Medical Billing Services | Medical Billing Company Checklist - Page 6 of 13

Business Intelligence – The Astute Tool to Empower Your Healthcare Business

October 23, 2013 by Ango Mark Leave a Comment

BED-IN THE BUSINESS INTELLIGENCE PLATFORM AT YOUR HOSPITAL… BOLSTER YOUR BUSINESS PERFORMANCE…

The healthcare IT initiatives of the WHO, and the Country’s Federal Government such as ICD-10, meaningful use, HITECH act, etc. are doggedly insisting on the instauration of the US healthcare facilities to exploit the positive impacts of the software products. In this milieu, the Business Intelligence (BI) software is gaining its magnitude in the healthcare arena due to the sizeable advantages in its implementation.

Bountiful Benefits :

Optimize Your Business Performance by Offering the Right Clue !

The business intelligence software provides many benefits for the business process shoot-up in the healthcare centers :

A. Substantiation for perfect and present source data.
B. Timed data creation and accession.
C. Effortlessly distribute updates within your facility.
D. Manage data access and provide HIPAA compliance.
E. Perform multi-departmental enhancement across the facility.
F. Proffer ready-to-use data for making verdicts.

A Thumbnail Sketch of the BI Models :

To make a kick start with the business intelligence or to extend the existing BI program, many providers are running pell-mell to analyze and settle down with ideal BI software. In an endeavor to proffer a decent navigation across the business intelligence landscape, the following unbiased options would be an enchiridion for the physicians who are planning for the BI migration :

Vendor-offered Data Analytics :

The stepping stone for fresh BI launchers !

As a healthcare provider, you could opt for the purchase of pre-packaged data analytics from your existing operational systems’ vendors like EHR/EMR/ECM/ERP or other healthcare IT vendor. For the providers who are about to commence your BI program, it is the ‘best pick’ as your existing IT vendor knows the nook and cranny of your organization’s workflow process and could suggest you the exact – even customized BI kit.

The SaaS Model :

The money-spinning option for the smaller providers !

In the market, there are ample vendors who offer Software-as-a-Service (SaaS) packaged analytics, as a service. Unlike the olden days, apart from administrative, financial and operational analytics – clinical analytics are offered by the external vendor, when you send the obligatory data using computerized ETL (Extract, Transform and Load) processes at preset data transmittance rates.

Data Visualization Tools :

Fewer staffs and trimmed down outlay make it attractive !

This model lets the users with scant technical proficiency to craft tailored graphical and tabular modules of data with slight IT reliance – suitable for their business setting. Data visualization tools could directly access the core application data sets even devoid of conventional data warehouse. To speak above board, this model is not recommendable when heterogeneous data sets are to be reported, from varied core applications.

Pre-bucketed Solutions :

The choice of providers who need specific analytics :

Pre-bucketed point solutions aid physicians deal with specific areas such as nosocomial infections forecasting, appointment scheduling, adverse event reporting, staff optimization, accounts receivable (AR) summary analysis, etc. Though, this system fills the lacuna when amalgamated with any comprehensive BI system, it could be substituted for any intact BI model.

Home-grown Data Warehouse :

The versatile alternative for BI prioritized centers :

For the large healthcare providers who deem that a full-bodied data warehouse is a vital element in the “big data” strategy, this serves as the best choice. This offers a broad analytics, better scalability from pilot level to big business level. As any model has its own demerit, the prolonged implementation time, high cost, more IT-savvy staff requirement are the drawbacks.

Just ink a deal with MedicalBillingStar and savor your practice with a perfect business intelligence model !

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”.

Negotiating Medical Practice Payer Contracts to Your Advantage

October 15, 2013 by Ango Mark Leave a Comment

Rapidly Changing Medical Reimbursement Environment :

Over a period of time, considerable changes in complexity and scope of contractual negotiations and agreements with federal, state, and private insurance organizations have been experienced by clinics and hospitals. At present, most of the practices accept whatever the insurance companies offer, rather than resorting to implement insurance contracts on a win-win basis.

