610 Green Hill Manor Dr, Franklin Park, NJ 08823
Send Message email@example.com
Hot Line 862-294-0851
Second – If employer has already submitted Injury to board than we don’t have to worry about it, we can simply initial C4 to WC board thru Fax, Online Submission or thru Mail. Most Practices send Claim form thru mail which takes time to process,
There is another way to send initial submission thru Fax, which would be very easy and convenient : http://www.wcb.ny.gov/content/main/forms/Howtofax.jsp and very easy submission is thru their online portal : http://www.wcb.ny.gov/content/ebiz/WEBForms/webform_HCProvider.jsp#c4 ( User name and Pass Required)
Am Not going to talk about CODING because there are many factors related to surgery, LCD NCD NCCI edits and Coverage. When surgeon was assistant in surgery than most of the Time I use 80 81 82 and AS modifier based on above factors.
I am not saying that he/she can’t do this, they can. Some insurance process a certain claim separately for Different provider But some do not. I don’t want to say their name, but surgeons already know that which insurance is a Pain in the neck.
Carrier may deny claim saying Duplicate or saying – there is one more claim for the same patient which is already processed hence cannot process this one (they have processed this claim for Primary Surgeon)
Now, what can we do here?
We can use different envelope. In the second envelop we can send a Letter stating that this claim is for Assistant in surgery.
Sometime I send license copy of assistant surgeon along with the letter, doing this my claims denial reduced to 40%.
Many providers do not know that claims can be send Electronically, some EMR/EHR does have these capability. And you can send OP/Medical notes electronically as well. This will definitely expedite reimbursement.
Some Clerks might wanna send claim thru Fax. You can do it, But, not when DOS is not 45 days old.
My suggestion is to get in touch with Carrier and can ask for privilege for sending fax for claim submission for newer DOS instead of submitting Claim thru Mail or thru Electronic format.
Currently I am sending Fax to some carrier after taking permission. You can also do that by paying some additional fee to your responsible carrier.
I have not covered claims denials and working with WC Board and Carrier because different cases have different terms.
Have Any suggestion ……:) !
The process for filing a workers’ comp claim varies from state to state, but nearly always involves an employer, the injured employee, an insurance provider, and medical professionals.
More serious cases include diseases caused by exposure to hazards, such as benzene, asbestos or silica dust. While mesothelioma is one extreme example of this, a more common example is rashes brought on by exposure to cleaning chemicals or gasoline.
Workers’ compensation typically doesn’t cover injuries resulting from horseplay at work, or injuries sustained while drunk or in an impaired state. Likewise, only a few states provide coverage for employees injured while travelling to and from work, unless that transportation is provided by the employer.
The vast majority of workers’ compensation cases are streamlined, and only involve filing a claim with the workers’comp insurance carrier. But there are times when it’s necessary to hire a attorney due to coverage limits or denial of benefits.
An issue in all states concerns the plight of temporary workers. Temp workers usually are treated as second-class citizens regarding their rights to training, safety measures and the collection of worker compensation benefits. Temp workers in New York City are often in the nonunion sector where workers are injured more often due to a lack of training and lesser safety protections.
The problem is that temp workers are not employed by the company where they are sent to work. The worker actually remains an employee of the employment agency. Thus, workers’ compensation premiums and unemployment compensation are paid for and managed by the temp agency.
There is a basic disconnect in such a system. At work, the temp worker is not viewed as an employee of the company and is not given training necessary to foster a stronger safety net and more proactive self-protections by the worker. This fact, documented by many studies, results in a higher percentage of work accidents to temporary workers.
The temporary workers are protected by the workers’ compensation system. This insurance coverage is purchased by the temp agency to cover its temp workers for accidents suffered while working at a temp assignment. A higher percentage of claims filed by temp workers are denied by the workers’ compensation insurance carriers. This may be due to a lesser sense of responsibility felt by insurers toward workers who may be there one day and gone the next.
