Crossover and Electronic Filling- Medical Billing

Cross Over :

A situation whereby gaps in coverage for the medical expenses for a Medicare Beneficiary are forwarded by the Medicare contractor to the Patient's medigap insurer for payment. Crossover applies only incase of Medicare, medigap and Medicaid plans. Medicare itself transfer the claims to the secondary insurance is called Automatic crossover. even few commercial insurance also doing crossover for the same group plans example BCBS, For Crossover patient must update the COB information with both primary and secondary insurance.

Electronic Filling:

It is one that is submitted via electronic format not that traditional paper format

National Standard Format (NSF)

It is a format used by the government.

It is a rigid format with 320 bytes.

American National Standard Institution (ANSI)

It is a format used by the private institutions with 132 bytes

It is flexible one.

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What is QMB / MQMB stands for?

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Revenue Cycle Management (RCM) is an essential process for healthcare organizations to ensure that they receive timely and accurate payments for the services they provide. Here are some of the key performance indicators (KPIs) metrics that healthcare organizations should track as part of their RCM process: Gross Collection Rate (GCR): This metric measures the percentage of charges that a healthcare organization collects from patients and insurance companies. It is calculated by dividing the total payments received by the total charges billed. Net Collection Rate (NCR): The NCR measures the percentage of expected payments received by the healthcare organization after accounting for contractual adjustments, bad debts, and other adjustments. It is calculated by dividing the total payments received by the total expected payments. Days in Accounts Receivable (DAR): This metric measures the average number of days it takes fo...

Rejection Procedure note qualifier is missing

Need to check the Charges tab and double click on the Procedure Code line to open up the Charge Entry window. There is a Notes section on the right hand side. If there is a note typed, we need to select the type. Need to select field and select the appropriate type of note you are sending. Save the changes made Check all the procedure if submitted many procedure. Save the visit again and submit the claim.

Medical Billing

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