This results in losing out on additional revenue to the tune of 15%. Successful renegotiation of insurance contracts results in a typical yield of 10-12 %. This is money that is available but lost because most of practices do not have the expertise to renegotiate their insurance contracts. The medical practice not only suffers from a bad insurance contract, but doesn’t even know what’s in the contract.

Expert Opinions :

Brian Workinger, business solutions consultant at Craneware, a specialist in software for health care billing, auditing, chargemaster management and medicare compliance, emphasizes “the need to compare reimbursement rates of insurance companies, rates of nearby hospitals, and know the clinic’s market shares in medical services. This information will help to negotiate with the insurance companies.”

According to Kyle Kobe, principal at Equation, a healthcare consulting firm, “it pays to do an extensive homework and understand the existing contracts, know market contract rates, and determine how the existing contracts can be improved.”

Mary Ely, director of physician relations at Greater Baltimore Medical Center (GBMC) and head of managed care and negotiations with insurers, adds that “there is a dire need to claim denial histories, Medicare fee schedule changes and insurance contracts, and follow up by extensive research on existing contracts. “

Multi-pronged Approach :

MedicalBillingStar has developed a sophisticated model that analyses existing and proposed contracts and ensures that the hospital management understands the financial and operational implications of existing contracts, as well as the implications of new contracts and/or proposed changes. We offer effective insurance contract negotiating services to the medical practitioners. We:

A. Help the clinic/hospital to maximize the profitability of each contract. We have developed sophisticated analytic methodologies, including modelling of contract to identify underperforming contracts.

B. Guide medical practitioners to process claims based on our knowledge and experience on the techniques used by insurance companies. We have in-depth knowledge of insurance contracting, including complex reimbursement terms, adjudication rules, and trends in public and private insurance policies.

C. Develop the necessary tools to work out contracts with insurance companies.

D. Help establish contacts with key personnel in each insurance organization.

E. Identify key insurance companies related to the medical practice and the top 20-25 codes billed.

F. Contact each insurance payer and find current reimbursement for these codes.

G. Present comparison of actual reimbursement and existing payment norms to the clinic/hospital management and recommend the insurance companies that are to be contacted for renegotiations.

H. Hard bargaining at the negotiating table: Approach the recommended insurance companies, and give as much details as possible about the medical practice, team of doctors, diagnostic, treatment, and rehabilitation processes, and so on.

I. Avoid being caught off-guard ! Help closely scrutinize finalized insurance contracts to identify language or hidden agendas which need to be eliminated. Understanding the health insurance language is very helpful, especially when each insurance company conveys the contract language in its own format.

J.Avoid dangerous evergreen trap! Help in avoiding “evergreen clauses” related to reimbursements, which implies that the insurance companies continue to pay the same rate to the medical practice, even when at a later time the rates are raised, paying more to other practices. We renegotiate a fair fee schedule. We stay tuned with the latest rates, which insurance companies are not too eager to give out.

Tie-up with MedicalBillingStar… We save your time and money with better payment and fairer insurance contracts…

Infographics: RAC Compliance for Maximized Revenue and Profit

October 10, 2013 by Ango Mark Leave a Comment

RAC Audit Compliance – The Obligatory Conformity

The Recovery Auditor Contractor (RAC) program was initiated to identify and correct improper Medicare reimbursement payments made to hospitals and clinics for claims for health care services provided to Medicare beneficiaries, and identification of underpayments to providers. There has been a meteoric increase in RAC activity ever since the program was initiated in 2008. The overall performance of the program has been satisfactory to some extent, as validated by the fact box :

RAC Fact Box

Recovery auditors detected $797 million in overpayments and $142 million in underpayments.
After taking all costs into consideration, underpayment determinations and appeal reversals – $488 million was returned to the Medicare trust funds.
RAC collections were highest in the following states: California ($143 million), New York ($45 million), Illinois ($43 million), Michigan ($39 million), Florida ($32 million) and Missouri ($31 million).

The Modality

Recovery auditors employ a staff consisting of nurses, therapists, certified coders and a physician Certified Medical Dosimetrist (CMD). These auditors offer an opportunity for the healthcare provider to discuss improper payment determination. Issues reviewed by the auditor are approved by the CMS prior to widespread review. Approved issues are then posted to Recovery Audits Website.

