Tag: medical billing

Posted in Insurance, Training, Updates

Importance of a trained Front Office Staff-avoid unnecessary claim denials & negative reviews.

Posted on by KR2Medical Billing

It is extremely important to properly train your FRONT DESK STAFF on verifying eligibility and conducting benefits investigation for patients.

Increasing the “clean claim” submission reduces your rejection and denial numbers= increase your revenue for the practice!

The other important aspect of training the FRONT DESK STAFF is customer service. Yes, a lot of times patients give the negative reviews based on how they were treated by the FRONT DESK STAFF.

Negative reviews potentially leads to less patients for your practice.

If you would like to find out more about training your FRONT STAFF on either checking patients eligibility, customer services skills, or how to verify properly benefits for your patients, please feel free to book 1-Hour Consulting/Training Session . If you would like to find out more information about my training/consulting services, please feel free to reach out to me via email: kr2medicalbilling@gmail.com (Subject Consulting Questions).

Posted in Insurance

What is an EOB?….a scary monster?…LOL

Posted on by KR2Medical Billing

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)

Posted in Insurance

Does your office accept BCBS exchange patients?

Posted on by KR2Medical Billing

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 Paycard%20300%20200providers 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.