new Medical Insurance Changes under Obamacare Law 2014

<div dir="ltr" style="text-align: justify;" trbidi="on">The Healthcare Reform including Affordable Care Act (Obamacare) is in full force instigating a series of changes in the health care industry that have already taken effect since the start of the year 2014. <br /> <br /> The Affordable Care Act has already expanded coverage of medical insurance for young adults who were not covered under the previous health care act. Some of the changes include outlawed life time limits on what insurance companies are required to cover and the lowering of costs of drugs for seniors in Medicare. <br /> <br /> <div style="text-align:center"><a href="http://www.medicalbillingcodings.org/2014/01/new-MedicalInsuarnceChanges-ObamacareLaw.html"><img alt="new Medical Insuarnce Changes 2014 under Obamacare Law" border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjO8pwW_Zief305DTZkPtcq9HVbPdIWDag03m1_6NrVCxvd8elqfuQAHG1Rrb1k6rojyaOiMzT6wjhkpkS7PGFUjoNRJm3fRBII5gxjSex1a5PVbzrvzGBycyPg9H89F5yckhUiHUlRVmg/s500/health-insurance-changes-ahead.jpg" /></a></div><br /> <h2>Medical Insurance Changes 2014</h2>The new changes in medical insurance has seen more than 1.1 million people gain coverage through the federal exchange, HealthCare.gov and the federal and state exchanges. Some of the changes that are expected to be part and parcel of health insurance are discussed below.<br /> <br /> <h3>Obamacare Insurance Mandate for Individual</h3>The affordable Care Act under the individual mandate requires almost all individuals and their dependents to have health insurance in 2014. Failure to do so, one looks set to incur a penalty during the filling of 2014 income tax returns in 2015. <br /> <br /> <b>Medical Insurance Tax Penalty</b><br /> The penalty to be incurred in 2015 is a 1% of the annual income or $95 per person whichever is greater. The penalties will increase with each year with uninsured kids incurring a penalty of $47.50. <br /> <br /> <b>Health Insurance changes for Employees</b><br /> Penalties will also be incurred even if you insure your employees. This could happen if one or more of your employees opt out of a plan you might be offering for exchange of a plan that allows him/her to receive premium credit. This could cause employees a penalty of $3000 for each of the employee receiving a subsidy<br /> <br /> <h3>Health Insurance Changes for Employers</h3>Employers with more than 50 employees under their payroll will be required to provide health insurance for their employees. This requirement was supposed to start at the beginning of the year but has been delayed due to increased uproar by employers. The change has thus been delayed by a year, by the Obama administration.<br /> <br /> <h3>Obama Health Insurance Tax</h3>Health insurers are required under the new changes to join medical devices makers and drug companies as participants in the payment of new taxes in exchange for new revenue. The premium tax on insurers is expected to raise $8billion in 2014 and more than 100 billion over the coming years. The money is intended to boost the Medicaid coverage and financial assistance for people purchasing marketplace health coverage.<br /> <br /> <h3>Medicaid Expansion</h3>The affordable Care Act estimates that over 9 million Americans will enroll for health insurance in 2014. Under the new changes non elderly adults who earn less than 138% of the federal poverty level will be entitled for Medicaid Coverage. This cap aims at covering the less privileged childless adults in the society a group that over the years has been shunned. The cap also intends to cover disable persons who do not meet requirements for supplemental security income.<br /> <br /> <h3>Insurance Market Consumer Protection</h3>New consumer rights and protections will only apply for individuals and small group markets under the new Affordable Care Act. The new rules guarantee full access to individual and small group coverage regardless of past health problems. Each plan under the revised changes will cover at least 60% of medical costs while limiting the amount that older policy holders would be charged.<br /> <br /> Insurers under the revised changes will not be allowed to change rates based on gender or occupation or medical claim history. If acclaim is turned down insurers will be mandated to explain why and how they came about the decision.</div>

new Medical Insurance Changes under Obamacare Law 2014

The Healthcare Reform including Affordable Care Act (Obamacare) is in full force instigating a series of changes in the health care industry that have already taken effect since the start of the year …

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Cardiology CPT/ICD Coding Changes 2014

