The Patient Protection and Affordable Care Act (ACA), or as some may refer to it, “Obama Care” could easily be considered one of the most hotly debated medical reforms the United States has ever embarked on. Love it, or hate it; one thing seems to be increasingly clear, it isn’t going to go away any time soon.
Thanks to the Patient Protection and Affordable Care Act (ACA) there are now over 17 million newly insured consumers in the U.S. One of the biggest issues facing medical practitioners is the fact that many of the ACA policies, although cheaper, come with high deductibles to be paid by the patient. What does that mean?
And What You Can Do to Solve Them
With all of the recent changes in the medical billing arena including the introduction of the updated ICD-10 coding system, it has never been more important to the success of your practice to keep up with the frequent changes in billing procedures. Here are 4 important factors you should take into account to avoid these medical billing issues. as you begin updating and maintaining your offices billing procedures to avoid these medical billing issues.
HIPAA Violations – Ignorance of the Law is Not a Defense
In 1996 the U.S. Congress along with the Department of Health and Human Services passed the Health Insurance Portability and Accountability Act, which, basically “established a comprehensive and uniform Federal standard for ensuring privacy of genetic information.” Over the years there have been several changes to these laws, but the message remains pretty much the same; violations to the HIPPA will not be tolerated.
With the ICD-10 billing codes set to replace the old ICD-9 system on Oct. 1, now may be the best time ever to take a closer look at your offices’ billing procedures and discover ways to improve your practices’ billing efficiency. Your AR department will soon be busy catching up to all the new codes and regulations, so, why not make the job easier for them, and more profitable for you, by implementing a few of these strategies designed to maximize the efficiency of your billing department.
Many businesses understand that it can be difficult to find and keep quality employees. The issues that face many people in their everyday lives can sometimes become overwhelming as they try to balance the demands of work and family while establishing a sense of balance and well-being on a personal level.
Making the Right Choice Between HRA or HSA
I think most of us can agree that with the high cost of medical services in today’s economy, it is important to have as much protection against unexpected medical expenses as possible. Of course, you eat right, exercise, and carry a reasonable amount of health insurance, but is that enough? Many people think not, and prefer to include the added benefits an HRA (Health Reimbursement Arrangement), or HSA (Health Savings Account) can bring to the table. But, which one is the right choice for you?
While it is true that no one can predict an emergency situation requiring urgent medical assistance, anyone who maintains medical insurance should be well aware of what his, or her insurance policy does, and does not cover. Having a medical claim denied by an insurance provider during a critical time is something no one should be forced to endure, especially when it takes precious time away from caring for yourself, or a loved one.
We have all heard horror stories about an insurance company refusing to pay off on a claim due to some oversight by the policyholder. In an effort to protect them against fraud, insurance companies pay hundreds of thousands of dollars annually to investigators and claims adjusters. These employees man the front line against fraudulent, and unscrupulous claims, which, in a perfect world, helps to stifle the high cost of health care insurance and result claim denials in which you spend thousands of dollars dealing with.
The sad part is when honest people with legitimate claims get caught up in the red tape of an insurance claim investigation. Policyholders can often wind up being denied their claim due to some small oversight, or policy stipulation, that they were not aware of prior to the claim being made.
Knowing and understanding how insurance companies and their investigative teams function will be invaluable to you should the day come when you must file a medical claim.
By taking these precautionary steps you may be able to avoid going to battle with your insurer over medical costs you believed should have been covered.
- Examine all provider documents carefully. This is a “cross your t’s and dot your i’s” step you can take to ensure that all of the information on those long forms you fill out at the doctors office is accurate. Name spellings, addresses, insurance policy numbers, date of birth, employee name, etc. As soon as next year, new government standards will allow patients increased access to their health records via computers, and they will be able make online corrections, and updates as needed.
- Understand the new IC-10 Coding System. With over 55,000 additional codes being added the potential for mistakes in this area could be high. Something as simple as a code being given for injury to the left side of the body when the injury is actually on the right side is just enough to disqualify your claim.
- Always carry your most recent health insurance card. Insurance companies will often send out new insurance identification cards when they have made changes to your policy. Discover what changes have been made in their services, and always replace your old card to avoid surprises.
- Make sure that all of the health services being provided to you are from agencies that are in-network. There is an important difference between asking; “Do you take my insurance?” versus “Are you in-network with my insurance company?” The latter will provide you with the greater cost savings.
- Find out if the procedures you are to undergo require prior authorization and make sure the authorization is granted before accepting the procedure. This takes very little time, but may end up saving you thousands of dollars in unnecessary costs.
There are many actions you can take to help protect yourself from a denied claim. It is up to you to do the due diligence, and to understand what your policy does, and does not cover. The best advice is not to leave anything to chance when it comes to understanding your medical coverage.
To prevent having claim denials let HPC Billing take care your medical billing for you! Give us a call today (888)517-4992. Make claim denials a thing of your past!
The official deadline for adopting the newly expanded ICD-10 is quickly approaching. By Oct. 1, 2015, medical offices will be required to adopt the expanded system of codes, or face the possibility of penalties, and delayed claims. Here at Health Care Partners, we are positioned to help you make this transition as smoothly as possible by providing important information and tools you need to make the leap.
The more comprehensive ICD-10 is designed to accommodate future expansions as well.
With more than 55,000 additional new codes the ICD-10 system is essentially a more complete medical language that will be used to collect and compare medical information from around the world. Over 100 countries utilize this uniformed system of codes to report mortality rates, as well as to track research and health trends.
- Affordable Care Act
- Benefits of Outsourcing
- Claims Processing
- Health Plan Patients
- ICD 9/ ICD 10
- Insurance Benefits
- Medical Billing
- Medical Billing Careers
- medical claims
- Medical Coding
- Physician Practice Management
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- Psychology Billing
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- Sleep Apnea