Priority Management Group, Inc.

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Priority Management Group, Inc."

Transcription

1 Priority Management Group, Inc. Presents Priority Management Group, Inc. 700 School Street Pawtucket, RI P: F: Agenda Introduction Clean Claim Components Elements of the Billing Process Feedback to Clinic Operations PMG Benchmarking Client Sampling Summary 1

2 Speakers: Ray Jorgensen, MS, CPC, CHBME Raymond T. Jorgensen is President and CEO of Priority Management Group, Inc. (PMG). Ray is responsible for oversight of consulting operations as well as coding, reimbursement, and payer related issues for the out-sourced billing component of PMG s services (more than 850,000 annual encounters). He has personally trained thousands of providers from over 35 states on coding, billing, and reimbursement in addition to authoring two books and dozens of articles. Ray s health care experience and education is unique in that he was schooled by the payers. Having worked for Blue Cross and Blue Shield as well as United HealthCare Corporation, primarily in professional relations and contracting, Ray has an understanding and perspective on the payer s objectives and process unlike other medical business consultants groomed from the provider side. BA from The College of the Holy Cross (Worcester, MA) MS from Northeastern University (Boston, MA) CPC from the American Academy of Professional Coders (Salt Lake City, UT) CHBME from the Healthcare Billing & Management Association (Laguna Cliffs, CA) Speakers: Caroline Peucker, CPC, CPC-H, CPC-I PMG s Vice President, Consulting and Compliance Caroline has more than 25 years experience in the physician billing and coding industry. Her extensive experience includes serving as the Vice President, Coding and Compliance, Manager of coding and Billing Operations Manager for physician billing companies that serviced a wide range of specialties and practice types. She has broad experience with hospital-based physician and private practice where she was integral to coding and compliance education and training for clinical providers, practice and billing office staff members. She has performed and managed chart audits with objective of both compliance and optimizing reimbursement through correct coding and thorough documentation. Caroline holds a Bachelor of Science degree in Health Service Administration from Providence College. She is an AAPC certified coder and PMCC instructor. 2

3 Speaker: Robert Skeffington, CHBME Robert Skeffington a founding partner and Executive VP of Sales and Marketing for Priority Management Group, Inc. (PMG). Responsible for PMG s overall business development strategy, Robert also works with staff to assess the impact of Health Care Reform on PMG and its hundreds of clients. Robert works diligently to enhance relationships with the National Association of Community Health Centers, state and regional CHC organizations, and individual community health sites.individually. In addition to his role in PMG Billing, Robert also leads marketing and sales efforts for PMG Consulting which provides CHC centric education, operational assistance, and training services around revenue cycle management, coding, and other health care finance related matters. During his more than 17 years in health care Robert has worked with CHCs in the 48 contiguous states with an exclusive focus on revenue cycle management for the past 12 years with PMG. He is a speaker for NACHC and other regional CHC associations on a variety of health care revenue cycle related topics. BS from Salve Regina University (Newport, RI) CHBME from the Healthcare Billing & Management Association (Laguna Cliffs, CA) Disclaimer: 1. The coding guidelines, interpretations, and recommendations set forth as part of this training session are presented as a guide only. Attendees understand and recognize that actual coding decisions are the sole liability and responsibility of the provider(s) and respective billing staff. Priority Management Group, Inc. does not accept any liability or responsibility in this regard. 2. The presentation today includes discussion about a particular commercial product/service and the presenter has significant financial interest/relationship with the organization that provides this product/service. 3

4 Clean Claim Components (What is your percent of clean claims??) Objective: Paid all the money anticipated on first claim submitted CMS Billing Formats: 1500 (Part B/Professional) UB-04 (Part A/Facility and UGS) Critical data Demographic: Name, Address, Phone(s), COB, MVA, etc. Eligibility Verification Payer Specific Data: Member and Provider Number(s), Coding, referrals/authorization DOS, POS, CPT, ICD.9, etc. (No Chart Seen) NO CHART SEEN BY BILLING Billing Process : The Elements Demographics Charge Entry Transmit Claims Patient Statements Post Payments Manage Denials Unpaids pads& Appeals ppeas General Management Close & Reporting 4

5 Billing Process : Demographics Most Critical Function Battle is won or lost at the front desk. Time of Service (TOS) Correct patient address, phone, work, insurance, etc. Name spelled as it is on the card Eligibility verification TOS Payment (unassigned credits) Co-pay: non-negotiable & CAN BE slid on scale No insurance verified pay cash (NO EXCEPTION) Donations: #1 reason people give? Someone asked Oversight By Whom? Typical boss: Clinic Services Director/VP (COO) Except providers: Medical Director Actual accountable party for revenue: CFO Billing Process : Charge Entry At Centralized Billing NOT Front Desk TOS Full Self-pay (not partial): Only charge entry Why?? Not Simply Data Entry National Correct Coding Initiative (NCCI or CCI) Charges (RVU based? No, how will they know order?) Ranked & linked ICD to CPT Modifier utilization Time from DOS to Charge Entry? Batch Cover Sheet Comparison Time to Enter a Charge: 30 to 40 seconds per Not happening? Why not? Automate EMR/EHR: Never easy or seamless Handheld: Medaptus, PatientKeeper, other PDA options 5

6 Billing Process : Transmit Claims Direct versus Clearinghouse What do you do really well EDI? Probably not Clearinghouse house edits before payer denials Percentage of Electronic Claims Paper pays monthly versus electronic weekly Frequency of transmission You Must Know Payment deadlines for top five payers Typical volumes (and verify) Secondary Claims to Paper: Who and How Patient Statements Policy to limit number and duration Time from Charge Entry to Transmission System Verification of All Patients Seen versus Billed Billing Process : Post Payments Define: Electronic Remittance Advice (ERA) EDI of Explanation of Benefits (EOB) versus paper Electronic Fund Transfer (EFT) Direct deposit Automatic Payment Posting (APP) Automatically posts entirety of EOB without manual intervention Timeline from Received Payment to Posting Time to Post a Payment: 30 to 40 seconds per Reconciliation of Check Amount to Posted Dollars Underpayment Management If paid within 10% of charge, charge is too low Scan line of EOB from right to left Sum payer payment and patient responsibility columns Subtract this total from charges for the DOS for this patient If 10% of charge, charge is too low 6

