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PRECISE EXPERIENCED SKILLED PROFESSIONALS





TERM FREQUENTLY ASKED QUESTIONS

Reimbursement:

Q. What is the average turn-around-time for billing a service to payment of service to the group?
A. This will vary from payer to payer and will be dependent on the completeness of the information received about the service and the patient. It will also be dependent on the type of carrier and if the claims are billed electronically. The industry standard for turn-around time to Medicare and Medicaid is approximately 30 days and for Commercial payers it is 45 days.


Q. How does Medicare Secondary (MSP) processes the claim and will there be any patient responsibility?
A. Once Medicare Secondary processes the claim then they will send an explanation of benefits that shows how they determined their payment or denial. This is based on the MSP formula that is mandated by CMS in which it is determined by using the total billed charges, the primary payment, the Medicare re-imbursement, and the co-insurance and deductible. Once these four factors are known then a calculation can be done in order to project the Medicare secondary payment. Depending on the primary carrier's co-insurance and deductible and Medicare's co-insurance and deductible the patient could have a responsibility. To find the formula used by Trailblazer please visit the Trailblazer website and click on the MSP overpayment calculators or go to the CMS Medicare Secondary Payer Manual to find out more information.


Q. What is an EFT and ERA?
A. EFT stands for an electronic funds transfer. EFTs are electronically deposited into the Client's bank account. By having your funds deposited using the electronic funds transfer option this helps to ensure no payments are lost and helps to ensure the payment is deposited in a timelier manner.


An ERA stands for an electronic remittance advice. The electronic remittance advices are sent when a payment is electronically deposited into the Client's Bank account. Some Insurances offer you the ability to print the ERA or EOB off of their website, have the ERA sent through your clearinghouse, and to even upload your ERA files to post automatically to your software.