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23 RCM questions you should ask when reviewing a medical billing company

August 23, 2016 by Ango Mark Leave a Comment

So, you have considered taking on the challenges of finding the best medical billing company for your medical practice.

We should all by now know that the healthcare industry’s reimbursement laws aren’t going to stay put and be as they are. The changes they undergo are constant and continuous. They are always reforming, molding and reinforcing themselves as the system matures, necessitating the need for constant financial vigilance amongst medical practices.

Associating with billing professionals has been the go to option for most, especially those who haven’t got a billing department annexed to their healthcare’s business frontier. Meaning that most of the billing endeavors would be taken care of by an outsourced billing company, and the providers would be free to go ahead with what actually matters most to them – patient care.

Now, back to hunting for a fitting company that will do your bidding (billing), without you having to worry about all the cumbersome processes associated with it anymore.

When you chose a wrong billing company, something similar can happen to your practice

But, what’s more to it is that choosing a ‘good’ medical billing service almost always guaranties an increase in collection rates, and reduction in overall rejection or denial rates!

So, outsourcing the RCM can result in your business making more money. And, since you wouldn’t have to allocate working staffs to take care of these tasks (coding and billing), they wouldn’t be feeling overworked and could work more efficiently. Or you could save further by simply cutting down on your no. of working staffs.

Either way, you are on the track to saving more while making more.

Now to the big question…

How should you choose your billing service? As you will trust them with you business’s most important segment – the revenue cycle management.

The answer: By asking them a lot of questions! (Just like how you would, when interviewing an in-house billing faculty.)

And, to get you started with those question-sessions, here are 23 questions that you should consider asking to your would-be medical billing service provider.

We have split these questions under two categories ‘Pre’ and ‘Post’ subscription services/functionalities. Choose the ones best suited for your specific needs

1. Do they provide a summary of your current ‘Accounts Receivable’?

Keeping your monthly AR under 1.5 times the monthly charges is the ideal target.

Measuring Accounts Receivable (Days in AR):

Days in AR = Total AR ÷ Avg. daily charges

(Where: Avg. daily charges = total charges in last 6 mo ÷ no. of days in these 6 mo)

As the AR days increase, cash flow to your healthcare organization decreases, thus lowering your means to pay or hire better staffs and physicians. Also, it affects your group practice’s ability to invest in current gen tools and technology. So, higher your avg. AR days the more negative its impact on your ability to treat patients better.

AR is grouped under 5 classifications, which are 0-30 days, 31-60 days, 61-90 days, 91-120 days and over 120 days. You can compare your AR Benchmark with MGMA Data here.(Best viewed in Chrome browser)

Check if they can help you with you in getting your current A/R summary. The below table is a summary of a practice’s bad A/R.

Other question you could be asking on that line…

Do they have an organized system in order to keep track of and follow through with your pending AR?
Would they be providing you with periodic analysis of AR, and assisting you with recommendations based off of it, so that your hospital’s overall financial performance can be boosted?

2. Do they offer ‘Denial Management’ on your existing claims?

A HIMSS Analytics’ survey found; “44% of the participating hospital executives indicated that they use revenue cycle management vendor solution to manage denials, while 31% use manual process and 18% use homegrown tools, but surprisingly, 7% are unsure about their denial practices.”

Should the billing company be pursuing after your ‘denied’ claims or would it be better for the group practice to take responsibility?

Whatever maybe your choice; a proven fact is, a dedicated medical billing company is more capable/efficient at managing payer denials than a medical practice.

Do they have dedicated platforms to do that!

Checkout if they utilize any denial management platform? If yes, then you may want to opt for a quick demo before proceeding.
Also, do they incorporate a team dedicated for denial management? If yes, go for a con-call and throw in few of your existing concerns.

3. Can they keep track of and make analysis of your ‘Rejected Claims’?

A research notes; “about 20 to 30 percent of the claims that are raised get rejected on a regular basis.”

Another report suggests; “of these (rejected) claims, almost 80 percent are left unprocessed.”

Considering these reports where true, you are seeing an avg. of tens of thousands of dollars lost due to rejections every year.

Can a healthcare organization afford to face such loses?

From sloppy documentation to issues such as up-coding/under-coding, there are numerous reasons why your claim could get rejected.

Check if you can get insights into unreviewed rejection reports like a one below:

And, you need a team of expert billers to handle all these rejections at a moment’s notice. An established billing company can afford that.

4. Can they offer a ‘Code Analysis’ based on your existing medical practice’s history?

Claim rejections, denials and low reimbursements are the primary causes of revenue undercuts in any healthcare organization.

So, reports such as ‘top used codes’, ‘top paying codes’ and ‘most denied codes’ go a long way in keeping you updated on revenue flow. A company that can work out these details and also provide you with alternate solutions (codes) that could save you from a lot of trouble and some money will prove to be a resourceful billing partner.

Are they up-to-date with the industry’s latest tweaks & amendments?

On an added note; a billing company that ensures continual training & orientation of its staffs on the latest resource/updates in the industry, will give your organization an edge in revenue handling.

Let’s take a look at the analysis of the Top CPTs of a medical practice.

5. How good are they at ‘Contract Analysis’?

Coverage plans can change from state to state…

At some states they could offer extended coverage (including even comprehensive healthcare issues), yet at other states they may only cover the program’s set ‘minimum requirements’ laid down by the federal governments.

