Archive for the ‘Billing’ Category

Reasons to Outsource Your Medical Billing

Monday, December 12th, 2011

The decision to outsource your medical billing is not always immediately clear. There are a lot of factors to consider including efficiency, staff costs, technology and a variety of other circumstances that may or may not make outsourced medical billing your best option. The following are some points to consider before making a final decision.

Your billing process is inefficient. You may have noticed that your in-house billing department processes claims too slowly and recovers far too little money. Outsourcing your medical billing will typically decrease the time it takes to process claims and increase the amount of money received.

You have high staff turnover. Employee turnover is a problem in almost all industries but it can be particularly damaging when it comes to medical billing labor. Claim processing is the  life blood of revenue for a medical practice and constant cycling of employees can slow down the process immensely.

Important Information about Medical Billing

Monday, December 5th, 2011

Medical billing companies are primarily responsible for the timely and complete processing of payments from both patients and insurance companies for doctor’s offices. Once a claim is filed with an insurance company, medical billing staffs are required to follow up on claims in order to make sure that money is received so that medical practices can thrive. The cycle of billing can take anywhere from a couple of days to as long as a few months. How long the cycle takes depends on how complicated the claim is and the insurance company that is being worked with.

The medical billing process starts as soon as a patient enters the office, whereby information is collected and kept up to date whenever the patient reenters the facility. The patient is then seen by the doctor and any work done is broken down into a five digit code from the CPT (Current Procedural Terminology) database. The diagnosis is then translated into a code that can be filed electronically known as the ICD-9-M database. These codes are transmitted by the Electronic Data Interchange; this is the most effective way of getting claims and payments processed as quickly and accurately as possible.

Claims are often rejected by insurance companies and the medical billing department and the process will have to start over again. If there are coding errors, those can be fixed and the claim refilled immediately. Otherwise, a patient will be sent an Explanation of Benefits sheet. Patients can always request that the insurance claim be filed again. Many insurance companies deny claims because they believe the procedure was not medically necessary. Payments for accepted claims will be received by the medical facility and the patient will be responsible for the balance of the bill. Regulations regarding these medical billing procedures have been instituted by the HIPAA (Health Insurance Portability and Accountability Act (HIPAA). Universal standards and practices are essential for an efficient and functioning medical billing system.

Coding and Billing Errors Can Decrease Revenue

Friday, December 2nd, 2011

Mistakes are unavoidable in most professions, but when it comes to mistakes in medical billing and coding, errors can end up costing a lot of money. Medical billing mistakes need to be addressed immediately in order to avoid a lot of lost revenue. Overlooking these mistakes can be a revenue disaster for any medical office in the long run. The following are some examples of medical billing and coding mistakes.

  • A physician performed an arthrocentesis on a 74 year old female. The biller billed the CPT code 20605 without the modifier-50. The insurer processed the claim and paid for unilateral service (100%) instead of bilateral service (150%). Medicare allowable for the procedure is $52.41 for unilateral service and $78.61 for bilateral services. In this case, the potential loss of this mistake if repeated over time can add up.
  • An ophthalmologist performed an excision of an eye growth with a graft but failed to document this on the chart. The staff didn’t know and used the CPT code 65420 (excision or transposition of a petrygium without a graft) in place of CPT code 65426 (excision or transposition of a petrygium with graft). The difference between these codes with Medicare is over one hundred dollars. This loss could have been avoided if the physician had documented in the chart that petrygium was done with a graft or if the staff had questioned the physician about the procedure.
  • A Chiropractor provided spinal manipulation on a Medicare patient and coded CPT 98940 (1-2 body area) but forgot to put in modifier-AT on the bill. The billing staff missed the fact that the modifier was absent. Medicare denied the claim saying that the procedure was maintenance therapy. The chiropractor missed out on about $25, which can easily add up over time if the mistakes persist.

