Ask A Medical Biller

Friday, May 28, 2010

Microsoft Office Training Videos

These are the best Microsoft Office Training Packages. They are all completed by a Certified Microsoft Office Trainer who is certified in Microsoft Applications. Get these highly detailed training for you and your medical office.

Use Word to create Letters, Patient Documents, Templates, Fax Sheets, Mailing Labels, and patient forms.

Use Excel to manage Accounts Receivable, create graphs, track business numbers.

Use Powerpoint to create marketing materials and presentations for conferences, talks, and onsite visits. It's also a powerful tool for medical billing services that are presenting their services and skills to new clients.

Wednesday, May 6, 2009

Professional Liability Errors and Omissions Insurance for Medical Billing Services

Do medical billing services, individual medical billers and certified coders require Professional Liability Errors and Omissions Insurance coverage to perform their job duties?

Professional Liability Errors and Omissions Insurance coverage helps to protect your business or company services from claims submitted by your clients.

Let's say you are a medical billing service and the doctor sends you $120,000 worth of Aetna medical claims. You are required to bill a clean CMS 1500 claim to Aetna within 90 days from the date of service (per doctors contract with Aetna) and you have issues getting a clean CMS 1500 medical claim sent through the electronic medical claim clearinghouse software. Your medical billing staff didn't realize they could drop the claims to a CMS 1500 form and bill it by paper so the claims sit their denied at the medical claim clearinghouse, waiting for someone to fix the issue.

95 days later you finally get the medical claim clearinghouse working and all CMS 1500 electronic claims are submitted to the carrier and denied for untimely filing. Your billing service can't appeal (although it doesn't hurt to try) because you can't prove you sent Aetna Health Insurance a clean CMS 1500 medical claim in the timely filing period.

Now let's say the doctor was expecting to collect about $73,000.00 from Aetna on the $120,000 worth of medical claims. The doctor is mad when he finds out that he just lost $73,000.00 in business and decides to sue you for this loss.

The Professional Liability Errors and Omissions Insurance Coverage can potentially protect you from most of these fees including court, attorney and lawsuit settlement fees.

Does a Medical Billing Service require Professional Liability Errors and Omissions Insurance - no but would it help out to cover the costs of protecting your business in the case of being sued by a doctor? Yes.

Who needs Professional Liability Errors and Omission Insurance in the medical industry? Anyone who performs "services" to a client. Services can be anything from billing, coding, doing work in a "timely" matter.

General Liability Insurance does not protect your business for errors, contract performance disputes, or any other professional liability issues which is why they have Error and Omission insurance.

Other Medical Insurance Policies

Medical Malpractice & Medical Liability Insurance covers providers and other professionals in the medical industry for liability claims arising from their treatment of patients. Pricing varies by the rendering providers specialty, location and state.
Some states do not require providers to have Medical Malpractice Insurance although most doctors do have Medical Malpractice Insurance.

Employment Practices Liability Insurance or EPLI insurance is insurance policies to protect employers from employees, former employees or "potential" employees. If employees feel discriminated against for their age, sex, race, disabilities, sexual harassment or wrongful termination you may find the need for EPLI insurance.

Keywords: Medical Billing Insurance, Certified Coders insurance, Insurance polices for medical offices, insurance policies for medical billing services, when to buy, do I need to buy, purchase, insurance policies, medical industry, medical billing companies, corporations, businesses, employed, employer, small businesses, health care, providers, doctors, nurses, assistants, biller, collector, collecting, collections, doctor error, erroneous,

Monday, February 16, 2009

How does a Medical Office gain insight into what their Medical Billing Service is doing with Medical Claims?

A medical office is outsourcing their claim billing to a medical billing service. The medical office has no transparency into what is happening with their medical claims and they were asking me what steps they should take to gain access to the billing services electronic medical claim clearinghouse Office Ally.