So, a billing company that can demonstrate in-depth expertise on those contract’s pros & cons, can significantly influence your healthcare’s revenue flow in a positive way!

6. Can the billing company add value to your business with their ‘Fee Scheduling’ knowledge?

Medicare fee schedules are updated once every year, and when they do so, they bring a load of changes to your reimbursement values. So, it is mandatory of your chosen billing company to know the ‘widths’ and ‘depths’ of these Medicare updates. Check out medicare physician fee schedule for CPT codes in your city

An example:

Let’s say a doctor from California sees 1000 patients in a month, of those 1000 there are 500 patients who are billed under a single code, which is ‘CPT code: 99241’.

Let’s say Medicare pays $150 per claim for that code…

Hence, the total reimbursement you should receive will be 500 * $150 = $75,000.

Now, let’s consider that Medicare has revised the fee schedule for this code to $100 instead of its previous $150. Then, during your next billing you would be left with a negative difference of a whopping $25,000 as reimbursement.

…which shouldn’t come as a surprise to you if you are prepared for it!

That’s why you need a billing company that’s aware of these changes, and is capable of passing on to you the warnings – on time and effectively.

Now; these six questions should get you through the pre-subscription short-listing process of your ‘medical billing company’ hunt. Further, the remaining questions will help you filter down your choices, based on their services/offers and your organization’s specific needs.

7. Do they have ‘Certified’ coders taking care of your coding needs?

About 80% of rejected claims are the results of wrong coding!

Under-level coding and general coding can leave constrains on your revenue flow, so, ensuring if the billing service providers will handle your coding processes with certified coders should be on the top of your need-to-do list.

Coding to the highest level of specificity will help you get the most for your services. So, that’s what the billing company must be proficient at.

8. Do they utilize ‘Specialty Specific Coders’?

While any experienced billing company can boost your productivity to a certain degree, a professional with expertise in your ‘specific specialty’ can do even greater good for your organization.

And a billing company with a collection of ‘specialty specific coders’ can potentially shift your revenue graph north almost instantaneously!

9. Do they offer ‘EMR Specific Billers?

Why EMR specific billers? Because, they can fit right in with any EMR the doctor is currently using.

Most common issue that the doctors face when having an in-house billing team is that they aren’t tech-savvy enough to handle claim operations through the EHR/EMR chosen by the doctors. And doctors aren’t trained to handle the revenue processes, but, only in treating the patients. This often leaves a void at the business aspect of a medical practice.

So, when a medical billing company offers EMR specific teams, you can rest-assured that your claim submission processes will see a massive boost. As an added bonus, these experts will be able to better navigate across the EMR software allowing them to effectively export revenue kpi performance reports.

End of the day, it is important for every medical practice to keep track and analyze their past week’s/month’s revenue performance, isn’t it?

Here’s how a sample for to help you question an eClinicalWorks RCM company on it’s workflow

10. Will they offer ‘Patient Eligibility Verification’ services?

Medical practices being aware of patient eligibility saves a lot of hassles when it comes to patient tracking & payments further down the line.

As missing out on eligibility verification prior to patient visit can leave you revenue-vulnerable it becomes a mandatory process, but, one that takes a lot of effort and dedicated resources to handle. So, when a billing company can offer it for you, it’s an advantage you wouldn’t want to miss.

Advantage of patient eligibility verification…

Allows you to be aware of the patient’s payment responsibility ‘estimates’ ahead of the treatment
Also, patients can be intimated of these estimates beforehand, helping them be prepared or keep their options open as they make the visit

Thus, you are more likely preventing most of patient payment issues, (especially the ones due to patients being unaware or incorrect about their insurance coverage).

But, we must all agree that insurance information is often confusing and is likely to change often. So, keeping patients aware of their coverage plans will allow them to make payment on time, which most patients want to.

Compare the billing companies insurance eligibility verification process with this sample report

11. Are they having separate teams for handling claims, rejections and denials?

Reimbursement models are continuously evolving, and medical billing companies can provide you with the most expert solution to tackling current claims, rejections and denials scenarios. However, what you should be looking for is how well they are equipped for meeting future needs as well.

Choosing a billing company that has individual teams to handle different sects of revenue cycle can ensure that they are well equipped to tackle the evolving trends quickly and efficiently.

12. How transparent are their reports?

To begin, let’s question yourself; was your previous medical billing company producing revenue reports that you were able to review on a regular basis?

Where you able to retrieve ‘specific’ details from these reports?
Where you sure of the accuracy of those produced reports?
Where you able to compare the sent reports with the industry’s standard benchmarks?

Well, these are all part of the components that affect your company’s financial growth; and only a billing company that can offer these reports ‘transparently’ can allow you to achieve maximum financial growth.

Note: Now that the mobile applications are ruling the technology world, does your biller offer opportunities to produce reports through mobile apps?

13. Is the medical billing company offering any dedicated revenue reporting app/platform for the organizations to keep track of their revenue whenever needed?

Today’s environment demands vast knowledge and expertise in handling reimbursements. Certain companies may counsel different technologies to meet both regulatory requirements as well as your specific needs.

From practice management tools, billing system to different IT solutions, however, certain billing companies offer dedicated platforms and revenue reporting applications. These companies should be able to better integrate your revenue setup such that the collection process is more effective.

14. Can they offer benchmarking services to track your doctors’ productivity levels with other doctors in the area?

Conducting benchmarking on regular basis will help track the progress of physicians in your group practice. Assessing and comparing performance metrics will allow you to test your standing on the industry’s standards.

