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Michele Redmond - EzineArticles.com Expert Author
Michele Redmond and her mother/partner own and operate a medical billing business in Upstate New York. They offer an unformational website for medical billing services, doctors offices, and people with insurance billing problems. Michele has authored several articles, books, and e-books on the subject of medical billing. She lives with her husband and three daughters in Rome, N Y.
[View Michele Redmond's Extended Author Bio]
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Michele Redmond Email Alerts
- Coding to the Highest Level of Specificity
[Insurance:Medical-Billing] Insurance carriers often deny claims for not being coded to the highest level of specificity. As many billers are not coders they often don't understand what has gone wrong or how to fix it. Learn how to remedy this problem here.
- GW Modifier For Care Unrelated to Hospice Terminal Care
[Insurance:Medical-Billing] Many billers think that if a patient is a Hospice patient that they cannot get reimbursed for services if they are not reimbursed by the Hospice carrier. But actually there is a modifier, GW, that indicates that the care is unrelated to the patient's terminal condition. In order for a patient to receive Hospice services they must have a life expectancy of six months or less if the terminal illness or disease runs its normal course.
- DME Suppliers Must Be Accredited by 9-30-2009
[Insurance:Medical-Billing] Medicare is mandating that all DME suppliers become accredited in order to continue to become reimbursed by Medicare DME carriers for supplies given to Medicare recipients. Accreditation is the process in which an independent organization evaluates a healthcare provider and certifies that the healthcare provider meets certain quality standards.
- Submitting Out of Network Medical Insurance Claims
[Insurance:Medical-Billing] If you are trying to submit medical insurance claims for a provider who is out of network with the insurance carrier you will most likely run into some problems. For example, if you need to call on the claim you may find that the insurance carrier will not even speak to you since you are out of network. This makes following up on the claim difficult.
- Billing Workers Comp at the Correct Fee Schedule
[Insurance:Medical-Billing] Workers comp insurance claims must be billed out at the workers comp fee schedule. Even though most doctors bill medical insurance claims out at much higher price than they will be paid, workers comp does not allow this practice. Keep from getting into trouble by following these practices.
- 3 Key Things to Do When a Doctor Changes Practices
[Insurance:Medical-Billing] Many problems that we see practices or providers run into is when a doctor decides to change practices. They don't realize what needs to be done to make sure payment for their services is made to the new practice. There are 3 key things that need to be done when doctors switch practices. Make sure you take care of these three important jobs before you change locations.
- Are Drug and Alcohol Rehab Out of Network Payments a Problem?
[Insurance:Health] Getting payment for rehab for drug and alcohol treatment when out of network can be a real problem. The family may have had to pay thousands of dollars up front for the services and then tried to collect payment from the insurance company. Here's how to get the insurance to pay.
- PT and Chiropractic Are Not Covered Concurrently
[Insurance:Medical-Billing] Most insurances, including workers comp & no-fault do not allow patients to be treated for the same condition with both chiropractic and physical therapy during the same time period. Sometimes the patient will not mention to the provider that they are already receiving treatment. Then the provider sees the patient, submits the claim, but gets denied since the patient is already receiving care.
- Deductibles in Depth - Understanding Medical Deductibles
[Insurance:Medical-Billing] Many people do not understand medical insurance deductibles, how they work, when and to whom they are paid. Here's the inside scoop on how and when deductibles are applied.
- Avoid Medicare Denials by Notifying Medicare of Any Changes in Your Information
[Insurance:Medical-Billing] Medicare requires that providers notify them when they make any changes to their office location, tax ID#, legal history, managing employees, or personal information. The notification is suppose to be within 30 days of the change. Many providers don't realize this until their Medicare payments suddenly stop for no apparent reason. Prevent this problem by following these few rules.
- Avoid Delays in Your Medicare Application by Completing Forms Correctly
[Insurance:Medical-Billing] When applying to become a Medicare Provider it is crucial that you complete the proper forms and that you complete them correctly. If you do not complete the proper forms correctly it can cause delays in your application and can even cause your application to be closed. If your application is closed you need to start completely over by resubmitting your application all over again. Don't let your application get delayed.
