xNoWVvLMQqahOUkpcSvNfFfwSurNwH: November 2012

Tuesday, November 27, 2012

Handling Denials For No Coverage or Coverage Terminated

One of the most important parts of billing is handling denials. Many providers' offices don't handle denials and end up losing thousands of dollars a year as a result. In fact, I saw a statistic once that said that 47% of denied claims don't ever get appealed. That is outstanding! Obviously based on that statistic the insurance companies have a great incentive to deny claims.

There are three reasons that denials don't get appealed. The first is that the denial is correct and there is nothing to appeal. In that case, there is nothing to be done except bill the patient if that is appropriate. The second reason is because the person responsible for handling the denials doesn't have the time to handle them. This problem can be rectified. If the right systems for handling denials are put into place then they can be handled in less time. Most time spent on denials is figuring out what to do about them, which brings us to reason number three.

The third reason that denials don't get appealed is that the person responsible doesn't know what to do about it. Many times they understand what the denial is for, but aren't sure what steps to take to rectify it. So over the next several months we are going to be covering the most common denial reasons and how they can be handled.

One denial that is very common is "denied for no coverage or coverage terminated." Seems pretty straight forward. But what do you do? There are actually a couple of things. First of all, receiving this denial does not mean that it is correct. Our local BCBS denies claims for this reason more often than I use a restroom. Many times it is just because BCBS issued the patient a new ID number or changed just the 3 letter prefix. It can actually be quite frustrating. If we receive a denial from BCBS for this reason we go to the BCBS website and do a search on the patient. In most cases we can pull up the correct ID number and resubmit the claim.

If the denial is for a company that does not have those issues, the next thing I do is look at the patient's claim history. Has the payor been making payments but suddenly stopped? In some cases the payor may have paid claims before and after the date of service they are denying. In that case a call must be made to the insurance carrier to question the denial. Hard to believe but they actually do make mistakes! (sarcasm)

Lastly, if the denial appears correct, or if we cannot find any additional information through the website or a phone call, then the patient must be contacted. Usually we send out a patient statement with the charges, and a note stating "Your insurance carrier states your coverage was terminated. Please contact

our office with updated insurance information." Many times patients forget to notify the provider when they do have an insurance change. Receiving a bill will prompt them to notify you. Usually they call us and give us the updated information over the phone and the claim can get resubmitted.

The most important thing here is that you come up with a system that you will use every time you receive this denial. That way you won't waste time trying to figure out what to do each time, and the denial will get handled promptly. If you do this for each denial you receive, all denials will be handled and it will cut down on losses.

How To Keep Up With So Many Changes in Medical Billing Maximize Your Medisoft! (Unknown and Underused Functions of Medisoft) Is the Job Growth Affected by the Existence of Software That Handles Medical Billing and Coding? General Overview of the Medical Billing and Coding Process

Checking Benefits and Eligibility on Patients

Whether you are working in a medical office or in a billing service you may be required to check with insurance carriers on eligibility or benefits on patients. Certainly in the medical office someone should be checking on the eligibility of each patient and what their benefits are or else that office is probably losing a lot of money. Some medical billing services offers this as part of their service. There are several ways this can be accomplished depending on insurance carrier and each individual office. And there are a few important questions to ask.

Generally when a new or returning patient comes to a medical provider they bring along their insurance identification card. The person responsible for checking them in should then check with the insurance carrier to insure the information on the card is up to date and correct. This can often be accomplished by checking the website of the insurance carrier or calling a representative of the insurance carrier. Some clearing houses are also capable of checking eligibility.

A primary care provider may be interested only in whether or not the insurance is in effect at the time of service and the patient's responsibility whether it be copay or coinsurance for a primary care visit; where a specialist needs to check to see if the copay for a specialist is different from the copay of a primary care physician. A specialist also needs to verify if their services will require a referral or pre-authorization.

