So, I took a ICD-10 training course from AAPC, for professionals. I have to say that from a Medical Biller perspective I didn’t see a lot of drastic change. However, there was a lot more change for the providers/doctors.
Those of you who have been documenting extensively for your patients have nothing to worry about….Yes, it will take a while for the payers to start processing your claims correctly and get payment. But you will have a less change of a rejected or denied claim, based on the simple fact that your diagnosis did not correspond to the treatment codes and you have no supporting documentation to show for it.
ICD -10 are more focused and more detailed but they are also more descriptive and require the supporting documentation to accompany the diagnosis.
There is more pressure on the provider to make sure that the documentation is correct so that the coder could select and code the diagnosis properly.
Please do not be discauraged. There is plenty of help…Courses from AAPC or even Availity. Or maybe you prefer a mobile approach of having an app on your phone with the ICD-10 refences. Of course, lets not forget your EHR/EMR software which could be quiet useful.
So, cheer up and brace the new ICD-10 with open arms and ease!
More often then not: I receive dissapointed feedback from patients about provider offices: their Front Desk Staff specifically.
It is disapointing to come to an office where the front desk looks like a Tornadoe went through or the fact that the front staff is chewing gum with their mouth open while talking on the phone with a friend….OK ….OK …LOL…this is the worst case scenario.
The more realistic could be the fact that the front staff is not customer friendly or does not know which insurances you as a provider accept or the biggi-how to check properly the patient benefits and elegibility!
The post possible scenario for you as a provider: you would lose your patients, therefore your practice would suffer from reduction in revenue or A/R will go down….The Cash Flow will decrease!….Not a good thing for you as a business.
Training your Front Desk staff will help you avoid the worst case scenario and better clean claim submission. Resulting in no loss of your A/R and a constant flow of cash or payments.
If you are looking for for comprehensive training programs for your staff please visit my website or my Front Staff Training Packages blog post: for available times and prices!
Everyday I receive at least 10 phone calls from patients freaking out about a “bill” they received from their insurance company. No it is not a “bill” just an EOB.
What is an EOB? EOB stands for Explanatiin of benefits. Its a piece of paper or papers that have a couple of components to it.
Fist listed is the DOS (date of service or visit). Then the codes that your provider has billed or submitted to your insurance company. Next is the POS (place of service). So far so good, right…you still with me?…Yes?..OK. Now come the billed charges-the amount that your provider billed your insurance company. Then the allowed charges-what your insurance will pay. Next column will show any amount that will go towards you deductible or coinsurance – this is your responsability and you have to pay that given amount to the provider. Then you will see the non covered changes- self explanatory. You still following me?…OK. we are almost at the end….LOL
There are also the numerical expalantion codes (reason codes)-explaining why this was paid and why not. Last but not least is the column of paid amount: the amount that was paid to your provider for the services billed.
Please remember that it is NOT a BILL….only an explanation of your benefits that you would receive after your provider submits a claim to your insurance company.
I hope this will help you in understanding about EOB. If you do have any other further questions please feel free to contact me via email or my contact form on my page and I will be glad to assist you. (You will receive an answer within 1 business day)
When the new healthcare reform took place so did the increase in more plans and networks that the payers, like BCBS started to offer to the members. Great! More people are covered and providers are able to see more patients.
However, the problem that the providers are running in is the fact that these plans have their own network. One of these networks is Pathway x Enhanced, offered by BCBS to the members that buy the insurance on exchange website.
Why is this a problem for the providers? Simple, Pathway X Enhanced network is exclusive to only certain providers that were selected for that network by the BCBS its self. But I am INN with my Local BCBS, can I join the Pathway X Enhanced network too? Unfortunately the answer to that question is NO. Why? Simply put there is a certain criteria that provider needs to meet in order to be in the Pathway X Enhanced network. You could also request the very complicated explanation from BCBS but if you have not received it in the early 2014. LOL
To avoid rejected/denied claims: train your front staff to recognize which patients have this particular coverage and double check the benefits for incoming patients BEFORE they come to the office-making sure that the incoming new patients have OON benefits and you are not incurring charges that you will have a hard time collecting.
Recently, I had a patient that contacted me, to inform me that her Employee Benefit Card was frozen since June. She was so distraught that she was not able to go to the doctor appointments because she was told we overcharged her for a visit.
What?! One thing that I value the most is honesty. “Fraud”- this word that does not sit well with me. I cannot admit or deny that I have seen any medical billing fraud, but it is something that I do not kid about!
Of course, I calmed her down and explained her that there is a perfectly good explanation why we charged her that specific amount for the visit instead of her usual copay. I assured her that I will get to the bottom of this and find out what is going on, and would contact her once I finish my research.
Anyway, after doing some research, I found out that we charged her for 2 DOS’s (dates of service), since she did not pay for her last visit. She used her card on that specific dos to pay for two.
However, what she nor I were aware of is that she cannot charge more than her copay per each visit.
Luckily, I was able to help this patient by sending an explanation along with the EOB, from her insurance, to the Employee Benefit Card Services. She was able to lift her suspension from the card and use it again.
The moral of this story: as a rule of thumb, use your Benny Card to pay only your copay and no more than that amount. Otherwise, you will be in the same situation as this patient and would have to go through the same ordeal.
As for Provider office front staff: make sure to charge only the copay for the given visit. Hint: if you have more than 2 people in the front desk it is extremely helpful to make a list of the patients that do have the Benny card, this way everybody in the office is on the same page!
Ok, so don’t panic! Starting October 1, 2015 ICD-10 is taking over. If you are already working as medical coder or biller in a medical office, you already know that every one is preparing for that very important transition!
Considering that there are going to be 68,000 ICD-10-CM codes and 87,000 ICD-10-PCS codes compared to 14,000 ICD-9-CM codes and 4,000 ICD-9-PCS codes available, will make you feel extremely overwhelmed!
Recently, I had the pleasure of meeting and with a Merk rep, Gina. I always get plenty of reps during my time @ Dr. Celina John’s Office. The visit is usually involves the doctor and the rep. However this time both her and I struck a coversation about medication coverage and pharmacies.
Although, I personally do not have this problem with pharmacies I found out from Gina that she was a victim of a pharmacy charging her a $120 copay for a medication (generic)?!
She, just like many other thousands of people has an exchange medical plan and until recently she thought that she would have no problem of using her local pharmacy for her medications. But to her suprise, she paid a whoping $120 copay for a medication that she thought had no copay at all. Why this happened? Well, it’s because that particular pharmacy was OON (out of network) with the particular exhange medical plan that she acquiered. What?! I personally do not know any doctor office that takes a copy of your pharmacy card. I always ask the patient for their pharmacy information-for escripts purposes.
In the end the moral of the story is that anyone that has an exchange medical plan please call the pharmacy number on your card and find out if a particular pharmacy you are going to use is INN (in network/ participates) with your plan. This way you will avoid those costly $120 copays, like Gina had to pay, and obtain your medication for low or no copay.
So, you got medical Insurance, YAY! And now the doctor you wanted to see is not in network with the plan?! But why?
Unfortunately, with the creation of the exchange plan a lot of providers find themselves out of network and members find themselves trying to find providers that will accept their insurance or lose their current provider.
So….. please check the availability of the provider for the plan BEFORE you purchase it! ****For every plan there is a plan description page and a link to its provider search.***
Hope this helps!
P.S. if you have any questions please feel free to contact me via email KR2medicalbilling@gmail.com (I will answer you within 24 hours)