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Want To Save $ 23,000 ? Switching To E-Billing Will Improve Your Practice’s Financial Health

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Still Stuck With Paper ?

What is your carbon footprint ? If you are still sending out paper claims, you are felling more trees. Agreed, this is an argument that is as old as fossils. Apart from saving trees there are a lot more advantages to using e bills ! It helps to track claims easily and lessens the amount of time your insurer takes to sign your check.

ebilling-infographic

Save More Dollars !

According to the American Medical Association submitting claims electronically can save a practice 55% of its claims submission costs. The AMA further states that physicians stand to gain above 23,000 dollars a year by switching to electronic claims.

Electronic billing also reduces the TAT of insurers. The overall efficiency and cost effectiveness of the process is just what overworked medical practitioners need. Paper claims are time consuming to generate, transmit, and maintain a record of. Electronic bills are quite simply put, the smarter way to bill !

Joining The e-club !

According to a recent survey of America’s health insurance plans the usage of billing electronically has doubled. From a measly 44% in 2002 to 94% in 2012 there’s been an exponential increase in providers who are switching to e billing.

Almost 79% of claims are now automatically adjudicated without manual support. Physicians are finding e billing helpful as it helps their staff to focus on patient engagement.

A Huge Relief For Billers…

What is the biggest headache of a medical biller ? No. It is not getting claims paid. The bigger headache is finding out which claim is in what stage of processing. An average medical office sends out dozens of claims per day. Keeping tabs on each one of them can trip up the most determined of medical billers.

ERA’s and EFT’s help medical billers to hasten the pace of the billing process. And make it easier for them to maintain a clear cut billing record.

Ask Your Insurer To Move On From The Stone Ages !

It is time for insurance companies to stop working with paper claims. Physicians need to put their foot down and ask insurers to accept electronic claims! Concerted and continuous effort across the continuum will ensure that the healthcare industry functions a lot more smoothly and efficiently. And yes, save a billion trees in the process !

Is Your Medical Practice Ready To Attest For Meaningful use?

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Are You Ready To Attest For Meaningful Use ?

If you are an EP, receiving the MU incentive check is going to top your list of priorities. It is time for physicians to pull up their socks and start working towards meeting the eligibility criteria for MU 2. Before getting down to the brass tacks it is important that you phase out the attestation process.

Meaningful Use

Being Up To Speed On Data Transmission…

Data transmission is a tricky word. It means you need to share data without making compromises on data privacy. To, begin with exchange a clinical document with one of your peers who use a, different EHR. Send out “trial” documents to test the waters. Check whether you are able to transmit clinical data securely.

Shop for a HIE and team up with one, to be able to transmit medical data easily across the care continuum.

Time To Stop Fighting Over Turf  !

Physicians have always felt a little queasy about letting patients access their EHR. A secure patient portal that allows patients to view and download medical information is important to meet the patient engagement criteria.

It is essential that stringent authorization methods are followed to prevent data misuse. And that, patients, are sufficiently educated about data security.

Dial Your Vendor’s Number…

You’ve pulled out all stops to make sure your practice meets MU standards. But is it is of little or no use, if your vendor doesn’t match your pace. Check with your vendor whether your EHR is compliant with the Meaningful Use 2 guidelines. Communicate with your EHR vendor and emphasize that a specific timeline needs to be adhered to.

With data interoperability being one of the key considerations, to attest for MU, it is important that you join forces with your EHR vendor, to reach the finishing line on time.

Have you spoken to your business associates ?

It is important that your business associates are an integral part of your MU attestation efforts. Whip up a plan with your business associates to optimize your workflow and streamline your everyday work processes.

2 hours a day !

Spending as little as two hours a day to work towards achieving MU can put you on the fast track to receiving your check. The key is to coordinate. Make sure that everybody who is involved with your medical practice is on the same boat. And to, make the most important person in the equation, your patients, to get more actively involved.

Should Patients Be Allowed To Access Their Physicians EHRs? Weighing The Pros And Cons

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Whose EHR Is It Anyway ? !

 This far and no further, is the approach physicians are taking when it comes to patient EHR access. Patient electronic access is an important objective of Meaningful Use. It can help physicians to deliver better quality of care.  And to bring everybody across the care continuum in one single, secure platform.

EHR-access

Data security risks is the key reason why the debate on patients access to EHR is still up in the air. Nothing can scare physicians more than a data breach. The average housewife in New Jersey may not be up to date on HIPAA regulations  And there is also the potential threat of patients misinterpreting their medical data.

A physicians understanding of a medical problem is not the same as that of a patients. It could cause unnecessary stress and anguish, and make patients vulnerable to self-medication dangers.

