Billing and Collections During Hard Economic Times Part II

As we discussed in the preceding article the fact that it's getting harder and harder to collect patient balances. This can definitely be frustrating, time consuming and often unsuccessful. The Commercial Collection Agency Association showed that after 3 months of an outstanding bill, the probability of collecting is 73%, after 6 months 57% and 29% after a year. When the amount of the bill is minimal the figures are even less.

Staff should be well trained as to how to collect payment from patients. When visiting a retail store and you decide on what you're going to purchase, do you walk past the registers and say "bill me", that would and could never happen. So why do physicians allow this to happen in their offices?

One way to tactfully implement payment is due upon service, is setting up signs in the office where they can clearly be seen. Staff members should also be trained as to how to ask for payment. Such as "how would you like to pay?" Then the staff member should start to write out a receipt to show the patient that payment is due. Reminding patients when confirming appointments is another opportunity to inform them of the policy.

Consider accepting credit cards and debit cards. This is a good way to collect payment due to the fact you have the assurance in a matter of seconds if the payment went through. One suggestion is due to some patient's having high deductibles and it's difficult to figure out what the exact bill will be, have the front desk take an imprint of the credit card and bill half the amount and then let them know that they will be billed the remainder and will receive a statement when they learn of the final amount from the insurer.

Sometimes it becomes necessary to use a collection agency. It's best to come up with a plan in this case. How many statements should go out before action must be taken? Some physicians send up to 6 statements. It should suffice to send 3 statements over a 3 month period. One method used by a physician's office was to send the 3rd statement as a certified letter; this ensures that it has reached the appropriate address with a person's signature showing that the statement was received. A phone call after the 2nd statement would do well also. After the 3rd statement is sent, give the patient 15 days to respond with an actual date printed on the statement of the day it will be sent to collections.

Collection agencies generally charge a percentage of the monies collected. Most companies fees range from 12% to 50%. It would do well for you and the patient to not have it get to that point but if necessary there are many good collections agencies to choose from.

Maximize Your Medisoft! (Unknown and Underused Functions of Medisoft)   Is the Job Growth Affected by the Existence of Software That Handles Medical Billing and Coding?   General Overview of the Medical Billing and Coding Process   

Medical Manager Billing Software for a Small Private Medical Practice

Medical Manager Billing Software is an effective and efficient IT solution for a private practitioner to manage a start-up or a smaller medical office more successfully. With the right software, you can look after your patients' care better and spend less time with administrative management. It would lead to a more satisfying patient-doctor relationship as well as a better service from the medical and administrative staff. The beauty about this system for small practice physicians is that many are offered with no upfront cost and as a free download for a trial period.

In determining the best type of medical billing software for your automation, you need to spend precious time reading about free and commercial billing and coding/EHR/practice management software reviews over the web. You have to compare the software solutions of some of the top rated ones for 2011 like the Lytec Medical Billing Software, MPMSoft, Medisoft Medical Billing Software, AdvancedMD, CollaborateMD and Total MD. You can then set up appointments for a free demo with those software developer companies whom you have discovered to specialize in automating small medical practice.

You may opt to enter into a service contract with a software company for the use of a reasonably priced system that offers basic, easy to learn and convenient to use features. It would be to your advantage to identify software which is a mix of EHR and practice management dealing with insurance claims and financial management rolled into one. However, some experts suggest that a small office can secure a deal with a software developer corporation that provides training and support in the use of their system covering office management automation as well as electronic billing, coding, dealing with patients, clearing houses, insurance companies, denial management and appeal of claims, etc. at a discounted rate under a negotiated arrangement.

There are software companies who offer to sell their medical manager software or optional alternative of billing services where they charge a certain percentage based on the number of electronic claims in a month like EZ Claim. Many users now want a software solution with the capacity to provide insurance billing, account receivables monitoring and electronic transmission of claims using the new electronic claim format and insurance templates.

One software corporation which caters to small office medical practice for many years now is Health Data Services Inc. With its FreeDom IT solutions, the company envisioned their technology to be the complete solution for smaller medical offices. It is both an EHR and a practice management system. It is easy to learn and easy to use. You can start immediately with a free download and usage for three months. After 90 days of enrollment, should you want to continue, the arrangement will be a charge of a minimum of $100 per month based on the number of billing claims. This includes your choice of at least 2 optional services such as claims generation and formatting and e-prescriptions.

FreeDOM sends all of your electronic claims exclusively through their own HDS Clearinghouse. The latter transmits claims electronically to major, government, corporate payors and insurance companies. For claims not coursed to the clearinghouse, you can use the HDS Print and Mail Services. The price is 50 cents per claim for clearing house services.

For e-prescription services, the fee per provider per year is $37.50 a month for 12 months plus an initial payment of $450. This amount is not applied to the monthly minimum fee of $100.

If you will analyze the low monthly minimum fee of only $100, the benefits you will gain in terms of reduced operational costs, faster collections and bigger revenues on the financial side and patient satisfaction, security and safety of your patient data base on the patient care side far outweigh the fees. As soon as your operations have expanded and you can already avail of an advanced certified medical manager billing software or whatever name the EHR/Practice Management solution is called, then it is the right time for you to upgrade.

Maximize Your Medisoft! (Unknown and Underused Functions of Medisoft)   Is the Job Growth Affected by the Existence of Software That Handles Medical Billing and Coding?   General Overview of the Medical Billing and Coding Process   

Why You Need a Compliance Plan

Most billing services know and understand the importance of having a well written contract but not all realize that they also should have a compliance plan in place. A compliance plan is for the protection of both the biller and the provider and it defines the policies and procedures to be followed. Each provider that they bill for should be given a copy of their compliance plan, and the plan should be reviewed on a regular basis. Improper billing practices can lead to civil or criminal offenses.