7 Billing Process : Manage Denials Quick Corrections at Time of Payment Posting Examples of Expected Denials to Be Worked ICD missing 4 th or 5 th digit (no record required) Prior Authorization missing (but in system) Place of Service Correction (SNF versus Residential) Should NOT Mitigate Payment Posting Timeliness Corrected Claims Batched for Immediate Resubmission in Next Run Transaction Codes to Track Denial Reasons Eligibilityibili Coding(ICD/CPT) Credentialing Communicate Reasons to Clinic Staff (all reasons to all staff clinical and administrative) Billing Process : Unpaids & Appeals More Complicated Than Denials Regular Work Flow Mondays- 9AMto10AM:UGSMedicare AM: Medicare Tuesdays- 9 AM to 10 AM: Part B Medicare & United Wednesdays- 9 AM to 11 AM: Medicaid Thursdays- 9 AM to 11 AM: Commercial Must Be Scheduled and Worked (ALWAYS) Form Letters with Check Box for Routine Issues Preventive E&M service with Problem E&M Visit Notes for surgical service Wrong DOS/POS/Provider Tracking of All Claims by Transaction Code Communicate Reasons to Clinic Staff (all reasons to all staff clinical and administrative) 7

8 Billing Process : General Mgmt. Management Information System Vendor relations liaison Internal staff training (front desk/data extraction) Support work with vendor System updates (new version, annual coding, etc.) Q&A Patients (balances, updated insurance) Clinic Staff (system, coding, general billing) Coding (education/auditing/resource) Tracking & Storing Encounter Forms (Charge Tickets) Bank Deposits Interact with Accounting/Finance Third Party Payer Relations Credentialing Billing Process : Close & Reporting Closing and Reconciliation Daily, weekly, monthly, and fiscal year end Management Information System Data Extraction Charges, payments, & adjustments Accounts receivables Unpaid claims work Productivity by provider, clinic, department, etc. Non-standard Data Extraction & Analytics UDS: Ethnicity to disease to age range to income FPAR: Birth control method to age to income Ryan White: HIV patients, multiple cross references Unique, last minute, grant requests Upload to General Ledger (GL) Sustain Auditor Scrutiny 8

9 Feedback to Clinic Operations What Actually Gets Paid Core Provider visit versus nurse/ma visit Most Common Denials Eligibility verification Inaccurate demographics What They Can Fix Coded encounter forms (at least one ICD and one CPT) Clearly legible and linked Why Patients Call I was told I did not owe any money. I was told my insurance paid for this. Encounter Rate by Clinic (by Provider) Charges versus Payments (by Clinic and Provider) Units of Services (HCPCS with understandable descriptors) Rejected EDI Analysis Monthly Transmission Rejected Claims Summary - MCC Sample Client January 2007 Total Claims Billed $ Number Rejected % 4657 $699, % Rejection Description # of Claims % Insurance ID# Incorrect 27 9% Demographics Error 14 5% CPT Invalid 0 0% Diagnosis Invalid 13 4% Hospitalization Dates Required Physician Name/Referring e e Physician Error 34 12% 0% Physician Not On File 1 0% Provider Number Invalid 43 15% Subscriber Policy Expired % TOTAL % **EDI: Electronic Data Interchange 9

10 Returned Item Analysis Reason For Return Jul Aug Sep Oct Nov Dec TOTAL % CPT Date(s) MISSING/INVALID INFO CPT not clearly indicated on encounter % Invalid CPT % Missing Tooth/Surface % Modifer indicated but not linked to procedure % Was an E&M service performed? % Missing Pre-natal Dates % Missing Date of Injury % Diagnosis Fee Schedule Insurance Invalid Dx marked on encounter % Diagnosis not marked on encounter % Dx missing 4th or 5th digit % Fee not in system for Procedure % Invalid Insurance ID % Invalid/missing Patient/Subscriber DOB % 2 Provider OTHER Treating Provider not indicated % Billing/Supervising Provider not indicated % Adjustments Sliding Scale Expired % 1 Reconciliation Missing Encounter % Registration/Demographic Error Patient not registered % Name does not match account # % Missing pt/subscriber address % TOTAL % Claim Status Analysis Jul Aug Sep Oct Nov Dec TOTAL # $ # $ # $ # $ # $ # $ # $ STATUS No Claim Found - Rebilled 135 $24, $ $25, Claim on File - In Process 16 $1, $1, $3, Claim on File - Set to pay 82 $9, $2, $12, Suspense 7 $ $ Sent back to office for info 11 $1, $1, Denial: Demographics 2 $ $ $ Eligibility 7 $ $ PCP 7 $ $ Diagnosis/CPT 1 $ $ $ UGS Rev Code Correction 0 $0.00 Duplicates 0 $0.00 EOB Needed 0 $0.00 Adjustments: Global 17 $1, $1, Non-covered 6 $ $ Free Care 1 7 $ $ Capitation 10 $ $8, $8, Small Balances 0 $0.00 Other (see comments) 34 $1, $ $2, Transfer Balance to: Secondary 6 $ $1, $1, Tertiary 1 $1, $1, Patient- 37 $4, $1, $5, Ded/Coins 10 $ $ $1, Mental Health Vendor 0 $0.00 Totals 383 $49, $20, $ $ $ $ $70,

11 PMG s Recommended Benchmarks DAR: < 60 Weeks of AR: < 9 FTE to Encounters Ratio: 1 : 12,000-15,000 Expense as Percent of Payments: < 9% Cost Per Claim: < $8 Electronic Claim Transmission: 90%+ Clearinghouse Utilization: Yes Certified Staff: At least one Net AR: As close to $0 as possible RVU/Medicare Based Charges: Yes Charge Entry or Payment Posting Each is 18-28% of Process Encounters equals visits equals units Full Time Equivalent is FTE Just entering charges and posting payments (no automation), FTE should manage 30,000 visits annually (easily) Production Benchmarking Charges or Payments Daily Units (Units = EF/Visit) Units Per 5 Day Week 1, Monthly Units (4.3 weeks) 5, Annually Units (48 weeks) 61, NOTE: Daily Units- 6 40/hour 11

12 Production Benchmarking Unpaid Claims Management 25-30% of Process Encounters equals visits equals units Full Time Equivalent is FTE FTE should work 20,000 unpaid claims annually (easily) Charges or Payments Daily Units (Units = EF/Visit) Units Per 5 Day Week Monthly Units (4.3 weeks) 1, Annually Units (48 weeks) 23, NOTE: Daily Units- 6 15/hour PMG s Evaluative Tool (1 of 3) Evaluative Category Scoring DAR <50 days, yes = 2, no =0 0 FTE Biller Managing 12K encounters annually; yes = 1, no = 0 0 Billing expense as percent of payments less than 8%; yes = 1, no = 0 0 Cost per claim less than $7; yes = 2, no = % of claims filed electronically; yes = 1, no = 0 0 Clearinghouse; yes = 1, no = 0 0 Staff with CPC or compliance/billing certification; yes = 1, no = 0 0 RVU system for charge schedule calculation; yes = 1, no = 0 0 Total: 0 Rating: 8+ = Exceptional billing process/product 6-8 = Needs improvement, change in process desirable 5 or less = Significant loss to organization, effect immediate change PMG Created Scoring for Mini-Assessment of Billing Process 12

