COMMON PHONETICS

In this section I am going to cover the common phonetics used on the regular bases as most of them do not follow the actual phonetics used mentioned as days go people try to change to easier one. Here is a list below with simple examples and you can use it too.

A As in Alpha
B As in Bravo/ Boy
C As in California
D As in David
E As in Edward
F As in Frank
G As in Girl
H As in Henry
I As in Indiana
J As in Jack
K As in Kite
L As in Linda
M As in Mary
N As in Nancy
O As in Oscar
P As in Peter
Q As in Queen
R As in Robert
S As in Sam
T As in Tango
U As in Uniform
V As in Victor
W As in Whisky
X As in X ray
Y As in Yellow
Z (zee) As in Zebra or Zullu

Most of them are used by all of them instead the actual phonetics. If you want the actual correct phonetics would post in next post.

Thanks for reading, Leave your comments and suggestion.

ACCOUNTS RECEIVABLES - CALLING

ACCOUNTS RECEIVABLES - CALLING

Medical accounts receivable follow-up involves following up with entities such as Insurance carriers, Physicians, Hospitals and patients for information required to resolve the pending accounts at the earliest. Calling is a support media for A/R Analyst to close an outstanding account. Calling is done on accounts which are outstanding for more than 40 days and for which no correspondence has been obtained.

SCOPE:

Calls are made to the following entities by an AR representative:

 Insurance carriers
 Hospitals
 Physicians office
 Patients

PATIENTS

PATIENTS:

Calls are made to the patient to confirm on the insurance policy details, to obtain and confirm on the patient’s other insurance details or to inform the patient about their responsibility that is due from them to the doctor.
UNDER WHOSE NAME DO WE CALL CARRIERS & PATIENT’S?

Calls are made to patients and insurance companies, hospitals, physician’s office under the client’s name. Thus the carriers and patients would have no way of knowing that they are being called from an outside firm, but rather the clients’ in house collections department.
WHO RECEIVES THE PAYMENT COLLECTED BY THE AR REPRESENTATIVE?
The accounts receivables would be managed under the client’s name, therefore the payments would be made directly to the client account as specified.

AR Calling - PHYSICIAN’S OFFICE

PHYSICIAN’S OFFICE:

Calls are made to the physician’s office/PCP office to obtain and confirm on the referrals, to confirm on the patient’s coverage information incase a contact cannot be established with the patient.

Ar Calling - HOSPITALS

HOSPITALS:

Calls are made to the hospitals to check on the pre-authorization, pre-certification, to confirm on medical records and also to check on patient’s coverage information in case a contact cannot be established with the patient.

Ar Calling INSURANCE CARRIERS

INSURANCE CARRIERS:

Calls are made to insurance carriers for the following reasons :
1. Patient eligibility verification:
Calls are made to the insurance carrier to confirm on the eligibility of the insured, the type of insurance the subscriber has with the respective insurance and/or the benefits that are covered by the insurance.
2. Provider enrollment department :
Calls are made to the insurance carrier to confirm on the provider enrollment details. In order to check whether the provider is participating with the insurance and/or to enroll the provider with the insurance carrier.

3. Claim status:
Calls are made to insurance company to enquire about the status of a claim that has already been filed to them, but for which there has been no correspondence from the insurance company for over 40 days.

What are the tools used by an AR Analyst in Claim Analysis Process?

Today I am going to explain you about the various tools used by an AR Analyst for calims analysing.
AR analysts uses the following tools, reports and documents to identify and investigate issues that are affecting cash flow and preventing timely and accurate reimbursement of claims by payers. One or more, and sometimes all, of the following tools, source documents and resources are required for complete and effective AR analysis:

• Patient Account Ledger
• Explanation of Benefits (EOB)
• Regular Mail or Correspondences
• AR calling
• System Reports like
1. AR Reports
2. Custom Reports
3. Financial Reports
4. Electronic Transmission Reports

The extent to which the above mentioned tools and resources are used will depend on the account receivables situation in the accounts. The AR analyst measures the success of collection efforts by computing the current and past AR and collection’s in the specialty and account he/she is handling, comparing it against industry standards, wherever available. The analyst investigates the reasons for any rise in AR or any fall in collections using the tools and documents mentioned above. The objective is to minimize AR and maximize the collection rate.

links

Links Webpage

<% ' # THE FOLLOWING BLOCK IS USED TO RETRIEVE AND DISPLAY LINK INFORMATION. ' # PLACE THIS ENTIRE BLOCK IN THE AREA YOU WANT THE DATA TO BE DISPLAYED. ' # Dimensioning variables - DO NOT MODIFY! Dim UserKey Dim ThisPage Dim OpenInNewWindow Dim PostingString Dim PassedQuery Dim AllowSearch Dim ErrorString Dim ResultString Dim Category ' # // Finished dimensioning variables. ' # .com user key: UserKey = "4748" ' # YOU MAY MODIFY THE VARIABLES BELOW: ' # The following variable defines whether links are opened in a new window ' # (1 = Yes, 0 = No) OpenInNewWindow = 1 ' # The following variable determines whether the search function is enabled ' # for your links page (1 = Yes, 0 = No) AllowSearch = 1 ' # DO NOT MODIFY ANYTHING IN THIS BLOCK!! ' --------------------------------------------------------------------------------- ' # The following variable is sent to the server in order to ' # generate working links on your page: ThisPage = Request.ServerVariables("SCRIPT_NAME") ' # Generate the data to post to the .com server PostingString = "&UserKey=" & UserKey PostingString = PostingString & "&ScriptName=" & ThisPage PostingString = PostingString & "&OpenInNewWindow=" & OpenInNewWindow PostingString = PostingString & "&AllowSearch=" & AllowSearch ' # pass through any querystring data to to allow paging PassedQuery = Request.QueryString Category = Request.QueryString("cn") ' --------------------------------------------------------------------------------- Function GetLinksData(strQuery, strPost, ByRef strResponse, ByRef strError) Dim hObj Dim ComponentString Set hObj = Nothing On Error Resume Next Set hObj = CreateObject("WinHttp.WinHttpRequest.5.1") ComponentString = "" & vbCrLf
On Error Resume Next
If hObj Is Nothing Then
Set hObj = CreateObject("WinHttp.WinHttpRequest.5")
ComponentString = "" & vbCrLf
End If
On Error Resume Next
If hObj Is Nothing Then
If TryMSXML(strQuery, strPost, strResponse, strError) Then
' the MSXML function will return the data
GetLinksData = True
Else
' we don't need to supply error information, since the error string
' is passed ByRef, the MSXML function will supply the data
GetLinksData = False
End If
Else
hObj.Open "GET", "http://linktradeexchange.com/get_pages.php?" & strQuery & strPost, False
hObj.Send

