Medicare Revalidation is Critical to Maintaining Eligibility

Medicare Revalidation is Critical to Maintaining Eligibility

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.

EZClaim Gives You the Onboarding Tools You Need to Succeed

EZClaim Gives You the Onboarding Tools You Need to Succeed

Are you worried that training your staff in a new medical billing system will be too overwhelming? No problem. Here at EZClaim, our focus is on our customers and providing the best support possible. We understand that every customer is unique with a different set of needs and we are here to help you. The medical billing industry is constantly changing and giving you the onboarding tools you need to achieve your practice’s goals is our number one objective. 

Here are three key points that differentiate EZClaim from our competitors. 

Hands-on and Personal

Once you sign up with EZClaim you are assigned an onboarding coach. The next step in the process is a discovery call that allows your coach to get to know you and your business better. This will allow your coach to create a well-defined onboarding program tailored to your individual business’s needs and learning style.

Customer Service Focused

Our onboarding process delivers “white glove support” by treating our customers as an extended part of the EZClaim family. Keeping our customer’s needs in mind, we continually add features that are aimed to make our customer’s lives easier. 

Multiple Learning Resources Available

Here at EZClaim, we understand that not everyone learns the same way, so we offer multiple learning resources to facilitate your training process. 

With multiple training tools and resources at your disposal, we feel confident that your staff will acclimate to our software in a manner that feels comfortable to them. When it comes to medical billing, EZClaim has your back. 


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.

Pandemic Impact and Outsourcing Revenue Cycle Management

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 ever know. Therefore, we understand that is it crucial for providers to re-assess their business and look for ways to cut costs with minimal impact on their practice of 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 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
    • 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 buckets over 60 days should hover at approximately 10% 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 an effort 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 captures 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 increase the provider’s revenue.

 

 

 

Patient Information, Time Savings, and the EZClaim Eligibility Feature

Patient Information, Time Savings, and the EZClaim Eligibility Feature

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.

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.