Medical Billing Facts

Medical Billing Fact: Insurance carriers spend in excess of $19 billion annually processing paper claims. Fact: Healthcare providers spend more than $7 billion annually just submitting claims to carriers.Fact: According to the New England Journal of Medicine, the U.S. Healthcare System wastes up to 24 cents out of every dollar on administrative and billing costs, or in excess of $6 billion annually.Fact: 30 to 35% of all paper claims are rejected due to typo's, errors and omissions.Fact: Less than 1% of electronic claims are rejected.  Medical billing fact An electronic claim takes just seconds to prepare. Fact: Most electronic claims are processed for payment by carriers within 24 hours.Fact: Electronic claims cost healthcare providers between $1.50 and $3.00 depending on volume,...

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What is ClearingHouse ?

In Medical billing Clearinghouses are a major part of a billing service's ability to conduct business. Your professionalism and reputation depend on aligning yourself with a reputable clearinghouse.What exactly does a clearinghouse do? Well, for one thing, they check claims for accuracy. But, the biggest thing they do is re-format the data you send to them to a format that a given carrier can read.Clearinghouses charge fees in many ways. Some charge an initial start up fee to the billing service ranging from $125 to $300. Others are free to sign-up with initially. Some charge a provider enrollment fee for every healthcare provider you enroll, while others don't. Most of them charge a per claim fee of some sort, depending upon the carrier.In the last couple of years, clearinghouses have adjusted...

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Useful provider related links

Useful Websiteshttp://www.upinregistry.com/provider_form.aspProvider UPIN search Enginehttp://www.cms.hhs.gov/NationalProvIdentStand/01_overview.aspNPI Application onlinehttp://upin.ecare.com/UPIN numbers are required for insurance billing specifically for referral based practices.This UPIN Number corresponds with the referring provider.http://www.healthlink.com/tech_tip_taxonomy_code.aspNeed to know your Taxonomy code? Look it up here!http://www.upinregistry.com/provider_form.aspRegister your UPIN number and begin the search engine for other provider to access your UPIN number.http://www.insurance.wa.gov/Need to contact the Washington State Insurance Commissioner?http://www.appeallettersonline.com/Online resource to assist your office in overturning denials, motivating insurers to pay more...

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The Glossary of Insurance and Medical Billing Terms

ICD-9A 3 to 5-digit number code describing a diagnosis or medical procedure.Inpatient A patient who is admitted to a hospital and receives medical services from a physician during at least a 24-hour period.In-Network ProviderPhysicians and other service providers who are contracted with a managed care plan.Out-of-Network ProviderPhysicians who are not contracted with a managed care plan.OutpatientA patient who receives health care services, but is not admitted to a hospital during a 24-hour period.Primary Care PhysicianA physician, usually a general, family practitioner or internist, who delivers general health care, and is most often the first doctor a patient sees. This physician treats the patient directly, refers them to a specialist (or secondary care physician) or admits them to the...

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UNITED STATES AND ITS CODES

Alabama ALAlaska AKAmerican Samoa ASArizona AZArkansas ARCalifornia CAColorado COConnecticut CTDelaware DEDistrict of Columbia DCFederated States of Micronesia FMFlorida FLGeorgia GAGuam GUHawaii HIIdaho IDIllinois ILIndiana INIowa IAKansas KSKentucky KYLouisiana LAMaine MEMarshall Islands MHMaryland MDMassachusetts MAMichigan MIMinnesota MNMississippi MSMissouri MOMontana MTNebraska NENevada NVNew Hampshire NHNew Jersey NJNew Mexico NMNew York NYNorth Carolina NCNorth Dakota NDNorthern Mariana Islands MPOhio OHOklahoma OKOregon ORPalau PWPennsylvania PAPuerto Rico PRRhode Island RISouth Carolina SCSouth Dakota SDTennessee TNTexas TXUtah UTVermont VTVirgin Islands VIVirginia VAWashington WAWest Virginia WVWisconsin WIWyoming WYArmed Forces Africa AEArmed Forces Americas AAArmed Forces Canada...

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Glossary - Payments

In Medical billing payment related terms are very important for follow up with insurances.Payments• Deductible• Explanation of Benefits (EOB)• Bundled Payment• Transaction Control Number (TCN)• Rejection & Reviews• Out of Pocket ExpensesDeductible:The amount of expense an insured must first incur before insurance begins payment for covered services.Explanation of Benefits (EOB)After an insurance carrier processed a claim, and the claim is paid, a document known as an Explanation of Benefits is usually issued to the Provider who receives along with a payment check and to the Insured, if the benefits have been assigned. If the claim has not been assigned, payment goes to the patient and the physician may have a difficult time obtaining this paymentIn General EOB is also called asStatement...

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Medicare Plan or Part D

Its a program for Prescription drugs. Its not like Part A or Part B. Patient has to pay their own premum to buy this services. Its run by private companies.All plans will have different costs and benefits from year to year, thus it is advisable for all beneficiaries to consider their options and make the best choice they can.Coverage and DeductibleThe Medicare law establishes a standard Part D drug benefit. Plans must offer a benefit package that is at least as valuable as the standard benefit. The standard benefit is defined in terms of the benefit structure, not the particular drugs that must be covered. In 2009, this standard benefit includes an initial $295 deductible. After meeting thedeductible the beneficiaries pay 25% of the cost of covered Part D prescription drugs, up to an initial...

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