Providers seeing Medicare patients definitely need to check with the carrier prior to seeing the patient as coverage with a Medicare Managed Care Plan can be very confusing to the patients. Many Medicare patients will tell you that they have Medicare and show you their Medicare ID card and not realize that they are enrolled in a Medicare Managed Care Plan. You can save a lot of delays in getting your claims paid by checking while the patient is there to see if they gave you the correct insurance information.

Appointments for new patients are generally set up in advance and the insurance information should be collected then. This gives the office time to check the information prior to seeing the patient. It is important to know what the patient's financial responsibility is before seeing the patient as it may be more than the patient expects and they may not be happy with a surprise. There are many things that can influence the patient's responsibility such as whether or not the provider is in network, is the patient has a deductible and the type of provider providing the service.

It is best to have a form in front of you when checking for eligibility and benefits so you make sure you don't forget an important piece of information. We have a form we have designed just for this purpose which you are welcome to download. This form can be stored in the patient's file for future reference. You can download our benefits and eligibility form at our website.

HIPAA 5010 - What It Is and How It Will Affect You

This is a basic breakdown of the HIPAA 5010. There are much more technical requirements, information and explanations.

Well, most of you should know what 5010 is and how it will affect you. If you don't you must have at least heard about it. It seems that all insurance carrier publications are overflowing with confusing information on this transition and the quickly approaching deadline. So we are going to try to break it down for those who still don't really understand what it is and if they need to do something.

First - what is it? HIPAA 5010 is a federal mandate that requires health plans, clearinghouses, and providers to use new standards in electronic transactions including claims, remittance, eligibility, and claims status requests and responses. HIPAA 5010 is an upgrade from the current mandate, or HIPAA 4010A. The new mandate is supposed to increase transaction uniformity and streamline reimbursement transactions.

The deadline for this new mandate is January 1, 2012. All affected organizations and providers should have long ago begun at the very least testing if they are not already compliant with the 5010 mandate or as Ingenix says "As the deadline approaches, affected health care organizations need to upgrade and test their claims management systems to accommodate 5010 and prevent operational disruptions." This means that if your current software is not compliant with 5010 then you will need to upgrade. And before we reach the deadline you will need to have tested your system to make sure it is compliant. Not doing so before the deadline may result in "operational disruptions" or in terms the provider will understand, mess up the accounts receivable.

So how do you know if you need to do something to prepare for HIPAA 5010? Well, if you submit all claims on paper and you don't receive any ERA's then you don't need to do anything. HIPAA 5010 is for electronic transactions only. That was pretty easy.

If you do submit claims electronically or do receive ERA's then you need to see if your system is compliant. Most people submit claims through a clearinghouse. If you use a clearinghouse then you need to check with your clearinghouse to make sure they are compliant or to see where they are in the testing phase. Most of the major clearinghouses are prepared. You should also make sure that the practice management system that you use to create your electronic batches is going to be compliant as well. Make sure there is nothing that you need to do on your end.

If you receive your ERA's through a clearinghouse, again you just need to make sure that they are compliant or are on track to be compliant. If you receive any ERA's directly from the insurance carriers you should check with them to see if there is anything that you need to do on your end.

Some providers or billing services submit claims using their own software as a clearinghouse. If you are one of these people you will need to make sure your software is updated by checking with your vendor.

Chances are by now your vendor should have contacted you with information but if they haven't you shouldn't wait. Contact them ASAP. Ask if there is going to need to be an upgrade to your system. Ask if the upgrade has already passed testing. Do not wait until you find out you are not compliant. Call and ask.

Don't be intimidated by all the confusing information that you are being bombarded with. If you receive something that you don't understand and you are worried that it does affect you, call the sender and ask for an explanation. Check your current system and make sure you are ready.

Proper Use of the 59 Modifier

Many people do not really understand modifiers and when they need to be used. A modifier should never be used just to get higher reimbursement. It shouldn't be just added on to get a code paid. Modifiers should be used when they are required to describe more accurately the procedure performed or service rendered.

