How does Health Insurance Impact your Tax this Year?

Friday, March 13, 2015 5:44
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The ’Individual Mandate’, one of the Affordable Care Act reforms, has been the hot topic in the US healthcare space lately. This policy has made buying health insurance mandatory for those people who are uninsured. The ultimate goal of this policy is to promote a healthier nation; however there is downside to it. American citizens were subjected to a tax penalty this year if they did not have a private, employer-sponsored or public health insurance for at least nine months in 2014. Nevertheless, there are certain exemptions that will keep most of them from facing this penalty. Some of them include:

  • American citizens who were unable to afford health insurance despite the provision of various subsidies.
  • Immigrants who are undocumented would qualify for exemption.
  • If people have a very low income that falls below the tax filing threshold, then they are exempt from this penalty.
  • American citizens who hold residency in foreign countries or live there, are exempted from the tax penalty.

So, what happens to the people who were not insured in 2014 and do not qualify for the penalty exemption? They will have to face the following consequences:

  • The individual has to pay 1% of his household income. Else, there will be a flat penalty of $95 per adult and $47.50 per child. For a family as such, the tax penalty is calculated as $285.
  • As per Turbo Tax, the fee is expected to increase each year. For 2015, the tax penalty would be $325 per adult and $975 per family. Else, there will be a 2% cut from the total household income.
  • The penalty will be paid along with the income taxes every month. In case an individual is qualified for a tax refund, then the penalty charge will be subtracted from that amount.
  • Even employers are subjected to a penalty in 2015 if they have 50 or more workers on board, but do not provide health insurance coverage.


In order to report health insurance on taxes, IRS has created various new forms:

  • W-2 forms are used to report the amount paid by employers for employer-sponsored health insurance plans. This amount in no way, affects the insured employee’s tax liability. At the same time, the taxable income will also not have any changes due to the employer’s contribution to the health insurance.
  • 1095-A is for those who bought health plans through healthcare exchange marketplace.
  • 1095-B and 1095-C are not required for reporting.

It is highly advisable that people follow these rules so that they are exempted from the tax penalty.

Preventative Healthcare Gets Its Importance In ‘‘Obamacare’’

Monday, December 22, 2014 5:08
Posted in category Obamacare
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‘Prevention is better than cure’ – Recognizing the truth in this adage, ‘Obamacare’ has brought in the preventative healthcare services to create a healthy tomorrow. Heart disease, stroke, cancer, chronic low respiratory disease and accidental injuries are considered as the five main causes for the increased mortality rate in the US. The Centers for Disease Control and Prevention (CDC) has estimated that approximately 69 million workers take sick leave every year thereby reducing the economic output by $260 billion. Only preventative healthcare can help reduce these numbers and promote a healthy, wealthy environment and nation for future generations. Let us learn the importance of preventative healthcare in ‘Obamacare’ and its benefits:

Reason for Introducing Preventative Healthcare:

Lack of access to quality and affordable healthcare, hygienic and healthy food items, proper shelter, and other financial barriers keep several US citizens from using the preventative healthcare services. To break this barrier of economic inequality, the Affordable Care Act (ACA) made preventative healthcare affordable and accessible to those US citizens who are under the poverty line.

Salient Features of Preventative Healthcare:

  • People can enjoy most of the preventative healthcare services free of cost or without being charged a deductible, copayment, co-insurance, or other cost sharing.
  • It offers 15 preventative healthcare services to adults, 22 to women and 26 to kids.
  • These services can help people get treated at the earlier stages of their diseases and stop them from developing to the chronic level.
  • Some of the free preventative care services include immunizations, well-woman visits, vaccine shots, mammograms, cancer & gestational diabetes screenings, human papilloma virus DNA testing, support for breastfeeding equipment, domestic violence screening & counseling and various clinical tests. These services are made easily available and accessible with no cost sharing.
  • Counseling is provided to people who wish to quit smoking, lose weight, treat depression, quit drinking and maintain a healthy diet that could prevent illness.
  • To prevent diseases like chickenpox, measles, meningitis, or even flu and certain forms of pneumonia, free vaccinations are provided.
  • Productivity and economic drain can be greatly reduced by preventing illness using the ‘Obamacare’’s preventative healthcare services.

