Medical Billing Information

EHR Adoption - New Jersey Experiments With EHR to Cut Physicians' Paper Work

2010-06-25T06:05:00.005-07:00

Can billing offices save time and money in insurance payments through EHRs?

Last month, five national health insurance plans along with the two largest plan industry groups announced that they will be launching a groundbreaking initiative in New Jersey to cut insurance paperwork for physicians' offices.

If it's successful, the initiative will be the first experiment in EHR adoption to cut down on chasing insurance money, what providers say is the biggest time and money drain on their practices.

According to a New York Times article about the initiative, the five plans - Aetna, AmeriHealth New Jersey, Cigna, Horizon Blue Cross Blue Shield of New Jersey, and United Healthcare represent about 95 percent of privately insured patients in New Jersey.

The plans are collaborating with two industry groups, America's Health Insurance Plans (AHIP) and the Blue Cross Blue Shield Association (BCBSA), and are using a multi-payer web portal developed by NaviNet, Insurer Connect.

According to AHIP, five physician groups are also collaborating on the project, namely, the Medical Society of New Jersey; New Jersey Academy of Family Physicians; New Jersey Association of Osteopathic Physicians and Surgeons; New Jersey Medical Group Management Association; and Partners in Care, Corp.

The health plans will provide the portal service to 50,000 providers at zero cost, and NaviNet says it will offer them one place where they can, in real-time: check eligibility and benefit information; submit and inquire about claims; and check referral and authorization submissions.

A probable twist in the system is that the individual plans still have to feed the site information, and not all the plans provide the same level of electronic health data, according to the Times. This means that doctors will still be obtaining different levels of individual EHR info from different subsections of the NaviNet portal.

However, provider groups are hopeful. Leaders at the New Jersey Academy of Family Physicians, one of the collaborating physician groups, continue to state their concern that administrative responsibility on physicians grow every year, but they affirm that this initiative is at least a step in the right direction.

A study put out late in 2009 by the Center for Studying Health System Change and referenced on the NJAFP's web site found a gap between policymakers' expectations of and practitioners' experience with EHR. According to the study, what's really required to make EHR work is to reform payment policies to address coordination of care, even within a single providers' office, but certainly among practices.

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Getting Technical With Your Patient Record Pay Offs - Here is Why

2010-06-25T06:05:00.003-07:00

Not an EP? If you know the ropes, here are other ways EMR can save you cash.

If you have not seen or lead a conversion from paper records to an EMR system, you are least aware that the process is a big undertaking - that very often results in even lower productivity and more confusion. As such, is the change really worth it? Experts agree that going electronic is worth it. Here's why:

1. Open more cash inlets

There are many research studies which pull their data through electronic records. Therefore if you cannot tune in to participate, opportunities for cash perks will fly by. For instance, grant money and incentive programs are available and they want data in the electronic form, according to Francine Wheelock, PT, MPA, manager of clinical systems for MaineGeneral Health. Just take a look at the nationwide push for value-based purchasing and outcome data, and expect to take the electronic route if you want to be in the loop.

Remain alert: Last year, the federal government launched HITECH act, which plans to pay eligible healthcare professionals incentives for the "meaningful use: of certain EMRs.

Kate Romanow, director of health care regulatory advocacy for the American Speech-Language Hearing Association confirms, under the HITECH act, some providers like SLPs, OTs and PTs are not classified as 'EPs' under the HITECH Act and are therefore not eligible for the incentive payment. However, she says they may be eligible in the future, so therapists may want to think about implementing EHR now.

To add to it, you increase coordination of care with healthcare providers who are eligible for HITECH incentives and are going for EHRs, according to Sarah Nicholls, assistant director for payment policy and advocacy for the American Physical Therapy Association. As such, think about your business interactions with those that are eligible today.

2. Quality of care gets a boost

Electronic systems oftentimes provide access to a database of national outcomes data from users of the same software, a jewel for weighing and boosting your care.

One more perk: Wheelock notes, "Many of the systems will connect you to research on best practices for treating certain diagnoses. Therefore, an EMR can really help drive evidence-based practice."

Electronic systems can help standardize your care too. For instance, if your practice witnesses the same diagnosis quite often, you could build shells for care plans so that you have some standardization of care to begin with.

3. Your clients anticipate EMRs

If you work for a rehab agency or are an independent contractor, whoever is buying your rehab services wants to see a modern operation. Kate Brewer, PT, MBA, GCS, VP of Greenfield Rehabilitation Agency in Greenfield, Wis.says, "Switching to an EMR is vital because when a customer wants you as the vendor to do so, you need to continue to meet the customer's expectation."

Another idea: A more modern feel in your clinic may also help bring in new patients who are shopping around for a therapist and are alert to little details like staying tuned to the times.

4. Errors get caught in their tracks

Did you forget to include a start date on your plan of care? Are you ready to code a claim and miss a CCI edit? Electronic billing and documentation systems can catch these mistakes before they cost you money.

Here's how: Wheelock explains, "Whether it is for a billing purpose, a compliance purpose or a best practice, you can program a documentation system to force users to answer certain questions before proceeding."

Garry Woessner, MA-CCC, MBA, CAS, regional director of Benedictine Health System in Minneapolis cheers, "We've made good progress (with our EMR) and it has definitely improved our clean claims, improved our compliance and helped train the therapists in how to do good documentation."

You can save yourself the hassle of certain HIPAA violations also. Wheelock recalls, "I used to be in home care, and until we went to an EHR, charts would get lost." "To add to it, there was no way to know unless you physically went in and looked at every chart if someone was tardy with their billing."

5. Easy access makes life smoother

Implementing an EMR system is had toil, but the convenience of pulling up a patient record in a matter of seconds, and having it portable too, is worth its weight in gold.

For instance, consider home care therapists who are driving around to various sites and need to get hold of patient history from a central server. Wheelock says, linking to a server remotely is now possible and some EMR systems will even let you do so through a phone line. The ability to connect to a central database is also a huge convenience for therapy organization with multiple sites.

As a matter of fact, easy access to a patient record is important for any facility. Say for instance a SNF setting working with a therapist shortage. "One therapist may be moving around to different facilities to tend to patients, thus not always available on site to discuss the patients with nursing," proposes Wheelock. But with an EMR in place, "the nurse, who is still back in the facility, can pull up the therapy information quite easily and quickly if she requires to."

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Medical Coding Career Options

2010-06-25T06:05:00.001-07:00

Medical coding is a complex process and the tricks of the trade should be learned in an accredited school. If you would like to become a professional in this field, enrolling in coding and billing classes is your first step. Make sure however that your teachers have certification in this profession.

Going to school for this career is not expensive. A budget of $700 would be enough. You do not have to be a college graduate to take these classes either, you just need a high school diploma. Completion of courses do not take years to finish so basically, you can start working as a coder in less than a year. You would have to pass the exam for certification before you can start working in the field. The best medical coding schools will be able to teach you all the knowledge you need to learn in the field. Patience is a requirement because profession entails a lot of it. Apart from that, you would need to know how to solve problems and how to analyze data.

Medical coders input different codes in a universal coding system. This system is used by healthcare providers such as clinics and hospitals. The codes are in numbers and they stand for different diseases, illnesses, and injuries. Your job will be responsible for keeping records of every patient in a certain clinic or hospital. All healthcare providers are always in need of coders, so basically, you will not run out of jobs to choose from -they are very much in demand.

This profession can also be done from home making it a very attractive field for work at home individuals. Many healthcare providers employ work from employees or contract outsourcing to do their coding tasks for them.

This is very different from a data entry job. Most people think that coding is a type of data entry job but it is more complicated than that. The information entered is also used for medical informatics i.e. determining if there is an epidemic or an outbreak, analyzing treatments and diagnosis actions among other things.

This profession enables a hospital to do paperless documentation of patient schedules and appointments, and patient records. Professional medical coders are also the ones who interact with insurers or insurance companies with regards to claims and reimbursement.

This career may be a bit complicated for some but it pays well. SO if you are determined to be a medical coder, go right ahead and enroll in a medical coding class.

