aag & misc test

Since Medicare’s inception in 1966, private healthcare insurers have processed medical claims for Medicare beneficiaries. Originally these entities were known as Part A Fiscal Intermediaries (FI) and Part B carriers. In 2003 the Centers for Medicare & Medicaid Services (CMS) was directed via Section 911 of the Medicare Prescription Drug Improvement, and Modernization Act (MMA) of 2003 to replace the Part A FIs and Part B carriers with A/B Medicare Administrative Contractors (MACs) in accordance with the Federal Acquisition Regulation (FAR). A Medicare Administrative Contractor (MAC) is a private healthcare insurer that has been awarded a geographic jurisdiction to process Medicare Part A and Part B (A/B) medical claims or Durable Medical Equipment (DME) claims for Medicare Fee-For-Service (FFS) beneficiaries. CMS relies on a network of MACs to serve as the primary operational contact between the Medicare FFS program and the health care providers enrolled in the program. MACs are multi-state, regional contractors responsible for administering both Medicare Part A and Medicare Part B claims. MACs perform many activities including: Process Medicare FFS claims Make and account for Medicare FFS payments Enroll providers in the Medicare FFS program Handle provider reimbursement services and audit institutional provider cost reports Handle redetermination requests (1st stage appeals process) Respond to provider inquiries Educate providers about Medicare FFS billing requirements Establish local coverage determinations (LCD’s) Review medical records for selected claims Coordinate with CMS and other FFS contractors Currently there are 12 A/B MACs and 4 DME MACs in the program that process Medicare FFS claims for nearly 70% of the total Medicare beneficiary population, or 37.5 million Medicare FFS beneficiaries. The MACs serve more than 1.5 million health care providers enrolled in the Medicare FFS program. Collectively, the MACs process more than 1.2 billion Medicare FFS claims annually, 210 million Part A claims and more than 1 billion Part B claims, and paid $367 billion in Medicare benefits. MAC A/B Jurisdiction Map (March 2023):   Source: www.cms.gov

Did you know that it costs an average of $25 to rework a single claim?  It’s true, according to a recent Health IT News article. The article goes on further to state that as many as 65 percent of denied claims remain unresolved because they are too costly to rectify. These unpaid claims eventually become lost revenue. Experian Health’s Denials Workflow Manager and Enhanced Claim Status solutions are part of an integrated revenue cycle platform for healthcare providers to manage payer billing and payment processes.  Effective management of these processes directly results in improved cash flow, lower days in A/R, and more efficient operations. Clients converting to our integrated claims and denial solution are experiencing a 50% increase in clean claim rates and faster turnaround on cash. Learn more by visiting our Claims Management page or reserve your spot at one or both of our Claims sessions at the upcoming HFMA ANI conference: June 27 | 1:30pm | Manage Denials to Maximize Reimbursement, Revenue and Cash Flow June 28 | 9:45am | Claims Management

Experian Health has launched Coverage Discovery® on demand, which is integrated into Epic’s EMR. We are the first-to-market with this functionality for Epic. In addition to Coverage Discovery’s batch reclassification of uncompensated care by finding previously misidentified patient coverage across both government and commercial payers by using advanced analytics, multiple data sources and a proprietary coverage optimization engine, the “on demand” feature provides Epic clients with additional opportunities to find coverage early in the revenue cycle—reducing additional downstream processes. By adding the on demand option, Experian Health’s clients can now run Coverage Discovery within their Epic workflow, which will help to reduce errors, save time and ultimately improve their revenue cycle. Every dollar found in our proactive, automated Coverage Discovery solution is a dollar that our clients are not spending pursuing patients for payment, paying for expensive collection agencies, or writing off to bad debt. Coverage Discovery is also available via eCare NEXT®, OneSource and Batch for non-Epic users. Coverage Discovery is providing significant results for over 300 Experian Health clients. In 2015, the solution discovered coverage associated with over $1.1 billion in charges. According to Murry Ford, Director, Revenue Strategy at Grady Health System, “Coverage Discovery consistently delivers value to our organization. Since our June 2015 go-live of the batch product and November 2015 go-live of the on demand product, Coverage Discovery has protected $2.3 million in reimbursement, $509,000 of which resulted from Coverage Discovery on demand queries for inpatient admissions over a two month period.” Read our latest press release, which further highlights Grady’s success using this solution.