- The Truth About Copays
[Insurance:Medical-Billing] Many people get very confused by all the different ways that insurance companies process claims and how they calculate what the patient owes. It is crucial that the providers have someone in their office or a good billing service that knows how to read the eobs and is billing the patients correctly. Here is everything you need to know about copays.
- Medicare Applications - Which Form is Used to Become a Medicare Provider
[Insurance:Medical-Billing] Medicare requires that you complete specific forms put out by CMS when applying to become a Medicare provider. Sounds easy enough but have you seen the list of forms that they have? How are you suppose to know the correct form to complete and once you figure that out, what fields on the form do you need to fill out?
- PT-OT Caps Exception Process Extended to 12-31-2009
[Insurance:Medical-Billing] The Medicare Improvements for Patients and Providers Act of 2008 which was passes July 15, 2008 not only stopped the 10.6% pay cut for medical service providers, but also extended the exceptions process of physical therapists and occupational therapists caps.
- What Should Your Billing Service Be Doing For You
[Insurance:Medical-Billing] Many providers today are choosing to outsource their billing. The billing process has become much more involved over the past few years and for many it makes sense to outsource. Between the software updates, required electronic filing of claims, NPI numbers, and other changes, it has become nearly impossible for providers to keep up.
- NPI Numbers and Legacy Numbers - New Rules As of May 23, 2008 For Billing Medical Insurance Claims
[Insurance:Medical-Billing] New rules for NPI numbers and legacy numbers are now in effect with Medicare when billing medical insurance claims. As of May 23, 2008 Medicare is no longer accepting claims which don't meet the current rules. Make sure you are entering your information correctly to avoid delays in your payments
- Prevent Down Coding By Insurance Companies On Medical Claims
[Insurance:Medical-Billing] Downcoding of medical insurance claims is a common practice with insurance companies to reduce their payment to you. Sometimes there is nothing you can do about it, but sometimes it is worth fighting. Know when and how to fight this practice.
- Basics of Medical Billing
[Insurance:Medical-Billing] Whether you are planning on starting a medical billing business, already own a medical billing business, work for a billing service or in a medical office, it is crucial that you completely understand the entire billing process. From the time a patient schedules an appointment to the time that full payment is received, everyone who interacts with either the patient or the billing process can affect the payment.
- Take Your Medical Billing Business to the Next Level
[Insurance:Medical-Billing] If you want to take on more medical billing business, you need to prepare. Look into the challenges you will meet and set out a plan.
- Marketing Your Medical Billing Business
[Business:Entrepreneurialism] Increase the income of your medical billing business by using our proven techniques for signing up new clients. Have you wished you could sign up more clients? Do you want to work full time at medical billing and quit your 9 - 5 job? Maybe you want to hire an employee and need a little more business to bring in enough income. Do you know how to market your business?
- How To Start a Medical Billing Business
[Home-Based-Business] Do you want to work from home? Do you have some experience with medical billing? Here's the book that can show you exactly what it takes to start your own medical billing business. There is currently a huge need for medical billing. And it is growing every day.
- CMS 1500 Form - Completing it Correctly
[Insurance:Medical-Billing] CMS 1500 forms are the universal claim forms used by medical providers to submit claims for their services to the insurance carriers. Make sure your CMS 1500s are completed correctly to insure proper payment for your medical services.
- DME Claims Denied For NPI Issue
[Insurance:Health] We've been seeing many DME claims being denied by Medicare for strange NPI issues that made no sense. You won't believe what the solution to the problem is. We had to dig deep to find the answer we needed. If you submit DME or durable medical equipment insurance claims, you must read this.
- Charging Patients For Deductibles, Copays, and Coinsurance Amounts
[Business:Management] Are you sure you are staying within the limits of the law when you bill or don't bill your medical patients a copay, a deductible, or coinsurance? Many offices lose money by not collecting all of the money that is due them from patient responsibilities. What about hardship patients? Make sure you are staying legal.