Who is Eligible?

  • ‘Obamacare’ has made it mandatory that most health plans must cover certain preventative care services without cost sharing.
  • For a better plan, one can check their State’s health insurance marketplace.
  • One may be eligible for these preventative care services even if they have a minimum essential healthcare coverage.
  • To make the most of these services, choose in-network providers, as out-of-network providers may not cover recommended preventative healthcare services.

It is wise to detect the diseases at a pre-clinical or an early stage and prevent them, instead of treating and curing fully-developed chronic conditions. Therefore, make complete use of ‘Obamacare’’s preventative healthcare services and stay healthy.

CMS’ Health Surveys to strengthen PQRS

Wednesday, December 10, 2014 10:55

Consumer Assessment of Healthcare Providers and Systems:

This is a survey developed by CMS, to gain feedback from patients and their relatives about experiences with and ratings of their healthcare providers and plans. The survey includes hospitals, home health agencies, Doctors (single and groups), and health drug plans.  The survey results are publicly shared by CMS, so Providers may have an impact due to ratings, because it is the feedback of the patients.  It is not similar to the patient satisfaction survey, which focuses mainly on the facilities provided to them in the hospital during their stay.  Whatever the patient is experiencing with the provider is recorded – the ambience, cleanliness, waiting times, the communication with the doctors, understanding the instructions provided by the Providers on their ailment and medications etc.

This survey uses a standardized questionnaire and data collection protocols to ensure that the information can be used for comparison across different healthcare settings.  This survey is finalized based on a technical expert’s opinion and through public comments obtained during the public comment period and if there are any mismatches, then those will be addressed.  This survey, thus helps CMS to initiate quality health programs to the patients and also used as a tool to initiate many value based payment initiatives.

CMS Patient Experience survey also includes:

  • Hospital CAHPS – This records the patients feedback on their hospital experience – the ambience, cleanliness, how they were treated by the staff and nurses at the hospital etc.  Basically it records the feedback of the overall performance of the Hospital.
  • Home Health CAHPS – This covers the patient receiving Home Health services and other Skilled Nursing care.
  • Fee-for-service CAHPS – This targets the enrollees of Medicare plans and their experience with the respective fee for service Providers.
  • Medicare Advantage and Prescription Drug CAHPS – This survey targets the enrollees of Medicare Advantage plans and prescription drug plans of Medicare.
  • In-center Hemodialysis CAHPS – This survey is the first of its kind, focusing towards a chronic disease.  This documents the feedbacks provided by the patients with End Stage Renal Disease (ESRD), regarding the ‘in-center’ Hemodialysis care.
  • Nationwide Adult Medicaid CAHPS – As the name suggests, this targets the low-income groups of patients and their experiences from national or state healthcare Providers through the Medicaid programs.

Health Outcomes Surveys:

Another important survey is known as Health Outcome Survey which is also designed and developed by CMS. This survey is the first patient reported outcomes measures used in Medicare Managed Care.  This also helps a lot in assessing the quality of health care to the patients from the Providers.

A random sample of Medicare Beneficiaries are drawn from each participating Medicare Advantage Organization and surveyed.  After 2 years, the same patients are approached again to compare the results with the initial assessment obtained.  These outcomes were analyzed by a team of technical assistants and this survey is used as a part of the effectiveness of Healthcare Effectiveness Data and Information Set (HEDIS).

The survey questionnaire contains questions on Socio-demographics, patients day to day activities, their mental status, records also number of unhealthy days in the past 30 days as well as height and weight categories used in calculating the body mass index etc.,   The answers to these questions are analyzed in-depth to determine the mental and physical ability of the patient, and for those who need additional attention are directed towards the proper Providers.  This in turn, will improve the member’s mental and physical health.

Once these data are collected and analyzed, they are shared publicly and these will be used by the Providers/Hospitals accordingly to improve the quality of care, or billing correctly using the correct techniques, which helps in better returns to the Providers and the Hospitals, thereby increasing their reputation.

Ebola Scare in the US!