13 PMG s Evaluative Tool (2 of 3) CHC Data Requirements Time Period (Months) Used for Charge & Visit Data: 12 Total Charges: $ 3,200, Total Payments: $ 2,100, Total Expenses: $ 2,600, Total Patient Visits 30, Medicare Encounter Rate: $ Medicaid Encounter Rate: $ Accounts Receivable (A/R): $ 700, Total Number of Full Time Equivalent (FTE) Billing Staff: 8.00 Total Detailed Billing Expense: $ 319, Basic Data Necessary for Mini-Assessment of Billing Process PMG s Evaluative Tool (3 of 3) Annual Billing FTE Expense Analysis: Data Points Total Number of Full Time Equivalent (FTE) Billing Staff: 8.00 Salary for billers $ 210, Salary for billing manager $ 50, CHC share of FICA / Social Security (6.20) & Medicare (1.45) $ 19, Health Benefits $ - Dental Benefits $ - Disability insurance $ - Unemployment taxes $ - Retirement match / costs $ - Workmens compensation $ - Billing software maintenance and support $ 40, Billing department computer, and network support* $ - Billing department printer, cartidriges, maintenance $ - Billing department rent & cleaning costs $ - Local government tax on equipment (tangable prorerty tax) $ - Patient call center cost $ - Temporary staff to augment billing staff for vacations, sick, etc. $ - Billing staff Training, Certification, Subscriptions & seminars (inc. $ - travel): Advertising i for new billing staff $ - Allocation of overhead to billing staff (CFO time, utilities, etc.) $ - Compliance officer (may be % of FTE dedicated to billing staff) $ - Personal Computer, IT Networking, Internet: $ - Telephone Expense (phone lines, handset, etc.) $ - Office Supply Expense (e.g., paper, printing supplies, claim forms) $ - Delineation of actual billing expense for purpose of Mini- Assessment. Postage for claims not sent electronically $ - Postage machine rental and maintenance $ - EDI (clearinghouse, direct payer link(s), etc.) $ - Total: $ 319,

14 PMG Consulting Client Sample A Benchmark Category/Description Benchmark Data Blended Encounter Revenue Rate: $ Blended Encounter Expense Rate: $ Net Profit/Loss Per Encounter: $ 1.70 Days of A/R: Annual Encounters Per FTE Biller: 5, Billing Cost Per Encounter: $ 9.10 Expense as a Percentage of Payments: 13.36% PMG Consulting Client Sample B Benchmark Category/Description Benchmark Data Blended Encounter Revenue Rate: $ Blended Encounter Expense Rate: $ Net Profit/Loss Per Encounter: $ (256.71) Days of A/R: Annual Encounters Per FTE Biller: 8, Billing Cost Per Encounter: $ 5.79 Expense as a Percentage of Payments: 29.56% 14

15 PMG Consulting Client Sample C Benchmark Category/Description Benchmark Data Blended Encounter Revenue Rate: $ Blended Encounter Expense Rate: $ Net Profit/Loss Per Encounter: $ (22.02) Days of A/R: Annual Encounters Per FTE Biller: 7, Billing Cost Per Encounter: $ 8.42 Expense as a Percentage of Payments: 8.07% Summary Stay Informed & Analyze Data Metrics Based Management & Compensation Longitudinal Analysis Staff Feedback & Education Commit to Educate (Top down) 15

Priority Management Group, Inc.

Priority Management Group, Inc. Priority Management Group, Inc. Presents Priority Management Group, Inc. 700 School Street Pawtucket, RI 02860 P: 401-616-2000 F: 401-616-2001 www.chcbilling.com Agenda Introduction Clean Claim Components

More information

Unpaid Claims Management

Unpaid Claims Management Unpaid Claims Management National Association of Community Health Centers (NACHC) 7200 Wisconsin Avenue, Suite 210 Bethesda, MD 20814 301-347-0400 301-347-0459 FAX www.nachc.com AGENDA Introduction Clean

More information

Charge Capture via EMR vs. Manual Charge Entry

Charge Capture via EMR vs. Manual Charge Entry Charge Capture via EMR vs. Manual Charge Entry National Association of Community Health Centers (NACHC) 7200 Wisconsin Avenue, Suite 210 Bethesda, MD 20814 301-347-0400 301-347-0459 FAX www.nachc.com Agenda

More information

2/8/2011. Clean Claims. Agenda. ICD to CPT Linkage Example A. ICD to CPT Linkage Example C. ICD to CPT Linkage Example B

2/8/2011. Clean Claims. Agenda. ICD to CPT Linkage Example A. ICD to CPT Linkage Example C. ICD to CPT Linkage Example B Agenda Charge Capture via EMR vs. Manual Charge Entry National Association of Community Health Centers (NACHC) 7200 Wisconsin Avenue, Suite 210 Bethesda, MD 20814 301-347-0400 301-347-0459 FAX www.nachc.com

More information

EDI, ANSI 837 Files, & Clearinghouse 101

EDI, ANSI 837 Files, & Clearinghouse 101 EDI, ANSI 837 Files, & Clearinghouse 101 National Association of Community Health Centers (NACHC) 7200 Wisconsin Avenue, Suite 210 Bethesda, MD 20814 301-347-0400 301-347-0459 FAX www.nachc.com Agenda

More information

Medicare FQHC Changes 2011 Change Request 7038

Medicare FQHC Changes 2011 Change Request 7038 Medicare FQHC Changes 2011 Change Request 7038 National Association of Community Health Centers (NACHC) 7200 Wisconsin Avenue, Suite 210 Bethesda, MD 20814 301-347-0400 301-347-0459 FAX www.nachc.com Agenda

More information

POST ACA REVENUE CYCLE TRANSFORMATION

POST ACA REVENUE CYCLE TRANSFORMATION POST ACA REVENUE CYCLE TRANSFORMATION Agenda Intro Revenue cycle features ACA impact areas What did we expect? UDS and PMG data analytics Top to-do items Summary WWW.GOPMG.COM ICD 10 Update* Encounters

More information

Understanding Your Role in Maximizing Revenue in a FQHC

Understanding Your Role in Maximizing Revenue in a FQHC Understanding Your Role in Maximizing Revenue in a FQHC Cynthia M Patterson President N Charleston SC 29420-1093 Firstchoice.practicesolutions@gmail.com P: (843) 597-8437 F: (888) 697-8923 Have systems

More information

Compensation and Claims Processing

Compensation and Claims Processing Compensation and Claims Processing Compensation The network rate for eligible outpatient visits is reimbursed to you at the lesser of (1) your customary charge, less any applicable co-payments, coinsurance

More information

Surgical/ASC Claims Revenue Cycle Management: An Introduction to Our Processes and Protocols

