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 We can give you back your time so you can do what you do best, take care of patients.

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MEDELECT, INC. is helping medical providers thrive in today’s healthcare industry, one practice at a time.  

We are a nationwide Management Service Organization offering your practice revenue cycle management and business solutions to increase and maintain your cash flow, become more efficient,  and build value in your service to better serve your community.  

Let’s face it, your Accounts Receivable is the lifeblood of your business and we understand that.  Our expertise in Revenue Cycle and Credentialing Management can help your practice thrive so you can do what you do best…take care of patients.

We can seamlessly integrate our Revenue Cycle & Business Management Services into our EHR/Practice Management System which enables you to operate at maximum efficiency.

MEDELECT, INC. will partner with you and tailor our services to meet your practice and your business needs, wherever and however you may practice.

Contact us today for more information.

 

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Credentialing Expertise – Let Us Take It On For You.

MEDELECT, Inc. specializes in giving you back your time to do what you do best, take care of your patients.

Have you received a denial from Medicare on your claims, only to find out you missed the Medicare re-validation deadline and have now been deactivated?  Or have had your claims denied because you missed the re-credentialing deadline with the payers you are contracted with?  Credentialing has become another administrative burden for medical practices and can be complicated and time consuming.  On hold and being transferred for the 3rd time?

We can help…let us take on the task for you.  Its what we do, its what we are good at.

We provide Credentialing Expertise and will manage the process and maintain your credentialing profiles with payers for you from this day forward.

We specialize in Credentialing with all payers, both government and private payers in all states.  Contact us today for a free consultation.

Narrow Networks…Providers Won’t Get Paid If No Out-of-Network Benefits and Patients Left Holding the Bill.

Recently, a report came out siting California as one of the top four states to host a high percentage of what is know as Narrow Networks.   Narrow Networks may have been around for awhile but I am seeing an increasing number of problems with medical claims in these narrow networks since 2014.

First, if a provider doesn’t know that an insurance has narrow networks, they aren’t asking the right questions when contracting and credentialing and may not understand that once their is an executed contract with a well known payer, they may not be part of their narrow networks.  Even when calling insurance companies, you have to understand how this works or you won’t ask the right questions and not all payers are forthcoming with this important detail.

Second, most consumers have no idea how their insurance plan works overall, let alone how narrow networks could impact them financially.  The assume if I have X insurance and I call my provider and they say, “Yes, we take X insurance”, that means, yes, their provider is part of their network and all they will be responsible to pay is co-pay and any deductible or coinsurance splits and will assume their In-Network benefit structure is at play.

The greatest problem happens when claim is submitted.  The provider will provide service in good faith they will be reimbursed by their patient’s insurance plan and either will receive a smaller reimbursement from insurance, with a greater patient responsibility or claim will deny out right as not covered and receive no reimbursement whatsoever from patient’s insurance.  This leaves a greater financial out of pocket expense for patients who are unprepared for the medical bills that will arrive in the mail months later.

This is a no-win situation for providers or their patients.  Traditionally, we have seen a greater reduction in insurance reimbursement to physicians over the years and they are already running their practice on very small margins.  Putting a greater out of pocket expense on their members and not clearly outlining this plainly to patients as they are purchasing these plans puts providers in more and more of a burden, as the cost of collecting from a patient after the service has already been provided.  Spending valuable resources to staff knowledgeable front office staff who can vet each patient’s plan out in order to determine if they really ARE in their network can be costly.

MEDELECT, Inc. can take the burden off of both providers and patients through our Benefits Check Services and Contracting and Credentialing Management,  please contact us today for a free consultation.

To read more about the recent study visit: http://www.californiahealthline.org/articles/2015/8/26/75-of-california-exchange-plans-have-narrow-networks

Senate approves SGR Replacement Bill and solidifies Value-Based Reimbursement

On Tuesday, the Senate passed the HR-2 bill by a vote of 92-8, which will do away with the Sustainable Growth Rate (SGR) as a formula to determine Medicare’s Physician Reimbursement.  Providers no longer have the 21%+ reduction in fee reimbursement looming over their heads.  However, this bill has now replaced the old fee-for-service reimbursement structure into a value-based reimbursement, in which providers will have to prove the value of their service in order to receive full reimbursement for their services.

