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Medical Billing & Insurance Article Category 

Articles about or concerning Medical Billing, Medical Coding, Outsourcing.
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Medical Malpractice Insurance Coverage: What Are My Options?

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 Maria Palma (February 01, 2011)  Medical malpractice insurance is considered a negligence, whether intentional or not, that leads to sickness, injury, or death to a patient. If this happens, a medical malpractice lawsuit can be filed against the medical professional(s) or hospital, which is very costly and time consuming to defend. As a physician or professional working in the medical industry, you probably want to .. (Medical Billing)

Tips For Buying Medical Malpractice Insurance

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 Maria Palma (February 01, 2011)  At the beginning of the year many medical malpractice insurance policies are up for renewal, and many doctors, physicians, and other medical professionals will be shopping around to get better rates. Although medical malpractice insurance is not required by every state, it should still be a consideration given the litigious society that we live in. Every day doctors put their career at .. (Medical Billing)

Nigeria industry

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 Emily Ben (December 20, 2010)  With the development that expects to arouse mainland manufacturing company. Ni in 2006 set two encouragements invest lately to raise Cuo:1, release “one-stop service". Invest environment for improvement. The Ni government released “is one-stop service" in March, 2006. Invest procedure by simplification. Shorten to carry out time concerning procedure. Concrete for at Nigeria .. (Medical Billing)

Managing Director

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 Richard Tamburello (June 11, 2009)  Principles of A/R management One of the most challenging principles and often overlooked key aspects of managing accounts receivables is the attention given to minimizing the investment. Ideally, patients and insurance companies pay charges on the same date of service. As we all can attest this does and likely will not happen, particularly in today’s credit driven economy and, of .. (Medical Billing)

Managing Director

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 Richard Tamburello (June 11, 2009)  Principles of A/R Management in Medical Practices One of the most challenging principles and often overlooked key aspects of managing accounts receivables is the attention given to minimizing the investment. Ideally, patients and insurance companies pay charges on the same date of service. As we all can attest, this does and likely will not happen, particularly in today’s credit .. (Medical Billing)

Outsourced Billing Nightmares - Why Billing Precision? - Part I

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 Erez Lirov (December 10, 2008)  The two chiropractors were chatting.   One was an older, experienced doctor.   He had tried it at low volume, high volume, cash, insurance, care plans, fee-for-service.   And several times, he had tried to outsource his billing - and failed.   The younger doctor, having practiced for only a couple of years, had just brought up the subject of billing, and remarked at how .. (Medical Billing)

Outsourced Billing Nightmares - Why Billing Precision? - Part II

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 Erez Lirov (December 10, 2008)  Part II - How is Billing Precision a Non-Traditional Billing Service? "See, the problem is that traditional medical billing companies are built for traditional medical doctors. " Now the older man was philosophizing. “We're different in many ways, but one of the most important ways is in our patient visit average. Chiropractors sometimes see dozens of visits for each of their .. (Medical Billing)

Five Mistakes Nearly Every Medical Practice Makes

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 Jean-Marie Taylor (December 10, 2008)  In these difficult economic times, medical practices need more than ever to collect every cent they've earned. As deductibles and co-pays increase, patient responsibilities also increase; yet, many patients believe they can put their physician at the bottom of the pile of bills to pay. To ensure your practice is not losing money unnecessarily, here are five (5) mistakes nearly every .. (Medical Billing)

You Can Negotiate Medical Bills

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 Kenneth Long (December 10, 2008)  Medical bills can be daunting. You never really get just one. A single medical procedure can result in a dozen separate bills. Some bills come from the hospital while some come from the attending physician. Even the anesthesiologist sends a separate bill. Knowing where to start can be a difficult task. If you add up all of the bills, you may find that the total is more than you can .. (Medical Billing)

Medical Billing is Important For Any Patient Medical Office

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 Jack M Patterson (December 09, 2008)  Any business that provides medical care for patients will most certainly face the process of medical billing. This is a process of not only submitting claims to insurance companies for payment, but also following up on those claims. It is an important procedure for any medical office and can become tedious. Today, a medical office can receive help with medical billing from respectable .. (Medical Billing)

