Why Did My Medical Billing Claim Get Denied?

Why Did My Medical Billing Claim Get Denied?

If a medical billing program has “scrubbing,” why did my medical billing claim still get denied? It is a common question that we are going to answer today.

First, let’s get a better understanding of the words we are talking about.  In the medical billing world, validation and scrubbing tend to be used interchangeably.  While they are similar – they are not actually the same. Understanding what you have and what you need will help you submit ‘clean’ claims.

According to Technopedia, data validation checks for the integrity and validity of data and ensures the data complies with the requirements. So, what requirements? Often people assume that this means payer requirements, but that is typically not standard. Validation rules are built into your practice management software and can be used for several points.  Following are some common rules you may find in your program:

  • Ensure NPI‘s and Tax IDs are the appropriate lengths
  • Ensure patients date of birth is entered
  • Ensure that a procedure code and place of service are present on each claim

 

While these scenarios are standard across the industry, there may be other situations that a validation rule can help. Some programs will allow you to create custom rules for your practice. A customized validation rule will allow you to create a rule for a payer requirement.  For instance, you could create a rule to prevent the following:

  • Do you have a code that always requires a modifier, but only for a specific payer?
  • Work with pediatrics and always need the ‘relationship to insured’ to read something other than self
  • How about insurance ID numbers that are a specific alpha-numeric combo, like 3 letters followed by 9 digits?

 

Keep in mind, if you are creating validation rules the program will make sure that the criteria are met based on the rule entered into your software. When creating custom rules, it is important to note that this will not verify payer billing guidelines. You will need to obtain information directly from your payer to create a rule that coincides with their policies.

Once any validation errors have been addressed your claims will go to the clearinghouse you are working with. Most clearinghouses offer claim scrubbing for an additional fee.  Technopedia defines data scrubbing as the procedure of identifying and then modifying or removing incomplete, incorrect, inaccurately formatted, or repeated data.

 

Claim scrubbing is available in several ways. It may be used within your practice management system, your clearinghouse, or even a third-party vendor. Claim scrubbing services can vary greatly in what they are looking for.

Once the claim has left your practice management system it will likely go through at least 2 scrubbing programs—one with the clearinghouse and one with your payer, prior to accepting the claim for processing. When claims are found to have an error, these results are sent back through a Claim Status Report (ANSI 277 file or a human-readable text file). This report will include information about why the claim cannot be processed. This report will also indicate whether it is the clearinghouse or the payer that is rejecting the claim. If you have further questions about the rejection, you will need to contact the entity that has rejected it.

 

Checking the Claim Status Reports on a regular basis will help you correct the errors and resubmit in a timely manner. In addition, the information you have gathered from the rejections can be used to update internal processes or create customized validation rules to prevent future rejections for the same error–saving you time and money!

RCM Insight is a medical billing company that uses EZClaim’s medical billing software. For any details that have to do with claims validation and “scrubbing,” contact RCM Insight directly.


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 by Stephanie Cremean’s with RCM Insights ]

Medical Bills and the Price Transparency Rule

Medical Bills and the Price Transparency Rule

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 ]

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.

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 ]

EZClaim’s Best Blog Posts of 2020

EZClaim’s Best Blog Posts of 2020

It goes without saying that 2020 will go down in the history books as unprecedented for us at EZClaim. Still, we worked hard to stay positive and navigate the storm by offering resources to you, our clients, the content that matters to you. As an end-of-year bonus, and a ‘kick-off’ for 2021, we reviewed the blogs and social posts you read and reacted to the most and thought we would share them.  

 

So, here are the best blog posts of 2020:

#1: How to Improve Medical Billing Revenues
As a medical billing company, we work hard to understand how we can help our clients increase their revenue and improve their billing process. Those who do this best are experts in the medical billing and coding industry. So, it makes complete sense that your interest peaked on our article concerning improving revenues. Enjoy reviewing our number one article of 2020!  [ Click to read the post ].

#2: What Will Be New for E/M Coding in 2021? 
Last year brought about a long list of changes to billing and coding, as well as, the medical industry as a whole. From the obvious boom in Telehealth, to the updates in evaluation and management services, those working in the industry were impacted immensely. Based on these shifts in industry and the impact on you, our clients, we thought a look into what was coming in 2021 would be useful—and so did you. You read, reacted, and shared the value of this content with others. Now we are sending you a reminder that this was our number two article for the year.  [ Click to read the post ].

#3: Collecting Payments from Patients. Find Out How.
No matter how chaotic things get, there is still a practical side of our industry that needs to be addressed. That is why we worked to keep the focus on the basics, speaking about the ‘bread and butter’ of our industry, collections. In this practical article, we focused on the keys to educating the patient and how doing so will help keep you ahead of the collection as a whole.  [ Click to read the post ].

#4: Reports – Nuisance or Necessity?
At the end of the day, you want to go home and no one wants to be stuck in the office doing double-duty on reports. You know as well as we, that getting reports done correctly the first time is key to reducing stress and going home happy. That is why we distilled some of the keys in running reports that would make your life more straightforward. The fourth article on our list will do just that by helping you make sure the dates, details, and destination of your reports are in the right place.  [ Click to read the post ].

#5: Why Do I Have A Balance? – Patient Payments
Saving the best for last, especially as we approach tax season, we come in with our final of our best of 2020 by talking about balances. Every practice ends up spending those final hours of the year figuring out where those dollars and cents went. In this article, we gave you tips on deductibles, co-pays, and max out-of-pocket that helps your bottom line. Closing out 2020, don’t miss a few keys to help you balance the books.  [ Click to read the post ].

 

These are EZClaim’s best blog posts of 2020, but these were not the only blog posts we did. So, if you would like to explore the other blog posts we did, click here for our blog page.

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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 support, or call a sales representative today at 877.650.0904.