Mar 10, 2021 | Medical Billing Software Blog, Partner, Waystar
New Patient Survey About Price Transparency Rule
With the cost of insurance premiums and deductibles both on the rise, patients have begun taking on greater responsibility for paying for healthcare than ever before. In return, they are becoming more discerning shoppers and expect more from the patient experience that their providers are delivering. One of the biggest steps that have been taken to create a more standardized, consumer-like experience is the introduction of the final price transparency rule from the Centers for Medicare and Medicaid Services.
More than half of consumers have received an unexpected medical bill
Despite the $3.81 trillion that was spent on healthcare in 2019, America’s healthcare payments system has long remained opaque and broken. Patients are frequently faced with unexpected or surprisingly high medical bills, discover too late that a provider they’d been told was in-network was actually out of network, and are forced to wait 60-90 days to receive their medical bills.
Patients are more concerned about billing than the quality of care
In October 2020, Waystar surveyed 1,000 consumers about their experiences with medical bills, and awareness and attitudes towards the upcoming price transparency rule. More than half of respondents have received an unexpected medical bill, meaning that they assumed a service was covered by insurance and it ultimately was not, or the amount they expected to pay out of pocket was different from the bill they received.
> > > CLICK HERE To Read the Results of the Waystar Survey < < <
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 contributed by Waystar ]
Mar 10, 2021 | Cloud Security, HIPAA, Live Compliance, Medical Billing Software Blog
How Can You Avoid Phishing Scams?
Phishing is the fraudulent practice of sending e-mails or text messages claiming to be from reputable companies in order to persuade individuals to reveal personal information, such as passwords and credit card numbers. Scammers use e-mail or text messages to trick you into giving them your personal information, trying to steal your passwords, credit card account numbers, or Social Security numbers. If they get that information, they could gain access to your accounts. Scammers launch thousands of phishing attacks like these every day—and they are OFTEN successful!
The FBI Internet Crime Complaint Center reported that $57 million was lost to phishing schemes in one year. Scammers often update their tactics, but there are some signs that will help you recognize a phishing e-mail or text message.
How to Recognize Phishing Scams
First, phishing e-mails and text messages may look like they are from a company you know or trust. They may look like they are from a bank, a credit card company, a social networking site, an online payment website, or an app or online store. Phishing e-mails and text messages often tell a story to trick you into clicking on a link or opening an attachment.
They may:
- Say they have noticed some “suspicious activity or log-in attempts”
- Claim there is a problem with your account or your payment information
- Say you “must confirm some personal information”
- Include a fake invoice
- Want you to click on a link to make a payment
- Say you are “eligible to register for a government refund”
- Offer a coupon for free stuff
What are the Signs of a Scam?
- The e-mail says your account is “on hold because of a billing problem.“
- The e-mail has a generic greeting, “Hi Dear.” (If you have an account with the business, it probably would not use a generic greeting like this).
- The e-mail invites you to click on a link to “update your payment details.”
Your e-mail spam filters may keep many phishing e-mails out of your inbox, BUT scammers are always trying to outsmart the spam filters. So, it is a good idea to add extra layers of protection.
Four Steps You Can Take Today
- Protect your computer by using security software.
Set the software to update automatically so it can deal with any new security threats.
- Protect your mobile phone by setting software to update automatically. These updates could give you critical protection against security threats.
- Protect your accounts by using multi-factor authentication. Some accounts offer extra security by requiring two or more credentials to log in to your account.
- Protect your data by backing it up. You can copy your computer files to an external hard drive or cloud storage. Be sure to check with
your IT department and designated Security Officer before copying data to other locations.
What to Do If You Suspect a Phishing Attack?
If you get an e-mail or a text message that asks you to click on a link or open an attachment, first answer this question: Do I have an account with the company or know the person that contacted me?
- If the answer is “No,” it could be a phishing scam
- If the answer is “Yes,” contact the company directly using a phone number or website you know is real, NOT the information in the e-mail. Attachments and links can install harmful malware.
- If you think a scammer has your information, like your Social Security, credit card, or bank account number, go to IdentityTheft.gov. There you will see the specific steps to take based on the information that you lost.
