Oct 27

Understanding the Family and Medical Leave Act As Applicable to Employees

There are certain rights and privileges that an employee may exercise. However, this is only possible if you are aware of the rights and the way to utilize those. One such is the Family and Medical Leave Act (FMLA). This act covers approximately 65% of all employed Americans.

The chief tenet of the FMLA is that an employee is eligible for a maximum 12 weeks of leave (unpaid) for reasons concerning family or medical problems. There is no risk of losing job, as per this law.

A proficient employment attorney would be able to help you understand the intricacies of this right. Who is eligible for this leave? Well, you need to fulfill certain criteria to become eligible for leave under this act. Here is a quick checklist.

- You must be an employee of the local, state or federal government
– Alternatively, you must work for an organization with staff strength of 50 or more

Another condition that you need to fulfill is that you have worked for your employer for a minimum of 1 year. Any other specifications may be there; talk to a good employment lawyer to know more details.

There are certain grounds on which you may take leave from work. These are as follows:

• To take care of a child (newborn/adopted/foster)
• To take care of a parent/spouse/child suffering from a serious physical or mental ailment
• To take care of yourself if you have a serious medical condition

The US Department of Labor offers a definition of ‘serious health condition’ as one that requires inpatient care or continuous medical treatment. This definition is, however, not very well defined. The usual cases accepted are terminal diseases like cancer and temporary issues like pregnancy or surgery.

When you face a situation where you need to take leave and know that you are eligible for it under FMLA, be sure to follow certain steps. This would help you get the leave, and in no way hinder your career.

An employment lawyer experienced in the laws would let you know what to do. If you know that you want a leave at a particular time, notify your employer about it 30 days earlier. However, in an emergency you can also take the leave immediately.

Gather medical proofs to support your demand for leave. Providing a doctor’s certificate will not do, you need to submit all relevant medical records. Your employer may conduct checks on you about your health condition. Do not get worried, it is just a check. You also need to decide whether you want to use your paid leave as part of the medical leave.

In case your employer fires you from the job even when you have fulfilled all the conditions, you need to take legal action. Contact a Miami employment attorney and discuss the details of the matter with him/her. If you can prove that, you were eligible for the leave and fulfilled all conditions the court would order your employer to give you your job back.

Oct 19

Your Medical Insurance is on the Line – And an Organization You’ve Never Heard of is Holding the Key

They know who you are, whether you smoke and how fast you drive. If you’re applying for medical insurance, you need to know what the MIB knows.

What does health insurance have in common with the CIA, Freemasons and the Skull and Bones society?

Your eligibility for health insurance just may be shrouded in the mysterious folds of an organization the general public knows little about. There are no secret handshakes or enigmatic symbols, but it does have a coding system known only by its employees and members.

What is this ominous-sounding organization? It’s the MIB Group, formerly known as the Medical Information Bureau, and it provides information to insurance companies that can make or break a consumer’s insurance application. Though the MIB has been in existence since 1902, most consumers have not heard of it.

The MIB is described as a “membership corporation,” and is owned by approximately 470 insurance companies who make up the MIB’s membership. The MIB’s stated mission is to detect and deter fraud that may occur during the course of a person obtaining medical insurance, life insurance, disability income and other types of healthcare insurance. It protects insurance companies from being defrauded by an applicant who knowingly or unknowingly omits critical information or lies.

The MIB is a lot like a credit reporting agency. It provides information to insurance companies to help them decide whether or not to provide medical insurance to an applicant. The information also helps the insurance company determine the patient’s premiums.

Not everyone has a report on file with the MIB. If you have not applied for health insurance or an individual life insurance policy within the last 7 years, then you do not have an MIB report. According to figures reported by the MIB, the organization collects information on around 15% to 20% of people who have applied for either medical insurance or life insurance policies.

The MIB’s similarity to credit reporting agencies isn’t a superficial one. The U.S. government classifies the MIB as a consumer reporting agency, which means it must comply with both the US Fair Credit Reporting Act and the Fair and Accurate Credit Transactions Act. That means consumers have the right to a copy of the information reported by the MIB to insurance companies. In fact, you have access to one free MIB report each year.

Some of the information collected and reported by the MIB includes:

* Medical conditions

* Medical test results

* Negative habits such as drugs, alcohol abuse, smoking and overeating

* Hazardous occupations and/or hobbies

* Poor driving history

Information collected about the MIB stays in a consumer’s files for seven years. Also, a consumer’s record will indicate which, if any, members have requested their information within the previous 12 months.

