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Category: Insurance

Insurance,Claim,Form
October 5, 2022 by smallcrowd 0 Comments

If a healthcare patient’s claims are denied, not only will they often wonder why claims are not being processed, but they may still submit claims that are inaccurate. Here are some of the common reasons that claims are denied.

Top Reasons Why A Claim Is Not Being Processed

Missing Or Incomplete Patient Info

An incredible portion of claim denials are administrative or clerical in nature and originate at the front desk. This means things like patient data oversights, such as a missing patient subscriber number, missing date of birth, and incorrect insurance eligibility are all routine reasons that a claim is denied. 

Basic Claim Form Errors

A huge portion of claim rejections is known to be caused by “simple errors” in either the patient data or in the procedure codes. This can be something as simple as a misplaced letter in the last name, or a patient ID number having two digits transposed. These errors are usually very quick and easy errors to fix, but they stretch out the revenue cycle, so they should be avoided if at all possible. 

Lack Of Official Documentation Supporting The Claim

Claims that have a component of medical necessity will need documentation or records that support that designation. In situations like this, the payer will often require additional support documents that not only illustrate medical necessity but also support the level of service.

Insufficient Medical Necessity

Even when substantial amounts of documentation and medical records are provided, occasionally a payer will simply decide that a procedure or treatment isn’t medically necessary. This can be a difficult situation for everyone involved, but in some cases, it can be avoided. 

 

The best way to fight insufficient medical necessity denials is to have good communication between your clinicians and coding staff. When a claim is denied, for this reason, the doctor’s office or provider may be forced to absorb the treatment cost, or they may be able to collect the full amount from the patient, which isn’t very likely. 

Pre-Authorization Or Pre-Certification Was Not Obtained

There are many situations that warrant getting pre-authorized to perform some type of care. Knowing which insurers require pre-authorization and what they require to authorize coverage is essential for your coding and billing team. Depending on what coding or billing software is used, there may even be built-in measures for highlighting certain procedures and special insurers.

Claims Filed After Deadline

With all of the different insurers out there, it’s no surprise that many of them have different deadlines for submitting claims, and have varying degrees and policies for exceptions when deadlines are missed. Some payers can fix a missed submission with a quick phone call, while others will require a more clerical and administrative fix by having you fill out some paperwork to get the issue fixed.

The Provider Used Was Out-Of-Network

Insurance companies and their networks can change drastically from one year to the next, and while many patients don’t realize it, this includes the various doctors and healthcare providers they have partnered with. To be sure that claims, benefits, and payments are made in full for your treatment and doctor’s appointments, use a doctor or facility that is in-network. While this may not mean that everything is covered, significantly more of the services that you need will be able to be obtained in this way. 

Prevent More Denials With AMS Solutions

Your billing matters and claims denied for simple and preventable mistakes. Ensure that your medical billing support is all properly trained in the methods that your biggest payers require by partnering with AMS Solutions.

August 11, 2022 by smallcrowd 0 Comments

Contracting with insurance companies can be a tricky business for a healthcare provider, but it doesn’t have to be. With the right information, you can make sure that your company is not only covered but also that you are getting the best possible deal. There are many aspects to consider when contracting with insurance and there are many different types of insurance providers and plans.

Healthcare providers should always contract with Medicare or Medicaid. These two insurance providers are a good option for anyone entering the healthcare field because they give you a lot of leeway in terms of what you’re allowed to charge. In other words, if you don’t have experience, these two insurance providers will give you the opportunity to build it.

What is a Medicare/Medicaid Contract?

A Medicare/Medicaid contract is a legal document that outlines the terms and conditions of a business agreement between a healthcare provider and an individual, organization, or government agency.

The Medicare/Medicaid contract is used to describe the services offered by the healthcare provider. It also includes information about the billing process and how payments will be made. The contract specifies that any medical services provided to patients covered by Medicaid must be at no cost to them. The patient may be asked for co-pays for other services not covered by their insurance plan.