- If you think you clicked on a link or opened an attachment that downloaded harmful software, update your computer’s security software. Then run a scan.
- Finally, contact your Security Officer and IT Staff Immediately.
What Can I Do to Ensure This Doesn’t Happen?
One of EZClaim’s partners, Live Compliance, will make checking off your compliance requirements extremely simple. They have a service that is:
- Completely online, our role-based courses make training easy for remote or in-office employees.
- Contact-free, accurate Security Risk Assessments are conducted remotely. All devices are thoroughly analyzed regardless of location. Conducting an accurate and thorough Security Risk Assessment is not only required but is a useful tool to expose potential vulnerabilities.
- Built directly into your portal, easily monitor where your workforce may be vulnerable with our Dark Web Breach Searches. Easily expose breach sources with ongoing searching of active employee email or domain ensuring continued awareness of potential breach exposure. Weekly automatic e-mail notifications if new breaches are discovered.
- Informational, and has short, informative, privacy awareness videos covering technical, administrative, and physical safeguards with topics such as Ransomware, Phishing, the Dark Web, Password Protection, etc. Delivered monthly with no logins required, empower your workforce to make conscious decisions when it comes to your organization’s privacy and security.
So, don’t risk your company’s future and avoid phishing scams especially when Life Compliance is offering a FREE Organization Assessment to help determine your company’s status. Call them at 980.999.1585, e-mail them at Jim@LiveCompliance.com, or visit LiveCompliance.com. For more specific information, e-mail support@livecompliance.com
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 contributed by Jim Johnson of Live Compliance | Photo Credit: Shutterstock ]
Mar 10, 2021 | BillFlash, Claims, collections, Credit Card Processing, Fullsteam, Medical Billing Software Blog, Revenue
How to Modernize Your Medical Billing Payments Now
It is now very important to modernize medical billing payments capabilities since upwards of 80% of medical services that don’t get paid by insurance, never get paid!
Are you tired of providing medical services and not getting paid? Have you billed patients for their medical visit or co-pay just to find out that the bill showed up in collections? Are you looking for a better way to use modern technology to increase the number of medical claims being paid on time? If you own a medical practice or work in the medical billing industry, then chances are you have answered each question with a hearty “Yes!”
Last month, medical billing industry leaders came together to discuss how medical practices can streamline their payment systems and integrate credit card processing into their billing system. [ Participants: Dan Loch (VP of Sales & Marketing, EZClaim), Tony Peterson (VP of Business Development, BillFlash), and Michael Jones (Payment Services Analyst, FullSteam) all joined host Susan Martinez (Sales Consultant, EZClaim) ].
[ Click Here to LISTEN to the Exclusive Podcast ]
[ Click Here to VIEW the Exclusive Video ]
KEYS That Came Out of the Discussion:
• CHANGING SYSTEMS AND PROCESSES: The practices that are winning in the payment collections game, and seeing the highest percentage of claims paid, are the offices that have updated their systems from the old school and traditional forms of payment collection to the modern, state-of-the-art systems with payment integration. Plain and simple, this means first educating the patient from the moment they walk in the door and streamlining your payments into one medical billing system to prevent human error. [ Click here to LEARN MORE ].
• STREAMLINING CREDIT CARD PROCESSING: Practices often have jumped headlong into credit card processing by using simple systems with variable fees like Square or Stripe. The problem with that is two-fold: First, understanding processing fees, and secondly, avoiding the errors that occur in the steps of processing those purchases over to the billing record. However, now EZClaim’s medical billing software has an integrated payment feature—which streamlines the billing and simplifies the fees. [ Click here to LEARN MORE ].
These are only a few of the very informational topics that were discussed during this podcast. If you are interested in learning how your practice can put these systems in place, increase patient payments, and simplify your billing process in your office, then click here to listen to the podcast and prepare to learn some new, up-to-the-minute ‘insights’ on modern medical billing systems.
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.
Feb 9, 2021 | Claim Status Inquiry, Claims, Denied Claims, Electronic Billing, Medical Billing Software Blog, Partner, Waystar
Reducing claim denials has long been a challenge for providers. In the worst case, denied claims end up as unexpected—and sometimes unaffordable—bills for patients. The challenge only seems to be growing. A recent survey conducted by the American Hospital Association (AHA) found that 89% of respondents had seen a noticeable increase in denials over the past three years, with 51% describing the increase as “significant.”
