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.

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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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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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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

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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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