It comes with a 0.05% annual raise through 2019 to providers who participated in Medicare before transitioning to an incentive-based payment structure. as well as encouraging providers to participate in alternative payment models focused on patient outcomes, with providers participating in qualifying models receiving a 0.75% annual rate increase beginning in 2026.

The HR-2 bill took the first steps in accomplishing this by consolidating several federal incentive programs – including the meaningful use program, physician quality reporting system and value based modifiers – into one value-based reporting system.  Clearly, there is a lot of work ahead as we move forward with these changes.  The bill is set to be considered by President Obama, who has indicated he will sign the measure, calling it “a milestone for physicians, and for the seniors and people with disabilities who rely on Medicare for their health care needs”.

MEDELECT, Inc. will work hard to keep you informed of what the real implications mean to you as a provider to Medicare patients.  Contact us for more information: http://www.medelectinc.com/contact-us/

 

Did we finally replace the SGR once and for all? Only if Senate will approve repealing the ACA, approve MU and MOC….

Last month the House approved H.R.2 – Medicare Access and CHIP Reauthorization Act of 2015 – which would permanently replace Medicare’s Sustainable Growth Rate (SGR) formula, which is used to determine the Physician Fee Schedule for reimbursement of services provided to Medicare beneficiaries.  This system has been broken for years and threatens to cut reimbursement to providers by 20-25% each year. While this seems to be a valid bill to do away with a dysfunctional system, this bill is a trojan horse that brings about more regulations that could negatively impact providers.

It looks as though HR-2 would be a permanent “doc fix” to the SGR, however, it is tied to repealing the Affordable Care Act of 2010 and is doubtful this will pass in the Senate, which is scheduled to hear the bill this month or signed by President Obama.  The reimbursement cut was pushed out until the Senate returns from recess.  HR-2 would do away with the traditional fee-for-service reimbursement model in exchange for the value-based reimbursement model, which will require providers to prove outcomes.

It also would permanently codify Meaningful Use (MU), which requires all providers to report benchmark measures electronically through an Electronic Health Record (EHR) system or through registries.  Currently, providers are starting to see penalties in their reimbursements for not reporting.  It also makes Maintenance of Certification (MOC) law.  This requirement is a process of keeping providers certification up-to-date through one of the 24 approved medical specialty boards of the ABMS or AOA.

To read more: http://medcitynews.com/2015/04/hr2sgr-repeal-bill/

SB277 Would End All Personal Belief Exemptions to Childhood Vaccination Requirements

On Wednesday, the California Senate Health Committee will consider SB 277.  This bill would strip away parents right to opt out of school vaccination requirements either by consulting with a licensed physician or by claiming religious objections.  Currently, according to informal polls, lawmakers are split on the vote:

According to polls, those in favor of or leaning toward voting yes on the bill include state Sens.:

  • Bill Monning (D-Carmel);
  • Holly Mitchell (D-Los Angeles);
  • Lois Wolk (D-Davis); and
  • Pan.

Those who are undecided include state Sens.:

  • Ed Hernandez (D-West Covina), chair of the committee;
  • Isadore Hall (D-South Bay);
  • Janet Nguyen (R-Garden Grove), vice chair of the committee; and
  • Richard Roth (D-Riverside).

To read more:  http://www.californiahealthline.org/articles/2015/4/6/lawmakers-split-on-vaccination-requirements-ahead-of-vote

Providers Could Face a 21% Reimbursement Cut on April 1st

Once again we are faced with a healthy reimbursement cut for providers on April 1st if Senate and House Leaders don’t come up with a “doc fix” bill to either kick the can down the road, once again; or finally come up with a permanent solution for the dysfunctional Sustainable Growth Rate formula currently used.

 

To read more: http://www.californiahealthline.org/articles/2015/3/20/house-senate-leaders-unveil-sgr-replacement-legislation

Blue Shield of California is Stripped of Its’ Non-profit Status

According to news reports, Blue Shield of California has been stripped of its non-profit status by the California Franchise Tax Board due to their surplus at the end of 2014 being four times as much as what the Blue Cross and Blue Shield Association requires insurers to stockpile to cover future claims.