Wednesday, October 29, 2014 5:57
Posted in category Medical Billing
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The growing panic among the US citizens over the Ebola virus has become the recent buzz in the country. The US Centers for Disease Control and Prevention (CDC, Atlanta) has estimated that by August 2014, approximately 68 Ebola scares were handled by US healthcare facilities and state labs. The numbers have doubled and tripled in the months of September and October. The latest news is that the deadly virus could reach Britain and France by the end of this month (October). The approximate number of people infected so far by this rapidly spreading virus is 7,200. Let us take a look at when and where it all started and how scientists and healthcare workers are struggling to contain a full-fledged outbreak:

Inception and Facts:

The much-feared Ebola hemorrhagic fever originated from the region of Zaire in Central Africa.

Named after the River Ebola, from where the disease was said to have been discovered, the first Ebola human infection was reported in 1976.

Scientists claim that there are five different Ebola virus types out of which four can cause severe human illnesses, while the fifth virus known as the Reston affects only primates.

When debated whether the disease is contagious or infectious, scientists describe the Ebola virus to be highly infectious and less contagious. It means that even a single Ebola virus has the ability to trigger a fatal infection and it is not an airborne disease like measles.

Ebola is transmitted to a healthy person when he/she comes in contact with body fluids of infected persons and contaminated objects used by them.

Symptoms vary from fever, headache, muscle pain, sore throat, vomiting, diarrhea, impaired kidney and liver functions, along with internal and external bleeding in some cases.

The most disturbing fact is that no cure has been found so far.

Ebola Scare in the US:

There was not even a single Ebola case reported in the US until August 2014. It was on Sept 30 that CDC announced that a Liberian named Thomas Eric Duncan visiting Texas was diagnosed with the Ebola virus. While Duncan died on October 8, the news spread ‘virally’ through the nation panicking the citizens. Adding to the panic was the news of the nurse who cared for Duncan also testing positive for Ebola on October 11. On October 15, another nurse who cared for Duncan, Amber Vinson was also diagnosed with the Ebola virus. Though there were so many speculations, the two nurses were declared free of the deadly virus on October 24. While that is good news, the fear of the deadly virus is still lingering in every part of the US.

Steps taken by the US:

To contain a full-fledged Ebola breakout, the nation is taking several precautionary measures,

A thorough airport screening is performed on all travelers traveling from West Africa.

Individuals who might have come in direct contact with infected persons will be isolated in quarantine for 21 days.

The Ebola scare has widely disturbed the normal working conditions of the US healthcare industry.

Why is India a Better Offshore Destination?

Monday, March 24, 2014 6:31

Lately, outsourcing medical billing has become a common practice in the US healthcare domain. To streamline the medical billing activities of a customer, US medical billing companies partner with offshore medical billing companies located in various countries, including India. Though there exists a variety of offshore medical billing companies in several countries around the world, India has always been the most sought after outsourcing destination for US medical billing companies. The following factors will substantiate why India is considered as a better offshore destination in the world:

Optimal Time Difference: Geographically, India and the US are placed at an optimal distance from each other with a 9 to 13-hour time difference. It is this favorable time difference that helps in the smooth flow of work between the two countries. As the US medical billing companies are closed during the US nighttime, offshore medical billing companies in India complete all healthcare outsourcing services precisely, during the daytime in India.  When the staff at the US medical billing companies arrive for work the next morning, most of the work is completed and can be processed further.  This results in faster submission of claims and cash flow to the Providers.  Sometimes, the work gets completed ahead of the scheduled TAT, which makes India a favorite offshore destination for US medical billing companies.

No Language Barrier: English is the most important language and preferred medium of learning in India’s education system. Unlike other countries, that have very less English-speaking population, India has a vast populace which speaks and writes English fluently. It is another major advantage that makes India a better offshore medical billing destination. As there is no language barrier, US medical billing staff find it easy to communicate their medical billing requirements to the staff working in offshore medical billing companies in India. With easy two-way communication, problems are escalated on time and resolved, enhancing the productivity.

Cost Efficient and High-quality Output: It is estimated that US medical billing companies save up to 60% of their revenue by outsourcing to medical billing companies in India. It means that there is no need for US medical billing companies to invest on high-end healthcare software and systems. Also, they can save huge revenue on staff training and automation. Even though offshore medical billing companies from other countries could provide slightly better cost savings, there is no guarantee that they will render quality work. However, most Indian medical billing companies follow extreme quality control processes to ensure maximum accuracy in the work delivered. Thus, India is considered the most cost-efficient and quality offshore medical billing destination in the world.