More and more providers are turning to third party billing services due to the complexity of billing. Some third party services also provide coding and other services as well. It is important that the provider is aware of their policies and procedures regarding claims submission and coding. It is best that the policies and procedures are outlined in writing to protect both the provider and the service.

In 1998 the Office of the Inspector General issued a guideline for compliance plans for third party billing services.

This guideline includes general principles that can apply to any compliance plan as well as specific guidelines. It identifies risk areas specific to third party billing services such as billing for services not documented, unbundling, upcoding, and inappropriate balance billing. There are seventeen specific risk areas identified.

It also suggests seven steps to prepare an effective compliance plan. The suggested steps are:

Step 1 - Implement written policies, procedures, and standards of conduct. A billing service should determine what and how services will be performed and write it down. All billing services know what they do and how they are going to do it, this just puts it in writing. It is a good tool not only for the provider, but for employees of the billing service as well. Employees need to follow the policies and procedures and it helps if they are in writing. If issues arise, the owner or manager can refer back to the compliance plan.

Step 2 - Designate a Compliance Officer and compliance committee. HIPAA mandates that any person or company handling PHI must have a designated compliance officer. Even if you are a one person show, you should be designated as the compliance officer. If the organization is larger, there should be a compliance committee as well. Any complaints or concerns would be addressed to the compliance officer. If there is a compliance committee then the issue would be brought to them by the compliance officer. The compliance plan should include the name of the compliance officer and contact information.

Step 3 - Conduct effective training and education. All billing services should have some form of training for all employees. They should also have ongoing education on any new issues or policies that arise.

Step 4 - Develop open lines of communication. Communication is the key to success. A compliance plan should encourage communication. Contact information for any owners or employees that would be appropriate for a provider to contact should be included.

Step 5 - Enforce standards through well-publicized disciplinary guidelines. In a perfect world this wouldn't be needed, but unfortunately there will be occasions where policies and procedures are not followed properly whether it was intentionally or not. It is important to have written guidelines for how infractions will be handled.

Step 6 - Conduct internal monitoring and auditing. Again, in a perfect world this wouldn't be needed. But, even the best of employees may make mistakes. It is important that monitoring and auditing is done on a regular basis to make sure that policies and procedures are being followed. When included in the compliance plan it assures the provider that the billing service is aware of what is going on internally.

Step 7 - Respond promptly to detected offenses and develop corrective action. When an offense is detected whether it was discovered internally or reported, it is important to respond promptly. Spelling out the actions that will be taken is effective for both the provider and for the billing service.

If you do not currently have a compliance plan you should implement one as soon as possible. The above list of suggestions should help. When your compliance plan is complete make sure you give a copy to each of the providers you bill for.

Copyright 2011 - Michele Redmond

Maximize Your Medisoft! (Unknown and Underused Functions of Medisoft)   Is the Job Growth Affected by the Existence of Software That Handles Medical Billing and Coding?   General Overview of the Medical Billing and Coding Process   

How Insurance Verification Services Helps Medical Practices

Health insurance verification is the process of confirming that a patient is covered under a health insurance plan. If insurance details and demographic details are not properly checked, it can disrupt the cash flow of your practice by delaying or affecting reimbursement. Therefore, it is best to assign this task to a professional service provider. Here's how insurance verification services help medical practices.

Gains from Competent Insurance Eligibility Verification Services

All healthcare practices look for proof of insurance when patients register for appointments. The process has to be completed prior to patient appointments. In addition to capturing and verifying demographic and insurance information, the staff in a healthcare practice has to perform an array of tasks such as medical billing, accounting, sending out of patient statements and prepare patient files Acquiring, checking and providing all patient insurance information requires great attention to detail, and is very difficult in a busy practice. Therefore more and more healthcare establishments are outsourcing health insurance verification to competent companies that offer comprehensive support services such as:

• Receipt of patient schedules from the hospital or clinic via FTP, fax or e-mail

• Verification of all necessary information such as the patient name, name of insured person, relationship to the patient, relevant phone numbers, date of birth, Social Security number, chief complaint, name of treating physician, date of service,, type of plan (HMO or POS), policy number and effective date, policy coverage, claim mailing address, and so on

• Contact the insurance company for each account to verify coverage and benefits eligibility electronically or via phone or fax

• Verification of primary and secondary insurance coverage and network

• Communication with patients for clarifications, if necessary

• Completion of the criteria sheets and authorization forms

One of the greatest advantages of outsourcing this task to an experienced company is that they have a specialized team on the job. With a clear understanding of your goals, the team works to resolve potential problems with coverage. By taking on the workload of insurance verification, they help you and administrative staff focus on core tasks. Other assured gains:

• Streamlined workflow • Fewer claim denials • Speedy billing cycle • Saved time • Quick insurance verifications and authorizations • Improved staff productivity • Simplified medical billing process

Companies that offer this service to help medical practices also offer efficient medical billing services. With the right service provider, you can save up to 30 to 40 per cent on your insurance verification operational costs.

Maximize Your Medisoft! (Unknown and Underused Functions of Medisoft)   Is the Job Growth Affected by the Existence of Software That Handles Medical Billing and Coding?   General Overview of the Medical Billing and Coding Process   

Hospital Forgives Medical Debt For 90 Year Old

A Colorado hospital forgave over $21,000 in medical debt for a local 90 year resident. Despite all the stories we hear bashing health care providers, a story where a hospital shows compassion is a welcome change of pace.