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Medical insurance - Its Need in Today's World

2010-06-25T06:04:00.002-07:00

Selection of Medical Insurance Company and our benefits...

Before I suggest you to how to select the medical Insurance Company out of the many options available, I must introduce the need of medical insurance to you and your family. Medical insurance thus needs to introduce clearly with its concept and its requirement in our lives.

INTRODUCTION: This is the century of Insurance. Many Insurance companies and there products came into being from the last century. But the concept gain momentum in end of the last century and start of this century. Earlier people gave little importance to such insurance. Reason being that people do not want to spend their hard earnings on such insurance does not give any return. Except for an assurance of medical aid. People may not have opted for medical insurance in the start. But the state government adopted it in the earlier phase. Actually, when the government employees salary is deducted before payment due to their accumulation of Provident fund, Gratuity etc. At that time deduction is also made for the medical insurance of the employee. So that in case of any accident or mishap, at that time he/her can be supported with financial aid. This helps the person to easily pay his dues towards the hospital and bear the expenditure of medicines.

In the early days the very popular insurances introduced were:
Life insurance: Wherein the person’s family is supported by financial aid in case of his/her death.
Auto insurance: Wherein the auto like car, bike etc when stolen or destroyed, then the amount spent on the purchase is been given to the person for buying the same new thing.
Child insurance: Wherein the financial future of the newborn child is secured.

But looking at the above insurance, don't we feel that something very important was missing? Let’s go through it again. Firstly, Life insurance of a person aids that person after his death. That means if a person finds himself in some irresistible problem during his lifetime, then he can’t get any financial aid for that reason. Secondly, Auto insurance gives financial assistance for the broken or stolen car or bike of the person. Then at time financial aid will be given just for new car or bike and nothing for the broken bones of the person himself. And finally, Child insurance helps securing the financial future of the child. But what do you really think that future of a child is secured with money only and he/she does not need healthy and financially secured parents.

All and all the above mentioned insurance’s does work as supplementary aids for the person. But what about the person himself? Doesn't he himself need to be secured? So that he/she live safe and secure and enjoy all the stages of life. Does not a person who lives for his family deserves to be secured with unforeseen dangers of life? A person who has lot of responsibilities on him/her about his child, spouse, parents etc., should may his/her medical insurance.

It is said that ‘If you have your own teeth then only you can eat and chew the tasty fruits, and if you don’t have strong teeth then no money or person in this world can bring you the taste of that fruit. The idea behind is that a person should give equal importance to himself, as much importance he/she gives to his family. After all If he/she is fit and fine and ready for unforeseen dangers in life then only he/she can fulfill their responsibilities fairly. And will do justice to his own life...

SELECTION MADE EASY: Now let talk about the company, which is fit for medical insurance. At the time of selection of the company take few things in mind. Like;

The age of the company. I mean how old is the company? What are the claims the company made in the past and did it really achieved them. Does it have a government backing behind it?

Hear what the agent says. But don’t believe the agent. Instead ask him to introduce you to their old customer and have a tea or coffee with that person, but away from the agent. So that the existing customer could fairly suggest you with his past experience with company and the employees.

And lastly, clarify all the terms and conditions of the company. So that at the time of need company should not say that they do not cover this area under insurance.

These are few things that can be taken as precautions before opting to medical insurance company. Don’t waste time and go for the required medical check up, so that your medical insurance can be started. Now let’s talk about who needs the medical insurance coverage?

And the answer is simple and easy. That is everyone in your house. The whole family needs the medical insurance. I will explain you how. Take for instance, You have parents, spouse and two children’s living with you. If your parent or parents at there finds themselves in some serious problem and need to be hospitalized or operated. Then a job doing person cannot at once arrange for so much money. A simple job doing person is considered successful when he/she manages to feed his family, spend on the school expenditure of kids, and fulfill some of the endless demands of spouse. And at such a tough time, a simple fixed salary earning person cant manage all things at once. At that time claim can be made for expenditure being made at the time of operation and hospitalization. As the financial head of the family never think that I can take care of all problems. Everyone needs help. And a medical insurance at such time offers the same and best help as needed.

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Outsource Medical Billing - Benefits of Medical Billing Outsourcing

2010-06-25T06:04:00.001-07:00

From the past few years, there is a significant change in healthcare treatment business. Currently, medical care service providers have to face many administrative problems. They are facing problems in insurance policies procedures and filling complicated claim forms. You can outsource medical billing work and avoid such complexities. In this modern age, medical billing outsourcing becomes a booming business.

If you are interested in making your healthcare practice more efficient, insurance billing outsourcing can be the best solution. There are many companies accepting this billing task. Most of the companies are following HIPPA standards. Through outsource medical billing you can solve various problems related to healthcare claim billing like; tracking your accounts, submitting claims, making follow-up a better process and reapplying for rejected claims.

Outsourcing can be beneficial to anyone associated with healthcare services such as; Individual doctors, hospitals, health organizations, insurance companies and many more. You must think about outsourcing insurance billing to get out from boring billing task.

Check out the various benefits of medical billing outsourcing:

Benefit for Cost Centric People: Generally, people outsource their task to save some money. Medical billing outsourcing will surly give a benefit of saving cost. You can save 40 to 60% on cost. You can also save cost of staffing professional, stationery, infrastructure and technologies. By outsourcing, you can find all such facilities without spending on it. So, outsourcing is beneficial to save cost.

Benefit for Quality Centric People: If you do the billing task by yourself or clinical staff, there may be errors. Those errors lead your claims to rejection. Less accurate billing is not helpful to manage financial condition. You can hire billing specialist but for him/her, you have to establish environment. If you are getting the same quality by outsourcing healthcare billing work, why not outsource!

Benefit for Quantity Centric People: Some healthcare providers require quick service and it is only delivered by experienced and skilled insurance billing specialists. It is very hard to find experienced professionals. Through outsourcing, you can get benefit of professionals who are working from long time in this field. As well you also get access of huge staff; through them you can get quick insurance billing service.

So, outsourcing medical billing can give benefits to each type of healthcare practitioner. Through insurance billing outsourcing, you can get benefit of accurate, quick and cost-effective solution.

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Medical Office Billing

2010-02-08T07:13:00.004-08:00

Medical office billing is done using standard medical codes to define diagnoses, procedures, levels of care, etc. It is a vital part of any medical practice and an excellent career choice currently with many new jobs being created in the area.

More than three million new jobs in the field were expected to be created in the decade from 2006, and new jobs are available in this field at a rate greater than the average increase in jobs nationally. Wages are generally good in this field. At the time of writing an average wage would be around $35000 in this field. Billers can work regular hours unlike most other staff of medical businesses, and can sometimes even work from home.

Medical billing and medical coding are closely related and many people train in both subjects. Billing could be considered a sub-area of coding, and is vital for revenue management in the current competitive business world.

Billing is the submission of medical codes from a medical or healthcare facility to the appropriate insurance agencies who in turn pay the medical or healthcare facility. This process is somewhat complex and prone to errors. It was found that a significant percentage of money claimed as part of the Medicare system included errors but this finding was by the company who are paid more if they find more errors, which itself is a practice which is obviously controversial.

One method of reducing errors in medical submissions is to submit via a clearing-house rather than directly. This can also speed up the submission process, but some insurance companies still process claims using a paper-based system which results in major delays as well as additional errors.

Almost all bill submission in this field is done electronically, and the use of specialist software is one of the areas that employees are trained in.

Medical office billing is an important function today, and a good career choice as the percentage of elderly in the population increases.

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Medical Claim Billing

2010-02-08T07:13:00.003-08:00

The process of medical claim billing involves first converting medical data into standard medical codes which are then submitted as a bill consisting of those codes to the relevant insurance companies who then pay the claim using pre-agreed payments for particular combinations of codes.

The job of medical billing is considered a sub-area of medical coding as the information in the medical bills is sent in the form of these standard medical codes. These professions are great career choices right now due to the rising percentage of elderly people in the populations of western world countries. The number of jobs in these areas is rising significantly faster than the average.

The interaction between the medical billing of claims and the insurance company paying for those claims is not always straightforward or simple. There are often disagreements about how much can be claimed for and other sources of error in the process. Some insurance companies still process claims using a paper-based system instead of doing things electronically, which leads to additional errors as well as considerable delays.