If hObj.Status <> 200 Then
strError = "Error: Status=" & hObj.Status & " Text=" & hObj.ResponseText
GetLinksData = False
Else
strResponse = ComponentString & hObj.responseText
GetLinksData = True
End If
End If
End Function
Function TryMSXML(strQuery, strPost, ByRef strResponse, ByRef strError)
Dim hObj
Set hObj = Nothing
' let's see if the server supports the XMLHTTP component, various versions
On Error Resume Next
Set hObj = CreateObject("Msxml2.ServerXMLHTTP")
ComponentString = "" & vbCrLf
On Error Resume Next
If hObj Is Nothing Then
Set hObj = CreateObject("Msxml2.ServerXMLHTTP.4.0")
ComponentString = "" & vbCrLf
End If
On Error Resume Next
If hObj Is Nothing Then
Set hObj = CreateObject("Microsoft.XMLHTTP")
ComponentString = "" & vbCrLf
End If
On Error Resume Next
If hObj Is Nothing Then
strError = "No support for HTTP requests found."
TryMSXML = False
Else
' # Open connection to .com server, sending the UserKey information via POST
' # Also, pass through the querystring information (contains category, link information)
hObj.open "GET", "http://linktradeexchange.com/get_pages.php?" & strQuery & strPost, false
hObj.Send

If hObj.status <> 200 Then
' # error!
strError = "Error: Status=" & hObj.status & " Text='" & hObj.responseText & "'"
TryMSXML = False
Else
' # We should have received the links information from the server,
' # the following line will return the data by reference:
strResponse = ComponentString & hObj.responseText
TryMSXML = True
End If
Set hObj = Nothing
End If
End Function

If GetLinksData(PassedQuery, PostingString, ResultString, ErrorString) Then
Response.Write ResultString
Else
' here we are just dumping error info to the page. You can clean this up to
' fit your site
Response.Write ErrorString
End If

' # //FINSIHED .COM SCRIPT BLOCK
%>

Medicare Announces Charging for Enrollment

Medicare will start charging fees for some enrollment applications
Wow, I’m not sure why this surprised me so much but when I saw this email I was surprised. Medicare is going to start charging providers who submit enrollment applications? Well it’s not all providers, but still it is going to affect many. But the CMS (Centers for Medicare and Medicaid Services) announced that effective Friday, March 25, 2011 Medicare Administrative Contractors will begin collecting application fees for certain provider/supplier enrollment applications. This is for both paper and online, or PECOS, applications.

How much will this application fee be? That is the first question I had. But the answer is not clear. There is a published document at http://www.GPO.gov/fdsys/pkg/FR-2011-02-02/pdf/2011-1686.pdf but it was a little difficult to wade thru all 110 pages. It appears that they are charging $500 for new enrollments for 2010 but since it wasn’t effective until March of 2011 I was left a little perplexed. Anyway, it looks like the fee for 2011 is $512 for new enrollments and $200 for revalidations and/or adding practice locations.

Also, the fee is not applicable to all providers. The fees do not apply to physicians, non-physician practitioners, physician organizations, and non-physician organizations. It is only applicable for institutional providers of medical or other items or services or suppliers. It is applicable for the CMS-855A, CMS-855B (not including physician and non-physician practitioner organizations), and CMS-855S applications.

Personally, I think this is going to cause some major confusion. As if it wasn’t hard enough for providers to just figure out what forms need to be submitted, now they need to determine if they need to pay. Also, some of the MAC’s (Medicare Administrative Contractors) are already difficult to deal with. (Just for the record, some are very pleasant and helpful.) Now they have another way that they can return apps stating that the fee was not included, even if no fee was needed. As we all know, Medicare being a government agency is full of red tape. If the provider makes a mistake they have to fix it, but if the MAC makes a mistake, the provider still has to fix it.

And I find it very ironic that Medicare is now requiring all providers to accept payments thru EFT (electronic funds transfer) but they are requiring payment for these apps by paper check. They haven’t developed a mechanism yet for receiving payment electronically. Of course they will have exceptions based on hardship but those will be determined on a case by case basis at the discretion of the MAC. I think consistency will be an issue there.

I’m usually a “glass is half full” person and as I read back thru this I feel I’m being quite negative. However, after doing thousands of Medicare applications over the past several years, I have seen many problems in the application process. To me, this addition of a fee is just going to complicate things even more. We’ll be watching to see how it plays out in future days.
courtesy - solutionsmb

The Payor of Last Resort

Remember one thing Medicaid is always the last payor.
If third party liability exists, then Medicaid is always the payor of last resort. This simply means that Medicaid always pays last where other insurance is present.


Whenever you receive a Medicaid denial advising you to bill the primary insurance, it is because Medicaid has on file that the recipient has other insurance. Recipients are required to keep Medicaid informed of any health insurance information. Providers are also responsible for notifying Medicaid of third party insurance they find out about as well as informing Medicaid of any third party payments they receive on behalf of the recipient.

State Medicaid agencies are required to reject claims wherever third party liability exists if they receive a claim without documentation of the primary insurance payment.

In instances that third party exists, if the Medicaid allowed amount is greater than the third party payment, Medicaid will pay the difference up to Medicaid's allowed amount. However, in instances that the third party payment is more than what Medicaid allows, Medicaid makes a "zero payment". This means that the provider must accept the primary insurance payment as payment in full and cannot balance bill the patient.

It is important to keep in mind that Medicaid is not an insurer. Medicaid is a program that makes medical payments on behalf of the recipient. If the provider or recipient fail to comply with any health insurance requirements that results in a denied payment, Medicaid can deny also due to noncompliance.

Third party liability is not just limited to Medicare and health insurance. It also refers to liability insurance due to motor vehicle accidents and work-related injuries or illness. For specific information on billing Medicaid claims, refer to your state Medicaid agency.

