Medical Billing

Medicare Part B Premium and Deductible Medicare Part B covers physician services, outpatient hospital services, certain home health services, durable medical equipment, and certain other medical and health services not covered by Medicare Part A.  Each year the Medicare Part B premium, deductible, and coinsurance rates are determined according to the Social Security Act. The standard monthly premium for Medicare Part B enrollees will be $164.90 for 2023, a decrease of $5.20 from $170.10 in 2022. The annual deductible for all Medicare Part B beneficiaries is $226 in 2023 , a decrease of $7 from the annual deductible of $233 in 2022.

 RCM Q&A 3 Duplicate Denial: Top RCM Technical Questions and Answers with Sample Notes Question: How do you work on – Duplicate Denial Answer : Step1: The status of a claim can be found on the insurance company's website, Through EOB, Correspondence,. Step2: Check-in the billing system, if you have any duplicate denial in the system. If yes check with the coding team. If it's a real duplicate adjust off the balance. If no Step3: Call the insurance company and ask the rep May I know the claim received and denied date and the Original claim status Step4: If the original claim is denied go by the denied scenario If it is paid go by the paid scenario and if it is in-process then go by the in-process scenario Step5: May I know the original and current claim#, Could you please send the copy of EOB( duplicate copy) Step 6: May I know the claim# and reference # If you need to answer all the above-mentioned steps with the interviewer   Sample Notes : Claim # Dos

RCM Q&A 2: Top RCM Technical Questions and Answers with Sample Notes  Question: How do you work on - Claim Denied for Authorization Same Question instead of denial Interviewer can ask the question like Missing/invalid/Authorization/Notification/Pre-certification etc.,   Answer : Step1 : The status of a claim can be found on the insurance company's website; but, for missing authorization denial scenarios, you must contact the insurance company for more information. Step2 : Provide Physician and Claim related information with the rep Step3 : Ask rep May I know the claim received and denied date Step4 : Ask why you required authorization for this service/cpt code and do they see any authorization on the file for another hospital claim Step5: If yes Step6: Could you please send the claim back for reprocess with that authorization and check the authorization effective and end date Step7: If No Step8: Can we get the retro authorization for this service Step9: If Yes Step 10:

RCM Q&A 1: Top RCM Technical Questions and Answers with Sample notes Format for Claim in the process: Interviewer Question: How do you work on  - In Process Claim Answer :  Step1: Check with the Clearing House to see if your claim has been accepted. Step 2: *Considering both Clearing House and Insurance Accept Check Claim Step3: *Considering - Insurance has not responded. After 15 days from the date of the Clearing House and Insurance acceptance. Step4: Claim Status can be located on the insurance website, however in our scenario consider there is no information about it. Step5: Call the Insurance Company Step6: Once you reached the Insurance Representative, after providing basic information about the claim. You need to ask the following questions May I know the Claim received date  Step7: May I know how many days it may take to process the claim Step8: If the received Date is more than 30 days then need to ask the below questions Step9: May I know the reason for the dealy Step10: 

It's critical to have a systemized and strategic reporting technique in place to follow the status of each and every claim from the time the patient registers to the time the claim is closed with full payment. To avoid refusal claims taking a back seat and ending up in older AR buckets, contact a billing professional for help with an efficient Medical Claims tracking Reporting system. You must first determine the Scope and Out of Scope of your inventory before you can begin working on it. Example: You may not work on Liability Insurance which is out of Scope for you Once you identified the scope of the inventory you need to Prioritize the inventory. Below give the sample for prioritization Prioritize Claims: First Priority: Higher aging and High dollar value Second Priority: Denied Claims Third Priority: Second Higher aging and Dollar value  Fourth Priority: TFL Experienced AR Follow up and Denial Management Team A skilled AR Followup, Rejection, and Denial Management staff are req

 The American Medical Association (AMA) announced a Current Procedural Terminology (CPT) code set update to include a code for administering a third dose of Pfizer’s COVID-19 vaccine in children 5 through 11 years of age. CPT code 0073A was added to the official CPT code set, effective immediately. The addition comes on the heels of the Food and Drug Administration’s (FDA’s) decision to expand Pfizer’s COVID-19 vaccine emergency use authorization to include a third primary series dose of the vaccine in children who are immunocompromised. The FDA’s decision to allow immunizers to boost certain children susceptible to poor outcomes if they become infected with COVID-19 is a welcome action, AMA stated.

  The No Surprise Act 2022 (NSA) establishes new federal protections against surprise medical bills that take effect in 2022.  What is No Surprise Act: NSAs occur when insured people are treated by out-of-network hospitals, doctors, or other providers they did not choose. This occurs in around one out of every five visits to the emergency room. In addition, surprise expenditures from out-of-network doctors (such as anesthesiologists) whom the patient did not choose an account for 9 to 16 percent of in-network hospitalizations for non-emergency care. Consumers suffer unexpected medical expenditures when health plans decline out-of-network claims or impose greater out-of-network cost-sharing; consumers also face "balance billing" from out-of-network providers who have not agreed to accept the health plan's discounted payment rates. The NSA is expected to apply to around 10 million out-of-network unexpected medical expenses per year, according to the federal government. Th