| Resource Evaluation Leaders Inc. |
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Serving the Business Needs of the Health Care Community
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RELI is a Development & Marketing Firm Dedicated to Health Care Professionals
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| The Key To Propietary Information |
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NPI for Medicare FFS Providers
The NPI or National Provider Identifier is here and now! It's May 22! Are you ready? As of May 23, Medicare FFS(fee for service) will require that you send the NPI-Only, in all provider identifier fields for all HIPPA transactions where a provider identifier is required. If you send Medicare a transaction with a Medicare Legacy Identifier (the old identifier) in any of the provider fields, your claim will be rejected. These transactions include all electronic and paper claims. Be sure all relevant claim information is correct because Medicare may not only reject an individual claim, but any discrepancy particularly the NPI, may trigger a 'Red Flag' on their servers and interrupt all claim payments. It is very difficult to get claim payments re-started once they have been interrupted. RELI is an expert in 'Regulatory Compliance' and a truly unique resource for Health Care Professionals. Click on the 'KEY' to Email one of our experts with your question. Initial phone consultations and Email responses are a no-charge courtesy.
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| The Key to Proprietary Information |
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National Provider Identifier-NPI
Got yours? Time is running out for doctors to apply for and receive their National Provider Identifier or NPI! If you do not have your Identifier, there will be disruption in claims payments from all Insurers. If you don't know, let me be the first to inform you. When claims stop being paid, it is very difficult to get them started again. Make no mistake about it! Though deadlines vary from insurer to insurer, generally speaking you have until May of this year to comply. We recommend that you submit claims with both your new NPI and your old Insurer ID until claims process without exceptions. In concurrence with your NPI we also suggest that you verify all other relevant information (names, addresses, spelling) because any discrepancy will trigger a 'Red Flag' on Insurer servers and interrupt payment of you claims. Forewarned is forearmed!
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| THE KEY TO PROPRIETARY INFORMATION |
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Retrospective Review & Recovery
This is a term that all Doctors should know and understand. In actuality, it is an insurance company software program that reviews claims that have been paid to doctors for services rendered to patients. This review or analysis seeks to identify patterns, mistakes, discrepancies or omissions in your billing, going back three to five years. We are talking 'Regulatory Compliance' here. Make no mistake, if problems are found, they will ask you for a group of your patient records. If your records are not computerized using a current computer, operating system and professional billing software, chances are you will not pass this claims review. This will leave you open for a 'Review' of all your insurance claims. And yes, the 'Insurance Companies' have the legal right to do this.
One of several reasons why doctors fail this review is because of inadequate 'SOAP NOTES'. If you are not recording comprehensive, 'Subjective-Objective-Assessment-Plans', you are not in 'Compliance' with your agreement with any insurance company that is paying you. This brings us to the 'Recovery' portion of our Blog. An 'Insurer' has the right and will seek to recover any and all monies sent to you, that they have discovered to be improperly paid during 'Retrospective Review'. If you respond to a 'Retrospective Review' with an adversarial approach, 'Insurers' generally cut off all future claims payments, until the issues are resolved to their satisfaction. Remember, all Doctors are subject to 'Regulatory Compliance'. Insurers make the regulations and Doctors are required to comply. Simple and true!
RELI is a specialist in 'Regulatory Compliance' and can set you up with all the systems and training necessary to keep you out of trouble with 'Insurers'. If you have already received a letter from an 'Insurer', we can help streamline and walk you through the process. Click on the 'Key' to send an email to one of our 'Information Specialists'. We at RELI are insurance experts and a truly unique resource for health care professionals. Initial phone consultations and email responses are free.
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| Time To Contact Us |
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