Surgical/ASC Claims Revenue Cycle Management: An Introduction to Our Processes and Protocols Surgical/ASC Claims Revenue Cycle Management: An Introduction to Our Processes and Protocols 200 Old Country Road, Suite 470 Mineola, NY 11501 Phone: 516-294-4118 Fax: 516-294-9268 www.businessdynamicslimited.com

More information

Chapter 5 Claims Submission Unit 1: Benefits of Electronic Communication

Chapter 5 Claims Submission Unit 1: Benefits of Electronic Communication Chapter 5 Claims Submission Unit 1: Benefits of Electronic Communication In This Unit Topic See Page Unit 1: Benefits of Electronic Communication Electronic Connections 2 Electronic Claim Submission Benefits

More information

Medical Billing. You need to streamline your Medical Billing today! Copyright Pradot Technologies Private Limited. India. United States of America

Medical Billing. You need to streamline your Medical Billing today! Copyright Pradot Technologies Private Limited. India. United States of America Medical Billing Are you aware that a part of all medical practice income is lost on account of Under Pricing, Inaccurate Coding, Missed Charges or Unreimbursed Claims? Have you ever felt that the charges

More information

The benefits of electronic claims submission improve practice efficiencies

The benefits of electronic claims submission improve practice efficiencies The benefits of electronic claims submission improve practice efficiencies Electronic claims submission vs. manual claims submission An electronic claim is a paperless patient claim form generated by computer

More information

Instructions for submitting Claim Reconsideration Requests

Instructions for submitting Claim Reconsideration Requests Instructions for submitting Claim Reconsideration Requests A Claim Reconsideration Request is typically the quickest way to address any concern you have with how we processed your claim. With a Claim Reconsideration

More information

Give Your Revenue Cycle a Boost Techniques to Improve Collections for Your Physician Practices

Give Your Revenue Cycle a Boost Techniques to Improve Collections for Your Physician Practices Give Your Revenue Cycle a Boost Techniques to Improve for Your Physician Practices Presented by: Alta Partners, LLC Stan Kasmarcak Susannah Selnick Lacy Sharratt June 8, 2015 2015 Ohio Hospital Association

More information

Revenue Cycle Management

Revenue Cycle Management ELIGIBILITY AND VERIFICATION Revenue Cycle Management Are you or your staff tired of waiting on the phone or jumping from website to website to verify patients insurance eligibility? Being able to verify

More information

BILLING COMPANY STANDARDS

BILLING COMPANY STANDARDS BILLING COMPANY STANDARDS ASSESSING PRACTICE VALUE OF OUTSOURCING Cost Saving Efficiencies gained Improved collections Compliance Once a decision to out source is made the following due diligence should

More information

Eligibility Patient s coverage verified prior to visit Coding Medical Records are reviewed and coded by Certified Coders Demographic & Charge Entry

Eligibility Patient s coverage verified prior to visit Coding Medical Records are reviewed and coded by Certified Coders Demographic & Charge Entry Eligibility Patient s coverage is verified prior to visit Coding Medical Records are reviewed and coded by Certified Coders Clearing Clearing Houses Houses For For Electronic Electronic Clearance Clearance

More information

What Every Medical Practice Must Do to Optimize Workflow and Maximize Revenue While Decreasing Costs

What Every Medical Practice Must Do to Optimize Workflow and Maximize Revenue While Decreasing Costs What Every Medical Practice Must Do to Optimize Workflow and Maximize Revenue While Decreasing Costs Don t just trust that your staff is maximizing time and revenue. It is up to you to monitor, analyze

More information

Our clients count on us, and we deliver.

Our clients count on us, and we deliver. Experts in Revenue Cycle Management For Medical Practices and Imaging Centers For over 20 years, we have forged successful partnerships with medical practices and imaging centers to improve their revenue

More information

Avoiding the Claims Denial Black Hole: Strategies to Accelerate and Maximize Claims Payments

Avoiding the Claims Denial Black Hole: Strategies to Accelerate and Maximize Claims Payments Avoiding the Claims Denial Black Hole: Strategies to Accelerate and Maximize Claims Payments January 30, 2013 Carmen Elliott, MS American Physical Therapy Association Senior Director, Payment & Practice

More information

Introduction FQHC Overview Medicare Reporting Part A Encounter Rate Services Part B Services EOB Examples Payment Posting & Calculations Summary

Introduction FQHC Overview Medicare Reporting Part A Encounter Rate Services Part B Services EOB Examples Payment Posting & Calculations Summary Partnering with CHCs to Help Achieve Their Mission Priority Management Group, Inc. 700 School Street Pawtucket, RI 02860 P: 401-616-2000 F: 401-616-2001 Introduction FQHC Overview Medicare Reporting Part

More information

How to Improve Your Revenue Cycle Processes in a Clinic or Physician Practice

How to Improve Your Revenue Cycle Processes in a Clinic or Physician Practice How to Improve Your Revenue Cycle Processes in a Clinic or Physician Practice Janice Crocker, MSA, RHIA, CCS, CHP Introduction Reimbursement for medical practices has been impacted by various trends and

More information

CLAIM FORM REQUIREMENTS

CLAIM FORM REQUIREMENTS CLAIM FORM REQUIREMENTS When billing for services, please pay attention to the following points: Submit claims on a current CMS 1500 or UB04 form. Please include the following information: 1. Patient s

More information

ICD-10 What To Expect

ICD-10 What To Expect ICD-10 What To Expect National Association of Community Health Centers (NACHC) 7200 Wisconsin Avenue, Suite 210 Bethesda, MD 20814 301-347-0400 301-347-0459 FAX www.nachc.com Agenda Introduction Common

More information

REVENUE CYCLE PRINCIPLES SERIES

REVENUE CYCLE PRINCIPLES SERIES REVENUE CYCLE PRINCIPLES SERIES Part 3 The Fundamentals of Producing Clean and Complete Claims Derek Morkel, President & CEO, GAFFEY Healthcare REVENUE CYCLE PRINCIPLES SERIES Part 3: The Fundamentals

More information

Compensation and Claims Processing

Compensation and Claims Processing Compensation and Claims Processing Compensation The network rate for eligible outpatient visits is reimbursed to you at the lesser of (1) your customary charge, less any applicable co-payments, coinsurance

More information

Revenue Cycle Responsibilities. Revenue Cycle. Objectives 4/9/2013

Revenue Cycle Responsibilities. Revenue Cycle. Objectives 4/9/2013 Revenue Cycle Kathryn DeVault, RHIA, CCS, CCS-P AHIMA 2013 Objectives Identify responsibilities within the Revenue Cycle Focus on management of the revenue cycle process Discuss the revenue cycle process

More information

Rejection Prevention. How Actionable Data Can Drive Results in Your Revenue Cycle

Rejection Prevention. How Actionable Data Can Drive Results in Your Revenue Cycle Rejection Prevention How Actionable Data Can Drive Results in Your Revenue Cycle Objectives Build a data collection strategy in denials and rejections that drives action and ultimately improved results

More information

The ROI of IT: Best Billing Practices

The ROI of IT: Best Billing Practices The ROI of IT: Best Billing Practices 1 R O S E M A R I E N E L S O N M G M A H E A L T H C A R E C O N S U L T I N G G R O U P The information and materials provided and referred to herein are not intended

More information

FAQ ICD 10. Categories: Compliance Billing General Claims Testing COMPLIANCE: Q. When is the ICD 10 compliance deadline? A.