I Don’t Want My Patients In The Drivers Seat…

According to a recent survey conducted by Accenture, around 65% of doctors feel that patients should be given limited access. About 82% of physicians endorse the view that patients should be actively involved in their healthcare. Around 4% of doctors told they’d like to ban patients from having an online access to medical records.

Most physicians were of the opinion that other than demographics, patients shouldn’t be allowed to edit or update any other medical data.

The Way Around This Catch 22 situation !

  • Talk to your EHR vendor about including patient identity proofing and authentication features.
  • Standardize the information you want your patients to access.
  • Educate your patients about your EHR.
  • Work with a  biller who has experience in working with your EHR so patient billing is streamlined to a great extent
  • Follow a clear cut privacy policy and usage guidelines.

Will Doctors Fade Into Oblivion? The Survival Guide For Newyork Physicians !

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Can I Meet A Physician ?

The answer would most probably be “no” in a few years time. It is going to get increasingly hard to find a physician in New York. The State University of New York center (SUNY) has predicted that there will be severe physician shortage in New York by 2030. The study further reveals that the average age of physicians in New York is alarmingly high.

Medical-Billing-Newyork

I Have An Insurance Number, But Not Medical Care…

The huge physician deficit can leave millions of newly insured patients, under Obama-care  have insurance numbers. But it is no guarantee they will get to meet a doctor. The physician workforce is slowly dwindling and finding a doctor can be the biggest challenge, in the years to come.

The problem is steadily getting worse and it is not just the healthcare law that is to be blamed. Proprietary and complicated EHRs and ambiguous reimbursement models are driving physicians out of the business.

84% Docs Feel The Profession Is In Decline !

And nearly 60% wouldn’t recommend medicine as a career choice. About 75% of physicians feel they are being overworked. These are just a few worrying markers of the disillusioning climate the healthcare industry is in.

Doctors Across New York ; The Much Needed Relief For Physicians !

The DANY program offers physicians based in New York the life support they need. It offers physician practice support, physician loan repayment and help for facilities that recruit new doctors. The application process has also been streamlined to help practices based in NY meet the financial pressures they’re under.

Large health plans are also working in tandem with local medical practices and community health centers to bring in more primary care doctors.

Joining Forces…

Nurse practitioners can fill in the void by offering primary care to patients. Physicians and NPs instead of being at loggerheads, can work together to provide better care for patients across the state. As the shortage worsens team based care will act as the most effective solution.

Outsourcing documentation and billing needs will also offer harried Newyork physicians a brief respite in an otherwise blistering healthcare climate !

The Face-Off Between Doctors And Nurse Practitioners!

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Working, without someone looking over our shoulder, is a secret wish of all of us. And that has led to one of the most heated debates in the healthcare industry. Coming, close on the heels, of the battle between, CRNAs, and, anesthesiologists. It is now physicians and nurse practitioners who are at loggerheads.

Endangering patients…

Physicians fear that working without their supervision can put patients at risk. And lead to fragmented, patchy patient data. Providing longitudinal care and unifying diverse factors across the care continuum is an ongoing challenge. Nurse practitioners functioning independently can lead to increased confusion, is the chief complaint of docs.

It is a known fact that recent regulations and compliance thresholds have put physicians under a lot of stress. To have nurse practitioners challenge their role in the medical fraternity. And compete for patients, is the last thing physicians need.

Nurse-practitioner

End the monopoly !

Do we know how to bill for services ? Yes.

 Do we know how to take care of patients in need of primary care ? Yes.

Do we need a physician to tell us what to do ? No.

This is the war cry of America’s nurse practitioners. They feel practicing under the supervision of physicians is unnecessary and restrictive. Despite being highly qualified and experienced, nurse practitioners feel they are being given a rough deal.

Not a turf war for money !

The request by NP’s to reduce physician interference can surprisingly prove to be beneficial. Obama care is going to result in a sudden influx of thousands of patients. As United States battles severe primary care physician shortage. Qualified nurse practitioners and a newer model of working might just be the right solution.

Once the dust settles down…

It is being hoped that once the storm settles down it will bring a lasting and mutually agreeable solution. The need of the hour is clear cut billing regulations. Reformed, payer policies, that don’t leave room for doubt. And, nurse practitioners and physicians, who work together towards a sustainable solution.

As a nurse practitioner there is enough on your plate already ! Here is the presentation on “Reimbursements guide for nurse practitioners to survive the storms in 2013 !”

Ten Tips For Surgery Centers To Pump In More Greens!

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surgery-centers

There you go ! Another rejected claim. Well, running a surgery center billing practice can be demanding, expensive, and on a bad week, thankless! With, surgery centers constantly battling with payers, and, patients who have no idea what their financial liabilities, are. It can be an uphill climb on a snowy day, to get paid !

Here is how you can fight those financial demons and come out at the other end a winner ! And also ensure your clinical documentation is never short of perfect !