One method of helping get claims processed quickly and effectively is to submit the bills via a clearing house instead of directly. This reduces the amount of errors and speeds up the process.

There is now a company given the task of finding errors in medical claims. Large numbers of errors are found, mostly concerning over payment. The fact that the company involved gets paid according to the amount of money it recovers by correcting errors is controversial for obvious reasons.

Most medical claims are currently submitted electronically, mostly using specialist software. Ability to use this software is one of the areas medical billing employees are trained in.

Medical claim billing is a vital part of any healthcare business, and a good career choice currently.

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Medical Billing Service - HIPAA Compliance is Mandatory For a Great Service

2010-02-08T07:13:00.001-08:00

The 2003 Health Insurance Portability and Accountability Act (HIPAA) privacy rules mandate the behavior of healthcare providers towards the flow of health information. HIPAA advocates electronic submission of bills, and has been instrumental in bringing about a great change in medical billing practices. Electronic billing enables medical providers to get more returns in less time.

HIPAA compels healthcare providers to improve their administrative processes. An increasing number of medical providers are turning to third party medical billing providers to implement the new standards. Medical billing providers are experts in HIPAA compliance and industry best practices. Hiring a billing service saves medical providers the trouble of learning a new system while reaping the immediate benefits of an improved revenue management cycle.

Advantages of electronic claim filing

Medical billing providers file claims electronically for their clients. There are many advantages to this:

* An online records management system reduces the chances of errors in the forms, radically increasing the collections.
* Filing claims electronically is fast as the interface is data intuitive.
* Managing and tracking electronic claims is easy.
* Electronic claims are processed and paid in less than 21 days. Manual submission and payment of claims takes 90 days on an average.
* Unpaid claims are reduced by almost 60%.
* Filing claims electronically saves cost. The cost of filing a claim electronically is half the cost of paper submission, and the cost of reviewing an electronic claim is one third of the manual process.

All these advantages are making more and more healthcare providers take to electronic submission of claims. More than 75% of the medical claims submitted are electronic.

Medical coding and billing services and HIPAA compliance

HIPAA requires healthcare providers to implement security procedures to meet government regulations and ensure the faith of patients. Medical practitioners should work only with professional medical billing providers who are experts in HIPAA compliance. Before signing up your potential billing partner, ask the following questions:

* What processes are in place to ensure HIPAA compliance?
* Is the billing provider's staff trained in HIPAA compliance?
* Does the staff appreciate the difference HIPAA compliance brings to billing services?
* How is the security of health information assured?
* Which medical billing software does the billing provider use?
* Does the medical billing software incorporate all the critical HIPAA-related requirements?
* Is the billing provider's software compatible with your records management application?
* Does the billing provider offer comprehensive patient records management services?

HIPAA has enforced standardization of billing transactions. While this was initially perceived as a needless time-consuming procedure, HIPAA has helped the medical industry increase revenue by billions of dollars. Administrative efficiency and effective record management systems help healthcare providers reduce time to payments and improve their bottom line dramatically.

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Medical Billing Course

2010-02-08T07:12:00.000-08:00

A medical billing course will train the student for employment in the field of medical billing. There are various courses available, both in classrooms and online. Such courses can train a newcomer to the area so that they can get a job in this field, or can offer advanced specialize training for those already in the field or can serve to certify knowledge and skills for someone who is already working in this career.

This career is a good choice as the "baby-boomer" generation is now beginning to retire, thus creating more need for medical and healthcare facilities, and a corresponding need for billing for those facilities. So courses in this subject are popular and widely available. If you are interested in a specific career or in working with a specific medical or healthcare facility, do make sure you check that the certifications delivered by a course will be satisfactory for that particular employment.

This field involves medical and healthcare facilities assessing the value of the services they provide by using standard medical codes, which are derived from data such as patient examinations, doctor's notes, lab results, X-ray data etc. These codes then define the level of service rendered, which then determines the bill which is sent to the insurance company which then remits the money back to the medical or healthcare facility.

However there are various ways in which this procedure can become more complex. One factor is that not all bills are submitted directly from the medical or healthcare facility to the relevant insurance company. The submission can be done via clearing house which can help lessen the degree of errors and rejected claims as well as speeding up the submission process. Specialist software can streamline the process of either direct billing or billing via a clearing house.

Other issues are that sometimes multiple submissions are needed before a claim is approved, and often the insurance company initially only agrees to pay part of what is billed for, so negotiations and re-submissions are often necessary.

A medical billing course will train the student in all such matters, preparing them for employment in this field.

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Learn Medical Billing

2010-02-08T07:11:00.000-08:00

While you could learn medical billing yourself and possibly obtain employment it is far more common to study classes in the subject either in a classroom setting or online, or maybe a combination of both approaches. Then it is typical to take one of the various recognized qualifications in the field. Some courses make waive any fees until the student passes the relevant qualification, which can make it a no-lose option financially for the student.

There are a variety of different specialist subjects within this field and study courses for all of them, whether the student is a beginner in the field or someone experienced in the practice of medical billing who is looking to get formal qualifications to support their existing experience, skills and knowledge.

Careers in this area are a good choice currently, as the number of positions in this area is increasing faster than the average in the USA, as the population tends more heavily towards the older age-groups. The practice of medical billing is to submit requests for payment from a medical or heath practice, to the relevant insurance companies which make the payments. The process can be complex, with multiple submissions sometimes being necessary, and sometimes long delays as some insurance companies still process the bills on paper.

The aims of the healthcare provider, and the aims of the insurance company are inevitably somewhat in conflict with the former wanting to maximize the money they receive for the work they do, and the latter wanting to minimize the payments they have to make. There is often some degree of negotiation between the two before an agreement is reached.

This job is mostly done using specialist software, which submits the bills either directly or via a clearing-house system. The use of the clearing-house system can reduce errors and rejected claims and speed up the process. The decision to learn medical billing can be a good one in today's increasingly aged society, with readily available training from a variety of suppliers, and an increasing number of employment opportunities.

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Pain Management and Anesthesia Coding - Get Payments For Unlisted Procedures

2010-01-14T07:05:00.003-08:00

You can get paid for unlisted procedures, but the road is not always easy, mor eso in pain management and anesthesia practice. However, there are ways you can boost your chances of reimbursement.

You should make an effort to obtain pre-authorization from the payer in a letter. If you have clinical trials that have been conducted by recognized bodies of physicians, see to it that you include that information in your pre-authorization letter requesting approval for a pain management procedure for which you'll be using an unlisted code.

The letter should also include any current CPT codes that are similar in work and risk.

Study payer's policies for tips. Most medical policies that payers publish on their websites include disclaimers that every benefit plan defines what services are covered and what services are excluded. One of the things you want to keep up with are those policies payers publish on their websites. It may so happen that sometimes those policies can very much work to your advantage.

Keep a watch on employer plans. Payers often handle medical plans for employers. It is essential to check the patient's benefit plan for payment information even if the payer website says that the procedure isn't covered. Be prepared for a bit of a surprise as well because sometimes a specific plan may cover the procedure.

But in the end you should stick to the AMA official coding guidelines unless your contract with a payer stipulates otherwise. If you have any difficulty with a payer processing any unlisted procedure code, then you may take in hand the issue with the payer rep who may direct your provider that it's all right to report a CPT code breaking away from the AMA CPT guidelines.

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Medical Billing and Coding Books Are Different

2010-01-14T07:05:00.001-08:00

Documenting the various facts and figures is very much essential and unavoidable when you do a medical insurance claim. All data should be entered in a clear and precise manner. For this, the coder should be aware of the very many billing codes that are generally used during the procedural and diagnosis level. You can see the procedural codes in the CPT code book and the diagnosis codes in the ICD9 code books. Both are updated and published in a yearly basis. The CPT codes are published by the AMA (American Medical Association) from 1963 onwards and it was started because of the necessity of a standard to coding and terminology that was urgently needed.

