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Posts Tagged ‘competent biller’

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.

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.

Medical Records Identify Theft Is Rising

Saturday, November 5th, 2011

The health records and medical billing industries have become increasingly digitized through the past decade. With this increase in technology comes a lot of advantages, but it comes with some disadvantages as well. One of the biggest dangers is the increased and unfortunate phenomenon of medical identity theft. Criminals are always looking to take advantage of information that might be financially advantageous, and they have found medical records to be an attractive target.

The theft of medical identities can take several different forms. Some perpetrators steal the names and social security numbers off patients and then use the information to obtain emergency medical care, which can be very expensive. Stolen insurance information such as member id’s and policy numbers can be used to receive medical care from a variety of medical facilities racking up huge bills. The most frightening form of medical identity theft is when medical billing employees take advantage of their access of records to steal information and then sell it on the black market.

Critics say that the problem stems from a lack of safeguards and proper evaluation of medical billing employees to ensure that theft is not taking place. With the increased digitization of all things medical into the future, the problem is not just going to go away. It is important that medical offices and patients are using secure systems that take very step possible to prevent identity theft. If the system does not properly adapt to securing the information of all patients, there may need to be a complete overhaul in the way records are kept in the future.

Improvements for Payers, Billers and Providers: Part I

Tuesday, August 9th, 2011

The Healthcare Billing and Management Association recently identified 10 major challenges to payer relations—and offered solutions. Here is a summary of the article courtesy of Integrated Medical Management:

Challenge: Electronic payment is wrought with confusing codes and non-standard remarks.

Solution: Select from a standard, nationally recognized set of remarks for consistent coding across organizations. Also, explain why a claim is denied and subsequently offer ways to resolve the issue. This would streamline processing and benefit all parties involved.

Challenge: Unpredictable benefit information and separate mailings (with paper payment files).

Solution: Consistent with the Patient Friendly Billing Project recommendations, standard and easy-to-read formats would allow claims to be processed quicker. Additionally, grouping EOBs and checks together would up efficiency and limit misunderstandings, phone calls and the need for looking at one claim multiple times.

Challenge: The claims appeals process is inefficient.

Solution: Provide a clear outline of the process and give providers online access to claims statuses and appeals in addition to a timeline for a response. This would save time and money wasted when claims are tracked down individually.

Challenge: Denials for several visits from several specialists on the same day. When a patient sees multiple specialists in a hospital in one day, oftentimes only the first provider to submit their claim gets paid.

Solution: If payers’ systems were able to edit same-day services by provider specialty, there would be less inquiries and less cost (because claims wouldn’t be handled multiple times).

Check back for Part 2 of the list dealing with medical revenue management later this week!

Major Savings from Medicare Drug Plan

Tuesday, July 26th, 2011

According to a new study, Medicare’s 5-year-old prescription drug plan is saving the federal program approximately $12 billion a year by keeping seniors out of nursing homes and hospitals. The savings offset only a fraction of the $55 billion the government spends on the drug plan, known as Medicare Part D, per year. The authors of the study claim that it means seniors are enjoying a better quality of life and staying healthier.

Appearing in the Journal of the American Medical Association, the Harvard analysis found that Medicare saved an average of around $1,200 per year for each senior citizen who had insufficient drug coverage prior to Medicare Part D. Lead author Dr. Michael McWilliams of Harvard Medical School said that with subsidized drug coverage, seniors are able to afford drugs that lower cholesterol and blood pressure and control diabetes, thus preventing trips to the emergency room—and medical bad debt collection for seniors unable to afford medication and emergency room bilss.

Medicare Part D is voluntary and there were 23 million Part D beneficiaries last year. Enrollees pay premiums covering approximately 25 percent of the cost.

The Medicare drug benefit began in January 2006. Prior to that date, around 2,500 of the seniors in the study reported having generous drug coverage—often purchased as supplemental insurance—while around 3,500 reported having limited or no drug coverage.

Check back for more news on billing for medical services and more.

All About Integrated Medical

Friday, July 8th, 2011

We have been specializing in billing and collections in Las Vegas and Henderson for more than 16 years, using cutting edge technology to make sure claims are submitted very quickly. According to the Medical Group Management Association (MGMA), the average percent of accounts receivable over 90 is 21.56%–but ours is less than 8%, and we have an average days to payment of 21.

Providers choose us for the following reasons:

  • Automated Claims Follow-up Processing
  • On-Line Patient Payment 24/7
  • Real-Time Access to Account Data 24/7
  • Reimbursement Tracking
  • Recurring Internal Audits
  • Automated Accounts Receivable Management
  • Electric Document Storage and Retrieval
  • Fast Turnaround Time for Electronic Claims Submission
  • Staff Training
  • Automated Concurrency Tracking
  • Ad Hoc Reporting Capability
  • HIPAA Complaint
  • Reduced Employee Headaches
  • Custom Reports at No Cost

Contact us for a free audit to see how we can help you with medical revenue management!

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.