Picking a Medical Billing Solution Part Two

Saturday, November 19th, 2011

The majority of medical practices want the most experienced and reputable medical billers to manage their invoicing. In some instances, this might also include additional services like billing to medical vendors such as pharmacies and anesthesiologist scheduling. Medical billing is one of the fastest growing industries because of the huge volume of medical practices and the growing percentage of GDP that healthcare takes up in our economy. Outsourced medical billing practices can be found in a variety of places, including online or through the local medical associations.

There are several key factors to discuss before engaging a medical biller. Obviously, a company that engages in timely and prompt billing is essential to increase income and production. This is a factor that should be discussed and analyzed before committing to a particular service. This can be discovered by contacting other medical offices or going into in depth discussions with the prospective medical billing company. Whether or not a medical billing company is right for your office will depend upon their procedures and their compatibility with your practice. Initial billing data may be entered into an in-house computer system and then transmitted to the medical biller, or data may be downloaded by the medical biller on a daily basis with the use of an intranet module.

Picking a Medical Billing Solution Part One

Saturday, November 12th, 2011

In the majority medical practices, the biggest concern for proprietors is the process of billing and collections. For smaller practices, billing consumes vast amounts of time that would be better spent through the actual care of patients. In-house medical billing usually results in higher labor costs, benefits and pensions that all reduce the level of profit an office receives. The answer to the problem is medical billing outsourcing to increase your income and production.

Depending on the number of clients being billed in a particular office, there are three significant factors for determining the right medical billing solution:  timeliness, efficiency and cost-effectiveness.  The other prerequisite is experience in medical terminology and billing techniques. Medical billing outsourcing practices maintain state-of-the-art billing technology and stay updated with changes to medical billing resulting from interface healthcare insurance industries. The right medical billing practices should be well versed in a wide range of healthcare insurance providers’ policies.

Medical billing practices base their costs to clients on the number of patients billed as well as specifications required by each medical practitioner. There are variations in medical billing such as those generated by primary care physicians and specialists as well as hospital care and diagnostic services. Medical billing practices should have a strong background in the area of health care in which they are operating.

Avoiding Medical Billing Coding Errors

Monday, November 7th, 2011

The need to improve the overall efficiency of medical billing and coding software is more relevant today than ever. Medical practice costs are increasing day by day, and with stagnant and receding reimbursements, the challenges before medical professionals are really daunting. Below are some suggestions to help medical billing professionals avoid common mistakes.

1. Hire the services of an experienced person to work on medical software. With lots of un-sourced get-rich-quick type medical billing courses churning out half-baked professionals, you should ensure that you are hiring someone who is competent and up to the task at hand.

2. Use the medical billing and coding solution available to its fullest. Keep up to date with the latest regulations and requirements. You can solve majority of problems by opting for a close relationship with the medical billing and coding software company.

3. It’s common to blame insurance payers for increasing denials or write offs. Instead look inward and tackle the repetitive issues that occur with different payers. Try to keep records of the particular insurance companies with whom you had issues and see what can be improved upon. What may work with one payer many not click with another.

4. Small companies with less than 70 employees are quite susceptible to internal frauds. These companies rarely have efficient control mechanisms in place to prevent the thefts. A single dishonest employee can cost thousands of dollars to a medical practice. By establishing requisite software solutions to control the money flow, huge savings can be made within a short period of time.

5. Offices that fail to modernize with new technology will fail and become obsolete. Increased focus on a medical billing software solution is essential for physicians and their offices. Medical software can take care of complicated tasks like use of predictive dialer, scrubbing claims, electronic remittances, and much more.

Solving the Problem of Overdue Medical Bills

Wednesday, October 26th, 2011

More medical practices get into financial trouble by not being able to collect receivables than for any other reason. This is why it is very important for any hospital or medical practice to have a good medical billing process and trained professionals in place to handle any issues. Many offices don’t follow common sense guidelines when dealing with billing, claims processing and collections. Without establishing the terms and policies regarding billing and payments with patients upfront, problems can occur later on.

Having a proper system or processes in place for medical billing and collections helps more than most people think. Many small practices just deal with issues as they come along and this hurts them in the long run. The chances of successfully collecting the payments are increased manifold when proper procedures are put in place. For example, policies need to be clearly expressed to the patient before any care if given. Patients need to be invoiced regularly and told clearly about the payment terms and are aware of what happens if they don’t pay on time.

