877.650.0904.
ABOUT EZCLAIM:
EZClaim is a medical billing and scheduling software company that provides a best-in-class product, with correspondingly exceptional service and support. Combined, they help improve medical billing revenues. To learn more, visit EZClaim’s website, email them, or call them today at 877.650.0904.
Apr 5, 2021 | EZClaim Premier, Features, Medical Billing Software Blog
EZClaim medical billing software has many features built into the program to help you submit clean claims for quick payment and some that can be customized to fit your specific needs. This post will look at the ability to create customized validation rules.
Your EZClaim program already includes standard validation rules. To access these rules and create your own, press CTRL-ALT-V. This will open the Rule Library.
Here you will find four different types of rules to work with, rules related to:
- Sending claims
- Saving a patient
- Saving a payer library entry
- Saving a physician library entry
Now, click on the rule type you would like to work with and click Edit Rules. A list of rules that are already in the program will appear, along with the option at the top to “Add new validation rule“.
To get started, you will fill in the fields on the bottom left side of the screen:
Name: Name the rule anything you would like
Field: This is the field in Premier that you want to validate
Message: This is the message that will show when the error is encountered (consider using casual wording or extra punctuation so it is easily identified as a custom rule rather than a default rule)
Severity: Do you want the program to simply warn you that there may be an error or stop you from completing the task?
Next, you will build the logic for the validation of the field you have named above. In the example below, the rule has been created to warn users if ALL the following statements are true:
- Authorization Number is blank
- Procedure Code is 90876
- Payer is Blue Cross
Before you begin working with your validation rules it is extremely important to keep the following in mind:
- Rules are created to check for bad or missing data, not to confirm good data.
- Rules in the Sending Claims area may prevent batches from being created.
- If you wish to bypass a built-in validation rule you may disable it, if you want to customize it you can Copy the rule, update, and disable the original rule.
- Rules are the sole responsibility of the practice, EZClaim cannot troubleshoot custom validation rules.
As you can see, custom rules allow you to be very specific and can include multiple data points. Learning to use validation rules can be tricky and may take a few tries to get the rule built correctly. However, once you have the rule in place you can avoid payment delays and needing to resubmit claims.
ABOUT EZCLAIM:
EZClaim is a medical billing and scheduling software company that provides a best-in-class product, with correspondingly exceptional service and support. Combined, they help improve medical billing revenues. To learn more, visit EZClaim’s website, email them, or call them today at 877.650.0904.
Apr 5, 2021 | Medical Billing Software Blog, Waystar
For many providers, medical claim denials are one of the single biggest drains on revenue. When you consider that working just one denial costs about $25, knowing why claims are being denied and how to prevent them in the future isn’t a luxury—it’s a necessity.
Automation and advanced analytics can take much of the burden off your billing team by helping you identify potential denial triggers, adapt to constantly changing payer guidelines, and uncover actionable trends in your claim data.
Waystar’s Denials by the Numbers:
- 5-10% average denial rate amount physician practices
- 90% of denials are preventable
- 76% of providers say denials are their biggest RCM challenge
[ Note: View or download Waystar’s “Defeat Denials with Data” white paper here ]
Waystar, a partner of EZClaim, integrates easily with its medical billing software, creating a seamless exchange of claim, remit, and eligibility information. To learn more about defeating medical claim denials, or to add Waystar as your clearinghouse, visit this page.
ABOUT EZCLAIM:
EZClaim is a medical billing and scheduling software company that provides a best-in-class product, with correspondingly exceptional service and support. Combined, they help improve medical billing revenues. To learn more, visit EZClaim’s website, e-mail them, or call them today at 877.650.0904.
[ Article and white paper contributed by Waystar ]
Apr 5, 2021 | Medical Billing Software Blog, Revenue, Support and Training, Trizetto Partner Solutions
In the world of healthcare revenue cycle management, there are numerous scenarios that can put a stranglehold on your revenue if you’re not prepared. With the COVID-19 pandemic causing varying degrees of change in inpatient volumes and visits, and telemedicine coming further into play, physicians and their practices are having to quickly navigate the nuances of their financial well-being. A practice may be buttoned up from the time the patient walks in the door, but what happens after the visit will determine when the practice will get paid. This element of the revenue cycle starts with coding. Here are five medical coding challenges that will ruin your bottom line.
