Wiki Mailing Patient Statements

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tworrock

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Hi everyone,

Are there any compliance regulations for mailing patient statements? Like do we have to use certain envelopes, mark it as confidential in big red letters, can't be in windowed envelopes, etc...?

How about for mailing out CMS 1500 forms? What materials do I need to use? Where is the best place to order CMS 1500 forms from?

Thank you!
 
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The only issue I am aware of is that if you use window envelopes, no other information should be visible through the window. I recall a few years back when a large carrier (maybe Aetna??) sent a mass mailing that included test results visible through the window.
Similarly, if you use very thin flimsy envelopes, the information inside might be readable even when the envelope is sealed.
The same applies to CMS1500 (or any other correspondence with PHI enclosed).
My personal recommendation is using security window envelopes (the ones with the tint/squiggles inside). Just make sure your correspondence is formatted and folded to not show any other info visible when the envelope is closed. This way you are compliant and no possibility of putting the incorrect patient letter in the envelope, or incorrectly writing the address.
I haven't ordered 1500s in years, but used to use justcms1500forms.com. At the time I evaluated, they were the cheapest. Not too much of a need for paper claim forms these days....
 
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csperoni said:
The only issue I am aware of is that if you use window envelopes, no other information should be visible through the window. I recall a few years back when a large carrier (maybe Aetna??) sent a mass mailing that included test results visible through the window.
Similarly, if you use very thin flimsy envelopes, the information inside might be readable even when the envelope is sealed.
The same applies to CMS1500 (or any other correspondence with PHI enclosed).
My personal recommendation is using security window envelopes (the ones with the tint/squiggles inside). Just make sure your correspondence is formatted and folded to not show any other info visible when the envelope is closed. This way you are compliant and no possibility of putting the incorrect patient letter in the envelope, or incorrectly writing the address.
I haven't ordered 1500s in years, but used to use justcms1500forms.com. At the time I evaluated, they were the cheapest. Not too much of a need for paper claim forms these days....
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Ooh thank you!

Okay, dumb question, my predecessor was still sending paper CMS1500 claims to some payers (I'm guessing mostly Medicare but haven't checked). Is there an easier way to submit to Medicare?
 
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tworrock said:
Ooh thank you!

Okay, dumb question, my predecessor was still sending paper CMS1500 claims to some payers (I'm guessing mostly Medicare but haven't checked). Is there an easier way to submit to Medicare?
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Most providers submit electronic claims to Medicare. It's typically mandatory to file electronically to Medicare.

There are a limited number of exceptions where providers can bill a paper claim to Medicare. Noridian should be your MAC, correct?

If you look on Noridian's website, there is a handful of exceptions listed under "Mandatory Electronic Filing." If Noridian is accepting your paper claims, sounds like your employer may meet one of the exceptions?


I'd find out which exception you fall under that you're still billing paper claims to Medicare, and then see if you could choose to bill electronically if you wished.
 
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sls314 said:
Most providers submit electronic claims to Medicare. It's typically mandatory to file electronically to Medicare.

There are a limited number of exceptions where providers can bill a paper claim to Medicare. Noridian should be your MAC, correct?

If you look on Noridian's website, there is a handful of exceptions listed under "Mandatory Electronic Filing." If Noridian is accepting your paper claims, sounds like your employer may meet one of the exceptions?


I'd find out which exception you fall under that you're still billing paper claims to Medicare, and then see if you could choose to bill electronically if you wished.
Click to expand...
Yes, our MAC is Noridian. I have had the hardest time doing anything in the Noridian portal. I will try to get in contact with them to help me navigate the website.
 
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Paper yikes! Sending paper claims is scary nowadays. There are some exceptions where it makes sense but it's pretty rare. The only time I have seen in recently was for a rare work comp here and there.
Even sending paper statements is really uncommon these days especially if you have a portal.
Agree with Christine above, it has to be non-visible through the envelope, protected, etc.
 
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tworrock said:
Yes, our MAC is Noridian. I have had the hardest time doing anything in the Noridian portal. I will try to get in contact with them to help me navigate the website.
Click to expand...

What clearinghouse are you using to send electronic claims to other payers?

You should be able to use that same clearinghouse to send electronic Medicare claims too - it doesn't have to be done through the portal.
 
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amyjph said:
Paper yikes! Sending paper claims is scary nowadays. There are some exceptions where it makes sense but it's pretty rare. The only time I have seen in recently was for a rare work comp here and there.
Even sending paper statements is really uncommon these days especially if you have a portal.
Agree with Christine above, it has to be non-visible through the envelope, protected, etc.
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Thank you so much! So it seems like I might need to start from scratch on everything. I was just told on Friday that I am taking over the entire revenue cycle and have no in house training or help. I have been taking classes but am not certified yet.

Our clearinghouse is Availity.

We are in network with Premera BCBS, Federal BCBS, Medicaid, Medicare, Tricare West, Cigna, and PEHTA EBMS. We are out of network with UHC, UMR, Aetna, ASEA, GEHA, Meritain, and MODA. Any idea if all of my claims can be submitted online for those payers?

Thank you so much for your help!
 
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tworrock said:
Thank you so much! So it seems like I might need to start from scratch on everything. I was just told on Friday that I am taking over the entire revenue cycle and have no in house training or help. I have been taking classes but am not certified yet.

Our clearinghouse is Availity.

We are in network with Premera BCBS, Federal BCBS, Medicaid, Medicare, Tricare West, Cigna, and PEHTA EBMS. We are out of network with UHC, UMR, Aetna, ASEA, GEHA, Meritain, and MODA. Any idea if all of my claims can be submitted online for those payers?

Thank you so much for your help!
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Wow! That happened to me about 18 years ago. I was sort of thrust into the role of managing everything in a very small practice when someone suddenly retired. I found paper claims in drawers that had never been filed, everything was on paper and Medicare claims were manually typed into the FISS (LoL). It was probably the best learning experience I could have had. No one else there knew anything about it at all, they had been depending on a single person to do it all. I had to figure it all out by myself.

Use any and all resources you can from Availity. Call and ask for help. How many providers is it? The practice may have to break down and call in an outside consultant for a short time or someone to help you get it set up for success.
 
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amyjph said:
Wow! That happened to me about 18 years ago. I was sort of thrust into the role of managing everything in a very small practice when someone suddenly retired. I found paper claims in drawers that had never been filed, everything was on paper and Medicare claims were manually typed into the FISS (LoL). It was probably the best learning experience I could have had. No one else there knew anything about it at all, they had been depending on a single person to do it all. I had to figure it all out by myself.

Use any and all resources you can from Availity. Call and ask for help. How many providers is it? The practice may have to break down and call in an outside consultant for a short time or someone to help you get it set up for success.
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Your story is basically the same as mine! Luckily, I've been with the practice for over a year, and it's the same 2 providers and same set of like 40 CPT codes :) I started watching Noridian webinars today while I was entering charges. So far the charge entry and insurance payment posting has been fairly straightforward. Now just to get the claims to the right places. I think that's what I'm struggling with the most!
 
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Your EMR company may also be able to help you set up electronic claim filing although they may want you to use a specific clearinghouse they have a business relationship with. I started out when paper claims were the norm and lived through the transition to all electronic filing. Nowadays the only paper claims we send are for a few small commercial plans and secondary claims where we don't have access to payer portals for direct entry.
 
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