Billing Error Analysis

Rather than having the other claims adjusted, the provider insisted that we not look into the matter further because they did not want us to take back any money. Sadly this is just one example of fraud; it is not uncommon to see providers change the coding of claims to get something that they know should not be paid to process for payment. Cracking down on this type of fraud will reduce the amount of money paid out on claims by insurance carriers. Since claims payments directly affect the cost of insurance, this will also help in lowering premiums.

In today’s seemingly ever-changing world of healthcare regulation, medical professionals are burdened with many compliance requirements. On October 14, 2016, the Department of Health and Human Services released its final rule implementing the Quality Payment Program as part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Starting January 1, 2017, clinicians who are reimbursed by the Centers for Medicare and Medicaid Services(CMS) are required to participate in the Quality Payment Program (QPP). (Centers for Medicare & Medicaid Services, 2016) The QPP replaced the Sustainable Growth Rate formula with the new payment structure in which clinicians are rewarded for delivering high quality care. There are now two pathways for

I have completed the form and returned it to my insurance company, just as you said to.

DI 23007.005G.2 indicates if attempts to receive information by mail is unsuccessful, DDS should contact the claimant by phone. “If you reach the claimant, collect the information requested over the phone. Thus, the prior determination was incorrect and a re-opening is warranted.

Reimbursement of court fines; $635.00 and late fees; $ 10,716.00, that was fined to the Plaintiff when he was never in the arrears

Would you please correct the patient sliding fee scale information that being entered incorrectly under the patient policies tab. I review the patient household family income ($22,432.41 for 3 family members) and the sliding fee scale level is B and under the patient policies tab the Sliding fee scale was selected as a Scale A and this is incorrect . You FWD message to the billing pool and PMG FWD back to the billing department b/c the information don't match. Please do the appropriate corrections and email me back so I can advise PMG.

I am writing in response to Jonathan Friedman’s inquiry to the Illinois Department of Insurance dated June 27, 2016. In the inquiry, Mr. Friedman expressed concerns over the adjustment of claim number 4079503H4820X.

Would you please contact patient and verify 2ndry Ins. information . I just receive a denial from her 2ndry insurance that we have on system saying that the patient is coverage under another payer. We receive payment already from Medicare and I bill out on paper and attach the Medicare EOB to the claim to her 2ndry insurance on 3.1.2017 and now the payer denied the claim. I transfer the visits to self paid but if the patient provide to us her 2ndry Insurance information we can bill the claim back to the payer. Please advise.

Another good recomendation to know: if the patient has BCBS under the Medicaid program the good new is that Delaware only had Highmark Health Options (mcd) under BCBS if the Insurance description don't said Highmark Health option thats mean that the patient had MCD coverage out of the stated and we need to contact the payer directly just to make sure if we are participate with them.

Administrative expenses have been seen through time not spent finding, filing, and retrieving patient charts. A reduction in employee time equals less money spent by the employer. Budget savings a seen through elimination of transcription, transferring, and transporting of patient charts. Billing components within EMR packages can provide cost savings through generation of direct billing and reimbursement; this process shows great potential for reduction in billing errors. Errors made during the billing/reimbursement process result in dollars lost or not recovered for the organization, which in turn drives up the cost of healthcare. The Centers for Medicare and Medicaid Services reported (in 2003) that a 10% error rate, regarding payments,

Thank you for the referral of this matter to our office. I look forward to working with you as we bring this matter to an equitable conclusion for all parties. As always, if you have any questions or comments concerning the above-referenced matter, please do not hesitate to contact me. It is my practice to return all communications within 24 hours, if possible. Please consider this letter a brief Initial File Analysis on this matter.

We received your grievance request regarding your monthly explanation of benefits showing services for a walker that you never received nor need. This request was received by Blue Cross® Blue Shield® of Arizona Advantage (HMO) on December 30, 2016

As of 4/1/17, the below employee it’s a member of Oxford, however she is unable to retrieve her medication. She stated she contacted Oxford and was told that her insurance still pending.

Thank you for post this week concerning coding errors in medical billing practices. In fact, Th Office of the Inspector General (OIG) has the authority to investigate and prosecute those who are found guilty of fraud and abuse. However, office managers are in position to detect and prevent coding errors in their medical practice through training and verification prior to claims submission.

You recently sent a package of claims to Horizon Behavioral Health for services rendered to your spouse John Stonelake, by Ronald S. Newman PhD, an out-of-network provider with your NJ DIRECT coverage. When you called to check on the status of the claims you were advised that they were not received. Additionally, you indicated that twice you have sent in a package of claims that were received and one of the dates of service included with the package was not