Reduce Your Medical Expenses with a Health Savings Account

Health Savings Accounts or HSAs are a new healthcare financing option introduced in 2004 that allows consumers to set up tax-deferred investment accounts tied to their health insurance policy and to use these tax-deferred funds to pay for incurred medical expenses. In essence, after setting up and funding an HSA in accordance with Federal and state regulations, you will be able to pay for many health-related expenses using pre-tax money. For most people, this is equivalent to receiving a 15% to 40% discount on qualified medical expenses! Consumers will realize even further savings by purchasing health insurance with a high deductible level -- a condition necessary to qualify for an HSA. In most cases, the benefits available under the HSA will offset the risk of that higher deductible level.

Let's look at how an HSA is normally established to better understand how this financial instrument works. An individual or family needs health insurance coverage, but must manage their overall expenses for healthcare. They choose a policy with a high deductible level (required for an HSA) in order to reduce their monthly premium. But, they are careful to select a plan that offers an attached HSA with the policy. Each tax year, this individual or family contributes funds into their HSA as follows (2006 rates): singles - $2700; families - $5450; and persons over 55 - an additional $700 per person. The actual contribution amount is claimed as a deduction against gross income on their tax return, reducing the amount of taxable income by an equal amount, even if they do not itemize deductions. The money in the HSA receives tax treatment similar to an IRA, and the investment growth of the money is not taxable while it remains within the account. At any time, money in the HSA can be withdrawn as needed to pay medical expenses without ever paying taxes or penalties. Finally, upon a person reaching the age of 65, HSA money can be withdrawn or spent for any purpose without penalty or taxes.

Another exciting advantage of an HSA is the wide array of medical expenses considered valid for the use of HSA pre-tax funds. Here is just a sampling of the types of services that can be paid for with HSA (pre-tax) money:

Dental - All expenses for regular exams, X-rays, cleanings, crowns, orthodontics, periodontics, dental supplies (toothpaste, floss) and prepaid dental plans.

Vision - All expenses for eye examinations, glasses, contact lenses, prescription sunglasses, and vision supplies (eyeglass cleaner, eye drops and contact lens solution).

Doctors - All expenses for office visits, labs, X-rays, medical supplies for asthma or diabetes, maternity, hospitalization, urgent care or emergency care.

Mental Healthcare - All expenses for psychiatrists, psychologists, therapists and counseling.

Alternative medicine - All expenses associated with naturopathic, chiropractic, acupuncture, homeopathy, ayurvedic medicine, and herbal medicine, all of which are not normally covered by health insurance.

For people seeking a way to assure good healthcare coverage for themselves or their families at a reasonable price, the HSA is a valuable tool in their arsenal. With the benefits offered through an HSA, they can choose an insurance policy with a high deductible, thereby dramatically reducing their monthly premium. When they take a portion of their monthly premium savings and fund their HSA, they will soon have access to discounted, pre-tax funds to pay for a wide variety of out-of-pocket medical expenses. And, if medical expenses remain low, the HSA savings will remain in the account for future years and for investment growth over time, much like a traditional IRA.

What to Do When Your Health Insurance Won't Cover Your Medical Care

It is becoming increasingly expensive to get a health insurance coverage nowadays. However, health insurance is a long term investment that would save you money in the long run.

If you have looked at the various health insurance plans, you would have noticed that there is no health insurance plan that will cover every kind of medical treatment you will need during your lifetime.

Regardless of how good your health insurance is, you may someday need to be treated for a health condition that is not covered by your health insurance policy. Elective treatments like cosmetic surgery and liposuction are typically not covered by health insurance plans but there are other health conditions and medical procedures that may not be covered.

If you ever need to undergo a treatment or procedure that your insurance policy does not cover but the treatment or procedure is not specifically mentioned in the "excluded treatments" section, inquire with your insurance company. Request a written explanation that states their reasons for not covering the treatment or procedure that you need to have. Show this letter to your doctor. Most of the time, a treatment or procedure simply needs to be re-stated and then presented to the insurance company, have it approved and get your treatment or procedure covered.

However, you could land in a situation where the treatment or procedure cannot be re-phrased, or the treatment has already been given to you and now the company denies you the coverage. The fact is, you do not have much options left. You might need to spend your own money for the treatment or procedure.

If your health insurance company denies your claim for coverage, you can make an appeal. Insurance companies have procedures for appealing a claim so you would need to follow the procedure of your insurance company. Insurance companies would generally reject an appeal based on technicality rather than use their resources to investigate the claim. Thus, if you decide to go with this route, make sure you follow all the steps. Check with your policy handbook as the proces to appeal would be in there. It is also good if you seek advice from your doctor before filing an appeal.

If, after going through all the process and following the steps for appealing a claim, you still lose, don't give up. The other options you can follow and which can save you from bearing the entire expense are:

1. Negotiate with your doctor for lower payment or if he can approve a payment plan.

2. Is your doctor a member of a medical discount program? Check with your doctor because many doctors do join such networks and groups.

3. If you have not started treatment or undergone a procedure yet, do a little research and find another doctor who can give you the same but at a lower cost.

4. Check if you are eligible for free treatment at a public hospital or clinic based on your income level, veteran status or some other socio-economic reason.

Be persistent and you will surely find a treatment or procedure, the price of which is affordable for you

California Medical Insurance Companies

California is one of the largest health insurance markets in the United States as many companies offer medical insurance plans in the state. In order to offer insurance in the state, a company must have a license from the state of California. This is a highly regulated process in order to ensure that insurance carriers have substantial assets and the necessary infrastructure to offer health insurance. General insurance companies like Aetna, New York Life, Prudential charge higher premiums. These general carriers do not have any specialized delivery mechanisms and usually third parties administer their plans. Specialized insurance giants like Blue Cross and Blue Shield are able to keep costs down with local delivery infrastructure and therefore offer lower premiums to the consumers. Health Maintenance Organizations (HMO) such as Kaiser and HealthNet maintain premiums even lower than the specialists and therefore, have developed a giant share of the market. HMO organizations manage to have such low premiums as they intervene in the health care delivery process as well. In some cases, for instance where carriers run their own delivery centers in California, as Kaiser does, it becomes quite possible to offer such inexpensive rates.


Medical insurance has multiple components and can be underwritten by specialized providers. Dental and vision insurance plans are some examples of this specialized underwriting. The terms of these plans vary widely as do their underwriting guidelines. Therefore, consumers have to be careful about the kind of plan they choose. There are also specialized carriers offering packages that specifically cover disability.