Commitment & Accountability For Medical Billing, Part II - Accountability & Support

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 Erez Lirov (December 08, 2008)  Workbench and Accountability Once the staff is committed, they must be actively managed and made accountable. One way that a Billing Network can ensure staff accountability is to provide a rigorous mechanism for information exchange between the practice and the billing service. Instead of calling the practice and leaving messages when common billing issues arise, the Billing Network .. (Medical Billing)

Effective Compliance Program Components

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 Jean-Marie Taylor (December 08, 2008)  The Department of Health and Human Services Office of the Inspector General (OIG) has issued a voluntary Compliance Program Guidance for individual and group practices. The OIG created this program to prevent fraudulent conduct and reduce the number of erroneous claims submitted to Medicare and Medicaid. The OIG thinks that a healthcare provider can use internal controls to ensure .. (Medical Billing)

PT and Chiropractic Are Not Covered Concurrently

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 Michele Redmond (November 17, 2008)  Most insurances, including workers comp & no-fault do not allow patients to be treated for the same condition with both chiropractic and physical therapy during the same time period. Sometimes the patient will not mention to the provider that they are already receiving treatment. Then the provider sees the patient, submits the claim, but gets denied since the patient is already .. (Medical Billing)

Bad Medical Billing Employees Can Destroy Your Practice

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 Carl Mays II (November 15, 2008)  A weak medical billing staff can undermine the best technology and billing processes. Medical Billing success requires great medical billing employees. Developing a strong medical billing team is a difficult, but worthwhile effort. Here is how to make it happen: 1) Installing a well-defined and predictable method for recruiting, identifying, hiring and keeping great medical billers: .. (Medical Billing)

Medical Billing Cannot Succeed Without Tough Denial Management

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 Carl Mays II (November 10, 2008)  It has been accurately stated that you cannot manage what you do not measure. This is particularly true in the arena of medical billing denials. Without a strong Revenue Cycle Denial Management system in place you cannot properly manage this critical element of medical billing. If you are not managing your denials then you are most likely leaving more than 20% of your revenues .. (Medical Billing)

UB04 Form - What is a UB04 Form, Where Do I Get One, and How Do I Fill it Out?

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 Alice Scott (November 09, 2008)  Do you need to get a UB04 form completed for an insurance company?  What is a UB04 form?  Where do you find one?  And how do you fill it out?  We run across these questions often in the world of medical billing.   Most medical health insurance claims are filed on CMS 1500 forms (sometimes called HCFA forms).   These are more common to most people.    Many billers don't know when . (Medical Billing)

Medical Billing Reporting - Proximity Condition For Monthly Practice Profitability Analysis

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 Yuval Lirov (November 09, 2008)  Cost-Revenue or Charge-Payment report is a useful and simple bottom line operational performance analysis tool, because it helps to extrapolate the success of proposed investment or process alterations. The great value of Cost-Revenue report as an analysis tool is only matched by its simplicity and ease of production: it simply displays side-by-side charges and payments posted in any .. (Medical Billing)

No Delicate Way

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 Nat Wynn (October 18, 2008)  There is no delicate way to put this. Huge amounts of provider revenues wind up in the hands of your employees and you never know. Until you discover it for yourself, you are in the absolute dark. Often times you have a sense that something is going on but you simply cannot put your finger on it. The problem builds up to a point and then seems to subside but you are not quite sure what .. (Medical Billing)

Accountability in Medical Billing

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 Nat Wynn (October 16, 2008)  Tomorrow I am meeting with another provider who has been wrangled into a medical billing arrangement that is good only for his medical billing company and not good for him. Seems they convinced him to pay a per claim fee for them to process claims. That is all they do, process claims-nothing more. His staff has to enter all of the patient data, key in all of the charges, key in all of .. (Medical Billing)

Avoid Delays in Your Medicare Application by Completing Forms Correctly

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 Michele Redmond (October 13, 2008)  When applying to become a Medicare Provider it is crucial that you complete the proper forms and that you complete them correctly.  If you do not complete the proper forms correctly it can cause delays in your application and can even cause your application to be closed.  If your application is closed you need to start completely over by resubmitting your application all over again. .. (Medical Billing)