New York City struggles with temporary worker problems similar to what is found in other population centers. In areas with a prevalence of industrial plants, factories, construction sites and warehouses, there will be a higher number of temp workers. Temp workers should complain to the employment agency when they are exposed to unsafe conditions or not given training. When the temp worker is given the “run around” about filing a workers’ compensation claim form, that is the sign to immediately obtain a free consultation with an experienced workers’ compensation attorney to assure protection of one’s legal rights.
1. If you : Are covered by Medicare and Medicaid
Situation : Entitled to Medicare and Medicaid
Pays first : Medicare
Pays second : Medicaid
2. If you : Are 65 or older and covered by a group health plan because you or your spouse is still working
Situation : A. Entitled to Medicare //// B. The employer has 20 or more employees /// C. The employer has less than 20 employees
Pays first : A Group health plan /// B. Medicare
Pays second : A. Medicare /// B. Group health plan
3. If you : Have an employer group health plan through your former employer after you retire and are 65 or older
Situation : Entitled to Medicare
Pays second : Medicare
4. If you : Are disabled and covered by a large group health plan from your work, or from a family member (like spouse, domestic partner, son, daughter, or grandchild) who’s working
Situation : A. Entitled to Medicare /// B. The employer has 100 or more employees /// C. The employer has less than 100 employees
Pays first : A. Large group health plan /// B. Medicare
5. If you : *Have End-Stage Renal Disease (ESRD) (permanent kidney failure requiring dialysis or a kidney transplant) and group health plan coverage (including a retirement plan)
Situation : A. First 30 months of eligibility or entitlement to Medicare /// B. After 30 months of eligibility or entitlement to Medicare
Pays first : A. Group health plan /// B. Medicare
6. If you : Have ESRD and COBRA coverage
Situation : A. First 30 months of eligibility or entitlement to Medicare based on having ESRD /// B. After 30 months
Pays first : A. COBRA /// B. Medicare
Pays second : A. Medicare /// B. COBRA
7. If you : Are 65 or over OR disabled (other than by ESRD) and covered by Medicare and COBRA coverage
Pays second :COBRA
8. If you : Have been in an accident where no-fault or liability insurance is involved
Pays first : No-fault or liability insurance for services or items related to accident claim
9. If you : Are covered under workers’ compensation because of a job‑related illness or injury
Pays first : Workers’ compensation for services or items related to workers’ compensation claim
Pays second : Usually doesn’t apply. However, Medicare may make a conditional payment (a payment that must be repaid to Medicare when a settlement, judgment, ward, or other payment is made.)
10. If you : Are a Veteran and have Veterans’ benefits
Situation : Entitled to Medicare and Veterans’ benefits
Pays first : Medicare pays for Medicare-covered services or items.
Veterans’ Affairs pays for VA-authorized services or items.
Note: Generally, Medicare and VA can’t pay for the same service or items.
Pays second : Usually doesn’t apply
11. If you : Are covered under TRICARE
Situation : Entitled to Medicare and TRICARE
Pays first : Medicare pays for Medicare-covered services or items. TRICARE pays for services or items from a military hospital or any other federal provider.
Pays second : TRICARE may pay second.
12. If you : Have black lung disease and are covered under the Federal Black Lung Benefits Program
Situation : Entitled to Medicare and the Federal Black Lung Benefits Program
Pays first : The Federal Black Lung Benefits Program for services related to black lung.
Generally, no. It’s against the law for someone who knows that you have Medicare
to sell or issue you a Marketplace policy. This is true even if you have only
Medicare Part A or only Medicare Part B. Therefore, if you already have Medicare, you shouldn’t need to coordinate benefits between Medicare and a Marketplace plan. On the other hand, if you don’t yet have Medicare but have coverage through the Marketplace, you can choose to keep your Marketplace plan after your Medicare coverage starts. But, if you’ve been getting premium tax credits or other savings on a plan you bough through the Marketplace, these savings will end once your Part A coverage starts, so you’d have to pay full price for the Marketplace plan. If you age into Medicare and decide to keep your Marketplace plan, then Medicare pays first. Where can I get more information about who pays first? Call your health insurance plan’s benefits administrator. You can also call the
Benefits Coordination & Recovery Center (BCRC) toll-free at 1-855‑798‑2627.
