OmegaTX Medical Billing Services | Healthcare Billing Services Houston, TX http://www.omegatx.com Medical billing services, medical coding, consulting & global management for urgent care, laboratory, pathology, gastroenterology & free standing emergency rooms. Thu, 23 Oct 2014 18:18:28 +0000 en-US hourly 1 http://wordpress.org/?v=3.7.5 Burden of High Deductible Health Plans http://www.omegatx.com/high-deductible-health-plans/ http://www.omegatx.com/high-deductible-health-plans/#comments Thu, 23 Oct 2014 18:16:38 +0000 http://www.omegatx.com/?p=817

2014

INCREASED BURDEN       PATIENT RESPONSIBILITY = down turn in provider revenue stream.

  • 44% of employers stated they would only offer high deductible health plans.
  • 87% of people enrolled through the Marketplace selected High Deductible Plans.
  • 45% of people wait greater than 30 days to pay a medical provider.

This is and will continue to be A VITAL PIECE OF A PROVIDERS REVENUE STREAM.

How to address this challenge:

  1. Create and Implement a Payment Collection Policy
  2. Deductible Collection UP FRONT.   At time service is rendered.
  3. Do not let payment arrangements accumulate make sure your Account Receivable is worked daily.

Hire OMEGA billing: Omegas percentage of clean claims accepted/processed by payers on first submission is 98%.  Omega has experienced AR professionals.  We invested in a robust system which provides daily work cues enabling us to balance bill within 10 days of receipt of insurance notification.  This translates to daily Clean up and resubmission when necessary.  Denials are worked timely as they come in.  Our Call Center follows guidelines to collect patient balances on your behalf  / we will follow your written payment policy. Omega will set agreed upon automatic electronic payment.

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What we know: Obamacare Renewals begin November 15th 2015 http://www.omegatx.com/know-obamacare-renewals-november-15th-2015/ http://www.omegatx.com/know-obamacare-renewals-november-15th-2015/#comments Mon, 11 Aug 2014 14:51:37 +0000 http://www.omegatx.com/?p=811

Advantages:

  • Small Business tax credit.
  • Can’t be dropped from coverage.
  • Individual tax credit subsidies.
  • Young adults insured to age 26.
  • All plans offer same set of essential health benefits.

Disadvantages:

  • Rates & Deductibles are going up 6%.
  • Networks are smaller.
  • Tax Credits are narrow.
  • 9.5% rule  increases to 9.56%  (employee contribution in large employer setting).

 

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MANAGE YOUR REVENUE CYCLE http://www.omegatx.com/manage-revenue-cycle/ http://www.omegatx.com/manage-revenue-cycle/#comments Thu, 26 Jun 2014 20:59:29 +0000 http://www.omegatx.com/?p=803

Take Advantage of ERAs and EFTs
Advantages ARE
Less time spent on payment posting
Fewer days on the books (Accounts Receivable)
Decreased labor Expenses
Removal of Lost EOB’s and or Checks
Reduce risk of Theft of your checks
Quicker Turnaround time to file on Secondary payors.

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Politics Behind Delay and Things TO DO!! http://www.omegatx.com/politics-delay-do/ http://www.omegatx.com/politics-delay-do/#comments Tue, 20 May 2014 16:25:05 +0000 http://www.omegatx.com/?p=799

A Political Compromise: Led to a 1-year delay in ICD-10.
A combination of volume growth and GDP slowdown have led to the Sustainable Growth Rate formula: Cuts to physician pay. Reminder, ICD-10 coding will capture a greater level of specificity for diagnostic information and offers the promise of greater insight from Data. The Delay affords organizations the chance to conduct testing and prepare themselves with financial reserves. Push your trading partners to verify they are ready. NO Assumptions.
Keep in Mind: Providers and Coders will work slower i.e. the time to pick the correct code & additional documentation requirements for the greater level of specificity. Estimates are that A/R days may increase in as much as 20 to 40%.
Last thought for Today: SET up a contingency plan — How should providers plan for the possibility that claim payment operations could be drastically slowed due to this change in coding?