My client, Liz, owed a local hospital for services received in 2008 as a result of an accident. Liz was not eligible for Medicare, and had private insurance. After admittance to the hospital on an emergency basis, she remained there for rehabilitation treatment. Her claims were paid at out of network level, leaving her with significant balances owed. While she made small monthly payments, she never really understood why she owed all that she did and how she got into this mess.

Liz had no family to help her and lives in downtown Denver. When she called me, she pleaded with me to come down to Denver and meet with her to help her, as she was very confused about all of her medical bills. I made the trip from Loveland to Denver and sat down with her at a local McDonald's restaurant (she told me her kitchen table in her apartment was not big enough to spread out the papers). She entered the restaurant very slowly, using a wheeled walker. As I spoke with her and looked through all of the piles of bills, I was amazed at how bright and sharp and intelligent her blue eyes were, as she seemed to understand most of what I was saying, and was able to intelligently answer my questions. Needless to say, I was impressed with her and I certainly felt compassion for her circumstances. She wanted to do what was right, and pay her fair share, but the weight of these large bills were more than she could handle.

I wrote a well thought out letter to the hospital, petitioning them to forgive Liz's debt, and providing a rationale for why I felt that they do this. The amazing thing: I received a prompt reply from them. They agreed to bring all of her accounts out of collection, and reduce them to a zero balance, for both the hospital and for the physicians amounts owed.

What a wonderful outcome and phone call it was for me to call Liz and inform her of this great news. Imagine her relief to no longer have this burden. And, it is encouraging that the hospital administration truly do have a heart.

Maximize Your Medisoft! (Unknown and Underused Functions of Medisoft)   Is the Job Growth Affected by the Existence of Software That Handles Medical Billing and Coding?   General Overview of the Medical Billing and Coding Process   

Starting A Home-Based Medical Coding Business

Medical coding, apart from being a promising professional career, is today a fruitful and progressive prospect in terms of initiating a home-based business. You will come across various experienced medical coders, offering their medical facilities and services to various healthcare providers by working from their home offices. Not only is this business excelling nowadays, it can also help any medical coder earn a good amount of profits while gaining maximum exposure by dealing with various clients.

Also, making medical coding work as a home business can be a matter of utmost convenience as well because you are able to work on flexible hours and avoid increasing your expenditure that may come otherwise due to frequent commute. Nonetheless, it is important to have some keenness and enthusiasm so start-up with a business that requires you to be dedicated and diligent. This is because in the course of assignment, you need to have a comprehensive plan that you can follow to deliver the work on a timely schedule.

When you are in the midst of starting a medical coding business based at home, it is significant to acquire its training and certification. As this certification is high in demand, there are multiple schools offering even online programs that are affordable and quite convenient for one to pursue. However, before you enroll, make sure you have had a detailed look at the course structure, your budget and lifestyle to ensure whether or not you will be able to cope with the program. Not to forget, the accredited certification in the end would surely be worth the efforts.

Moreover, sufficient experience in established companies, hospitals or in a medical practitioner's clinic can prove to be quite valuable for such an initiative. A hands-on experience is quite valuable in this field, as one without any familiarity with the functioning scenario and task schedule of medical coding would not be easily hired by any company or hospital. Also, the exposure will give a better idea regarding the profits of the business.

Having done with the training, certification and the experience, you would then surely be ready to start-up your medical coding profitable home-based business. If you already have substantial amount of funds saved for the business, that is fine; otherwise, you would have to secure a loan to start-up a running business. Also, do not forget to market your services as this is quite a competitive field and clients are attracted to only the medical coder who is able to solve their problems in minimal time. Focus on what they require and what are their expectations, and your business will be thriving within no time.

Maximize Your Medisoft! (Unknown and Underused Functions of Medisoft)   Is the Job Growth Affected by the Existence of Software That Handles Medical Billing and Coding?   General Overview of the Medical Billing and Coding Process   

Hospital Business Offices and Healthcare Consumers

A recent study by a company that addresses healthcare office cash flow trends came up with some interesting findings on the consumer impact of hospital services, particularly billing. It suggests the vital role the "back office" operations as they are called, play in keeping patients satisfied. In addition to billing and collection, these activities include accounting, customer service, medical billing and coding and troubleshooting patient issues.

The number of consumers who gave top scores (5 on a 1 to 5 Likert scale) to hospital billing processes was just 21%. Good health made a difference in perceptions. Those who enjoy good health are more likely to be satisfied with business office processes with 52% of them giving high marks on their experiences. Those self-assessing fair or poor health were 39% more likely to rate the processes a 2 or less, with only 15% saying a 5. Time away from discharge also made a difference. Satisfaction with the overall hospital experience was 32% at the time of discharge and 22% post-discharge and after business office processes. Another consumer trend is that complaints about collection agency activity have reached an all time high. In fact, according to the Federal Trade Commission 2011 Annual Report, there were 140,036 complaints about debt collector practices compared to 119,609 in 2009. Medical debt is a primary driver of this.

These results suggest that there is a lot of room for improvement regarding office procedures and how they relate to the healthcare consumer, especially in the medical bill and claim resolution process.

One of the reasons for the growing awareness of business office practices by healthcare consumers is deductible creep. According to recent data deductibles have increased dramatically over the last two years.

For example, high deductible health plans and savings accounts (as of January 2011) cover 11.4 million lives. A year earlier, that number was 10 million and in 2009, it was 8 million.

Plus, the deductible amounts for workers enrolled in PPOs with single coverages increased 21% over three years from $560 to $675.

