Medical Billing Blog

Let’s face it, no provider really wants to implement and maintain a compliance program in their office, but if nobody bothered then the estimated $60 billion in Medicare fraud would continue to prosper.  Like every other law and regulation our government imposes, medical office compliance programs are intended to better society.  An effectively designed compliance plan should be implemented and enforced with the goals of preventing, detecting, and correcting inappropriate and potentially criminal conduct. 

A major change is coming. The format of all transmissions of all claims to all payers is about to change. It’s called 5010 and it’s the precursor for ICD‐10.  5010 refers to the electronic transmission of claims sent to insurance payors.  The transition to 5010 will be completed on January 1, 2012, when all claims will be required to use this new format. 

Generally, the faster you can bill a claim the faster you’re paid, but navigating through today’s revenue cycle is, to say the least, challenging.  Technology has become an integral part of today’s medical billing, and there are a number of new software applications designed to accelerate reimbursements.  Eligibility verification, claim scrubbers and online payment portals are three of the latest programs designed to speed up reimbursements.

The decision whether or not to outsource your billing is less complex of a decision than most physicians make it out to be.  Today’s medical billing takes a highly specialized set of skills and resources to be successful.  Billing has become an ever-changing complex field of codes, modifiers, rules and regulations.  So here are the top 5 reasons you should outsource your practice’s medical billing function:

We are taught from an early age that we should always return something that does not belong to us. As adults the rules are the same. This is especially important in our roles as billing agents and collectors; we are the stewards of our client’s finances. Just ask the Office of the Inspector General (OIG). In 1998, the OIG published its Compliance Program Guidance for Third-Party Medical Billing Companies, which included a list of risk factors the OIG identifies as “particularly problematic.” Bullet five on this list is “Inadequate Resolution of Overpayments,” otherwise known in the billing industry as resolution of credit balances. In essence, it says that providers may not keep payments that do not belong to them.

ICD-10 goes into effect October 1, 2013.  This is the biggest change in medical billing in years.  ICD-10 has fundamental changes in structure and concepts that make them very different from ICD-9. 

CMS has announced that some Medicare Providers will be required to revalidate their enrollment status in order to comply with Section 6401(a) of the Affordable Care Act.  Any provider who enrolled prior to March 25, 2011 may be affected by the requirement.  Beginning now and going through March 23, 2013, Medicare Administrative Contractors (MAC’s) will be contacting providers who need to revalidate their enrollment.  Only Providers who are contacted by a MAC need to revalidate their enrollment, and they must wait until after they are contacted.