MADD Strategies Billing & Consulting

26/10/2022

26/02/2020

Nearly 21,000 military retirees and beneficiaries at Fort Bragg will eventually have to change which medical clinics they go to, officials announced last

28/10/2018

A Lenoir County woman was sentenced Friday to more than three years in prison for filing hundreds of bogus health insurance claims, authorities said.

25/09/2018

What are 90839 and 90840?
The CPT codes 90839 and 90840 are used for emergency sessions with patients who are in high distress and under complex or life-threatening circumstances that demand immediate attention. Examples of this may include patients who display suicidal intent, disabling anxiety, or other overwhelming psychological symptoms.
It's important to note that 90840 is an add-on code that must be used in conjunction with 90839. In a crisis scenario, 90839 is billed for the first 60 minutes (though it can be used for 30-74-minute sessions), and 90840 is billed for each additional 30 minutes. Using both of these codes together requires that the session lasts 75 minutes or longer. If you don't meet the time required to bill one or both of these two crisis codes, you can bill the standard CPT code for the session, such as 90832 (Individual psychotherapy, 30 minutes).

Billing to insurance
In general, 90839 can only be reported once per day, though the time does not need to be continuous, and 90840 can be used a maximum of 2 units per day (up to 60 minutes total). You may also be limited by how many times per month or year you can bill, depending on where you live. Check your local regulations.
Because 90839 and 90840 are used for crises, you can't bill these codes in conjunction with the following standard therapy codes:
* 90791 and 90792 (initial evaluations)
* 90832, 90834, and 90837 (psychotherapy)
* 90875 (interactive complexity)
Medicare doesn’t always reimburse crisis situations, and other carriers make their own decisions about whether to cover them. Because of this, APA Practice Organization recommends listing the fee you think is appropriate for the session, with the understanding that it may not be covered by Medicare and that private insurers may limit the amount you can bill.

12/09/2018

The Risks Of Text Messages
While text messages are convenient, they also carry with them certain risks that more traditional communication methods lack. For instance, unlike a voicemail, which typically gets deleted after a certain period of time, many text messages remain on a device that receives them indefinitely.
Phones can easily be hacked or otherwise compromised, which can expose sensitive information to third parties. Even the act of throwing out or recycling a phone can expose an individual's information
What's more, SMS is not an encrypted medium, and anyone who intercepts the data can read it. Some iPhone users are under the impression all their text messages are encrypted, but this is only the case for messages sent between Apple device users. Text messages sent via normal means -- such as the automated texts your pharmacy would send out -- are not encrypted.
HIPAA And HITECH
As part of their work, pharmacies deal with personal health information, or PHI. HIPAA requires pharmacies and other health providers to take steps to secure patients' PHI, no matter the communication medium. A patient's PHI includes any personally identifiable data about a patient's past, present, or future physical or mental health, including prescription information and insurance payments.
While HIPAA is the best-known health privacy law, it's far from the only one pharmacies need to worry about. In 2009, President Barack Obama signed a health information regulation called HITECH into law. HITECH takes HIPAA's protection a step further and requires providers to report any mass data breaches to the Department of Health and Human Services. It also limits the disclosure of electronic health records to third parties.
Because these formats are unencrypted, sending any PHI in a text message (without consent) is illegal under HIPAA. This includes basic information about an unspecified prescription being available for pickup -- even confirming that a given person comes to your pharmacy is illicit disclosure.
You can incur up to a $50,000 fine for each violation -- which is to say, each text message. Texting PHI without permission is a serious infraction, and your pharmacy should treat it as completely unacceptable.
Best Practices: Using Encryption And Gaining Consent
Given these concerns, it's no surprise many pharmacies have simply opted to avoid text messages altogether. But the convenience of SMS has encouraged many pharmacies to find a way to make it work. Here are some tips on how to use text messages and assure you're in compliance:
• Let patients consent to texts: Under HIPAA, patients can always opt to release their data via an insecure channel. To do this legally, you must give patients a secure alternative, receive their written consent to text, keep this consent on file and take reasonable steps to ensure the security of the information you send.
• Never text health care providers with PHI: Even if a patient signs off on communicating with your pharmacy via text, you must use a secure channel to communicate PHI with other health care providers.
• Consider using an app: Especially if you're a larger pharmacy and can afford the investment, you may want to design a secure app that patients can opt into using. This app can send push notifications and encrypted messages.
• Use a secure texting solution: Several companies have devised means of sending encrypted messages via normal SMS. Providers can send automated texts to patients via these means, and most of them are designed to be easy for pharmacy staff to learn to use.
Texting is a very convenient way to get in touch with patients. But texting isn't secure enough to meet HIPAA's stringent standards regarding patient health information, and even confirming that a patient has an account with a pharmacy via unsecured text message is a serious breach.
Thankfully, there are several ways for pharmacies to use texts while remaining in full HIPAA compliance, including securing patient consent, using secure apps or texting protocols, and remembering to never communicate with other health care providers via insecure means. By remembering these guidelines, you'll safely and securely incorporate texting into your day-to-day operations.