Minimizing loss will be top of mind for providers as the COVID-19 pandemic continues to put a strain on their resources, and minimizing or preventing denials will need to be a core part of that strategy. With that in mind, we’re offering four tips to help guide revenue cycle strategies for better denial reduction in 2021.
1. Analyze and Assess
In order to achieve and maintain a healthier denial rate, it’s vital to have a good handle on the factors creating problems in the first place. Keep the following in mind as you start to structure your analysis:
- Review key performance indicators: Take a look at which metrics are being used to benchmark success or failure and see if it’s time for a refresh
- Evaluate workflows: It’s important to have a clear understanding of how your team operates, and that you can detail workflows as step-by-step processes
- Assess tools: Inventory the software you’re using and discuss with your team how it helps or hinders them
- Staff efficiency: Consider the number of team members and resources involved in each step of the denial management process
It’s also important to talk to staff. Your team can offer invaluable insight on what is and isn’t working to help you develop a more comprehensive understanding of the shape and scope of the systemic issues contributing to your denial rate.
2. Reduce Errors Upfront
Eligibility, registration, and authorization errors remain the greatest cause of denials and write-offs, so a good first step is to focus on being proactive instead of reactive. Often, it’s easy to get into a routine where errors are only addressed after they occur. But incorporating tech to verify coverage and benefit accuracy in advance can lead to higher efficiency and much less manual labor spent to correct those issues later on.
Similarly, a recent AHA report found a failure to obtain prior authorization to be one of the most common reasons for a claim to be denied by a commercial health plan. In another recent survey, the American Medical Association found that 86% of providers surveyed were struggling with a high administrative burden created by prior authorizations.
Recent innovations have made the process simpler than ever. The right prior authorization solution can automate the process and make it simpler, smarter, and much less labor-intensive, reducing manual input errors and preventing denials.
3. Cut Down on Manual Labor
Claim denials are often the result of staff trying to keep track of a seemingly overwhelming number of rules and regulations while juggling various systems and filing requirements. When your staff is overburdened, it’s that much easier for them to make simple errors or miss deadlines.
There are numerous tools available for teams who are either struggling with paper-based processes or databases without automation. With an AI-powered solution, you can streamline a number of time-consuming tasks while simultaneously automatically ensuring you’re identifying missing data or claim errors that can be corrected before they’re submitted.
It’s also a good idea to review any potential new tools with your team. Their insight will help you properly determine which solutions will actually improve their workflows, and which could prove an expensive time sink.
4. Use Stronger Reporting Tools
Accurate and in-depth reporting should be core to your strategy. Effective reporting tools let you quantify and assess the issues that influence your denial rate, allowing you to easily spot persistent workflow errors or other systemic problems that can create extra work or strain resources.
New tools powered by AI and machine learning offer more robust reporting options than ever, with advanced analytics and visualization capabilities that make it easy to explore complex data sets or identify trends. Mountains of information can now be easily managed and measured, giving you access to operational insights that will help you better understand problem areas and identify opportunities for improvement.
The Wrap-up
With the right tools, a solid strategy, and expert guidance, you can take a proactive approach to reducing claim denials. Our automated tools make it easy for your team to streamline their workflows while reducing errors and administrative costs. With Hubble, our AI and RPA platform, you can unlock the insights you need to reduce your denial rate and increase cash flow.
Waystar, a partner of EZClaim, also offers a number of front-end solutions to help you take a more proactive approach to your denial rate. Click here to learn more about how Waystar can help you with reducing claim denials and claim management. For more information about Waystar’s platform, visit their website, or give them a call at 844.492.9782.
To find out more about EZClaim’s medical billing software, visit their website, e-mail their support team, or call them at 877.650-0904.
[ Contribution: Waystar ]
Feb 9, 2021 | Electronic Billing, Medical Billing Software Blog, Partner
Do you have a fee schedule? If so, do you maintain it on a regular basis?