This contract is also used when patients are enrolled in Medicare Part B or D plans. The patient may need to sign this form in order to receive coverage from their insurance company for any medical service provided by the healthcare provider on their behalf, regardless of whether they choose to pay the provider or not. The terms and conditions of the Patient Acknowledgement form are set by the healthcare provider who has contracted with Medicare Part B or D.

What Kind of Health Coverage Does A Medicare/Medicaid Contract Provide?

Medicare is a national health insurance program for people who are aged 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant). Medicare offers healthcare coverage for hospital stays, doctor visits, medical equipment, and other medical services.

Medicaid is a joint federal and state program that helps pay health care costs for some people with low incomes and limited resources. Medicaid provides health coverage to millions of children, adults, and seniors near or below the poverty line who meet certain eligibility requirements.

How to Get Started with a Medicare/Medicaid Contract?

The Centers for Medicare and Medicaid Services (CMS) has a website that provides information on how to get started with a Medicare contract. This website is the first place to start if you are looking to become a Medicare provider.

There are two ways in which CMS can award contracts: “competitive bidding” and “no-bid.” The competitive bidding process is open to all providers, while the no-bid process is reserved for providers who have been awarded contracts in the past.

In order to participate in competitive bidding, you must submit an application and then wait for CMS approval. If your application is approved, then you will be awarded a contract if the bid amount exceeds your competitors’ bids by 10%.

Let AMS Solutions Get You Contracted with Medicare/Medicaid

AMS Solutions is a billing company in Dallas that specializes in Medicare/Medicaid contracts. We have a team of professional, certified, and licensed coders who are experts in the healthcare industry. We can work with any insurance company and they provide the best customer service. We will take care of all your needs and provide you with the highest payout possible.

Contact us today if you need help with getting your healthcare practice contracted with Medicare or Medicaid. We’ll answer any questions or concerns you may have about working with us. 

Doctor working with his computer
July 21, 2022 by smallcrowd 0 Comments

Everyone needs healthcare at some point in their life. The article is intended to assist you in understanding the different types of health insurance plans that are available, and how to choose the one that will be best for your patients. It is essential for everyone to fully understand this topic as it can make a big difference for your patients and their families.

What Is Health Insurance and Why Is It Important?

Health insurance is a type of insurance coverage that helps to protect an individual against high, unpredictable costs of medical care. It is designed to cover a person’s medical expenses and can be used in conjunction with other types of insurance, such as life insurance and disability insurance.

Healthcare coverage is important because it provides protection for the insured person when they are ill or injured, which can be expensive. Without health coverage, you may have to pay all your medical bills out-of-pocket or go into debt if you cannot afford treatment. This isn’t what most patients who need healthcare want. 

As a healthcare provider, you want to ensure your patients have options when it comes to what insurances you accept.

What Are Different Types of Health Insurance?

Health insurance is a type of insurance that covers the cost of medical expenses. In the United States, health insurance is provided by private companies and individuals, with most Americans receiving their coverage through their employers.

Many different types of health insurance plans are available to consumers in the United States. These plans include:

  • Individual plans
  • Family plans
  • Medicare Plans
  • Medicaid Plans
  • Military Health Benefits

There are also two different types of health insurance plans: HMO and PPO. An HMO plan limits a patient’s choice of providers, while a PPO plan allows patients to see any doctor they choose.

Some people prefer an HMO because they have lower monthly premiums, but they usually have higher deductibles and copays than a PPO plan.

How to Choose the Best Health Insurance for Your Practice?

Medical insurance is one of the most important aspects of any medical practice. It makes it possible for a provider to provide their patients with the best care possible and ensure that they have access to all necessary treatments. Without this, many practices would be forced to close their doors for good.