The definition of the 59 modifier per the CPT manual is as follows:

Modifier -59: "Distinct Procedural Service: Under certain circumstances, the physician may need to indicate that a procedure or service was distinct or independent from other services performed on the same day. Modifier 59 is used to identify procedures/services that are not normally reported together, but are appropriate under the circumstances. This may represent a different session or patient encounter, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries)not ordinarily encountered or performed on the same day by the same physician. However, when another already established modifier is appropriate, it should be used rather than modifier 59. Only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used."

The 59 modifier is one of the most misused modifiers. The most common reason it should be used is to indicate that two or more procedures were performed at the same visit but to different sites on the body. Unfortunately many times it is used to prevent a service from being bundled or added in with another service on the same claim. It should never be used strictly to prevent a service from being bundled or to bypass the insurance carrier's edit system.

It should also only be used if there is no other more appropriate modifier to describe the relationship between two procedure codes. If there is another modifier that more accurately describes the services being billed then that modifier should be used over the 59 modifier.

When using the 59 modifier to indicate a distinct and separate service, documentation should be in the patient's medical file to substantiate the use of the 59 modifier. The insurance carrier may request medical records to deem if the 59 modifier is being appropriately used. If a provider is going to bill using the 59 modifier they need to make sure they are documenting the services provided in the patient's file, showing that the services were distinct and separate.

Use of the 59 modifier does not require that there is a different and separate diagnosis code for each of the services billed. Also, just having different diagnosis codes for each service does not support the use of the 59 modifier.

An example of appropriate use of the 59 modifier might be if a physical therapist performed both 97140 and 97530 in the same visit. Normally these procedures are considered inclusive. If the 59 modifier is appended to either code they will be allowed separately. However, the 59 modifier should only be added if the two procedures are performed in distinctly separate 15 minute intervals. If the therapist does the codes simultaneously then the 59 modifier should not be used.

Another example would be if the patient is having a nerve conduction study with cpt codes 95900 and 95903 being billed. If the two procedures are done on separate nerves then the 59 modifier should be used to indicate that. If the codes were performed on the same nerve then the 59 modifier should not be used.

Billers should never add the 59 modifier to a claim even if they know that billing the services without the modifier will result in bundling or a denial. The 59 modifier should only be added by the provider or by a coder who has access to the patient's chart. If you are the biller and you believe that the 59 modifier would be appropriate but it was not indicated, you should go back to the provider to see if it was omitted by mistake. Don't just add the modifier to the claim.

New Healthcare and How It Will Impact Medical Billing

Radiology practices and imaging centers face many threats to their profitability. Radiology billing is becoming even more complex, and reimbursements are steadily decreasing. There are three key challenges you'll need to understand and address for your radiology business to thrive in the coming years.

The future is less.

Bundling of services and codes has already resulted in lower (and in many cases significantly lower) reimbursements for providers. Some revised codes carry lower RVUs, reflecting the belief that those services were previously "misvalued" (overpriced).

The Medicare Payment Advisory Committee (MedPAC) recently recommended measures to further reduce imaging reimbursements, including lowering the threshold for bundling review from 75% to as low as 50%, reducing professional component payments for multiple procedures and studies conducted by the same practitioner during the same session, and discounting payments for providers who both order and read images.

Some "thought leaders" (see the Radiology Business Journal June/July 2011) think that professional component reimbursements are likely to decrease another 30% over the next five years.

Complexity is increasing.

Impending new coding procedures will affect both clinical and business operations. New compliance requirements will further affect radiology billing procedures. And then there's the move toward more electronic data standards and requirements.

With ICD-10, coding isn't simply being refined and updated. New codes will be longer, and there will be a lot more of them. RVUs will be different, too. Since you won't see much matching between ICD-9 and ICD-10, your staff will have to figure out how to accurately "translate" to the new world.

Of course, we can count on the government to keep working to "correct" pricing, uncover new bundling opportunities and eliminate overuse of procedures. You'll also see more emphasis on linking radiology billing and reimbursements with outcomes measurements, expanding on initiatives such as PQRS (was PQRI).

Change is the new normal.

Your in-house costs are going up.

Daily operations costs will keep increasing, and incorporating new radiology billing requirements will add cost pressures to your financial situation.

