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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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Avoid Medical Claims Billing Problems

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All providers want to be reimbursed promptly and accurately for their services. Unfortunately, human and electronic errors are unavoidable and can slow down medical claims processing. Our goal at APEX EDI is to reduce as many of these delays as possible and accurate reimbursement.

There are some very basic information errors that can be quickly eliminated by using a medical claims software. Inaccurate patient information such as a misspelled name, date of birth, address, or insurance ID number can lead to a rejected claim.

Mismatching medical codes or confusing ICD, CPT or HPCS codes can result in too many or too few digits for a claim to be processed. Insurance policy numbers, addresses, and contact information can also be difficult to enter correctly when required numerous times during service. If you can reduce the number of these simple errors in your medical billing, you’ll have a much higher percentage of claims that pay you for service quickly.

Poor documentation and misinformation such as coding for a less serious or extensive procedure than the patient received can also cause serious problems. Intentionally misrepresenting the work performed on a patient is considered fraud and illegal, even when the intent is to help the patient save money.

It’s important to stay current on medical billing regulations and be proactive by preventing problems before they occur. Always have clinic staff double check for errors and communicate quickly about any billing questions. At Apex EDI, we have a highly trained team of experts ready to answer questions about billing regulations.

Our software can also help eliminate many simple billing errors. The investment in a few preventative actions and tools will pay off greatly. You will have the peace of mind knowing your medical claims are being handled with speed and excellence.

Contact Apex EDI for a demonstration of our software today.

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Medical Claims Can Be Appealed

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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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Are You Ready to Handle a Medical Malpractice Claim?

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Medical malpractice claims have become so common that 42% of physicians will face one at some point in their career according to the American Medical Association. The process of investigating, processing claims and responding to legal requests can be quite complex and time consuming for you and your clinic.

The legal process itself can take up to five years, but there are several ways to prepare your staff. First, medical records and treatment notes must be thorough. Memories years after the treatment can be sketchy. You’ll want to be prepared to provide a detailed account of the patient’s medical case, the treatment, and all communication with the patient.

The physician will be required to respond to a series of questions during the legal process. Accurate and complete information about the patient’s medical case and claims processing decisions made must be available. During deposition meetings and court testimony, the doctor will be required to answer questions from attorneys for several hours under oath.

Your medical claims software must be capable of storing accurate and detailed patient records. You will want your staff to be able to retrieve information quickly during an investigation. You will also want to feel confident that all medical claims have been processed perfectly.
When you are faced with a malpractice claim there is not much you can do to speed up the process of responding. However, the Apex EDI software will make the burden a little easier for you. With accurate information at your fingertips, there is a good chance your malpractice claim could be withdrawn or dismissed early.

Contact us today to request a free software demonstration.

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How to Settle Medical Billing Disputes

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Health care insurance billing is very complex and can be quite confusing. At some point in time you will no doubt find yourself in a billing dispute trying to determine what has been paid for and what payment is due. It’s important to know how to dispute a medical billing issue, how to appeal a denial and to be able to strengthen your case for receiving payment.

The best prevention is a little preparation up front. Make sure you keep a record of all communications you have about the patient’s healthcare. You will want to note phone calls made with the date and time of the call, the number you called, the people you spoke with, and exactly what you discussed. Also save copies of emails or written communications.

You will also want to have a copy of the insurance plan’s Summary Plan Description (SPD) on hand for reference. This document clarifies all billing services covered by insurance. You will also find a list of any exclusions in it. If you have questions about the policy, you can use the SPD to find the answer.

When there are billing discrepancies, you will want to be certain first that the health care provider billed the correct insurance plan. Simple errors in name, policy number, or address can result in rejected claims. It’s important to understand your plan’s annual deductible, the different terms and limits set forth in the plan for the medical services.

Also check for errors and make sure all charges were applied correctly to the insurance provider. You will want to make sure that there aren’t multiple bills being sent for the same service. If a payment was delayed, it’s not uncommon for a patient to receive a follow up notice for the same service although they may have already submitted the payment.

If a claim has been rejected or denied, find out the specific reasons why. When a patient disagrees with the reasons, they may file an appeal with the insurance company. It’s important to take this action quickly and provide any documentation supporting the patient’s position.

While we are certain you will be faced with questions about medical billing and insurance coverage, we can simplify the record keeping process and minimize errors for you with our electronic billing software.

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

Posted in: Medical Claims

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