Because this information can affect a person’s ability to obtain medical insurance, consumers are encouraged to check with the MIB and to request their report if one exists. That way the consumer can check the report for accuracy and will be aware of any issues which may negatively impact their ability to qualify for medical insurance. Consumers have the ability to dispute any of the information on their report through the MIB’s dispute process.

To request your file, phone the MIB by calling their toll-free number: 866-692-6901866-692-6901. You will be asked to provide certain personal identifying information, and only you can request your file. A consumer’s guide to the MIB is available on the group’s website at www.mib.com.

Oct 11

Billing Software Very Helpful in Medical Centers

The billing software is used in electronic bill submission. Everything related to billing is included in the same software with no need to incorporate any additional module. There is also no need to export or import any data between the different modules for generating the billings. The billing software significantly saves time and money. All the bill payers can be billed by the same system and the electronic claim functionality is equal for all the payers which make the billing process simple and hassle free.

The billing software has the ability to also check the patient’s eligibility for the services from the insurance provider. The medical billing process is an interaction between the health care provider and the paying insurance company. The entire interaction is called a billing cycle which takes some time to complete. To ease out this process and quick processing of claims, a medical billing software has been designed which is an automated process and reducing much of the time in processing the same.

The consistency in this billing software increases the accuracy and lessens the workload on employees. Electronic claim status of the bills is retrieved automatically without downloading any things and the company is automatically alerted of any errors while submitting the same. The high level of automation used here simplifies the entire claim process and enhances the productivity of employees. The automated system also reduces the requirement of handling the claims during entire process. In case of any denial from the insurance companies, the system automatically alerts the user.

The billing software processes the bills of both primary as well as secondary insurers hence reducing the time taken in entering the data for both separately. With the use of the software the claims are processed as per the hierarchy of the payer. After the primary insurer processes the bill, it is then moved to the secondary insurer automatically. The different types of charges which are billed by many companies like professional charges, technical charges or the global charges the software will automatically add these to the electronic bills.

Oct 03

How to Deal With Medicaid For the Medical Biller

When a patient has medicaid it can sometimes pose some problems with getting the medical claim paid. Here are some special medicaid scenarios for the medical biller.

When you are dealing with medicaid HMO’s prompt the patient to appeal to the carrier if the bill is denied for no authorization for medical services. This applies especially when the carrier is HIP.

In one situation the patient had medicaid and GHI insurance and the patient died and left no estate and medicaid had soaked up all savings and other monies. If New Jersey medicaid cannot be filed you must accept the GHI insurance payment as payment in full. If the patient had medicaid then medicaid would have liquefied her assets for reimbursement. So in this circumstance you would call medicaid for information, call the nursing home and ask what insurance the patient had and order a duplicate EOB or explanation of benefits from the insurance company so you know how much money to expect and how much to write off.

The Medicaid pre-pass program this means that even if you are denied New York State medicaid as a medicaid HMO, for this example it will be Home First, the anesthesia insurance claim will still go to New York State medicaid because some medicaid HMO’s do not reimburse or provide for anesthesiology services.

Ask the patient to put in an application for medicaid if the date of assistance was a crisis and they have no insurance. Call the insurance company and explain to them there could be no pre-authorization as it was for a crisis service. Before you do that make sure that the procedure was billed as an outpatient if the patient was an outpatient and inpatient if the patient was an inpatient. For an crisis service you should also see if the place of service was in or out of network as well.

At the doctor’s request you should send a medical client to the collections department at the doctor’s courtesy rate regardless of whether or not the patient has a medicaid hmo (health maintenance organization). We have to contact the carrier, especially if the traveler is HIP, and send a letter of grievance.

When you have both Medicaid and Medicare on an insurance claim Medicaid is the primary health plan and Medicare is secondary insurance. You should file to Medicare after Medicaid. For medicaid accounts you would check medicaid online at the medicaid website to see if the service comes up as an eligible emergency service under medicaid. Then add the medicaid identification number and lower the fee and file to medicaid on both or all accounts that the patient has with you.

For medicaid cases you call the client and have them call the hospital’s inpatient or outpatient billing division to get a correct copy of their medicaid number. The client then calls the hospital to confirm their medicaid number and then calls us back with that information.

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