Need Help With Your To-Do List?

Need help getting your To-Do list done? We have you covered!

With 2019 nearing its close, now is a great time to evaluate your revenue cycle management
and look for areas of improvement in the coming new year. Make 2020 the year you put the
focus back on your patients by automating your revenue cycle and improving your bottom line.
The best place to start is by ensuring you get your To-Do list done early!

Making the list is just like a New Year’s resolution: Easy to do but hard to complete without a
partner there to support you. The right solutions should be at the root of your strategy. EZClaim
and TriZetto Provider Solutions (TPS), a Cognizant Company, have the tools and support to
make a difference in your practice and can help you get through the list:

  1. Go digital – Check!
  2. Improve denials management – Check!
  3. Get paid faster – Check!

If these challenges are at the top of your 2020 To-Do list, get in touch with our revenue
cycle experts now to find out how we can help you check them off your list and make sure you
are ready to recoup all that you are owed in the coming new year.

In the meantime, download our infographic with the details of the financial and operational
benefits of getting your To-Do list done early this year.

Electronic Data Interchange (EDI)

Electronic Data Interchange (EDI)

Don’t run off, Electronic Data Interchange or EDI is quite simply a standardized method for businesses to transfer documents electronically. Some typical business uses for EDI are purchase orders, invoices, shipping notices – types of transactions where the pertinent data can be separated from the regular communication related to negotiations, business deals, vendor contracts, etc. Why are we talking about it here? Easy. A set of standards for the healthcare industry has been adopted and make your life easier.

EDI creates efficiency and helps to automate data entry that is often performed manually. Before HIPAA, there were more than 400 different process forms in paper format. Thanks to the research of the Workgroup for Electronic Data Interchange (WEDI) to explore ways to control skyrocketing healthcare costs and patient privacy protections and the subsequent enactment of HIPAA, EDI is available for use in the healthcare landscape. 

Just like EDI used in business, Healthcare EDI functions by exchanging information via transaction sets created as standards by organizations like the American National Standards Institute (ANSI). When HIPAA-covered healthcare providers electronically exchange any of the information covered in the list below, the transaction requires the use of adopted standards.

  • Claims and encounters information
  • Payment and remittance advice
  • Claims status
  • Eligibility
  • Enrollment and disenrollment
  • Referrals and authorizations
  • Coordination of benefits
  • Premium payments

Why is this important? – Efficiencies created in the entry and transference of data reduce errors, saves time and, in turn, saves money. These efficiencies have been adopted for the healthcare industry as they apply so readily to patient and claims data, eligibility, and security.

The EDI Benefits 

  • Standardization: The elimination of proprietary formats creates consistency, reduces errors and the need for translation.
  • Efficiency: Data does not require manual entry. This reduces errors and speeds up the process as it becomes more automated.
  • Accuracy: Automated data entry means a reduction of errors, which translates to a savings of both time and money.
  • Cost savings: Digital transactions reduce paper usage, storage solutions and time used for manually completing paperwork.
  • Greater security: Since only authorized parties can access the data, patient data is better protected and the risks of HIPAA violations are significantly decreased.

HIPAA Compliance – Healthcare EDI transactions are more secure than paper methods of transmitting information. Only authorized users have access to transactions, which is in keeping with healthcare data management practices. That being the case, EDI helps to enable secure data transmissions that comply as HIPAA mandates.

So, why isn’t everybody using EDI? – The use of EDI for data entry and transfer requires both parties to be technologically equipped to handle the transaction. For many smaller businesses, these initial costs can be prohibitive. In many instances, the standards to use between provider and payers are not defined or agreed upon; this results in paper documents being used a fallback.

Looking forward – In addition to the advancements in mobile and smartphones, we now have many types of wearable tech that can be used to track all types of health data. The advancements of mobile EDI can empower patients and practitioners alike to not only ease the portability of patient data, but also mobilize patient health information, track health trends, diagnose potential or emerging health issues, and simplify billing. While technology marches ahead, we will all need to keep in mind the methods for enabling data transfer and keeping compliant for security, safety, and privacy.