FAQ ICD 10. Categories: Compliance Billing General Claims Testing COMPLIANCE: Q. When is the ICD 10 compliance deadline? A. FAQ ICD 10 Categories: Compliance Billing General Claims Testing COMPLIANCE: Q. When is the ICD 10 compliance deadline? A. October 1, 2015 Q. What does ICD 10 compliance mean? A. IDC 10 compliance means

More information

HOW TO PREVENT AND MANAGE MEDICAL CLAIM DENIALS TO INCREASE REVENUE

HOW TO PREVENT AND MANAGE MEDICAL CLAIM DENIALS TO INCREASE REVENUE Billing & Reimbursement Revenue Cycle Management HOW TO PREVENT AND MANAGE MEDICAL CLAIM DENIALS TO INCREASE REVENUE Billing and Reimbursement for Physician Offices, Ambulatory Surgery Centers and Hospitals

More information

Section 9. Claims Claim Submission Molina Healthcare PO Box 22815 Long Beach, CA 90801

Section 9. Claims Claim Submission Molina Healthcare PO Box 22815 Long Beach, CA 90801 Section 9. Claims As a contracted provider, it is important to understand how the claims process works to avoid delays in processing your claims. The following items are covered in this section for your

More information

Duplicate Claims Verify claims receipt with BCBSNM prior to resubmitting to prevent denials.

Duplicate Claims Verify claims receipt with BCBSNM prior to resubmitting to prevent denials. Claims Submission Electronically : Use Payer ID 00790 For information on electronic filing of claims, contact Availity at 1-800-282-4548. Paper claims must be submitted on the Standard CMS-1500 (Physician/Professional

More information

Trusted Partners for. Revenue Cycle Solutions

Trusted Partners for. Revenue Cycle Solutions Trusted Partners for Revenue Cycle Solutions for over 25 years! 44 Stelton Road Suite 315 Piscataway, NJ 08854 1.800.682.5749 732.752.7052 Fax: 732.424.0084 Revenue Cycle Management Outsourcing Ensuring

More information

Seven revenue-driving best practices

Seven revenue-driving best practices NextGen Revenue Cycle Management Seven revenue-driving best practices 1 2 3 4 5 6 7 Self-pay Collections Measuring Performance Claims Scrubbing Track and Prevent Denials Create and Enforce Write-off Policy

More information

The Power of Revenue Management

The Power of Revenue Management The Power of Revenue Management Presented By Judy Capko Capko & Company www.capko.com The Power of Revenue Management 6/13/07 1 About the Speaker The Power of Revenue Management 6/13/07 2 The Speaker:

More information

Management Report Services. Staff Training and Education Services

Management Report Services. Staff Training and Education Services Management Report Services Your management team will receive reports that are clear, well defined and serve as a tool for increased performance. These include a brief description emphasizing how the information

More information

This information is current as of the training dates.

This information is current as of the training dates. Welcome to this training on Billing Basics for Washington State Local Health Jurisdictions. This training will help you understand basic principles and processes needed for billing private insurance. This

More information

Glossary of Terms. Account Number/Client Code. Adjudication ANSI. Assignment of Benefits

Glossary of Terms. Account Number/Client Code. Adjudication ANSI. Assignment of Benefits Account Number/Client Code Adjudication ANSI Assignment of Benefits Billing Provider/Pay-to-Provider Billing Service Business Associate Agreement Clean Claim Clearinghouse CLIA Number (Clinical Laboratory

More information

Shellie Sulzberger, LPN, CPC, ICDCT-CM. Coding & Compliance Initiatives, Inc.

Shellie Sulzberger, LPN, CPC, ICDCT-CM. Coding & Compliance Initiatives, Inc. Shellie Sulzberger, LPN, CPC, ICDCT-CM Coding & Compliance Initiatives, Inc. My connection to coding and documentation My connection to clinical processes My connection to ICD-10 My connection to YOU Coding

More information

Protect and Improve Profitability in Your Practice. Positioning Your Organization for a RAC Audit

Protect and Improve Profitability in Your Practice. Positioning Your Organization for a RAC Audit Protect and Improve Profitability in Your Practice Positioning Your Organization for a RAC Audit 2011 Annual Educational Seminar March 9, 2011 Presented By: Cindy Tipton-Cain, Exec. Director Physician

More information

Glossary of Insurance and Medical Billing Terms

Glossary of Insurance and Medical Billing Terms A Accept Assignment Provider has agreed to accept the insurance company allowed amount as full payment for the covered services. Adjudication The final determination of the issues involving settlement

More information

Claims Procedures. H.2 At a Glance. H.4 Submission Guidelines. H.9 Claims Documentation. H.17 Codes and Modifiers. H.

Claims Procedures. H.2 At a Glance. H.4 Submission Guidelines. H.9 Claims Documentation. H.17 Codes and Modifiers. H. H.2 At a Glance H.4 Submission Guidelines H.9 Claims Documentation H.17 Codes and Modifiers H.22 Reimbursement H.25 Denials and Appeals At a Glance pledges to provide accurate and efficient claims processing.

More information

REIMBURSEMENT CODING SERIES

REIMBURSEMENT CODING SERIES REIMBURSEMENT CODING SERIES Occ. Work Prob. Effective Last Code No. Class Title Area Area Period Date Action 4839 Reimbursement Coding Representative 02 445 6 mo. 11/15/15 Rev. 4840 Reimbursement Coding

More information

Michael Orseno Director Regent Revenue Cycle Management Karen Franklin Client Manager ZirMed October 23, 2015

Michael Orseno Director Regent Revenue Cycle Management Karen Franklin Client Manager ZirMed October 23, 2015 Revenue Cycle Best Practices to Increase Collections, Reduce A/R and Increase Patient Satisfaction Michael Orseno Director Regent Revenue Cycle Management Karen Franklin Client Manager ZirMed October 23,

More information

Revenue Cycle Management. A Primer for School Based Health Care Centers Presented By Jane Speyer, Senior Billing Manager OCHIN

Revenue Cycle Management. A Primer for School Based Health Care Centers Presented By Jane Speyer, Senior Billing Manager OCHIN Revenue Cycle Management A Primer for School Based Health Care Centers Presented By Jane Speyer, Senior Billing Manager OCHIN Discussion Overview The Revenue Cycle demystified: How do appointments turn

More information

INSURANCE BILLING & COLLECTIONS PROCEDURES

INSURANCE BILLING & COLLECTIONS PROCEDURES INSURANCE BILLING & COLLECTIONS PROCEDURES I. PURPOSE: To establish logical, consistent methods of billing and collections follow-up for Insurance balances to ensure that all staff members possess a good

More information

ICD-10 Frequently Asked Questions

ICD-10 Frequently Asked Questions ICD-10 Frequently Asked Questions ICD-10 General Overview... 3 What is ICD-10?... 3 Why are we adopting ICD-10?... 3 What are the benefits of the ICD code expansion?... 3 What does ICD-10 compliance mean?...