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ICD-10 What to DO NEXT http://www.omegatx.com/icd-10/ http://www.omegatx.com/icd-10/#comments Thu, 24 Apr 2014 17:05:48 +0000 http://www.omegatx.com/?p=796

As you Know CMS assured organizations that the ICD-10 deadline would not change, Congress pushed the date back by at least one year to October 1, 2015. The reaction has left provider organizations wondering what to do next.

Navicure is offering a Webinar to clarify “What to do Next”
To learn what your organization should be doing with this additional ICD-10 preparation time by attending a free webinar sponsored by Navicure on Tuesday, May 20th at 12:00 pm CDT: ICD-10 Is Delayed – Now What?

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GEM ???? http://www.omegatx.com/gem/ http://www.omegatx.com/gem/#comments Tue, 18 Mar 2014 20:30:44 +0000 http://www.omegatx.com/?p=794

GEMs ARE NOT A “CROSSWALK”   they are a guide.  All users should exercise CLINICAL judgement when choosing the appropriate code or codes to map between ICD-9 and ICD-10.  In Laymans terms:  THE GEMS are not a substitute for a COMPLETE system Change to ICD-10. 

Get your PHYSICIANS involved.    As you know VISIT your resources  like the CMS website, for more information.

Manage your REVENUE CYCLE be prepared for payment issues, Coding errors etc. 

Clearing houses & Billing Service Providers are a sure fire way to assist you in navigating this new territoy

Contact Omega Billing Service  (281) 358-4900  for information on how to become a Client.

 

 

 

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Implementation: Clearinghouse http://www.omegatx.com/implementation-clearinghouse/ http://www.omegatx.com/implementation-clearinghouse/#comments Thu, 20 Feb 2014 16:11:17 +0000 http://www.omegatx.com/?p=767

ICD-10 | Medical Billing & Payers
ICD-10: OCT. 1, 2014:
Are YOU READY OR NOT ?       Implementation
Clearing House:::::
Things to ask

1. Do you anticipate any pricing changes for your services due to the switch to ICD-10?
2. Where is your organization in the transition process?
3. Have you updated your system to Version 5010 standards?
4. What are your plans for testing claims containing ICD-10 codes? How will we be involved in this process?
5. Will you provide training on clinical documentation changes to support ICD-10?
6. When can we send test claims?
7. Can we set up regular meetings to track progress?
a. Involve your committee members; assign tasks and circle back to verify completion.

Conduct testing of transactions with ICD-10 codes.

Resource:
www.cms.gov/…/ICD10/…/ICD10SmallandMediumPractices508.pdf
ehrintelligence.com

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ICD-10 TRAINING http://www.omegatx.com/icd-10-training/ http://www.omegatx.com/icd-10-training/#comments Wed, 12 Feb 2014 16:14:08 +0000 http://www.omegatx.com/?p=768

ICD-10 | Medical Billing & Payers

ICD-10:   OCT. 1, 2014: 

Are YOU READY OR NOT LETS TALK TRAINING

One Cannot prepare enough–   

GET ON THE TRAIN                          

TASK: 

1.    Identify staff members ( including clinical staff) who need training on ICD-10

2.    Identify the level of training each job function will need

3.    Identify the one expert on ICD-10:  THAT PERSON IS YOUR TRAINER……

4.    Create a training plan for each job function

5.    Begin staff training in group settings by job function or areas of use i.e. back office, front office, ancillary

6.    Incorporate the ICD-10 training into new employee orientation program

7.    Implement at a minimum Quarterly ICD-10 review sessions after training is complete.

Conduct testing of transactions with ICD-10 codes. 

