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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.

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.

Best Practices for Medical Billing

Friday, October 14th, 2011

In order to maximize the inflow of cash into a medical office, it’s important to follow some basic rules and procedures to insure that insurance claims are properly fulfilled and patients pay on time. Integrated Medical Management offers a wide variety of services to help fulfill these goals. Their billing, scheduling and consulting services will allow your office to improve efficiency in patient care and increase the income your office needs to operate to the best of its ability. Consider a few of the following ideas for improving efficiency even more.

-Know the right ID’s. There are codes and identifications for almost everything in medical billing, and this will be even more true once new standards for recording medical ailments and conditions come to effect in October 2013.

-Verify eligibility before an appointment. Determine what kind of care is covered for patients by their insurance providers before they arrive at the office. This will increase efficiency and overall care for all patients once they physically arrive at the office.

-Check for mistakes. It takes a lot less time to double check your reports before you submit them than it does to fix them once they have already been processed.  Electronic form submissions have made it much easier to process paperwork, but mistakes can still be made at the doctor/nurse/patient level and it’s always best to recheck information in order to save potential time wasted in the future.

-Follow-up on submitted claims and bills. Sometimes things can fall through the cracks, even in an electronic billing environment. Allowing claims or bills to go unpaid will mean less money for the office and less care for the patients.

Evaluation & Management Tips

Monday, April 11th, 2011

As we move closer to Healthcare reform implementation, auditors will become increasingly tougher on documentation requirements. Medical necessity is defined by the American Medical Association as “Healthcare services or products that a prudent physician would provide to a patient for the purpose of preventing, diagnosing, or treating an illness, injury, disease or its symptoms in a manner that is: (a) in accordance with generally accepted standards of medical practice; (b) clinically appropriate in terms of type, frequency, extent, site and duration; and (c) not primarily for the convenience of the patient, physician, or other healthcare provider.” Evaluation and management documentation must demonstrate medical necessity for the visit and thus must include specific requirements to avoid rejection.
First, the chief complaint should be listed in the first or second sentence. It might even be helpful to spell out the words “chief complaint” and then the list the reason for the visit. Make it as easy and foolproof as possible if an auditor or payer should review the notes. Every note must stand on its own. In other words, even if a patient is a repeat patient and you’ve listed out their chronic problems in other notes, it’s important to list out the chief complaint during every visit, every time. If the note isn’t documented properly, payment can be denied or rescinded.
Secondly, the chief complaint should not be ambiguous. Be specific. If the patient is coming in for a variety of complaints, make sure the chief complaint is listed as such.
A physical exam should be conducted even though Medicare doesn’t explicitly require it. Some carriers require it so unless you know that yours does not, you should document the physical exam. Coding guidelines require a physical exam of varying degrees depending on the chosen code.
Medicare generally expects to see evaluation and management services billed every three months for patients with chronic, stable conditions. However, medical necessity should always dictate how often a patient is seen. Documentation should always demonstrate the medical necessity for the visit so be sure your notes indicate the need. If your claim is denied for payment or an overpayment is requested based on a RAC audit, appeal with your records. Practices have been successful in overturning the rejection when their documentation supported the visit.
In summary, stricter standards are going to become the new norm as reimbursement levels decline and payers try to hold on to payments. It’s up to providers to keep this from happening by ensuring their documentation passes muster to support medical necessity. Self-auditing should be implemented to look for deficiencies before an auditor finds them.

Congress acts to prevent the 21.3% cut to Medicare payments.

Monday, July 12th, 2010

Congress continues to delay fixing the flawed Sustainable Growth Rate formula. Again, Congress pushed off the 21.3% Medicare cut to doctors pay until 12/1/10. It is believed that this was because Congress doesn’t want to deal with an unpopular pay cut before the elections.

Instead of the cut, a 2.2% increase was passed and is effective retroactively back to June 1. Many Medicare contractors had already begun to process claims at the 21.3% cut for June dates of service, but there is no need to worry because they have been instructed to go back and reprocess underpaid claims. As of 7/8/10, the new June Medicare fee schedule had not been posted on CMS’s website but it should be soon.

The new conversion factor used to calculate payments is $36.8729, which is up from the $36.0791 rate used earlier this year and the $36.0866 rate used in 2009. However, more than 4,000 codes saw a decrease due to a change in Relative Value Units so make sure to review your codes. Congress said it wants fix the SGR formula during this 6-month period before the more than 23% cut goes into effect on 12/1/10.

Hire Compentent Billers

Friday, June 11th, 2010

Hiring the right biller can be a challenge. They interview well, but how do you know they are competent? Give them a test. Nothing complicated, just give them an EOB with some basic questions. If they don’t understand the difference between what a payer allows vs. a contractual write-off or they can’t calculate the patient’s responsibility or they can’t tell you what network is being accessed, then you need to continue looking.

Once you hire competent staff, here are some suggestions to support them:

1. Make sure your staff know who the provider is contracted with including payers, leased networks, insurers, etc.
2. Ensure your fee schedules are properly loaded in your software. Make sure to update them for any cost of living adjustments or annual changes such as Medicare.
3. Ensure the staff know the timely filing requirements of the different payers, including for appeals.
4. Get your patient statements out promptly.
5. Do audits to ensure your staff is performing well. More training may be needed at all levels. Don’t assume because their title is Supervisor that they don’t want training. There is always something new to learn.
6. Last, but not least, send in your appeals! Too much money is left on the table because appeals are not sent in. If you provided the service in accordance with your contract then fight for your money. Don’t be afraid to send in second level appeals or get your provider representative involved.

Physician Cuts Delayed

Wednesday, March 3rd, 2010

Yesterday, the President signed H.R. 4691, the Temporary Extension Act of 2010 into law. This act postpones the cuts to Medicare reimbursement to physicians until March 31st. Hopefully, this will give Congress time to determine what to do about the flawed Sustainable Growth Rate calculation.

Possible Delay in Medicare Cuts

Thursday, February 18th, 2010

The Senate may give doctors a temporary reprieve from the proposed 21% cuts scheduled for 3/1. Added to the jobs-creation bill is a seven month delay of the cuts to October 1. It all hinges on whether the bill becomes law by the end of this month.

Senate Approves $82 Billion Fix

Tuesday, February 16th, 2010

The Senate approved a five-year pay fix totaling $82 billion. That’s how much it will cost to keep 2009 Medicare rates fixed until 2014. Something has to be done to correct the sustainable growth rate (SGR) and the continued cuts to physicians’ reimbursement. Congress has to move quickly since the March 1st deadline is fast approaching.