10 ways to increase the revenue of your surgery center…

  1. Encourage your surgeons on-board to have a financial stake in your surgery center to avoid losing out on case load.
  2. Create a better atmosphere to work by upgrading to better systems and work processes to attract and retain a strong physician base.
  3. Collect copay’s and deductibles at the front-desk and have multiple payment options.
  4. Compare your staff members’ cost per case with your competitors, and how reimbursement varies across different specialties. Analyze and set benchmarks.
  5. Follow a rigorous claims follow up process and fight denied claims as soon as they reach your table, to increase the revenue and valuation of your center.
  6. Physician documentation plays an important role. Surgeons should dictate clearly, name the procedure. And ensure details and events are sequenced in the operative note.
  7. Don’t put off renegotiating with your insurer. If you put off renegotiating year after year there are little chances of your insurer ever giving you a reimbursement hike !
  8. Collect and verify patient information during the pre-registration stage to avoid fall outs.
  9. Call your patients prior to their appointment and inform them about their financial liabilities.
  10. Have a quick sheet that includes pertinent questions, such as, how many surgeries were performed, the number of co-surgeons etc for physicians to fill out after a surgery.

28 Million Dollar Fine,Prevent Your Practice From Being Booked Under The False Claims Act

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False Claims And A 28 Million Dollar Lawsuit !

false-claims-act

False claims, data breaches and billing errors happen to others right ? ! No. It can happen to your practice, despite your efforts and best intentions. Don’t wait for a watershed moment to catch you unawares and throw you off the course. Federal regulations are becoming stricter, and the penalties and punishments for fraud and abuse allegations, are more unforgiving.

28 Million Dollar Fine For Fraudulent Billing…

Even as this blog is being written a nursing home based in Illinois has been booked for charges against the false claims act. Two ex employees filed a case against the nursing home for providing inadequate care. And, sending, multiple fraudulent claims to insurance companies. The hospital was penalized for offering useless services and more than 19 million dollars for filing false claims.

The employees were awarded more than 400,000 dollars for bringing to light the billing malpractices of the nursing home.

What Is A False Claim ?

There are physicians who end up with summons for faults they were not even aware of. To safeguard your medical practice from false claims you must first be aware of what constitutes a false claim.

  • Submitting an unbundled claim when the claim could have been bundled and submitted as a whole.
  • Up coding a medical service.
  • Billing for medically unnecessary services.
  • Increasing time units or any units of services for acquiring more reimbursement.
  • Submitting secondary claims that have to be sent to a different insurer, to the primary insurer.
  • Inflating patient care costs.
  • Copy pasting records in the EHR can lead to duplication of claims content.
  • Making use of automated coding tools and claim edits can lead to over-billing errors.

Tips To Safeguard Your Practice From Being Booked Under The False Claims Act !

  • Ensure your claims are, bundled/unbundled appropriately. If you are not too sure pick up the phone and discuss with your insurer.
  • Always provide additional documentation substantiating the medical necessity of a treatment prior to transmitting a claim.
  • Document facts such as time units, complexity of a medical decision and gravity of a wound, always.
  • Communicate with your patients and explain about patient liabilities.
  • Submit primary and claims appropriately.
  • Avoid copy pasting billing details in your EHR as it creates “cloned” notes.
  • Review and update information in your EHR constantly.
  • Finally, make use of the features your EHR offers but don’t rely on them completely.

 

5 Ways Small Practices Can Thrive In A Hostile Economic Environment

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Will Private Practices Be Forced To Go Off The Grid ?

Independent practices are dying a quiet death all across the country. It is becoming increasingly difficult to manage expensive transitions, pay the bills, and focus on patient care. Every statistic about healthcare, points to one grim fact- it might be the end of private practices. Unable to withstand mounting financial and regulatory pressures, small practices are shutting their doors.Private-Practices

Between, A Rock And A Hard Place…

Most independent physicians feel like a fish out of water when working in the hospital environment. It means getting used to different terminology, processes and working hours. And it is not just adjustment issues. As with any big organization, the red tape involved can confound and trip up medical practitioners. Small, perfectly reasonable requests may take forever to be processed.

Small clinics are way below the food chain and will be treated that way.

Is Concierge Medicine The Answer ?

Forget third party payers. A, complicated, billing process. And those nasty cuts and audits ! Is concierge medicine a heaven-sent option? Yes, if you are a competitive physician who doesn’t mind being on call 24/7. If being at the beck and call of patients doesn’t scare the daylights out of you. Or, the “I paid you, you work for me” approach doesn’t deter you, opt for concierge medicine.

But the limitations, drawbacks, pressures and financial stability of the concierge model needs to be analyzed before you arrive at a decision. “Boutique practices” or “Personalized healthcare” sounds sweet. But for the physician who is not good at money or time management, it can spell doom.

For Those Determined To Stay The Course !

