Archive for January, 2012

5010 Review

January 31, 2012

The healthcare industry has been using HIPAA 5010 standards to transmit electronic medical claims for a few weeks. How’s that working for your practice?  Are you seeing denials?  Do you know what to be looking for and get the data fixed?  While it’s tempting to assume that no news is good news, a lack of response doesn’t mean there is not an issue.  Make sure you watch out for any medical claim rejections and denials and fix them as quickly as possible. Some of the problems that could be causing rejections or denials includes:

  • National Provider Identifiers (NPI) need to be used, not an employer’s tax ID or Social Security number.
  • HIPAA 5010 requires that a street address – not PO Box, be used on all medical claims.
  • Providers can use a PO Box for a billing address that receives reimbursement checks. But make sure the payers have that on file and are using it.
  • Speaking of addresses, providers need a nine-digit zip code with the billing and physical addresses.
  • HIPAA 5010 allows as many as 12 diagnosis codes on each claim, but each specific service can only have four codes.
  • Any claim using an unlisted Current Procedural Terminology (CPT) or Healthcare Common Procedure Coding System (HCPCS) code also needs a code description.
  • Healthcare providers must submit a Medicare Secondary Payer (MSP) indicator on the primary and secondary claim when Medicare is the secondary payer.
  • Drug quantity and unit of measurement are required when a National Drug Code (NDC) is listed.
  • All ingredients in a compound prescription must be listed with a HCPCS code.

In addition to watching the number of denials or rejections, make sure the reimbursements match what you expect. Just because the claims get out the door, doesn’t mean they it will be processed correctly for reimbursement.  There are many aspects to the claim process and all must be evaluated.

We hope you are having  success with the transition from 4010 to 5010!



January 30, 2012

Outstanding leaders go out of the way to boost the self-esteem of their personnel. If people believe in themselves, it’s amazing what they can accomplish.

– John Quincy Adams


January 26, 2012

Be a professional at whatever you do, and you’ll reap the benefits for a lifetime.

– Glenn Shepard

Year End and IRS Forms

January 23, 2012

Year End comes every 365 days.  For many, it sneaks upon them very quickly each and every year.  Many people don’t plan ahead for tax time, yet if you are diligent and do the necessary steps in bite size chunks, tax time will not be a nightmare for you.  In order to evade the nightmare, you must plan ahead.  To plan ahead, that means you must be diligent to complete the steps required and be aware of what forms are needed on both a state and federal level.

Are you ready to file your IRS Forms for the previous calendar year?  Once you have all your data together you are ready to file your forms.  Today, I want to share with you a resource to assist you with the forms needed.  These forms may be purchased by many vendors.  However, did you know that you can order them from the IRS for free?  Yes!  It takes planning ahead, but you can order them here.  You can also search to get instructions on the forms you need to file on a federal level.

What other free resources do you utilize for your accounting and tax filing purposes?


January 19, 2012

Leadership is the capacity to translate vision into reality.

– Warren G. Bennis

new definition for 5010

January 18, 2012

I want a new definition for 5010.

Is it Fifty Ten…or is it Five o One o?

Wonder what its true meaning will be?

  • Five months of hell?  One month of revenue?
  • Five times as long to complete one task?
  • Five steps back one step forward?

I need some humor to make it through the overwhelming fiasco that has launched.  I am trying to find it.  Help me please.

Medical Necessity means just what?

January 16, 2012

When an Insurance Carrier processes a claim and denies for this does not meet Medical Necessity, what do they mean by that?

The term “Medically Necessary” or “Medical Necessity” is defined as a health care services that a Provider, exercising prudent clinical judgment, would provide to a patient for the purpose of evaluating, diagnosing or treating an illness, injury, disease or its symptoms, and that are in accordance with generally accepted standards of medical practiced; clinically appropriate in terms of type, frequency, extent, site and duration, and considered effective for the patient’s illness, injury or disease; and not primarily for the convenience of the patient or Physician, or other Physician, and not more costly than an alternative service or sequence of services at least as likely to produce equivalent therapeutic or diagnostic results as to the diagnosis or treatment of that patient’s illness, injury or disease.