The Medical Office's concerns are the lack of insight into all electronic claims, which claims are getting submitted, are any kicking out, if they are getting claim denials what are the reasons, how often is the medical billing service actually billing their medical claims, and what percentage of claims are getting passed on to the health insurance carrier? Because of these concerns they want access to the electronic claims clearinghouse.

Let's first review how the medical claims clearinghouse Office Ally works?

All data is entered into the Practice Management/Billing Software

A claim file is generated

The claim file is downloaded to the desktop

The user logs into Office Ally
The user uploads the claim file from the desktop into Office Ally Clearinghouse Software
The user submits these claims electronically through Office Ally after it passes through certain claim edits
Any denied claims will be received in a report format, the medical billing service should be fixing the issues in both the claim clearinghouse software and in their Practice Management Software
The medical billing service should be permanently deleting the Claim File from their desktop to remain HIPAA compliant

If the medical billing service has the contract with Office Ally Clearinghouse and you are the medical office contacting them to gain access they will most likely forward you on to your medical billing service to get a user name/password. Office Ally Medical Claim Clearinghouses contract is with the billing service and not you.

If you are not on speaking terms with your medical billing service or you would rather they not know you are trying to log into Office Ally Clearinghouse than you will need to work this through another angle.

Your other option and one that you have more control over if you cannot get a user name and password into Office Ally's Clearinghouse.

The doctor has access to setting up user names/passwords with all health insurance carriers they are contracted with including BCBS, Cigna, Aetna, UHC, Humana and many more. This is the same place that you might use to check patient eligibility online but instead of clicking on the eligibility click on the claim status section.

Side Note: If the billing service has registered the doctors on these websites you will need to ask them to give you user names/passwords to access. If they ask why you need access (and they shouldn't but if they do) explain the doctor would like to monitor new coding updates, releases, fee schedules and that the front office needs access to check patients eligibility and pre-authorizations. Notify the billing service that you would like them to keep you updated with the most current user names/passwords for each health insurance carrier.

How to use your Health Insurance Carriers websites to track what your billing service is doing?

Use the online claim status screens to track your patients and identify how long it takes from the time you give the claims, medical records information to your billing service until it gets accepted by your health insurance carrier. Plus you can check for denials etc. If the patients claims are not on file with the health insurance carrier than it means that the billing service is having issues submitting claims through Office Ally (they are kicked out because information is being sent incorrectly so they do not send on to the Health Insurance Carrier).

For a list of additional Articles I have written please check out this website and scroll down until you get to the Electronic Medical Billing Clearinghouses section.

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Friday, January 16, 2009

Medicaid of Illinois is requiring doctors to register NPI numbers

Medicaid of Illinois Health Insurance currently requires providers to report a one digit payee code in the Billing or Pay-To-Provider Loops. This one digit payee code designates the appropriate Pay-To-Provider.

Illinois Medicaid is now requiring medical providers to register their NPI numbers associated with their designated Payee ID's. They will soon be transferring their software to accept the NPI number in lieu of the 1 digit payee code.

If you are a medical provider and bill to Medicaid of Illinois Health Insurance you should immediately register your NPI number for each designated payee number. You can register the NPI number at either website:

myhfs.illinois.gov
illinoisnpi.com

After the NPI information is registered with the HFS, the Payee NPI can be reported in the 837 (electronic medical claims) and DDE transactions. Also, after the NPI number has been registered you can start billing your medical claims using the NPI number and the 1 digit Payee ID will no longer be required.

The deadline for registering and using the NPI number is March 1, 2009. Any claims submitted electronically not using the NPI number will be rejected.

Register now to prepare for these changes by March 1, 2009.

Medical Billing and Coding Tags: Medical Health Insurance, Medicaid of Illinois Health Insurance, Medicaid NPI updates, Medicaid Payee one digit updates, New change over, New Medicaid of Illinois deadlines, Electronic Claim Denials for invaid NPI number, update, switch over, electronic

Oregon Medicaid MMIS Updates on Claim and ERA issues

Oregon Medicaid Health Insurance was recently converted to a new MMIS system and the bugs have already started to reveal themselves. Oregon Medicaid Health Insurance has identified issues with the Electronic Remittance Advice and some claim processing issues.