Coding and billing staff will have to learn an exhaustive new ICD-10 coding system very quickly. Even after the October 2013 change-over deadline, providers will have to continue processing ICD-9 codes for services rendered before the deadline. Since payors will have an extended deadline, you may face additional "dual" processing issues. This will create more work for your staff and possibly unwanted reimbursement consequences, too.

New, more involved ways to link financial data to reimbursement will require more sophisticated technology and better trained staff. Failure to accurately document patient data, including benefits details, could result in increased denials, even fines.

Annual planning and budgeting may be tougher, because the ICD-10 timeframe doesn't announce changes until October, giving you less than three months to prepare for the next fiscal year.

These radiology billing challenges mean even more attention to the ever-changing coding and compliance requirements. And you'll have to manage the business side of your practice or center smartly and efficiently to remain competitive and prosper.

Baby Boomers Take On the Digital World

Seniors hear a lot about "Gaps" these days. There's the Medicare Gap (which often leads to the need for Medicare Supplemental Insurance coverage), the Employment Gap (seniors who want to stay in the workplace are often finding it harder to do so), and there's the Technology Gap, which is basically the belief that Baby Boomers can't keep up with the tech changes embraced by Gen-Xers and Millenials. Well, Baby Boomers are proving that "Gap" to be a bit of a myth.

Baby Boomers and technological innovation go hand-and-hand, and others are finally starting to realize it. In many cases, it's simply a question of numbers. Despite the "employment gap" we just mentioned, large numbers of Baby Boomers are still running major companies all over the world. In that capacity, they're dictating the course that technology takes. Other important numbers involve the all-powerful "$." Baby Boomers are still major consumers, and in some cases they're the ones who can most easily afford the latest tech products flooding the market.

Of course, Boomers are closing the technology gap in purely social ways, as well. Check out Mashable's How Baby Boomers are Embracing Digital Media and you'll see just how quickly Boomers are growing their numbers online:

"Social network use among Internet users 50 years old and older has nearly doubled to 42% over the past year. In fact, in the U.S. alone there are nearly 16 million people 55 and older using Facebook."

So, let them keep throwing out the latest "Gap" and telling the world where Boomers are lagging behind this time. You know the truth. It's a digital world, and we're not going to just sit on the sidelines and let it pass us by.

About Medigap Supplement Insurance

Medicare Supplemental Insurance, or Medigap Insurance Plans, are not an alternative to traditional Medicare like Medicare Advantage Plans, but instead work with traditional Medicare. Also, Medigap Insurance Plans differ from Medicare Advantage Plans as they have no deductibles, no co-pays and no network restrictions as to where you can receive medical treatment.

Most Medicare Insurance recipients could save money by switching to the same plan with another company. However, most people covered by Medicare Insurance pay more than they should for their Medicare Supplemental Insurance Plan. The reason is that they simply don't shop around. By shopping multiple companies many could get the exact same coverage at a lower rate.

If you choose the right Medicare Supplement Plan (like Medicare Supplement Plan F) you will never have to pay a single dollar when you receive treatment in a physician's office, hospital or specialty treatment center that accepts Medicare.

Medigap Insurance Costs differ between Medicare Supplement Insurance Companies for the same coverage. This is why it is important to work with a Medicare Supplement Broker who will help you find the best Medigap rates and plans.

How Much Money Can I Make As A Medical Insurance Biller And Coder?

How much money you can make as a Medical Insurance Biller and Coder is one of the first questions people ask who are interested in taking medical billing training. I've included coding here since some many schools combine billing and coding courses and programs now and there are good reasons to be familiar with how to do both.

You may not need to do actual coding if you are a biller but you will need to understand codes. Likewise you may not need to know how to do billing if you're a coder. This is all going to be dependent on the company that hires you and there are hundreds of variations related to a job as a medical insurance biller or medical coder.

The amount of money you'll make or your wages and salary as a Medical Insurance Biller and Coder will depend on how much education you've had and what kind of medical billing training and how much experience you've had. You may make more money in a billing service that focuses on medical billing than you would if you worked in billing in a doctor's office or even a large medical office.