Now from the passing of time 'medical coding' has become a complete arena by itself and these days you will be able to find many courses for teaching all about them. Almost all the insurance companies go by the individual codes and the coding industry has become of great importance. So we can see the true value of medical boding books and the significance of these books in the present world of medical insurance billing. Every year new version is given to these books and you must understand that insurance companies won't accept out-dated codes. If you by any chance happen to quote the out-dated codes there is every possibility of your claim getting denied!

Generally four categories of coding books are available like the CPT (Current Procedural Terminology), ICD9 (International classification of Diseases, HCPCS (Healthcare Common Procedure Coding System) and RBRVS (Recourse Based Relative Value Scale). You should be familiar with at least these four books in order to be a good and successful coder.

CPT code books contain the descriptions of the various services and procedures of physicians detailed using different CPT codes listed both in numerical and alphabetical way. Under each and every code, clear-cut explanations are given so that there are no ambiguities between the different services and procedures of physicians. Every year these codes are updated and coder should be aware of this fact. The CPT code books also contain a record of 'modifiers' which specify whether a service is modified or not. These AMA notified CPT modifiers are the 'two digit' numeric codes which are listed after the procedural codes.

As far as the ICD9 code books are concerned, they give the details of the coding system relating to the grouping and classifying of various diseases and covering the actual facts regarding them. Mainly these codes are employed in registering the incidence of medical diagnoses. Here also the listing is done both alphabetically and numerically and is updated annually.

HCPCS code books will give you the codes which are to be used with respect to the products, supplies and services which are not covered in the CPT code book. Some of the areas covered in this book are the ambulance services, durable medical equipments, and prosthetics/orthotics products. This code book also gives the coder an idea about the coding of the various materials which are used outside of the treatment place. This code book will be of much help to the insurance providers, the billing service centers who are doing the billing work for the providers, and agencies which offer services or supplies to the patient.

It is the RBRVS code book that determines the true value regarding the money paid to the medical facility providers including a physician is determined. Learning the latest version of RBRVS code book and acting accordingly is really a vital part in coding jobs. You must be always familiar with the renewed version of the RBRVS code book.

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Outrageous Medical Costs Responsible For Devastating Families

2010-01-14T07:04:00.000-08:00

Approximately half of people experiencing economic ruin in recent years are a direct result of medical problems and most of those people were covered by health insurance at the start of the illness. Medically related impoverishment involves more than 2 million annually. Often, the destructive illness led to job loss and therefore a loss of health insurance. As a result, one-third of those with private health insurance lost coverage by the time they lost everything else, too and needed to hire an Oklahoma City bankruptcy attorney. Researchers found that illness and medical bills were responsible for over fifty percent of those experiencing total financial ruin. When they have lost everything to paying off medical bills, who can afford to get the advice they need from an Oklahoma City bankruptcy lawyer?

Researchers concluded that a new approach to health reform is necessary. Health insurance cannot offer much protection for families when a serious illness brings with it co-payments, insanely high deductibles and bills for uncovered items like physical therapy and prescription drugs. Filing Chapter 13 is often the last resort for families to pick up the pieces and try to start their lives over.

Surely anyone in this country can appreciate just how fatally flawed the conventional health care system truly is. For the majority of the U.S. population, there is no good reason that health care should be as expensive as it is today. Aside from the rare situation where intensive costly intervention is required, most of us absolutely do not need to rely on expensive medications to treat chronic illnesses.

Some of the astonishing truths that the researchers uncovered are that 75 percent of the families who became impoverished had health insurance and about one-third had eventually lost their coverage by the time they had filed for Chapter 13. People who were slammed with the highest out-of-pocket costs were those who had medical coverage but lost it during the course of their illness. A government-funded, socialistic health care system may not be the answer, but patients, doctors, hospitals and insurance must start communicating and work out a compromise so that the needs of everyone involved are met.

Many are convinced that most of this financial devastation could have been avoided if conventional health care focused on treatments that actually address the cause of disease rather than prescribing and administering expensive, toxic and unnecessary cures. It is evident to us all that even if you have substantial health coverage, there is absolutely no guarantee that your finances will be protected should you come down with a serious illness. It cannot be stressed strongly enough that taking responsibility for your own health is one of the most important actions you can take today to protect not only your physical health but also your very financial security. We might do our best to speak out to our government and protect and improve our current state of health by becoming educated in how to live a healthy lifestyle. The keys are to eat natural foods, drink clean water, and get enough exercise and plenty of sleep every day.

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

Anticoagulation Management - Attend Audio Conferences and Steer Clear of Denials

2010-01-14T07:03:00.000-08:00

An anticoagulant is a substance that prevents blood from clotting. Anticoagulation therapy is extensively used to prevent and treat thromboembolic disorders. The four most common conditions for which anticoagulant therapy are used are atrial fibrillation, pulmonary embolism, deep vein thrombosis, and mechanical heart valves.

The first report of the clinical use of warfarin as an anticoagulant was made in 1941. Over the last few years, big changes have taken place in the area of anticoagulate management. New strategies have come into the picture and new indications have been identified for existing anticoagulants.

Anticoagulation management throws open a lot of challenges for coders and billers. Although AMA has specific codes for these services, Medicare still does not recognize them. So how do you get to know the right coding and billing options for anticoagulation management? And are you getting your rightful payment for anticoagulant management? If you're not getting them, don't give up.

Attend audio conferences and get the reimbursements you deserve for anticoagulate management. When you attend such conferences, you'll hear smart ideas on how to deal with payers so that you don't miss out on the monetary benefits. Other than that, theses conferences will teach you ways to avoid the top 5 compliance risks. If you have queries pertaining to anticoagulation management, you can go right ahead and ask the speaker.

These audio conferences are beneficial for coders, billers, and office managers in family practice, nurses, internal medicine, office managers, and others.

Moreover, the best thing about such conferences is that even if you miss out on one, there are CDs to take you through the entire event.

So go for an audio anticoagulation management conference and know how to stay away from problems that clot your anticoagulation management.

Article Source: http://EzineArticles.com/?expert=Angela_S._Martin

CPT Code List - Get Acquainted With It

2009-12-13T02:48:00.003-08:00

Current Procedural Terminology (CPT) is a useful tool for streamlining the medical information technology. These CPT codes are continually reviewed, revised and updated to reflect changes in health care. There are three types of CPT code -- Level I, II and III.

Understanding the CPT coding is particularly important for employees of records, billing and insurance firms, who do not possess any medical training but depend on their knowledge of the CPT code for their work.

If you want to enter the medical coding world and need to have a good understanding of CPT coding, here's what you can do:

* You can spot these code on discharge paperwork, on bills from health care providers and from "explanation benefits" paperwork from Medicare and insurance companies. So get hold of paperwork to have a better understanding of these CPT codes.
* You can usually find the CPT code next to all entries for any service performed. Normally these codes will either be entries of 5 digits or 4 digits and a letter.
* If you want an explanation of what each procedure entails, go to the physician's office. Here your local physician will be able to help you match the CPT codes to specific services.
* The customer service at the insurance company will also be able to explain to you what each CPT code means and what services were provided.
* You can get the entire CPT code list at American Medical Association's Website Knowing the CPT codes inside out before embarking on a medical coding career will do you a world of good. So get going.

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

Give More Bones to Your Spinal Instrumentation Coding

2009-12-13T02:48:00.001-08:00

Spinal instrumentation is a method of keeping the spine stiff after spinal fusion surgery. It is used to treat the deformities of the spine owing to birth defects, fractures, scoliosis, spine diseases, and other injuries. When the spine no longer maintains its normal shape, and nerve damage occurs, different kinds of instrumentation (made of metal/titanium) are inserted into the spine. The instrumentation is typically comprised of pedicle screws, rods, plates, intervertebral cages, hooks and rods.

Guidelines in spinal instrumental coding: New techniques and technologies for spinal instrumentation are moving faster than codes can keep up. What's more, procedures come in a variety of configurations, which are often puzzling. While coding, these procedures could prove to be tricky. In a nutshell, unique coding guidelines and billing requirements for spinal instrumentation test the knowledge of even the most experienced neurosurgery coders.