More information

Coventry receives claims in two ways:

Coventry receives claims in two ways: Coventry receives claims in two ways: Paper Claims Providers send claims to the specific Coventry PO Box, which are keyed by our vendor and sent via an EDI file for upload into IDX. Electronic Claims -

More information

Molina Healthcare of Washington, Inc. CLAIMS

Molina Healthcare of Washington, Inc. CLAIMS CLAIMS As a contracted provider, it is important to understand how the claims process works to avoid delays in processing your claims. The following items are covered in this section for your reference:

More information

How to Conduct an Old Fashioned Practice Assessment

How to Conduct an Old Fashioned Practice Assessment How to Conduct an Old Fashioned Practice Assessment Why The Need For An Assessment No such thing as the perfect medical practice Need to improve the bottom line Need to improve physician compensation Need

More information

The ABCs of Claim Rejects: Causes, Identification and Resolution

The ABCs of Claim Rejects: Causes, Identification and Resolution June 2008 The ABCs of Claim Rejects: Causes, President and Chief Executive Officer The ABCs of Claim The ABCs of Claim Healthcare rivals only the U.S. military in the use of acronyms to denote various

More information

Reimbursement Solutions for the Mobile Healthcare Industry

Reimbursement Solutions for the Mobile Healthcare Industry Reimbursement Solutions for the Mobile Healthcare Industry The Problem... The environment of healthcare reimbursement continues to be unstable. The cost of providing air and ground medical transportation

More information

Chapter 3: Data Mining Driven Learning Apprentice System for Medical Billing Compliance

Chapter 3: Data Mining Driven Learning Apprentice System for Medical Billing Compliance Chapter 3: Data Mining Driven Learning Apprentice System for Medical Billing Compliance 3.1 Introduction This research has been conducted at back office of a medical billing company situated in a custom

More information

REIMBURSEMENT CODING SERIES

REIMBURSEMENT CODING SERIES REIMBURSEMENT CODING SERIES Occ. Work Prob. Effective Last Code No. Class Title Area Area Period Date Action 4839 Reimbursement Coder 02 445 6 mo. 00/00/00 Rev. 4840 Reimbursement Coding Specialist 02

More information

Effective Revenue Cycles Are No Accident

Effective Revenue Cycles Are No Accident Effective Revenue Cycles Are No Accident ICAHN Boot Camp October 10, 2014 Jerrie K. Weith, FHFMA, CMPE, CMOM Learning Objectives Characteristics of Best Performers Efficient Encounters = Revenue Cycle

More information

INTERMEDIATE ADMINISTRATIVE SIMPLIFICATION CENTERS FOR MEDICARE & MEDICAID SERVICES. Online Guide to: ADMINISTRATIVE SIMPLIFICATION

INTERMEDIATE ADMINISTRATIVE SIMPLIFICATION CENTERS FOR MEDICARE & MEDICAID SERVICES. Online Guide to: ADMINISTRATIVE SIMPLIFICATION 02 INTERMEDIATE¬Ľ Online Guide to: CENTERS FOR MEDICARE & MEDICAID SERVICES Last Updated: February 2014 TABLE OF CONTENTS INTRODUCTION: ABOUT THIS GUIDE... i About Administrative Simplification... 2 Why

More information

Revenue Cycle Management Optimized

Revenue Cycle Management Optimized rreturnsttopbooth2014final.indd 1 6/13/2014 9:32:34 AM Revenue Cycle Management Optimized Powerful technology combined with expert knowledge and resources Innovative Revenue Cycle Management brought to

More information

BUILD A MEDICAL BILLING MACHINE IN LESS THAN A WEEK. isalus Healthcare. Page 1

BUILD A MEDICAL BILLING MACHINE IN LESS THAN A WEEK. isalus Healthcare. Page 1 BUILD A MEDICAL BILLING MACHINE IN LESS THAN A WEEK isalus Healthcare Page 1 TABLE OF CONTENTS Introduction Page 1 Monday Page 2 Tuesday Page 5 Wednesday Page 7 Thursday Page 8 Friday Page 10 Wrap-Up Page

More information

The LSU Health Care Network

The LSU Health Care Network The LSU Health Care Network Mission and Vision Statement The Louisiana State University Healthcare Network (LSUHN) is a multi-specialty physician practice comprised of the distinguished members of the

More information

Molina Healthcare of Ohio, Inc. PO Box 22712 Long Beach, CA 90801

Molina Healthcare of Ohio, Inc. PO Box 22712 Long Beach, CA 90801 Section 9. Claims As a contracted provider, it is important to understand how the claims process works to avoid delays in processing your claims. The following items are covered in this section for your

More information

CLAIMS Section 5. Overview. Clean Claim. Prompt Payment. Timely Claims Submission. Claim Submission Format

CLAIMS Section 5. Overview. Clean Claim. Prompt Payment. Timely Claims Submission. Claim Submission Format Overview The Claims department partners with the Provider Relations, Health Services and Customer Service departments to assist providers with any claims-related questions. The focus of the Claims department

More information

E/M coding workshop. The risk of not getting it right. PAMELA PULLY CPC, CPMA BILLING/CLAIMS SUPERVISOR GENESEE HEALTH SYSTEM

E/M coding workshop. The risk of not getting it right. PAMELA PULLY CPC, CPMA BILLING/CLAIMS SUPERVISOR GENESEE HEALTH SYSTEM E/M coding workshop. The risk of not getting it right. PAMELA PULLY CPC, CPMA BILLING/CLAIMS SUPERVISOR GENESEE HEALTH SYSTEM Disclaimer This information is accurate as of December 1, 2014 and is designed

More information

EDI Solutions Your guide to getting started -- and ensuring smooth transactions empireblue.com/edi