These and the other numbers suggest a trend. It points to commercial revenue that was considered high-recovery now being assumed with patient self pay bills. Historically, this is tougher to collect. And as indicated above, this aspect also influences potentially negative customer feelings about the whole medical experience, particularly the medical center business offices that bear the administrative responsibilities of the medical practices. This includes medical records, billing and collections.

Maximize Your Medisoft! (Unknown and Underused Functions of Medisoft)   Is the Job Growth Affected by the Existence of Software That Handles Medical Billing and Coding?   General Overview of the Medical Billing and Coding Process   

Why Medical Billing and Coding Jobs Are in Demand Nowadays

What does a medical billing and coding personnel do? Why is it that this job is very much the trend and in demand nowadays? For one, hospitals, private doctors, insurance companies - for their insurance programs like Medicare and Medicaid, community hospitals, medical outsource companies, nursing caregiver facilities; home health care, long term and outpatient care facilities, etc. greatly need the expertise of somebody to efficiently perform medical billing and coding for them.

There are lots of employment opportunities for those with this kind of expertise. You will not be surprised to find yourself working with private lawyers helping out with the claims of patients of their clients, the hospitals, private clinics and even rehab and physical therapy facilities. If you are seriously inclined to engage in this field, you can be both the employer and employee coder/biller from the comfort of your home armed with a top-of-the-line computer, high tech software and internet access.

Usual job openings are as medical billing specialist, in patient or outpatient coder, billing clerk, billing associate, senior claims operation associate and many more. As a billing specialist, you must have at least a one year hands-on experience and knowledge of the latest coding software. Your responsibility is the procedural and diagnostical coding of every patient case, supervision of accounts receivable and patients' statements of accounts.

For the job of a billing associate, you should have at least finished High School or possess a GED equivalent and must have at least 2-3 years experience in medical billing. You must have technical knowledge with computers and skills with MS Excel, EMR, electronic claims, billing procedures and revenue monitoring.

If you are after the position of an outpatient coding specialist, you should have finished High School or GED with at least one certification as a Certified Coding Specialist (CCS), Registered Health Information Administrator (RHIA) or Registered Health Information Technician (RHIT). In addition, a three years coding experience in ICD-9-CM, DRGs, and CPT/HCPCS, including modifiers and APCs are necessary.

Let us go into details with what your job as a Corporate Outpatient Coding Specialist will be. You are to coordinate with the Health Information Management group to provide outpatient surgery coding support. Assignment of accurate diagnostic and procedural codes with ICD-9-CM and CPT / HCPCS (3M coding software), and appropriate references is your main responsibility. Another important work is the centralization of a coding system for CHS hospitals through scanned medical records and abstracts by way of access to hospital abstracting systems. In addition, you will be making independent decisions regarding accurate code assignments. The decisions you make will determine the formulation of appropriate company policy, reimbursement viability of CHS and corporate compliance with regulatory requirements for an accurate billing strategy.

When it comes to a senior claims operations associate job, you should have a High School diploma, at least 2-3 years experience in Medicare Part A and B claims processing and medical billing, knowledge in medical coding like CPT, HCPC, ICD9 and DRG. Your job is data entry, review and process, and monitor and log production of error free claims.

Having a bachelor or postgraduate degree, proven track record experience, updated knowledge and technical skills with the latest technology coding, certification from the American Medical Billing Association are your plus factor credentials. This is the reality of the supply and demand free market. A medical billing and coding job is trendy and much in demand nowadays! If you are competent, a very bright future awaits you with a competitive compensation and bonus packages as well as a fantastic professional development career with the way things are shaping up in the medical industry!

Maximize Your Medisoft! (Unknown and Underused Functions of Medisoft)   Is the Job Growth Affected by the Existence of Software That Handles Medical Billing and Coding?   General Overview of the Medical Billing and Coding Process   

How The Hospital Payment Processing Really Works

Hospital Billing

There is no doubt that everyone feels a real jitter and have butterflies in their tummy whenever they visit a hospital either for a planned check up or even during emergencies. The jittery feeling is due to the worry about the hospital bills that they will be facing. It is never an easy task or a layman to calculate approximately what the hospital billing would look like. Most of the times you will feel that the billing done by the hospital are expensive and a bit confusing too. There are plenty of staff in the hospital at the billing section who are trained to help you out know how the billing has been calculated and what are all included in the bill.

Electronic Billing And Payments

Medical billing and hospital payment processing is a fast developing and growing field and it has become a norm in most of the countries all across the globe. As there are rapid advancements in technology, there are also vast improvements in hospital payment processing methods. Now, all the bills pertaining to a patient are filed as hard copies in single folder and are mailed to the insurance provider through e-mail. There are plenty of software that are available that will allow in carrying out the hospital billing on the computer. There are plenty of coding software that are available these days that will help in quick and accurate processing of bills and will also be less time consuming.

There are a lot of hospitals that now accept credit or debit cards from patients and this is considered one of the easiest hospital payment processing method that will save a lot of time both or the patient as well as the hospital. Everything will be done electronically once the patient's card is swiped in the electronic credit card reading machine. The request for issuing the payment pertaining to the bill has to be keyed in and once the bank authorizes the payment electronically, a payment slip will be generated by the machine and the bill amount will be transferred from the patient's account or bank to the hospital's bank account.

Payment From Patients

If the patient is not covered by any medical insurance, then the patient will be needed to pay the hospital amount in advance for planned admissions or during the check in time for emergency cases. Most hospitals all over the globe would accept cash, check, credit or debit cards and even money orders as payments. There are also hospitals that will be offering pay out plans by offering financial assistance to patients who are cash struck and do not have the full amount to pay or their treatment.