- Facility Insurance Billing - Billing Insurance on UB04 Forms Correctly
[Insurance:Health] Facility billing is insurance billing for hospitals, inpatient or outpatient clinics, and other offices such as ambulatory surgery centers. This insurance billing is not the same as billing for a regular doctor or specialist. Facility billing is required to be submitted on UB04 forms instead of the more common CMS 1500 forms. The information required on UB04 forms is different than the information required on the CMS 1500. Make sure you are submitting your UB04 forms correctly.
- Billing Medical Claims Electronically - Are You Reading Your Electronic Reports?
[Insurance:Medical-Billing] We have finally reached the stage where most offices are billing at least some of their medical claims electronically. But the more important question is, are they reading their electronic reports?
- Electronic Medical Billing - Should You Use A Clearing House Or Bill Directly To Insurance Companies
[Insurance:Medical-Billing] Most people think that the only choice is whether to bill on paper, or submit your claims electronically. Actually, if you decide to file your claims electronically, that just opens the door to many other decisions that must be made.
- Third Pary Companies Trying to Reduce Your Reimbursement
[Insurance:Health] Have you been contacted by a third party company telling you that all you need to do is sign a faxed paper and they will release payment to you immediately for services that you provided to a patient? Make sure you read the fine print! They are taking a chunk of your money for this supposedly great deal of getting paid quicker. You will want to read this article before signing anything!
- Starting Your Own Medical Practice - What Needs To Be Done
[Business:Management] Whether you are just out of college or you've decided to start up a private practice after working for someone else, there is much to be done. The one thing that they don't teach in medical school is how to run a business and let's face it, a medical office is a business. It isn't as simple as finding a door to hang your sign on and waiting for patients to come in. There is a lot of paperwork that needs to be done prior to opening your doors.
- Bundling Medical Insurance Codes - Stop Loosing Money To "Bundled" Medical Insurance Claims
[Insurance:Medical-Billing] Stop loosing money to bundled insurance cpt codes by proper billing of medical insurance claims. Make sure your claims are submitted correctly on the initial submission with the use of proper modifiers. When codes are bundled, go through the appeal process.
- NPI Deadline Extension? How Does the CMS 1500 and NPI Deadline Extension Affect Your Office
[Insurance:Health] There is a lot of buzz out there about the CMS, Center for Medicare and Medicaid Services, extending the deadline for NPI's from May 23, 2007 to May 23, 2008 but what does that mean to the average medical provider’s office? Does that mean that you don’t need to apply for your NPI number for another year?
- Mandated Electronic Claims Filing – Some Insurance Carriers Mandate Electronic Claims Filing
[Insurance:Health] They've been talking about it forever but it looks like it might finally have arrived. Insurance companies are starting to mandate electronic submissions of insurance claims. We've gotten our first notice that medical insurance claims must be filed electronically in 2007.
- NPI Number Individual or Group - Which One Do I Use?
[Insurance] There is so much talk about getting your NPI number. You must have it by May 23rd or your cash flow can be severely affected. Don't wait till the last minute to get it because you will need to report it to all of the different insurance carriers. But if you had to apply for two NPI numbers, an individual one and a group one, which one do you use to submit claims?
- Taxonomy Code For NPI Number-What Is A Taxonomy Code And Why Is It Important?
[Insurance:Health] Need to pick a taxonomy code for NPI Number? Picking the correct taxonomy code is extremely important because it can directly affect your reimbursement by insurance companies.
- UB92 Forms Obsolete – Changing to UB-04 Forms in 2007
[Insurance:Health] UB92s are no longer going to be accepted for facilities billing medical insurance claims by the insurance companies. The UB92 is being replaced by a new form that will allow for reporting the newly required NPI or National Provider Identifier Number.
- HCFA 1500 Form Becomes Obsolete in 2007 - Welcome CMS 1500
[Insurance:Health] There seems to be a lot of changes in the world of medical billing and here comes another one! The classic red and white HCFA 1500 form is soon to be outdated. It won’t be anything drastic- just a few small changes. The HCFA 1500 will be obsolete and the new replacement is called the CMS 1500.