The 2014 cardiology CPT codes have been updated to include the advancement and changes being experienced in the Cardiologist and Cardiac medical industry. <br /> <br /> The Cardiology CPT Coding Changes being experienced in cardiology are a reflection of last year’s extensive increase in procedures, which are intended to be more specific to services being rendered as well as assisting in data reporting for the purposes of tracking purposes.<br /> <div class="separator" style="clear: both; text-align: center;"> <a href="http://www.medicalbillingcodings.org/2014/01/cardiology-cpticd-coding-changes-2014.html" imageanchor="1"><img alt="Cardiology CPT/ICD Coding Changes 2014: Ablation, Angiography, PCI, PVAD, TAVR" border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiwj4kV7fLosICIB3iPT-ZVUyvlAesBQ5ANVcAPGcIilq9WA_F3AwhB9YeGUDfaUyBjK379lQQZBrwHRCFG0P6mtheJUe27twmjzvnUQQGAQhJLw6L4eoqM8CAgsgQlvzNCoLpkcpI9m7CF/s1600/cardiology-medical-billing.png" /></a></div> Cardiology practice is in line to experience the much publicized changes in medical billing and coding as from October 1 this year as the industry plans to switch from ICD-9 to ICD-10.<br /> <br /> <h2> Cardiology CPT Changes 2014</h2> The CPT code book will see a total of 329 changes with 175 being completely new compared to ICD-9 with another 107 revision and 47 deletions. <br /> <br /> <h3> new Cardiology Codes 2014</h3> 2014 Cardiology CPT Codes experienced the most changes as compared to other codes with an introduction of 19 other completely new codes.<br /> <br /> One of the biggest changes cycles around the creation of five new codes 37217 and 37236-37239 that will greatly impact peripheral stenting and for the bundling of radiological supervision as well as interpretation S&I. These revisions will greatly impact procedures for reimbursements. <br /> <br /> <h3> Endovascular Aorta Repair</h3> Cardiology CPT Codes have new eight categories codes 34841-34848 that will be used for fenestrated endovascular aorta repair.<br /> <br /> <h2> Cardiology CPT Codes 2014</h2> Four new codes, 37241-37244 that will be used for reporting vascular embolization or Occlusion, the codes will also bundle S&I as well as intraprocedural road mapping as well as image guidance. These codes will further be divided into venous; arterial tumors and organ ischemia or infarction. <br /> <br /> Arterial or venous hemorrhage these will act as a replacement for the deleted 37204 which were being used for Transcatheter occlusion or embolization as well as 37210 which are being used for Uterine Fibroid embolization. <br /> <br /> CPT codes cardiology that pay a greater emphasis on instructions for documentation requirements as well as the reporting of the 10 categories III codes for subcutaneous ICDs, the codes that will be used in this case are 0319T-03228T. There will also be new eight category I codes for FEVAR (34841-34848).<br /> <br /> Cardiology CPT codes 2014 have four new embolization codes 37241-37244 with the addition of two new codes that will be used for reporting various defects in the heart 93582-93583. The revision will also come with parenthical codes for EP ablation solely for easing reimbursement flow. <br /> <br /> Some of the deleted codes include 32420 that was used to report Pneumoncentesis, puncture of lung for aspiration, 32421 for Thoracentesis, puncture of pleural cavity for aspiration, initial or subsequent and 32422 Thoracentesis with insertion of tube, includes water seal (eg, for pneumothorax), when performed (separate procedure).<br /> <br /> Some of the revised codes that will be used in CPT cardiology coding include 32551 Tube thoracostomy, includes connection to drainage system and 32554 Thoracentesis, needle or catheter, aspiration of the pleural space; without imaging guidance<br /> <br /> You can also view <a href="http://www.medicalbillingcodings.org/2013/05/cardiology-cpt-codes-new-changes.html">Cardiology CPT Changes 2013</a> with the new Codes for Ablation, Angiography, Implants, PCI, PVAD, TAVR and Wearable Cardiac Device Evaluation.<br /> <br /> The new Cardiology CPT Coding Changes for 2014 also reflect the changing societal trends with physicians being given the chance of selecting CPT codes for inter-professional or internet consultations with colleagues.