Conclusion

With all the latest technologies in place, hospital payment processing is not a difficult or tiresome job anymore. In fact, it has really eased the job and also provides the patients as well as the payment receiver hassle free payment processing which does not include any counting of liquid cash or writing of checks and so on. Everything is doe electronically and in a speedy manner that will save the time o the patients as well as the hospital staff.

Maximize Your Medisoft! (Unknown and Underused Functions of Medisoft)   Is the Job Growth Affected by the Existence of Software That Handles Medical Billing and Coding?   General Overview of the Medical Billing and Coding Process   

Rising Medical Costs - Figures and Financial Help

The devastating emotional consequence of severe illness is something we hope to never have to experience; either for ourselves, family or friends. But a recent report published by children's cancer charity CLIC Sargent revealed that the financial effects of cancer and young people in the UK should also be a cause for concern.

On average, the report revealed that parents and young people spent £367 and £277 respectively on extra expenses every month as a result of a cancer diagnosis and its treatment - amounting to an additional annual spend of £4,400 for parents and £3,325 for young people.

However, the most worrying finding was that two thirds of parents surveyed had built up debt as a direct result of the additional costs of childhood cancer, with 6% of those forced to borrow money through through high interest, short-term payday loans to make ends meet.

Speaking in the report, Lorraine Clifton, chief executive of CLIC Sargent, said: 'Many families told us how their money worries nearly brought them to breaking point at a time when they were already dealing with the life-changing impact of childhood cancer.'

After the shock of cancer diagnosis, the cost of caring for children with cancer is often unexpected. These costs may include travel to vital cancer treatment at specialist hospitals often miles from the family's home, additional childcare for siblings and increased food and heating bills to name just a few.

The government does provide some statutory support known as Disability Living Allowance (DLA), a tax-free benefit for children and adults with disabilities to help with the extra costs of living with a disability, but it is often not enough to cover the rising costs of care, particularly when children are involved.

In some cases, private health care provided through medical insurance may offer families a small peace of mind in such difficult circumstances. However, it is important for families to be certain what is covered in their medical insurance policy before purchasing, as different insurers offer different levels of cancer cover. In some instances private health care may mean treatment at a time and place which is most suitable for your child and family. In other instances, the NHS and private hospitals will have access to different drugs and treatments.

Those considering purchasing private medical insurance as a result should always consult an independent private medical insurance advisor to see whether specific illnesses are covered. A medical insurance broker can help to make an effective comparison of various medical insurance policies available, such as individual or whole family.

Maximize Your Medisoft! (Unknown and Underused Functions of Medisoft)   Is the Job Growth Affected by the Existence of Software That Handles Medical Billing and Coding?   General Overview of the Medical Billing and Coding Process   

The Advantages of Flat Fee Billing

The most common way billing services charge providers for their services is with a percentage of the receivables. This is often based on what is actually paid by the insurance carriers and sometimes the patients depending on the agreement between the billing service and the provider. This type of arrangement often works well for both as it is an incentive for the billing service to do a good job as their pay depends on it. There are both advantages and disadvantages to this way of charging the provider.

First of all, in some states it is illegal for the provider to enter into such an agreement as it is considered fee splitting and prosecutions have resulted. It is not common for providers to be prosecuted for entering into this sort of arrangement but it is a possibility and should be considered. Two states we know of that have fee splitting laws in effect are Florida and NY. So as a billing service you may think you are off the hook because it is only illegal for the provider to enter into this sort of arrangement but not so. The problem for the billing service is that you have entered into a contract that is illegal and unenforceable. So if you end up in court for any reason such as the provider didn't pay you for the last three months, basically your contract may not even protect you at all. It can be found to be an illegal contract and not enforceable.

So what's a billing service to do? Why not consider flat fee billing? Most billing services do not want to consider it as they don't know how to come up with a reasonable flat fee and providers are used to being quoted a percentage so they can't compare your price as easily. So if we tackle these two objections, you can start offering a flat fee instead of a percentage and you may find many advantages.

When a doctor objects to a flat fee for his billing instead of a percentage it is usually just because he can't compare it to other offers. Some providers are not aware that this practice is illegal and when they find out that it can get them in trouble they want to hear about other alternatives. A billing service can explain to the potential provider that they do not ever want to steer a provider toward an action that could be considered illegal or get them in trouble. They are here to help the provider and to keep the provider from doing anything that unintentionally that could be considered a problem later on.

Even if you are in a state that allows percentage billing it can be an advantage to the provider to know up front what it is going to cost him or her every month to have someone taking care of the billing outside of the office. From a billing service standpoint I much prefer a flat fee so I know what I can expect each month. With a flat fee I have a much better idea whether or not we are making a profit on that account. When charging a percentage it can fluctuate enough to leave you wondering if the account is worth the work. There are many circumstances that can affect payment that were in no way caused by the billing service who still did the full amount of work, but because the income was down that month, the billing service doesn't get paid either. Here's an example.

We had a provider sent his information by fax a couple times a month so we didn't see him often. He moved his office and didn't tell us. By the time we found out, so did Medicare who stopped his payments as they will if mail can no longer be delivered to the address they have on file. We filed a new 855I for him and waited three months for his application to process before he started receiving Medicare money again. We also waited three months before we could bill him again.

The important thing here is that you recognize the advantages and disadvantages of all methods of charging your providers and you choose the one that works best for you.