Why benchmarking is important?

Because, it is one of the best ways for finding problem areas and opportunities

15. Do they offer patient billing services?

Who follows up when a patient doesn’t pay his/her bill?

A medical billing company that can correspond with your patients, who don’t pay their bills on time and/or handle your organization’s similar billing concerns, can become a valuable asset to the business.

As, outsourcing to such companies will help optimize your revenue collection practices significantly!

Check out their collection techniques. How do they follow up with? A sample procedure:

16. Are they engaging ‘Insurance Specific Calling Teams’?

How import is it to have dedicated calling teams for different payers?

Primary reason for opting for insurance specific calling teams is that with experience they know what the fine prints say. They know what the reasons behind different denials and rejections would be. And they know how to answer in the language of (how to handle) the particular insurance company.

And since over 30% of most practice’s revenue comes through AR, a payer specialized service will be more efficient at collecting than a general biller.

17. Is the billing company ‘HIPAA Compliant’?

Handing over your patient’s medical information to other third-party organizations is a huge responsibility as you become liable for legal issues.

So, ensuring the billing service provider is HIPAA (Health Insurance Accountability and Portability Act) compliant is a must. Privacy, security and confidentiality of the protected health information (PHI) must be practiced rigorously.

News like the ones below should alert you on doing a rigorous check:

18. Are their teams well-versed at mapping codes from ICD9 to ICD10?

Like already discussed a number of times, since the healthcare billing regulations are changing rapidly, it is vital to ensure that the billing company you are opting for is playing an active role when it comes to healthcare revenue cycle management.

You should look up for information on how the company is staying updated with these changes and how effective their ICD10 coding service is.

Now this is what I mean when I said well-versed in mapping:

19. Will they be providing ‘RVU Analysis’ specific to your healthcare organization?

RVU analysis allows you to determine the performance of your individual physicians based on their contribution to the organization.

Since it is consistent across the nation and is vetted by specialty societies; they are much more appropriate for benchmarking when compared to other values. (Example: Charges are arbitrary, costs are often unknown and encounters don’t show the intensity.)

A professional billing company offering this service can automate the evaluation process for you.

And, here’s what you need for RVU Analysis and how it comes up:

20. Do they offer ‘Contract Negotiation’ services to maximize your revenue?

Improper contract negotiations have known to hold down 10-30 percent of a business’s revenue; however, an expert in the field can help negotiate aggressively and yet maintain a formidable balance with the payers.

The process of contract evaluation and negotiating is complex, and frankly most of the staffs in a healthcare organization wouldn’t have the time or expertise to handle it.

From auditing Explanation of Benefits (EOB) to scheduling renegotiation reminders and verifying termination deadlines, there are a lot of painful steps involved with contract negotiation.

A fine way to tackle it would be to let the billing company handle this process entirely. Outsourcing it can potentially increase your revenue, and save you a lot of time while at it.

21. Would they assist the medical practice in ‘Credentialing’ with a specific insurance company?

After long hours of documentation, regular follow ups and lots of ‘on hold’ minutes, you can finally expect to get credentialed (in-network) with the insurance panel you want to be a part of.

Or you could have someone else help with all the meticulous procedures and simply get on with getting your credentialed… Ok’ed!

22. Do they schedule weekly/monthly governance meeting?

A major benefit of hiring medical billing services is that they will be having better business insight when compared to the provider’s team. This should allow them to provide valuable feedback on how your organization is performing and how it can be improved.

Would you rather prefer a one-page statement each month?

But, a billing service provider who organizes weekly or at the least a monthly governance meeting should allow you to handle billing issues better by giving you valuable feedback on the business part of your medical practice.

Doctors and the billing company can have a discussion to come to the next step of action and improvements required.

23. Are they having teams who can manage ‘Patient Support’ and ‘Patient Portal’ to assist you with patient management?

Offering alternate ways for patients to keep in touch with your healthcare adds value to your organization. They will appreciate communicating with the providers, being able to keep updated in-between visits and the convenience in general.

Likewise, providing patient portals for better overall patient management is a welcome accessibility not just to the patients but the physicians themselves. From setting up appointments, to asking and answering clear and pointed questions (where email volumes would be problematic), these portals are very effective.

But, they also mean setting-up dedicated additional resources both technology-wise and staff-wise. This could add on to an all already complex revenue management.

Then, there are some billing companies who offer these service as well; with dedicated teams to handle them expertly.

40% of patients have no idea of patient portal benefits
49% said their doctors have portals
11% said their doctors don’t offer portals

This is the first roadblock to using a portal. So if your billing partner can help you in creating a plan to make your portal usage a success, it would be an icing on the cake.

And Remember:

What must be considered is that as the no. of rendered services increase, so does the cost/fees. The healthcare practice must engage a proper balance by considering their in-house proficiency and the billing company’s expertise to work out a cost effective, performance-centric solution.

And, keep in mind, that you get what you pay for. Lower costs aren’t always the better option, and a lower fee of smaller bottom line doesn’t always save money!

Drive up operational efficiency with these business intelligence tools!

April 23, 2015 by Ango Mark Leave a Comment

The healthcare ecosystem is fragmented, complex and forever evolving. To stay on top of changing challenges and reforms, an increasing number of hospitals are turning to business intelligence tools. BI tools eliminate hazy guesses, redundant processes and workflow inefficiencies.