Some medical offices and hospitals are experiencing problems with inconsistent denial codes, medical claims dropping out of the system, missing electronic remittance advice and problems with weekly electronic funds transfers.

The transition to the new MMIS system happened in Mid-December. If this is happening to you please be aware that Medicaid is aware of most problems and are working to resolve these issues. If you feel your issue is new please contact Medicaid and notify them of the problem.

Medical Tags: Clearinghouse, Medicaid of Oregon, Health insurance claims billing issues, Electronic Remittance Advice issues, medical claims billing and coding issues

Friday, January 9, 2009

Will United States of America ever get Universal Health Care?

Universal Health Care is how the government likes to describe a Socialist environment where all Americans would get FREE Health care including illegal aliens. (Oh I forgot Illegal Aliens already get free health care).

The media loves the concept of Free Health Care and anytime a democrat talks about free health care they rave and talk it up in hopes to gain favor amongst the Americans. However States have tried this on several attempts and not one has ever worked (TennCare (bankrupted hospitals, doctor practices and the state of Tennessee, Hillary Clintons Single-Payer plan (pilot was TennCare), Hawaii Universal Health Care for all children lasted 7 months due to unsufficient funds, San Francisco Medicare for All program was voted down even by democrats because they knew it would bankrupt the City). It's mainly the democrats who attempt to push this jargon on the Amercians with the dream of getting free health insurance. What they don't tell you is that since the government would own the doctors they would also own the right of who got to see them.

Of course something else the democrats don't tell you is that the government can't actually afford to pay the doctors equal or more of what they are currently earning so the middle tier and BEST doctors will leave their practice and do something else.

I found this hilarious You Tube video about what the world would look like if America were to socialize the medical industry. All I can say is thank goodness for Google.

If the video didn't make it clear to you try thinking back to your days at Public High School. How many teachers did you feel were actually qualified to cross-teach you. And of those teachers how many did you actually like listening to. Now think about this with doctors. How many doctors on Government Pay Scales do you think will be good at their jobs?

Let me know what you think about Socializing Health Care or I mean Universal Health Care. As a medical biller how do you think this would affect your job? Do you think you would even have a job as a biller if the government ran the medical industry?

Medical Tags: Socializing Health Care, Doctors, Providers, Physicians, Universal Health Care, Single Payer, Mandated Insurance, Hospitals, Health Care Insurance,

Tuesday, December 23, 2008

Utah Health Information Network (UHIN) to raise electronic fees

If you are a medical billing service or are a medical provider in the state of Utah and you are credentialed with UHIN (Utah Health Information Network) please be advised that they are raising their per transaction surcharge from $0.12 to $0.168 effective January 1, 2009.

If you submit claims using RelayHealth please be aware that they will pass this fee onto the providers as it is currently in place at this time.

The health insurance carriers that this affects:

CPID 1536 Altius Health Plan
CPID 4726 Altius Health Plan
CPID 4728 Deseret Mutual Benefits Association
CPID 4410 Educators's Mutual Insurance Association
CPID 4480 SelectHealth
CPID 4727 Public Employee Health Program (PEHP)
CPID 1529 Utah Blue Cross
CPID 1530 Utah Blue Cross FEP
CPID 2412 Utah Blue Shield
CPID 2788 Utah Blue Shield FEP
CPID 1486 Utah Medicaid
Please be aware of these changes when you are looking at your 2009 invoices.

Medical Billing Tags: medical billing claims, claim coding, health insurance carriers, medical claims processing, medical claims clearinghouse, medical claim billing and coding, medical billing and coding, new updates, Electronic modifications, new changes to electronic claims submission, aware of New Years updates

Aetna Health Insurance Electronic Remittance Advice Updates

For all medical offices that bill to Aetna Health Insurance please be aware of their new announcement regarding electronic remittance advice.

