How to Set Up Validation Rules in EZClaim

How to Set Up Validation Rules in EZClaim

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 websiteemail them, or call them today at 877.650.0904.

Modernizing Medical Billing Payments

Modernizing Medical Billing Payments

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 ]

Medical Billing Payments 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 featurewhich 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.

Fee Schedule – 3 Key Items to Consider

Fee Schedule – 3 Key Items to Consider

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 ]

Medical Billing Insights – Interview with ABA Billing Service

Medical Billing Insights – Interview with ABA Billing Service

Are you working in the medical billing industry as a biller or an owner of a billing company? If so, the KEY medical billing insights and best practices that came out of our interview with Maura Jansen (VP of Operations) and Jennifer Withington (Director of Revenue) at Missing Piece Billing & Consulting Solutions will be VERY VALUABLE for you to consider.

Jennifer, an expert in understanding the problem-solving techniques and the investigative nature of medical billing, offers insights that both educate and inspire. Maura, an executive member of the billing community, also added an important perspective about EZClaim’s medical billing software. The following are some highlights from our interview.

EZCLAIM: When did you get into the industry?
JENNIFER
: “I worked in group homes for the waiver side of group aid and then I went to Missing Piece. Missing Piece primarily deals with ABA providers and provides early intervention rendered to children. For me, the move from waivers with adults to professional billing, indirectly assisting children, was attractive and I took to the billing side of things.”

EZCLAIM: What does that mean when you say you took to the billing side of things?
JENNIFER
: “Insurance doesn’t make a lot of sense when you first start. So, I took to the investigative side of making sense of medical billing claims. Figuring out what the payer’s rules are, reading their manuals, and figuring out the technical jargon with the purpose of preventing claim denials was attractive. I liked the puzzle of it.”

EZCLAIM: Are there things that you value in your work that offer meaning to what you do?
JENNIFER
: “It’s really when I know that if I do not intercede with the insurance company and get this paid the patient is going to be responsible for the balance. So, to help, I have taken things to the department of insurance, or I have gone ahead and filed that third letter of appeal and really taken the time to research it. Because I don’t want a parent who is already struggling with having a child with more needs than maybe the other children would have, I don’t want them struggling with a $25,000 bill. ABA is extremely expensive because it works. And so, if insurance doesn’t pay it then the only other funder is the parent. And my goal is that parents should not have to pay any more than they absolutely have to.”

EZCLAIM: What are some of the strengths that make you good at what you do?
JENNIFER
: “I am a good problem solver. I am good at taking a large problem and breaking it into smaller problems and knocking each one down until I solve the bigger issue. At the end of the day, that’s really what accounts receivable is.”

EZCLAIM: What would be an example of your problem solving on a day-to-day basis?
JENNIFER
: “So you always start with the denial and then you have to work back to the billing. For example, if I have a claim denied for services rendered from an out-of-network service provider, but we know we are in-network then my first problem is, are we actually in-network? Then, you go onto the next link which is did the payer recognize you as in-network? It becomes like a decision tree, if you get a ‘yes’ then you are probably done, and you get the claim processed. If it is ‘no’, then you have to start digging with the payers contacting reps, make calls, and supply them with documents to get down to why they don’t have your provider listed within the network. Once you solve that problem, then the claim should be able to be processed. It is either going to pay or deny. Then depending on which one it is, you apply the same technique.”

EZCLAIM: What would you offer someone who is considering entering the field?
JENNIFER
: “You should be good at processing and reading information because to get a claim paid you to have to know the rules of engagement. You need to be familiar with how to read a contract, how to read technical information about billing, and have to have a glossary of information about what you are billing. Those are the building blocks to get to know what you are doing.”

EZCLAIM: You work with EZClaim’s medical billing software platform, what role does their software providers and how does that impact your work?
JENNIFER
: “EZClaim really serves to eliminate these denials before they happen, which is the ultimate goal of any accounts receivable or billing. EZClaim has edits that we use. It alerts us if the system thinks the claim is a duplicate, for example. It also helps in the set-up of the claim. We load all the fee schedules in EZClaim’s procedure code library and that lets us monitor the charge rate, make sure all the points of billing are on the claim (i.e. correct code, modifier, and charge). They also make sure that the authorization is appended to the claim. And then after we have actually done the work of getting a claim in the system, we use EZClaim reports to audit our own billing. So, we use the EZClaim service report. It makes it easier for us and our providers to see what has been billed and make sure that the billing is correct.”

