Searching for a Medical Billing Software?

Medical Billing Software searches just take up too much time for most people. Who wants to give out their personal information just to spend 5 minutes trying to figure out if the software is even what you are looking for.

Well, I found a website that does a lot of the research for you. Identify if a software is Web-based or server based, what services they offer and some even list their prices. Save time and money by visiting http://medicalbillingsoftwarepro.com/.

The feature I like the most is if you scroll down to the bottom they ask people to leave comments about that software. So, if you are currently using a software or are looking to see what other clients have said go visit this website now.

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Claim Adjustment Reason Codes and Remittance Advice Remark Codes

Medicare came up with a simpler way to bill secondary claims so that all insurance carriers can handle electronic claims without a paper EOB. In reality it is great to not have to print the primary EOB, Secondary claim and snail mail this to the carrier anymore but learning something new has become quite complex.

My medical billing software came out with a nifty release so that my medical billers can handle attaching claim adjustment reason codes and remittance advice remark codes however; they didn't stress the importance of doing it correctly and well my billers did their best but came up short.

So a few months later and many secondary claim rejections I have identified that it would be best to research for myself why those my billers post are getting rejections while my electronic remittance advice (ERA) are getting paid out on. Currently I get my EOB's electronically for my top 10+ insurance carriers and I can review and approve the payments. My EOB also is archivable so I never have to print it and I have it on file forever in my software. The other benefit is when I use the ERA all of my claim adjustment reason codes and remittance advice remark codes are pre-populated so I don't need to waste time adding them.

What I don't like is that when I still get paper EOB's my billers have to attach these codes and if they don't get it right the first time the claim gets rejected when billing secondary insurance carriers electronically.

Medicare updates these codes 3x's a year and can inactivate a code and deny payment when a inactive code is used. I am not sure if my medical billing software is going to manage this part for me but I am definitely going to request this of them.

After some research I identified that all active codes can be found at http://www.wpc-edi.com/codes and click on the Claim Adjustment Reason Codes and Remittance Advice Remark Codes. Get to know your codes including Group Codes, CARC's and RARC's because if you don't use these correctly you will get denial EOB's.

Group Codes: used to identify who is financially responsible for the amount that the payor is not reimbursing.
CARC's: used to explain why an amount of the claim is being adjusted
RARC's: used to give additional information about the adjustment codes

Group codes:
CO for contractual adjustment
PR for patient responsibility
OA Other Adjustment
CR Correction used with a reversal and correction

CARC Codes:
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. This change to be effective 4/1/2007: At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code.)

17 Payment adjusted because requested information was not provided or was insufficient/incomplete. Additional information is supplied using the remittance advice remarks codes whenever appropriate. This change to be effective 4/1/2007: At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code.)

96 Non-covered charge(s). This change to be effective 4/1/2007: At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code.)

125 Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. This change to be effective 4/1/2007: At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code.)

A1 Claim denied charges

204 This service/equipment/drug is not covered under the patient’s current benefit plan

RARC Code:
N130 Consult plan benefit documents for information about restrictions for this service

I hope this helps you as much as it has helped me and my billers.

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Do patients have to give Social Security Numbers to Medical Providers?

It was a sunny Saturday morning and in comes our last patient of the day. The office was cleared out and I thought this was going to be a quick in and out patient. I handed the patient his "new" patient registration forms and went back to my desk hoping to complete my confirmation phone calls so I could leave the office on time.

A few minutes later the patient came to my desk and gave me the completed patient registration form. I quickly scanned through it and saw that the social security number was missing. Sir, can I get your Social Security Number. He explained politely that he does not give it out. I let the patient know that I appreciated his reasons for not wanting to supply this # but explained that the provider has policies to not treat patients without the social security number.

I went to the doctor and notified him of the situation. The next hour I went back and forth between the doctor and the patient explaining each others side. Finally, the doctor came from his room and explained that he has the right to deny services for the patient not supplying the social security number.

In the end the patient gave the social, the provider treated the patient and everyone was happy but the question that many of my colleagues asked me is" Does the provider have the right to deny services for a patient who does not want to give his social security number?"

The answer is Yes.

Patient's privacy rights can be found at http://www.privacyrights.org/fs/fs10-ssn.htm and it clearly indicates the patient has the right to not give their social security number for a medical office visit however the provider can choose to deny services.

Our only reason for gathering our patients social security number is if the patient defaults on their bill and must be sent to an outside collection agency they can find the patient and collect.

The patient eventually understood we weren't going to resell his information to anyone. And after spending 1 hour working with me and the provider he trusted that we would not only treat his body and his patient medical records with respect.

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Can Providers bill for Missed or No Show Visits?

A client wrote me last week the following scenario:

8:00 am and all is quiet. A quick glance at the schedule let's me know that I am going to have a busy day so I need to enjoy this brief moment before things pick up. I have over 20 patients scheduled and 1 doctor to treat them all.

The middle of the day and things are going well. I look at the schedule and we have treated 10 patients so far. 1/2 done YEAH our next patient is a sweet elderly woman who started getting treated a few months ago. She is usually a few minutes early but today it appears she is really behind putting me behind schedule. I call the patient and identify that she hasn't even left her home but completely forgot about her appointment .

We rescheduled her appointment but now I am in a dilemma. Can I bill her for this visit as a No Show? She is a Medicare patient but can we bill Medicare patients for No Shows? We charge $35.00 for our other patients who do not cancel within 24 hours.

The answer is YES
Medicare has stated that a provider can bill Medicare patients for missed appointments not as a service but as a missed business opportunity. The provider is responsible for billing all of their patients the same and can not discriminate against Medicare beneficiaries.

If the provider accidentally bills Medicare for a missed visit charge Medicare will process the claim and submit a EOB with Reason Code 204: This service or equipment/drug is covered under the patient's current benefit plan.

To read Medicare's complete statement:
http://www.cms.hhs.gov/transmittals/downloads/R1279CP.pdf
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5613.pdf

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

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Claim Adjustment Reason Codes and Remittance Advice Remark Codes

HIPAA of 1996 instructs health plans to be able to conduct standard electronic transactions (submission of claims, claims inquiries, electronic remittance advice, etc.) adopted under HIPAA using valid standard codes.

Read this entire article at to learn more:
Medicare Health Insurance

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