Starting March 30, 2009 Aetna will not send Electronic Remittance Advice (ERA's) to providers subject to the National Provider Identifier regulations when

1. A billing provider NPI is not sent on the claim and

2. we have not been notified of a specific override NPI to use on ERA's and

3. the payee does not have a default NPI recorded in Aetna's health insurance providers records

If Aetna Health Insurance does not have a NPI or they adjudicate or reprocess a claim that was submitted without a Billing Provider NPI you will receive the explanation of benefits by paper.

At this time your medical office or billing service maybe submitting medical claims without submitting the NPI number. Right now Aetna health insurance will send your Explanation of Benefits using the Electronic Remittance Advice if it is currently enabled. But on March 30, 2009 those same medical claims will no longer be eligible for electronic remittance advice until you submit the Billing Provider NPI.

If you would like to ask Aetna Health Insurance to continue to receive the payee NPI loaded in to the Aetna Health Insurance system you may send Aetna a email request to their dedicated mailbox aetnanpiera@aetna.com.

Aetna health insurance will be looking for NPI's at the Payee ID source, Group ID source and/or the Rendering Provider ID Source.

The TIN and provider business group (PBG) will always be sent to identify the taxpayer ID that will be used for IRS reporting and the provider business area handling remittances for the claim.

If you have access to Aetna Health Insurance's Secure Provider Website you can access the NPI's assigned to your provider if you have registered for the ERA/EFT feature.

Please be aware of these new updates and confirm that you are submitting the NPI numbers now so you will not see a issue with your Explanation of Benefits. Waiting on paper EOB's can become extra work for any billing department when identifying paid/unpaid claims and the status of such.

For those who bill using RelayHealth: Aetna Health Insurance CPID#'s are 4500 and 6400. If you are new to billing or are interested in learning more about medical claims reports please visit: Medical Claims Clearinghouse Reports

Medical Billing Tags: medical claims clearinghouse, electronic medical claims clearinghouse, medical billing and coding, new ERA updates, new changes, reviews, reporting, Health Insurances, medical billing, medical billing, claims coding and billing, medical claims, claim submission, claim billing, healthy medical claims, clean claims submission, faster payments on insurance claims, health insurance billing and coding

Oregon Medicaid MMIS Updates

On December 11, 2008 RelayHealth, a medical claims clearinghouse, began submitting electronic claims to Oregon Medicaid Health Insurance Carrier (CPID#1481 and 5517).

RelayHealth, a medical claims clearinghouse, is adding new claim edits that you should be aware of if you bill to Oregon Medicaid Health Insurance.

The following apply for Professional CPID 1481:

Professional claims are CMS-1500 formatted claims to indicate the providers services:
HU 0019C:INVALID BILLING PROVIDER ID QUAL - IN LOOP 2010AA, NM108 MUST BE SENT AND MUST BE EQUAL TO XX
HU 0022C:INVALID CLAIM REND PRV ID QUAL - IN LOOP 2310B(PROF)/2310C(INST), NM108 MUST BE SENT AND MUST BE EQUAL TO XX
HU 0028D:INVALID SRV LINE REND PRV ID QUAL - IN LOOP 2420A(PROF)/2420C(INST), NM108 MUST BE SENT AND MUST BE EQUAL TO XX
HU 0031D:INVALID SRV LINE SUP PROV ID QUAL - IN LOOP 2420D(PROF), WHEN NM108 IS SENT IT MUST BE EQUAL TO XX
HU 0043C:INVALID CLAIM REF PROV ID QUAL - IN LOOP 2310A(PROF) NM108 MUST BE SENT & MUST BE EQUAL TO XX

The following apply for Institutional CPID 5517:

Institutional Claims are UB-04 and indicate facility charges
HU 0019C:INVALID BILLING PROVIDER ID QUAL - IN LOOP 2010AA, NM108 MUST BE SENT AND MUST BE EQUAL TO XX
HU 0020C:INVALID PAY-TO PROVIDER ID QUAL - WHEN LOOP 2010AB IS SENT, NM108 MUST BE SENT AND MUST BE EQUAL TO XX
HU 0022C:INVALID CLAIM REND PRV ID QUAL - INVALID CLAIM REND PRV ID QUAL: IN LOOP 2310B(PROF)/2310C(INST), NM108 MUST BE SENT AND MUST BE EQUAL TO XX
HU 0024C:INVALID CLAIM SRV FAC ID QUAL - IN LOOP 2310D(PROF)/2310E(INST), WHEN NM108 IS SENT IT MUST BE EQUAL TO XX
HU 0026C:INVALID CLAIM ATTEND PHY ID QUAL - IN LOOP 2310A(INST), NM108 MUST BE EQUAL TO XX
HU 0027C:INVALID CLAIM OPERATE PHY ID QUAL - IN LOOP 2310B(INST), NM108 MUST BE EQUAL TO XX
HU 0034C:INVALID SRV LINE ATTND PHY ID QUAL - IN LOOP 2420A(INST), NM108 MUST BE EQUAL TO XX

Please be aware of the NPI updates when billing electronic medical claims.

Want to read additional information on Medical Claims Clearinghouse?

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Harrington Benefit Services of OK new claims processing center

the Medical Claims Processing for Health Choice, Department of Rehab Services (DRS) and the Department of Corrections (DOC) providers are being transitioned over to a new medical claims processor effective January 1, 2009.

If you are a medical provider and you are currently submitting electronic claims to your medical claims clearinghouse please be aware of the new payor ID 22521.

Payor ID# 59142 has been deleted as of December 23, 2008 which correlates to RelayHealth's medical claims clearinghouse CPID#'s:
CPID# 1751 Harrington Benefit Services of Oklahoma Professional CMS-1500 Claims CPID# 2554 Harrington Benefit Services of Oklahoma Institutional UB-04 claims

If you use RelayHealth as your medical claims clearinghouse has not identified the new CPID# that they will use to accept electronic medical claims. They are asking that medical providers hold their medical health insurance claims until the new payor ID is created.

Another reminder is that Health Choice providers will need to send their medical practice location in loop 2010AA REF01 with the LU qualifier. The practice location code is a 6 digit code which is assigned by the HealthChoice Provider Relations Division and they can be called at 800-543-6044.

Read more articles on Medical billing and Coding

Medical Billing Tags: Harrington Benefit Services of OK, medical claims clearinghouse, medical claims processing, medical billing, medical health insurance claims, claim billing, medical coding and billing, asking, ask, choosing, selecting, using, billing, health care, health insurance, processing, producing, electronic claims billing, electronic health,

RelayHealth Medical Claims Clearinghouse has Report Update

RelayHealth a Medical Claims Clearinghouse has announced that on January 8 2008 they will be modifying the way you look at their medical claims clearinghouse reports.

Health Insurance Carriers return two reports to RelayHealth, medical claims clearinghouse. One report is the Print Image File also known as Availity Electronic Batch Report and the second report is the Data File or Availity Data File. Both of these reports contain duplicate data but the report formats are different.

RelayHealth is trying to streamline the data the their clients get so on January 8th 2008 they will no longer be parsing the Data File (Availity Data File) to clients.

You will still have access to the Payor Claim Data Report (SR), Payor Claim Rejections Report (SE), and Payor Report Data File (SF).