25/06/2018

MADD Strategies assists professionals in private practice. With twenty years of experience, we get the job done quickly and efficiently. We are dedicated to helping medical practices become more efficient in the reimbursement process.

Practices can save time and money by outsourcing their medical billing and processing for expert reimbursement services. Let us help you stop cashflow issues as you focus on delivering health care.

20/06/2018

10 Tips for Practices that can enhance timely and accurate processing.

1. Always collect copy of Insurance card and identity card, in addition to filled patient demographic forms.

2. Maintain a Matrix showing IN/OUT status with Major payers along with plan names. Display and discuss with patients to avoid discrepancies at later time.

3. Maintain a matrix with payers and plans that require Referral/Auth. Validate every policy with the matrix.

4. Plan to follow up within 3 days on authorization request and find if approved or denied.

5. The moment you find the termination of policy in any account, Set ALERT to check with patient for new coverage information on next visit.

6. Allocate time for Office Manager / Front desk Rep to review patient account in RCM before patient check in for appointment. This will help you to keep handy if any data or payment need to be collected from patient.

7. On each visit verify with patient any recent changes in insurance policy, COB, patient address/phone #. Keep your records up to date.

8. Account any copays collected from patient in RCM software immediately to avoid incorrect bills to patient.

9. Help patients to fix COB with payer or filling questionnaire at Front desk to make sure they do it timely and correctly.

10. Obtain feedback from patients on each visit which will help to improve the service.

18/06/2018

CMS Proposes Pre-Claim Review Demonstration for Home Health Services

On May 29, 2018, the Centers Medicare and Medicaid Services (CMS) announced its intention to implement a revised Medicare demonstration project that will affect Home Health Agencies (HHAs) providing services to Medicare beneficiaries in Florida, Illinois, North Carolina, Ohio, and Texas. The proposed demonstration is currently limited to these five states; however, CMS expressly retained the option to expand the demonstration project to other states in the Palmetto/JM jurisdiction, which includes Alabama, Arkansas, Georgia, Indiana, Kentucky, Louisiana, Mississippi, New Mexico, Oklahoma, South Carolina, and Tennessee.

The new demonstration project proposes to give participating HHAs the choice of submitting to 100% pre-claim review or 100% postpayment review, or of facing a 25% payment reduction on claims. An HHA that chooses to participate in pre-claim or postpayment review remains subject to its chosen method until the HHA reaches CMS’s target affirmation or claim approval rate. The current rate is set at a lofty 90 percent, based on a minimum of 10 pre-claim requests or claims submitted. After reaching the target affirmation or claim approval rate, the HHA may opt out of 100% pre-claim or 100% postpayment review but will continue to be subject to spot checks of 5% of their claims. HHAs that do not participate in the pre-claim or postpayment review options will receive a 25% payment reduction on all claims submitted for home health services and may be subject to review by Recovery Audit Contractors.

CMS states that the new demonstration is designed to “assist in developing improved procedures for the identification, investigation, and prosecution of Medicare fraud occurring among [HHAs]” and offers a solution in “working towards the prevention and identification of potential fraud, waste, and abuse; the protection of Medicare Trust Funds from improper payments; and the reduction of Medicare appeals.” However, CMS previously implemented a similar pre-claim review demonstration that ended at the end of March, 2017, after the demonstration was found to highlight more paperwork errors than Medicare fraud.

The proposed demonstration has already been met with resistance from the Home Health industry. The National Association of Home Care & Hospice (NAHC) stated that, “[n]o other health care sector is forced to submit every claim for review or face a punishing [25%] pay cut.” In addition, NAHC President, William A. Dombi, described the demonstration program as a “great concern to the home health community” and dismissed CMS’s suggestion that the demonstration offers HHAs choices: “While it is touted as a choice of options for [HHAs], the options presented are two with increased paperwork burdens and one that would financially cripple a HHA with a 25% pay reduction.” Mr. Dombi also noted that the addition of the postpayment review feature, which was not included in the precursory 2017 demonstration, “is very likely to lead to a substantial appeals backlog.”