For those who cannot afford health coverage but are eligible for medical aid, the State of California provides a state government driven program. The state of California runs its own facilities to deliver medical benefits to medical recipients.

Electronic Medical Billing Software and Service - Top 4 Transparency Attributes

Medical billing industry has volumes of arcane terminology and payer- and time-dependent claim validity and pricing interpretation rules, facilitating massive payments of invalid or ineligible claims and denials of error-free claims. Process transparency provides its participants greater visibility of internal process activities. An increased level of access promotes teamwork, increases client satisfaction, and assists in process streamlining.


Billing process is the interaction between the participants (i.e., insurance company (payer), healthcare service provider (provider or doctor), patient, and billing service provider (biller)) designed to pay or deny a payment request (claim) submitted by the biller to the payer and to the patient on behalf of the provider. The amount and complexity of billing information make it very difficult for the doctor to maintain compliance and identify and resolve errors and underpayments.

Billing service transparency allows participants of the billing process to expedite error identification and resolution, resulting in reduced over- and under-payments and improved regulatory compliance.

Attributes of Billing Transparency

Billing transparency has four key attributes, including universality, continuity, ubiquity, and scalability.

• Universality: every participant in the billing process, including patient, provider, payer, and biller, has access to every aspect of the billing process.

• Continuity: process detail is available continuously on a 24 x 7 basis.

• Ubiquity: access to billing process is provided over secure standard Internet browser that requires no special hardware or software and is available everywhere.

• Scalability: both the big picture and minute detail are available for scrutiny universally and continuously. The big picture consists of total cash flow in a given time period, current submitted and failed claims, and billing quality metric. It must contain comprehensive summary of patient visits and unpaid balances. The minute detail pertains to individual claims making up the big picture, including complete history from the moment of creating the claim, testing its validity and eligibility, making corrections, performing submissions, reconciling payer messages and explanations of benefits (EOB) with original claims, until payment. Both perspectives must allow arbitrary aggregation of claims and drill in for detail to enable effective followup.



How to Build Transparency Into Your Billing Service?

A transparent billing service leverages technology to enable competent personnel to execute disciplined billing process. Therefore, to implement a transparent billing process, you must

[ ] Get access to adequate technology to support universality, continuity, ubiquity, and scalability.

[ ] Develop and thoroughly document claim processing procedures, including compliance and integration with practice workflow.

[ ] Train personnel in following the procedures and using the technology

[ ] Review personally and continuously billing quality, technology capabilities, adequacy of procedures, discipline, and training.

Note that Vericle-like technologies based on Straight Through Billing (STB) methodology implement billing transparency by design because billing transparency is an integral attribute of every component of STB process.

Q & A on Credentialing a Medical Provider - Why is this Necessary?

Q. What is credentialing?

A. It is a process by which insurance carriers and hospitals verify the credentials of the medical provider. This includes verification of licenses, verification of malpractice insurance, verification of college degrees and background checks to disclose any felonies or criminal activity.

Q. Why is credentialing important? Who is it important to?

A. It is important to the provider to maintain his credibility with the insurance carriers and to hopefully receive a contract to participate in an insurance companies various programs. This is critical to a medical provider due to the fact that most of us want to see a doctor in our network as it creates a savings for us with our medical expenses. Most out of network benefits require us, the patient, to meet a deductible before any payments to the provider of services are made.

Q. How does credentialing help the medical provider?

A. Once a medical provider is credentialed and accepted into an insurance plan, their information is then posted in the provider directory. If a patient is looking for a medical provider in their network, they usually search by zip code. If a medical provider is not listed in that directory, the medical provider has missed the opportunity to get a new patient. Therefore, credentialing in a sense is a marketing tool as well.

Q. How does a medical provider go about the process of credentialing?

A. Credentialing is an extremely time consuming process and requires an individuals' undivided attention. Current documents must be attached to a standard application which should be type written for legibility. Documents include licenses, diplomas, resumes, and declaration pages of the current malpractice. A cover letter should accompany the application and documents, introducing the provider to the carrier or hospital. Most providers use an outside service for this process.

Q. How long does it take to be credentialed?

A. Most carriers take from 90-180 days to complete their credentialing process. Once the provider is credentialed, the applications goes before a committee for final acceptance into an insurance plan.

Q. How will the provider know if they are accepted into a plan?

A. Most carriers inform the provider via letter along with a welcome packet of some type. Another method is to track your application which requires someone to contact the carrier every couple of weeks to check the status of the application.

All in all, credentialing is a very important part of the medical providers' business.

Submitting Medical Insurance Claims - Which Form Do I Use?

When it comes to submitting medical insurance claims to the insurance companies, it is important to file the claims on the appropriate forms. The most common medical insurance form is the HCFA 1500.

The HCFA 1500 form is a 8 ½"by 11" white paper printed with red ink. It contains many fields that must be completed. In an effort to standardize the medical industry, HIPAA (Health Insurance Portability and Accountability Act of 1996) mandated that all medical service providers use the HCFA 1500 form when submitting insurance claims.

It is crucial that the fields on the HCFA form are filled out accurately and completely. If any information is missing or incorrect it can cause the entire claim to be denied. In some cases they will return the incomplete or inaccurate claim with an explanation as to why it is not being paid. Other times, you just don't hear anything. Did they end up with your socks that never returned from the dryer?

There are some instances that a HCFA wouldn't be used. If the claim is for an on the job injury, or a workers' compensation claim, then a workers' compensation form would be used. These forms vary from state to state, but can usually be found on the state's workers' compensation website.

In many states forms can be downloaded and printed or purchased in quantity by private suppliers. Some medical billing software comes with the capability of printing the workers' compensation forms. The workers' compensation forms are white with black print and have fields similar to the HCFA 1500 form. As with the HCFA 1500, it is important that these fields are filled out accurately and completely.

Facilities such as hospitals, outpatient clinics, and ambulatory surgery centers use a UB92 form. It is the facility version of the HCFA 1500. UB92 forms are also white with red ink, but the fields are different.

When claims are submitted electronically, no forms are needed as the claims are not ever printed to paper. The claims are actually put into the correct format and sent on to the insurance companies in a file. The claims can either be sent via the internet, or thru the phone lines.

HCFA and UB92 forms can be purchased from a variety of suppliers and they vary greatly in price. The higher the quantity purchased, the lower the price per form. Shop around to find the best buy.