For more than a decade now, eCare India has been a favorite offshore medical billing company for many US medical billing companies. ISO 27001:2005 and 9001:2008 certified and HIPAA compliant, this medical billing company in India has acquired a respectable place in the US healthcare domain.

It is Insurance Eligibility Verification time!

Friday, February 28, 2014 7:45

The effort taken by most healthcare entities in minimizing claim denials has become remarkable in the recent times. They pay more attention in documenting patient demographics, entering ICD & CPT codes, updating current charges, performing regular AR follow-up and more. However, their claims still get denied by the Payer. The reason is that Providers and medical billing companies fail to pay attention on the insurance eligibility verification. Most importantly, it has to be done even before a patient visits a Provider. If all the steps in the insurance eligibility verification are followed perfectly, then denial management would become much easier. Let us have a brief review of this process:

Basic Verification: Insurance eligibility verification can be done at two levels and the first one is the basic verification. In this level, healthcare entities verify general information like patient details and insurance coverage period & services. In addition, co-pay, co-insurance, and deductible details are also checked. Verifying all these details in the first 3 months of a year is very crucial. The reason is that most patients fail to meet their calendar-year deductible, which gets renewed every January. This information must be communicated in advance to concerned patients whose calendar-year deductible is outstanding. Only when this deductible amount is paid does the insurance company starts paying for the covered medical expenses. Therefore, Providers must carry out the insurance eligibility verification process prudently to avoid claim denials.

Advanced Verification: It is an in-depth insurance eligibility verification process which includes the basic verification details and in addition also checks the insurance plan’s code-specific benefits, which may have ‘Annual Maximum’ or ‘Lifetime Maximum’ limits. An insurance plan with Annual Maximum benefits states that patients are responsible for bearing medical expenses that exceed the specified limit in that particular calendar year. Lifetime Maximum is the total expense borne by an insurance company until the plan’s specified limit is reached. Once this limit is met, then the patient has to pay out of his pocket. In case, healthcare entities fail to check these details before providing care, then they will have a tough time receiving their payments from patients whose Annual Max or Lifetime Max limits have been reached. This in-depth verification is ideal for Healthcare Specialty Units like Cardiology, General Surgery, Physical Therapy, and specialties that have high $ value services. It helps in effective denial management and faster reimbursements.

Be it basic or advanced level insurance eligibility verification, a renowned offshore medical billing company like eCare can do it perfectly. eCare recently has deployed a dedicated team to carry out the insurance eligibility verification process. The team’s highly skilled professionals do this job efficiently and deliver the benefit details before the turn-around time (TAT).

Pros and Cons of Offshore Medical Billing

Monday, February 17, 2014 5:46

We all know that Healthcare Providers are trying their best to sustain their practice, especially after the  new healthcare reforms. It is the same scenario with US based healthcare outsourcing companies as well. Since their end-clients are facing the changes, the healthcare outsourcing companies also face the same concerns. It is to surmount these challenges that offshore medical billing companies are in existence. Like there are two sides to every story, medical billing outsourcing to offshore medical billing companies has its own pros and cons. Lets discuss a few of them:
Pros: On the positive side of offshore medical billing, there are several advantages to discuss,

  • Cost Factor: Performing all kinds of billing operations by incorporating new changes in-house is not an easy task. It requires a lot of spending on space, overhead costs, recruitment, training, and technology. When a part of medical billing and coding operations is outsourced to an offshore medical billing company, there is a good chance for a medical billing company to save money.
  • Volume: The volume of medical billing operations has increased a lot as medical billing companies handle multiple Healthcare Providers at a time. Medical billing outsourcing happens to be the best option as it reduces the burden of medical billing companies by sharing most of the mundane repetitive work.
  • Accuracy: As mentioned earlier, when medical billing companies handle huge volumes of billing operations, the accuracy level declines. However, with an offshore medical billing company’s help, they can perform medical billing and coding functions precisely without any compromise on quality.
  • Bandwidth: When part of the work is sent to an offshore medical billing company, it liberates the bandwidth within the organization.  Instead of handling day-to-day operations, only guidance and audit needs to be performed.  The liberated extra bandwidth can be utilized to acquire new clients and on-board them with very less ‘transition bumps’.