EZClaim Premier can generate, parse and display ANSI Healthcare EDI transaction sets as well as clearinghouse formats. This means you are ready to start processing claims using HIPAA-compliant EDI methodology right away with the end-to-end simplicity, compliance, and the peace of mind that comes with ease of data entry, assurance of data free from errors to produce clean claims and, with that, fewer rejections. We continually update our software to keep pace with any changes that may occur in the EDI space.

You can learn more about the Healthcare EDI standards by visiting the Centers for Medicare & Medicaid Services.

Ready to simplify your life? Take EZClaim Premier for a spin for 30 days.

Security – Keep Your Head In The Clouds

Security – Keep Your Head In The Clouds

Security - Keep Your Head In The Clouds

The cloud is still a mystery to many and when it comes to cloud security regarding Health Insurance Portability and Accountability (HIPAA) compliance and your patients’ protected health information (PHI), the unanswered questions you may have can lead to a lot of stress. We’re here to help make your life easier, so we’ll put this in plain and simple terms. Here are the necessities that make for HIPAA compliant secure hosting and cloud storage solutions. Making sure your hosting and/or cloud storage provider ticks these boxes ensures adherence to the security standards that are required to keep your patients’ PHI, your practice and your reputation safe.

  • Two-Factor Authentication
  • Business Associate Agreement (BAA)
  • Encrypted VPN
  • Firewall
  • Offsite backups
  • Physical safeguards
  • Private hosting environment
  • SSAE 18 Certification
  • SSL Certificates

Cloud computing is an impossible-to-ignore convenience and EZClaim Cloud provides the best of both worlds – the ability to work wherever you want and the peace of mind that comes with knowing your practice and patient data are protected on secure servers with nightly backups. EZClaim Cloud uses Netgain, the industry standard for secure and scalable HIPAA compliant for hosting and secure cloud storage. Rest assured EZClaim Cloud has the security of you and your patients’ PHI covered in every respect. 

Not to mention EZClaim Cloud gives you these additional benefits: 

  • Automatic upgrades
  • Data Permissions Control
  • Less onsite technical support
  • No Contracts
  • Program support
  • Works on all Operating Systems

If you would like to dig deeper to get extensive information regarding HIPAA compliance and the cloud computing environment, visit the U.S. Department of Health and Human Services (HHS) for their Guidance on HIPAA and Cloud Computing.

If you like the sound of the outstanding benefits that EZClaim Cloud provides backed by Netgain, a leader in secure cloud-based hosting and storage, we invite you to learn more or upgrade your account today.

We hope you enjoyed the “Security – Keep Your Head In The Clouds” blog article. Click here to see our full blog page to see all of our most recent posts!

Payer Reimbursement Pitfalls

Payer Reimbursement Pitfalls

Contributed by Dana Bellefountaine, President of Codetoolz. Payer Reimbursement Pitfalls.

We often find that the reason behind declining medical practice revenues doesn’t have to be uncovered – it’s right there in plain sight in your payer contracts.

  • Practices that don’t track their payer contract rates are reimbursed on average 4 percent less. (1)

  • Payers make inaccurate payments on one out of every 14 healthcare claims. (7.1%) (2)

  • A recent study showed that physicians billed $5.15 below their contracted fee schedule per code. (3)

While working with healthcare groups across the country, we have seen payers reduce their fee schedules by 5 to 12%.

Fortunately, longstanding patterns of poor attention to contracts can be broken by analyzing and monitoring your payer contracts. You’ll be more informed and in a much better position to compete and thrive.

Updating Your Charge Fee Schedule

Making yearly updates to your charge fee schedule is one of the most important things a provider can do to ensure the collection of an appropriate amount for services.

Rates change over the years due to Amendments, Proprietary Market Fee Schedules or CY Medicare-Based Fee Schedules.

