CMS Will Pay for COVID-19 Booster Shots, Eligible Consumers Can Receive at No Cost
Coverage without cost-sharing available for eligible people with Medicare, Medicaid, CHIP, and Most Commercial Health Insurance Coverage
Following the FDA’s recent action that authorized a booster dose of the Pfizer COVID-19 vaccine for certain high-risk populations and a recommendation from the CDC, CMS will continue to provide coverage for this critical protection from the virus, including booster doses, without cost sharing.
Beneficiaries with Medicare pay nothing for COVID-19 vaccines or their administration, and there is no applicable copayment, coinsurance, or deductible. In addition, thanks to the American Rescue Plan Act of 2021, nearly all Medicaid and CHIP beneficiaries must receive coverage of COVID-19 vaccines and their administration, without cost-sharing. COVID-19 vaccines and their administration, including boosters, will also be covered without cost-sharing for eligible consumers of most issuers of health insurance in the commercial market. People can visit vaccines.gov (English) or vacunas.gov (Spanish) to search for vaccines nearby
Jun 09, 2021
New PPE Billing Law in Effect
Senate Bill 5169, requiring commercial insurance carriers to reimburse for personal protective equipment (PPE) costs during COVID-19, was signed into law April 16, 2021. The bill applies to services incurred from April 16 through the end of the federal public health emergency, which has now been extended to at least July 20, 2021.
Under the bill, health care providers as defined in RCW 48.43.005 can bill state-regulated commercial health plans the newly created CPT code 99072 for PPE costs and be reimbursed $6.57 per patient encounter as a separate expense
Mar 15, 2021
No Surprises Act
Starting January 1, 2022, healthcare providers will be subject to a new surprise billing law that makes it illegal for providers to bill patients more than in-network cost-sharing for out-of-network services and establishes an arbitration process to resolve unexpected out-of-network charges.
The law, the No Surprises Act, was passed in December 2020 as part of the omnibus spending bill and comes as a long-awaited solution for surprise medical bills. The new rules for unexpected out-of-network charges will have major implications for healthcare providers.
Feb 9, 2021
Top Reason for getting denial
According to a December 2020 poll conducted by the Medical Group Management Association (MGMA), 42% of healthcare leaders reported prior authorization as the top reason for denials in their organization, followed by demographic issues (29%), and timely filing (7%). Another 22% reported “other” reasons, including CPT® codes (23%), payer requirement inconsistencies (14%), medical necessity requirements (14%), missing information/documentation (11%), and coordination of benefits (9%).
Most billing companies leave the prior authorization under the provider’s responsibility, but AURA does the prior authorization for many of our clients. In addition to obtaining authorization, we also track and remind providers before the authorization get exhausted.
Jan 21, 2021
Having difficulty to collect patient balance?
1. Don’t give a surprise bill to patient
All patients would normally be aware that insurance plans that cover under co-insurance basis, like Medicare would pay 80% and applies 20 % co-insurance to their responsibility. But what actually bothers them is the $ value they need to pay.
2. Keep them well informed
Definitely the practice would be well aware of the Insurance fee schedule of the services being rendered. It will help the patient if practice let them know how much would be patient’s responsibility when the claims are processed. Keeping the patient well informed about the balances to be paid will help them to plan themselves
3. Remind your patient
A study shows that 30 % of Americans doesn’t listen to voicemail at least for 3 days, whereas 95 % of the text messages are read within 3 minutes. So sending a reminder text will help the patient to pay their dues on time
Dec 29, 2020
The annual deductible for all Medicare Part B beneficiaries is $203 in 2021, an increase of $5 from the annual deductible of $198 in 2020
Medicare Part B deductible for 2021 has been raised to $203 from $198 in 2020.
Therapy cap for 2021
$2,110 for PT and SLP services combined, and
$2,110 for OT services.
