Jul 26, 2021 | Partner, Trizetto Partner Solutions
Medicare is the largest payer for most practitioners, so it’s important that providers maintain current credentials. Medicare requires providers to revalidate every five years to verify credentials and ensure they meet Medicare qualifications. Providers must confirm or update information including the legal entity name, physical address, phone, fax, national provider identifiers, employer identification number, and board certifications and licenses if applicable.
While typically a straightforward process, if not completed correctly and on time, providers will be terminated from the program and required to reapply. Until a new application is processed and approved, which can take anywhere from 90-120 days, reimbursements will stop, disrupting the revenue cycle.
Occasionally, providers may receive off-cycle revalidation requests. These are typically triggered when anomalies are identified such as billing rates that are significantly higher than other providers in the same geography, billing for services not rendered, or billing patients for services that Medicare doesn’t allow.
To comply with Medicare revalidation requirements, providers need to know their revalidation schedule and make sure applications and supporting documentation are submitted through Medicare’s PECOS online application portal. Revalidation dates cannot be extended, so it’s important they’re submitted on time. Using a third party to navigate the nuances of Medicare revalidation and PECOS removes the burden from provider staff and ensures accurate and timely filing.
TriZetto Provider Solutions (TPS) offers an end-to-end credentialing service that includes continuous payer follow-up and insight into enrollment status. Our dedicated team takes provider data, verifies it for accuracy, and submits credentials for revalidation through PECOS. All Medicare-participating providers are subject to revalidation, and mistakes made before or during the process can result in loss of eligibility and other penalties.
Having nearly four decades of experience working with payers and providers, the TPS credentialing experts understand the importance of maintaining current credentials. Contact us to learn more about our Medicare revalidation services.
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.
Jul 22, 2021 | BC Medical Billing, Medical Billing Software Blog
After Pandemic Impact and Outsourcing Revenue Cycle Management
The impact of the COVID-19 pandemic will be felt in every industry for many months to come. For medical providers, they are facing some of the most challenging financial times they will or have known. Therefore, we understand that it is crucial for providers to re-access their business and look for ways to cut costs with minimal impact on their practice or their patients.
To compound the issues providers are facing, there has been a wave of changes in recent years with new coding and telemedicine requirements that are making it difficult for provider offices to remain independent. Add on the constant rise in the cost of living and expenses while insurance reimbursements continue to decrease, and the issues get worse and worse.
Many have decided that outsourcing to a complete revenue cycle management company could help alleviate some of the undue burdens, cut costs, and keep providers compliant with their coding and billing. Ultimately this allows providers to continue to focus on patient care, which is their goal. As providers, you understand that revenue cycle management is a crucial part of your physician’s office. If not managed properly, it could result in an office leaving thousands of dollars on the table in unclaimed revenue. Over the years, our free audit services have allowed providers to have a free, transparent, and unbiased assessment of how their accounts receivable department functions. We are always amazed at how many providers do their billing in-house, and sometimes even when they outsource, are not aware of how much money they have sitting in their accounts receivables. Getting this knowledge is the first step to increasing revenue and efficiency.
In-house medical billers and third-party outsourced revenue cycle management companies should be giving provider offices monthly aging reports to assess their financial forecast. Each accounts receivable bucket over 60 days should hover at approximately 1 0% or less of the entire revenue balance. If account receivable buckets are higher than 10%, providers may be leaving money on the table, and the account may not be getting worked as providers think they are. In efforts to avoid unpaid claims and a spike in accounts receivable, outsourcing your revenue cycle management to a third-party medical billing company, such as BC Medical Billing, could help providers in countless ways. Many practices recognize that keeping their revenue cycle management optimized is key in delivering regular practice operations; however, they are not always sure how to achieve that. Outsourcing may be the solution!
Outsourcing alleviates the practice from managing a new medical billing employee, paying a salary and benefits, completing training and onboarding protocols, and managing the lost time from a learning curve. Many providers feel that it is not a wise use of the back office executive personnel’s time to worry about finding coders in-house and then wondering if the charges are captured and billed correctly. Instead, the business office should be focusing on how to grow the providers and the physician practice.
Our free audits will help you determine if you have found the right solution for you. If not, we are always there to assist and always increase the provider’s revenue.
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.
[ Contribution from the marketing team at BC Medical Billing ]
Jul 14, 2021 | BillFlash, Partner
There is no surprise that the cost of healthcare continues to rise creating financial hardships not only for patients but for physicians as well. While the COVID-19 pandemic severely impacted how patients interacted with their physician’s office, it is important to understand that patients want to be financially responsible for their medical bills and have preferences on communication methods to increase revenue.
In order to improve the overall patient experience and collection of revenue, it is important for physician offices to truly understand the demographics of their patients and the differences amongst their generational behaviors. Using a one-size-fits-all approach to communicate with patients is an outdated method and oftentimes leads to patient frustration, lack of engagement, poor retention, and missed opportunities to enhance revenue collection.
In a recent article published last month, physicians must adapt to the patient’s digital experience in order to enhance receiving payments for medical bills (Healthleaders, 2021). Patients desire modern payment options such as a payment portal, mobile ability, texting capabilities, and/or scanning a QR code. In addition, 76% of healthcare consumers desired a contactless method that allowed them to view their statements online and make payments without the need to visit the doctor’s office. According to (Healthleaders, 2021), the number one payment option patients desire is contactless debit and credit card options. In addition, patients desire payment options to help them manage their medical expenses such as payment plans and/or auto-pay methods.
As a medical billing expert, EZClaim can help medical practices improve their revenue through their billing and scheduling software in conjunction with BillFlash, which provides contactless and modernized communication methods that patients highly desire. Let EZClaim and BillFlash enhance the options to modernize your medical billing and communication systems.
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.
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.