So, if you want to be on track the next time a spinal instrumentation procedure hits your desk, you'll do well to attend quick and convenient audio conference that will coach you on what you need to know about spinal instrumentation coding. What's more is that you'll walk away with the know-how to determine proper reimbursement and avoid any inappropriate payment denials.

Audio conferences will also help you get the low down on spinal anatomy and definition, common types of posterior and anterior instrumentation and how they translate to codes, real life examples of instrumentation coding, new technologies and the latest codes, and so much more.

Neurosurgeons, orthopedic surgeons, coders and billers, office managers and compliance officers, health insurance company claim processors - will all return enriched after attending these audio conferences.

Article Source: http://EzineArticles.com/?expert=Angela_S._Martin

5 Common Chiropractic Coding & Billing Mistakes to Avoid

2009-12-13T02:47:00.000-08:00

Everyone knows denials and documentation requests reduce the value of your chiropractic claim and frustrate your billing department. To get paid on time and in full, be sure you avoid the following common errors in your chiropractic coding and billing:

1. Modifier Failures. Depending on which procedure code you use, a modifier may be appropriate. In Medicare, for example, you need to indicate whether the service represents Active Treatment (using the modifier -AT) or it will not be paid. Similarly, performing Manual Therapy (97140) on the same visit as an adjustment will also require a modifier to be present to signify that it was a separate and distinct service (Modifier -59).

2. Stagnant Adjustment Codes. Billing for a 5 region adjustment (98942) on every visit just because you are a full spine doctor will not sit well with most insurance companies. From the viewpoint of the insurance company, it is statistically improbable that every one of your patients needs an adjustment from top to bottom every visit.

3. Routine Use of Full Spine X-rays. This is another easy red flag for an insurance company to spot and it follows the same logic as the previous entry. If other practitioners all take x-rays in a wide variety of anatomical regions, but every one of your x-rays is a full spine series, then you suddenly stand out from the rest of the pack and are essentially inviting an auditor to investigate your billing and coding practices.

4. Billing for an E/M Code on a Daily Basis. Some shady chiropractic "coaches" and practice management gurus advise their clients to increase services through the repeated, routine (or even daily). Unfortunately, anyone with a knowledge of proper coding practices will tell you that this is not warranted and will just lead to big trouble when the insurance company catches on.

5. Billing for all New Patients With a High Level E/M Code. Certainly, high level E/M codes such as 99204 or 99205 reimburse the most. But there are probably few (if any, in certain chiropractic offices) times when an exam truly meets the criteria of these codes. To simply bill these codes in hopes that it will fly under the radar is foolish and misguided at the least and possibly fraudulent as well.

Hopefully, this "red flag list" will serve as a reminder of some of the poor practices that will get you audited by a third party payer. If you are a chiropractic office that is actually utilizing one of the above billing or coding practices in your office, let this article be a warning that your current procedures have you headed for trouble. My advice would be to correct any of the actions necessary immediately and/or get experienced help quickly. There are many ways to get paid for your services through proper chiropractic billing, coding and documentation; utilizing some of the above methods will only get you in trouble over time.

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

Coding to the Highest Level of Specificity

2009-12-13T02:46:00.000-08:00

Insurance carriers often deny claims for not being coded to the highest level of specificity. As many billers are not coders they often don't understand what has gone wrong or how to fix it.

If a service line is denied for this reason they are saying that the diagnosis code needs to be more specific. Some diagnosis codes are only three or four digits but many are five digits. The diagnosis must be coded to the absolute highest level for that code, meaning the most number of digits for the code being used.

For example, the diagnosis for hypertension begins with 401. However if you submit a cliam with the diagnosis 401 it will be denied. The code 401 requires a 4th digit. 401.0 is malignant essential hypertension. 401.1 is benign essential hypertension. 401.9 is unspecified essential hypertension. So to bill a claim with a diagnosis of hypertension it must be either 401.0, 401.1, or 401.9.

Another example of a diagnosis needing to be billed to a higher level of specificity would be diabetes. 250.0 indicates diabetes however you neeed a 5th digit to specify what type of diabetes. 250.00 is diabetes mellitus type two, 250.01 is diabetes mellitus type one (juvenile type), and 250.02 is diabetes mellitus type one uncontrolled and so on.

As you can see in the above example just putting 250.0 does not indicate specifically what the problem is. Without the fifth digit the claim is lacking enough information to be processed and therefore will be denied.

If you are unsure if the diagnosis is coded to the highest level of specificity you can look it up in an ICD9 code book or on the web. There are several websites with current ICD9 codes available. They will indicate if the code is coded to the highest level.

Some practice management systems have scrubbers that will catch under coded diagnosis and give you a warning. Sometimes the biller may recognize a truncated diagnosis (or a diagnosis requiring an additional digit.)

In either case the biller should go back to the coder or provider and ask them to be more specific with the diagnosis code so the claim can be resubmitted.

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

Looking For the Next Medical Billing Opportunity? Consider Collections

2009-11-24T07:58:00.004-08:00

You can put your medical billing education to work in a different way - consider a career in debt collection. Medical billing collections have become a vital part of health care offices nationwide. With over 47 million American uninsured and countless others underinsured, there is a need for qualified medical billers to help re-coup outstanding bills.

You may not know that your medical billing courses and related experience prepare you to undertake a career in medical collections. Your knowledge of the medical billing process, practice dealing with insurance carriers, understanding of Medicare, Medicaid and Blue Shield, and compliance with HIPAA guidelines put you in a unique position to succeed in this career

You'll bring an exclusive understanding to a medical billing collections career- something that will make you more effective and efficient. You'll be prepared to address any billing questions or concerns of the patients and bring a more effectual approach to collecting outstanding balances. Additionally, you can effectively deal with delayed payments due to misfiled claims and billing errors.

As a medical billing collections professional, you can choose to build your career in an office for a doctor or health care provider, or you can work in a third-party collection agency. Whatever you choose, you must always practice decorum when interacting with patients. Doctors and health care providers pride themselves on good client relationships - you can help foster these relationships by handling delicate billing matters with patience and understanding.

Medical billing collectors are often the solution to recovering outstanding debts. It's a necessary part of doing business. Doctor's offices and health care providers need these professionals to stay on top of outstanding balances and address billing errors. Having one person dedicated to these efforts can free up other employees to perform necessary medical tasks - also it is helpful for one devoted professional to act as the go-between for billing issues.

With a slowing economy and rising unemployment, health care providers, hospitals and clinics are experiencing a shortage of income from people unable to pay their medical bills. As people continue to get sick and can't pay the costs of medications, hospitalization, as well as preventative care, many health care providers and facilities will seek the help of a medical billing collector.

Apply the knowledge learned from your training to a career in a doctor's office, health care facility or third-party agency. Your insight into the medical field and related practices will provide the gateway to a successful career in the medical field. There's no reason medical debts can't be effectively managed - it just takes someone familiar with the billing process. That someone can be you.

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

Medical Billing - Are You Ready For ICD-10-CM?

2009-11-24T07:58:00.003-08:00

What is ICD-10-CM and ICD-10-PCS? ICD-10-CM is the new US clinical modification standard of the International Classification of Disease ICD-10. It will replace the current ICD-9-CM by October 1, 2013. ICD-10-CM is maintained by NCHS (National Center for Health Statistics). It includes the level of detail needed for disease classification and diagnostic specification in the United States. It consists of more than 68,000 diagnosis codes while ICD-9-CM has a little more than 13,000 diagnosis codes.

ICD-10-PCS is the new US procedural coding system developed under the direction of CMS ( Medicare & Medicaid Services). It is more detailed than the short volume of procedure codes in ICD-9-CM. It consists of 87,000 procedure codes while ICD-9 CPT has 17,000 codes. It will too replace the current ICD-9-CM procedure coding by January 1, 2012 for inpatient procedures.

What are the differences between ICD-10-CM and ICD-9-CM?

ICD-9-CM: 3-5 characters; first character is numeric or alpha; characters 2-5 are numeric; always at least 3 characters; use of decimal after 3 characters; lacks sufficient capacity; no longer reflect current knowledge of disease and latest medical terminologies.