Start discussion of establishing A proper credit line w/ an implementation date to cover interruptions or delays in claims processing & reimbursement

Resource:

American Medical Association (AMA) ICD 10 fact sheet etc.   www.cms.gov/…/ICD10/…/ICD10SmallandMediumPractices508.pdf

American Academy of Professional Coders (AAPC) ICD10 Code Translator

 

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ARE You ready or NOT? Step one PLAN & Assess http://www.omegatx.com/ready-not-step-plan-assess/ http://www.omegatx.com/ready-not-step-plan-assess/#comments Wed, 05 Feb 2014 21:58:49 +0000 http://www.omegatx.com/?p=762

ICD-10 | Medical Billing & Payers

Are YOU READY OR NOT ?

Step one Plan & Assessment

PROJECT PLAN:
Gain an overall understanding of the impact headed your way. Go to Professional Associations. ie. AMA, AAPC, AAFP, APMA, etc.

Become familiar with ICD-10 requirements & tools to assist you.

Human Capital Investment: Identify your project manager and key personnel to work in conjunction with him/her. Set meeting dates: stay on task.

Set a preliminary budget for this team. I.e. project hours/resource purchases etc.

Team: Develops project plan based on the following categories:

  • Impact Assessment
  • Implementation
  • Training
  • Conversion & Monitoring
  • Budget/Credit line

IMPACT ASSESSMENT:

  1.  Create a list of your practice electronic systems including written protocols that use ICD-9.
  2. Create a list of Vendors , include contact person, phone number and email addresses
  3.  Identify staff who work with ICD-9 ( for training purposes )
  4. Identify work-flow interruption and or changes that will take place with this implementation
  5. Identify billing company/ clearing house(s) and payer contact persons. Name, phone no. and email address.
  6. Contact each vendor to determine their implementation plan. (Contracts renegotiation–Testing periods–Identify downtime software updates & plan accordingly)
  7. Identify & Modify work flow protocols i.e. data collection processes, data reporting processes etc.
  8. Establish internal testing and document success and or areas of correction/improvement, based on dates each vendor has begun testing within their own implementation plan.
  9. Determine If you do not have a reserve of cash flow, establish a line of Credit, be prepared for changes in reimbursement and or possible payment lag time.

Resource:
American Medical Association (AMA) ICD 10 fact sheet etc. www.cms.gov/…/ICD10/…/ICD10SmallandMediumPractices508.pdf
American Academy of Professional Coders (AAPC) ICD10 Code Translator

Monday, January 27th 2014

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ICD-10: OCT. 1, 2014: Are you ready or Not? Will All Payers Comply? http://www.omegatx.com/icd-10-oct-1-2014-ready-not-payers-comply/ http://www.omegatx.com/icd-10-oct-1-2014-ready-not-payers-comply/#comments Tue, 21 Jan 2014 18:42:23 +0000 http://www.omegatx.com/?p=759

ICD-10 is revealing some of the more obscure nuances of the Healthcare industry. While all providers and clearinghouses must comply with ICD-10 regulations as ‘covered entities’ under the Health Insurance Portability and Accountability Act (HIPAA), not all payers are required to. Worker’s compensation (WC), disability insurance, and auto insurance payers are not covered by HIPAA, and therefore not required by the federal government to adopt ICD-10 codes.

The Centers for Medicare and Medicaid Services (CMS) is encouraging these payers to transition to ICD-10 but with potentially high costs associated with a changeover, some WC and MVA payers may not take part.

Contact your vendor ask if your EMR/Practice management system will be able to accommodate both ICD-9 and ICD-10 codes until all claims for services before October 1, 2014, have been processed and completed. Ask when you will receive the enhanced software version aka: upgrade. Do they plan to roll out Web training?

Prepare an action plan. Promptly processing your ICD-9 transactions as the transition date nears will help limit disruptions and will limit the timeframe when dual code sets need to be used.

Omega Billing Service is ready and willing to assist you with the transition. We prepare by educating our clients. We ensure protocols are written and adhered to. We invested in State of the art Software and most importantly “Human Capital”. We believe hiring the right people for the right job is one important way to excel in the ever changing world of Healthcare.

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