Cardiology CPT/ICD Coding Changes 2014

The 2014 cardiology CPT codes have been updated to include the advancement and changes being experienced in the Cardiologist and Cardiac medical industry. The Cardiology CPT Coding Changes being expe…

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Affordable Care Act (Obamacare) and Medical Billing and Coding

<div dir="ltr" style="text-align: justify;" trbidi="on">The Affordable Care Act, also know as ‘the Patient Protection and Affordable Care Act (ACA) and ‘ObamaCare’, is significant legislation signed by President Obama in March, 2010, that will result in significant changes to our health care system. Notably, this comprehensive healthcare legislation, is intended to make preventative health care more affordable for citizens of the United States.<br /> <br /> Medical Billing and Coding professionals may be wondering what effects Affordable Care Act (ACA), commonly known as Obamacare will have on the Medical Billing and Coding Industry when Meaningfull Uuse II (MU2) Stage is rolling out in 2014.<br /> <br /> As many medical coders and billers are already aware, the current system is tedious, time taking and confusing. Whether the ACA will simplify or complicate this is another matter. However there is always one fact that is guaranteed: people will become sick or injured and visit their doctor, and doctors will continue to bill their services.<br /> <br /> <div style="text-align:center;"><a href="http://www.medicalbillingcodings.org/2014/01/AffordableCareAct-MedicalBillingCoding-Obamacare.html"><img alt="Affordable Care Act (Obamacare) and Medical Billing and Coding" border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjA5Zzp-U5q-tWvNlzIkFl1GZwGZha3DvGqp81z8_rFDItwBu9WBNfinmAmVMazaMtcfjk_B8QJCOZ8nxgetBuViL8QarlEA1tY8Rsx4ioi3_lBiNbVy_v1XKz965KfjI3nqzzWSkcHB2M/s1600/AffordableCareAct-MedicalBillingCoding-Obamacare.jpg" /></a></div><br /> <h2>Affordable Care Act (ACA) Effects on Medical Billing</h2>The ACA has been sold to the public on two main provisions: as a piece of legislation to provide millions of Americans with insurance who do not already have it, and to make healthcare more affordable. Considering this first point in itself can begin to shed some light on the effects of the ACA.<br /> <br /> In theory, thanks to the ACA more Americans will have health insurance. Assuming this turns out to be the case, more insured Americans means more people obtaining healthcare services, which logically means a greater demand for the medical billing and coding profession. So far so good.<br /> <br /> One of the provisions to provide coverage for more people was the expansion of Medicaid. During the Supreme Court challenge of the ACA, justices declared that Medicaid expansion was an optional provision which states could choose to accept or reject. Although some have done this latter, others have chosen to expand their Medicaid system, and although many medical billing and coding professionals start to get a migraine when they think about billing with the federal government, for many others it is the only thing they do. The Medicaid program is nothing new, and as this expands it simply means a greater demand for billers and coders who specialize in this niche.<br /> <br /> However this also alludes to another possibility. Some have speculated that as the federal government begins to foot the bill for more citizens it will be able to have a greater influence over the prices the medical industry sets for their services. Of course medical billing and coding professionals will already recognize this in the reduced rates that are billed to the existing Medicare and Medicaid programs. The fear is that these rates could be reduced even further, leaving doctors, hospitals, long-term care facilities and other medical provides with less money in their pockets. This in turn could have a real impact on the salaries of medical billing and coding professionals.<br /> <br /> Speculation this is however, and the many expansions Medicare has undergone since it was created in 1965 combined with the bottle-necking baby boomer generation exploding the demand in the medical billing and coding industry, it is difficult to compare the salary of a medical billing and coding professional in the past with that of the present, and to predict the macro effects more government influence on reimbursement prices could actually have.<br /> <br /> Less likely but far more devastating to the industry would be a single-payer, government mediated insurance program based on some European models of healthcare such as the National Health Service of England. As basically a universal Medicare system, this would greatly simplify the industry and despite having additional population coverage, the amount of jobs lost in the profession would greatly outweigh this benefit. Think how accountants would feel if the IRS simplified the tax code so everyone from multinational corporations to Joe the plumber filled out a 1040EZ.<br /> <br /> But fortunately for the medical billing and coding profession, the chances of switching to a single-payer healthcare system are less than having the tax code simplified- and we all know what the odds of that are. So the overall prognosis: Obamacare means more people will have health insurance coverage, more medical services will be obtained, and there will be a greater demand for medical billing and coding professionals.<br /> </div>

Affordable Care Act (Obamacare) and Medical Billing and Coding

The Affordable Care Act, also know as ‘the Patient Protection and Affordable Care Act (ACA) and ‘ObamaCare’, is significant legislation signed by President Obama in March, 2010, that will result in si…