1. Coding to the Highest Specificity
Missing data on a claim relative to the patient’s diagnosis and procedure can easily cause a rise in denials once received by the payers, resulting in potentially thousands of dollars in write-offs. Medical coders are responsible for coding patients’ claims to the highest level of specificity, ensuring the appropriate CPT, ICD-10-CM, and HCPCS codes are applied based on the patient’s chart from the day’s services.
COVID-19 and telemedicine are frequently bringing on new codes and code sets, all with different variations and modifiers to make the matter even more complex. Medical coders spend a lot of time researching and learning new codes, but every year – and throughout the year – changes and updates are made. Payers don’t only want to know the diagnosis and the treatment; they want to know the cause as well. The Coronavirus Aid, Relief, and Economic Security Act passed in March of 2020 allows for an additional payment from Medicare of 20 percent for claim billed for inpatient COVID-19 patients, however, it was later indicated that a positive COVID-19 test must be stored in the patient’s medical records in order to be eligible for this payment. Being able to stay on top of codes specific to the patient’s diagnosis at treatment is more difficult than ever before.
2. Upcoding
While code specificity is important, so too is ensuring the claims do not contain codes for exaggerated procedures, or even procedures that were never performed, resulting in reimbursement for these false procedures. This seems logical enough, but upcoding can easily occur as a result of human error, misinterpretation of a physician’s notes, or lack of understanding of how to appropriately assign the thousands of ICD-10-CM codes in existence. To add to the pressure, the Office of the Inspector General issued a plan with objectives to prevent fraud and scams, and remedy misspending of COVID-19 response and recovery funds.
Much like under-coding or not providing enough data on the patient’s visit can create issues, upcoding can be a major contributor to financial loss for a practice. Questionable claims can be denied and sent back for corrections and appeals, but upcoding can have more serious ramifications outside of paper-pushing between coders and payers.
Whether it’s making sure the codes are in accordance with the care provided, understanding the code sets that apply for each procedure, or comprehension of the medical record, refraining from upcoding will help ensure a sturdy and compliant revenue stream.
3. Missing or Incorrect Information
There’s a common theme to coding challenges, and that’s having the sufficient information necessary. This information typically is pulled from a patient’s chart or record of a visit, which is often completed by the attending physician. However, even when a claim is submitted, providing required information relative to the procedure to the payer is critical as well. Situations such as failure to report time-based treatments (such as anesthesia, pain management, or hydration treatments) or reporting a code without proper documentation can result in denials.
Furthermore, information in a patient’s electronic health record may also contain inaccurate information. Keystrokes and other human errors can cause these situations to flare up, and it takes a diligent, thoughtful coder to read between the lines and ensure claims have the appropriate information.
4. Timeliness of Coding
The Medical Group Management Association (MGMA) suggested in their 2018 Setting Practice Standards report that a Primary Care Physician should maintain a claim submission rate of 3.11 days after the date of service, but it is becoming increasingly difficult for practices to sustain anything close to this rate. Constant changes to code sets, an increased focus on submitting claims with sufficient and compliant information, and the requirement to code claims to the highest level of specificity, can easily delay the submission by days or weeks.
Nevertheless, delays in coding and submitting claims can cause major lags in payment and substantial loss in revenue. Insurance payers have statutes of limitations that require claims to be submitted anywhere from 120 to just 60 days after the date of service. Simply put – the more time spent coding the claim, the later it will be submitted, thus increasing the odds that the claim will be denied. Expert coders are aware of this and do everything in their power to get coded claims out the door.
5. Staffing Shortages
However, finding experts well versed in coding claims quickly, accurately and in compliance with the False Claims Act is not always an easy task. As you can imagine, the increasing need for care within the senior population is causing a rise in claim volumes, and trying to find a team of coders who know the ins and outs of complex ICD-10-CM coding can easily cause a bottleneck in the revenue cycle. Health executives expressed their struggles to find talent back in 2015, and some forecasts expect a decline in commercial payments by 2024 to further hamper a C-suite’s ability to manage labor costs. The ramifications of incorrect coding are still a key topic of discussion to this day.
The time has come for practices to begin looking outside of their organization for coding support. How is your practice planning to tackle the coding conundrum? When choosing a partner for your medical coding needs, you need to pick an expert to help your practice stay on target. TriZetto Provider Solutions, a Cognizant Company, has available highly-trained, AAPC & AHIMA certified coders with the experience of getting the details right the first time and understand the importance of coding to the medical practice.
For more information about TriZetto Provider Solutions, a partner of EZClaim, visit their website, contact them, or give them a call at 800.969.3666.