Healthcare business intelligence tools enable better decision-making and accountability.

6 amazingly efficient BI tools that no medical practice should be without!

Dimensional Insight’s Diver

Dimensional Insight’s Diver allows you to analyze and assemble the external and internal sources in a single view. This software BI tool comes with an integrated web-based suite with many features like dashboards, scorecards, alerts, and interactive reports. The enterprise -wide reporting and analytics platform indicators are delivered to the specific users like hospitals, chief financial officers or clinical care administrators.

Pandora Suite

The Pandora suite software allows analysis of the medication and supplying distribution throughout the health care organization. The tool allows tracking the costs for each patient visit and also prioritizes their issues like compliance, lowering costs and addressing operational issues. It is also used to identify suspicious activity and canceled medication transactions for clinical operations. With the help of Pandora analytics tool, the healthcare organizations assist in drug diversion prevention, regulatory compliance, and inventory optimization.

IBM’s Cognos

The IBM’s Cognos BI tool offers features that aid in patient care and business performance. To measure the performance of an organization, IBM Cognos allows users to create scorecards. These scorecards will track the performance of key performance indicators. Healthcare organizations can gain insights into the different processes that make up the everyday workflow of healthcare systems.

QlikView

QlikView BI tool helps healthcare organizations to analyze huge volumes of business data. This QlikView helps hospitals to monitor and to improve performance within various functional areas like clinical operations, care delivery, resource planning, finance and revenue cycle, the executive suite, and supply chain management.

Oracle suite

Oracle suite BI tools help providers, to derive complete value from clinical and operational data for financial and operational performance. The Oracle suite integrates data from electronic medical records, clinical departmental systems, patient accounting, enterprise resource planning, research, and other systems.

theBillingBridge

theBillingBridge, is a business intelligence, and, reporting app, specifically built to work with Android and iOS powered devices. It has a user-friendly interface and offers highly analytical reports and dashboards. BillingBridge offers on-demand financial reports. It makes tracking key performance identifiers and setting benchmarks easy. Detailed reports about claim submissions/rejections, breakdowns on insurer payments, coding details and payment analytics are provided. Users can send queries within the system. Proactive alerts can be set.

Dismal patient collections? Make sure you aren’t making these 5 mistakes

April 1, 2015 by Ango Mark Leave a Comment

Are you making these 5 common mistakes?

There can be nothing more discomforting than talking to patients about payment responsibilities. Coverage cuts and high deductible healthcare plans make it imperative for healthcare organizations to focus on patient collections.

But do you feel queasy every time a patient collection issue crops up? Avoiding these 5 mistakes and training staff to steer clear of them, can boost your patient collections.

1. Giving the wrong signals!

Body-language matters. Smiling, while discussing about payments, can signal to your patients that you aren’t serious, or undermine the importance of paying the due amount. Frowning or speaking in a grave tone can put off patients. Maintain a neutral body language throughout. Familiarize yourself with contractual terms and coverage details before the discussion. Fumbling or giving the wrong information will further prolong the entire process.

2. Sending out overly complex patient statements…

You can bet your bottom dollar that most patients are not familiar with insurance terminology. So don’t send out a statement that can only be understood by a biller or insurance expert! Simple patient statements that don’t overwhelm patients work best. Don’t add aging buckets at the end of the statement. It can be an open invite for patients to procrastinate payment.

3. Let the patient speak!

Most medical offices make the mistake of dominating conversations with patients. Let the patient speak. More often than not the amount they agree to pay or the deadline they agree to clear bills will be much better than what medical practices expect! Encourage patients to come up with suggestions, payment options and payment schedules. This way, patients feel less browbeaten and more involved.

4. Not exploring newer methods for collecting payments…

A lot many medical practices are implementing the “credit card on file” program. The details of the credit card are securely stored and the medical practice “swipes” the card to recover payments due, if and when required. Discover new, convenient and patient friendly payment options.

5. Missing out on upfront collections…

Failing to capture upfront collections complicates and delays the patient billing cycle. Ensure your front-desk staff, collect desk payments promptly. Call patients prior to an appointment to inform about their payment responsibility and what method of payment would suit them best. Have a swipe machine or request patients to pay online.

Provide a receipt, and if possible a note of thanks, upon receiving payment. This will induce patients to more promptly the next time around.

Top 5 Reasons For Claim Denials! You Cash In On Your Medical Practice

July 31, 2014 by Jennifer Brown Leave a Comment

Though physicians are very careful in filing the claims to the payer, still most of their claims are denied.

Here are top 5 reasons for claim denials which most physicians face but either realise later or are not able to figure out:

Duplicate claims:

Have you ever tried to resubmit a claim for which you have not received any response? If yes then you shouldn’t, as it creates confusion for the payer and may ending up as a duplicate claim.

Claims/service lacks information:

Make sure you get CO16 code which says information is incomplete to process the claims. A remark code is required for additional information.

Benefit for this service is included in the payment:

The insurance company denies the claim for a service as it has already paid for another service on the same date (as a part of bundled service).

At least one remark code must be provided:

This may include either a Remittance Advice Remark Code or NCPDP Reject Reason Code.

The time limit for filing has expired:

The maximum filing limit of Medicare is 2 years and minimum 1 year. If you have filed your claim within the time limit then appeal it with a required proof.

Infographics: Automate.Integrate.Outsource the new mantra of the healthcare industry

July 21, 2014 by Ango Mark Leave a Comment

Work smart; automate and outsource business processes!

