Posts Tagged ‘electronic medical records’

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.

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.

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.

New Information about Private Medical Insurance

Tuesday, September 20th, 2011

Valuable information about spiraling medical costs throughout the past few decades has been limited. This is partly due to the lack of data available. Statistics for Medicare and Medicaid have been widely available for study while data on private insurers has been anything but transparent. With such a large segment of the health economy in the United States being mostly hidden, it has been difficult to analyze trends and determine the cause of rampantly rising medical costs.

Recently a not-for-profit group in Washington D.C. called The Health Care Cost Institute was launched. The group will be responsible for analyzing large amounts of private insurance data from some of the largest health insurance companies in the United States such as Aetna, Humana, Kaiser Permanente and United Healthcare. The group will release trend reports twice a year that should shed valuable information about rising medical costs.

Research from available data so far has suggested several possible culprits for rising costs. One of them is that the health system is poorly organized and fragmented. Current financial incentives also goad hospitals and doctors to do more medical procedures and tests in order to earn more money. Disclosure of private insurance data will do a lot to disclose how influential these causes actually are to rising medical costs.

New Payor Reporting Tool

Wednesday, August 17th, 2011

The CPR Committee recently introduced its “CPR Reporting Tool,” which was developed as a resource for CPR communications with payers, to HBMA’s website. The tool documents significant quantifiable issues so that CPR and payors can jointly work to solidify reasons for improvement or change on behalf of HBMA membership and was originally designed to address only commercial payor claims issues. It was expanded, however, to include all payors including Medicare and Medicaid and provider enrollment issues.

Using the HBMA Heal The Claims survey conducted in April 2009, CPR developed a Top 10 List of payor issues, from which the reporting tool evolved, as a dynamic real-time survey approach to collecting information from HBMA membership. The tool has been designed using radio buttons and drop down menus—ideal for quick entry—and also features a “Comments” field.

The “Frequency” field is an important part of claims denials. It is meant to capture the amount of times you experience a particular recurring denial program that usually represented a programmatic issues with the payor’s adjudication system.

Improvements for Payers, Billers and Providers: Part 2

Thursday, August 11th, 2011

A myriad of issues affect medical bill management companies. Earlier this week, we discussed challenges facing billing and insurance companies, patients and providers, so here is the rest of the list:

Challenge: Incorrect claims adjudication based on the specialty of a physician.

Solution: Implementation of a mechanism that better enables claims adjudication for physicians with dual specialties.

Challenge: Loading of contract payment terms across multiple systems is inconsistent.

Solution: It is important for payers to make sure contract payment terms are loaded consistently across systems. Also, clearly identify the correct arrangements so provider staff can verify that the claims are paid accordingly.

Challenge: Websites are outdated.

Solution: Payers can help reduce most of the inaccurate claims submissions stemming from inaccurate or outdated information by providing physicians with real time information on their members eligibility and claims history.

Challenge: Authorization systems are outdated.

Solution: Replace the ineffective system—in which PCPs fax authorizations for specialists—with automated information technology so payers can help reduce the amount of paper, facilitate reimbursement and speed things up.

Challenge: Credentialing processes are unregulated.

Solution: Payers could increase the speed and efficiency of the present system (from several months to just 60 days) by applying a consistent process for enrolling or credentialing physicians.

Stay tuned for more from the official Integrated Medical Management Inc. blog!

How You Can Stop Medicare Fraud

Wednesday, July 20th, 2011

Last month, the Department of Health and Human Services (HHS) and the Department of Justice (DOJ) paired together for the sixth Health Care Fraud Prevention Summit, held in the City of Brotherly Love (Philadelphia).  Since the start of the Health Care Fraud Prevention and Enforcement Action Team (HEAT) task force back in 2009, more than 670 defendants have been charged for attempting to defraud Medicare of over $1.3 billion in taxpayer dollars!

Fraudulent Medicare claims are now being predicted and identified using the same technology that your bank uses to protect you from credit card fraud. This helps Medicare stay one step ahead of criminals.

As billing specialists, we have some tips for stopping Medicare fraud in your own home:

  • Be wary of anyone who offers you free medical equipment or services and subsequently requests your Medicare number. They do not need your number!
  • It is illegal to let anyone borrow or pay to use your Medicare ID card or identity. So don’t do it!
  • Treat your Medicare and Social Security cards like they are your credits cards and keep them safely guarded.

Stay tuned for more news on credentialing medical!

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.