Cons: Instead of calling them as disadvantages, it can be termed as ‘fear factor’ of healthcare outsourcing companies about offshore medical billing companies,

  • Data Security: It is the first main ‘fear-factor’ that most medical billing companies have about offshore vendors. They hesitate to share the confidential information (PHI) with the offshore vendor and thus, eliminate the idea of healthcare outsourcing.  What they fail to understand is that the new changes to HIPAA mandate the same level of punitive actions for breach on offshore medical billing companies that are applicable to them. Some vendors like eCare have pro-actively acquired ISO certifications both for processes and Information security and have better security measures than even some of the US based companies.
  • Choosing the Right One: Some medical billing companies fear that they might end up partnering with the wrong offshore medical billing vendor and rightly so.  There are many instances where a choice is made in haste without proper due diligence that results in a horrible experience. With proper research and due diligence they can find a good, reliable medical billing company in India like e-Care.

By partnering with the right offshore medical billing company, US based healthcare outsourcing companies can easily eliminate these fear factors and enjoy great benefits that offshore medical billing companies have to offer.

Benefits of ERAs/EFTs

Friday, February 7, 2014 10:11

The introduction of ERAs (Electronic Remittance Advice) and EFTs (Electronic Funds Transfer) created a revolutionary change in the healthcare billing domain by replacing traditional, paper-based EOBs (Explanation of Benefits). Though the facility has been available for many years, even today only 46% of the claims are processed electronically, while the remaining 54% claims are processed in the traditional paper-based method. However, the Patient Protection & Affordable Care Act (PPACA) under section 1104 has mandated that all healthcare plans adopt and support EFT/ERA operating rules before the deadline – January 1st, 2014. Before adopting ERAs and EFTs in your system, get to know their benefits:

  • Cut-down Processing Time: The major benefit of implementing ERAs/EFTs in one’s system is that it considerably brings down the medical claims billing processing time. While payment postings are done electronically, the time involved in posting paper EOB payments manually gets reduced. The electronic way of posting payments has quickened and accelerated the cash flow of Providers to a significant level. Also since everything is electronic, the time a paper check or EOB spends in the traditional ‘snail mail’ system is avoided.  EFTs transfer the funds directly into the Provider’s bank account or a lock box.
  • Reduced Manual Effort: By adopting ERAs and EFTs, Providers and healthcare billing companies can reduce manual effort significantly. Therefore, there is no need for recruiting new employees who are adept at payment postings. Also, it is not necessary to train the existing employees on the payment posting method. This manual effort can be used for other complicated medical claims billing functions.
  • Auto Posting Efficiency: EFTs/ERAs allow the use of auto posting feature, which enables posting of payments on to the system automatically. The error rate of the automated posting method is less than that of manual posting. The manual effort involved in correcting these minimal errors is also less.
  • Cost Efficient: Healthcare Providers and outsourced medical billing companies can save a considerable amount of money by implementing ERAs and EFTs. The cost involved in recruiting new employees and training the current employees is saved. Huge savings in terms of paper costs, printing costs and mailing costs can be achieved. Therefore, the electronic payment posting method is not only time efficient, but also cost efficient.
  • Environmentally Friendly: The adoption of ERAs and EFTs has encouraged several healthcare billing companies and Providers to ‘Go Green’. Approximately, 2.5 billion pieces of paper can be saved by using the eco-friendly electronic payment process.

Several small healthcare providers and facilities are still using the traditional paper-based method of payment posting. Consequently the US based outsourced medical billing companies follow the same process. However, with the new legislation mandating the use of electronic payment method, there is an exigency for them to implement ERAs/EFTs as quickly as possible for these Providers and facilities. Doing so can consume a lot of productive time affecting the normal work and cash flow. Therefore, outsourcing medical billing functions to an offshore billing company like eCare India would be the right choice.

How soon can you start saving when using Offshore Medical Billing?

