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Medical Billing Tips for Optimal EHR Usage

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Renovate your EHR strategy

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”.

Cloud Computing for Optimal Revenue Cycle Management

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Cloud Computing Healthcare Industry

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.

Revenue Cycle Management – The Road to Maximized Profit

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RCM Workflow

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 :

 

Here is What Physicians can do to make 2013 the best year for their Practice !

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 Time for Self Reflection…

As the year draws to an end, it is important that physicians spring clean their revenue cycle. 2013 is going to be a hectic year with major regulatory updates, compliance issues and, yes, unfair deadlines !

So, now, is the best time to take stock of their revenue management cycle process and performance, and formulate better strategies.

Run a Quick Audit ! 

Audits needn’t be extensive or time consuming. Focusing on any one major area to audit can save on time and streamline the auditing process. To start with review the codes that have a high error rate.

According to a CERT report there is a 24% error rate for 99205, 20.8% for 99204 and an 18.6% error rate for 99215.

Run a check on these codes and see if your practice is getting it right.

Cloned claims, non specific diagnosis codes, and errors while assigning evaluation and management codes, are the other few problem areas.

Bundled Payments ; Work out the Math

Work out a clear strategy for bundling and unbundling claims. Most practices lose money due to submitting separate claims instead of one single bundled claim. Determine which claims can be bundled and which ones need not. Work out a reimbursement formula that works for all concerned.

Test the waters…

ICD-10 isn’t going away, no matter how hard you pray. Have an ICD 10 implementation plan in place. If you work with a third party biller, ask them to start checking and working with the new set of codes.

Cut Costs not Corners !

Where does all the money go ? Don’t ask yourself this question again this coming year. Contain costs. Draw up a detailed income and expenditure spreadsheet and enter all the information that matters. Analyze and see where you can scale down on costs. It could be over-staffing or inefficient coordination with ancillary service providers.

Pick out the main reasons and start working on a better future for your practice, now !

Do EHR’s really help Physicians take the Back-Seat ?

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An Electronic Health Record (EHR) is quite arguably the single most expensive investment a physician is ever going to make. An increasing number of medical practices are taking the electronic route. Implementing an EHR is just one small step towards a more streamlined medical practice. It is not a magic vehicle that can help you reach your goals faster. But focus and constant effort can help you reach there.

Geared up for Change  !

An EHR can revolutionize your workflow. It leads to greater operational efficiency and helps different departments, specialists and healthcare facilities to access and share data effortlessly. But the huge change that it can bring to your practice may not always be for the better. The shift can unsettle your existing revenue management system.

It is imperative for physicians to upgrade their revenue cycle and better optimize its functions to support the new entrant into the office. The most critical components of the revenue management system such as claims submissions, insurance verification and front-end processes need to be reworked to work in a new environment.

Are all your Claims Clean ?

Yes, an EHR greatly automates your workflow process and helps in maintaining accurate medical information. But quite disturbingly there have been several hospitals that have been warned for misusing an ehr to create falsely inflated claims. The lack of clarity in CMS guidelines is cited as one reason for physicians to make billing errors.

But the major reason could be that physicians are still learning the ropes of working with a new system.

Better Patient Communication and Care…

This is a debate that has been raging in Linkedin, Facebook and near the water cooler for the past few months. Can an EMR or EHR system truly help the doctor to spend more time with patients? It does help save on time and effort but whether an ehr can help in better communication, is still being debated about.

EHR’s certainly a Quantum Leap into a Better Future !

EHR’s are a huge, collective step forward for the healthcare industry. It is certainly going to light the way ahead and be a catalyst of change. But EHR’s cannot in themselves create a more profitable or efficient medical practice. The other important parts of the puzzle such as revenue cycle management services , patient communication and everything in-between needs to be fitted together to create a pretty picture !