TTY users should call 1-855-797-2627..
If you More Questions about Medicare Claims Than please contact us for Free Advice
This is not an April fools joke, it is really happening. Effective 01 April 2019, all WC claims will be paid using the new and increased formula released by the NYWCB. As many medical practices know that the WC fee schedule has not changed for the past 9 years, and many doctors have stopped seeing worker comp patients due to lack of reimbursement and many different problems with worker comp carriers. I am not going to discuss the various problems with worker comp carriers, I will say that out of 100 claims only 50-60 % get paid or even less for some doctors due to lack of information in their billing department or contracted billing companies. This is implemented to improve the quality of Healthcare for patients and for Medical Providers.
Now, let’s talk about medical reimbursement fees.
Effective 04/01/2019 conversion factor and RUV (Relative Value Unit ) is getting changed.
There is a conversion factor for each geographic region and general type of medical service provider (e.g., E&M, surgery radiology or maybe medicine.)
The region is divided into 4 parts, Region 1 and 2 will be identical, I mean medical reimbursement fees will be the same.
The fee schedule is updated for Medical (It’s for all specialties), behavioral health, Chiropractor/PT dental, pharmacy, DME and podiatry.
DME codes are not covered by worker comp, however, DMEs are covered with a specific CPT code and its subject to invoice cost and other things.
Now you must be wondering that if I can show some quick example so you can get a clear idea about changes, see below for the difference between the updated and old rates. (Region I and Region II are not identical on old Fee Schedule but they are Identical on the New Fee Schedule)
99204: $114.20 (Old)
99204: $163.85 (New) Difference: $49.65
99214: $71.40 (Old)
99214: $102.45 (New) Difference: $31.05
99244: $181.96 (Old)
99244: $261.10 (New) Difference: $79.14
· Region II:
99204: $119.60 (Old)
99204 : $163.85 (New) Difference : $44.25
99214: $74.89 (Old)
99214 : $102.45 (New) Difference : $27.56
99244: $190.60 (Old)
99244 : $261.10 (New) Difference : $70.50
· Region III
99204: $136.78 (Old)
99204: $187.39 (New) Difference: $50.61
99214: $85.53 (Old)
99214: $117.17 (New) Difference: $31.64
99244: $217.97 (Old)
99244: $298.60 (New) Difference: $80.63
· Region IV
99204: $148.69 (Old)
99204: $203.76 (New) Difference: $55.07
99214: $92.97 (Old)
99214: $127.40 (New) Difference: $34.43
99244: $236.94 (Old)
99244: $324.69 (New) Difference: $87.75
I have mentioned only 3 very commonly use CPTs by most of the medical providers, this new fee schedule is applicable on all billable codes, again DME fee schedule depends on invoice cost. Medical Testimony and Phone DEPO Refer to Rules (as per my suggestion don’t change old fee schedule on these two)
Many Medical Biller’s and medical billing companies don’t know about this update go ahead and ask them about this update. Some doctors are happy with their current medical billers because biller just shows the things which they want to show medical doctor and medical providers are too busy to check data of reimbursement and open items.
Most of the time medical biller’s are unable to reach any worker comp case manager or Customer care department and they keep leaving voicemails and notes into the system, this leads to nowhere, old claims still sitting down in system for years and eventually they adjust/write-off the claims after 2 years and medical doctor don’t even know about these loss. I can understand that there are few Govt. carrier are really tough to deal with, I can show you many examples. To deal with these Govt. carriers there are many easy ways to reach them and get claims paid in no time, but people are not creative any more they just want to finish the work and go home, that’s it.
After this new fee schedule, I guess medical provider should not lose more money because this new fee schedule is equivalent to Commercial fee schedule.
I hope this information would help many medical doctors to improve cash flow and may increase revenue after 04/01/2019 would very help full for all people in the Healthcare industry especially in New York. One more important thing, This new fee schedule is also applicable on No-fault claims.
And Please, don’t criticize this article just send feedback and ask any question if you may have I will try to resolve everything you ask, send me email or drop me a message in the box.
Also, please share if you like this article.