Ultimately the medical record from the Physician or Healthcare Providers documented notes along with an appeal letter to specifically outline the reasons for Medical Necessity in regards to the patient’s case, are the only way to substantiate a case against a denial by an Insurance Company.  If the claim is still denied by the Insurance Company, you can attempt a 2nd or 3rd Level Appeal with the Medical Review Board.


January 12, 2012

Failure is not fatal, but failure to change might be.

– John Wooden

Keys to Achieving Your Goals

January 9, 2012

Another year and another set of resolutions. If you’re like most Americans, you’ll probably forget your goals by mid-February. So how do you make your resolutions actually happen this year?

First, keep in mind that goals are dreams; but don’t stop at just dreaming. Turn your dreams into bite-sized pieces that will gradually create a big event in your life. If you’re waiting on an outside variable to change your life, you have a long wait. You have to do something. It’s your responsibility to fix your life, not someone else’s. It’s time to sit down, make some goals, and take control.

Goal setting is how you win. Once you’ve made your resolutions, they will drive you forward. The goals will motivate you to seek activities that will help you succeed. It’s not always fun, but those exercises bring you closer to your goal and make you a winner.

If you want to actually achieve your goals this year, then consider the following:

1.Be specific.

When setting goals, be specific in what you want to achieve. Vagueness will only cause you to feel overwhelmed, and you will just give up.

2.Make your goals measureable.

In order to know if you achieved the goal, it must be measurable. For example, if you want to lose weight, don’t simply write down “lose weight” as a goal. How much weight do you want to lose? Or don’t just write “spend more time with family.” How much time do you want to spend with your family every night?

3.Are they your goals?

Only you can set your own goals. If your spouse, co-worker or friend sets a goal for you, you’re not going to achieve it. Taking ownership will give you more incentive to meet your goal.

4.Set a time limit.

Setting a time frame will help you set realistic goals. For example, if you want to save more money, list how much money a month you want to put into your savings account.

5.Put them in writing.

Putting your goals in writing will make you much more likely to achieve them. Write down your goals and review them often. This will give you motivation to make them a reality.

This is the process to succeed. Successful people reassess their lives and then start living intentionally, in writing, on paper, on purpose. Make your resolutions a reality in this year!  What are your goals for 2011? Leave a comment below.  Check out Dave Ramsey’s resources to help you achieve your financial goals.

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January 5, 2012

The quality of a person’s life is in direct proportion to their commitment to excellence, regardless of their chosen field of endeavor.

– Vincent T. Lombardi

5010 Fiasco has HIT

January 4, 2012

You ever played the game, Battleship?  Where you hit something with the aim to sink the boat?

The 5010 Fiasco has “hit”.  It is here.  Full blown in a mode of Insanity.  I had hoped not to be seeing this.  I had hoped the hype would be all wrong.  It isn’t.  It is here…it is now.  It must be addressed.

I will not let it sink our boats.


January 3, 2012

Treat every time like it was your first time.

-Jon Acuff

[2012] Business Goals

January 2, 2012

It has been harder this year for me to come up with what I want in my business goals.  Some years, this is easy, this year with the horrific challenges being faced by my industry, I have had little time to reflect and focus on my plan.  I may revise this at a later date, but in order to get my post out…I will go with what I have decided is the focus of 2012:

  • Increase the number of Blog posts written each week from 3 to 4, include more than just information, tips, and motivation…make it more personal with stories and real life examples
  • Meet twice  a month with a Strategic Business Partner to share ideas, brainstorm and encourage one another
  • Resolve to delegate more tasks to my employees and eliminate the 6 Day Work Week
  • Increase Business by 25%
  • Schedule and perform 5 speaking engagements

What are your goals for 2012?


January 1, 2012

There are a lot of different ways to say Thank You! And we make a point to do that throughout the year in many different ways.

On behalf of Medical Account Solutions and Our Team, I would like to take this moment to Thank You in our own way, sincerely from the heart of each of us, for being a Client, an EntreLeadership supporter, a strategic Business Partner with our client base, to the Vendors providing services to us, and lastly our Friends!  We appreciate your business and look forward to working with you this year toward our goal of providing you the best Medical Billing Services, Consulting Services, Accounting Services and Administrative Services.  Our motto remains:  Accuracy Counts!


Misty Gilbert, President