EDI Solutions Your guide to getting started -- and ensuring smooth transactions empireblue.com/edi EDI Solutions Your guide to getting started -- and ensuring smooth transactions empireblue.com/edi 00175NYPEN Rev. 12/11 This brochure is a helpful EDI reference for both new and experienced electronic

More information

Delta Dental of Nebraska. Electronic Claims Submission

Delta Dental of Nebraska. Electronic Claims Submission Delta Dental of Nebraska Electronic Claims Submission Revised 04082009 Table of Contents Introduction... 3 Why Submit Electronically?... 4 Getting Started... 4 Technical Requirements... 5 Submitting Electronic

More information

Basics of the Healthcare Professional s Revenue Cycle

Basics of the Healthcare Professional s Revenue Cycle Basics of the Healthcare Professional s Revenue Cycle Payer View of the Claim and Payment Workflow Brenda Fielder, Cigna May 1, 2012 Objective Explain the claim workflow from the initial interaction through

More information

Insurance 101. Infant and Toddler Coordinators Association. July 28, 2012 Capital City Hyatt. Laura Pizza Plum Plum Healthcare Consulting

Insurance 101. Infant and Toddler Coordinators Association. July 28, 2012 Capital City Hyatt. Laura Pizza Plum Plum Healthcare Consulting Insurance 101 Infant and Toddler Coordinators Association July 28, 2012 Capital City Hyatt Laura Pizza Plum 1 Agenda Basics of Health Insurance Frequently Asked Questions Early Intervention and working

More information

Credentialing, 855 Forms and NPI for Community Health Centers

Credentialing, 855 Forms and NPI for Community Health Centers Credentialing, 855 Forms and NPI for Community Health Centers National Association of Community Health Centers (NACHC) 7200 Wisconsin Avenue, Suite 210 Bethesda, MD 20814 301-347-0400 301-347-0459 FAX

More information

Revenue Cycle Management: The steps Title X agencies must take to get paid

Revenue Cycle Management: The steps Title X agencies must take to get paid Revenue Cycle Management: The steps Title X agencies must take to get paid Webinar 2: Revenue Cycle Management: After the Client Visit August 7 th, 2013 Intended Audience Title X Grantee and sub-recipient

More information

Elements for Successful Immunization Billing Practice

Elements for Successful Immunization Billing Practice Elements for Successful Immunization Billing Practice at New York State s Local Health Departments June 2012 New York State Department of Health Bureau of Immunization and Office of Public Health Practice

More information

Accelerating your Revenue Cycle: From Patient Encounter Through Account

Accelerating your Revenue Cycle: From Patient Encounter Through Account Accelerating your Revenue Cycle: From Patient Encounter Through Account Resolution Anders Health Care Webinar Series July 17th, 2013 Jerrie K. Weith, FHFMA, CMPE Chastity D. Werner, RHIT, CMPE, NCP Learning

More information

EDI Solutions Your guide to getting started -- and ensuring smooth transactions bcbsga.com/edi

EDI Solutions Your guide to getting started -- and ensuring smooth transactions bcbsga.com/edi EDI Solutions Your guide to getting started -- and ensuring smooth transactions 00175GAPENBGA Rev. 12/11 This brochure is a helpful EDI reference for both new and experienced electronic submitters. It

More information

The following online training module will provide a general overview of the Vanderbilt University Medical Center s (VUMC) technical revenue cycle.

The following online training module will provide a general overview of the Vanderbilt University Medical Center s (VUMC) technical revenue cycle. The following online training module will provide a general overview of the Vanderbilt University Medical Center s (VUMC) technical revenue cycle. This Revenue Cycle Overview training will establish a

More information

Provider Revenue Cycle Management (RCM) and Proposed Solutions

Provider Revenue Cycle Management (RCM) and Proposed Solutions Provider Revenue Cycle Management (RCM) and Proposed Solutions By: Ranjana Maitra General Manager, Manufacturing & Healthcare Vertical Executive Summary It takes more than world-class service to be competitive

More information

Understanding the HIPAA standard transactions: The HIPAA Transactions and Code Set rule

Understanding the HIPAA standard transactions: The HIPAA Transactions and Code Set rule Understanding the HIPAA standard transactions: The HIPAA Transactions and Code Set rule Many physician practices recognize the Health Information Portability and Accountability Act (HIPAA) as both a patient

More information

Overview on Claims Submission Requirements, Electronic Billing Options, and Provider Website Features

Overview on Claims Submission Requirements, Electronic Billing Options, and Provider Website Features Overview on Claims Submission Requirements, Electronic Billing Options, and Provider Website Features Magellan Direct Submit Electronic and Contracted Claim Submission Clearinghouses Webinar Session for

More information

Preparing for ICD-10 WellStar Medical Group Toolkit

Preparing for ICD-10 WellStar Medical Group Toolkit Preparing for ICD-10 WellStar Medical Group Toolkit Preparing for ICD-10 On Oct. 1, 2015, WellStar will transition from ICD-9 to ICD-10 coding for all medical diagnoses and hospital procedures Systemwide.

More information

practice management advisor

practice management advisor practice management advisor Spring 2014 Use templates to monitor financial performance 8 steps to implementing ICD-10 in your practice Group medical visits... still a viable option Placing a value on your

More information

Molina Healthcare Post ICD 10 FAQ

Molina Healthcare Post ICD 10 FAQ Molina Healthcare Post ICD 10 FAQ On March 31, 2014, the Senate voted to approve a bill to delay the implementation of ICD-10-CM/ PCS by at least one year. President Obama signed the bill into law on April

More information

RFP 745-15-P03: Medical Cycle Revenue Management Related to the University of Texas Rio Grande Valley (UTRGV)

RFP 745-15-P03: Medical Cycle Revenue Management Related to the University of Texas Rio Grande Valley (UTRGV) RFP 745-15-P03: Medical Cycle Revenue Management Related to the University of Texas Rio Grande Valley (UTRGV) Clarification No. 1: Questions and Answers Q: Please provide volume information so we can put

More information

Your Revenue Cycle It s not just billing anymore. Presented by: Candy Edie, MBA, CRCE-I

Your Revenue Cycle It s not just billing anymore. Presented by: Candy Edie, MBA, CRCE-I Your Revenue Cycle It s not just billing anymore Presented by: Candy Edie, MBA, CRCE-I POSITIONS Staff Accountant Chief Financial Officer Financial Systems Analyst Patient Access Director Patient Financial

More information

Children s Long Term Support (CLTS) Waiver Third Party Administration (TPA) Claims Processing

Children s Long Term Support (CLTS) Waiver Third Party Administration (TPA) Claims Processing Children s Long Term Support (CLTS) Waiver Third Party Administration (TPA) Claims Processing Wisconsin Department of Health Services Division of Long Term Care Bureau of Long-Term Support 1 Third Party