To read more: http://www.californiahealthline.org/articles/2015/3/18/officials-revoke-blue-shield-of-californias-taxexempt-status

Anthem Blue Cross sued…could it finally be justice served?

A consumer watch dog group filed a class action lawsuit against Anthem Blue Cross on Tuesday, July 8, 2014.  The lawsuit alleges Anthem Blue Cross mislead millions of consumers during the October 1, 2013 – March 31, 2014 enrollment period by falsely listing providers as network providers on the Covered California website.  As I understand it from representatives at California Medical Association, Anthem Blue Cross was notified as early as January of this year that members were starting to receive denials for services because the provider listed on the website as in network was actually out of network.  This was a surprise to both members and providers.  Anthem Blue Cross was asked to correct its provider list on the Covered California website.  They are alleged to have taken the provider list down, only to put the same list back up, which continued to mislead consumers.  Hopefully justice will be served…

To read more: http://www.californiahealthline.org/articles/2014/7/9/lawsuit-alleges-anthem-misled-millions-about-health-plan-networks

Proposed Medicare Rate Increases and Quality Measures for ACOs in 2015.

CMS proposes an increase in reimbursement for hospitals and ambulatory surgery centers, as well as bundling some payments rates for ancillary services that have an average cost of $100 or less for:

  • Certain Psychiatric Services.
  • Drug administation-related services.
  • Preventive Services.

CMS also proposes to increase the number of quality measures used in the Medicare Shared Savings programs for ACOs.

MEDELECT, Inc. will keep you informed of the changes as they are announced and approved.  To read more: http://www.californiahealthline.org/articles/2014/7/7/cms-proposes-medicare-reimbursement-changes-increases-for-2015

 

Mid-level providers needed asap…

With the Affordable Care Act in play, mid-level providers are just what the doctor ordered, no pun intended…

It was just reported that California enrolled 1.4 million people through the California Health Insurance Exchange Program, Covered California since January 1st.  In order to ensure quality care for everyone, mid-level providers are going to be needed more than ever.

MEDELECT, Inc. can assist you in building your practice, give us a call at 877-543-2824.

To read more:  http://www.californiahealthline.org/articles/2014/5/2/expanding-role-of-nps-could-save-california-1-8b-over-10-years

 

Credentialing Expertise – Let Us Take It On For You.

MEDELECT, Inc. specializes in giving you back your time to do what you do best, take care of your patients.

Have you received a denial from Medicare on your claims, only to find out you missed the Medicare re-validation deadline and have now been deactivated?  Or have had your claims denied because you missed the re-credentialing deadline with the payers you are contracted with?  Credentialing has become another administrative burden for medical practices and can be complicated and time consuming.  On hold and being transferred for the 3rd time?

We can help…let us take on the task for you.  Its what we do, its what we are good at.

We provide Credentialing Expertise and will manage the process and maintain your credentialing profiles with payers for you from this day forward.

We specialize in Credentialing with all payers, both government and private payers in all states.  Contact us today for a free consultation.

Narrow Networks…Providers Won’t Get Paid If No Out-of-Network Benefits and Patients Left Holding the Bill.

Recently, a report came out siting California as one of the top four states to host a high percentage of what is know as Narrow Networks.   Narrow Networks may have been around for awhile but I am seeing an increasing number of problems with medical claims in these narrow networks since 2014.

First, if a provider doesn’t know that an insurance has narrow networks, they aren’t asking the right questions when contracting and credentialing and may not understand that once their is an executed contract with a well known payer, they may not be part of their narrow networks.  Even when calling insurance companies, you have to understand how this works or you won’t ask the right questions and not all payers are forthcoming with this important detail.

Second, most consumers have no idea how their insurance plan works overall, let alone how narrow networks could impact them financially.  The assume if I have X insurance and I call my provider and they say, “Yes, we take X insurance”, that means, yes, their provider is part of their network and all they will be responsible to pay is co-pay and any deductible or coinsurance splits and will assume their In-Network benefit structure is at play.

