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In 2016, practices that do not meet Physician Quality Reimbursement System (PQRS) requirements could lose as much as 6% of their Medicare reimbursements.
CMS and other payers require a specific format for submitting claims electronically.
When submitting a claim to an insurer or payer, you must complete a CMS 1500 form. This form has 33 required entries that must be completed prior to a payer processing a claim. A missing entry will usually result in a rejection from the payer, with the bill returned unpaid. The claim must then be corrected to be resubmitted, which delays receipt of the payment.
MpowerMed’s services are able to submit “clean” claims that are promptly paid without being returned. This is the result of having trained and experience personnel. MpowerMed’s specialized software programs have been developed to evaluate claims for completeness before submission, a process known as scrubbing. Incomplete claims are identified, completed, and then submitted. The consequences of this scrubbing process are fewer rejected claims and increased cash flow for the practice. For example, CMS will process correctly submitted electronic claims in 10 to 14 days.