Healthcare Providers’ Burden

Providers who agree with the Recovery Auditor’s findings pay by cheque, allow recovery from future payments, or request for extended payment plan. They otherwise appeal if they don’t agree.

Expert Tip to Avoid Penalty

According to Dawn Crump, HealthPort’s Vice President of Audit Management Solutions, “Audit Insights, hospitals and clinics must ensure that they are not billing for services beyond those they deliver, ensure that correct higher E/M levels are justified and reported, update themselves with RAC activity via the RAC websites, and shore up clinical documentation improvement (CDI) programs with an eye on known RAC targets and documented issues.”

Be Well-prepared for RACs to Avoid Embarrassment

Some of the many precautionary RAC compliance measures are:

A. Have written policies and procedures in place to deal with RAC audit.
B. Train physicians on these policies and procedures and their roles in audit compliance.
C. Conduct self-audit : Conduct internal reviews to ensure that they are in compliance with the Medicare standards, guidelines and criteria for claims.
D. Implement internal tracking system : Track RAC activity to minimize financial risk and ensure timely response to RAC to avoid denials.
E. Designate an experienced and qualified compliance officer to coordinate and control RAC compliance activities.
F. Look out for risk-prone areas : Identify high risk areas for proactive correction.
G. Adopt best-practice techniques for appeals management :
1. Familiarize physicians with appeals process to reverse improper RAC actions.
2. Earmark experienced physicians to assist during appeals processes
3. Make physicians acquainted with medical necessity issues for both inpatient and outpatient services.

Always Bank on MedicalBillingStar for RAC Related Issues : MedicalBillingStar is more than happy to clarify your issues on RAC audits through its network of qualified professionals to clinics and hospitals across the US.

Cloud Computing for Optimal Revenue Cycle Management

October 7, 2013 by Ango Mark Leave a Comment

Viable Financial Options: Data Centers or Cloud Computing Services?

Outdated Revenue Cycle Management (RCM) systems are likely to make a big dent in financial viability of small and medium clinics and hospitals across the US. In such a scenario, these healthcare establishments face the bleak prospects of extinction or take over by larger hospital groups and lose their independence.

As a proactive action to preserve their independent healthcare business, these organizations are seriously considering two viable options, namely data centers and cloud computing based services, each with its pros and cons.

Data Center Versus Cloud

The data center is an onsite, high tech physical entity that houses a multitude of server banks. Data centers are experiencing a boom with an increasing demand. However, demand for data centers has outstripped their availability, mainly due to constraints of physical space.

Cloud storage, the virtual model, also utilizes many server banks with thousands of serves, although off-site. Usually, a third-party vendor incorporates an extensive network of servers located anywhere in the world. However, instead of electronic healthcare software or other applications downloaded on each computer, a central server in the cloud is accessed by the entire network.

The Winner !

Hospitals and clinics are evaluating alternative strategies of data management. They are analyzing relative financial and operation merits and demerits of data centers and cloud computing systems for storing and processing electronic health records, diagnostic images, email programs, and other healthcare applications.

The dice is heavily loaded in favour of cloud computing systems. Some of the reasons, out of the many, are :

1. Lower cost for computer configuration.
2. Decrease maintenance costs while freeing data storage capacity.
3. Enable hospitals and clinics to better utilize their resources and focus on their core mission – patient care.
4. Ensure fool-proof backup and eliminate break down of hospital RCM services.

Be Cautious in Initial Crowd Approach

Rather than adopt an over-energetic posture and move over all healthcare workflows and processes in bulk on to the cloud, it pays to adopt a step-by-step process.

