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.

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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.

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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.

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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.

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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!

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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.

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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.

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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.

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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.

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