Healthcare News December 31, 2011

  • Planned Parenthood tops $1 billion in assets

    The groups annual report, released Friday, is sure to rekindle Republican lawmakers efforts to defund the organization in 2012.

  • 5010 for Insurance Claim Submission is Here
    Insurance Claim Rejected - Capture Billing - Medical Billing Company

    5010 is the Standard Now: Are Your Insurance Claims Going to Get Paid?

    Capture Billing has been working toward preparing for the transition to HIPAA Version 5010 for the past several months. The time has come and we are ready. As of January 1, 2012 all insurance claims must be submitted with the new 5010 format as mandated by the federal government.

    Just because we are ready does this mean that insurance companies are ready? Will there still be some problems with insurance claims submission? Yes, I believe so.

    The reason we estimate there will be problems is that as the insurance companies start receiving claims in the new 5010 format, even with all the testing that should have been done, there still may be issues with acceptance of the insurance claims. There are always glitches when software is upgraded and this is a big huge change.

    I hope 5010 goes smoothly but I am not holding my breath!

    Not only is Version 5010 a huge transition, it is happening all at once on January 1st with all medical practices, claim clearinghouses and insurance carriers. I have been in the medical billing industry for quite a while and have experienced insurance carriers upgrading software and having our claims rejected or denied inappropriately as a result of those updates. I hope it goes smoothly this time but I am not holding my breath!

    My main concern is for small medical practices that may not be as tech savvy or have the resources to get help. Are they ready? Will all their claims be denied? Will they know how to work with their practice management software vendor and insurance company Electronic Data Interchange (EDI) departments to get their claims paid?

    I think practices may have cash flow problems in the next few weeks as glitches in the system appear. And not just the small practices but the big medical practices also. Reimbursement issues may well extend into February before there is some relief.

    We will be monitoring the 5010 transition situation very closely to make sure the medical practices we service don’t see a reduction in revenue or at least only a minimal change.

    Keep a close eye on your claims to make sure they go through and are accepted by the clearinghouse and insurance companies. Make sure you carefully review all the Explanation of Benefits (EOBs) you receive from the insurance payers to ensure you are getting paid for the services you provided.

    I would like to hear how your transition went and if you are having any problems. Please leave me a comment.

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  • Hispanic group takes issue with Obama administration’s Plan B decision

    A Hispanic women’s group wants the Obama administration to lift barriers to emergency contraceptives in the wake of a medical study showing pharmacists in low-income neighborhoods often restrict their sale.

    The National Latina Institute for Reproductive Health has asked for a meeting with Health and Human Services Secretary Kathleen Sebelius to urge her to reconsider last month’s decision not to make the emergency contraceptive Plan B available to girls under the age of 17. The request comes after a study in the Journal of the American Medical Association found that more than 1 in 5 pharmacists in low-income neighborhoods refused to sell Plan B to women aged 17 and over, even though they don’t legally require a prescription.

    “A disproportionate number of teen pregnancies occur among adolescents from disadvantaged neighborhoods,” the study concludes. In those same neighborhoods, “misinformation regarding access was common.”

  • Democratic House candidate produces graphic anti-abortion-rights ad

    The ad is part of a campaign designed not to win elections but to highlight abortion.

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