The much anticipated Black Book survey findings are out and they indicate a strong possibility of medical practices undergoing a completer makeover! For years together physicians handled two very different and almost contradictory aspects of their workflow. It was a tight-rope walk between patient care and managing the business side of their medical practice.

The business side of medicine has almost become a catchphrase in the healthcare industry. There was no clear definition or a strategic plan to manage it. What was once regarded as a niggling pain, that one had to live with, has snowballed into a serious issue that demands to be dealt with. And dealt with immediately!

Shifting landscape makes it vital for practices to buckle up or die a quiet death!

There was a time, not very long ago, when physicians had to just take care of patients. The filing and transmitting of medical claims was something that the biller did. A cursory glance over the month’s collections was all that physicians did, as managing their medical practice’s finances was not their job.

The Affordable Care Act, which opened the doors to millions of uninsured, PQRS and Meaningful Use measures, an entirely new coding system and increased financial pressures, have shaken physicians out of their comfort zone. The alarming rate at which small medical practices shut their doors and the growing threat to the survival of independent practices, are a huge wake-up call across the entire healthcare continuum.

Desperate times call for desperate measures. The Black Book study that includes the perspectives and opinions of 400,000 respondents has indicated three emerging trends that are going to challenger the traditional way medical practices are going to function.

Upgrade, integrate, outsource…

This seems to be the magic formula that can save medical practices from drowning under a sea of reforms. Though most medical practices have finally got the hang of technology and are experimenting with different workflow models, there hadn’t be a clear sense of direction or collective change insofar.

Challenging old notions…

The Black Book survey challenges the common belief that physicians are still unwilling to let go of archaic methods of working.

There is a huge move to eliminate outdated software and about 21% of medical practices surveyed, are planning to upgrade their RCM software within the next 6 to 24 months.

91% of medical practice business managers feel that EHR systems that are not integrated with a full- fledged revenue management system can back their practices, further into a corner.

Facing the bitter truth!

The study also clearly illustrates that physicians are no longer in denial mode. About 90% of physicians surveyed admitted that their billing systems needed a facelift. There is also a huge demand for integrated systems so physicians will have to coordinate with a single point of contact. Speeding up workflow is the major objective of most medical practices and automating their workflow seems to be the perfect solution.

Utilizing system intelligence to perform business functions such as appointment scheduling, insurance eligibility checks, sending patient reminders and payment posting can quicken tasks and reduce headcount. Most medical practices still hire FTEs to perform tasks that their systems can do. Automating tasks can not only shorten the time taken to perform tasks but can also help in resource optimization.

Automating administrative functions: the way forward…

The administrative functions of medical practices can drive up efficiency. Prior to automating a process draw up a checklist of objectives and see whether through automating you actually end up saving time. Automating for the sake of automating can do more harm than good. Like investing in an automated voice recognition system and wasting productive time editing and correcting the transcripts.

Have a clear work-plan, educate staff about the software and strategy you are going to use and compare your existing process to the revised one, to make sure your switch to automation is successful. A spread-sheet that details the transition can ensure everybody in the medical practice is on the same page.

Creating a flow-map can standardize your automated processes and improve efficiency. You don’t want your staff to be bewildered by the sudden change in workflow processes. Listing out repetitive tasks is the easiest way of freezing on tasks that can be automated.

Here is what to automate…

Automating can be healthy but it can quickly turn into a major headache if not handled with caution. Medical practices should take care not to let their workflow processes spiral out of control. Though automation of tasks is common in other industries, automating workflow in the healthcare field is still at a nascent stage.

Here is a list of tasks that can be automated efficiently…

A patient portal can automate everyday tasks to a large extent. Implement a patient portal that enables patients to fix up appointments based on available time-slots. Prescription refill requests can also be sent online. Patients can also be encouraged to pay online through a secure payment gateway.

Setting up error prevention alerts and a thorough claim scrubbing tool or software can eliminate denials.

Charge review alerts can reduce no-charges.

E-prescribing allows physicians to communicate directly with pharmacies and can save medical practices from the tripwire of misplaced prescriptions.

Setting up an email reminder or automated call reminders can reduce no-shows and late appointments.

The ability to gather the financial performance data of a medical practice and track metrics will result in actionable and current financial being just a click away! This will help set targets and benchmarks.

There is no magic wand that can wipe away manual efforts completely!

Great! So now all physicians can just shop for software, or tool that can automate practice functions and go back to taking care of patients. But it is not as simple as that. The heterogeneity of workflow processes in a medical practice demand different methods of working. Automating completely, a practices business functions can prove to be counterproductive. As many as 90% of small medical practices and 95% of independent physicians are planning to outsource their medical billing and revenue cycle management functions and that could be because relying on tools alone cannot deliver the goods.

An increasing number of medical practices are downsizing to cope with financial bottlenecks and processes that were previously handled in-house are being outsourced. The increased need for outside expertise has been the major driver behind the shift to outsource business functions.

The bottomline…

It is the survival of the fittest out there! Healthcare organizations that successfully, integrate, automate, and outsource processes, will come out at the other end, more streamlined, productive and compliant.

Medical Billing Strategies of 2014 – Sink-in to Amplify Your Funds

December 16, 2013 by Ango Mark Leave a Comment

Decide Here – Whether to Dwell-in or Leave the Page!

This article is especially designed to meet the needs of the physician practices and other healthcare delivery organizations that are looking for the tactics to revamp their medical billing process so as to boost your cash inflow.