There are quite physicians who are refusing to buckle under pressure. “I am sticking to my private practice as I don’t know, and cannot stand, any other way of working” is what Terry Williams a private practitioner based in Mississippi has to say. And there are several physicians who echo his views.

Here Are Five Tips For The Small Practice Owner To Fight The Good Fight !

  • Consider relocating your practice to a neighborhood where there is a shortage of medical care, to get better reimbursement rates.
  • Become a micro practice to slash-down on operational expenses.
  • Optimize your workflow and outsource tasks that don’t have to be done in-house.
  • Focus on the business side of your practice.
  •  Market your practice and go active on social media sites.

At 84,000$ Will ICD 10 Sound The Death Knell For Private Practices?

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Will Your Practice Get Caught, In The ICD 10 Quicksand ?

ICD 10 is lurking round the corner. 55,000 more codes and an entirely new coding structure is no stroll in the park.  Medical practitioners might just be thrown of track. It is being feared, that it could be a deathly blow to practices, which operate on small budgets. Small medical practices will be forced to align with hospitals to survive in this tough economic climate.

ICD-10-Medical-Coding-Infographic

Another Nail In The Coffin For Small Practices…

ICD 10 is being likened to Y2K. Though it petered out eventually and died a natural death, the panic and havoc it caused still remains fresh in people’s memories. But with ICD 10 coding we may not be as lucky. It is highly unlikely that ICD 10 will be postponed once again. Or like what most medical practitioners, pray for nowadays, simply disappear.

ICD 10 Comes With An 84,000 $ Price Tag  !

Don’t gasp! That is the figure put down by the MGMA. For the small practice that is barely making ends meet, this is an astronomical amount. Consolidation is the only glimmer of hope. But it can prove to be a double edged sword. As physicians will lose their freedom to decide their working hours and make key clinical decisions, independently.

It seems to be a throwback to the 80’s when there was a mad scramble to partner, align and consolidate.

And The Price Is Not The Only Headache…

If the fear of hogging headlines is the major fear of big hospitals. To keep the lights on in the building is the biggest challenge of small and medium practices. A few of the challenges that ICD 10 throws in the face of medical practitioners are:

  • Loss of productivity.
  • A hit in the coders efficiency and working hours during the transition.
  • Expensive system upgrades.
  • Additional staff to handle the workload especially when both ICD 9 and ICD 10 are used to submit claims.
  • Higher chances of fraud and abuse charges due to the lack of training, knowledge and resources.

Here Is What Small Practices Can Do To Keep Their Head Above The Water !

  • Partner with a medical billing agency to handle the transition.
  • Make use of online resources to the fullest extent.
  • Start early and phase out the implementation to avoid drastic changes and expenses.

Make Sure Your EMR Doesn’t Make You Face Medical Billing Malpractice Charges

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EMR-Overbilling

Beware your EMR could land you in a tight spot !

There is a lot of dust raised about EMR’s again. According to recent reports an EMR can lead to inflated costs and fraudulent billing. Allegedly, physicians have added about 11 billion more to their fees, over the last decade alone. The Center for Public Integrity’s “Cracking the code” series, has found that the usage of EMR/EHR’s have resulted in widespread billing malpractices.

More to it than meets the eye…

Healthcare experts argue that this a strong marker of the negative impact, wishy-washy rules can cause. It can not only make physicians vulnerable to fraud and abuse charges, but also be potentially life threatening for patients. Mostashari, the National Coordinator for Health IT rues that “documenting care that didn’t occur, that’s not just fraud, it’s really dangerous medicine.”

It is being argued that the system is flawed. And it is high time the government sat up and took notice before it snowballs into a huge issue and causes irrevocable damage.

Has coding higher become par for the course ?

Upcoding is rampant. And emergency rooms in particular have been pulled up for assigning high level codes, despite the treatment not warranting it. Whistle-blowers  worried physicians and confused patients are making one collective demand. For, strong auditing tools, and transparent uncomplicated regulations.

The new CMS directive !

The centers for Medicare and Medicaid have issued a new directive to restrict billing malpractices. Federal authorities will be keeping a close eye on EMR users to curb this unhealthy trend.

Where the cracks appear…

Physicians are unusually busy people. Most doctors fume that EMR’s have reduced them to efficient machinery. Nobody likes to sit, and copy paste information. Or, working with straight out of a can, point and click templates. Long loading times and a maze of options can drive physicians round the bend. Impatience with the system, more than the willful intent to over-bill  might be the reason behind improper billing.

A quick guide to bill right !

  • Train your billing team to work closely with your EMR/EHR system.
  • Use an accredited medical billing software.
  • Conduct regular in-house financial audits.
  •  Ensure the same information isn’t entered again. Redundant data is the major cause of over-billing.
  • Educate your practice about CMS guidelines and updates.