1. Evaluate hospital/clinic-specific needs : Carry out an in-depth analysis of needs specific to the subcategory of the healthcare system.
2. Assess existing cloud services vendors in terms of :

A. Proficiency in providing cloud computing services specific to the healthcare industry.
B. Financial and professional standing of the vendor.
C. Reliability of back-up facilities provided by the vendor in the event of major breakdown and disruption.
D. Ascertain the confidentiality and security of hospital/clinical data.
E. Willingness and ability of the vendor to scale up or scale down the services depending on increased/decreased fluctuations of healthcare business.
3. Start cautiously on a small scale : If healthcare entities find that cloud concepts are enticing, they must be vigilant at the initial phase, to move some of the less complex healthcare systems such as email and payroll to the cloud, while leaving the more critical and complex software in their in-house setting.
4. Be familiar with the cloud : The physicians and in-house IT personnel should use this opportunity to familiarize themselves with the cloud with lower risk.
5. Conduct pilot trial : Once major applications such as RCM and Enterprise Content Management (ECM) services are moved up into the cloud, a pilot trial should be conducted to ascertain the functioning and performance of these services.
6. Fine tune and incorporate enhancements : The pilot trial will highlight refinements to be made in the workflow processes to extract maximum leverage.
7. Constantly review the cloud-based services.

Infographics: FDA’s Final Canon on Healthcare Mobile-Software Apps

October 4, 2013 by Aurum Smith Leave a Comment

FDA ‘s final regulations on Mobile Medical App

Smartphones and other mobile gadgets have become part and parcel of daily life in Unites States. The ubiquitous espousal and use of mobile apps is unbolting ground-breaking techniques to liven up the health care domain. Very recently, on Sept. 23, 2013, the U.S. FDA (United States – Food and Drug Administration), the federal body for regulating food, drugs and biomedical devices – has issued a final regulation on mobile medical applications (apps), to take a whack at the healthcare mobile technology while preserving the consumer safety.

On the eyes of Watch Dog

“Some mobile apps carry minimal risks to consumer or patients, but others can carry significant risks if they do not operate correctly. The FDA’s tailored policy protects patients while encouraging innovation,”

– Jeffrey Shuren, M.D., J.D., Director of the FDA’s Center for Devices and Radiological Health.

The FDA is clear on its way that all the mobile apps would not fall under its regulation. Mainly mobile apps that help people bolster their health and support the patients in monitoring and improving their health may fall under the FDA’s control.

FDA’s regulations eye on the mobile apps that propose the use in the diagnosis of disease or other health ailments, or in the cure, alleviation, treatment, or prevention of disease or disorders. Besides, apps identifying pills, performing medical calculations, etc. may also come under FDA’s scrutiny. Some of the apps that may meet this rule are listed in the FDA’s official page. The guidance document to know the regulatory pathway of FDA for Class III (high-risk) to Class I (low-risk) mobile medical apps is available right at the FDA website.

The Out-of-Scrutiny Catalog

Mobile devices : FDA’s healthcare mobile apps statute does not control the sale or consumer utilization of mobile platforms.

Apps Stores : FDA’s healthcare mobile apps rule does not mull over companies that solely deal out mobile apps (e.g.: iTunes App store, Google Play store, etc), to be medical device manufacturers.

EHRs : FDA’s policy on medical mobile-software apps does not apply to mobile apps that are used as electronic health records (EHRs) or personal health record system.

The Fact Coffer

As the apps innovation is propagating at an awe-inspiring pace, there are now more than 13,000 health and medical applications available to consumers and a further 5,000 marketed to healthcare professionals.
FDA bureaucrats have projected that in excess of 1,000 new medical software products are being sold each month for smartphones.
The mobile software industry guesstimates that about 500 million smartphone consumers globally will be using healthcare apps by 2015.
By 2018, 50 percent of the more than 3.4 billion smartphone and tablet users, including medical professionals, consumers, and patients will have ‘downloaded mobile healthcare apps’.

Talk to us to choose the standard mobile medical apps for your gadget – and for your practice !

Infographics: Physicians Going ‘Tabletized’ to Access EHRs

October 1, 2013 by Ango Mark Leave a Comment

The E-gadget Backdrop

The mobile gadget revolution in the healthcare arena is at the cusp of ‘tabletization’, according to a string of new reports. Clinicians are increasingly using their mobile devices, especially tablets at practices for the rapid, secure and amicable electronic health records’ (EHRs’) usage, storage and exchange.