ABOUT EZCLAIM:
EZClaim is a medical billing and scheduling software company that provides a best-in-class product, with correspondingly exceptional service and support. Combined, they help improve medical billing revenues. To learn more, visit EZClaim’s website, e-mail them, or call them today at 877.650.0904.
[ Contribution of the TriZetto Provider Solutions Editorial Team ]
Apr 5, 2021 | AMBA National Conference, Medical Billing Software Blog, MMBA Chapter Meetings, Support and Training
In this interview with a medical billing expert and co-owner of Elite Billing Resolutions, Vicky Greenwood, we talk about dealing with the challenges in owning a billing company, some important skills that every medical biller needs, and the value of choosing the right medical billing software. In our time speaking with Vicky, we focused on topics that will aid, contribute, and help grow the skills of the medical billing community. We at EZClaim believe in highlighting the best practices in the industry and sharing those with the larger community. We encourage you to consider these insights, and then let us know what topics you would like to learn more about.
EZCLAIM: When did you get into medical billing?
VICKY: “I started in 1994, and at the time we were working on a dinosaur of a system called, “Signature.” We would have to wait overnight to process the entire day’s work. Then we would return in the morning to see if there were any errors in the batch or denials in the claims, which meant being accurate in entering information was essential. Outside of that, we kept all our paperwork in filing cabinets, and they needed to be sorted and organized by date. If a date was off in the filing system it could take the better part of a day to find a patient’s claim. The difference between then and now is night and day. I am definitely thankful for technology.”
EZCLAIM: Why did you start Elite Medical Billing?
VICKY: “We started Elite Medical Billing because we wanted to be able to directly impact our medical practices with the services we provided, and we wanted the freedom to enjoy doing it for our clients. I also knew that I was experienced in the field, was competent at my job, and enjoyed doing what needed to be done to get practices paid. Once I honed those skills and knew we could do it. We hired a lawyer and an accountant, then formed our company.”
EZCLAIM: What are challenges in starting a company?
VICKY: “First, you have to understand the value of time management and delegation. You don’t want to bite off more than you can chew. It is good to know when you need to ask for help. Next, you want to find good staff. I look for people who have the right attitude about the job first and have the characteristics to be proactive and work hard. Then, I look for experience in the field, learning if they had hands-on experience with claims, denials, and coordination of benefits is part of that. At the end of the day, my staff are my [company], and fortunately, most of my staff have been with me from the beginning.”
EZCLAIM: Why did you choose EZClaim?
VICKY: “We had a client who needed software and, being a smaller company, we needed cost-effective software with strong tech support. When we searched on Google for “easy to use medical billing software,” we found EZClaim. We were won over by the first phone call. Since then, we have been reminded of how great a decision that we made. The simplicity by which you can enter the information, process new patients, and ‘claim them’ within minutes is invaluable. That combined with the great customer service—that answers our questions most often on the first call with detailed answers—and video tutorial support is why we will continue to use and promote the software.”
EZCLAIM: Are you a member of AMBA and MMBA?
VICKY: “We joined the MMBA and AMBA in 2016 to help us certify our billing company. That process and the training, testing, and materials were amazing pieces of helping us get established and grow. In addition, the expos, webinars, and online support offer an abundance of information. Of course, the annual expos are both informative and a great work trip for team building and fun. We make it annually to the MMBA, but our next big goal is to go to the AMBA in Las Vegas!”
EZCLAIM: Have some final thoughts to offer fellow medical billers and business owners?
VICKY: “As a medical biller and owner, you have to be willing to talk with physicians. You need to show them the vouchers and documentation of your work. And it is important to communicate how they bill and how they can be sure to properly classify to get paid. You need to review what they have done in the past and how they can improve in the future by training staff.”
“You can also add value by making them the good guy and yourself the bad guy when dealing with patients and getting paid. We allow patients to call us directly, we answer the questions, and tell them how much they have to pay—then we forward the call to the office. Remember, at the end of the day, you have to show them the money. They work hard and they deserve to get paid.”
ABOUT EZCLAIM:
As a medical billing expert, EZClaim can help the medical practice improve its revenues since it is a medical billing and scheduling software company. EZClaim provides a best-in-class product, with correspondingly exceptional service and support. Combined, EZClaim helps improve medical billing revenues. To learn more, visit EZClaim’s website, email them, or call them today at 877.650.0904.