If a patient does not pay after the deadline is over and after repeated reminders by office staff, then it may be time to take it to collections. Details would need to be handed over to the collection agency, which either work based on a flat fee or on a commission basis where they get a percentage of the payments they collect. It would be best, however, for  medical practices to outsource their billing to a more professional firm like Integrated Medical so that the office can focus on what they do best, providing patient care.

How Technology Has Improved Medical Billing

Friday, October 21st, 2011

Computer technology has had a major impact on the entire practice of medicine. From advanced scanning machines and bioengineering to electronic medical records, the world of medicine has transformed from a slow paper filled world to a quick and efficient electronic one. Below is a list of ways that the process of medical billing has changed since the inception of electronic computer based records.

The Old Way

  • careless errors were often made by hand on paper without any way to correct them
  • only a limited amount of information could be processed due to the limits of human calculations and fatigue
  • insurance claims would be rejected more often due to inaccurate paper work or from unfamiliarity with proper insurance procedures
  • lower numbers of patients being seen by doctors and nurses due to the time consuming process of filling out hand written records
  • things were hard to understand without lots of experience and access to a vast wealth of information that was not readily available

The New Way

  • Doctors, nurses and even patients can look at medical files from any computer terminal that allows remote access
  • Custom built programs can increase efficiency and care for specific types of practices
  • Medical offices can see more patients since less time is spent hand writing and submitting reports
  • A greater base of knowledge can be accessed to allow for more accurate record keeping and patient care
  • Offices can receive revenue more quickly and efficiently due to electronics based billing and offsite but on demand records management.

Upcoming Changes to Medical Billing

Friday, September 23rd, 2011

Starting in October of 2013 there is going to be significant changes to the way medical-billing takes place in the United States. The new federally mandated system will require doctors to use a bank of more than 140,000 alphanumeric codes to describe medical services and injuries sent on bills to health insurance providers. Below is a description of the way things can be expected to change for health care delivery according to Dan Feinberg, the director of the health informatics program at Northeastern University.

The new system will not fundamentally change the way that data is collected by doctors and nurses. Instead it changes the way that data is recorded within information systems. By using codes for specific medical conditions and circumstances computers will be able to find patterns within the data. Dan Feinberg says, “We will be much better at detecting outbreaks, and we will be much better at identifying how to keep people healthy… finer data in ICD-10 will allow us to identify patients with problems and pair them with nurses who can address them.”

The ICD-10, or International Statistical Classification of Diseases and Related Health Problems, is a coding system developed by the World Health Organization. Its use in medical billing practices will allow the detection of health trends and increase the potential of preventative care. Standardized medical information is paramount for successfully sharing information about conditions and diseases throughout the health care system. Many other countries in the world already use the ICD-10 in their health care.

Safeguarding Patient Information

Thursday, September 15th, 2011

Keeping patient information confidential is one of the most important issues concerning both patients and their medical providers. The reason for this is clear. Public exposure of private health information can lead to a lot of hardship for patients. These hardships can include identity theft, fraud and embarrassment. Medical providers never intend for private information about their patients get out, but large data leaks of private patient information remains a large problem for medical providers throughout the United States.

There are several different reasons why private patient information is so vulnerable to leaks. Medical offices and companies tend to be behind the times when it comes to computer security and technology. This can leave them open to simple computer attacks. Without integrated systems in medical-organizations there tends to be a lot of duplicate files, which create ripe opportunities for thieves to steal data. Defragmenting data and technology in medical offices and organizations is essential for keeping patient information private.

Eric Johnson from the Wall Street Journal suggests several approaches to solving the problem. Security managers should take close inventory of data throughout an organization in order to determine vulnerabilities and best practices for securing data. Access restrictions should be implemented as not everyone in a health company would need to see all available data about patients. Most of all, data technology should be easy to use for doctors in order to encourage use of information systems that emphasize security.