Insights into the Penchant for Tablets

It’s a trendy ‘spectator sport’ among new practices and the mobile purveyors to fathom why physicians are utilizing their tablets. Two recent reports, “Mobile Usage in the Medical Space 2013″ and “Tablet Usage by Physicians 2013″ from American EHR Partners based on the survey of about 1,400 physicians, underscored that tablets are more useful than smartphones for doctors using EHRs.

The doctors use their tablets in the clinical settings for performing the following activities :

1. Sending and receiving e-mails (52.4 percent);
2. Accessing electronic health records (EHRs) (50.6 percent);
3. Retrieving diagnostic information (41.7 percent);
4. Research data about drugs (33.3 percent);
5. Keeping abreast with medical field through journals and articles (29.8 percent).

Snapshots on Tablet Usage in Healthcare Space

1. Physicians use Epocrates^®, Medscape^®, Up To Date^®, MedCalc^®, and Skyscape^® as the top five tablet apps in their medical practices.
2. Smaller enterprises, with three doctors or less, are expected to carry out an extensive range of bustles on their tablet, such as banking, patients’ correspondence, or taking snaps for medical research, etc.
3. One-third of EHR users and one-quarter of non-EHR users prefer a tablet gadget in their clinical practice.
4. The users of EHR are hanging about 25 hours per week on their tablet device, with a better portion of time used up on business (59 percent) than for personal points (41%).
5. With an increased clinical and healthcare research funding, the research about medications is escalating. About 33 percent of EHR users employ a tablet to research medications every day.
6. About 70 percent of the physicians are tablet users who access EHR through password.
7. More than 32 percent have installed device tracker apps on their tablets, so as to remotely clear all data on their tablet – if misplaced or stolen.

Tablet- Benefits Overwhelm !

A. Though smartphones and tablets are competitively used by physicians, most physicians are feeling convenient with the EHR access on a portable, wider screen as in tablets.
B. Making video calls to interact with patients for research, feedback and patient services is much easier and pleasing with this device.
C. During business meetings and even during special patient encounters, this is a great instrument to scribble upon.

Contact MedicalBillingStar to know about the recent healthcare trends in gadget landscape !

Rest Assured – Coding Howlers in Oncology Practice are Removable

September 23, 2013 by Ango Mark Leave a Comment

Oncology is a clinically-focused specialty that is undergoing frequent technological and process updates. It requires a high degree of physician’s skill, experience and the urge to learn to stay tuned with the revisions related to documentation, coding, billing, and revenue cycle management (RCM).

Common Oncology-Specific Coding Errors :

Errors abound. Some of the many are:

1. Coders are not up-to-date with on-going changes in codes and related modifiers.
2. Failure to capture correct levels of CPT (Common Procedural Terminology) codes.
3. Under-coding and over-coding errors.
4. Misusing modifiers, using of wrong modifier and mixing up of modifiers.
5. Coders are not conversant with coding for specialist oncology services such as bone marrow procedures, transplantations, and blood transfusions.
6. Coders round off drug administration times instead of noting the exact time.

What the Experts Have to Say :

According to oncologists, correct coding is the main ingredient for successful practice. The complexity and regular updating of coding system contribute to unintended coding errors. According to the American Society of Clinical Oncology (ASCO), failure to complete the code capture at the time when oncology procedures are provided is common.

Continued usage of codes that have been eliminated by Medicare continues to be the bane of the US oncologists. A survey conducted by two nationally recognized experts in oncology practice management-Roberta Buell from OnPoint Oncology LLC and Patrica Falconer from Health Options, on behalf of the Association of Northern California Oncologists (ANCO), revealed that only 1 out of the 14 surveyed practices had updated their oncologists about the elimination of consultation codes by Medicare.

According to Cynthia Stewart, coding education coordinator president of AAPC, problems arise for coders when physicians fail to document the steps they went through to arrive at a diagnosis. Enos further clarifies that coders need to understand the depth or extent of medical decision making. Medical decision depends on complete documentation to make a “medical necessity linkage” between the procedure performed and the diagnosis code.