Well, this is an easy step to skip, but an annual review could put some extra cash in your pocket and help you keep a better handle on how much collectible money you have outstanding. Here are three things you should consider when creating or maintaining your fee schedule:
1. Mark Up the Charge Amount: Did you know that most payers will not pay you more than what you charge, even if you charge less than the allowed amount? They will accept whatever charge amount you have and adjust the difference, but they won’t pay you more than you charge. This can really cost your practice!
2. Allowed Amounts Change: In addition to payers updating the allowed amount for services, many insurances are offering incentive-based programs you may be eligible to collect a percentage over the allowed amount! If you are basing your charge amount on the payer’s allowed amount you may never see the incentive money that you have earned! Even a small percentage can add up quickly!
3. Decide on an Amount: If you aren’t sure where to start, consider setting your charge amounts based on the Medicare allowed amounts. Using 150% of the Medicare allowed amounts is a fairly standard starting point.
In addition to keeping the fee schedule current, make sure to monitor Allowed Amount and Paid Amount on a monthly basis. If you find that you are collecting the full allowed amount, it is time to increase the charge amount so you don’t leave money on the table!
If you need help getting started, consider working with a consultant. At RCM Insight, we offer annual fee schedule reviews. During the month of February 2021, we will be offering four practices a FREE fee schedule review, so visit our website at www.rcminsight.com and visit the CONTACT US page for your chance to win!
RCM Insight uses EZClaim’s medical billing software for their billing services. For more details about EZClaim’s medical billing solutions, visit their website, e-mail their support team, or call them at 877.650.0904.
[ Contribution: Stephanie Cremeans with RCM Insight ]
Feb 9, 2021 | Medical Billing Software Blog, Partner, Trizetto Partner Solutions
The COVID-19 pandemic has put a spotlight on the need for mental health resources as illness, job losses, and isolation continues to create unprecedented stress levels. According to recent surveys conducted by the Larry A. Green Center, more than half of clinicians reported declining health among patients due to closed facilities and delayed care, and more than one-third noted that patients with chronic conditions were in noticeably worse health as a result. Even more striking, over 85 percent reported a decline in inpatient mental health with 31 percent seeing a rise in addiction.
With mental health access at the forefront of our minds, there is no doubt a demand for qualified professionals that can handle these complex patient needs. While the sense of urgency for these services exists, especially as more and more healthcare consumers are resuming in-person appointments, unfortunately, there are processes in place that can create unnecessary roadblocks for practitioners.
Complying with the Council for Affordable Quality Healthcare’s (CAQH) behavioral health credentialing requirements are especially challenging. Unlike traditional medicine, treatments and therapies for conditions such as addiction are not as well understood by payers. This makes it more difficult to gain or maintain the credentials necessary to submit claims for therapy services.
Ninety percent of the time counselors and therapists apply for network status are denied! That’s a striking statistic, even for seasoned professionals, and everyone can agree that appealing denials and requesting payers review credentials in greater depth are a time consuming and expensive burden. On average, the time required for behavioral health credentialing of professionals is up to five times greater than for medical professionals because of nuances specific to the industry. The turnaround for completed enrollments is slower too, on average 180 days versus 120 days. In addition, some payers will only allow certain therapies for providers without advanced degrees. Because denials for behavioral health are common, therapists must understand which therapies a network will accept and focus on therapy-specific credentialing. In the current environment, practitioners should also ensure that Telehealth or virtual appointments will be covered for the safety of all.
So how can mental health providers stay ahead of enrollments and avoid credentialing-related denials? Outside assistance from experts like those at TriZetto Provider Solutions offers an end-to-end credentialing service that ensures continuous payer follow up and insight into enrollment status. Our credentialing professionals are devoted to helping providers gain and maintain their credentials. We understand the nuances associated with behavioral health credentialing and have direct relationships with all major payers. TPS allows you to do what you do best – manage patient care – by alleviating the burden of credentialing and making sure you never miss quarterly re-attestation deadlines.
If your mental health services are being denied, we are here to help. Learn how solutions from TriZetto Provider Solutions can help your practice simplify credentialing.
TriZetto Provider Solutions is a partner of EZClaim and can assist you with all your coding needs. For more details about EZClaim’s medical billing software, visit their website, e-mail their support team, or call them at 877.650.0904.
[ Contribution: The TriZetto Provider Solutions editorial team ]