EZCLAIM: If you were going to share something with your colleagues in the field, what would you share about the software that makes your life easier?
JENNIFER
: “Number one, it is not the software itself, it’s the EZClaim staff.  Their customer service is far beyond what a normal billing software company provides. If I have a problem, or if I have a report, or if I have a data point that isn’t in any report, they are available and they are there for me. And if they don’t have a solution for the problem, they will provide me with a workaround. So, that is very valuable. That is why Missing Piece works so well with EZClaim because customer service is number one for us, too. They don’t just want to answer your question, they want to help you understand your question.”

“The other thing that I find valuable is that their reporting modules are just a lot more robust than the other billing software companies that I have dealt with.”

EZCLAIM: Maura, do you have any thoughts from an administrative level that you can offer on EZClaim?
MAURA
: “Well, when we hire a new person we know that, even if this person has very little experience in the healthcare field, it’s going to be a quick and easy process for them to learn EZClaim… EZClaim has also made it kind of a joy to work with. We really value them as a partner. We love the service they provide, and we value them as a platform.”

ABOUT EZCLAIM:
EZClaim can also help you with medical billing insights since it is a medical billing and scheduling software company. It 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.

Ransomware Hackers Target Medical Billing Companies

Ransomware Hackers Target Medical Billing Companies

Ransomware hackers target medical billing companies, and it CAN AFFECT your entire company! (Ransomware is a type of malicious software designed to block access to a computer system until a sum of money is paid.)

Often out of one’s control, ransomware hackers target medical billing companies because of the tremendous value of the data. BUT, there are steps that CAN BE TAKEN to protect you, your company, and your patients and/or clients.

 

NetWalker Ransomware, for example, gained notoriety for targeting hospitals and healthcare providers with e-mails claiming to provide information about COVID-19. (The e-mail usually has an attachment that downloads the ransomware from a remote server when clicked on.) The thing is, this is very lucrative for identity thieves since medical records information sells anywhere from $1-$1000!

As the number of healthcare providers taking advantage of Telehealth continues to increase—now outnumbering in-person visits—the number of ransomware attacks continues to increase as well. This means Billers and Providers must be aware of the programs that are used on their machines and ensure necessary steps are taken to safeguard against hackers and attacks.

How can you protect yourself and/or your organization?

  • Carefully monitoring where you store and enter your passwords can be extremely beneficial to help minimize the risk of a hack and keeping personal or patient information protected.
  • Routine password changes and monitoring where you store and enter your passwords can be extremely beneficial to help reduce the risk of becoming a victim to a hacker. Passwords should be long, unique in characters, capitalization, and alphanumerical.
  • Have you had an accurate and thorough Security Risk Assessment and/or penetration testing? If you haven’t completed an accurate and thorough security risk assessment, you could also be penalized under ‘willful neglect’ (this category alone is $50,000 per violation!) in addition to the higher risk of ransomware attacks.
  • If you believe you might have revealed sensitive information about your organization, report it to the appropriate people within the organization, including network administrators. They can be alert for any suspicious or unusual activity.
  • The strength of your passwords directly impacts your online security.

 

Live Compliance can help. They aggregate breaches which enables you to assess where personal data has been exposed. Dark Web scanning is built right into their Portal, and it allows you to keep an eye on employees whose information was involved in a breach, where the breach took place, and then suggest the next steps to take.

At Live Compliance, they make checking off your compliance requirements extremely simple and to ensure this doesn’t happen to you or your organization:

  • Reliable and effective compliance
  • 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, including those such as password protection.)
  • Policies and procedures curated to fit your organization ensuring employees are updated on all workstation use and security safeguards in the office, or out of the office—all updated in real-time
  • Electronic, prepared document sending and signing to employees and business associates

 

So, don’t risk your company’s future on ransomware hackers. Contact one of EZClaim’s partners, Live Compliance, especially since they are offering a FREE Organization Assessment to help determine your company’s status. E-mail them, visit their website at LiveCompliance.com, or call them at 980.999.1585.

For more information about EZClaim’s medical billing software, which provides a best-in-class product with correspondingly exceptional service and support,  e-mail, visit their website, or contact them at 877.650.0904.

[ Article contributed by Jim Johnson of Live Compliance ]