How To Appeal When Your Medical Insurance Doesn't Pay

Here is an intresting article which I wanted to share with all the readers which I found really intresting.
Have you ever received a bill from your doctor and stopped breathing? Have you wondered why you are receiving a bill when you have medical insurance? Have you asked the question, why am I paying this astronomical monthly payment?


MEDICAL BILL:

When you receive a medical bill from any provider; example, doctor, hospital, lab or x-ray is it paid correctly? Has any payment from your medical insurance been paid to your bill?

When a payment has not been paid or very little and you call and speak to a representative from you medical insurance company and the doctor's office, what is the next step?

If you're medical provider is going to appeal your bill or claim, great. Just make sure they follow through in a timely manner. Some appeals are time sensitive.

If you're medical provider says it is your responsibility to appeal your claim keep reading.

APPEALING YOUR MEDICAL BILL:

1. Write a letter and explain why you feel your claim was not paid correctly or was not paid.

2. Make sure you have your name, address, city, state, zip code and telephone number on your letter.

3. The name of the person insured on your insurance plan. (Guarantor)

4. The name of the person that was seen by a provider.

5. The date of service the medical care was obtained.

6. The place of service the medical care was obtained.

7. Attach a copy of your explanation of benefits (EOB) you received from your insurance company.

8. Attach any correspondence you received from your insurance company prior to receiving the final explanation of benefits.

9. Attach a copy of your medical insurance card.

10. Attach a copy of all your medical records pertaining to this date of service. Include x-rays, lab slips, anything that will present your case completely with one viewing.

SECRET:

Insurance Companies need your date of service and place of service. This is how they track all your medical care by each individual provider.

Example:

You were seen by your doctor that morning in her office. That afternoon you were admitted to a hospital. Now you have two different providers on the same day.

Try to make your presentation as professional as possible. The person that will be reviewing all your information will expect to see your entire case presentation in one sitting.

If the appeal board needs more information from you, they will probably send you a letter or phone you.

EXCEPT:

You will not win an appeal if your deductible or co pay was not met. Another denial is a non-covered service. With this denial your medical provider can help you make a decision before you go through the entire appeal process.

Sometimes this is not entirely true and an appeal would be perfect.

So I say go for it. Appeal your claim. Pour your emotions and passions out in your letter to the appeal board.

If you do not have a computer to type your letter hand write it. Just make your letter legible. Sometimes a hand written letter is more effective.

Supplemental Medical Insurance - What is Supplemental Health Insurance?

Group health insurance rates have been increasing year after year and employers have been forced to make some drastic changes in their employee benefit programs. Many employers have changed their health insurance to high deductible plans. Dental Insurance has been discontinued by some companies as well as vision care. Disability programs have been trimmed down as well as group life insurance. This has created gaps in coverage and employees have had to look for alternatives for coverage that has been omitted or decreased in their benefit package. The answer to this problem has come in the form of supplemental health insurance. Supplemental health insurance companies will enroll employees with these products and the premiums are paid through payroll deduction.

Supplemental health Insurance Products

1. Disability Insurance - Supplemental disability insurance is sold to employees to fill in gaps or replace lost benefits. Long term and short term disability insurance can be purchased with a variety of waiting periods and benefit periods.

2. Life Insurance - Supplemental life insurance includes a variety of permanent plans as well as term life insurance. There are non-medical life policies available for larger groups when a certain amount of employees participate in the plan.

3. Dental Insurance - This is one of the more popular supplemental health products because it usually the first discontinued by the employer.

4. Cancer Insurance - The cancer policy is a single need policy with relatively low premiums.

5. Accident Insurance - The accident policy covers accidental injury and death. There are accident disability riders on some accident policies.

6. Hospital Income - The hospital income policy pays a daily dollar rate to the insured while hospitalized. These policies can pay as low as $10 per day and as high as $200 for each day hospitalized.

The need for supplemental insurance is stronger than ever before. These policies can also be purchased on an individual basis with most companies.

Child Medical Insurance

We love our children. From the moment we realize they are making their way into this world, we begin making plans for them. We want the best of everything for them, from homes and communities to schools and activities. We strive to raise them in safe, healthy, nurturing environments in hopes that they will grow into and remain safe, healthy, nurturing adults throughout their lives.

Child medical insurance must be included in our plans for our children. Children are constantly growing and exploring. They are active little people who spend a lot of time running, tumbling, playing sports, and creating potentially dangerous little games of their own. Plus, classrooms full of children are perfect breeding grounds during the cold and flu season. If your daughter's best friend has a cold, you can safely bet that your daughter will have the sniffles within a few days, too. Inevitably our children will get sick, hurt, need medicine or x-rays once in a while or even more often!

The health and safety of our children is our most important goal. Unfortunately, sometimes we find ourselves in situations when our jobs don't offer medical insurance. It is easier to tell ourselves "not right now" when it comes to treating a medical problem, but it is not that easy to tell our children "not right now" when they are running a dangerously high fever and ask us to help them feel better.

If you do not have medical insurance covered by your place of employment, or you are covered by medical insurance you purchase yourself, you need to stop and think about the medical insurance of your child. If you are not covered, or can not afford medical insurance for yourself or your child, there are agencies out there that will help you. You can find affordable, and sometimes even free, child medical insurance that will cover dental, vision, and health costs for your child.

Group Medical Insurance - It is Different but Here are Some Tips to Figure It Out

Group Medical Insurance is a type of health insurance that is purchased by employers as a benefit to their employees. The group policy is a master policy that covers all of the employees and describes the benefits and features of the health insurance plan. This can be a very expensive portion of employers overhead. Health benefits help maintain employee stability and morale. The employer shopping for group insurance today must be wary of the market place. It has changed. There are a lot more insurance scams. It is better to stay with reputable companies.

The small business community has to be more creative with their group health package. There is a growing demand for small businesses to employ the services of a professional benefit counselor to develop alternatives when purchasing or revising their health plans.

The insurance companies are well aware of the problem and have been hard at work developing new versions of Group health insurance plans. The insurance companies are using every avenue available to keep their business clients. Group policies have many more deductible options than in years past. There is a strong move toward encouraging the employees to enroll in Health Savings Accounts. These accounts help the employee to off-set the higher deductible expense. There is also a trend with Group Health carriers to partner with supplemental health insurance companies. The supplemental health insurance companies can help fill the gaps that the group health plan no longer provides.