The salary range can vary a great deal from $25,000 on up. If you start your own medical billing service you'll make more money perhaps once you have the clients but you'll also have more expenses and overhead to contend with. And getting those first clients will not be easy.

You can work part-time and full-time in billing claims services. Many opt to work part-time to get their foot in the door and gain some experience then approach large companies and offer their resume, experience and services.

What your salary or wages will be shouldn't be the only criteria for working in medical billing and coding. You want to make sure you'll like the work and would be happy. Also you want to get your training in the minimum amount needed and without paying a lot of money outlay before you know that you'll like the work and be happy go to work every day.

You can call your local billing services and ask for the Human Resources Department and ask what the pay averages for a Medical Insurance Biller and/or Medical Coder. Some areas of the country pay more money than others and you'll get a good idea if this field is the best fit for you in terms of salary.

What Medical Billing Job Ads For Specialists And Medical Billers You Should Look For

If you've spent any time looking for a medical billing job you know that there are a wide variety of jobs that could fit the bill. Oftentimes it's not clear in the title of the ad what they're looking for. But after looking at ads for many months I've found there are a few important things to look for.

The most important thing I think is once you've found the medical billing ad or billing specialty ad, whether it's on Craigslist on in your local newspaper, is to read the ad all the way through. They're looking for the best person they can get with the experience they want. They will start out asking for certification or an associate degree or related education but if you read the entire advertisement all the way through they often say they'll exchange experience instead.

I recently read one ad that strongly asked for medical being certification or an associate degree but farther on down the ad clearly said they would exchange that for experience. Many people by that time may have tossed the ad aside or closed the window on Craigslist.

Employers are really trying to find someone capable of doing the job and are less interested in the medical billing certification or degree. Experience is what they need and they don't care how you got it. Often someone with experience will outdo someone with the degree in that field who has little medical billing job or career experience.

Let's say you've found an ad for a medical biller or related job. Perhaps you have some office experience and it's in the insurance or health fields. You may have worked with billing somewhat so it's certainly worth pursuing. I would submit a job application and detailed resume focusing on your experience that is related for that job. They may not be able to find someone with the medical billing certification or college degree they're looking for.

It can be discouraging sometimes when looking for a job or maybe you're just scouting out what type of ads are out there for billing specialists or medical billers or assistants. But if you're serious about looking for a medical billing job I would apply to any that sounds within reason. Others may be too discouraged or don't think they have enough experience to even apply. It's always worth a try. As they say - nothing ventured nothing gained. You have nothing to lose and will gain more experience in the job application process.

International Traveling and Your Health

This is the time of year when many people travel, some internationally. If you plan to leave the country, you may want to consider the following when it comes to your health:

- You may not have health insurance coverage for illnesses or injuries that are treated abroad, even if you have US based medical coverage.

- Medicare does not provide coverage for hospital or medical costs incurred abroad.

- Senior organizations can assist with obtaining foreign medical coverage for Medicare supplement plans.

- US consulate personnel will help you locate health care providers and facilities and even contact family members, if necessary.

- You can purchase travel insurance that covers health care needs and pays for medical evacuation if you need to be transported back to the US for treatment.

Obtaining medical treatment in another country can be expensive and a medical evacuation can cost over $50,000. Plus, any medical bill and claim resolution which may be needed to decipher charges may be difficult to do while abroad.

Other Considerations

If you are older or have a disability and will be traveling out of the US, there are other things to consider:

- The conditions of the local area. For example, is there any local topography (like high altitude) or climate conditions (hot and sticky) that may have an effect on you?

- Your own preparations. Avoid a lot of physical activity when you are getting ready for your trip. Realize that sudden changes in diet, climate and physical activity can have serious health consequences for an unseasoned traveler.

- Find out what you can about the standards of accessibility for travelers with disabilities in the country where you are going. Also, the Department of Transportation has published two informative pamphlets: New Horizons for the Air Traveler with a Disability and Plane Talk: Facts for Passengers with Disabilities, that will help you.