Copyright Alice Scott - 2011

Maximize Your Medisoft! (Unknown and Underused Functions of Medisoft)   Is the Job Growth Affected by the Existence of Software That Handles Medical Billing and Coding?   General Overview of the Medical Billing and Coding Process   

Keys To Keeping Good Medical Records

Medical records are an important part of any medical practice. Keeping good records is essential in avoiding an audit or possibly not getting payment from an insurance company. Several auditing groups include, licensing boards, payers, litigants, accreditation organizations, each one is looking for specific things in the documentation. Licensing boards want to find out if the doctor acted within his or her scope of practice or if they were grossly negligent. Payers want to determine if a claim is justified for reimbursement. Litigants want to know whether a breach happened during care. Accreditation organizations want to determine if their standards and elements of performance have been met by the doctor.

These are some general requirements for documentation.

Medical Records should be complete and are legible. Documentation of each patient that is being seen should include a reason for the visit and a history that is relevant to the complaint, physical examination findings and any prior diagnostic test results, a full assessment and clinical impression and diagnosis, a plan for care and date the record along with signature of attending physician, nurse etc. Reason for ordering tests. If this is not recorded, it can be easily proved that it was not necessary. Past and present diagnoses whether it be from the patient or other past office visits from other physicians. Appropriate health risk factors should be identified and noted. Patient's progress, response to changes in treatment, and a change of diagnosis should be clearly documented. The CPT and ICD-9 codes reported on the insurance claim form should always be supported by the documentation in the medical record.

Meeting the standard of care medical records must:

Document any details regarding a patient's history during the exam Document referrals Document refusals of treatment and the reason the patient has refused treatment Document that the physician has clearly reviewed the possible consequences of refusing a specified treatment to the patient Document encouragement of the physician of healthcare maintenance and risk reduction (example: weight loss or smoking) Document advice that has been given to the patient (example: pink eye can spread to others in the family) Document patient noncompliance with treatment regimen or referral, including the patient's reason for not complying and advice to the patient about the risk of failing to take the advice given.

Good medical record keeping is an important part of good business. The consequences of errors can result in a denial of payment, audit, loss of contracts, accreditation or possible lawsuit brought on by a patient. It may take longer to do but in the end it benefits you, your practice and most important of all your patients.

Maximize Your Medisoft! (Unknown and Underused Functions of Medisoft)   Is the Job Growth Affected by the Existence of Software That Handles Medical Billing and Coding?   General Overview of the Medical Billing and Coding Process   

Stop the Bleeding! - Ways to Prevent Unnecessary Loss of Income During These Hard Times

For most Americans, whether or not the government has officially declared these times as a recession or a depression, things are a little tougher than they were 10 years ago. This includes doctors. Many patients think that all doctors are living good and aren't hurting like "the rest of us" but that isn't true. Doctors are feeling the pinch now too. After all there are a lot of expenses in running a medical office, especially with all of the changes going on with EMR and ICD 10.

They have the normal expenses of office space rent, taxes, receptionist(s), nurse(s), physician help (NP's or PA's), insurance, office supplies, utilities, computers, software, and the list goes on. In addition to that many are faced with needing to buy new software to be compliant with the EMR laws and training expenses to prepare their staff for the switch to ICD 10. Most patients really don't have any idea how much a doctor has to pay just to keep their office open.

Now more than ever medical providers need to "stop the bleeding" by plugging the holes in their office that are causing them to lose money. One of those holes for many providers are denials. I read a statistic a while back that said that 47% of denied claims are never appealed. To me, that number is staggering. Sure there are claims that are denied correctly, the services may not be covered, or the patient may have met a maximum and the patient is responsible for the charges. But I don't believe it can be that many. And unfortunately, I've been in enough medical offices to know that many have office staff that are just not dealing with the denials.

I have found there are a couple of different reasons why denials in an office can go neglected. One of them is due to lack of time. Many offices are chaotic. They not only have the regular patient load, which in and of itself is enough to keep them running all day, but they have the add on patients who just have to be seen immediately. In addition, they've got the phones ringing, someone has called in sick so they are short handed, and they've got pharmaceutical reps coming in. You get the picture. They barely have time to get the billing out, possibly record the payments that have come in, but handling denials? Maybe they will get to those tomorrow. Unfortunately tomorrow never (or at least not usually) comes.

The staff isn't purposely ignoring the denials. They truly think they will get to them. The problem is that many insurance carriers have time limits on when a claim can be appealed. Most allow 60 or 90 days from the date the claim was processed to file an appeal. Also, if the denial means that a different insurance needs to be billed the timely filing limits on that carrier may be reached if the denial isn't handled quickly. If the denial means that the patient needs to be billed, the odds of getting payment are greater the closer it is to the date the services were provided. The doctor usually isn't even aware there is a problem. Many times, neither the doctor nor the staff have any idea how much money the office is losing due to these denials not being handled.

Another reason that denials go unresolved is if the staff in the doctors office doesn't know how to handle them. It's not always that they don't have a good comprehension of medical billing, but they don't always know what needs to be done in the case of certain denials. It may be a denial they are unfamiliar with or haven't run across before. Or it may be an insurance carrier that they haven't dealt with much. If they don't know how to handle it then it may go unresolved.

In some cases, doctors hire people to do their billing that don't have a good comprehension of medical billing. In this case not only do the denials go untouched, but there are a larger number of denials than there are in an office with an experienced biller. It is unfortunate, but some providers don't understand the importance of the billing.

No matter the reason that the denials are not being handled, the important thing is that the doctor do something to change it. There are a couple of things that can be done. First, see if there is anything that can be done on the initial billing to prevent any of the denials that are being received. If a doctor is receiving a lot of denials for terminated insurance plans then the staff needs to do a better job of verifying the insurance with the patient at the time of their visit. Maybe they are not asking the patient when they come in if there are any changes in their insurance information. Many patients forget to inform their doctor when they change policies. Having the receptionist ask will cut down on these denials.