Where the healthcare billing is travelling?

Though, physicians aren’t tethered to the aged technology and strategy, circumambient healthcare milieu may revoke your cerebral cortex due to diversified growth in healthcare information technology (HIT).

Do you have numerous “wh-questions” on your mind – pertinent to the funds management in your revenue cycle management (RCM) process? Then, this is the go-to technique to enliven your cash coffer.

MEDICAL BILLING STRATEGIES – 2014

Hoard your revenue in each phase of RCM!

Physician Credentialing and Contract Negotiation:

The federal payers have already fixed your reimbursement rates for the patient care services. Despite this, there is a dire need for the providers to negotiate with the payers to get lucrative reimbursements for the service rendered by you. Besides, abiding the payers’ rules during credentialing process brings you more savings.

Front-desk Collection:

Start collecting payments from the scratch – don’t let your staffs ignore the front-end tasks:

1. Point-of-service (POS) payments (Co-pays, deductibles, etc.).

2. Collection of dues well before patient encounter.

3. Thwarting denials through accurate eligibility verification.

4. Gathering insurance accurate data to avoid reimbursement disappointments.

Charge Capture:

HITECH Act, ACA’s “performance based payment” and other federal mandate are the driving forces that accentuate the ideal EHR implementation.

Charge capture must be done accurately for each encounter, procedure and surgery. Evolving ICD-10 guidelines call for the renovation of your super bills in sync with your clinical practice so that charge capture will be immaculate.

Claim Scrubbing:

This is the vital phase in the medical billing process that aid abridged AR process. AAPC/AHIMA certified coders must be a part and parcel of the claim scrubbing process – so that revenue loss due to underpayment and overpayment issues could be avoided. Concentrating on this phase greatly mitigates the claim rework cost.

Electronic Transmission:

Timed Clearinghouse transmission for fresh claims is one of the overlooked approaches in most practices. Large practices may need to file the scrubbed, “clean” claims daily.

Delay in addressing the rejected/denied claims with the remedial action may also hamper your cash in-flow.

eRemittance:

Interpretation of the remark codes and timely payment posting after the receipt of EOBs/ERAs is very essential for a successful RCM process. Besides, prompt cash inflow/ AR feed into the practice management system (PMS) or electronic medical/ health records (EMR/EHR) is mandatory to avert payment miss-outs and pointless follow-ups.

Denial Follow-up:

The denials must be addressed with an immediate effect to avoid delayed payments or re-denials. While working out on denials, the obligatory documents must be attached during re-submission or appeal. Though the cost involved in denial appeals or re-submissions is an additional burden, ignorance of denial management would be a serious pecuniary loss.

Patient Billing:

Don’t load your dice against yourself! Precision in the patient billing is a crucial point in the bill settlement. Inaccurate and difficult-to-read billing statements ensue in patient discontent, consequently culminating in bulldozed physician – patient relationship. Above all, a clear statement supports timely payment.

Resource Utilization:

Exploiting the resources like human resources, infrastructure, funds, technology, etc. to run a practice profitably is a master skill. Among that, leveraging the technology to satisfy patients and enhance practice profits is the challenging task. The following technology platforms ameliorate your patient experience, accelerate revenue cycle process and thus perk-up your business.

Practice Website:

Patient portal
Online forms and statements
Online EHR access
Online lab and imaging reports
e-Payment support
mHealth support (iPad, iPhone, Tablet, etc.)
Chat support
Healthcare News
FAQs
Social media (e.g. Facebook, twitter, etc.)
Patient Blogs & forums

Benchmarking:

Setting a yardstick and working towards its accomplishment must be the prime goal, if you are attempting to reach your vision and mission.

What functions of the billing process that must be set in the yardstick achievement program?

1. Follow-up and retrieval of underpayments.

2. Averting penalties due to the breach of laws and audit policies (RACs, HIPAA, HITECH Act, etc.).

3. Aggressive follow-up of accounts receivables/bad-debts.

4. Evaluating and making small balance write-offs.

Besides, regular evaluation of your practice, process and finance must be done through the following reports:

Practice Analysis Report
RCM Analysis Report
AR Summary Report

“PERSISTENT REVENUE INFLOW IS THE SINGLE PARAMOUNT WANT OF THE MEDICAL BILLING PROCESS”

Stretch your achievement from good to excellent with these proven medical billing strategies. It will be the hot topic in 2014 as most practices are going out-of-kilter due to stringent policies and other industrial factors.

Medical Billing Tips for Optimal EHR Usage

October 21, 2013 by Ango Mark Leave a Comment

Doctors Fed-up by EHRs with Inefficient Billing Workflows :

Healthcare practitioners have implemented EHRs/EMRs to comply with federal stipulations. However, many of them are unable to make optimal utilization of these EHRs/EMRs. Hospitals and clinics fail to receive complete payments for their services rendered – due to sloppy billing processes. Such improper billing workflows pose many revenue collection problems for doctors. Overworked doctors find it difficult to cope up with the requirements of healthcare business. They do not have the time to ensure optimal revenue collection and adhere to changing federal/state regulations and stipulations of insurance companies. Rather, they would prefer focusing on patient care.

What is the Expert Opinion ?

