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 5010 Update and Current Cash Flow
The format for electronic claims is governed by HIPAA law and on January 1st, that format changed for everyone--all insurance companies, clearinghouses and providers. The transition has not been a smooth one--many insurance companies and other organizations were not ready for the new format. We sent a short newsletter out to everyone in February, as we had started to see that insurance payments were not coming within the normal time frames.
As we researched why revenue had dipped, we discovered that not all of the claims that we sent were received at the insurance company--random claims were lost somewhere between the clearinghouse and the insurance companies. This situation didn't improve until the middle of March when a major software fix was installed at Medicare. As you can imagine, the number of claims that needed to be resubmitted was higher than normal.
To handle the extra rebilling, we doubled the number of staff who follow up on claims and have been systematically reviewing every insurance balance to make sure it is being processed by the insurance company. Payments have improved substantially and we hope that the majority of these claims will be paid during the second quarter. It is very important to us to collect any missing revenue. At this point we have confirmation that every claim submitted has been received by the payer and is either paid or in process.
As we mentioned in February, if you have any concerns, please contact us and we will give you a status report of your claims. |
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 Correspondence from Insurance Companies
Some of the changes that were implemented in the new 5010 version were designed to prevent fraud. A "Pay-To" address has always been required to submit a claim and in the new 5010 version they have added a requirement for the "Physical" address of the provider. If you have recently revalidated or are a new provider with Medicare, you know that someone from Medicare actually comes to your location and verifies that you are a legitimate ambulance provider. These are all methods of preventing healthcare fraud.
Occasionally, insurance companies are sending correspondence, usually a denial notice, to the physical location instead of the Pay-To address. This is particularly unfortunate if mail cannot be delivered to the physical address.
If you receive any mail from insurance companies in error, you can fax, email or send it to us. We will follow up with the insurance company to resolve this issue. |
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 A/B MAC Carrier Jurisdiction F
For quite a few years, Noridian has been the Part B Medicare Contractor for Washington, Oregon and Alaska. Every 5 years, Noridian and other contractors compete for our region. With this last round of competition, CMS created 15 new regions, called MAC Jurisdictions, which roughly serve an equal number of Medicare patients. The winner in each Jurisdiction will process claims for both Part A (hospital) and Part B claims, which will improve efficiency and add services.
In August 2011, Noridian was awarded the contract for Jurisdiction F (J-F), which includes Washington, Oregon and Alaska plus 7 other western states. We were very pleased with this outcome, as the transition, which happened in February, had a minimal impact on production.
During the month of May, we will be receiving training on some of the improved services available to us under the MAC system, such as web-based eligibility and claim status. We have a great relationship with Noridian and are looking forward to another 5 years. |
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 Medicare Revalidation
Medicare's revalidation project is still going on! If you have not yet received a revalidation request from Medicare, and your Medicare enrollment was done prior to 3/25/11, you will be required to go through this process in the next few years. If a request arrives at Systems Design, we will get in contact with you immediately to begin gathering the necessary paperwork. If it is sent to some alternate address, we may not know about it until too late. Please visit this link to check if a revalidation request has been sent out for your organization recently. If you receive mail from Medicare, please forward it to us promptly!
We would also direct you to the link for "Internet-based PECOS" on this same page. This program is to allow Medicare providers to enroll and maintain their provider files via the internet. Since ambulance suppliers are generally organizations rather than sole-proprietors, there is an additional requirement for the Authorized Official (the person(s) who signed the original Medicare application) to get a log-in and password separate from the one used for the organization in order to access PECOS. We have been told that the vetting process for the Authorized Official can take up to 60 days to complete, so to have it in place before the revalidation letter arrives, please consider beginning the process for getting a log in and password for your Authorized Official as soon as possible. Once this is done, it will facilitate not only your revalidation, but all provider file maintenance that is needed in the future.
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 NEW! Web Access to Reports
& Patient Accounts - Coming in June
Systems Design has recently completed a major update to our Billing software. Included in that project is a feature that enables our clients to log in to the Systems Design secure web site and access their financial reports as well as search patient accounts and specific transports (tickets). If you are interested in this feature, please contact Systems Design administration at 800-585-5242. Our IT department will initiate the set up for this feature including user names and passwords for access to the system.
In the near future we will begin providing our month end report delivery to our clients via this web access. At the close of your month end and when the reports are available to download, we will begin sending an email notifying you that your month end accounting reports are completed and available.
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 Credit Card Processing
Systems Design and Point and Pay, LLC have completed an "Online Credit Card" processing agreement for Systems Design's public agency clients. This agreement includes both Convenience Fee method (payer pays fees) and an Absorbed Fee method (Fire District pays fees). Additionally, this agreement includes an individual online cart page for the Fire District with no set up charge or monthly maintenance cost. This agreement includes Visa, MasterCard, American Express, Discover, Debit Cards and Electronic Checks. Convenience Fees are $ 3.00 per every $ 100.00 in payment and this will be charged to the payer's credit card account. The fees for the Absorbed Fee are 2.5% of the payment and this can be invoiced to the Fire District each month. It will take approximately 30 days to complete the set up. Electronic payment notification will go to Systems Design (and the Fire District, if requested) for each payment. The online cart page can be linked from the Fire District's website, the Systems Design emspatient.com site (printed on the statements) or any other site. Credit card processing can also be performed over the phone with our patient services representatives.
If your agency is interested in providing this convenience to your patients, please call our Administration line at 800-585-5242 to initiate the set up. |
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Quick Links | |
Maybe you missed an earlier newsletter, or want to refer back. Just click the link below to view our Newsletter Archive page.
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THIS LOOKS LIKE A GOOD IDEA...
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Administration
Toll Free: 800-585-5242
Phone: 360-394-7020
Fax: 360-394-7099 |
info@sdwems.com |
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