Things to consider

1. Tax advantages of HSA - The health savings account is becoming a favorite option for employers and employees.

2. Higher Deductibles - this is more than a trend now. The higher the deductible-the lower the premium.

3. Supplemental Insurance - using supplemental insurance companies to fill in the gaps at a lower cost to the employer and employee.

Health and Medical Insurance - Comparing Managed Care Health Plans

Health insurance plans have been forced to take action to contain costs of quality health care delivery as health care costs have skyrocketed. Health insurance premiums, deductibles and co-pays have steadily increased, and health insurance companies have implemented certain strategies for reducing health care costs. "Managed care" describes a group of strategies aimed at reducing the costs of health care for health insurance companies.

There are two basic types of managed care plans; health maintenance organizations, or HMOs, and preferred provider organizations, or PPOs. So which health plan is best? How do you choose what type of health insurance best suits the health care needs of you and your family?

Both HMOs and PPOs contain costs by contracting with health providers for reduced rate on health care services for its' members, often as much as 60%. One important difference between HMOs and PPOs is that PPOs often will cover the costs of care when the provider is out of their network, but usually at a reduced rate. On the other hand, most HMOs offer no coverage for health care services for out-of-network providers.

Both HMO and PPOs also control health care costs by use of a gateway, or primary care provider (PCP). Health insurance plan members are assigned (or select) a primary care practitioner (physician, physician assistant, or nurse practitioner). Usually a family practitioner or internal medicine doctor for adult members or a pediatrician or family care practitioner for children. The primary care provider is responsible for coordinating health delivery for plan members. Cares by specialist physicians require referral from the primary care provider. This cost containment strategy is intended to avoid duplication of services (for example, the cardiologist ordering tests that have already been done by the PCP, or a sprained ankle being referred to an orthopedic) and avoid unnecessary specialist referrals, tests and/or procedures.

HMO and PPO plans also contain costs by requiring prior approval, prior authorization, or pre-certification for many elective hospital admissions, surgeries, costly tests and imaging procedures, durable medical equipment and prescription drugs. When such services are required, the provider must submit a request to the health insurance plan review department, along with medical records that justify the service. The request is reviewed by the health insurance company to determine whether the services are justified as "medically necessary" according to the health plan policy and guidelines. Review is usually performed by licensed nurses, and, if the reviewer agrees that the service is necessary, approval is given and the service will be covered by the health insurance plan.

As health care costs continue to rise, many indemnity health insurance plans, or "fee for service" plans are being forced to adopt some managed care strategies in order to provide quality health care and keep health insurance premiums affordable. And as long as health care costs continue to rise, the distinctions among PPO, HMO, FFS and other health insurance plans will become blurred. Rest assured, however, that managed health care is here to stay.

Medical Insurance Rate - Why Does It Change and How is It Decided?

Are you shopping for health insurance? Are you looking for the best rates? Are you totally confused? There are so many people scrambling for health insurance and are trying their best to compare the rates. This is not easy at first because the health insurance companies have had to come up with creative alternatives in their insurance portfolios. Those creative alternatives can give the average person an insurance headache.

The rising costs of hospital and physician services are always passed on to the consumer. The consumer depends on their insurance company to pay for their medical expenses in exchange for a premium. The medical rates are based on several criteria.

Here are a few:

1. Gender - Male/Female rates differ.

2. Tobacco - Non-Tobacco - Tobacco users are higher

3. Household Status - Single, Parent-child, Parent-children, Husband-Wife, Husband-wife-child, Husband-wife-children

4. Deductible - $500 to $5000 (with some companies)

There are some things that you can do to affect the rate. The most cost savings method is to choose a high deductible plan. The higher the deductible calculates into a lower the rate. Low deductibles no longer justify the premiums paid. This trend toward high deductibles is called self-insuring. You are taking on the financial responsibility for the deductible amount.

The best way to offset and prepare for the out of pocket deductible is to start a health savings account. This is a tax deductible savings plan for medical expenses. It's the equivalent of a medical IRA. The tax deduction offsets some of the out of pocket expense you incur with the higher deductible. Contact your tax advisor or accountant about starting a health savings account.

Private Medical Insurance - What's it all About?

The origin of private medical insurance goes back a long way - before the NHS was formed. In pre-NHS days, people contributed to "friendly societies", which provided financial assistance to people in times of need. Some private medical insurance providers, such as BUPA, remain non-profit-distributing bodies, though there are also many commercial insurance companies providing private medical insurance these days. One of the best-known names in private medical insurance cover is AXA PPP healthcare - which was actually conceived in 1938 to provide a health insurance scheme for middle income earners in London.


The principal aim of private medical insurance is designed to cover treatment of "acute illness" - defined by Which? As "conditions which can be cured or substantially alleviated by treatment." Treatment of chronic illnesses, such as multiple sclerosis or arthritis, may not be covered by private medical; so critical illness insurance might be more suitable. Critical insurance cover will be based on your individual requirements - so shop around for the right policy and always be completely open with your insurance provider, or you may invalidate a claim at a later date.

Other treatments generally excluded from private medical insurance include cosmetic surgery, treatment for alcohol or drug abuse and infertility treatment. The majority of standard policies exclude private consultations of a GP, routine check-ups and dental work - unless it is undertaken in a hospital. However, always check your private medical insurance policy - as some will be more comprehensive than others.

Private medical insurance can be an effective way of ensuring swift access to medical care for your family. Just remember that insurance policies reflect your exact circumstances - so don't assume that one size fits all.

Appealing Medical Bills

Did you ever receive a medical bill and wonder what it means? Is this Greek? Do you receive bills even though you have medical insurance? If you want to know how to fight back, read on!

Welcome to a better understanding of the first step in the processing of your medical bill. The charges are entered into the computer. This information is then submitted to your insurance company by mail or electronically.

This claim form has been sent by your provider, Example: Hospital, doctor's office, x-ray or laboratory.

The insurance companies love to send the doctor's office or facility complicated Explanation of Benefits. You, as their client, receive the same copy.

WHAT CAN GO WRONG WHEN YOUR CLAIM FORM IS SUBMITTED FOR PAYMENT!

(1) Everything

(2) Your claim form may never get to the correct insurance company.

There are many addresses attached to each insurance company.

The chances of yours submitted to the correct address is rare.

(3) Your personal information may have been entered into the computer incorrectly.

That is why when you call the insurance company and you hear say, "we never received the claim form from your medical facility", it is probably true.