EHRs/EMRs with inefficient billing workflows continue to cause dissatisfaction among physicians. Holly Knapp, President of Loveland-based Medical Billing Advocacy of the Rockies (MBAR), LLC, and member Medical Billing Advocates of America (MBAA) claims:

A. Patients do not know whether their bills are correct.
B. Clinics and hospitals are not sure whether the insurance company has correctly reimbursed medical claims.
C. Only 20% of prepared claims are correct.

Need for Professional Billing Experts :

Any EHR without the right billing option is like bread without butter and will not meet the revenue collection requirements of clinics and hospitals.This requires a team of experienced and knowledgeable professionals, who are well-versed with the intricacies of existing and changing codes and resulting billing processes across the US.

Increase the Efficiency Of Your Medical Practice :

There is an imperative need to enhance the functionality of the EHR by :

1. Ensuring streamlined, accurate and thorough clinical documentation. This documentation covers all workflow stages in a hospital or clinic, right from the time the patient reports at the reception and passes different stages of diagnosis, treatment, and discharge, and finally collection of patient’s dues.
2. Correct selection of codes and related modifiers based on clinical documents.
3. Ascertain medical necessity of diagnosis and treatment from the point of view of insurance agencies.
4. Check whether the patient is eligible and covered by the insurance for claiming reimbursements.
5. Prepare the insurance reimbursement claims correctly based on the combinations of codes and modifiers.
6. Prepare the claims in time and send to insurance payers.
7. Check the progress of claims sent to insurance.
8. Analyze rejected claims and resubmit corrected claims.
9. Make tight follow up for every claim.
10.Collect patient’s payment dues through aggressive follow-up.

You are free to contact MedicalBillingStar for any problems related to EHR/EMR or medical billing.

Here’s the presentation view on “12 tips to rebuild your EHR strategy”.

Infographics: Eradicating Impediments In Medical Claims Reimbursements

July 23, 2013 by Paul Martin Leave a Comment

Existing turbulent healthcare industry scenario :

In the current turbulent economy-ridden environment healthcare providers and physicians are not able to precisely and correctly claim the actual reimbursements of expenses incurred for diagnostic and treatment purposes from the insurance agencies, resulting in loss of revenue, profitability, incorrect claims, delayed claims, missing out on claims, the main reason being that they are not fully equipped to provide precise diagnostic and treatment documentation, backed by capturing the correct medical codes for medical billing. The physicians do not have the time to oversee capturing the correct medical codes and medical billing procedures as they have to focus on their core competency of diagnosis and treatment as first priority.

Vital issues compounding the problems :

Healthcare professionals are constantly under pressure due to increased patient/financial constraints and regulatory pressures, forecasting a doomsday for medical services. This situation is worsened further due to federal regulations that advocate improved, affordable healthcare services without comprising on quality issues even under the present economic scenario where the inputs for provision of healthcare services are experiencing spirally increased costs. To further complicate the issue, in-house administrative personal are not inadequately trained, inexperienced and lack the requisite expertise in medical coding and billing, as well as thorough and accurate clinical documentation.

The physicians would like to spend most of their time and efforts by focusing on core issues of diagnosis and treatment, rather than diverting their resources and energies over the nuances of managing and monitoring their to maximize revenue. Rather than have in-house medical coding and billing services, it pays to opt for outsourcing or right sourcing the billing services to established and experienced vendors. There is a dire need for in-house analysis of existing problems, solutions, future trends, and remedial measures.

The situation will further worsen in the near future since presently health care reforms are under way with focus on affordable health coverage and quality.

Medical Reimbursement Problems faced by Health Providers :

Insufficient knowledge or experience in medical coding and billing
Lack of training in medical coding and billing
Physicians using In-house medical coders and billers have to feel the consequences by struggling with inexperienced coders straight out of college
These billers and coders fail to cope up with evolving coding and billing guidelines, for medical procedures, and stay abreast with the latest procedures
Nightmares of lost revenue and unpaid bills

Lost revenue opportunities :

Physicians tend to miss opportunities to maximize medical reimbursements from the insurance companies.Lost revenue due to various factors includes:
Undercoding level of treatment,
Omitting modifiers,
Submission of medical reimbursement claims without the requisite documentation required to support the reimbursements.
Wastage of resources in determining and tracking reasons for claims rejected, besides finding out claims missed or under claimed.

The pathway to maximum reimbursement :

Out sourcing or better known as “Right sourcing” the medical billing and coding, clinical documentation, claims processing, EMR services to professional one-stop third party vendors results faster, precise and complete reimbursement of medical claims, boosting up revenue and profits.
Besides assigning the right codes for medical services the outsourcing vendor provides specialty specific coding services using experienced and AAPC credentialed coders on board.
The vendor is conversant with the significance of coding for the technical and professional components of a medical service, place of service codes, e/m codes, revenue codes, and when claims need to be bundled or unbundled.Compliance with all medical coding systems such as ICD, CPT and HCPCS ensures that working with such vendor is a smart option.

Remedial Measures :

Wise,prudent, and strategic to partner established third party vendors such as MedicalBillingStar who have long-standing expertise, experience in dealing with state-of-the-art coding and billing services to a wide range of categories in the US medicare industries.
Healthcare and medical units, irrespective of whether they are small, medium, or large, stand to experience hassle-free boost-up of medical reimbursements, without the nightmares of returned claims, missed-out claims, and piling up of rejected claims, and efforts to resubmit claims.
MedicalBillingStar closely follows the on-going trends in medical coding and billing and medical insurance claims processing methodologies.

The AMA Suggests That Physicians Should Focus On Billing. Are You?