The greatest problem happens when claim is submitted.  The provider will provide service in good faith they will be reimbursed by their patient’s insurance plan and either will receive a smaller reimbursement from insurance, with a greater patient responsibility or claim will deny out right as not covered and receive no reimbursement whatsoever from patient’s insurance.  This leaves a greater financial out of pocket expense for patients who are unprepared for the medical bills that will arrive in the mail months later.

This is a no-win situation for providers or their patients.  Traditionally, we have seen a greater reduction in insurance reimbursement to physicians over the years and they are already running their practice on very small margins.  Putting a greater out of pocket expense on their members and not clearly outlining this plainly to patients as they are purchasing these plans puts providers in more and more of a burden, as the cost of collecting from a patient after the service has already been provided.  Spending valuable resources to staff knowledgeable front office staff who can vet each patient’s plan out in order to determine if they really ARE in their network can be costly.

MEDELECT, Inc. can take the burden off of both providers and patients through our Benefits Check Services and Contracting and Credentialing Management,  please contact us today for a free consultation.

To read more about the recent study visit: http://www.californiahealthline.org/articles/2015/8/26/75-of-california-exchange-plans-have-narrow-networks

Senate approves SGR Replacement Bill and solidifies Value-Based Reimbursement

On Tuesday, the Senate passed the HR-2 bill by a vote of 92-8, which will do away with the Sustainable Growth Rate (SGR) as a formula to determine Medicare’s Physician Reimbursement.  Providers no longer have the 21%+ reduction in fee reimbursement looming over their heads.  However, this bill has now replaced the old fee-for-service reimbursement structure into a value-based reimbursement, in which providers will have to prove the value of their service in order to receive full reimbursement for their services.

It comes with a 0.05% annual raise through 2019 to providers who participated in Medicare before transitioning to an incentive-based payment structure. as well as encouraging providers to participate in alternative payment models focused on patient outcomes, with providers participating in qualifying models receiving a 0.75% annual rate increase beginning in 2026.

The HR-2 bill took the first steps in accomplishing this by consolidating several federal incentive programs – including the meaningful use program, physician quality reporting system and value based modifiers – into one value-based reporting system.  Clearly, there is a lot of work ahead as we move forward with these changes.  The bill is set to be considered by President Obama, who has indicated he will sign the measure, calling it “a milestone for physicians, and for the seniors and people with disabilities who rely on Medicare for their health care needs”.

MEDELECT, Inc. will work hard to keep you informed of what the real implications mean to you as a provider to Medicare patients.  Contact us for more information: http://www.medelectinc.com/contact-us/

 

Did we finally replace the SGR once and for all? Only if Senate will approve repealing the ACA, approve MU and MOC….

Last month the House approved H.R.2 – Medicare Access and CHIP Reauthorization Act of 2015 – which would permanently replace Medicare’s Sustainable Growth Rate (SGR) formula, which is used to determine the Physician Fee Schedule for reimbursement of services provided to Medicare beneficiaries.  This system has been broken for years and threatens to cut reimbursement to providers by 20-25% each year. While this seems to be a valid bill to do away with a dysfunctional system, this bill is a trojan horse that brings about more regulations that could negatively impact providers.

It looks as though HR-2 would be a permanent “doc fix” to the SGR, however, it is tied to repealing the Affordable Care Act of 2010 and is doubtful this will pass in the Senate, which is scheduled to hear the bill this month or signed by President Obama.  The reimbursement cut was pushed out until the Senate returns from recess.  HR-2 would do away with the traditional fee-for-service reimbursement model in exchange for the value-based reimbursement model, which will require providers to prove outcomes.

It also would permanently codify Meaningful Use (MU), which requires all providers to report benchmark measures electronically through an Electronic Health Record (EHR) system or through registries.  Currently, providers are starting to see penalties in their reimbursements for not reporting.  It also makes Maintenance of Certification (MOC) law.  This requirement is a process of keeping providers certification up-to-date through one of the 24 approved medical specialty boards of the ABMS or AOA.