FIGHT BACK:

If you have not received an Explanation of Benefits from your Insurance Company within 2 months of your date of service - CALL THEM!

INFORMATION NEEDED:

(1) Your name and the patient's name.

(2) Your Identification Number

(3) The date of service (DOS)

(4) The name of the facility or doctor where you were seen.

With this information your insurance company can give you the history of your bill.

With this information in hand you can then call your doctor's office and have them intercede in your behalf.

Your claim can always be appealed by the doctor's office and by yourself.

Your claim can always be re-billed if necessary.

YOUR RESPONSIBILITY:

(1) co pays

(2) non covered services

(3) deductibles

All these are listed on your Explanation of Benefits. This is the way your insurance company pays your claim without any money changing hands.

Keep all your Explanation of Benefits. Do not be afraid to call your insurance company.

If you feel you do not get an adequate explanation ask to speak with the supervisor.

The insurance companies rely on untrained people in medical facilities to prepare and submit your claim form. The insurance companies hope the Explanation of benefits will be accepted at face value and never challenged.

PATIENT CONFIDENTIALLY:

Be aware of all the changes pertaining to the laws of patient confidentially.

(1) You can't call a medical facility and expect answers if you are calling about anyone other than yourself, spouse, or minor child.

(2) If you need information about your parents or friend, you need a letter signed by that person filed in the provider's office.

Congratulate yourself, you have mastered some words in Medical Insurance Billing.

A little bit of knowledge goes a long way.
Hope you would leave your comments and suggestion. Thanks for reading.

Medical Insurance Claim Form - What You Need To Know

So you wonder, why on earth a complete article on the medical insurance claim form? Well to be honest, I wasn't sure myself until I began doing research for this article. Another applicable term might be health insurance claim form and from that point of view it equates with a return to health following an accident or illness and taking care of incurred expenses.

Don't be fooled by the medical insurance claim form. There's a lot of significance tied to filling one of these little babies out. And frankly while I have been fortunate, up 'til now, I have had more dealings with these forms than I care to think about due to the accident and geriatric issues so prevalent among my friends and family these last few years.

Getting Down To The Nitty Gritty

Getting down to the real reason why we humans fill out yet another of the many forms required of us in order to get the things that we need involves looking at a medical insurance claim form in all its glory. Now if you don't have a head for remembering numbers make sure and have all the necessary ones at hand because the form is rife with questions needing numerical answers.

If the person filling out the medical insurance claim form has Medicare, Medicaid, Group Health insurance or some other form of group health insurance they will need to supply that number sometimes even before being asked their name. There are questions relating to relationships. Married or not, relationship to the insured, provided the person filling out the form is not the insured himself or herself.

There are the usual questions about sex, birth, employment, employer, history of illness, federal tax numbers, account number, dates unable to work, date of admission to the hospital and date of release, how much was charged for services rendered and so on and so on.

These are all necessary components to filling a health insurance claim form. And it must be filed in order to make a claim so that insurance will pay for medical expenses as opposed to you doing so out of pocket.

The Importance of Medical Insurance

A medical policy is an essential product to be considered in managing risk in lives. Anyone can be a victim of critical illness/dread disease and it can happen at the most unexpected time and the person can be in deep trouble, not knowing what to do and whether something can be done about it and if so, how much it will cost.

More and more people are seeking treatment and care from private hospitals and the rising medical expenses is of utmost concern to these patients and their families. It is a known fact that hospitalization and surgical costs have risen tremendously throughout the years. Medicare costs do not only involve medication but also a host of other related services/equipment such as surgery, diagnostic tests, physiotherapy, purchase or rental of medical equipment, ambulance services etc.

These can exhaust a person's savings or retirement fund in no time at all, depending on how costly it is for that particular need. It is well beyond many people to obtain a large sum of money for surgery, hospitalization and medical attention, of which they might resort to "charity”, that could be the most uncomfortable and undignified way. Therefore, it is of utmost concern for every one to realize the importance of medical insurance not only to assume their risk and to protect them against financial burden and even poverty, but to also preserve and maintain their current lifestyle.

A look at the family medical history may be good as some diseases may be inherited. Early action taken to apply for coverage will be recommended as the premiums will be lower and before his health deteriorates so as to render the applicant uninsurable.

If you are under employment, it is always advisable to check with your company whether your group insurance policy covers for critical illnesses, medical as well as hospital and surgical, and how comprehensive their coverage are, especially in cases where one has no other insurance policies.

Medical Insurance is one of the numerous insurance policies that cater for different type of risks and insurable interests. Should any unfortunate event occur, the financial benefits derived from the policy would definitely be more than adequately compensate the premiums paid. It is best to transfer the risk to an insurance company who has the capability to assume the risk. One can still retain a portion or whole of the risk if the probability of certain risk happening is remote. One has to assess the situation and not fall in the trap of "Penny wise, Pound foolish". By neglecting or saving on purchasing a medical insurance policy, one is left exposed to high probability of risks occurring resulting in a financial loss that can be substantial.

The Importance of Medical Insurance

The purpose of medical malpractice insurance is to cover doctors and other healthcare professionals for any liability claims arising from their treatment of patients.


If a doctor or healthcare provider is found guilty of medical malpractice, the damages awarded often reach into the millions, and can be even larger if punitive damages are awarded. Malpractice insurance shields him or her from financial liability in the case of a malpractice verdict.

However, just as your auto insurance rates go up with each ticket you receive, being found guilty of medical malpractice can drive a doctor's insurance rates up for many years. In addition, recent years have seen a steep rise in the cost of medical malpractice coverage. This has, in many cases, caused great hardship for those in the medical community, and some are pushing for limits on certain types of damages in order to defray costs.

Despite these concerns, many attorneys for malpractice victims disagree with such limits. Specifically, they blame high premiums on poor investment choices while large plaintiff rewards simply reflect an unacceptable level of patient care and medical practice.

This crisis has been particularly prevalent in Pennsylvania. Physicians and hospitals are citing a lack of availability and affordability for malpractice insurance, so much so that it is driving many practitioners right out of business.

High-risk specialty areas have been hit the hardest, as they face the greatest chance for malpractice claims, and therefore carry the highest rates. In general, malpractice payouts have been on the rise in recent years and the fallout for healthcare professionals has been severe.