Payer Reimbursement Pitfalls

  • “Evergreen” Clause

Most contracts contain an evergreen clause, which is a fancy way of saying that the contract goes on and on until something triggers renegotiation and/or termination. The contract is automatically renewed unless one or both of the parties modify or terminate it.

  • % of Billed Charges (BC)

Contracts that are primarily based on a percentage of billed charges (BC) will be devastating if, for example, your charges are at 150% of CY Medicare and the Agreement pays 50% of billed charges – you are getting paid 75% of CY Medicare.

  • Payer Amendments

Oftentimes an agreement will state that the payer has the right to amend the contract without prior written notice. Reject any language which gives the payer unilateral amendment rights.

If the agreement requires the payer to provide notice of the amendment, remember, usually; “Following (30) days written notice. Failure to object constitutes agreement.”

  • “Lesser of” Language

All too often, practices have certain codes that fall below contract rates and almost all contracts have a “lesser of billed charges (BC) or contract rate” provision. Meaning, if your contract rate is $100 and your charge is $50 – you just lost $50 and cannot get it back!

The primary mission of CodeToolz is to help medical providers increase their revenue. It’s as simple as that.

  1. Texas Medical Association, 2019

  2. American Medical Association’s National Health Insurer Report Card, June 2019

  3. Medscape Physician Compensation Report 2019

We hope you enjoyed this article about the Payer Reimbursement Pitfalls. Click here to visit our main blog page to read more interesting and useful articles from EZClaim!

Electronic Visit Verification (EVV)

Electronic Visit Verification (EVV)

Written by: EZClaim Contributor 

Is Electronic Visit Verification (EVV) a buzz word or is there really something that must be followed? It is not just a buzz word in the market so if you have not already dug into it we suggest you do so soon. It is a rule that goes into effect in less than a month. If you provide personal care services you need to understand what to do so that you do not have a disruption in your revenue stream.

Section 12006(a) of the 21st Century Cures Act mandates that states implement Electronic Visit Verification (EVV) for Medicaid personal care services (PCS) and home healthcare services (HHCS) that require an in-home visit by a provider. States must require EVV use for all Medicaid-funded PCS by January 1, 2020, and HHCS by January 1, 2023. State Medicaid programs providing PCS and HHCS will be required to submit data that will electronically verify 6 elements of the service:

  1. Type of Service
  2. Individual receiving service
  3. Date(s) of Service
  4. Place of Service
  5. Who Rendered the Service
  6. Time Service began and time service ended

Electronic visit verification was created to help cut down on fraud and ensure that people receive the documented care they need and was designed to help verify that services billed are for actual visits made. Any state that fails to comply with the Cures Act EVV requirements will be subjected to up to a 1% reduction in payments. Each individual state can choose how they implement an EVV system. The Centers for Medicare and Medicaid Services (CMS) do not endorse any one type of system and states may choose to implement more than one EVV system. States can choose to either build and manage their own EVV system or they can select an external vendor, each at their own cost. Some states are allowing providers to choose a state-sponsored vendor or one of their own choice. Providers will need to contact their state to see what model they will be implementing.

Some states are using a model that allows providers to submit EVV information on electronic data interchange (EDI) 837p claims. If your state has selected this option, EZClaim Premier along with its partners can accommodate the EVV requirements and you will be able to send your information on your electronic claims. Please contact your state for what your EVV reporting requirements are and how they will be implemented.  For additional information and resources, visit the EVV Guidance page at

Ready to take advantage of the flexibility and simplicity of filing claims with EZClaim Premier? Download your free 30-day trial today!


Clearinghouses – Simply a Pass-Through Portal?