Blog Written By: Raman
My Email: Raman@alphabillingsolution.com
Credit: http://www.wcb.ny.gov and https://www.optum360.com/
Well, it is!
We will in the post itself, discuss why Tele-medicine is trending by now and then.
So, do follow through the guide as well as understand its benefits at the same time.
Therefore, let’s get started!
Now, we will start with benefits to ensure that we understand how effective Tele-medicine has been so far in our lives.
Well, we discussed what Tele-medicine is as well as benefits you should be looking after!
P.S. Are you looking for Medicine Billing End-To-End Services? Do you perform medical practices or work at ambulatory surgery centers? Furthermore, does it become impossible to submit medical billing, manage AR, and improve collections and capture hard to collect payer reimbursements? If this is the case with you, then all you have got to do is to get through us at AlphaBillingSolution since we will help you take up each activity efficiently! With that being said – We are looking forward to hearing from you!
And, thanks for the read, though!
Furthermore, things typically go off due to musculoskeletal aliments at the same time.
In saying so – From Joint Deformities to Pain in the Muscles, what measures do you take to ensure you are given an edge to cope up with the difficulties and minimize pain effect by far?
With that being said – Do comment and share what you do uniquely for sure!
Well, here in the guide itself, we will be discussing the importance of Orthopedic Care which we usually neglect and do not take into the consideration.
So, the question is – Are you the person who feels completely Off-Track and feel difficulties in performing everyday operations in your life?
If you are the person who has a vast range of Musculoskeletal Issues such as Osteoporosis, Arthritis, Bone Tumors, and Sprained Ankles, then it’s certain – You are a good candidate for Orthopedic Care.
Yes, you need the care that certainly helps you recover and bring about the best version of yourself.
P.S. Are you looking for the robust and highly preferred Medical Billing Solutions? If yes, do contact alphabillingsolution.com and get yourself started right away!
Are you a person who goes along and have deformities issue?
If this is what it is, then it’s high time to get note of Orthopedic Care since this will manage to get you out of the pain you have been for a longer period of time!
And, at the same time – Do share your opinion in the comment below!
Have you been to Mental Health Conditions such as Schizophrenia & Posttraumatic Stress Disorder?
If yes, follow the guide.
In addition to it, is Medical Marijuana a questionable term?
Well, to clear objections, it is because it works pretty well to cure severe disorders and diseases.
Are we still not sure?
Frankly speaking – It’s time to dump unreasonable myths.
Consider it a brain disease! It destroys memory and thinking skills.
It’s when you lose desire to eat!
Call it an Inflammatory Bowel Disease (IBD). Affected people experience inflammation in their digestive tract!
Reduction in body weight!
It’s a neurological disorder. People with Epilepsy happen to create unusual behavior, sensations and loss of awareness!
Eye disorder! It causes blindness.
People with this disorder experience double vision weakness!
Contractions of body muscles! However, painful, though.
It’s a disorder that affects individuals with gastrointestinal disorders, food poisoning, motion sickness, migraine and low blood sugar.
Thus, we covered why Medical Marijuana is inevitable and vital enough!
Similarly, we have something to share.
P.S. Are you looking for Medical Billing Experts? Do you need Medical Billing End-To-End Service? If this is what you are thinking of, then it’s high time to get started with us at Alpha Billing Solution! We provide clients with One-Stop Solution for RCM, meaning Guaranteed Client Satisfaction. With that being said – Let’s schedule an appointment, today!
Even, Cancer is disturbing disease.
It gets cured through Medical Marijuana.
Now, we have a question – How effective it seems to you, just comment!
The best part is – Medical Marijuana has been proven to improving human lives.
It’s good and super effective to cure typical disorders and diseases at the same time.
More like Machine Learning (Artificial Intelligence into Healthcare Industry).
Now, it’s a way to give Reliable, Accurate & Concise Medical Care to Patients.
In fact, Big Hospitals around the world have started investing in Healthcare AI Applications.
Sounds something we are unfamiliar with?
Well, yes – It is.
The magical part of AI in Healthcare industry is to automate Hospital, Clinical & Medical-Related Administration & Functioning in the best possible manner.