For any situation, speak with your physician about your general physical condition and the activities you are planning to do while on your trip. This discussion should include decisions on any medications you are taking and immunizations that may be required.

In addition, if you have medical expense coverage and you are travelling out of the US, contact your insurance plan representative to see if you are covered. If not, decide whether you need to purchase a travel insurance and/or a medical evaluation policy.

There is more information available on this topic at the US Department of State site: http://www.travel.state.gov.

Effective Marketing for Your Medical Billing Service

Marketing is the hardest part of medical billing for most owners of medical billing services. Billing, entering charges and payments, submitting the claims, following up on denied or unpaid claims, that's the easy part. Getting the clients is usually what holds most people back. Dan Kennedy (a very successful marketing consultant) says that "marketing is not something you learn, it's something you do". He's absolutely right.

We all know ways to market. Some are easier than others, some cost more, some require us to get out of our comfort zone. It's not that we don't know marketing techniques. In most cases it's that we really don't like to market. Nobody likes rejection. I don't think anybody gets up in the morning and says "Yes! I should get about 20 'no's' today!" So we avoid it. But it is a very necessary part of a successful billing service.

Avoiding marketing only hurts ourselves. It doesn't hurt the providers we aren't marketing to. Unless you truly believe that you are the only billing service out there that can provide the service to get them reimbursed all that they are entitled to. Avoiding marketing prevents you from growing, and taking your business where you want it to go.

OK, so we've established that marketing is a necessity to grow your business. So what can one do to make marketing less painful? Well one strategy is efficiency. If you develop your marketing to target providers that will most likely be interested in using your service you will reduce the number of 'no's' you will get. For example, if you specialize in a certain field then you would want to target your efforts in that field since you can use your expertise in that field as leverage.

Another way to make your marketing efforts more efficient is to do some research about the providers you are going to market to. If you have some clients, you can ask them if they have any colleagues that they feel may benefit from your services. Doctors talk to each other. They know who is having issues in their offices. If you are doing a good job for your doctor, they should be willing to refer you to others. Make sure you ask if you can use their name. It always helps to say "Dr. Soandso suggested that I contact you."

The best way to make marketing less painful is to do it smart and make your marketing efforts more effective.

Patients Have Options for Their Medical Procedure Financing

Today, there are numerous services offered to patients to make their life more convenient. Among them are the options for medical procedure financing. This medical service gives the standard terms concerning the method and treatments for the patients financing plans. Some of the these medical procedures include dermatological procedures, cosmetic dentistry, DNA testing, hair restoration, and many other medical treatments.

Additionally, most of these medical procedure financing services provides credit medical which offers financial aid for eligible patients. Applying and registering in these methods is done through a very simple process. At the same time, it also gives several benefits to people. As a matter of fact, it can arrange interest rate with a repayment option and can definitely secure privacy.

On the other hand, applying for medical procedure financing requires an ICD-9 which can be obtained from the physician. By doing so, the healthcare company can effectively secure every patient's billing. In that case, it is advisable for every patient to inform the insurance company regarding the overall coverage of the methods incorporated into these medical codes. Furthermore, it is also equally important to contact a state's welfare facility to check the patient's eligibility.

In addition, patients can also place their medical billings to a credit card. Moreover, there are also many healthcare establishments that provide credit which can be really beneficial to all patients. Most of the time, promotions are even offered without interest as well. This is conventionally done with a local bank where various options can be chosen such as personal loans.

Furthermore, these healthcare financing methods are available for a large number of health issues. There are also lenders that can assist people with their healthcare loan. However, for those individuals who wish to begin a particular treatment, but don't have the money for it, will need to discuss it with the physician. On the contrary, there are limitations to every credit before a patient can be eligible, though these limits ranges from people based on several aspects.

However, for those individuals who need a fast approval for a healthcare financial aid because of some critical emergency, may get assistance by a health insurance. In contrast, the service may vary based upon the conflict and financial requirements. As a result, it is necessary for people to discuss the matter with a medical associate to determine the most effective billing options. Moreover, every patient will be updated with the procedures concerning all necessary medical documents.