Tips to Ensure Correct Coding :

There are umpteen of them – to name a few :

1. Be aware of on-going changes in codes and modifiers.
2. Continually train oncologists and coders on coding mistakes and consequences, along with how to avoid the mistakes.
3. Do not neglect equipment or instrument used : Be conversant with recent codes related to the equipment or instrument (e.g. for radiation oncology) used to provide oncology services.
4. Beware of the tendency to code according to the complexity of the diagnosis, rather than the extent of decision making involved.
5. Be aware of new or established (existing) office visit codes and in-patient visit codes established by Centres for Medicare and Medicaid Services (CMS).
6. Make sure you understand the billing rules and regulations for Medicare and private payers. In fact, with the high cost of new cancer therapies, many oncology practices are now verifying insurance information before every treatment.
7. The American Medical Association’s (AMA) multi-specialty Relative-Value Update Committee (RUC) frequently reviews and updates oncology codes. Keep in sync with these changes.
8. Oncology clinics and hospitals will find the guidebook on billing and coding for oncology-related services offered by American Society of Clinical Oncology (ACCO) very useful.

Escapade from the Oncology Coding Malaise :

Perplexed and unsettled due to plethora of oncological coding errors! Don’t panic. Be assured by adopting a prudent approach by outsourcing or rather “Right Sourcing” your coding worries to MedicalBillingStar,as we :

A. Are an established, experienced, and knowledgeable one-shop outsourcing vendor for oncology coding in the US.
B. Are conversant with intricacies of oncology coding practices and comply with medical coding systems such as International Classification of Diseases (ICD), Current Procedure Technology (CPT), and Healthcare Common Procedure Coding System (HCPCS).
C.Understand your EMR and work with any platform, with security features and options. You are free to select EMR/EHR of your choice and we will cover the involved expenses.

Here’s our presentation on 8 Oncology Coding Tips !

Revenue Cycle Management – The Road to Maximized Profit

September 19, 2013 by Ango Mark Leave a Comment

Effective and efficient Revenue Cycle Management (RCM) is bread-and-butter for survival and prosperity of any medical practice business. RCM is not limited to medical billing and collecting reimbursement claims. It involves tightly integrating all the clinical workflow steps, commencing with patient’s registration at the front desk, diagnosis, treatment, discharge, recovery of dues from the patient and the insurance company, and follow up on denied claims.

For ensuring financial viability of the business and before initiating implementation process of RCM, it would be prudent to carry out an in-depth assessment of the current position of the practice.

In-depth Self-examination :

There is a need to evaluate the present standing of the practice with the following posers :

1. Does it take unduly a long time to collect reimbursement claims and patient payment?
2. Is the denial rate for the first submission of reimbursement rate more than 4%? (For best practice standard the rate should be less than 4%)

3. Are write-offs and adjustments of pending reimbursement money very frequent and high?
4. Is percentage of accounts receivable, which are more than 120 days old, higher than 10%? (For best practice it should be less than 10%).

If answer to any one of these posers is in the affirmative, then the financial viability of the practice is jeopardized.

Critical Post-evaluation Measures :

Patient Reporting-in :

On receipt of a phone call for an appointment from the patient, the front desk should ascertain medical problem and insurance coverage of the patient, and then guide the patient to provide information for registration by going online on the hospital’s/clinic’s website. Any incomplete information should be followed up before the appointment, so that the insurance coverage of the patient can be verified. An alternative process involves a kiosk for patient check-in at the clinic or hospital for collection of patient’s demographic data and automatic verification of insurance coverage.

Charge Entry and Capture in the Superbill :

As a basic requirement, physicians should ensure that the correct code with appropriate modifier is recorded in the clinical document of the patient, to ensure correct billing and preparation of claims. The billing should be timely and close to the date the patient has been provided with the medical services to avoid delay and piling up of pending claims.

Bill Clearing House :

Bill clearing house checks whether all the required data are included in the bills transmitted to the clearing house by the clinic/hospital.

Follow-up with Insurance Company :

Once the claims are transmitted to the insurance agency, follow-up is a must to ascertain the progress on submitted claims. When the claims are passed, in full or partial, the insurance company remits the payment automatically to the practice account.

Patient’s Portion of Payment :

Ascertain and recover patient’s payment contribution for diagnosis and treatment through aggressive AR callers.

