Category Archives: iMAX Medical Billing Insights

Take Time to Understand Time-based Codes

Without a thorough understanding of the guidelines, calculating time may land you in hot water. When time is the controlling factor in a patient’s visit, be sure to capture the appropriate time-based service code. Per CPT®, unless there are code or code-range-specific guidelines, parenthetical instructions, or code descriptors to the contrary, the following standards apply to time measurement: A unit of time is attained when the midpoint is passed. For example, an hour is attained when 31 minutes have elapsed (more than midway between zero and 60 minutes). A second hour is attained when 91 minutes have elapsed. When codes

Medicare Cards Dropping SSI Numbers in 2018

Nearly 58 million Americans pack Medicare cards, and because their Social Security number is on the card, this puts them at great risk of fraud and identity theft. Medicare is planning to replace the cards as mandated by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) to protect beneficiaries. New cards begin mailing April 2018, and that gives providers a year to convert their systems. In the works for years, the Centers for Medicare & Medicaid Services (CMS) has developed the randomly-assigned Medicare Beneficiary Identifier (MBI) as a replacement. By congressional fiat, all cards must be replaced by April 2019. The new, unique MBI

What’s the difference between a Claim Denial and Claim Rejection?

Insurance claim denials and rejections are one of the biggest obstacles affecting healthcare reimbursements.  Too often the terms “claim rejection” and “claim denial” are used interchangeably in the billing world. This misunderstanding can create very costly errors and can have a significant, negative impact on your overall revenue cycle.  Proper education and management of accounts receivable and workflow are essential for timely cash flow. Let’s spend a little time defining the terms and differences between a claim rejection and a claim denial. Claim Rejections Claims Rejections are claims that do not meet specific data requirements or basic formatting that are rejected by

Opioid Addicts Share Their Story

The below link features patients from Cornerstone Project in Dayton, Ohio who share their stories.

Real-Time Data for Denials Management Aids Practice’s Lagging A/R

Urgent Care Now improved A/R days by 18 percent and collections by 30 percent after gaining real-time access to claim denials management data. Without transparency throughout the claim denials management process, healthcare organizations are leaving a significant portion of potential revenue on the table. Limited access to timely claim denial and reimbursement data can prevent providers from recouping revenue that is rightfully theirs. As a result, providers are passing up an opportunity to recover reimbursement for up to 63 percent of denied claims, a recent Change Healthcare study revealed. Urgent Care Now in New Jersey used to be one of

36% of Providers Never Address Patient Financial Responsibility

Providers reported a rise in uncollected self-pay revenue, but only 23 percent said they always discuss patient financial responsibility, a survey showed. August 29, 2017 – Healthcare organizations are struggling to collect full patient financial responsibility, especially with the rise of high-deductible health plans. Yet, 36 percent of providers report never discussing a patient’s ability to pay prior to delivering care, a recent survey of over 230 providers and 1,000 adults revealed. The survey from West showed that healthcare organizations are seeing uncollected self-pay revenue increase because of high-deductible health plans. About 80 percent of individuals said that affordability is their

How to encourage patients to post online reviews

Studies have shown that a majority of patients are now using online reviews as a first step to finding a new doctor, and nearly 65% of people form an opinion by reading anywhere from one to six reviews. According to BrightLocal’s Local Consumer Review Survey, 70% of consumers will leave a review for a business if asked, so encouraging patients to leave positive reviews for a practice not only helps to build a solid reputation, but also helps to buffer the occasional negative review. That’s why it is absolutely essential that doctors strengthen their online reputation. “Doctors need to get

Rags to riches to rags: How a booming addiction treatment biz goes bankrupt

Stephen Fennelly was at the top of his game and it seemed like there was nowhere to go but up. After rough times in Connecticut – including arrests for narcotics possession, larceny and weapons offenses – the former home builder had conquered his drug problem, hung up the hard hat and donned a sharp suit. The new Fennelly was the passion-driven chief executive of a swiftly expanding addiction treatment empire in California. Solid Landings Behavioral Health started out in 2009 with a handful of workers and rode a cresting wave of opioid addiction – and ballooning insurance coverage – to what

Watchdog: Drug lab raided by feds made millions. Now it’s for sale.

In November, federal agents raided a Lawrenceville toxicology lab, serving warrants and taking away boxes of papers. Two days later, the lab filed Chapter 11 bankruptcy. Next month it heads for the auction block after years of Medicare reimbursements at one of the highest rates in the nation, according to one study. The firm is Confirmatrix Laboratory, and if that name sounds at all familiar it’s likely because the company was at the center of a campaign donation bundling scandal in 2014 when then-U.S. Rep. Jack Kingston was running for an open Senate seat. Employees with Confirmatrix and associated companies combined

Opioid Fraud: OIG’s Largest Healthcare Takedown in History

The Office of Inspector General’s (OIG) combat on healthcare fraud, waste, and abuse of taxpayer’s money recovers $5 for every $1 spent on investigating, which gives them incentive to target more areas of fraud. The OIG’s latest and largest fraud takedown happened this month when opioid fraud was exposed with the help of state and federal law enforcement. According to the OIG’s release, Media Materials: 2017 National Health Care Fraud Takedown: More than 400 defendants in 41 federal districts were charged with participating in fraud schemes involving about $1.3 billion in false billings to Medicare and Medicaid. OIG also issued exclusion notices to 295 doctors, nurses,