- ICD-10-CM: 3-7 characters; first character is alpha; characters 2-7 are alpha or numeric; always at least 3 characters; use of decimal after 3 characters; has the capacity for new diseases like SARS and WNV; it will have the capacity to include current and future knowledge of disease and medical terminologies; offers greatest coding accuracy and specificity; ICD-10 codes are broken down into chapters and sub chapters, disease are grouped be letters.

Will ICD-10-CM and ICD-10-PCS affect physician Office billing?
Providers in all healthcare settings will use ICD-10-CM diagnosis codes for reporting, payment, and other purposes. ICD-10-PCS wil be used only for inpatients billing by hospitals. Physicians will continue to use Current Procedural Terminology (CPT-4) and Healthcare Common Procedure Coding System (HCPC) to bill for their services.

Does ICD-10 lend itself to the use of Electronic Medical Record?
Yes, ICD-10-CM and PCS are better suited for use in EMRs because they permit a better mapping from SNOMED-CT the clinical reference terminology and more suited to computer-assisted coding.

How long would it take coders and healthcare providers to learn the ICD-10?
Various studies have suggested that coders and healthcare providers will have a level of proficiency within 6 months of using the new coding system.

Are mapping available between ICD-9-CM and ICD-10-CM?
Yes, for a more detailed mapping visit http://www.cdc.gov/nchs/about/otheract/icd9/icd10cm.htm.
Where can I find more information about ICD-10-CM and ICD-10-PCS?
o For ICD-10-CM visit NCHS website at "http://www.cdc.gov/nchs/about/otheract/icd9/icd10cm.htm.
o ICD-10-PCS information can be found on the CMS website.
o For more ICD-10 resources visit AHIMA Web site.

Where can I find information about estimated costs to my practice for transitioning to ICD-10-CM? A study done by Nachimson Advisors titled "The Impact of Implementing ICD-10 on Physician Practices and Clinical Laboratories" has detailed cost estimates of transitioning to the new coding system.

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

Medical Insurance - Know the Lingo

2009-11-24T07:58:00.001-08:00

Finding the right medical insurance for yourself can be a daunting and complex task. Every insurance company has different models and unique features. In order to get the best coverage for the best value, you need to assess your current situation and know the jargon of the industry. It will also help to understand what the plans truly offers.

Health plan documents are full of technical jargon, but you don't have to be intimidated. Here are some helpful definitions you might see:

Cap: This is the maximum amount of the insurance company will pay over a lifetime.

Claim form: In order to receive payment for services rendered, you or your health care provider must complete this form and send it to the insurance company.

Coinsurance: This is the percentage of the health care bill you have to pay after the deductible.

Co-payment: This is an out of pocket charge for a visit to the doctor or hospital.

Covered expenses: These expenses will be paid for by the insurance company. Remember, not all expenses are covered by the health plan.

Customary fee: This is the amount the health care provider charges for a service. It can also be called a usual and customary fee.

Deductible: This is an expense that you need to pay before the insurance plan begins paying.

Exclusion: Services that are not covered by the insurance company.

In Network: In order to avoid higher costs you can choose from a list of health providers selected by your insurance company.

Maximum out of pocket expenses: This is the most you will ever have to pay during one year of deductibles and coinsurance.

Out of network: These are licensed health care providers who are not on the in network list.

Premium: This is the annual cost of the insurance coverage.

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

Medical Billing Work

2009-11-24T07:57:00.000-08:00

Doctors and other health care professionals are hard-pressed for time when they have to take good care of their patients as well as conform to the legalities of the medical system. So many administrative tasks like medical billing and insurance claims handling can draw focus away from their main line of expertise. Instead of practicing medicine and saving precious lives, doctors could be forced to chase down payments and submit claims if the proper administrative infrastructure is not in place. Erroneous data entry, delayed claims and a host of other unforeseen contingencies can considerably sap a health care professional's money, time and energy. With the need to adhere to legal requirements in medical practice, doctors are burdened more than ever before with formalities that are totally unrelated to their profession.

One of the most efficient solutions to this issue is to outsource most of the administrative work to professionals who specialize in this area. Right from carefully entering patient records to handling all the legal issues related to insurance claims, every step of the process is efficiently handled by these professional services. Conforming to the Health Insurance Portability and Accountability Act or HIPAA is another important reason why health care professionals need to outsource these administrative tasks. Maintaining the confidentiality of patient records is a highly technical and resource intensive task. And since failure to comply with the HIPAA could mean loss of accreditation or reputation and the possibility of financial penalties, it is of utmost importance for doctors to leave the responsibility of handling patient records with people who know how to do the job efficiently.

Medical billing service providers utilize highly efficient software to enter patients' medical data as precisely as possible. Error free records get processed much faster which minimizes the risk of claims being denied. This results in faster and better payments for doctors. All changes in legal requirements are immediately incorporated into the software by service providers, thus relieving doctors from the headache of restructuring their systems every time there is a change made in the law.

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

Tips For Training Your Staff on Chiropractic Billing Software

2009-11-18T06:46:00.005-08:00

The effectiveness of any chiropractic billing software you implement for your practice is highly dependent on the quality of the training your staff receives. Even though you may have selected the optimum medical billing software for your practice, if your staff does not buy in to fully adopting the software and if they do not fully understand how to use it correctly, your investment in the software may not pay off as well as you had hoped.

Here are several tips for effectively training your staff in medical billing software:

1. Select a Medical Billing Software Vendor Who Has a Full Time Trainer Available-Never try to learn medical billing software without the help of the vendor. And, most important, request a representative from the vendor who is dedicated to training and has a track record and background in training other customers in the use of the software. Effective software training requires a specialized skill set that only someone with an in-depth training background can provide.
2. Contact a Vendor's Clients and Ask Specific Questions About the Quality of the Training- Here are examples of the type of questions you should ask a software vendor's clients about the training provided: - How would you evaluate the overall quality of the training program? - What didn't you like about the training provided? What could have be done better? - Was the training effective enough for your staff to make effective use of the medical billing software?
3. Recognize That Your Biggest Challenge in Training Is Managing Change- One major obstacle that must be overcome in implementing a new system for your practice is that some of your staff will naturally resist quickly adapting to the new system. Most people don't like change because it means they must learn something new- often totally different from the way they used to do things. Any training program must incorporate an initial orientation and discussion session about the benefits of the software to those being trained. The training program must also address what is different about the new system compared to the old system and must address the steps of converting from the new to the old system.
4. Don't Forget the Basics! During the training program, it is best not to assume those being trained know anything. The training program must teach to the lowest level of knowledge. For example, if any of the people being trained don't have basic typing skills, this must be dealt with.
5. Use Hands on Exercises- Training should not be theoretical but should include real life examples and exercises those being trained can use. You may want to even consider using real data from your practice.
6. Follow Up is Critical- Often one training session is not enough to effectively implement a new system for your practice. If for no reason other than for review purposes, you should consider having a second follow up training session to cover any problems or issues trainees may have encountered since the first training and orientation session.

Training is one important aspect of successfully implementing a medical billing system for your practice. Make sure you use experienced trainers who fully understand all aspects of effective training including overcoming the natural resistance many have to change.

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

Medical Billing Services - Get the Facts

2009-11-18T06:46:00.003-08:00

If you would like to learn more about medical billing services then this is the article for you. Specifically we will discuss how all doctors that interact with patience are required to pass HIPAA, how medical billing can actually be a great job to do from home, and how electronic medical billing has increased staff productivity by a great margin. After reading this article, you should have a better idea if medical billing services are right for you.

HIPAA (the Health Insurance Portability and Accountability Act) requires that all doctors that interact with patients must pass a test. Most of the billing claims for the service are required to file electronically. The reason HIPAA was enforced was to prevent abuse like fraud in both healthcare delivery and insurance. Let's now discuss how billing can be a way to make a living from home.

Medical billing can actually be a great way to make a living from home because it offers a decent salary and the comfort of working from a place you love. Most billing service workers are paid on an hourly basis and not yearly. A medical biller can earn roughly $40,000 a year if he/she is experienced. A biller and a coder that runs his/her own firm can expect to make closer to $100,000 a year. Let's move on to how staff productivity is increased when using electronic billing.