- Electronic Billing Clearing House - How to Choose the Right One For Your Needs
[Health-and-Fitness:Medicine] How do you find the electronic billing clearing house that is right for you? Here are some guidelines for choosing a clearing house to submit your medical claims.
- Unpaid Medical Claims - Should you just Resubmit them to get them Paid?
[Health-and-Fitness:Medicine] When you realize that a claim hasn’t been paid should you just resubmit it and hope it gets paid the second time? Even though in many cases an unpaid claim can mean that the insurance company never received the claim, it is not a good idea to simply resubmit a claim just because you show that it hasn’t been paid.
- NPI Number - Who Is Required to Have Them by May 23, 2007
[Health-and-Fitness:Medicine] Don't wait until May 23, 2007 to figure out if you need an NPI number. All covered healthcare providers will need an NPI number.
- Billing Code Books: ICD Books, CPT Books, HCPCS - What Are They?
[Reference-and-Education] Are you confused by all the different medical billing code books out there? Here is a description of the different billing code books and what they each are.
- Ub92 Medical Claim Forms - When And How To Use Them
[Health-and-Fitness:Medicine] Everything you need to know abouts UB92 forms; what they are, when to use them, how to fill them out.
- Hcfa 1500 Forms - When To Use Them, Where To Buy Them, How Much Should They Cost?
[Health-and-Fitness:Medicine] What is a HCFA 1500 form and when do you need to use them? What do they cost and where can you buy them? Find out all you need to know about HCFA 1500 forms.
- C4 Forms - What Are They And When Do You Use Them?
[Health-and-Fitness:Medicine] What is a C4 Form and when do you need to use them? A C4 form is a medical claim form that is used for billing services that are related to an on the job injury.
- NPI Number - Do I Need One and Where Do I Get It?
[Health-and-Fitness:Medicine] There is a lot of talk out there in the medical community about NPI numbers. But what is an NPI number? Do I really need one, and where do I go to get one?
- Doctor Stop Losing Money - 6 Ways To Stop The Bleeding
[Health-and-Fitness:Medicine] Are you one of those doctors who thinks that if you want more money you need to see more patients? The reality is that you just need to get paid for ALL of the patients that you are already seeing.
- Bill From Your Doctor - To Pay or Not To Pay
[Insurance] What do you do if you receive a bill from your doctor for services that you think should have been paid for by your insurance company? What if your doctor states that your insurance company has denied payment, so you are responsible. What if it’s hundreds of dollars? What if it's for an old date of service? Do you pay the bill?
- Hiring A Good Employee - What To Ask In The Interview
[Business:Management] Is the difficult task of hiring new employees left up to you? Hate trying to figure out who would be a good employee? The key to finding a good employee is a good interview system. Here are some guidelines for interviewing potential employees.
- HIPAA And How It Will Affect Your Office
[Health-and-Fitness:Medicine] How does HIPAA actually affect your medical office and who are the HIPAA police? Here are the specific actions required for your office to be HIPAA Compliant.
- Submitting Medical Insurance Claims – Which Form Do I Use?
[Insurance:Medical-Billing] 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.
- Medical Billing - What's All The Hype About?
[Business:Careers-Employment] We see so many ads for Medical Billing. Earn lots of money! Work from home! No experience needed! The ads say anyone can make lots of money doing medical billing, but is it really true?
- Medical Billing Software - How to Choose the Right One for Your Needs
[Computers-and-Technology:Software] With so many choices of medical billing software on the market, it is important to pick the one that best fits your needs. Here's a list of the things you need to consider before purchasing your medical billing software.
- Medical Billing Services
[Home-Based-Business] Medical billing services allow medical professionals to be more productive. Companies that specialize in medical billing allow a medical professional to get his money quickly which helps cash flow.
- Is Electronic Billing The Best Way To Send Your Medical Claims?
[Computers-and-Technology:Software] Will all doctors one day be forced to submit their medical claims electronically? Do the benefits of submitting claims electronically outway the pains of change?
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