Another thing that can be done is to develop a system for handling each denial. Having a system will eliminate the need for the staff to determine what needs to be done each time a denial is received. For example, if the doctor receives a denials for timely filing the staff should know exactly what to do. First, check to see if the claim was originally submitted in a timely manner. If it was, a claim should be reprinted along with proof of the original submission. If the claim was submitted electronically that proof may be an electronic report verifying the first submission. If it was a paper claim, it may be a patient ledger printed out from the practice management system.

In addition to the claim and the proof, an appeal form should be attached. It's best to design a generic one for the insurance carriers that don't have their own adjustment forms. This will cut down on time since the staff can just simply grab the generic form and attach it to the claim and the proof instead of writing up new one each time one is needed. For the carriers that have required adjustment forms, they should be kept handy for quick and easy access.

Having a system in place for each denial will greatly reduce the amount of time needed to file the adjustment request or submit an appeal. It will also make the process easier for the staff so it won't be such a dreaded task. Reducing the number of denials received and having a system for handling those denials will help the staff be able to deal with them in a more timely fashion.

In this economy a doctor must do all they can to ensure that they collect all of their receivables. Their growing expenses coupled with the declining reimbursement rates from insurance carriers make it a necessity to reduce the amount of money lost to unpaid or denied claims. Making sure that denials are being handled is one way they can "stop the bleeding".

Copyright 2011 - Michele Redmond

Maximize Your Medisoft! (Unknown and Underused Functions of Medisoft)   Is the Job Growth Affected by the Existence of Software That Handles Medical Billing and Coding?   General Overview of the Medical Billing and Coding Process   

6 Benefits of a Medical Billing Service

In these uncertain times, with all the changing regulations of how claims are submitted, received and processed by Insurance Carriers, it can be quite overwhelming financially. The most common questions asked are... Am I collecting the maximum amount possible? How do I know I am collecting as much as possible? How can I increase my revenue? Perhaps a Medical Billing Service could answer all of these questions and calm the angst that is associated with them. There are many benefits to a Medical Billing Service. Below are six benefits that are explored in more detail.

Increase Collection Rates with a Medical Billing Service

Many people are under the impression that Medical Billing is merely data entry; however, it is much more than that. In order to bring in the maximum amount of money on the claims being submitted there needs to be follow-up on the claims. This often times is where in-house billing falls short, depending on the amount of staff that is part of the department, claim submission and payment posting become the priorities. For instance if you have one biller in a two physician practice that sees a decent amount of patients per day, the biller's time is mainly going to be spent on creating, submitting and posting payments for claims. Entering in the claims, and reviewing each claim before it gets sent to the insurance carrier is time consuming. This is also true with payment posting; it is time consuming to post the money received to each CPT code, yet extremely important. With just those two responsibilities, there is little time left for the claims that require more action. Most often the claims that are denied require little action in order to become paid claims. However, it does take time to follow-up with the insurance company to see what is required to get the claim paid. Follow-up alone is a full time position. With a Medical Billing Service there are multiple personnel working for your practice. Often times there is one full time dedicated person following up on all claims that require further action. Instead of paying for two full time employees most Medical Billing Services have follow-up on claims as a standard service of Claim Processing.

Increase Profitability with a Medical Billing Service

There are multiple ways that a Medical Billing Service can increase the profitability of a Medical Practice, including, but not limited to staff availability, eligibility services, and CPT trending. When you hire a Medical Billing Service you are getting multiple billers working on your account. There is constant activity with claims submissions, payment posting, follow-up, patient billing and account inquiries. If one of those billers happens to be out, there are multiple billers there to fill in, ensuring that no work is left until that biller is back in the office. This means there is no disruption in the Billing Process and no hiccup in the revenue received. Patient Eligibility is one of the easiest ways to ensure proper payment of claims. Before the patient even walks through the door, the patient has had their eligibility verified. This in turn ensures the practice that the patient is currently covered under the insurance carrier on their file, and any referral that is needed has been obtained. It also allows for any Insurance Carrier discrepancies (such as a change of insurance, mistyped ID number, etc) to be fixed prior to the visit, leading to an increase in "clean" claims, which in turn leads to an increase in profit for the practice. Another way to increase profitability with a Medical Billing Service is through CPT trending. When payments are getting posted to CPT codes, the billers often see a trend to what codes are being paid and how much is being received per code. This can often lead to two different scenarios. One being that certain codes are not being paid on, which in turn allows the practice to decide whether or not to continue to offer that service to their patients, or find an alternative or comparable service that they can provide and which will be paid. The second scenario is that the practice is performing a procedure often, therefore allowing a renegotiation with the Insurance Carrier of how much to be compensated. The above are only three out of many ways a Medical Billing Service can help Increase Profitability for a Practice.

Increase Physician Productivity with a Medical Billing Service

When a physician is confident that the financial aspect of their business is in good hands, and is not worried about whether or not claims are being submitted and money is being collected, they can focus on what is the most important aspects of a physician's job - patient care. With a Medical Billing Service if there is a CPT code in question or a diagnosis code that cannot be found, the Medical Billing Service will be able to assist in finding that code. This in turn allows the physician to keep on seeing patients and charting without skipping a beat, instead of sitting and trying to figure out what the code is. Similar to CPT trending, which helps increase profitability, a similar trend happens when the billers are reviewing claims prior to them being submitted to the insurance carrier. The billers will assist the physicians when there is a conflict in the codes being billed or if they see something that is being repeated that will help the physician and save them time when doing their chart notes. Many Medical Billing Services offer the services of a Business Analyst who will work with the physician and their office staff and provide suggestions on how to maximize the usage of tools on hand (i.e. EMR, MAs, office flow, etc). This will increase efficiency and productivity.

