Medical Billing Blog: Section - Claims

Archive of all Articles in the Claims Section

This is the archive containing links to all articles written in the Claims section of our blog.

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7 Things Your Governance Agreement Must Include

A governance agreement forms the foundation of how a practice’s board of directors is comprised, how it makes decisions and operates, and how it maintains authority. An effective agreement can get a practice through a partner disagreement, financial crisis, legal issue, or natural disaster. It’s a critical document no matter if your group has two or 200 physicians. Most practice governance agreements fall short on detail. Often they contain just the legal statements about board size and voting that are required to file the organization’s corporate documents. Add strength to yours by making sure it includes these seven essentials…   Continue reading the full article on Physicians Practice  

By: Melissa Clark, CCS-P, RT - CEO
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Many EHR Vendors and Providers Block Information Exchange

Half of electronic health record (EHR) vendors and a quarter of hospitals and health systems routinely engage in information blocking that restricts data flow between providers with different EHRs, according to officials of public health information exchanges (HIEs) surveyed by researchers at the University of Michigan. The top motivation for EHR developers was revenue maximization, whereas the hospital systems were mainly motivated by a desire to maintain or enhance their competitive position, the authors state. The study was published online March 7 in the Milbank Quarterly. In a report issued 2 years ago, the Office of the National Coordinator for Health IT (ONC) said there was anecdotal evidence showing that

By: Melissa Clark, CCS-P, RT - CEO
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HIPAA Certified: Not So Fast

A healthcare organization is looking for a new electronic medical record, secure messaging application or any other solution. It compares a number of vendors, product features and gets close to choosing one. Just before making the ultimate decision, someone asks, what about HIPAA? As this question enters the discussion, another person says that the chosen product is HIPAA “certified.” Hearing that the product is certified, everyone is satisfied and thinks that HIPAA obligations are all set. Unfortunately, HIPAA “certification” does not settle any issue. The question of certification is one that has been around almost as long as HIPAA itself. From the legal perspective, certification is not even worth the

By: Melissa Clark, CCS-P, RT - CEO
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20 stats for EHR adoption rates

Less than a decade ago, nine out of ten doctors in the U.S. updated their patients’ records by hand and stored them in color-coded files. By the end of 2017, approximately 90% of office-based physicians nationwide will be using electronic health records (EHRs). Health records are changing quickly — here’s a snapshot of the current EHR landscape: Support for EHR adoption The annual healthcare spending of the country reached ~$2.9 trillion in 2011. It’s expected to soar to $3.5 trillion by 2015. Medical errors cost $19.5 billion a year, and maybe as much as $1 trillion a year when accounting for lost productivity. Medical errors are the third leading cause of death

By: Melissa Clark, CCS-P, RT - CEO
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Demonstrating the Complexity of Care

SCENARIO: So, you are working at a multi-specialty practice that recently employed a urologist. As the Lead Medical Auditor and a member of the Corporate Compliance Team, you begin to worry about the chart audits as you have no members on your team that have worked within this specialty before. Take a deep breath – and remember that the largest volume of claims that the urologist will bill are E&M services. Regardless of the specialty of any medical practice, each will utilize Evaluation and Management (E&M) services in greater volumes than surgical services. Specialty-specific trained medical auditors are well versed in trudging through records to note the disease processes and

Guest Article By: Shannon DeConda
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Is Your Small Practice Ready for ICD-10?

It’s 193 days to ICD-10 and to be honest, that’s not much time! It’s time to get your practice ready to use ICD-10, but where do you begin? There’s no question it can be overwhelming! Here’s the steps we recommend to any Providers that ask. Let’s get started. Put One Person in Charge First things first, you need to assign the task of overseeing ICD-10 to someone on your staff. It doesn’t matter whether that person is the biller, a coder, the office manager, or someone else. Their goal is to lead the process, ensure things are on task and on target, and to oversee the details.   Develop a

By: Kathryn Etienne, CCS-P, RT - DOO
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EHR Meaningful Use and Stage 2 Guidelines

January has brought upon the EHR (electronic health records) Stage 2 incentive programs start for physician and medical practices. However, there is a great deal of concern that those doctors who can meet Stage 1 requirements will not be able to meet the Stage 2, because their EHRs are not up to standard and neither are the vendors that they deal with. There are 2200 products and almost 1400 EHR certifications for Stage 1, but only 75 products and 21 EHR certifications for stage 2. Around 90 percent of the vendors are expected to not be ready for stage 2. Stage 2 is the second step of meaningful use for

By: Melissa Clark, CCS-P, RT - CEO
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ICD-10 Preparation Steps and Tips for Medical Providers

As a Provider, ICD-10 preparation, and the subsequent upcoming transition can be a bit daunting. The first thing I recommend you do is to assign one individual to be the driving force behind the process and to oversee the details. This could be your coder, office manager, biller or anyone in your staff with the drive to make it as smooth as possible. Next, you should begin to develop your timeline. It’s important for you to have goals in place so that you can achieve your plan. One of the key elements you will need to do in your preparation is to identify the most common codes that your practice

By: Melissa Clark, CCS-P, RT - CEO
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