Earlier in 2020 the cap was $2080.00
Dec 10, 2020
UHC Waiving cost-share for Medicare advantage plans: Extended till December 31/2020
United Healthcare is waiving cost share(copay,coinsurance and deductible) for Medicare advantage plan for all covered services effective from May 11,2020. This was ended on September 30th 2020, however it is extended till December 31,2020 now.
Remember this is applicable only for PCP visits and not for specialist visits.
Why primary care visits are important ?
Getting regular checkups may help patients healthy and make it easier for doctor to catch issues or illnesses early. During the visit, the primary care provider (PCP) should check blood pressure, height and weight, and address overall well-being, which helps to prevent critical illness.
Emergency use ICD codes for COVID-19 disease outbreak.
An emergency ICD-10 code of ‘U07.2 COVID-19, virus not identified’ is assigned to a clinical or epidemiological diagnosis of COVID-19 where laboratory confirmation is inconclusive or not available.
Both U07.1 and U07.2 may be used for mortality coding as cause of death. See the International guidelines for certification and classification (coding) of COVID-19 as cause of death following the link below.
Jan 21, 2020
Team completes 1000+ benefit verification in the first two weeks of January !!! Why is it crucial to re-verify benefits beginning of New Year ?
With deductible start over with most of the payers in the beginning of New Year, the dip in insurance collection is inevitable. Of course the patients are liable to pay the deductible, still a well informed financial care plan is essential. It not only helps the patients and providers to plan the financials, but also helps to continue a healthy relationship.
Just because your patients claims are getting paid consistently, it doesn’t mean it would continue to get paid. What may change at the beginning of New year ?
1. Deductible and out of pocket expenses would start over
2. Copay per visit may change
3. Coverage could be terminated.
4. COB issue may have raised.
5. Patient may have bought new insurance.
6. Complete change in benefits.
If practice knows all these changes upfront at the beginning of Year for their patients, it will help to reduce the dip in collection.
We anticipated most practices would do re-verifications of benefits. Even though most of the insurance would have a very long hold time in benefits Dept at the beginning of year, We planned well to complete them as quickly as within 1 hour from request and up to a maximum of 48 hours TAT based on the client needs. Proud to say that we completed 1047 verifications in the first 2 weeks of January.
Dec 6, 2019
Medicare does not accept old policy number with SSN effective 01/01/2020.
It is a well-known fact that Medicare started to issue new cards to all their members beginning April 2018. The idea is not to have the SSN# as part of the policy number. Medicare has been accepting both the old and new policy number during claims submission during this transition, however effective 01/01/2020 Medicare will not accept claims with the old policy number.
Submission with old policy number will end up in getting denials and affect the revenue of the practices. By the beginning of December 2019, Aura proactively initiated request to all our client partners to setup a validation in the RCM software that gives a POP up alert to physicians on respective patient accounts to collect new card copy from patient where ever old format is not changed. This will help reduce the denials. In addition to that, we also suggested validation to stop the claims submission when the accounts does not have new policy number. This will help to increase the clean claims submission. Both these validations helped our client partners to make this big change happen hassle free to all physicians
Sep 25, 2019
Delayed and Denied payments are the nightmares for Physicians
Getting this fixed is not a Rocket science. Understanding the problem is the first step to resolve it. Aura identify the root cause of the problem and address it. There are only 4 reasons for payment being delayed or denied by insurance.
1. Error from Billing office side (Example : Ineffective follow up, Delayed follow up etc.,)
2. Error from Provider side (Example : Incorrect coding, missing MR etc.,)
3. Error from Patient side (Example : COB, Coverage termination etc.,)
4. Error from Insurance side.(Example : Incorrect processing, Delay in processing etc.,)
Of course all billing companies strive to avoid the first reason and they achieve it. But this will not be sufficient enough to increase the provider’s revenue. We in AURA assist providers to understand their errors, helps them to avoid it future. We identify the patient’s error quickly, notify providers to discuss with patients to resolve it. We also give the heads-up before an error can occur. Insurance error is something not completely in our control, however identifying it quickly and escalating to higher level to fix their adjudication system will definitely helps to resolve it.
