Category Archives: Health IT

Medical Denial Claim

Delays become denials – quickly

The American Medical Association has reported that over 17% of all denials of claims are for the simple reason the failure of the physician to file the claim in a timely manner.

The reality is that there is no reason why any claim should be lost to timely denial. If timely filing denials are among one of the reasons your revenue is leaking away, only you can stop it, and there is no reason to allow it to continue.

Unfortunate too often physicians have become victims of the staff excuse of blaming the insurance company for the denials, lumping them all together.  This denial cause, timely filing should not be occurring. To prevent this, however, EHR for small practice have come into play an attempt to streamline workflow and filing but the transition from physical practice to digital forms of administrative work is an impediment to the cause. Furthermore, the misnomer that small practices don’t require EHRs or are too costly creates a further hassle in the filing situation

A claim denied for timely filing is a self-inflicted injury to your income.  It occurs for the simple reason that your practice cannot get a claim “received” by the payer within the payer’s filing deadlines, usually 60 days.  First off it is outrageous that your practice can’t get a bill to the payer in 60 days, and equally outrageous that you are letting your income lag even that long.

The standard in your office must be to bill daily.  No excuses.  Every day the prior day’s claims must be sent out.  In most cases, this means sent electronically.  If paper claims are still being created, mailed daily. Do not allow your office to fall behind, and if it is not the standard practice in your practice to bill daily, then review the processes in your office, find out what the impediments are, and remove them.  Do not allow excuses.  Daily billing needs are the standard.  Ok if you’re a surgical practice and need to get a copy of the surgical report from the hospital to the bill, then billing within 48 hours may be the appropriate standard.  In any case, it is too easy to fall into the trap that your staff is too busy to do daily billing.  What possibly could be more important than getting you’re your earned income?

But you are not done there.  You need to keep an eye on your receivables.  Now that it’s billed, if you are not paid by day 30 from the date sent, you must go to the payer’s website and look up any claim that is still outstanding.  No this is not an overwhelming task.  If your office is billing out daily, most of your bills will be paid within 30 days, especially with daily billing.  This means that day you will have a short list, if any, claims outstanding at 30 days.  Check these on the payer’s website.  If you do not find the claim listed, and its status, then send the claim again.  Electronically or if paper, by certified mail.

The task is to assure that your claim has been received.  Sending is not the goal, receipt by the payer is.  Therefore, by checking at 30 days you are making sure that no claims have gotten lost in the process.

Once you have assured that your claims have been received, if you are not paid within 45 days of receipt, then now with a copy of the proof of receipt, a copy of the electronic receipt, or paper receipt of mailing, your clam cannot be denied for timely filing.  And you are in a position to send a complaint to the state regulatory authority, generally the Department of Health or Insurance in your state.  Nearly all states now have statues that mandate prompt payment form insurance companies.  No reason not to let these tax dollar paid staff help you get paid.

In any case, your proof that the payer has received your claim keeps your claim a legitimate claim against the payer, however, you want to pursue it.  It cannot become lost to timely filing.

Author Bio:

Alex Tate has served in various positions at leading health IT organizations for the past thirteen years. Most recently Mr. Tate served as Vice President at a leading EMR organization. He currently oversees product management and revenue cycle consulting for a number of organizations. Mr. Tate oversaw the development of many emerging products and held leadership roles across health-tech strategy, operations, service organization development, delivery, and optimization. His ongoing collaboration with startups and academic research centers are paving the way for the development and commercialization of groundbreaking technologies like artificial intelligence, augmented reality, HCI and other initiatives for a future that offers the promise of transforming care delivery through cutting-edge technology and progressive methodologies.

EHRs and Pay-for-Performance

EHRs and Pay-for-Performance: The way forward for Primary Care?


Primary Care physicians struggle to earn even close to what other specialists such as cardiologists, urologists and orthopedic doctors do. However, the introduction of Electronic Health Records (EHRs), and the talk of an industry-wide shift towards the pay-for-performance model in the coming years have begun to stir up winds of change.

