Hello my name is Eric BOTS and I am a practicing optometrist I help many doctors and their staff efficiently file insurance claims and maximize the reimbursement I know there are many practices that struggle to get paid I am offering you a solution to the problem of filing your Medicare insurance claims where do you begin here are four scenarios that you can choose from to ensure that you are maximizing your insurance reimbursement you choose which one is best for you so scenario number one this is not the most efficient way to submit claims but easy to access you're going to utilize a clearinghouse like Gateway or ENSO those are two that I've used in the past some requirements here for you and your staff those you must understand how to code and use modifiers it's a slow enough inefficient because you have to put the information into their website you have to submit secondary insurance claims you have to resubmit denied claims after you've researched why they were denied and then you have to send a bill to the patient for the balance due so you have to hire you have to train and you have to maintain a billing person in your office unless you the doctor are going to do this yourself here's websites and information for to the clearinghouses that I mentioned earlier the ENS Ingenix and Gateway scenario number two this is much more efficient you're gonna utilize practice management software you're going to connect to a clearinghouse you still have to understand coding and modifiers you're still going to submit claims to secondary insurance you're going to send bills to the patient for balance due and you're gonna resubmit any denied claims after you have researched them you need to hire...
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Medicare reconsideration Form: What You Should Know
Appeals Level 2: Public Safety Agency A redetermination is required when you file an appeal to this level of appeal. The appeals level 2 (PSA) is where you file appeal to verify that the Medicare contractor followed its usual procedures for conducting a redetermination, and that this redetermination is justified in order to correct a clerical error. Appeals Level 3: Public Safety Agency For those who believe their claim should have been approved, you can file an appeal at this level of appeal. Public Safety Agencies are responsible for the accuracy of Medicare payments and have power to adjust payments for errors in order to correct a clerical error or clerical error that has been corrected. Appeals Level 4: Feds The Medicare provider must notify this appeals level of appeal to confirm that it has acted in accordance with the CMS regulations. The provider must then follow the CMS guidelines for correcting errors and notifying consumers, and notifies all CMS-covered persons (i.e., Medicaid providers). Any Medicare provider is required to make timely adjustments to Medicare payment if an error was identified or corrected. (There are no public safety agency reviews.) Appeals Level 5: HHS The Medicare provider is also required to notify HHS of any error that occurred with the payment. Appeals Level 6-7: CMS The provider must notify CMS regarding the results of an appeals audit, within 5 days. Appeals Level 8: Medicare Your appeal cannot be determined within the 10-day appeal process (if you are notified of an error, then you will have 20 days to file a claim). If you are granted an appeal, it becomes final and will affect your next determination of eligibility. Appeals Level 9: Other The Medicare provider must notify Medicare of any error and a failure to follow the Medicare Provider Rules Within 3 days of receiving a notice from the Medicare contractor. Any Medicare Provider that fails to abide by the Medicare Provider Rules will be subjected to suspension, penalty, or prosecution and may be required to pay a penalty equal to 25,000 per error. If the provider fails to abide by the Medicare Provider Rules, or if an error is determined to be made out of policy, we will request that the contractor conduct a mandatory appeal process. An official notice of appeal will be mailed to any Medicare account that has received a required notice within 45 days of this initial notice.
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