Avoid Medicare Denials by Notifying Medicare of Any Changes in Your Information

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 Michele Redmond (October 13, 2008)  Medicare requires that providers notify them when they make any changes to their office location, tax ID#, legal history, managing employees, or personal information. The notification is suppose to be within 30 days of the change. Many providers do not realize this until their Medicare payments suddenly stop for no apparent reason. An example would be if a provider changes their office . (Medical Billing)

The Truth About Copays

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 Michele Redmond (October 12, 2008)  Many people get very confused by all the different ways that insurance companies process claims and how they calculate what the patient owes. It is crucial that the providers have someone in their office or a good billing service that knows how to read the explanation of benefits and that they are billing the patients correctly. Many plans today have a straight co pay that is due at .. (Medical Billing)

Deductibles in Depth - Understanding Medical Deductibles

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 Michele Redmond (October 11, 2008)  A deductible is a set amount of medical expenses a patient must pay to become eligible for insurance benefits under an insurance program. What does that mean exactly? It means that before an insurance company begins to make payments for a patient, the patient must meet their deductible. How does a patient meet their deductible? Many people get very confused over how this is actually .. (Medical Billing)

Dealing With Insurance Denials

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 Alice Scott (October 11, 2008)  One of the most difficult tasks in the medical office for the billing department is dealing with insurance denials. Unfortunately many claims are denied for a variety of reasons and if not handled properly no payment will ever be made on that service. Most offices are extremely busy and it can be difficult to find the time to take care of these problems. If your office does not have the . (Medical Billing)

Timely Claims

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 Nat Wynn (October 11, 2008)  Two months ago I had a colonoscopy. I bring this up, because only this week did many of those claims get paid. Why? I had not gotten my EOBs and on one of the claims a large amount had been applied as due from the patient. I had already met my deductible and my out of pocket stop loss so I found this baffling. I called the phone number on the bill to find out what was going on. What a .. (Medical Billing)

Medicare Applications Which Form is Used to Become a Medicare Provider

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 Michele Redmond (October 10, 2008)  Medicare requires that you complete specific forms put out by CMS when applying to become a Medicare provider. Sounds easy enough but have you seen the list of forms that they have? How are you suppose to know the correct form to complete and once you figure that out, what fields on the form do you need to fill out? If you are a solo provider, can you bill under a tax ID number (EIN .. (Medical Billing)

Why Doctors Need Personal Medical Software

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 Nancy Sandhu (October 09, 2008)  Create a Paperless Medical Office. . . For years, practices have been putting up with heaps of paperwork, taking them forever to fill, file and then store every bit of information. It's not only difficult but time-consuming for practitioners to manually process claims and visit insurance companies every now and then to get their payments. Thankfully, private practice software has taken . (Medical Billing)

Health Care Claims Appeals

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 Nat Wynn (September 23, 2008)  I often wonder how many claims (dollars!) per day are being rejected where providers do not appeal the adjudication. I imagine the numbers would be staggering! The insurance companies know this little tidbit and use it to their advantage. Let's say an insurance company is paying out $1,000.000.00 per day in insurance claims. If they deny just 1/10% of those claims, it adds up to .. (Medical Billing)

Blame the Insurance Company

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 Nat Wynn (September 22, 2008)  Blame the insurance company is the mantra exclaimed by all, but does it really fit. I know they can give us a fit when trying to collect our money, but they really want to pay the provider, they just want the provider to play by their rules. I know I will get a lot of grief by saying that they really want to pay the provider, but hear me out. The reason they want to pay is because they . (Medical Billing)

Medical Billing Books and E-Books

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 Alice Scott (September 21, 2008)  Medical billing books are no longer available only at bookstores and by ordering from the internet. You can now download many medical billing books directly to your computer instantly. New technology has made it extremely easy to get medical billing information immediately by ordering with a credit card and downloading the book or “ebook" as it is now called directly to your .. (Medical Billing)