These changes will affect health insurance carriers like:
CPID 1403 Oklahoma Blue Shield
CPID 1405 Illinois Blue Shield
CPID 1406 Texas Blue Shield
CPID 1414 Florida Blue Shield
CPID 1514 Oklahoma Blue Cross
CPID 1563 Illinois Medicaid
CPID 1997 Washington Regence Blue Cross
CPID 2404 Oregon Blue Shield
CPID 2440 Ohio Choicecare HMO
CPID 2449 Humana
CPID 2488 Illinois Medicaid
CPID 3417 Florida Healthy Options HMO
CPID 3517 Florida Blue Cross
CPID 3540 Idaho Blue Shield Regence
CPID 3561 Florida Health Options
CPID 3890 Humana Encounters
CPID 4544 Humana
CPID 5501 Texas Blue Cross
CPID 5508 Illinois Blue Cross
CPID 5516 Oregon Blue Cross
CPID 5565 New Mexico Blue Cross
CPID 7403 New Mexico Blue Shield
CPID 7426 Idaho Blue Shield Regence
CPID 7451 Washington Regence Blue Shield
and more...

If you use RelayHealth as your electronic medical claims clearinghouse please be aware of these new changes. Tell the medical billers in your office that on January 8 2008 the Data File report will no longer be available for the majority of health insurance carriers but since this report contained duplicate content you should just notice less reports to have to sort through.

Happy Billing!

Read here for additional medical claims exclusion articles Medical Claims Clearinghouse

Medical Billing Tags: Medical claims clearinghouse processing center, medical claims processing, electronic medical claims, medical billing and claims, billing and coding, medical claims clearinghouse updates, reports, news, features, help, what's new, what to expect, changes in the industry, features, health insurance carriers, medical claims,

CDPHP Health Insurance Carrier offers new claim exclusion reasons

As of December 19th 2008 RelayHealth a medical claims clearinghouse facility will be implementing new claim exclusion edits for CPID#'s 3786 and 2987 because the NPI is now required from the health insurance carrier.

CAPITAL DISTRICT PHYSICIANS HEALTH PLAN (CDPHP)

The following payor edits are for institutional or UB-92 / UB04 facility billing

CPID 2987 - CDPHP:
HU:0019C:

INVALID BILLING PROVIDER ID QUAL - IN LOOP 2010AA, NM108 MUST BE SENT AND MUST BE EQUAL TO XX
HU0020C:

INVALID PAY-TO PROVIDER NPI - IN LOOP 2010AB, NM108 MUST BE SENT AND MUST BE EQUAL TO XX
HU0026C:

INVALID CLAIM ATTENDING PHY NPI - IN LOOP 2310A(INST), NM108 MUST BE SENT AND MUST BE EQUAL TO XX

The following payor edits are for professional CPID 3786 or CMS-1500 provider services CDPHP:
HU:0019C:

INVALID BILLING PROVIDER ID QUAL - IN LOOP 2010AA, NM108 MUST BE SENT AND MUST BE EQUAL TO XX
HU0020C:

INVALID PAY-TO PROVIDER NPI - IN LOOP 2010AB, NM108 MUST BE SENT AND MUST BE EQUAL TO XX
HU0022C:

INVALID CLAIM RENDERING PROVIDER NPI - IN LOOP 2310B(PROF), NM108 MUST BE SENT AND MUST BE EQUAL TO XX
HU0021C:

IN LOOP 2310A(PROF), WHEN NM108 IS SENT IT MUST BE EQUAL TO 'XX'

To fix if you get any of these medical claim exclusions is to add the correct NPI number in the appropriate field before submitting medical claims electronically.

To read additional posts on medical billing please see: Asking a Medical Biller

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Saturday, December 13, 2008

How to use Medicare Part B Electronic Data Interchange (EDI) Hotline

A few years ago Medicare Health Insurance began requesting medical offices to submit all Medicare Health Insurance claims electronically to save processing costs. In order to handle the connection of software products to Medicare they created a department called the Electronic Data Interchange or EDI.

The EDI department has the right to kick out a claim before it comes through their claim processing system. If a medical claim is kicked out at the EDI level it is like the insurance carrier never received the medical claim in the first place.

If you have issues where you are sending Medicare Health Insurance claims and they are not appearing in the IVR or in the support line it means one of two things:

1. Your clearinghouse kicked out the claim for issues
2. The Medicare EDI department kicked out the claim for issues

I would first recommend viewing your EDI reports for the patient that Medicare Support was not able to find on file. Now that you have the report read the exclusion reason...