Aura breakdown the problems into these 4 segments, fix at root level and keep an Healthy RCM process.
Aug 16, 2019
UHC : Effective with dates of service on or after Sept. 1, 2019, the GN, GO or GP modifiers will be required on “Always Therapy” codes to align with CMS.
Humana requires Modifiers 96 / 97 ( Habilitative / Rehabilitative Services) on Therapy services.
Mar 02, 2019
Here is the quick check for chiropractors to make sure records meet the medical necessity criteria of Aetna
Aetna often deny the claims as not medically necessary and they do not explain in detail what is lacking on records.
Aetna considers chiropractic services medically necessary when all of the following criteria are met:
1. The member has a neuromusculoskeletal disorder; and
2. The medical necessity for treatment is clearly documented; and
3. Improvement is documented within the initial 2 weeks of chiropractic care.
If no improvement is documented within the initial 2 weeks, additional chiropractic treatment is considered not medically necessary unless the chiropractic treatment is modified.
If no improvement is documented within 30 days despite modification of chiropractic treatment, continued chiropractic treatment is considered not medically necessary.
Once the maximum therapeutic benefit has been achieved, continuing chiropractic care is considered not medically necessary.
Chiropractic manipulation in asymptomatic persons or in persons without an identifiable clinical condition is considered not medically necessary.
Chiropractic care in persons, whose condition is neither regressing nor improving, is considered not medically necessary.
Manipulation is considered experimental and investigational when it is rendered for non-neuromusculoskeletal conditions (e.g., attention-deficit hyperactivity disorder, asthma, autism spectrum disorder, dysmenorrhea, epilepsy, and gastrointestinal disorders, and menopause-associated vasomotor symptoms; not an all-inclusive list) because its effectiveness for these indications is unproven.
Manipulation of infants is considered experimental and investigational for non-neuromusculoskeletal indications (e.g., infants with constipation).
Chiropractic manipulation has no proven value for treatment of idiopathic scoliosis or for treatment of scoliosis beyond early adolescence, unless the member is exhibiting pain or spasm, or some other medically necessary indications for chiropractic manipulation are present.
No time to send EOB copies across to Billing Company? You are probably affecting your revenue!!!
Delay in sending the EOBs across to Billing company is a major mistake that some practices do. The office staff may not get time to scan the EOBs on daily basis due to their busy schedule. And at times they completely miss to send across the EOBs. Once they detach the chk and deposit in bank, scanning the EOBs to billing company is not in their top priority. Believe it or not, each day you delay in sending the EOBs, you are delaying your own revenue.
What happens when the Billing Companies do not get the EOBs on time?
Once the claims cross the 30 days bucket, the Billing Company call payer inquiring the reason for non-payment. The time spent by the billing company on already paid claim is nonproductive. Though it does not affect the practice directly. It badly affects indirectly. Billing companies allocate their resources ONLY a specific amount of time for each practice. The resources allocated for thee practice would be spending more time on already paid claims and get less chances to reverse the denied claims into paid claims.
Most insurance process the denials quickly, as they don’t have to spend money on it. Until the claim cross the 30 days bucket, the denied claim will not come under the billing team attention. Sending EOBs on time will ensure to address the denials much earlier.
Many payers specify the appeal procedure in detail on EOBs, which payer may not disclose in detail over phone when the billing team don’t have EOBs.
When zero paid EOBs are ignored or delayed, patient get delayed bills on their deductibles or non-covered charges, so your patient payment also gets delayed.
Forwarding the claim to secondary payer to cover coinsurance or deductible get delayed.
Auto insurance and WC adjusters get annoyed if Billing Company checks status on claims that were paid and cashed by provider. They may even stop responding to voicemails when it happens frequently.