E&M Medical Necessity

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 Nat Wynn (September 19, 2008)  E&M medical necessity denials, what can that mean? On the surface, what could not be right about an E&M code? A lot of the rejections come from an office visit and another procedure performed on the same day. In many of the practices where we take over the medical billing, the physicians have lost money by not following the right protocols and/or not challenging the EOB. If the visit .. (Medical Billing)

Medical Billing Services (The Facts) All You Need to Know

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 Mary Owston (September 18, 2008)  If I decide to out-source my billing how will I keep track of it? Many physicians today wonder if out-sourcing their billing to a professional billing service is the right way to go. They ask themselves if it is not in-house how will they really know what is going on with their money. Well first of all you need to find a billing service that you are comfortable with and has experience. . (Medical Billing)

Medical Claims Rejections

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 Nat Wynn (September 18, 2008)  Rejected medical claims come from many sources. The most common is likely keystroke error. That is usually a relatively easy fix and for our business it is also one that is easy to catch. The best method of catching some of these simple mistakes is to use a good scrubber for your claims. Once the claim batch has been created, as it is processed through the intermediary software, it .. (Medical Billing)

9 Biggest Mistakes Health Care Providers Make That Result in Surprise Visits From Fraud Investigator

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 Daniel J Osborne (September 16, 2008)  It's no secret for today's health care provider that investigators from regulatory boards, insurance companies and law enforcement agencies are on the prowl looking for providers who are not following the laws & rules - with a major focus on health care fraud! And, these investigators, especially law enforcers, are particularly interested in finding health care providers engaged in .. (Medical Billing)

How to Reduce Rejected Medical Claims

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 Nat Wynn (September 15, 2008)  For a process that can be so simple, many make it so hard. Let's start at the beginning. What software are you using to process your claims? That decision alone can solve a litany of problems. There is not enough space available to analyze all and it would not be fair to promote only one. Is the software easy to understand? Does it allow you to make additions, corrections, .. (Medical Billing)

Health Claims Processing Terminology

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 Nat Wynn (September 11, 2008)  Every field seems so have its own secret set of terminology. I think it has more to do with a need by those on the inside to feel superior to those on the outside than for any real need on part of those utilizing the terms. You see it in every field. Education has it, nuclear medicine has it, lawyers have it, and even medical billing utilizes such terms. A particular phrase will come .. (Medical Billing)

Medical Professional Claims Processing

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 Nat Wynn (September 10, 2008)  Claims processing does not have to be complicated. Start with a few basic and simple rules and stick with them. Before you can do your medical billing, you have to get all the pieces together. Start at the front door. As the patient signs in, make sure you get a complete-repeat, complete-patient demographic form filled out. This must include all phone numbers, cell, home, work and .. (Medical Billing)

Medicare Patient and Providers Act

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 Samuel Tarwell (September 10, 2008)  A few months ago, Congress showed a strong sense of bi-partisanship. They quickly and overrode President Bush's veto of a bill that affected the reimbursement of physicians by Medicare. The payments to doctors who participate in Medicare was set to decrease by 11% and many members of congress felt that this would decrease the number of doctors who participate in the Medicare Program. .. (Medical Billing)

How to Use a Medical Bill Negotiator to Lower Your Health Savings Account Expenses

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 Wiley P Long (September 10, 2008)  Medical Bill Negotiation companies are familiar with the discounts negotiated by large companies, insurance companies, PPO networks, and other big players, so are familiar with what the “lowest available price" might be. If you use one of these services, you only pay if they are indeed able to negotiate a discount. Lower Those Medical Expenses! Being swamped with medical expenses . (Medical Billing)

Medical Billing Clearinghouses Defined

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 Paul Hackett (August 13, 2008)  Medical billing clearinghouses are simply middlemen that take electronic medical claims information and then submits that information electronically to insurance companies that they are contracted with. So how does this impact you as a prospective medical billing business owner? Look at it this way: Your client sends you a medical claim in superbill format, you input that information .. (Medical Billing)