The public, including interested Home Health providers, have until July 30, 2018, to comment on the CMS proposed demonstration.

13/06/2018

IMPLEMENT CORRECTIVE ACTION
One method to reduce denials due to improper coding is to hold the coder of a denied claim responsible for all rework. While this method may seem like a form of punishment, it serves as an opportunity for coders to learn from their mistakes.

Under this method, managers are responsible for explaining to the responsible coder what mistake was made. If managers effectively explain why the claim was denied, this method provides coders with a chance to be retrained and eliminates the chance of an error recurring. Moreover, coders then have an incentive to keep up to date on coding changes to avoid rework. This new motivation alone may result in a decrease in coding errors.

With these practices, resources and diligence, healthcare provider organizations can effectively combat errors and aid in the reduction of denied claims.

11/06/2018

CODE CHANGES REQUIRE PROPER TRAINING
ICD-10 coding was implemented just over two years ago and has allowed healthcare providers to code diagnoses, injuries, symptoms with far greater precision than ICD-9. This change, while a great asset for accurate coding, makes proper training for coders critical. ICD-10-CM has over 70,000 codes with updates and changes made annually. Likewise, CPT codes are updated each year, with the most recent update containing 314 changes.

Coders must be aware of the most recent changes if they wish to avoid a denial, as submitting a claim with outdated or deleted codes guarantees the denial of a claim. This is a common and costly mistake that can be easily avoided with proper training and resources.

There are also many resources designed to keep coders knowledgeable on the latest updates. From software applications to online references, coders have more resources for accurate coding at their disposal today than ever before.

07/06/2018

Denied claims are a major issue faced by virtually every healthcare organization. Minimizing and managing denials is of the upmost importance, as unchecked denials wreak havoc on a practices financial well-being. While some denials are inevitable, healthcare providers must do everything they can on the front-end to catch improper coding issues and prevent denied claims.

Preventing denied claims is tricky. There are hundreds of reasons a payer can deny a claim, some of which are out of a healthcare provider’s control. However, changes in CPT and ICD-10 coding are one of the largest factors leading to denied claims.

06/06/2018

UnitedHealthcare Establishes Long-Term Strategic Partnership with Quest Diagnostics
Beginning Jan. 1, 2019, Quest will be participating as a national provider of laboratory services for all UnitedHealthcare plan participants
Partnership will include broad range of value-based programs, rewarding high-quality, easily accessible laboratory services at the best value and real-time data sharing to drive more personalized care support.

04/06/2018

Fast Track Claims revamp and upgrade each and every time a new modification comes in the principles of Healthcare Revenue Cycle, Medical Claim Processing, Denial management, Internal Audit, PRO services and Quality checks.

01/06/2018

MEDICAL BILLING
Important Steps to Follow in Medical Billing Process

Medical billing is the process of submitting and following up on claims with health insurance companies in order to receive payments for services rendered by a healthcare provider.
Medical billing translates a healthcare service into a billing claim. There are 8 steps we follow:

1. Register Patients

First step is medical billing process starts When a patient call to setup an appointment with a healthcare provider (doctor), they pre-register or schedule for their doctor’s visit. If the patient has seen doctor before then he or she will be an established patient and their information is on file, that person only need to explain the reason of visit, but if a person comes first time he will be called a new patient and must provide his personal and insurance information to the provider (doctor) to ensure that they are eligible to receive services from the provider. We maintain patient database by registering patients as per scheduling and make sure the security of patient’s records. And confirm insurance eligibility.

2. Confirm Financial Responsibility

Second step is medical billing process is Financial responsibility which describes who owes what for a particular doctor’s visit. Once the we have the pertinent information from the patient, we can determine which services are covered under the patient’s insurance plan.
Insurance coverage differs dramatically between companies, individuals, and plans, so the we must check each patient’s coverage in order to assign the bill correctly. Certain insurance plans do not cover certain services or prescription medications. If the patient’s insurance does not cover the procedure or service to be rendered, we make the patient aware that they will cover the entirety of the bill.

3. Patient Check-In And Check-Out

Patient check-in and check-out are relatively straight-forward front-of-house procedures. When the patient arrives, they will be asked to complete some forms (if it is their first time visiting the provider), or confirm the information the doctor has on file (if it’s not the first time the patient has seen the provider). The patient will also be required to provide some sort of official identification, like a driver’s license or passport, in addition to a valid insurance card.