Appeal limit for certain payers are as low as 30 days from initial denial date. Delay in receiving EOB will increase the risk of losing time to appeal.
Help Billing Companies by providing the EOBs on time. Billing Company will help you to get paid faster on denied claims.
July 18, 2018
Aura not just talks about women empowerment but practices it.
Aura strongly believes that women form the backbone of a family and feels they are the strong workforce of the future. Adhering to it Aura has provided equal employment with more than 45% of its workforce are women.
Jack Ma Founder of Alibaba rightly said “In the age of AI, women’s attention to experience and detail can outperform machine learning, whereas men’s traits of rational thinking will be challenged by machines”. He also added that 47 % of their employees are women, which is the secret behind their success.
Women empowerment has become the buzzword today with women working alongside men in all spheres. With equal opportunities to work, they meet the deadlines matching to their male counterparts and are focused to stay longer in their profession.
The biggest question is “Are they able to successfully strike a balance between their profession and their family?”
To make work life balance easier and to make them financially independent we at Aura give utmost benefits to all women employees. We had given 6 months maternity leave even before it was mandated, along with flexible working hour’s option and also offer work from home whenever they are not able to make it to office. Keeping the health aspect of its women employees in mind, Aura had never encouraged them to extend their work for long hours. Also, we always insist them to take breaks and go for a walk to breathe fresh air to keep their mind and body relaxed.
Is quitting the only option when they are not able to work 8 hours a day due to family commitments?
When it comes to household works, taking care of children, it is women who contribute most than men in spite of the tight competition they give to men in Professional life. Aura always stress that “There is a positive solution for this problem than quitting”. Understanding the difficulties, Aura has introduced “Work at Ease” for all women Employees who are financially dependent on their earning. With this option, Women Employee can opt to work on flexible duration and get paid accordingly.
June 9, 2018
10 Tips for Practices that can enhance timely and accurate processing
1. Always collect copy of Insurance card and identity card, in addition to filled patient demographic forms.
2. Maintain a Matrix showing IN/OUT status with Major payers along with plan names. Display and discuss with patients to avoid discrepancies at later time.
3. Maintain a matrix with payers and plans that require Referral/Auth. Validate every policy with the matrix.
4. Plan to follow up within 3 days on authorization request and find if approved or denied.
5. The moment you find the termination of policy in any account, Set ALERT to check with patient for new coverage information on next visit.
6. Allocate time for Office Manager / Front desk Rep to review patient account in RCM before patient check in for appointment. This will help you to keep handy if any data or payment need to be collected from patient.
7. On each visit verify with patient any recent changes in insurance policy, COB, patient address/phone#. Keep your records up to date.
8. Account any copays collected from patient in RCM software immediately to avoid incorrect bills to patient.
9. Help patients to fix COB with payer or filling questionnaire at Front desk to make sure they do it timely and correctly.
10. Obtain feedback from patients on each visit which will help to improve the service.
May 21, 2018
How to keep the AR120 + % low ?
Diligently working on 120 days old claims to reduce the AR120 % is still only a firefighting job. As you may all agree on the proverb “Prevention is better than Cure”, the key to maintain the AR120 % low is never allowing the claims to reach 120 bucket.
Billing companies work hard to get the claims paid on time, while the payers find loop holes to delay/deny the payments. Though on-time payment from payer is not fully under biller’s control, setting up a better process, plan and execution on the areas which are in control will definitely help to get the claims paid on time. As the first step, we at Aura, ensure to submit CLEAN claims to payer. Aura does a thorough eligibility and benefit verification to avoid numerous denials. We ensure providers know beforehand what services are covered and what not. When Benefit verification data is handy at the time patient checked-in for appointment, provider get chance to discuss and decide on treating non-covered charges and come up with a game plan. With the advancement in technology, the RCM software helps us to identify the missing/incomplete/invalid data errors on the claims before submission. In addition to that, Aura also do manual audit on the patient demographic information which helps to almost submit a clean claim.
