A well designed medical billing process does not allow errors to propagate. This design tenant results in less effort required to collect payments and payments arriving much faster. One of the most important manifestations of this concept is insuring that claims are clean before they are submitted to payers.

Implementing a process that submits clean claims can lead to days in AR of less than 45.

If claims are indeed submitted clean, then over 90% can be paid after the first submission. This leaves a much smaller number of "real" issues for the medical billing staff to pursue. By eliminating avoidable errors, collections accelerate and increase (since in many billing offices there is no time to perform basic tasks like no response calls). A key tool in realizing these improvements is a claim scrubber. These scrubbers, which are used by all leading medical billing services, compare claims to the rules utilized by payers to decide if a claim will be paid. These scrubbers include:

* A Basic Demographic scrubber. Such a scrubber insures that the basic elements of the claims are in place (for example, a 9 digit social security number that is not composed of repeating numbers, a valid date of birth, etc),
* Coding and Diagnosis Scrubber. This scrubber looks for ICD-9/CPT mismatches based upon Medicare and CCI rules. The rules not only identify sources of denials, but also identify overlooked CPTs.

These scrubbers will lead to a marked improvement versus a billing process with no scrubbing; they are, however, not a complete scrubbing solution. A full solution requires a scrubber that can have a customized rule set that takes the knowledge of the billing company or medical practices and codifies it so that it can be applied to every claim before submission. This scrubber is:

* Knowledge Management Scrubbers that allow the medical billing operation to continually reevaluate the adjudication rules of each payer and update the rules accordingly. The proper implementation of the scrubber requires a clear feedback loop from the follow-up department to the scrubber so that the lessons learned from denied claims can be quickly incorporated in to the scrubber. Any top notch medical billing service utilizes a scrubber like this.

Medical Practices will see a significant improvement in both the speed and the magnitude of collections if the begin using the scrubbers outlined above. With all of the technology payers employ to minimize the amount they pay to providers, it is difficult to survive without utilizing these scrubbers.



Article Source: http://EzineArticles.com/?expert=Carl_Mays_II

In September, the Chiropractic Office Billing Precision Index (BPI) gained 2 points above its August mark. Overall, September BPI reached 21.2 under-performing the national average of 17.7 by 3.5, and 5.7 points away from its best record of 15.5 in March of 2008.

Keeping one hundred percent of its August membership unchanged, three members of the September index, changed positions. Specifically, while BCBS Illinois and CIGNA retained their top first and second positions respectively, Medicare Illinois and Blue Cross Blue Shield New Jersey each upgraded their positions, pushing United Healthcare down two levels to the fifth position.

Billing Precision Index 21.2 - September 2008

1. Blue Cross Blue Shield Illinois 7
2. CIGNA 13.6
3. Medicare Illinois 13.8 (up from #4)
4. Blue Cross Blue Shield New Jersey 14.6 (up from #5)
5. United Healthcare 16.27 (dropped from #3)
6. Aetna 22.1
7. Medicare New Jersey 28.9
8. Blue Cross Blue Shield South Carolina 40
9. Medicare South Carolina 49
10. Medicare Indiana 62

BPI = 21.2 means that the average of ten top performing payers, used by the patients of Billing Precision providers, reached 21.2% of Accounts Receivable beyond 120 days.

Note that an insurer can turn a profit even if the cost of administration and insurance claims exceeds the premiums it collects. It does so by investing income on the float in stocks and bonds between the time when a client pays a premium and the time when the client needs payment for his or her medical expenses. For instance, Aetna (number six on BPI of September 2008), taking advantage of the float, earned about 7% net interest income on the premiums, bringing its total profit margin to around 14% (ignoring taxes and other revenue sources).

BPI is one of the few important billing performance characteristics because it approximates the proportion of claims that are never paid. It is also a key billing transparency instrument, which allows the practice owner to see both the big picture of office billing and its position within the national average.


Article Source: http://EzineArticles.com/?expert=Yuval_Lirov

How efficient are you in your claims processing. How many providers are in your office? How many billing clerks do you have?

In our office we know that one medical billing clerk can easily handle the paper work of up to ten providers. If you have three billing clerks, do you have thirty providers? If your ratio is not as good, likely as not you are buried in bureaucracy. I go into office after office and see it. The management (physicians) is led to believe the work just cannot be done with any less employees. The truth is a completely different story. The more employees the less efficient the office will be.

The adage that if you have one person in an office you have one interruption an hour and if you have two people in an office you have four interruptions an hour and three you have nine interruptions really holds true in the medical profession. You have to wonder what work is keeping them so busy. I see billing clerks with their desks piled high and it stays that way; day after day, week after week.

We set them up to scan documents to us. Everything is automatic. They simply load fifteen or twenty sheets into the document feeder, push the little green button and the machine does all the rest yet they do not seem to even have time to do that. When questioned, there is a litany of excuses as to why, but none seem to be related to assigned tasks.

In so many cases it is the socialization that stands in the way. Do yourself a favor, exam your staff and cut out the dead weight. If you have someone who is really busy, they can get the work done but if you have someone who does not stay busy, they are never able to even keep up.



Article Source: http://EzineArticles.com/?expert=Nat_Wynn