Since the advent of electronic medical billing, staff productivity has been greatly increased. Electronic billing does not take nearly as much man power because it is automated, unlike paper filing. The billing software is actually very easy to use and it makes the whole billing process much more accurate. Electronic billing saves time and money because of reduced printing, folding, and sealing costs. This savings of time and money greatly helps doctors across the country because they don't have to focus on menial tasks like billing.

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

Efficient Electronic Medical Records Software

2009-11-18T06:46:00.001-08:00

There are many companies that provide electronic medical records (EMR) software that is reliable, efficient and easy to use. Most of the software can be customized to fit your own particular business needs. The software is driven by you, the customer, and is continually updated to keep your records completely current and accurate. Any new changes in the medical world that could affect your records are incorporated into the software immediately. The software is appropriate for all workflow settings and can manage numerous medical specialties. The software allows you to manage all of your business requirements including financial, clinical and regulatory needs.

Most of the EMRs are designed in part by physicians and other medical professionals. That is why it is so vital for your own private practice to utilize the amazing and secure features it offers. Electronic records are fast replacing manual records because of quality, innovative technology and expertise. Large and small medical practices can use EMR software to enhance their patient care, streamline their business practices and improve financial processes.

You don't need to be a computer expert to use EMR software. The training is quick and you will be able to learn how to use the programs in a matter of minutes. All you have to do is point and click and you're on your way to a carefree way to organize medical records. Simply sit at the computer and review notes, medical histories, allergies, medications and other factors regarding your patients. You no longer will have to rely on ICD-9 or CPT coding books because the information contained in them is embedded in the software's databases. You'll be able to schedule and reschedule patient visits and prescribe medications using this software, saving time and paper. And, EMR software is available in a variety of system sizes, from entry-level small practices to large clinics.

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

Medical Billing - Are You Prepared For the Red Flags Rule?

2009-11-18T06:45:00.000-08:00

Red Flags Rule is instituted by the FTC and it is designed to protect against identity theft. The rule will take effect on November 1, 2009. It sets out how physicians offices, clinics and hospitals assess and identify medical identity theft. This occurs when a person uses another person's personal information (Name, Social Security Number or insurance information) without the victim's consent to obtain medical services. As defined by the FTC, "Red Flags" are suspicious patterns or practices that indicate the possibility of identity theft.

Physicians and medical practices are covered under the rule if it is a "creditor" that offers or maintain "covered account". FTC classifies physicians and medical practices as "creditor" because they extend credits to patients when they bill them and do not collect at the time of service. Patient billing account is considered a "covered account" because it permits multiple payments and it carries a reasonably foreseeable risk to patients.

Four steps to developing a Red Flag compliant program:
1. Identify relevant red flags in your practice. Your program must include policies and procedures to identify the red flags of identity theft
2. Detect red flags: Set up procedures to detect those red flags in your daily operations.
3. Prevent and Mitigate identity theft: Respond appropriately to prevent and mitigate.
4. Update your program and keep it current as the risks of identity theft change rapidly.

The FTC guidelines offer a detailed description of each step as well as providing some examples.

Steps physicians and medical practices can do to prevent a compromise of patient record:
• Check patients photo IDs and require a second identification prior to providing medical services.
• Train staff to detect fraud and misuse.
• Monitor who is accessing patient files and records.
• Look for patterns or suspicious activities in patient accounts
• If you detect a fraud, report incident to a law enforcement agency and lockup patient account.

After the Red Flags Rule take effect on November 1 of this year, physicians and medical practices must keep their program updated and to guard against latest threats. Physicians who fail to comply could face a fine of up to $2,500 per identity theft incident. Physicians may even face a lawsuits as well.

Resources to learn more about Red Flags Rule:
The AMA-American Medical Association has prepared a guidance document, along with sample policies to help physicians incorporate a simple identity theft prevention and detection program into their existing compliance and HIPAA security and privacy policies. You can visit The AMA website to access these documents to access these documents.

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

Best Medical Transcription Courses

2009-11-04T02:01:00.001-08:00

Even though formal training is not mandatory to be a medical transcriptionist, having a certified degree or associate degree is very ideal to get a job. There are plenty of courses available to train people in medical transcription. They are available in both the forms; web based training and classroom based courses. However online training courses are more popular because of the convenience and flexibility. It is ideal for those who already have another job, because online training institutes let them learn transcription in their own pace.

Medical transcriptionists convert the verbal medical record dictated by the doctor into text document, which will be included in the patient's permanent medical record. So a thorough understanding of the medical terms, procedures, human anatomy, physiology and abbreviations are very essential. Lack of knowledge in these subjects will interfere with accuracy and interpretation.

Medical transcription courses help students to be fast and accurate. They provide the students with 'real life situations', which helps to work them in a stressful, noisy and busy environment. As learning medical terminology is very important, it is equally important to learn to listen regardless of what is happening in the surroundings, because accuracy and efficiency mainly depends on the importance given to the details.

Medical transcriptionists have to deal with the doctors, surgeons or any other health care professional from all over the world. Hence, it is very essential to understand their dictation no matter what accent and tone they talk. Training courses train the students in this regard, so that they can transcribe in the real life very accurately.

A good knowledge of English grammar, punctuation and spelling is required for a successful transcriptionist. Along with these fast typing, data entry, word processing and computer knowledge are prerequisite for a transcriptionist. Medical transcription courses train these linguistic skills to their students. Transcriptionists should also know about legal and ethical issues surrounding the medical records. Since transcriptionists handle patient's personal and medical records, maintaining patient confidentiality is very essential. Even though medical transcription is a stressful job, it helps to earn a lucrative income.

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

Medical Billing Made Easier

2009-11-04T02:00:00.002-08:00

Electronic medical billing has made the billing procedure much easier and more efficient. The software helps in fast and accurate billing while reducing denials or rejection. It is a cost effective way of increasing cash flow in the medical office.

The improved productivity is directly related to the software used in electronic filing. That means, if well programmed software is used to process the billing, the cash flow is more in the medical facility. As per the government all the electronic medical billing should comply with HIPAA, health insurance portability and accountability act.

Some of the software may provide only partial HIPAA compliance. Any flaw in following HIPAA could lead to complications and penalty. In built compliance prevents any fraud in coding and billing. So before buying any electronic medical billing software, it is better to evaluate the complete HIPAA compliance and other security measures.

This type of software provides a wide range of benefits. While paper claims take around 1-2 months to get paid, electronic claims are paid in 10-15 days. This is possible because any error in the claim can be fixed in few hours, unlike paper claims; where it takes days to notify the error in the claiming.

Patient and customer satisfaction is guaranteed in electronic medical billing. The software is well designed so that it is more user friendly, yet very secure. This gives the flexibility in scheduling appointment and updating any personal information.

With the usage of electronic medical billing, the staff productivity is highly increased. When compared to paper filing, E-billing doesn't require much of man power as it is automated. This software is so easy to use; it helps to process the billing very fast and accurate. E-Billing saves time and money for health care professional by eliminating printing, folding, sealing and mailing the statements. Since electronic medical billing software produces reports and statements by automation, it saves a great deal of time.

One of the disadvantages of electronic medical billing is the cost involved in purchasing the software. Software is available in two forms. First one is completely installed in the health care facility's computer and the other one is a part of the software is in Software Company's data base. Productivity wise both work the same. Technology becomes outdated every few years. So physicians are compelled to buy the new ones in the market.

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

Medical Billing Electronically

2009-11-04T02:00:00.001-08:00

Medical billing is a complex procedure of billing and collecting payments for the health care service provided to the patient. To run a profitable medical business, hospitals and other health care facilities should follow an effective way of collecting reimbursement. Electronic medical billing is vital to run a successful practice.

The cash flow in any health care facility depends on fast and accurate billing. This is a tedious process which requires attention to minute details. Accuracy and efficiency are very essential for medical billing. Any error occurred in the data entry will finally end up in denial of the claim. This not only causes loss but also waste of time and energy of the health care professionals. In paper claiming denial is as high as 30%. Electronic medical billing has reduced denials to a greater extent. However electronic billing cannot prevent rejections if not performed by a skilled professional.

