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Posts Tagged ‘Healthcare’

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.

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.

Benefits of a Medical Billing Service

Monday, September 12th, 2011

Your average medical office is a busy place with a constant inflow of patients whose medical needs are of the upmost importance. The primary concern for employees in the office including doctors, nurses and assistants is the health and well being of the patients. While the collection of money into an office is essential for maintaining care, taking up the valuable time of medical office workers to chase patients and insurance companies is not an efficient use of time and resources.

Efficiencies gained through using a third party medical billing service can be drastic. These gains come from the ability of medical billing services like Integrated Medical Management to collect more money than is normally possible from traditional medical offices. They are able to do this because of their extensive knowledge and techniques along with state of the art billing and practice management software.

Health insurance companies in particular can be difficult to collect from due to complicated policies and claims adjusters looking to deny payments whenever possible. Harnessing the deep knowledge of medical bill collectors means getting paid more often so that expenses like payroll and equipment costs can be met. Otherwise inefficient medical offices will be able to increase revenue and therefore increase the quality of their patient care.

Medical Billing and the HIPAA

Tuesday, September 6th, 2011

In 1996 the U.S. Congress passed the Health Insurance Portability and Accountability Act. The purpose of this act was to address security and privacy concerns of health care data. The standards implemented in the law are meant to improve the efficiency and effectiveness of the entire health care system in the United States. It does this by encouraging the widespread use of electronic data interchange. Title II of the act, otherwise known as the Administrative Simplification provisions, requires there to be national standards for electronic health care transactions and national identifiers for providers, health insurance plans and employers.

Integrated Medical Management is in full compliance with the HIPAA. What this means for patients and doctors is full confidentiality in their records, which is an essential component for the safety and wellbeing of all patients within a given medical organization. Complying with this act means that patients won’t be exposed to identity theft, medical fraud and various other maladies that come from the leakage of their private medical data.

The HIPAA did not only affect medical billing services and insurance companies. Software companies and medical offices initially spent thousands of dollars in order to update their systems to the standards of the HIPAA. Thankfully, medical offices that use a medical billing service will be in automatic compliance with the HIPAA. They will also drastically reduce the burden on employees in the office and increase efficiencies across the board.

Manufacturer Rebates Offset Mounting Costs of Medicaid Brand-Name Drugs

Tuesday, August 23rd, 2011

Prices and payment amounts for Medicaid brand-name drugs soared at around three times the inflation rate between 2005 and 2010, reports the Office of the Inspector General. These significant increases, however, were offset by savings created by the Medicaid drug rebate program.

Reports issued by AARP reveal that wholesale acquisition costs (WAC) for the most widely used brand-name prescription drugs have significantly increased since 2002. Addressing Senator Bill Nelson’s concern over AARP’s findings, OIG reviewed drug pricing changes and their impact on Government health care programs like Medicaid. The study examined changes in WACs, average manufacturer prices (AMP) and Medicaid payment amounts for brand-name drugs from 2005-2010. OIG also looked at the effect of rebates paid by drug manufacturers as part of the rebate program.

WACs, AMPs and Medicaid payment amounts increased between 34 and 40 percent at the median over the five-year period, while the inflation rate increased by just 13 percent. Increases in prices and payment amounts for brand-name drugs didn’t just outpace overall inflation though, they outpaced the inflation rate in each of the five years under review. The Office of the Inspector General did find that the per-unit net cost to Medicaid increased at a lower rate than other points of comparison between 2005 and 2009 when the per-unit payment amounts for Medicaid brand-name drugs were adjusted to account for the rebate amounts paid to States by manufacturers. Medicaid’s rebate-adjusted payment amounts for brand-name drugs actually declined at the median in 3 of 4 years.

The results of the study indicate that price increases for brand-name drugs don’t necessarily result in corresponding increases in Medicaid costs. Medicaid’s net costs for brand-name drugs actually increased at a lower rate than other points of comparison, including the inflation rate, due to the savings generated by the rebate program.

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!