Thus, it’s so rewarding and worth the deal.
Let’s dig and get to the point.
We use Electronic Health Records.
All it means is we can now store Medical Health Records & Other Details of the Patients Electronically.
The best part is – It avoids cumbersome paperwork.
What we ensure that the healthcare provider is properly reimbursed for their services.
It’s something we have been doing for a longer period of time.
Once a patient is diagnosed and treated with right medication, Medical Coder records the disease or symptoms, and translates them into numerical value.
What it does further the Medical Biller takes all the records, and prepare for Financial Billing Report to see how much a patient has to pay, and if anything is covered in patient’s insurance coverage.
Thus, if you own a Hospital or Clinic, you always need Medical Billing & Coding Services in place.
Schedule an appointment and get to the work straight for the betterment and accuracy, today!
Imagine how amazing it would be?
So, it’s good to share – Artificial Intelligence (AI) is becoming very promising in Healthcare Industry.
To add – Optimizing Patients transfer between Departments can speed up the operation process and effectiveness in the treatment.
The reason is – Widespread AI Use can make our life better and easier.
Furthermore, it will become possible to identify High Readmission Risk Patients & figure out Early Sepsis Prediction Everlastingly.
The best of everything – Doctor Offices & Hospitals can simply explore more into Patient’s Medical Background and History, and further avoid any wrongful Diagnosis.
So, you can state that Healthcare AI can Perform, Assist with Diagnosis, Decision-Making, and Therapy Recommendations & Healthcare Management at the same time.
Now, we are going to discuss what is Medicare Inpatient-Only (IPO) List?
Well, not now.
It’s for low-income people and their long-term care. It includes:
This coverage comes with a major medical care for seniors.
Do follow and learn more about Medicare Cover.
This covers Inpatient Hospital Stays, Home-Health Care Services, Short-Term Nursing Home Care, Including Care In Hospice & A Skilled Nursing Facility!
It’s a Medical Insurance that covers Laboratory Tests, Medical Equipment, Mental Healthcare, Doctor’s Services, Outpatient Care, and Medical Supplies & Preventive Services.
It has Medicare Advantage Plans that offers Dental, Vision, Hearing Programs & Coverage from a Private Insurance Company. Furthermore, this plan may include Rx Coverage.
It has the coverage for Certain Prescription Drugs. With that being said – It’s a voluntary program that offers Low Premiums and Wide-Access to Drugs!
Similarly, why not to discuss about Inpatient & Outpatient Care?
It requires for patients that need immediate hospitalization on a doctor’s order. Following their admission in the hospital, they get treated till they are discharged.
This is a sort of care that may include Medical Procedures, Tests and Services that patients get without being admitted or for a stay of less than 24 hours in the hospital.
Again, it’s high time to discuss what our subject title says us all about.
Total Knee Arthroplasty (TKA), also known as Knee Replacement Surgery, has now called off from Medicare Inpatient-Only (IPO) List.
All it means the procedures as well as services involved in Inpatient Care does not have Knee Replacement Surgery included in it.
This is a change has already been made to live by CMS which is The Centers for Medicare & Medicaid Services.
To ensure we are on the same page and follow the context constructively, every year CMS evaluates Inpatient & Outpatient Only List, and makes amendments as needed and required.
Therefore, to be a healthcare profession or doctor, you always have got to understand the seriousness of these notes and changes to stay updated and advanced since this can impact reimbursement and affect other intersections pertaining to the procedure at the same time.
P.S. It’s never easy to do all we can to have perfect medical billing solutions in place. That’s why we at Alpha Billing Solution recommend doctors, medical and healthcare professionals to contact us. We provide robust and constructive medical billing solutions to ensure you get all covered. Therefore, do contact us, today!
On the same note – This removal has also been a significant advantage to patients.
Patients who want to have their Knee Replacement Surgery to be done in a day can have it treated and leave for home later that same day.
Needless to say – We can understand the fact ‘Outpatient Knee Replacement Surgery Has Just Arrived’.
Do share your thoughts, and comment below what is that you liked the most!
Similarly, thanks for the read, though!