Despite the difficulty some practitioners may be experiencing in regards to paying their malpractice insurance premiums, it's a problem that is not likely to go away. Since it is really the only shield doctors have from the financial ruin that might result from a huge damage award, healthcare professionals must cover these rates to stay in business.

Do Discount Fees for Medical Service Programs Really Work?

Having a health insurance policy provides a great sense of security for many families. Most people with health insurance usually have it through their employer and the employee and the employer may share the responsibility on paying the premium. Even though health insurance coverage provides a great benefit, it also provides a great fear that looms over our heads. The fear of not being able to afford health insurance or not having health insurance can provide great difficulty to many people.


We can also see a trend that more people do not have job-based health insurance. I'm sure if you have been in the work force for the last 5-10 years you can see that rates are rising every year (I have experienced a 20% increase in my rate last year alone) and with those high rates we have to pay more of a deductible. You have to wonder how long the middle class family can sustain health coverage. Plus I know supplemental Health Insurance (specifically Dental and Vision Care) is out of the question for me to provide to my family. It really is a shame isn't it?

So our system is faced with many challenges, perhaps our healthcare system needs a total overhaul. So what are we to do? Well, I'm not sure if there is anything we can do to change the entire system immediately. However, if you are like me we can do something that will help limit the costs of supplemental Health Care. For those who cannot afford the additional $100.00 per month for Dental Care on top of your $650.00 plus payment for medical insurance, I would suggest into researching a supplemental health care program.

Basically, most of these programs contact providers to provide discounts to program member card holders. Some have many questions about the validity of these programs. I had doubts myself. However it is really how I look at healthcare in general that raised my doubts. Most of us have a "Health Insurance" mindset and we expect all of our providers to be available and only pay $30 for the care we need. The approach is different with medical discount cards.

The best way to look at such a program is to evaluate where you stand with your current health care coverage: If you do not have insurance for Dental Care or Vision Care, then you have to work at making the best as to what you have. Medical Discount Card programs provide a good alternative and they do save you money. However, I learned it takes persistence and a little work. The benefit you get with persistence and little bit of work is you have control over your costs and the care you receive.

Another immediate concern I had was my provider was not listed with the plan I had. However, I researched the Dentist's available with my plan and found someone suitable for the care I needed. So the extra time spent on finding a dentist gave me two benefits: (1) Control over my care and (2) Savings on the services itself.

So even though health costs and coverage for those costs are sky rocketing. The middle class American family can still save money with a little research and persistence. As we have access to less and less services, there are alternatives that can take advantage of to help our families.

Step-by-Step for Completing CMS 1500

CMS 1500, also called a HCFA 1500, is an insurance form submitted by the provider to the insurance company for payment of services rendered to a patient. Most of the larger medical offices file insurance claims electronically and receive payment through electronic funds transfer, whereas in a small medical office, insurance claims are filed on paper by submitting the CMS 1500 for payment of services. This form contains basic personal and insurance information about the patient, along with the appropriate diagnosis and treatments for the physician encounter being billed. The administrative medical assistant is usually the one responsible for filling out the CMS 1500 in order to solicit payment for services from the insurance company.

The first 2 things which you would need.

• Insurance card
• CMS 1500 form     

1. Insert the name and address of the insurance company in the upper right-hand corner of the form. The insurance company address is referenced on the form to let the medical billing agent know where to submit the insurance claim.  
2. Fill in boxes one through 13 of the upper section with personal and insurance information from the patient registration sheet. Box 1 is where you would check the type of insurance and 1a is for the insurance group identification number. Boxes 2 through 8 are self-explanatory. Box 9 is for the primary insurance information of the patient. Check all boxes applicable in Box 10 as related to the current injury or condition. Box 11 is for secondary insurance information. Boxes 12 and 13 are for the patient, guardian and/or insured's signature.
3. Fill out the bottom section of the CMS 1500 form with pertinent information regarding the physician encounter for which you are billing the insurance company. Box 14 is where you would enter the date for the physician encounter. Enter a date into this space if the patient has had the same or similar illness. Box 16 is where you would enter the dates the patient was unable to work due to the injury or illness. Fill in the dates in boxes 15 and 16, if applicable.  
4. Enter the name of the physician who saw the patient on the date being billed in Box 17 and their National Provider Identification (NPI) number in 17b. Enter dates of hospitalization, if necessary, in Box 18. Box 19 is left blank.
5. Check Box 20 if the patient has received outside lab tests or blood work. Box 21 is for the diagnosis. The diagnosis code can be found on the patient encounter form and is needed by the insurance company to show the medical necessity for the procedures or treatments being billed. The physician will fill in the diagnosis code at the end of the visit, after he or she has evaluated the patient. Diagnosis codes are found in the International Classification of Diseases, 9th Edition (ICD-9), now that ICD-10 is out you can refer that also, by looking up the condition in the alphabetical section. Once the code has been found in the alphabetical section, it has to be double-checked in the numerical tabular section to verify the proper diagnosis code has been referenced. There are spaces on the CMS 1500 form for up to four diagnoses.  
6. Enter a Medicaid Resubmission Code or reference number in Box 22. Box 23 is where you would enter a prior authorization number if prior authorization was required for the procedure being billed.
7. Enter specific encounter information in Box 24. The date is entered in 24A. The place of service code is entered. A place of service code is found in the front of the Current Procedural Terminology, 4th edition (CPT-4). Box 24C is used for an emergency code. Box 24D is for the procedure code and modifiers from the CPT or HCPCS coding books. The medical office assistant will fill in these codes according to the services which were provided by the physician during the visit. In Box 24E, enter a diagnosis pointer. The diagnosis pointer refers to the diagnosis from Box 21 to which the procedure was related. Box 24F is for the charge of the procedure performed. Fill in Boxes 24G, H, I and J with unit, EPSDT Plan, medicinal codes and the rendering or national provider identification number, whichever is required for that specific insurance company. Procedures must be written one per line in Section 24. If the form is not properly filled out, the insurance company can deny the claim, leaving it unpaid.  
8. Enter the physician's federal tax ID number in Box 25, the patient's account number in 26 and check the box that says "accept assignment" in Box 27. Box 28 is for the total charges. Fill in the amount paid, if any, in Box 29 and the balance due in Box 30. Box 31 is for the physician's signature. In Box 32, fill in the facility name and address where the services were performed. Finally, in Box 33, fill in the name, address and contact information for the billing provider, along with their NPI or Medicare provider number.