Welcome Katie Zibelin, Experian Health Marketing’s newest team member. Katie made her Experian debut in August 2015 as an intern where she supported client events, tradeshows and proposal efforts behind the scenes.  Upon securing her advertising degree from the University of Texas at Austin in December 2015–one semester ahead of schedule–Katie joined the team full time this February. In her current role as a Marketing Coordinator, Katie is responsible for tracking projects, managing vendor activities, conducting tradeshow and vendor research, developing new vendor relationships, coordinating and supervising tradeshow activities and communicating programs and events. Katie also serves as the project leader of our 2016 Regional User Conferences. In her first solo performance at our Southeast Regional Conference in New Orleans, Katie received rave reviews for demonstrating project management and event planning maturity and grace under pressure. Fun Fact: Katie is also an accomplished contemporary dancer/performer/instructor. Please do not hesitate to reach out to Katie with questions regarding any of the upcoming Regional User Conferences at Katie.Zibelin@experianhealth.com.

Did you know? In 2015, Experian Health helped nearly 700 provider clients screen over 51 million patients for financial assistance. That’s important for healthcare providers that are ramping up to meet 501r regulation requirements this year. Experian Health’s Patient Financial Clearance automates the financial screening process prior to service or at the point of service, to determine if patients qualify for Medicaid, charity or any assistance program, while auto-enrolling eligible patients. This new solution can help you: Meet 501r regulatory requirements Increase staff productivity by expediting financial assistance decisions Improve point-of-service collections Reduce overall AR days Patient Financial Clearance uses a proven combination of consumer data, patient-provided information and provider policies to automate the screening process and empower patient access staff to be more productive and effective. Help your patients while protecting your bottom line. Contact us today at experianhealth@experian.com or 1 888 661 5657 to find out how Patient Financial Clearance can help you.

Screening for the Human Immunodeficiency Virus (HIV) infection On February 5, CMS released a change request to inform contractors that CMS has determined that the evidence is adequate to conclude that screening of HIV infection for all individuals between the ages of 15-65 years is reasonable and necessary for early detection of HIV and is appropriate for individuals entitled to benefits under Part A or enrolled in Part B. Effective date: April 13, 2015 Implementation date: March 7, 2016, for non-shared A/B MAC edits; July 5, 2016 for CWF analysis and design; October 3, 2016, for CWF Coding, Testing and Implementation, MCS, and FISS Implementation; January 3, 2017, for Requirement 9403.04.9 View Transmittal R3461CP View Transmittal R190NCD Screening for Cervical Cancer with Human Papillomavirus (HPV) testing On February 5, CMS released a change request stating CMS has determined that for dates of service on or after July 9, 2015, evidence is sufficient to add HPV testing under specified conditions. Effective date: July 9, 2015 Implementation date: March 7, 2016, for non-shared MAC edits; July 5, 2016, for CWF analysis and design; October 3, 2016, for CWF Coding, Testing and Implementation, MCS, and FISS Implementation; January 3, 2017, for Requirement BR9434.04.8.2 View Transmittal R3460CP View Transmittal R189NCD Revision to Fiscal Intermediary Shared System (FISS) lab travel allowance editing to include new specimen collection code G0471 On February 5, CMS released a change request updating FISS reason code 32436 to include HCPCS code G0471 in the list of specimen collection fee codes that will allow the travel allowance to be paid on outpatient claims. Effective date: April 1, 2016 Implementation date: July 5, 2016, for claims processed on or after View Transmittal R1619OTN View MLN Matters article MM9471