Increase Staff Productivity with a Medical Billing Service

As well as offering the services of a Business Analyst, some Medical Billing Services will also offer training on how to properly register a patient, collect co-payments, and create an optimal office flow that will increase productivity throughout the office. Many office staff members do not realize the importance of their job; not realizing that they are projecting the first impression on patients that walk through the door. Properly trained office staff will give more of their attention to the patients, which in turn will be appreciated by those patients who are also more likely to recommend the physician to their friends and relatives. Along with increasing the efficiency of the office a Medical Billing Service also eliminates many patient calls regarding their accounts. When a patient has a question regarding a statement, or a bill that they have received either from the office or an insurance carrier, the call is handled by the Medical Billing Service. They are able to assist your patient in a professional manner, without the pressure of having to check in patients, answer the phone, etc. The attention and professional manner in which the Medical Billing Service personnel conduct their business will assure the patients that their questions and concerns are being dealt with properly.

Decrease Claim Denials with a Medical Billing Service

With a Medical Billing Service, the staff that is dedicated to your practice goes through each claim before it is submitted to make sure that it is a "clean" claim. A "clean" claim is what it sounds like; a claim that has the correct CPT codes associated with the diagnosis codes, complete patient information, and complete insurance information. This decreases the chance of denial by the insurance company. Medical Billing Services ensure that the highest percentage of "clean" claims possible are being submitted to the insurance carrier. This increases the revenue coming back to the practice as well as decreases the amount of labor needed to follow-up on claims. Medical Billing Services know that the time spent reviewing claims to make sure they meet the insurance carrier standards is well worth the time.

Gain insight into your practice financials with a Medical Billing Service

A Medical Billing Service knows which reports to run to give physicians complete insight to the financial side of their practice. Medical Billing Services know what money is being billed out to the insurance carriers, as well as what is being received from insurance carriers and patient payments. This is turn allows the Medical Billing Service to run the appropriate reports that show the physicians what they want to know, instead of giving reports that show miscellaneous data that does not pertain to the main financial insight of the practice. Many Billing Services are also able to provide physician requested financial reports very easily. For instance, if a physician needs to know how many specific procedures were done in a date span for Credentialing, the Medical Billing Service can easily obtain this information. Another way to gain insight into the financial side of the practice is to trend how the insurance carriers are paying. If an Insurance carrier increases or decreases the amount received, it will be seen right away by the Medical Billing Service, thereby allowing the correction or renegotiation of any discrepancy in payments.

Revenue is generated by the clinical side of the practice, meaning that physicians gain revenue by seeing patients, not by doing administrative work. Increasing time spent on the clinical side, means increasing the amount of revenue.

Maximize Your Medisoft! (Unknown and Underused Functions of Medisoft)   Is the Job Growth Affected by the Existence of Software That Handles Medical Billing and Coding?   General Overview of the Medical Billing and Coding Process   

How To Keep Up With So Many Changes in Medical Billing

There is so many changes happening in the medical industry that has physicians and medical insurance billers stressed out and frustrated. It's getting more and more difficult to maintain a steady revenue due to changes in HIPAA laws, coding changes, government mandates and payer rules. Here are some practical ways to improve your practices revenue flow.

CPT CHANGES IN 2012

Using Modifier 33 (Preventive Services)

What this modifier does is designates that the code you are using is a preventive service which means that the patients receiving these services are receiving them at no cost, (no cost sharing happens when this modifier is used).

These services must be identified before billing so patients are not billed inappropriately which could prompt many phone calls to the office.

New Patients Versus Established Patients

The definition of a new patient is one that has not received any professional services within the past 3 years from the physician or another physician of the same exact specialty. If you have a subspecialty in your practice, make sure you correctly identify when a patient can be billed as a "new" patient; In order to maximize your reimbursement. By doing this you will see a difference in reimbursement of up to 15% to 20%.

Prolonged Evaluation and Management Services

Time that must be spent related to a patients visit is often times separate from the one-on-one or face to face codes that are often used. For code 99358 (prolonged E/M service before/or after direct patient care for the first hour) the wording of "face to face" is not in the description, which can affect code 99359 (each additional 30 minutes).

At one time, these two codes were once limited and could only be used by physicians, they are now available to use by other qualified healthcare professionals. If your practice employs other qualified healthcare professionals, make sure that these codes are being used when it is necessary and appropriate.

Medicare Physician Fee Schedule

Medicare payment rate for the physician's fee schedule was threatened to change for the year 2012. There could have been a possible decrease in the physician's fee schedule of 27.4% this year. This would have really hurt doctors who treat Medicare patients, and would have made it harder for seniors to find physicians.

However on Friday, February 17, 2012 Congress passed an extension of the payroll tax for the rest of 2012.

Many physicians are very busy and don't have the time to evaluate every single change made but it is very important to be proactive in their practice and keep up to date with the ever-changing rules and regulations set forth by different entities. Time that is set aside to research such things will only make the physicians practice more efficient.

If you are using a Medical Billing Service, they should be keeping you up-to-date with the changes of 2012, so that you can just focus on your patients.

Maximize Your Medisoft! (Unknown and Underused Functions of Medisoft)   Is the Job Growth Affected by the Existence of Software That Handles Medical Billing and Coding?   General Overview of the Medical Billing and Coding Process