The provider’s office will also collect copayments during patient check-in or check-out. Copayments are always collected at the point of service, but it’s up to the provider to determine whether the patient pays the copay before or immediately after their visit.
Once the patient checks out, the medical report from that patient’s visit is sent to the medical coder, who abstracts and translates the information in the report into accurate, useable medical code. This report, which also includes demographic information on the patient and information about the patient’s medical history, is called the “superbill.” The superbill contains all of the necessary information about medical service provided. This includes the name of the provider, the name of the physician, the name of the patient, the procedures performed, the codes for the diagnosis and procedure, and other pertinent medical information. This information is vital in the creation of the claim.

Once complete, the superbill is then transferred, typically through a software program, to us (medical billers)

4. Prepare Claims/Check Compliance

When we take the super bill from the medical coder and put it either into a paper claim form, or into the proper practice management or billing software. We also include the cost of the procedures in the claim. We won’t send the full cost to the payer, but rather the amount we expect the payer to pay, as laid out in the payer’s contract with the patient and the provider. After creating claim we ensure that the claim meets the standards or compliance, both for coding and format.

The accuracy of the coding process is generally left up to the coder, but we review the codes to ensure that the procedures coded are billable. While claims may vary in format, they typically have the same basic information. Each claim contains the patient information (their demographic info and medical history) and the procedures performed (in CPT or HCPCS codes). Each of these procedures is paired with a diagnosis code (an ICD code) that demonstrates the medical necessity.

5. Transmit Claims

Since the Health Insurance Portability and Accountability Act of 1996 (HIPAA), all health entities covered by HIPAA have been required to submit their claims electronically, except in certain circumstances. Most providers, clearinghouses, and payers are covered by HIPAA.

HIPAA does not require physicians to conduct all transactions electronically. So we make sure that the standard transactions listed under HIPAA guidelines must be completed electronically.

In the case of Medicare or Medicaid, we can submit the claim directly to the payer. If, however, a provider is not agree for submitting claims directly to these large payers, we go through a clearinghouse.

“A clearinghouse is a third-party organization or company that receives and reformats claims from billers and then transmits them to payers. Some payers require claims to be submitted in very specific forms. Clearinghouses ease the burden of medical billers by taking the information necessary to create a claim and then placing it in the appropriate form. Think of it this way: A practice may send out ten claims to ten different insurance payers, each with their own set of guidelines for claim submission. Instead of having to format each claim specifically, a biller can simply send the relevant information to a clearinghouse, which will then handle the burden of reformatting those ten different claims.”

6. Monitor Adjudication

Once a claim reaches a payer, it undergoes a process called adjudication. In adjudication, a payer evaluates a medical claim and decides whether the claim is valid/compliant and, if so, how much of the claim the payer will reimburse the provider for. It’s at this stage that a claim may be accepted, denied, or rejected.

Once the payer adjudication is complete, the payer will send a report to the provider/biller, detailing what and how much of the claim they are willing to pay and why. This report will list the procedures the payer will cover and the amount payer has assigned for each procedure. This often differs from the fees listed in the initial claim. The payer usually has a contract with the provider that stipulates the fees and reimbursement rates for a number of procedures. The report will also provide explanations as to why certain procedures will not be covered by the payer.

7. Generate Patient Statements

Once we have received the report from the payer, it’s time to make the statement for the patient. The statement is the bill for the procedure or procedures the patient received from the provider. Once the payer has agreed to pay the provider for a portion of the services on the claim, the remaining amount is passed to the patient.

8. Follow Up On Patient Payments And Handle Collections

We ensure those bills get, well, paid. We as billers are in charge of mailing out timely, accurate medical bills, and then following up with patients whose bills are delinquent. Once a bill is paid, that information is stored with the patient’s file.

If the patient is delinquent in their payment, or if they do not pay the full amount, it is the responsibility of the biller to ensure that the provider is properly reimbursed for their services. This may involve contacting the patient directly, sending follow-up bills, or, in worst-case scenarios, enlisting a collection agency.

29/05/2018

Allow Visits by Appointment Only
Creating a consistent scheduling plan is the first step in optimizing billing success. An appointment-only scheduling structure promotes insurance verification prior to service and it also leads to greater accuracy in capturing necessary billing information. Such a setup may be difficult for public health agencies to transition to, but it’s a vital step in cleaning up and optimizing the claims and billing processes. One idea to make this easier would be to have self-service online scheduling.