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How to Reduce Claim Denials and Increase Medical Billing Practice Revenue

<div dir="ltr" style="text-align: justify;" trbidi="on">How to reduce Claim Denials and increase Medical Billing Practice Revenue collection is one of the most important concern in revenue cycle management and optimization.<br /> <br /> With changes in the economy, legislation and healthcare reform; healthcare service providers are facing financial issues in terms of improving profitability.<br /> <br /> Claim Rejections by Medicare, Medicaid and other insurance providers have become a major headache affecting many healthcare service providers. It is not a surprise that between 3-5% of net revenues is normally lost as a result of payment denials by insurance companies. <br /> <br /> Year 2014 statistics shows that that up to 25% of claims submitted to insurance companies always end up being turned down because of errors that can be easily be identified and managed. Managing and reducing medical denials is one of the most important step towards increasing Medical Billing Practice Revenue for the providers as decreasing health care costs for the patients.<br /> <br /> <div style="text-align:center"><a href="http://www.medicalbillingcodings.org/2014/01/reduce-claim-denials-rejected-medical.html"><img alt="How to Reduce Claim Denials and Increase Medical Billing Practice Revenue" border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj0U09HWjff72riOQzeeh8ImIzyteAcpqoL0InPisIMvNuV_7HdWcNBOC7FzF21d7Mzl8KRyKfw9bRXeU5G-vHPmoOocK7uP6xgRxvkyyVZ69sV7IFZtAfKrl8LNuas3f8yZy_ZeEW0qDcm/s1600/howTo-reduce-rejected-claims-denials-medical-billing-practice-revenue.jpg" /></a></div><br /> Claim denial or delay come with its own consequences that can harm a healthcare service provider. These include:<br /> <ul><li>Increased costs of appealing the denial something that should always be avoided, It is worth noting that reduced reimbursement from many players would always impact income generation.</li> <li>Some rejections are not appeal-able once a claim has been rejected on the first instance of posting a claim; this essentially translates to loss of income for services provided.</li> </ul><br /> <h2>Revenue Cycle and Accounts Receivable Audit to Reduce Denials</h2>An annual audit for the assessment of efficiency and effectiveness of Revenue Cycle and Accounts Receivable is the first step towards Denial Management.<br /> <br /> Analyze the annual practice data including payroll, staffing, labor, payer mix, contracting, revenue cycle, accounts receivable (AR), billing/expenses, supply costs, sales prospecting and closing, denials, utilization review, staffing, and costs of core services. The revenue cycle audit must be able to answer following questions:<br /> <ul><li>How many claims are being submitted?</li> <li>How many claims are being rejected?</li> <li>What are the more common reasons for claim denials e.g services not covered, medical necessity not established, prior authorization not obtained, claims filed incorrectly, incorrect diagnosis code, provider error, lack of supporting documentation, coverage terminated, timeliness of filing, improper coordination between primary and secondary providers.</li></ul><blockquote>A recent survey conducted in United State reveals that the single largest yet avoidable reason for about 78.2% of all Insurance Claim Denials is incorrect patient demographic information.</blockquote>Therefore, the answers to above all question are essential to let you know how to reduce denials for your practice. <br /> <br /> <h2>Reduce Claim Denials and Increase Medical Billing Practice Revenue</h2>As a Senior Medical Insurance Claims Analyst, below are few steps to Reduce Claim Denials in order to increase Medical Billing Practice Revenue from my years of experience in Medical Billing industry, working on various practices and specialties: <br /> <ol><li><h3>Updated Patient Information</h3>It is common for patients to update their personal and insurance information that is vital when submitting claims for reimbursement. It is prudent for Practice Staff or Medical Billers to always take their time in asking the patients of their updated insurance card and updated address. <br /> <br /> Many claims are normally turned down because of mistakes in patient profile or demographic info. Some of the patient information like First Name, Last Name, DOB, Phone Numbers, Address and SSN. should always be counter checked.<br /> <br /> Further, medical practice billing staff should always in touch with a patient's insurance provider to ensure the healthcare provider is a component of the policy's network.