More information

PREPARING FOR ICD-10 IDENTIFYING THE STEPS TO BE TAKEN AND THE TIMELINE MAY 2014

PREPARING FOR ICD-10 IDENTIFYING THE STEPS TO BE TAKEN AND THE TIMELINE MAY 2014 PREPARING FOR ICD-10 IDENTIFYING THE STEPS TO BE TAKEN AND THE TIMELINE MAY 2014 Diane Taylor, BSN, RN Selman-Holman & Associates LLC, Senior Associate Selman-Holman & Associates, LLC Diane Taylor, BSN,

More information

12 16 Memorial Physician Network Billing Cycle Audit Report

12 16 Memorial Physician Network Billing Cycle Audit Report O FFICE O F T HE C ITY A UDITOR C OLORADO S PRINGS, C OLORADO 12 16 Memorial Physician Network Billing Cycle Audit Report September 2012 O FFICE O F T HE C ITY A UDITOR C OLORADO S PRINGS, C OLORADO 12

More information

Third Quarter Updates Q3 2014

Third Quarter Updates Q3 2014 Third Quarter Updates Q3 2014 0714.PR.P.PP. 2014 Agenda Claim Process Reminders and Updates Top Rejections Top Denials IHCP Updates Resources Claim Process Electronic submission MHS accepts TPL information

More information

Welcome. ICD-10 Road to Ten : ICD-10 Implementation Guidance

Welcome. ICD-10 Road to Ten : ICD-10 Implementation Guidance Welcome ICD-10 Road to Ten : ICD-10 Implementation Guidance Jean Stevens, RHIT, CCS-P AHIMA ICD-10 Ambassador and OSMA education consultant Melissa Little, Medicaid Health Systems Administrator, Ohio Medicaid

More information

ebilling Support ebilling Support webinar: ebilling terms Lifecycle of a claim

ebilling Support ebilling Support webinar: ebilling terms Lifecycle of a claim ebilling Support ebilling Support webinar: ebilling terms ebilling enrollment Lifecycle of a claim 2 Terms EDI Electronic Data Interchange Flow of electronic information, specifically claims information

More information

Region V Training Project 3rd Party Billing Practices for Title X Clinics Outline October 13, 2011

Region V Training Project 3rd Party Billing Practices for Title X Clinics Outline October 13, 2011 1 Region V Training Project 3rd Party Billing Practices for Title X Clinics Outline October 13, 2011 The "Affordable Care Act" is coming on-line and has significant implications for the provision of Reproductive

More information

Practice management system criteria checklist

Practice management system criteria checklist Practice management system criteria checklist The American Medical Association (AMA) and Medical Group Management Association (MGMA) have created the following checklist as a starting point for assessing

More information

10/14/2015. Common Issues in Practice Management. Industry Trends. Rebecca Lynn Hanif, CPC,CPCO,CCS, CMUA AHIMA Approved ICD-10-CM/PCS Trainer

10/14/2015. Common Issues in Practice Management. Industry Trends. Rebecca Lynn Hanif, CPC,CPCO,CCS, CMUA AHIMA Approved ICD-10-CM/PCS Trainer Common Issues in Practice Management Rebecca Lynn Hanif, CPC,CPCO,CCS, CMUA AHIMA Approved ICD-10-CM/PCS Trainer cpmresults.com Industry Trends cpmresults.com Patient Responsibility Patients are now responsible

More information

Denial Management Process. Strategies to ensure that claims are received and PAID!!

Denial Management Process. Strategies to ensure that claims are received and PAID!! Denial Management Process Strategies to ensure that claims are received and PAID!! Why is Denial Management critical? The current medical practice s path to survival and success 2 . Climbing Cost of Denials

More information

Q4. Is BCBSAZ going to update the HIPAA Version 5010 Companion Guide??

Q4. Is BCBSAZ going to update the HIPAA Version 5010 Companion Guide?? An Independent Licensee of the Blue Cross and Blue Shield Association ICD-10 FAQs General Questions Q1. What are ICD-10-CM and ICD-10-PCS? A1. ICD-10-CM is the International Classification of Diseases,

More information

Mountain Park Health Center Billing Services. Request for Proposal

Mountain Park Health Center Billing Services. Request for Proposal Mountain Park Health Center Billing Services Request for Proposal Mountain Park Health Center 2702 North 3 rd Street, Suite 4020 Phoenix, AZ 85004 Page 1 of 8 I. Purpose of Request Mountain Park Health

More information

Handbook for Providers of Therapy Services

Handbook for Providers of Therapy Services Handbook for Providers of Therapy Services Chapter J-200 Policy and Procedures For Therapy Services Illinois Department of Healthcare and Family Services CHAPTER J-200 THERAPY SERVICES TABLE OF CONTENTS

More information

Zimmer Payer Coverage Approval Process Guide

Zimmer Payer Coverage Approval Process Guide Zimmer Payer Coverage Approval Process Guide Market Access You ve Got Questions. We ve Got Answers. INSURANCE VERIFICATION PROCESS ELIGIBILITY AND BENEFITS VERIFICATION Understanding and verifying a patient

More information

Transactions Module. 70 Royal Little Drive. Providence, RI 02904. Copyright 2002-2014 Optum. All rights reserved. Updated: 3/1/14

Transactions Module. 70 Royal Little Drive. Providence, RI 02904. Copyright 2002-2014 Optum. All rights reserved. Updated: 3/1/14 70 Royal Little Drive Providence, RI 02904 Copyright 2002-2014 Optum. All rights reserved. Updated: 3/1/14 Table of Contents 1 Transactions Module...1 2 Charge Overview...3 2.1.1 Explosion Codes...3 2.1.2

More information

ICD-10 THE BASICS. Agenda

ICD-10 THE BASICS. Agenda ICD-10 THE BASICS PMG, Inc. 700 School Street Pawtucket, RI 02860 P: 401-616-2000 F: 401-616-2001 E: PMGConsulting@gopmg.com 2015, PMG, Inc. All Rights Reserved Agenda Intro ICD-9 vs. ICD-10 ICD Basics

More information

ICD-10 Post Implementation: News from the Front Lines

ICD-10 Post Implementation: News from the Front Lines ICD-10 Post Implementation: News from the Front Lines Presented by: Paula Kleiman, RHIA, CPC, AHIMA ICD-10-CM Trainer CEO/President, Creatively HIM Consulting Services, Inc. Agenda ICD-10 Post Implementation

More information

Revenue Cycle. Management. The AdvancedMD Training & Companion Guide

Revenue Cycle. Management. The AdvancedMD Training & Companion Guide Revenue Cycle Management The AdvancedMD Training & Companion Guide How to Use the Tools and Reports within AdvancedMD to Support Industry Standard Best Practices in Revenue Cycle Management Table of Contents

More information