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Monday, November 26, 2012

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.

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.

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.

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.

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.