Denied Claims and Follow up :

Correct and resubmit denied claims to the insurance company and follow up till receipt of payment.

Complete End-to-end RCM :

RCM encompasses all the workflow of the clinic or hospital, with each step linked to the next step as under :

The Hallmark Solutions To Frequent Medical Coding Gaffes

September 11, 2013 by Ango Mark Leave a Comment

Most healthcare providers are on the horns of dilemma due to the medical coding mistakes and the ensuing claim denials. The Best Medical Coding Practice paves the Greenway to recoup your dollars for the exact service rendered by you, whilst improper coding takes away your dollars. This article underscores the common coding mistakes and the conduit to resolve them.

Ensure Medical Necessity :

The healthcare insurance payers are progressively more apprehensive about the medical necessity. The payment for the physician services is based on the CPT codes, whereas the claim approval and reimbursement by the payer is based on the diagnostic codes. Thus, elucidating the harmony between CPT and diagnostic codes is a key step in the coding process. If the payer deems that the service is medically necessary, you will be paid or else your repayment will be hampered and/ or even you will be monetarily penalized.

Ethically Exploit the Modifiers :

A Modifier is the Nucleus of Multi-procedure Coding-based medical claim. Modifiers can be the benchmark for full reimbursement – abridged reimbursement – complete denial – or partial denial. Forgetting, abusing or confusing modifiers in requisite circumstances may lead to negative impacts on reimbursements.

Examples :

1. Failure to tag on Modifier 25 to the E&M service or erroneously appending it to the surgical procedure will cause claim denial.
2. A CPT code linked with Modifier 51 notifies the payer that two or more procedures are being done on the same day and to employ the multiple procedure payment formula. Modifier 59 tells that the procedures/services those are not usually reported collectively, but are apt under a specific circumstance.
3. CPT advocates using Modifier 24 with an “unrelated E&M service by the same physician during a postoperative period.”
4. Modifier 53 is tagged on, when the physician opts for ceasing a surgical or diagnostic procedure because of extenuating events or a hazard to the patient’s health.

Shun Missed Charges :

Most biggies among healthcare providers, can simply fail to spot charge captures for the multiple services delivered. Imaging, laboratory and other subsidiary services often miss the unwritten/ verbal orders of the clinic or lab staff. Better avoid or document the ‘verbally communicated orders’ so as to rule out this problem.

Take Cognizance of the Code Revisions :

Many providers use out-of-date encounter forms thinking that updating is an onerous and mind-numbing task. But, it is inevitable to update the Superbills with the revised codes so as to recoup your payment for the rendered service. Every year, procure new CPT, HCPCS and ICD-9 books and educate the pertinent staff members to get accustomed with the revised codes.

Eschew ‘Over-coding’ and ‘Under-coding’ :

Over-coding is sometimes deliberately done to acquire a higher reimbursements, but it may lead to claim denial and often resubmission or appeal processing/ penalty cost more than that of the anticipated payment.
Example: If, the code 413.9 (unspecified angina pectoris) is used along with 414.01 (Coronary atherosclerosis of native coronary artery), instead of 414.01 alone, it is ‘over-coding’ and would be considered as a fraudulent activity by the corresponding statutory authorities.

Under-coding is usually a result of ‘fear for denials’. The best solution is to do ethical coding using coding and quality control veterans. Besides, perform NCCI (National Correct Coding Initiative) or other appropriate edits to ensure correct coding and to control the inappropriate assignment of codes that result in improper reimbursement or penalty.
Example: Some physicians consider 99213 as the default code as they believe much documentation will be desired for coding anything higher and they deem 99213 is the safe and sound option. But, in point of fact, this is an under-coding and culminates in diminished reimbursement.

The Soul of Medical Coding Remedies :

In a nutshell, our think tanks say that the following tips can augment accurate coding, and sequentially, medical practice revenue vanished to denials:

1. Keep your staff abreast of the revised codes.
2. Educate your staff to hone their coding skills.
3. Create a channelized workflow between coders and physicians.
4. Follow ethical coding practice.
5. Resubmit denials earlier and rigorously track the denied claims.

Click here to have a word with MedicalBillingStar and crash the coding menace effortlessly !

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