AMBA 2019 National Conference Session Recap

Written by Stephanie Cremeans of EZClaim – AMBA 2019 National Conference Session Recap

AMBA 2019 National Conference Session RecapI recently attended a breakout session of a seminar with a slide titled: “Clearinghouses are not Simply a ‘Pass-Through’ Portal.” With my role as a software support specialist, I immediately tensed up and thought about how inaccurate this statement is – I hear from clients that think that the software or the clearinghouse has changed their data, but that simply isn’t how it works. Well, kind of not how it works. You know that nothing in medical billing is as simple as it seems! Depending on how your practice management system works and depending on your understanding of how electronic claims are filed this may or may not be a valid statement. While I’ve always described a clearinghouse as simply a “pass-through” for your claims this seminar got me thinking about how much more a clearinghouse is! Let’s explore a little, starting from entering your claim into your PM system and clicking send.

The first piece of the puzzle is understanding what your PM system is (or isn’t) doing with the data. You’ve entered the claim data and you are ready to send your claims to the clearinghouse, but how is that data transferred?  There are 2 typical formats – Print Image or ANSI 837. All claims being sent to payers must be in the ANSI 837 format, following specific guidelines for submissions. Although some clearinghouses are no longer accepting Print Image files, some do. In this instance, the PM system creates a snapshot of a claim form which requires the clearinghouse to move data into the correct fields for claim submission to the payer via the ANSI 837. Preferably, your PM system can create the ANSI 837 file for submission to the clearinghouse. The biggest advantage here is that you can typically view the file and the clearinghouse will not be changing anything before submission to your payer. If your PM system cannot create an ANSI 837 file I would consider upgrading or find a new solution.

So that’s it, right? If you have a system that creates a Print Image the clearinghouse is more than a pass-through and they “change” your data. If you send an ANSI 837 file, it simply passes your file along. Well … while this may be true, it’s really only part of the story, and you are potentially missing out on some pretty amazing resources that are at your fingertips! In addition to submitting the claims to your payers, they can scrub claims for common errors, confirm batch receipt and acceptance, provide claim level updates of accepted/rejected claims, and provide electronic remittance advice for auto-posting insurance payments. In addition, many offer additional services (for an additional fee) that can integrate with many practice management systems like integrated eligibility, determine deductibles and co-pays, patient cost estimators, claim status inquiry, patient statement processing, and printing services for your paper claims.

I’m working hard to remove the phrase “just a pass-through” from my definition of a clearinghouse. Once you have submitted an 837 file, they are still doing so much more than simply passing along the file.

EZClaim partners with TriZetto Provider Solutions but is designed in such a way that it will work with any clearinghouse a customer would like to use. The white-glove support team is even there to help set up the connection if needed.

We hope you enjoyed this AMBA 2019 National Conference Session Recap by EZClaim. Click here to view our blog page for more interesting and useful articles. 

New Medicare ID Cards

New Medicare ID Cards

New Medicare ID Cards

New Medicare ID Cards – Written by Stephanie Cremeans of EZClaim

Medicare updated their cards with a new Medicare Beneficiary ID (MBI) and has finished a mass mailing effort to send new cards to every beneficiary (including Medicare RR members). 

Medicare updated cards to help protect patient information by not printing social security numbers on the new cards.  Effective January 1, 2020, Medicare will be denying claims submitted with the old ID numbers. Here are some tips to help you avoid Medicare denials:

  • ​​Ask your Medicare patients for their new card at the next visit and update your billing system
  • Use the MBI lookup tool online to look up the new MBI number using their social security number (available through your local MAC)
  • Check remittance advice for new MBI number on payments through December 31, 2019.  Medicare will be returning the MBI on every remit, even when claims are submitted with the old number – this means you can access this information within EZClaim Premier through our customizable grids.  
  • You can also contact EZClaim to create a validation rule to keep claims from being submitted after January 1, 2020, with the old number. 

Capturing the correct insurance information at the registration or check-in plays a vital role in the revenue cycle.  If you need to review your processes RCM Insight offers workflow assessments to help you fine-tune the processes and can help you ensure your processes are working efficiently from registration to payment in full.