If you don't understand the denial reason you have 3 different options depending on how you are submitting the claim:

1. If you use a Practice Management software that is integrated with the medical claims clearinghouse you might want to contact them first to see how to resolve the issue.
2. If you use a Practice Management Software that is not integrated with the medical claims clearinghouse and you can contact your medical claims clearinghouse do so now. Ask them to pull the file and see why they can identify the claim is getting kicked out.
3. If you have a direct connection with Medicare Health Insurance follow the EDI Hotline Rules

To make a phone call to the EDI Hotline please have this information handy:
1. Submitter ID number. It can also be called Sender ID, User ID and/or Billing Location Code for providers sending to Medicare Health Insurance through Blue Cross of Michigan.

2. NPI number (National Provider Identifier) and can be found in the NPPES directory

3. Date you submitted the claim

4. Processed Date if report states "deleted"

Do not call Medicare's EDI Hotline until you have prepared all of this information. They are usually very nice in the EDI department but they are in a hurry so they need this information quickly.

EDI Hotline for Medicare Part Health Insurance Carriers: 877-567-7261

To read more about Medicare updates including Billing Health Insurance Information check out Medicare Medical Coding and Billing Courses

Medical Billing Insurance Tags: Medicare Health Insurance, Health Insurance Claims processing, Medical Claims Billing, Medical Health Insurance Claims, Electronic Claim Submission, EDI Hotline for Medicare Part B, How to fix denials for Medicare, Deleted Files on EDI Reports, How to work EDI Denial Reports, EDI Denial options, Medical Billing, Medical Billing and Coding, Medical Coding,

Sagamore Health Network moves to new location

RelayHealth was updated with a new physical address for Sagamore Health Network.

The new location is:
Sagamore Health Network
11595 North Meridian Street
Ste #600
Carmel, IN 46032
800-933-3466

Sagamore Health Network will have the servers down during this transition and will not be able to process electronic claims during Friday December 12th 2008 - Monday December 15th 2008. RelayHealth will submit files to Sagamore Health Network up to December 11th 2008 and resubmit to Sagamore on December 15th 2008 after 8:00 am ET.

Clients do not need to stop submitting claims to RelayHealth as RelayHealth will just hold the Sagamore claims and process them the next week to Sagamore. Please be aware of the delay for claims submission and claims reporting.

Also please update your records with the new physical location.

Medical Billing Tags: Indiana, Sagamore Health Network, Medical Billing, Medical Billing and Collections, Medical billings, Medical Health Insurance claim filling,

Present on Admission (POA) for Institutional Medical Claims (UB-04)

Starting December 30, 2008 RelayHealth medical claims clearinghouse will print the Present on Admission (POA) indicator for institutional paper claims that are submitted through RelayHealth (electronic file sent to RelayHealth and RelayHealth drops claim to paper).

CMS was the first to require the POA but RelayHealth wants to open this up and make it available for institutional medical claims to submit these to other insurance carriers as needed.

When dropping Institutional Claims to Paper through RelayHealth please use these CPID#'s:
4350 ~ Commercial
4352 ~ Medicaid
4353 ~ Blue Shield
4354 ~ Commercial Carrier Direct
Reporting Options to indicate POA (Present on Admission)
Y = Yes, was present at the time of inpatient admission
N = No, was not present at the time of inpatient admission
U = Unknown, documentation is insufficient to determine if condition is present on admission
W = Clinically undetermined provider is unable to clinically determine whether condition was present on admission or not
Unreported/Not used (exempt from POA reporting)

Medical Billing Tag Words: Medical Billing Health Insurance Claims, Medical Billing Hospital Facilities, Medical billing and Coding, Medical Billing and Collections, Coding, Reporting, Present on Admission, POA, ICD-9 codes, when to use POA, updates to POA

Monday, December 8, 2008