Electronic Medical Records

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 Ralph Bass (August 11, 2008)  Electronic Medical Records is not something that will be in our future someday, it is very much present now. It's all around us. Is it a good idea? To the home-based medical transcription industry, that is like asking horse and buggy makers what they think of that new gadget the automobile. You're not likely to get a helpful answer. But emotion aside, for the physician there are several . (Medical Billing)

Outsource Medical Billing - Deciding If It Is Right For You

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 Brad Ferth (August 10, 2008)  Over the next two weeks I plan to discuss a framework for thinking through whether outsourced medical billing is the right decision for you. The decision is a critical one, so it is imperative that it be based in facts and not in urban legends and myths. Although I am focusing on medical insurance billing services, the basic concepts apply to any outsourcing decision. Today I will .. (Medical Billing)

Medical Insurance Billing Services - Verifying the Sales Pitch With Reference Checks

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 Brad Ferth (August 10, 2008)  So, you have decided that it is time to outsource medical billing. There are many important steps to insure that the medical insurance billing services company you select is the right one for you. A key step of the process is checking references. As with the overall selection process, there are many important elements that need to be addressed to insure that your reference check is .. (Medical Billing)

The First Step in the Medical Billing Process

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 Samuel Deutscher (August 07, 2008)  There are ten steps in the Medical Billing Process. The first step in the process is to Pre-register the New Patient. There is much critical information that must be obtained at this juncture: (Demographics) patient name, address, phone number, date of birth, the nature of the medical problem, the insured's name address, phone number, date of birth, relation of insured to the patient, .. (Medical Billing)

Chiropractic Billing Index Drops in July But the Blues and Medicare of Illinois Maintain the Lead

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 Yuval Lirov (August 02, 2008)  In July, the Chiropractic Office Billing Precision Index (BPI) lost 5.5 points below its June mark - reaching the worst performance mark in 2008. Overall, July BPI reached 23.1 under-performing the national average of 17.7 by 5.4, and 7.6 points away from its best record of 15.5 in March of 2008. In a precise reverse of its June pattern, the July index returned both GEICO and Blue .. (Medical Billing)

PT-OT Caps Exception Process Extended to 12-31-2009

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 Michele Redmond (July 29, 2008)  When Congress passed The Medicare Improvements for Patients and Providers Act of 2008 on July 15th not only did it stop a 10.6% pay cut for most medical service providers. There were other provisions as well. One of the other provisions was to extend the exceptions process of PT and OT therapy caps. Claims for outpatient therapy with dates of service on or after July 1st that exceed .. (Medical Billing)

Therapeutic Procedures Explode Your Practice

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 Daniel J Osborne (July 25, 2008)  One of the more potentially volatile risk areas for health care practitioners today is the delegation of therapeutic procedures to unlicensed assistants, and billing for those procedures as though the practitioner personally provided the procedures. This practice activity is particularly prevalent and ever-growing in chiropractic! Some practice consultants - with promises of increased .. (Medical Billing)

Investigating Health Care Fraud

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 Daniel J Osborne (July 25, 2008)  Investigations relating to health care fraud activity are reportedly at an all time high, and will continue to flourish with the advent of new working groups, task forces and other fraud-fighting activity that existence depends on the development and investigation of health care fraud cases. Simply put, the investigation of health care fraud consists of proving that the provider engaged . (Medical Billing)

What Should Your Billing Service Be Doing For You

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 Michele Redmond (July 16, 2008)  Many providers today are choosing to outsource their billing. The billing process has become much more involved over the past few years and for many it makes sense to outsource. Between the software updates, required electronic filing of claims, NPI numbers, and other changes, it has become nearly impossible for providers to keep up. However, if you have only ever used one biller, or .. (Medical Billing)

Medical Professional Liability Insurance Claims Made, Occurrence

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 Louis Zhang (July 13, 2008)  Medical professional liability insurance is another name for medical malpractice insurance. There are two types of medical professional liability insurance, claims-made and occurrence policies. There are advantages and disadvantages to each of these types of policies. Claims-made insurance policies are one year long policies that are renewed each year without interrupting the coverage. . (Medical Billing)




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