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Tag Archives: Participating

Exempt from MIPS?  Think Again About Participating as a Group

With the first year of the Merit-Based Incentive Payment System (MIPS) already well underway, the Centers for Medicare and Medicaid Services (CMS) began sending out MIPS Participation Status Letters in April. The letters were sent to each Eligible Clinician (EC) associated with a group Taxpayer Identification Number (TIN).  An EC can also check the Medicare Quality Payment Program (QPP) web site to determine his or her eligibility.  The letter and web site contain general information about participation in MIPS, along with email and telephone contact information that should be used if a provider feels his or her status is incorrect.

Radiology Billing and Coding Blog

New Hampshire BCBS Begins Participating with Medicare Part C & D

Medicare is a social health insurance backed and funded by the US federal government for senior citizens and for younger people with disabilities. Originally, beneficiaries of Medicare are provided with funding by the government itself, but with the inclusion of Medicare’s Part C, people can now opt to be covered through a network plan.

While third-party health insurance agencies like the New Hampshire Blue Cross and Blue Shield Anthem exist for beneficiaries opting for Medicare’s Part C and D, why would anyone want to choose paying more for something the government offers at a lesser price?

Medical Billing and Coding Process:

Anyone who has ever been hospitalized and has filed a claim for Medicare or Medicaid services should know how troublesome it can be. As wonderful and beneficial these social health insurance coverage can be, the process of them actually being wonderful and beneficial could take from a few days to a few months, depending on the nature of the claim. Imagine having to go through illness and disease, and processing an insurance claim at the same time.

Granted, health insurance like Medicare cannot help it when certain claims take too long to be processed. The reason for this is because as a government-funded and backed program, it caters to a whole multitude of people who essentially file claims at the same time. Imagine the staggering amount of paper and electronic forms that get submitted to Medicare carrier offices daily, and the reason for the delay seems clear.

Faster Processing with the New Hampshire Blue Cross and Blue Shield:

Fortunately, third-party insurance companies like Anthem can process these claims faster than if a beneficiary were to file a claim to the government or original Medicare program. This is because third-party agencies will get a substantially smaller bulk of claims as not all qualified beneficiaries opt to choose a third-party health insurance.

Furthermore, agencies like the New Hampshire Blue Cross and Blue Shield have affiliated pharmacies and physicians who all provide Medicare and Medicaid coverage. Should their beneficiary member seek treatment or prescribed medications from their affiliates, the process of medical billing and coding gets easier, as the interaction between the medical provider and the insurance agency is faster than it would be if the medical provider were to interact with a government-issued carrier.

For medical providers, opting to be affiliated with a third-party insurance agency can also prove to be more beneficial, especially when it comes to the process of coding medical bills. Medical bills can be so confusing that there are separate Medical biller to do the job. For a physician filing a medical bill under the government-centered Medicare, he or she will most probably complete the taxing medical coding and billing process. If he or she is affiliated with a third-party agency, he or she might not have to, as the agency will probably have a Medical biller on staff.

Though it might be true that going for a third-party option for Medicare and Medicaid will be more expensive, it can provide faster, smoother, and better handling with the troublesome coding, filing, and processing of medical bills.

Click Here to visit the New Hampshire BCBS website for more information.

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