Once the clean claim is out of the door, our expectation is to get paid and posted in account on time. To enhance quick turnaround, we work with our clients to enroll for Electronic submission, EFT payment and ERA for all possible payers. We are not worried about the claims that get paid and posted on time; we are worried only about the claims that did not get paid. EFT and ERA will help to identify those claims at least 10 days earlier.
When a claim not paid or underpaid, review the EOB thoroughly, make a call to payer if need. We must know the exact reason for non-payment. Understanding the problem is half way through moving towards the solution. Once we identify the problem, fix it and resubmit/reprocess over phone. Of course payer will always find reasons to deny though there is no fault from provider/billing company side. A normal billing company will request the payer to reprocess the claims for payment, wait for payment, if not paid in another 2-3 weeks, follow up again. This cycle may go on an endless loop. To break this, We at Aura identify the root of problem and fix it within 2 to 3 follow up calls. If not resolved by 3rd follow up, we escalate to supervisor / Manager Level. It is absolutely ok to remain on call for extended period of time, but make sure to fix it right away. Many billing companies’ fails at this stage. They keep calling payer, listen to the reasons and wait again. Escalation at right time at all levels will definitely help to resolve the issue quicker.
The task is not just complete after getting the claims paid. Medical billing is an Ocean. Each time we work with payer and resolve a claim, we learnt something new. Think of how to avoid such denials in future and set a process. Many insurance companies are ready to upgrade their process to avoid incorrect denials, but they may not be aware of it or fix it voluntarily. When we notice insurance errors, we explain to supervisor and request to upgrade their process. Our suggestions will definitely be consider at Manager level escalation. There are some factors which is completely out of control on the billing company side, like COB issue, medical necessity denial, etc., Escalation to provider at right time and requesting a decision from them helps to keep them under control.
AURA has been consistently following these principles and maintains the AR120 + percentage around 5. The graph shows the AR % of one of big size practice, from the time of signing up through 1 year period with us. It shows how Aura gradually brought it under control.
April 12, 2018
Why Medicare pays Chiropractors only when billed with both Subluxation and non-Subluxation diagnosis codes?
Chiropractic billers know Medicare need a primary subluxation DX and secondary non-subluxation DX to pay CMT. But WHY ? How many knows it…
Before you know, You need to understand some anatomy behind it.
Our Spine is made of 33 individual bones, known as Vertebrae that interlock with each other to form the spinal column. The nerves from brain passes through the spinal canal before it reaches vary part of the body. Just as the skull protects the brain, vertebrae protect the spinal cord.
Spinal Subluxation is a partial dislocation of vertebrae which may results in damage of ligaments, nerves, and joint surfaces as depicted in the picture.
If we take a MRI scan of our spine, most of us may have a spinal subluxation, but not all of us develop discomfort/symptoms. It goes unidentified until it develops symptoms. It may not develops any symptoms ever as well. Coming back to Medicare rule, They pays chiropractor only when there is a Spinal subluxation that develops a symptoms.
a) When you have a back pain, discomfort or any symptoms but the cause is not the spinal subluxation, Medicare does not pay when billed by chiropractor.
b) When you have a spinal subluxation but that did not develop any symptoms, Medicare does not pay when billed by chiropractor.
To get paid from Medicare, Need to have a symptoms/discomfort (Secondary non-subluxation DX) which is developed primarily due to spinal subluxation (Primary diagnosis).
Feb 26, 2018
Aura has a new landmark
The room for experience and experiment widens as Aura steps into its new premises. Aura BPO @ Mount Road Guna Complex Annex 1. A bigger, brighter place for our Employees. Look forward for more success
May 1, 2017
Aura 5th Year Anniversary
Proud moment for all of us as we complete 5 years of journey and stepping into our 6th year.