Ever since the Affordable Care Act of 2009, EHRs have been in the headlines of the healthcare industry. By now you probably know that questioning the need for such systems is redundant as they’re here to stay and, moreover, those who have used these systems properly have seen significant productivity and revenue boosts.

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Are You Ready for #HIMSSanity?

The Oscars of Health IT, as my boss likes to call it, is less than a week away. I personally believe HIMSS is more like the Golden Globes; you actually get to party while working and networking with your peers rather than being suffocated with lame jokes and an air of formality which pretty much sums up the Oscars. Anyways, I digress.


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The Shakespearean World of ICD-10 Mental Disorders

William Shakespeare’s works are known for their universality. His plays and characters are relatable to every time and age. These plays reflect the depravity of society that manifests in the form of human mental disorders including psychopathology.



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Missing Behavioral EHR Data Hinders Patients’ Healthcare

Sharing of behavioral health patient data has been a conflicting issue since the healthcare technology reforms started in the country. Under these reforms providers are required to implement Behavioral  Health EHRs for data sharing with healthcare stakeholders, including physicians from different specialties.

Behavioral health providers have been reluctant to share electronic records of patients with non-psychiatric physicians. This is because of the patients who hesitate to share their records from fear of privacy breach.

This American Medical News reported that most of the psychiatric records are not stored with rest of the data of mental health patients. This fear comprises the healthcare of psychiatric patients that has prompted groups like American Psychiatric Association to voice their concerns about restricted EHR data.

Non-psychiatric physicians emphasize on sharing of psychiatric data because it gives them a holistic view of the patients’ health, which will help them in creating a well-informed diagnosis and treatment plan. This is particularly necessary when physicians recommend medications that can react with mental health medicines.

Professor Johns Hopkins University School of Medicine, Dr. Adam Kaplin said, “The psychiatric illnesses patients have play a huge bearing on their medical illnesses. As an example, whether or not you have depression following a heart attack is as big as or bigger than any other risk factor as to whether you are going to die in the year following that heart attack.”

The U.S. News and World Report conducted a survey on data sharing by 2,000 psychiatrists from 18 different hospitals. The survey showed that patients of psychiatrists who shared electronic records with non-psychiatric physicians were less likely to be readmitted to the hospital within the same month.

The need is to address the fears of patients regarding the privacy and security of the sensitive details of their mental health data. Moreover, taboo surrounding mental health problems should be dealt with, so that patients allow psychiatrists to share their data.


The Buzz Surrounding Portable Care: mhealth

Mobile phones and devices might have been created to make and receive telephone calls, but technology has evolved at an exponentially rapid pace since. Now we’re at a point where video conferencing, interactive games, internet access, location trackers, apps and numerous other features and services, many not even fathomable a few years earlier, are in the palm of your hand.


One such development and an extremely significant one is mobile health (mhealth). This growing industry is changing the way doctors provide healthcare services, and how patients perceive and deal with medical decisions.

Mhealth tools such as mobile-based apps and devices which allow patients to monitor their heart rates, blood pressure rates and glucose rates, for example, and will help patients pay more attention towards managing their own health, will consequently decrease the number of trips they make to the doctor, and will cause the actual visits to be more effective.

Both doctors and patients will benefit from lower healthcare costs via such mobile apps and devices. As the focus for clinics, hospitals and the healthcare industry moves from the quantity of care to the quality of care, the payment benefits are also trending in that direction.

Moreover, the increasing collaboration between app developers and healthcare experts is resulting in the formation and improvement of such apps every day. Moreover, they are making apps for everything. For example, there’s an app which tells you how much you’ve saved since you gave up smoking, another which allows you to document weight loss through selfies (self photographs) and those which help identify potentially fatal symptoms so you can schedule doctor visits accordingly.  Physicians can also integrate the mhealth apps with their EHR Software.

However, the biggest hurdle to the process, isn’t the endorsement of such devices by doctors, but instead patients and their decision to adopt mhealth. If mhealth treatment plans are not followed, there will not only be health-based costs but huge financial ones too.

Mhealth has not been adopted by the masses yet, but at the current rate of progress in the industry, the day when every American has endorsed mhealth looks an actual and achievable possibility.