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Archive for Medical Claims

Medical Claims: Patients Can Claim Medical Expenses on Taxes

Series for United States Tax season, with 1040 forms, etc.

When patients have unexpected medical expenses, it’s nice to know that there are many claims that can be deducted from income taxes with proper documentation. Preventive care, treatment, surgeries, dental, vision care, medications, and health related appliances like glasses or false teeth can all qualify under IRS rules as medical expenditures.

Medical expenses that the patient is reimburse for by the insurance company or employer cannot be deducted from income taxes. Non-prescription drugs and other general health related fees such as health club dues, vitamins or diet foods do not qualify for exemption.

To utilize these tax rules, the patient must be able to itemize tax deductions. This requires billing receipts and documentation of all medical claims incurred by the patient for health care services. Travel expenses such as mileage to and from the doctor’s office, taxi fares, and parking fees can also qualify for deductions with accurate records.

The patient must also be able to show these medical deductions are greater than the standard tax deduction allowed and that they exceed 10% of their adjusted gross income for the year. While it’s a lot of information to keep up with, the Apex EDI software helps organize the details they will need for you.

We know you want to provide exceptional patient service and be prepared to respond to tax time requests. Let Apex EDI simplify the process of filing medical expenses and claims information for you. You will be able to retrieve all of the information your patients need quickly with ease.

Contact Apex EDI to request a free demonstration of our software.

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Medical Claims: How Long You Should Keep Medical Claims and Bills

Keeping medical claims documents and billing information can be useful for many reasons. They help you establish a health history for yourself or loved one, ensure you are receiving the medical benefits you are entitled to, and demonstrate that you’ve met an annual insurance deductibleYoung woman physician with stethoscope prescribing treatment and qualifications for income tax deductions.

You will want easy access to records showing the services provided, the payment amounts billed for services, the amount covered by insurance or Medicare, and the amount you paid the provider. People often wonder how long they should keep this information. If you have ongoing health care needs, paperwork can pile up very quickly.

Generally, if you are in good health and seeking treatment for normal preventative health care and maintenance you should keep medical claims and billing information for one year. At the end of the year, if you qualify for a medical tax deduction then file this information with your income taxes. Keep your tax file on hand for seven years.

If you are facing a serious health condition or chronic illness, it is important to keep medical claims and billing information close by for at least one year. At the end of the year, if you have filed for a tax deduction store the information with your income taxes and cross reference it in a medical file. In the medical file, you will be able to match services with billing receipts and retain the information until the health condition has subsided.

In the unfortunate event that the patient has passed away, the medical services and billing information may be needed for the execution of a will. The information will be available to wrap up the legal process and settle the estate as quickly as possible for the entire family.

While a file cabinet may do, a more effective and efficient way to store medical records is to keep them electronically. This will keep the information you need safe and secure from water damage, disorganization or loss. At Apex EDI we provide the service and software to organize your medical claims and billing information.

Contact us to request a free demonstration of our software today!

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Medical Claims: Medical Claims Can Be Appealed

Medical appeals form
Processing medical claims can get confusing, especially when someone files an appeal. According to the Department of Labor (DOL) Employee Benefits Security Administration (EBSA) there are four determinations during the medical claims process that can be appealed by anyone.

An urgent care claim is one that would substantially impact the life of the claimant or result in severe chronic pain unmanageable without treatment. Pre-service claims are those that require precertification by a healthcare provider before services are rendered. Post-service claims are those payments due after health services are rendered. Disability claims are those that create a medically related barrier to the claimant’s return to work.

All claims and appeals must be responded to as soon as reasonably possible. Administrators only have up to 30 days to respond, with the possibility of a one-time 15 day extension. Any requests for additional information or clarification must be detailed and specific.

The claimant has up to 45 days to respond. He or she is also entitled to any rules, protocols or medical basis for the determination free of charge. This exchange can make the burden of claims processing expensive and quite time consuming.

We want to take care of this headache for you, so you can focus on the care of your patients. The APEX EDI medical claim filing software simplifies the claim payment process. Our award winning team understands the laws related to claims processing, protecting health information and they want to save you time and money.

Contact APEX EDI for a demonstration of our software today!

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Medical Claims: How to Review Medical Claims

The medical claim review process can be tedious, time consuming, and even stressful due to a system that is often complex and demands accuracy. However, reviewing your claim denials and rejections on a semi-regular basis can save your practice time and money in the long run by reducing the number or denials that you have to deal with in the first place. Here are some of the things you should be doing on a monthly basis to ensure that your medical billing is running as efficiently as possible.

Young doctor explains how to fill out a medical form. Partnership, trust and medical ethics concept

1. Review Your Billing Register

Analyzing your billing register will help you find out how many bills you are have to rebill- and as a result, how many denials there have been. Subtracting the dollars billed out in a given month by your monthly charges will give you the amount of money that has been rebilled over the course of that month, and you’ll start to get an idea for how efficiently your system is running over all.

2. Review Paper Denials and Electronic Explanation of Benefits

The next area to review should be the paper denials and E-EOBs (Electronic Explanation of Benefits) your practice receives. This should give you an idea of why claims are being denied, and help you identify frequent problems such as illegibility of the claim or codes that are frequently reported in error.

3. Identify Recurring Issues

Once you have a good idea of how many claims are being denied and what the reasons are for them, you can start to identify patterns in your denials. Are members of your billing staff writing off some accounts that they shouldn’t be? Are claims being denied due to missing information or missing signatures? Are members of the billing staff selecting incorrect or out of date codes?

Any of these mistakes or many others could be contributing to higher volumes of denials or other billing issues, wasting your practice’s time and money. Identifying these issues early allows you to make adjustments that will make your medical claims billing run more efficiently.

Tired of investing so much time, money, and manpower into your claims filing process? Simplify it by hiring a medical clearinghouse that offers the tools and assistance you need to run your billing department stress-free and with fewer errors. Request a demo today to see how Apex EDI outshines other services and allows you to get back to work helping your patients.

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Medical Claims: How to Audit Medical Claims

It’s important to stay on top of medical claims and ensure that they are being filed correctly. It will save you and your patients time and money that would otherwise be spent missing or chasing errors with the insurance company. The best way to keep ahead of these mistakes is to conduct medical claim audits from time to time.

What does it take to conduct an audit of your business’s medical claims?

Claims - Ring Binder on Office Desktop with Office Supplies. Business Concept on Blurred Background. Toned Illustration.

You’ll need to organize either an internal or external review of how your medical claims are being filed, and determine where there are insufficiencies. You will need to determine whether a full audit of all recent medical claims is plausible or if you will instead take a random sampling. Some of the items that you will be examining include the following:

  • Reviewing coding accuracy, and making sure staff are assigning the correct codes for services rendered.
  • Identifying outdated codes.
  • Correctly identifying opportunities for reimbursement.
  • Identifying mistakes that may put the practice at risk for liability.
  • Reviewing changes to policies or procedures.

Once you have identified any possible discrepancies in these categories, it’s important to create a report that can be addressed by an administrator. A plan should be put in place to adjust training or implement new checks to ensure that these discrepancies are taken care of so that medical billing can run more efficiently.

Internal medical audits can be costly, as they take a lot of personnel and hours to complete. Many practices do not have these resources available, so an external review would be better suited to their needs. Hiring a reliable clearinghouse such as Apex EDI can take much of the stress out of audits, and our professional staff and excellent software will ensure that you get accurate reports every time. Try a demo for free and start streamlining your medical claims filing today.

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