We hope you enjoyed this blog article about the New Medicare ID Cards! Click here to Follow Us on Facebook to stay up to date with our most recent happenings at EZClaim or view our additional blog posts on our blog page to read our large collection of interesting and useful articles!

Compliance Plan Breakout

Compliance Plan Breakout

AMBA 2019 National Conference Session Recap

Compliance Plan Breakout – Written by Stephanie Cremeans of EZClaim

Any provider that is treating Medicare or Medicaid patients is required to have a compliance plan for their practice. This is mandated under the Patient Protection and Affordable Care Act of 2010.

The Office of Inspector General (OIG) has established an outline of seven components to help the small or individual provider offices get started. They also understand that small practices don’t typically have extensive resources creating and establishing a plan, and encourage practices to start with one item, making the compliance plan a working document that is updated and added to as necessary. The seven components are as follows:

  • Conduct internal monitoring and auditing
  • Implement compliance and practice standards
  • Designate a compliance officer or contact
  • Conduct appropriate training and education
  • Respond appropriately to detected offenses and develop corrective action
  • Develop open lines of communication with employees
  • Enforce disciplinary standards through well-publicized guidelines

Let’s dig in a bit to the first component, conducting internal monitoring and auditing. Starting with this step will help a practice lay the groundwork of its compliance plan and shed light on areas that need additional work. There is no set number of records that are required to be audited, rather a suggestion of 5 (or more) per provider annually for a small or solo practice. You can start your compliance plan by simply documenting that no less than 5 charts per provider will be audited annually. Keep track of the results and use them to start implementing other components. For instance, you have the audit results, but what is considered passing? What are you going to do if a provider isn’t compliant? Document the answers and you are building your plan. Did the audit show specific areas for improvement? Find applicable training or host training for those that need it, document it in your plan. Did you find overpayments? Document how these are to be handled, resolve it quickly and put policies in place to prevent a bigger problem.

By taking steps to create a compliance plan and show a good-faith effort to improve on risk areas your practice will reap the benefits of clean claims with a reduction in denials, fewer billing errors and the assurance that your records are ready for an audit. This will also reduce your risk exposure to fines.

For help getting started with that first audit, setting benchmarks and improvement plans or for education on problem areas contact RCM Insight. For additional assistance with building your HIPAA compliance plans contact Live Compliance.

If you are enjoying the informative content we’re providing and have a specific topic you would like to see covered, we would love to hear from you! Please feel free to send along your ideas via email to

MMBA Michigan Chapter Meeting – Northeast

Northeast MMBA Chapter Meeting

MMBA Chapter MeetingsKick-off the new year with valuable insights at the Northeast MMBA Chapter Meeting.

Cybersecurity – Cybercriminals are developing more advanced attacks and they are no longer purely technical. In today’s internet-connected world we all have a role to play in securing the environment we live in. Senior Security Analyst JJ Strieff will lead a discussion regarding the technology we use every day and the part we must play in keeping it secure.

2020 CPT Updates – The 2020 CPT updates bring many exciting changes and opportunities for more accurate reporting of the services provided by healthcare professionals. Speaker Robin Hicks has over 25 years of health care experience and has been teaching Medical Assisting, Billing and Coding for over 15 years at Macomb Community College. Please join Robin as she takes an in-depth look at the new codes.

Please note that the CMU Health College of Medicine building now has a required keypad pin code to enter the building. After registering for the event, you will receive a pin code for entry two days prior to the meeting.

This program has the prior approval of AAPC for 3.5 continuing education hours. Granting of prior approval in no way constitutes an endorsement by AAPC of the program content or the program sponsor.

Northeast Chapter Meeting | January 8, 2020 | 8:00-11:45 AM

CMU College of Medicine | 1632 Stone Street | Saginaw, MI 48602

Register today at the MMBA website

Can’t make it to one or more of the MMBA Chapter Meetings? Get an EZClaim demo at any time. We have pre-recorded demos or you can schedule a one-on-one demo to meet your needs.