July 10, 2013 by Ango Mark Leave a Comment

Are you losing out on billable dollars ?

This is not the best time to be a healthcare provider! Financial constraints and regulatory pressures are giving physicians, sleepless nights. Doomsayers have crawled out of the wood works to proclaim that medical practices are going to fold up and die.

It is certainly not like healthcare is circling the drain hole. But it is essential that medical practices up their game to stay afloat.

Still stuck with a payment contract that is five years old ?

The major mistake that healthcare practices make is to get paid much lower than the services they provide. Nobody likes getting on the phone and haggling with insurers. But what has to be done has to be done! Frequently negotiating reimbursement contracts will go a long way in increasing revenue.

Thorough claim analysis and evaluation of top paying CPT codes every three months can prevent and clot the bleeding.

It is okay to discuss money with patients !

Do you feel delicate when discussing about money with patients? Instead of dillydallying be forthright with your patients about treatment costs and payment options. Give them a lowdown on what and how much the insurer will cover.

A lot of patients promptly sue their doctor the minute they receive a bill. Discussing about payment prior to a medical procedure will prevent heartaches and heated arguments.

Don’t rely on straight- out of a- can solutions…

Most EMR/EHR systems come with coding and billing features. But no matter how loaded your system is, don’t lean on it completely. There are certain factors such as duration of treatment or the extent of injury that play a crucial role in increasing reimbursement. Middle of the road coding isn’t going to cut it anymore.

Why work just eight hours ?

As pressures mount and operational costs skyrocket, outsourcing has become a viable option. It makes a lot of sense to work with a billing company that works 24 hours. You not only process claims faster you can clear revenue backlogs.

Furthermore it is a nice feeling to walk in to your practice the next day knowing fully well that your biller has transmitted your claims to the insurer. And that now, finally, the accent will once more be on patient care.

ACO Wars – Pioneer vs Shared Savings Programs

July 3, 2013 by Ango Mark Leave a Comment

Well, it is not a war in the strictest sense of the term, but it does denote the recent developments in the ACO or Accountable Care Organization scene where many Pioneer ACOs have been opting out of the program due to difficulties in meeting the targets and the high risks involved. About 25% of the Pioneer registered Accountable Care Organizations are in the process of exiting the program and joining the lower-risk option, the Shared Savings Program. CMS had this to say about the fallout :

“We’re encouraged that these organizations want to continue in programs that promote better care at lower costs, we fully anticipated that as these programs get up and running, some organizations would shift between models.”

Health Reforms & ACOs

For those of you, who have been too busy to register what an ACO exactly is, it is a category of CMS program, which is part of the government health reform, which includes others like Patient Centered Medical Home, Medical Neighborhood, Health Home, etc. The reforms themselves consist of three main components, which is a superset of any practice models. They are :

a. Care Delivery Reforms.

b. Payment Reforms.

c. Health and Healthcare Community Reform.

ACO is a model which is, to quote a popular definition, “an organization, virtual or real that agrees to take on the responsibility for providing care for a particular population while achieving specified quality objectives and constraining costs.”

As the above definition clearly points out, an ACO platform is expected to stimulate more integrated care for the patients, which would ultimately result in quality improvements and healthcare cost reduction. Also, in these programs the ACO gets a share in the costs ultimately saved.

Pioneer vs Shared Savings Programs

SSP and Pioneer were two landmark ACO programs created by CMS. The latter has a slightly complex format, which takes into consideration organizations that already have some experience in providing coordinated care.

The Main Differences between the two are:

1. SSP has two payments tracks and it is upto to the ACO to choose either the non-risk sharing one (which has less cost savings share) and the risk-sharing track (which has higher cost savings share but at the same time there are possibilities of losses upto even 60%).

2. The Pioneer utilizes a trending methodology that, all other things being equal, produces a slightly higher benchmark than the SSP for high-cost areas.

3. The SSP will need to cater to at least 5,000 Medicare fee-for-service beneficiaries, whereas the Pioneer needs to service 15,000.

4. The Pioneer program importantly includes a clause that 50% of Pioneer ACOs revenues should come from participating in “risk” contracts with other non-CMS (private) payers.

The Significance of events such as the above

Republicans have been ardently opposing the health reforms (which is really an attempt for universal healthcare). The recent refusal by the National Football League to team up with the government to promote ObamaCare has been touted as some sort of vindication for their stance. Also, the refusal of some states to adopt the Medicaid expansion plan and the setting up of online HIE, to realize the goal of “healthcare for all” , is seen as further supporting evidence. And the above developments in the Pioneer ACO scene is construed by some health reform detractors as the “straw that will break the ACO camel’s back”.

MedicalBillingStar : A Voice of Sanity

With a decade of hands-on experience in servicing over 500 clients when it comes to the RCM Cycle, MedicalBillingStar always endeavors to float above the cacophony of healthcare gossips and half-truths, to provide their medical billing and coding clients with information that is relevant, besides of course catering to their entire RCM workflow. We are aware of the impact that ACO’s will have on payment models, the changes from which ultimately have to be incorporated into the RCM process. Thus, we keep abreast of the latest happenings in the payment model scene. Meanwhile you may call MedicalBillingStar at 877-272-1572 or visit our website at www.medicalbillingstar.com if you any questions about any of the above or the Medical Billing/Coding processes in general.

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Lisa Maciejewski-WestCMC, CMOM, CMIS, MCS-P