<br /> <br /> </li><li><h3>Eligibility Verification and Authorization</h3>Medical Billing staff should always make an effort of getting the phone number of their patient's insurance provider. This is essential to verify details of a patient's Insurance coverage or benefits verification prior to sending in the claims. This process should ideally be done one day prior to the appointment. <br /> <br /> Insurance plan eligibility checking should always be done quarterly and more frequently especially in instances where they are employer sponsored coverage. The reason for this is that employment can always vary from time to time with group health plans also being affected. Three most important questions that billing staff should always ask in this step include:<br /> <ol><li>Will the patient insurance be able to cater for all the cost at the time of a patient visit?</li> <li>Is the practice in network for the patient or not?</li> <li>Will the patient be required to co-pay for his visit and by how much?</li></ol><br /> </li><li><h3>Check for Coding Errors and Deadlines</h3>All claims should always be filed ahead of insurance vendors filling deadlines while ensuring the claims are fitted with the legitimate and complete HPCS and CPT codes whenever applicable.<br /> <br /> </li><li><h3>Check CCI for Medicare and Medicaid Services</h3>Always apply National Correct Coding Initiative (NCCI) for Medicare and Medicaid Services in your defense. If you are up to standard as far as the CCI goes, use it when appealing denials and defending your billing. If you think that CCI is a popular crime-fighting drama on TV AND you select your own CPT/Billing codes, you may be in trouble.<br /> <br /> </li><li><h3>Resolve Detected Problems</h3>Any problems that might be detected in the first stages should always be solved as soon as possible before filling a claim with an insurance provider. Very few people understand the entire billing process, therefore it would the work of the billing staff to sit down with the patient and try to sort out all the problems amicably. Small problems with many patients can always escalate into frustration when they are left in the dark. Sharing any troubling findings with patients is thus essential.<br /> <br /> Staying ahead of the problem in terms of billing is essential if all the costs of medical billing are to be minimized, this also presents an opportunity to fix an issue before it holds up payment. Engaging in preventive care and effective communication with patients is always sure to considerably minimize the chances of a claim being turned down by an insurance provider.<br /> <br /> </li><li><h3>Medical Claim Denial Appeal Advantages</h3>A well documented and supported Denial Appeal does more than what is believed. The insurance workers become cautioned about future denial of your medical claims for bogus reasons. You can also get a <a href="http://www.medicalbillingcodings.org/2013/12/how-MedicalBilling-Advocates-legal-help-issues.html">Medical Billing Advocates help</a> for this.<br /> <br /> Approximately 30% of all claims submitted to an insurance carrier on the initial submission are denied whether they are correct or not. Insurances workers do this because less than 25% of medical practices appeal their claims denial in in USA.<br /> <br /> Most practices think they made the mistake when they get a denial from a carrier and so they don't appeal because they believe they will get more denials. The fact of the matter is other way round. <br /> <br /> The worker at Medical Insurance company are human like us an as pron to error as the worker involved in claims submission process. One successful appeal send them a message that you are vigilant about your claims making them cautioned to avoid as much as possible to issuing denials and raising disputes.<br /> <br /> </li><li><h3>Use Reporting System</h3>The last but an important step to decrease denials takes us back to where it all has started, the need for an effective reporting system to be in-place and available for audit anytime. You should consider using a healthcare IT solution like an <a href="http://www.medicalbillingcodings.org/search/label/EMR">EMR System</a>, some of the <a href="http://www.medicalbillingcodings.org/search/label/Medical%20Billing%20and%20Coding%20Softwares">Medical Billing Softwares</a> or a <a href="http://www.medicalbillingcodings.org/2013/07/free-medicalbillingsoftwares-smallpractices.html">Free Billing Softwares for Small Medical Practices</a> for the purpose, if you are not using it already. <br /> <br /> A good reporting system is necessary to analyze all denials qualitatively and quantitatively at any point of time in a financial year to effectively avoid some of the very obvious reasons, right now rather then year end, when its already too late.</li></ol>Obviously there are several further measures that can be taken to reduce denials of medical claims. These are the basics that Medical Billing and Coding professionals need to be aware of because they are the ones to correct all the mistake doctors have made with responsibility to submit and make medical claims paid.<br /> </div>

How to Reduce Claim Denials and Increase Medical Billing Practice Revenue

How to reduce Claim Denials and increase Medical Billing Practice Revenue collection is one of the most important concern in revenue cycle management and optimization. With changes in the economy, leg…

Read more »