Top Three Reasons CEHRT Reporting Will Earn More Points and Maximize Reimbursements

Top Three Reasons CEHRT Reporting Will Earn More Points and Maximize Reimbursements

Guest Author: Sarah Reiter of Health eFilings

The Medicare Access and CHIP Reauthorization Act (MACRA) and the program designed to implement the law, Merit-based Incentive Payments Systems (MIPS), have raised the financial stakes and the complexity of regulatory compliance for all healthcare systems.  Simply put, healthcare organizations, like yours, have no choice but to engage and embrace the shift to value-based care to improve outcomes and therefore maximize your reimbursements.

And the method of reporting for the MIPS program can have a significant impact on your ability to earn points.  Not all reporting methodologies are the same. There are BIG differences between MIPS reporting methods and what you don’t know could result in a 7% penalty increasing to 9% penalty for the 2020 Reporting Period, not to mention lost bonuses! The most effective, and most efficient, reporting methodology is known as a Certified EHR Technology or CEHRT.   

But why is CEHRT reporting the superior method?  In this post, we will address the comparison of CEHRT reporting with the legacy “Registry” reporting method.  Here are the top three reasons that working with a CEHRT, like Health eFilings, is the superior approach:

1. The software does all the work

Health eFilings’ ONC certified software is an “end to end electronic solution”.  The software will extract, analyze and prepare the data in the most complete and accurate manner without requiring any administrative or IT support from you, the practice. 

In contrast, registry reporting is fully a manual process and simply is a combination of purchased forms and a submittal vehicle.  With a registry, the burden of all the administrative work is placed on staff and requires manual measure calculation and measure selection, all with no visibility to the measure benchmarks.

2. eCQMs earn more points

Health eFilings uses eCQMs (electronic Clinical Quality Measures) for purposes of reporting, and eCQMS offer more and better measures to optimize the points that can be earned.  Almost all eCQMs have benchmarks that provide a clearer and more concise way to determine your performance and earn more points. As a point of insight, think of how points are earned as grading on a curve, where your actual performance percentage is irrelevant but what is relevant is the way that percentage compares to your peers, and by peers it means all providers, regardless of specialty or geographic location, who submit data for that measure.

As a point of comparison, almost half of registry measures don’t have benchmarks which means no matter how well you do on that measure, your score (or points earned) will be significantly limited, resulting in few overall points.  

3. End-to-end electronic solution and earns bonus points

CMS has determined that the data submitted via technology is more complete and accurate, and because of this, CMS is incentivizing clinicians and practices by awarding them bonus points toward their MIPS score when they use a CEHRT like Health eFilings.

However, a registry is not a CEHRT and does not meet CMS’s definition of technology and as such does not provide verified accurate and complete data.  Therefore, a registry provides no opportunity for any bonus points for the practice.

So, when complying with MIPS, its critical to utilize the reporting method that optimizes the points that could be earned and leverages technology to facilitate the ease, accuracy, and completeness of tracking and reporting to maximize the score.   Reporting via a CEHRT like Health eFilings is the best approach because it optimizes the points that could be earned and therefore, maximizes Medicare reimbursements.

Beyond the inherent benefits of leveraging technology, working with Health eFilings has many advantages versus any other reporting methodology:

  • Seamless integration with any EHR or billing system
  • No IT or Administrative resources needed from the practice
  • Tracks and reports for all MIPS categories 
  • Earn bonus points because Health eFilings is an “end to end electronic solution”
  • A proprietary algorithm evaluates 9 million combinations to select best quality measures to optimize the score
  • Electronically submits all data to CMS

Is there anything I can still do for 2019 reporting?

Even though the end of the 2019 reporting period is quickly approaching, you do not need to accept that you must take the automatic penalty for this year.  Health eFilings can support you with reporting for the 2019 reporting period and also advise you on your situation to set you up to be ready for the start of the 2020 reporting so you are able to optimize your score.


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