Posts Tagged ‘electronic health records’

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.

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.

What You Need to Know About E-Prescribing

Wednesday, June 8th, 2011

Want to stay current on the latest news when it comes to e-prescribing and everything else in the medical billing world? You have come to the right place! Las Vegas’ Integrated Medical Management has all of the latest news, including news about e-prescribing.

According to recent reports, physicians seeing Medicare patients now have additional opportunities to avoid being penalized for failing to prescribe medications electronically by the June 30 deadline, issued under a proposed rule via the Centers for Medicare & Medicaid Services. This is welcome news for eligible physicians who don’t expect to report at least 10 electronic drug orders to CMS by June 30.
Medicare will reprimand those doctors that don’t meet 2011 e-prescribing requirements by reducing payments by 1% in 2012 and said on May 26 that doctors would be given a second chance to avoid the penalty post-deadline. Said physicians are allowed to claim one of the hardship exemptions online through October 1.

Additionally, the proposed rule would apply to physician practices that have already adopted certified electronic medical record systems—which could be used to satisfy the e-prescribing requirements, too—in an effort to earn Medicare or Medicaid meaningful use bonuses. Practices that use certified EMRs to send paperless drug orders will satisfy the e-prescribing requirement under the current program, as long as the system meets four functionalities. EMRs will be acceptable for e-prescribing in future reporting years (even if they don’t meet the four specific functionalities) if the proposed rule is finalized later this year.

“Eliminating unreasonable penalties and burdensome requirements, and providing physicians with more flexibility through an exemption process, will help ensure more physicians are able to successfully participate in the e-prescribing incentive program. The AMA has continually stressed to CMS that these changes were essential and is pleased to see them become a reality in a rule that will be finalized later this summer,” said AMA president Cecil B. Wilson, MD.

Market Growth Predicted to Surge as a Result of Anesthesia Data Management Systems

Friday, May 27th, 2011

In related anesthesia billing news, sales of anesthesia information management systems will result in a surge in the need for anesthesia, respiratory and sleep-management devices. A report from iData Research reports that the market will expand to around $4 billion by 2017.

The report revealed that the market for anesthesia, respiratory and sleep-management devices was valued at over $2.5 billion last year, representing a 3.7% increase over 2009. As additional companies enter the market, industry leaders will have to lower their prices in order to remain competitive.

“The market for anesthesia information management systems will increase by over 50% in 2012 as hospitals automate their anesthesia departments” (before health IT deadline included in the 2009 federal economic stimulus package), says CEO of iData Research Kamram Zamanian.

Additionally, iData Research released a companion report estimating that electronic health records and medical billing records will rake in over $7.4 billion in annual support revenue and sales by 2017, according to InformationWeek.

The Impact of Health Information Technology Applications

Tuesday, May 24th, 2011

The effect of health information technology applications on medical management is the focus of a new report funded by the Agency for Healthcare Research and Quality (AHRQ) and conducted by McMaster University, Hamilton, Ontario, Canada. After reviewing over 400 studies, the report revealed that health IT-enabled applications show moderate evidence of improved care processes. This especially holds true when clinical decision support and computerized physician order entry systems are concerned.

Although few studies looked at clinical or economic outcomes, when they were addressed studies found mixed results of clinician effectiveness and cost-effectiveness. Additional research is needed on the effectiveness of medical management in Henderson in dispensing, order communication, administering and medication reconciliation.


Wednesday, September 15th, 2010


Nearly every doctor’s office is frantically analyzing electronic medical record (EMR) software companies to get their share of the government money. The clinical side of many of the programs is slick. The bells and whistles are exciting for you and your staff. But what about billing?

Many EMR systems added a billing component almost as an afterthought to provide a ‘complete’ software system. Unfortunately, some key elements are usually missing.

Here are a few items to consider when speaking with a potential EMR vendor:

1. Can you load all your contracted rates?
2. Can you run a report of claims paid less than the contracted rate?
3. Can you run a credit balance report?
4. Can you ‘hold’ patient statements if you have returned mail?
5. Are you able to track the reasons for denials?
6. Can you put an ‘alert’ on the account for the front desk, i.e. wrong insurance/address on file?
7. Is there an audit trail by user?
8. Does the system accept electronic remittances?

While keeping the above in mind, make sure to have your billers see a demonstration of the EMR you like. They are the best ones to determine if the billing component is worth the extra money.