There are many different types of health insurance, each with its own pros and cons. The best medical insurance for doctors will depend on their individual needs and goals for their practice. For example, if a doctor wants to have the freedom to focus on patient care without worrying about the financial ramifications of running a business, they might want to try a concierge-style plan where they are only accepting so many patients each year. 

Every practice varies on what insurances they accept. What insurances you want to work with depends on what kind of work you do and how you want to run your practice.

Let AMS Solutions Help Your Practice

AMS Solutions is a leading provider of best-in-class medical billing and coding software. Founded in 1998, AMS Solutions has been providing top-quality products to the healthcare industry for over 20 years.

We are a company that provides a variety of services to help practices and hospitals automate their billing and coding processes, streamline the revenue cycle management process, and maximize reimbursement potential. We are known for utilizing cutting-edge technology solutions in order to make these tasks easier, saving time, and improving quality.

Contact us today if you are looking to contract with insurance companies! We have helped a number of healthcare providers and practices get the coverage they need so that they can focus on what matters- providing high-quality care to their patients.

Closeup of Doctor Typing on Laptop
May 13, 2022 by smallcrowd 0 Comments

Healthcare providers venturing out into private practice often don’t know how to deal with the process of getting paid for services. They’re understandably unfamiliar and can feel a sense of confusion surrounding billing and insurance. Healthcare providers are typically not taught about healthcare billing in their training, so this is an area that needs to be addressed in order to succeed in their offices. 

Creating a revenue cycle for your practice can be a difficult process, but with some advance planning and a bit of research, you will feel much more confident about the entire process.

First things first, you need to understand the difference between in-network and out-of-network insurance companies, how they operate, and why it’s integral to have insurance credentials. Without insurance credentials, you won’t be paid for the medical services you provide to your patients. 

What is the Difference Between In-Network and Out-of-Network Insurances?

Health insurance is an important topic for many people. However, it can be tricky to understand the difference between in-network and out-of-network coverage. It’s easier to comprehend than you think. When patients find you, you’ll either be in-network or out-of-network. 

In-network coverage is when a person goes to the healthcare provider that they have chosen to be in their network. This means that they will not have to pay any more out-of-pocket expenses for the medical care that they receive. As a provider, you want to be in-network with as many insurance companies as possible. Patients prefer to go to providers that are in-network. 

Out-of-network coverage is when a person goes to a healthcare provider outside of their network. This means that they will have to pay more out-of-pocket expenses for the medical care that they receive. Patients are less likely to go to providers that are out-of-network. 

Why Is Insurance Credentialing Important?

The credentialing process for insurance is an important process for a number of different reasons. For starters, it ensures that the person applying for a license is qualified to do so. 

This can reduce instances in which unqualified individuals represent themselves as licensed professionals, which in turn can provide consumers with false information and potentially cause them to make bad decisions. 

You should consider what insurance companies you would like to contract with. Some major insurance companies are Blue Cross Blue Shield (BCBS), Medicare/Medicaid, United Healthcare, Cigna, and many more. You will have to fill out an application for each insurance company that you want to be in-network with. 

These applications can easily take around 2-6 hours to complete. This is where a medical billing company can provide some assistance. Hiring a medical billing company can help you with insurance credentialing applications and speed up the complicated process. 

Get Professional Streamlined Medical Credentialing 

Credentialing with insurance is a lengthy, time-consuming process. If you’re looking for professional streamlined insurance credentialing, you’ve come to the right place. Here at AMS Solutions, we take medical and insurance credentialing very seriously. 

AMS Solutions is a leading provider of credentialing services in the insurance industry. No matter what insurances you are looking at, we’ll make sure you get contracted with them. 

Let us take care of all of your medical credentialing needs with quickness and efficiency. We know you don’t have the time required for proper medical credentialing, which is why we’re here to save you time and money. 

Send us a quick message here, or feel free to call us anytime at 214-522-0210. We’re so excited to hear how we can help you and learn more about your private practice!

We also offer free practice audits for your convenience.