Monday, February 3, 2014 8:18

Due to the recent changes in the US healthcare domain, the onus of providing medical billing services with consistent quality has increased for the US based medical billing companies.  The offshore medical billing model has become a ‘hard to avoid’ option in recent times. Evidently, many outsourcing medical billing companies in the US consider it a better option than to expand their team of employees. However, they have to wait for sometime before the workflow kicks off and follows a steady pace. Most US medical billing companies expect savings immediately after outsourcing to an offshore medical billing company which is not realistic. Let’s analyze how soon outsourcing medical billing companies can save in offshore medical billing:

  • Learning Curve: The initial transition is the most crucial stage as a considerable amount of time and effort will be consumed for both the outsourcing and the offshore medical billing companies. This stage emphasizes the learning curve for the teams of the offshore medical billing company. The team gains knowledge of the work and TAT requirements of the outsourcing companies. Patience is indispensable during this time as the normal workflow might slowdown a little.
  • Productivity Factor: During the learning phase, offshore medical billing companies cannot contribute 100% productivity as the teams are still getting acquainted to the work assigned. The productivity of the US outsourcing medical billing companies might also get affected as the staff devote time in explaining their requirements to the offshore team. Therefore, it is highly essential that they understand this fact and wait patiently to reap great benefits in the near future.
  • Adapting to Work Change: Once a part of the medical billing and collections is outsourced to offshore medical billing companies, the in-house billing team is assigned with some other work. Mostly, the work involves administering and providing front-end support to the offshore team. This change in job nature will consume a considerable amount of the in-house billing team’s time until the employees adapt to their new roles. Here again there is chance of the normal workflow getting affected.
  • The Kick Start: Once the billing team of the offshore medical billing companies gets a hang of the work, then they will render better medical billing solutions with 100% productivity. Also, the accuracy level increases reducing claim denials. Gradually, outsourcing medical billing companies will start earning huge savings which will continue to progress as time passes. However, to enjoy these benefits, they have to assist and ‘hand-hold’ the offshore team and help in sorting out issues that may happen in the initial stages of offshore medical billing.

If you are looking for a highly-experienced offshore vendor that requires minimal ‘hand-holding’ during the initial phase, then look no further than eCare.

EDI Set-up – Save Time and Money!

Monday, January 27, 2014 11:31

Working effectively and efficiently is crucial when it comes to performing medical billing functions. Several factors help in the enhancement of medical billing functions of a provider to save money and time. Among them, EDI set-up plays a key role in promoting faster medical claims processing and quicker reimbursements. Though EDI (Electronic Data Interchange) has been around for some time now, its adoption rate is still less. To emphasize its efficacy, the Health Insurance Portability and Accountability Act (HIPAA) had mandated the EDI set-up. Once EDI is set-up, the Providers can send their claims and also receive the payments and denials electronically which reduces the revenue cycle time to a large extent. There are two ways in which this complex process can be set up for one’s practice and they are as follows:

  1. Clearing House: EDI set-up can be done using the help of a clearing house. To accomplish this process, Providers or medical billing companies will have to submit an enrollment form initially. An agreement emphasizing the fulfillment of HIPAA security and privacy requirements are signed between the Provider and the clearing house. Once it is done, Providers can start exchanging their patient information with the clearing house for further medical claims processing. Clearing houses help in promoting faster reimbursements, reducing denied claims and offer more medical billing solutions. They act as a bridge between the payer and the Provider. To ensure auto payment posting, clearing houses use ERAs (Electronic Remittance Advice) and EFTs (Electronic Funds Transfer) instead of paper EOBs and checks.
  2. Direct Approach: It is another way of setting up EDI where all EDI transactions are done directly to the payer. Here again, a Healthcare Provider or Facility will be expected to submit an enrollment form. Following the enrollment, it has to sign an agreement binding to HIPAA security and privacy requirements with the payer. EDI can also be set-up during provider credentialing. The process of collecting and verifying a Provider’s credentials is known as provider credentialing. Providers who are already in the payer’s network can also subscribe to EDI set-up during re-credentialing.

Whether Providers follow the clearing house or direct payer approach of EDI transactions, they must make sure that the normal medical claims processing workflow is not affected in any manner. For successful EDI set-up and uninterrupted medical billing, Providers or medical billing companies can get help from a reputed offshore medical billing company like e-Care. This ISO certified and HIPAA compliant offshore vendor will take care of the complete EDI set-up process.