Incompetent Medical Management - Who Cares?

Everything in medical field is about knowledge, professionalism and experience. And this statement should apply not only to medical, but to administrative staff as well at any level of medical practice: would it be hospital, rehabilitation center, hospice, nursing home, physician office, treatment center, etc.

Administration, managers, support specialists, clerks and front desk secretaries, all of them, have to have knowledge of the policies, rules and regulations specific to their level of responsibilities.

Well, sometimes, one can even see total or partial opposition of the professional knowledge in action, and it's very unfortunate. I want to share just one of many examples I had encountered.

Recently my daughter had needed an X-ray. We went to one of well known in our region chain-diagnostic centers, where I, by chance, overheard conversation between medical manager of the facility and front desk receptionist/ billing clerk. Girl who enters patient information into the system asked manager a question regarding ABN form and in what instances it suppose to be filled out. Manager told her that:" ABN form has to be filled by Medicare patients when DEXA (bone density study), or chest X-ray needs to be done, because Medicare pays only 80% of the allowed fee, so they have to collect other 20%".

I was surprised hearing this kind of answer from the manager, who, I thought, should have some kind of understanding of why we fill out certain forms.

Is it purposeful misleading or honest incompetence?

The correct answer to that question had to be:

ABN form is filled when Medicare patient receives procedure that is not covered (or may not be covered) by Medicare policies.

It has nothing to do with Medicare paying 80% of allowed $ amount. Since all MCR patients know that they are responsible for the deductible, co-insurance and co-pay, depending on supplemental coverage.

Then why MCR patients filling out ABN forms at this facility?

By regulation MCR pays for only 1 DEXA in two years. It should not be performed more then once in two years because there would not be significant changes in less time, except when patient takes certain drugs that could affect the condition. However, in case of the later MCR would pay for the test. Which means, when patient comes to do DEXA nobody knows (or disregard the knowledge) when last time this kind of test had been done for that patient. It means, that physician who refers patient to do DEXA might don't pay attention to the date when last time test had been performed, ordered test that is not medically necessary and patient would end up paying for it. What's interesting that patient would not even know that test is not that necessary.

Moreover, the actual MCR payment fee is not that big, but facility might charge their established fee that could be pricy for patients. Especially, when we are talking regarding MCR patients.

So we came to unfortunate conclusion: the patient must have some knowledge about medical rules and regulations. Otherwise there is a risk to be ripped off by incompetent or simply unfair medical practice.

Medical Insurance Quotes - Things That Can Affect Your Premiums

Medical insurance quotes are available online to anyone who is need of such coverage and does not want to have wait ages in order to find out how much it is going to cost. However when obtaining these types of quotes there are certain things that need to be considered.

The first of these being their medical history and the other is what insurance company they should be using. Should they go with a better-known large company or a much smaller relatively unknown one?

When you do decide to get medical insurance quotes you must understand that your medical history will dramatically affect how much you pay. Also the quote you get online will only be accurate if you provide specific and accurate information about your current health and previous health problems you may have suffered from. If any of the information that you provide is incorrect then this will change how much the quote is immediately.

Certainly for anyone who suffers from or has suffered from a major illness such as cancer or heart disease the premiums to be paid will be much higher. Also you are likely to find that the level of coverage provided is sketchier. Therefore it is wise to speak to an agent so that they can fully explain the conditions of the policy relating to such illnesses in far more detail.

When getting medical insurance quotes you can go to any insurer you want. However the policy will be completely useless if the company you go to isn't reputable. Make sure that you always select companies where they have received good ratings in relation to customer satisfaction and who have been involved in this area of insurance for a number of years.

Also make sure that you obtain several medical insurance quotes so that you can compare each one. It is important that you don't only look at the premiums being charged but what sort of coverage they offer. This way you can make a more informed decision with regards to policy you take out and it will help to ensure that you find a policy, which meets your needs, the best.

Tuesday, November 27, 2012

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