To read more: http://medcitynews.com/2015/04/hr2sgr-repeal-bill/

SB277 Would End All Personal Belief Exemptions to Childhood Vaccination Requirements

On Wednesday, the California Senate Health Committee will consider SB 277.  This bill would strip away parents right to opt out of school vaccination requirements either by consulting with a licensed physician or by claiming religious objections.  Currently, according to informal polls, lawmakers are split on the vote:

According to polls, those in favor of or leaning toward voting yes on the bill include state Sens.:

  • Bill Monning (D-Carmel);
  • Holly Mitchell (D-Los Angeles);
  • Lois Wolk (D-Davis); and
  • Pan.

Those who are undecided include state Sens.:

  • Ed Hernandez (D-West Covina), chair of the committee;
  • Isadore Hall (D-South Bay);
  • Janet Nguyen (R-Garden Grove), vice chair of the committee; and
  • Richard Roth (D-Riverside).

To read more:  http://www.californiahealthline.org/articles/2015/4/6/lawmakers-split-on-vaccination-requirements-ahead-of-vote

Providers Could Face a 21% Reimbursement Cut on April 1st

Once again we are faced with a healthy reimbursement cut for providers on April 1st if Senate and House Leaders don’t come up with a “doc fix” bill to either kick the can down the road, once again; or finally come up with a permanent solution for the dysfunctional Sustainable Growth Rate formula currently used.

 

To read more: http://www.californiahealthline.org/articles/2015/3/20/house-senate-leaders-unveil-sgr-replacement-legislation

Blue Shield of California is Stripped of Its’ Non-profit Status

According to news reports, Blue Shield of California has been stripped of its non-profit status by the California Franchise Tax Board due to their surplus at the end of 2014 being four times as much as what the Blue Cross and Blue Shield Association requires insurers to stockpile to cover future claims.

To read more: http://www.californiahealthline.org/articles/2015/3/18/officials-revoke-blue-shield-of-californias-taxexempt-status

Anthem Blue Cross sued…could it finally be justice served?

A consumer watch dog group filed a class action lawsuit against Anthem Blue Cross on Tuesday, July 8, 2014.  The lawsuit alleges Anthem Blue Cross mislead millions of consumers during the October 1, 2013 – March 31, 2014 enrollment period by falsely listing providers as network providers on the Covered California website.  As I understand it from representatives at California Medical Association, Anthem Blue Cross was notified as early as January of this year that members were starting to receive denials for services because the provider listed on the website as in network was actually out of network.  This was a surprise to both members and providers.  Anthem Blue Cross was asked to correct its provider list on the Covered California website.  They are alleged to have taken the provider list down, only to put the same list back up, which continued to mislead consumers.  Hopefully justice will be served…

To read more: http://www.californiahealthline.org/articles/2014/7/9/lawsuit-alleges-anthem-misled-millions-about-health-plan-networks

Proposed Medicare Rate Increases and Quality Measures for ACOs in 2015.

CMS proposes an increase in reimbursement for hospitals and ambulatory surgery centers, as well as bundling some payments rates for ancillary services that have an average cost of $100 or less for:

  • Certain Psychiatric Services.
  • Drug administation-related services.
  • Preventive Services.

CMS also proposes to increase the number of quality measures used in the Medicare Shared Savings programs for ACOs.

MEDELECT, Inc. will keep you informed of the changes as they are announced and approved.  To read more: http://www.californiahealthline.org/articles/2014/7/7/cms-proposes-medicare-reimbursement-changes-increases-for-2015

 

Mid-level providers needed asap…

With the Affordable Care Act in play, mid-level providers are just what the doctor ordered, no pun intended…

It was just reported that California enrolled 1.4 million people through the California Health Insurance Exchange Program, Covered California since January 1st.  In order to ensure quality care for everyone, mid-level providers are going to be needed more than ever.

MEDELECT, Inc. can assist you in building your practice, give us a call at 877-543-2824.

To read more:  http://www.californiahealthline.org/articles/2014/5/2/expanding-role-of-nps-could-save-california-1-8b-over-10-years