HIPAA, health Insurance Portability and Accountability Act requires most of the claims to be done via electronic filing. As soon as a patient enters a health care facility, office personnel takes the personal details such as name, age, sex, address and insurance company of the patient. Before giving any service, the health care processional checks the eligibility of the patient electronically for the planned treatment with the insurance company. This is known as "health care eligibility and benefit response" transaction. Upon treating the patient, medical billers submit a claim form that is customized for each patient to the insurance company and insurance company acknowledges that the claim has been received and will be processed. Once the claim is processed, the payer responds which all claims can be reimbursed or denied with reasoning. With the help of electronic billing, all these procedures are done very fast. So, the doctors will be reimbursed in 10-15 days, where as paper claiming takes months together to get the payment. Electronic medical billing has made the back office job almost paperless and also helps to reduce the number of employees needed in the non-clinical department.

Paper filing requires inventory, postage, phone calls and employee expenses. Since electronic billing is much faster and efficient, the staff requirement is greatly reduced. Electronic billing needs software and computer. When the advantages are considered, spending on computer and software is really worth.

One of the drawbacks of electronic claiming is technical problems. Medical office personnel may not be able to fix the glitches in the software. Electronic medical billing is a good option for those who have already established and have a great number of patients, so that they can afford the electronic medical billing software. Otherwise, the cost of the software itself can make this an unprofitable business.

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

Learn Electronic Medical Billing

2009-11-04T01:59:00.000-08:00

Medical billing is the process of submitting the claims to insurance companies in order to receive money for the service rendered by a healthcare professional. Before treating and billing a patient, healthcare providers check the eligibility of the intended service with the insurance company electronically. The insurance company has medical directors, who review the claim to check the validity of the payment based on the credentials of the care provider and the necessity of the treatment. A response to the eligibility request is returned by the insurance company through electronic means or more commonly from their website. Proved claims are reimbursed up to certain percentage of the billed amount. Failed claims will be rejected and the healthcare provider will be notified.

Since 1997, all practices which involve patient interaction should pass HIPAA, the Health Insurance Portability and Accountability Act. Under HIPAA, most of the billing claims for the service are required to file via electronic means. HIPAA was enforced in order to prevent fraud and abuse in healthcare delivery and health insurance. While manual filing is time consuming, electronic billing is fast and accurate. With the usage of electronic billing, the rejection and denial has reduced drastically and the percentage of reimbursement has improved.

Electronic medical billing is nothing but the combination of IT and health care sector. Medical practices have been using software to manage their finances for several years. However, the present electronic medical billing programs are well known as medical management practice software. Electronic medical billing software covers a wide range of functions including tracking patient demographics, scheduling appointment, tracking billing information and insurance payments, patient's visits, diagnosis and generating records.

Electronic billing is easy to use, thus helps the staff to improve their productivity. They have also made entire billing much faster .With the electronic billing, any error in the claims are notified to the billing center in minutes, so corrections can be made immediately. Healthcare providers are also satisfied with this system, because electronic billing makes the reimbursement very quick. This software is very friendly to the patients and customers as they give flexibility in scheduling appointment and easy access to the personal information. The cost of electronic claiming is less when compared to the claim submitted on paper. So, insurance carriers encourage electronic medical billing. Electronic billing also helps to eliminate the hassle of posting, printing and sorting the mail.

So, in total, electronic medical billing was a result of combined effort of software companies and healthcare departments to invent a new technology to simplify the process of medical billing.

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

Improve Your Billing in Orthopedics

2009-10-21T22:52:00.003-07:00

Making sense of confusing anatomy terms in the op notes when you're billing in orthopedics is not fun. But your grasp on orthopedic anatomy is key to billing and coding properly. Learn how to streamline your claims to make your billing in orthopedics simpler and more accurate.

Take the Confusion Out of Hand Surgery Billing

When you're billing in orthopedics, hand surgery claims can be the most frustrating of all. You have to read and interpret the op note thoroughly, as well as understand the anatomy references in order to code the procedure and diagnosis properly.

You need to know the anatomy of the hand and wrist, including how all the tendons connect and interact. Most surgical procedure codes don't designate which digit the physician is repairing, but you still need to identify the specific digit. Append HCPCS Level II modifiers to the CPT codes to identify the digit(s).

Use modifiers FA and F5 to the left and right thumbs, respectively. Use modifiers F1, F2, F3 and F4 for the fingers on the left hand, and use F6, F7, F8 and F9 for fingers on the right hand.

How to Use Unlisted-Procedure Code When Billing in Orthopedics

When billing in orthopedics, you'll certainly encounter situations in which you have no choice but to use an unlisted-procedure code. For example, when the orthopedist performs a laminotomy and extension of herniated thoracic disc, you'll soon realize that the only thoracic codes are for transpedicular or costovertebral approaches.

You'll need to use an unlisted-procedure code in this case, which can make your billing in orthopedics a bit more labor-intensive. Whenever you have to use an unlisted procedure code, you must ensure that the orthopedist documents,the procedure carefully and that you include certain information in your claim.

Here are a few tips regarding using unlisted-procedure codes when billing in orthopedics:

- Include a cover letter when you file the claim that states why you are using the unlisted-procedure code, which explains in simple layman's terms what the orthopedist did;
- Include diagrams or photographs of the procedure to better help the reviewer understand the procedure;
- Make sure you give the reviewer a way to contact you with questions; and
- Reference a similar listed procedure code with an established reimbursement value to suggest an appropriate fee.

Article Source: http://EzineArticles.com/?expert=Angela_S._Martin

Electronic Medical Claim Billing

2009-10-21T22:52:00.001-07:00

Electronic medical claim billing is offered by outsource strategies international that are leading business outsourcing of Process Company with headquarters in Oklahoma. It is specialized in providing electronic medical claim billing for outsourcing. This medical claim billing aids in providing quicker payments from various insurers by pruning time taken for preparation of conventional claims with various papers. Processing rate of electronic claim's load is less in paperwork when it is produced on paper.

Electronic medical claim billing can also be offered by the company by translation of automated claim by a stream of maintenance of database as well as reporting. This billing brings about quicker payments for innumerable clients. You have a provision for avoiding costs of labor that is required for making payment for various clients. Costs are also involved in printing, mailing as well as sorting that are resulting in savings in a big way. Electronic medical claims are edited for getting valid information, diagnosis, codes of procedures not akin to various other paper claims.

Salient features of electronic medical claim billing can be enumerated as under:

• Reduction in billing and errors in insurance.
• Restoration of data and backup.
• Management of time of clients for the purposes of accounts receivables of these people.
• Costs need not be incurred upfront.
• No maintenance expenses or on installation of software or hardware.
• Low rates in processing.
• Quicker processing entailing faster payments.
• Receipt of timely reports for claiming information regarding status.
• Faster turnaround time for cash flow improvement.

The company creates, follows up, submits as well as posts various claims. They can transmit various files uploaded for the bill players by utilizing secured file transferring protocol. For any extra audits or omissions, the companies system of assurance of quality by receiving notifications through electronic medium and generate immediately various alerting check points. The company has special technique for matching clients' accounts as well as bills with numbers of claims and has a review of codes before dispatch takes place to various payers. The company also affords accessibility to all clients' accounts with a solitary user-name. Various software packages of medical billing are available such as medical manager, inception, eclipse, e-clinical, etc. They also provide collections as well as medical billing by using the software.

To conclude, the company also is offering free trial for their services such as online medical billing, coding, medical billing, medical transcription and many more. If you have faith in handing over the company all your electronic medical claim billing, immediately you can contact them at any time through telephone or through email.

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

Medical Billing Online

2009-10-21T22:50:00.000-07:00

Medical billing is the process in which there is submission and follows up of claims to insurance companies so as to get the payment of services provided through a health care provider. This process is also used for lots of insurance companies, either they government owned or private companies.

There are various types of online medical billing processes:

• First is recording the patient information, name, age, sex and address and other basic information's of the patient.
• Second is coordination of benefits
• Third is collection of insurance.
• Fourth is the basic coding.
• Fifth is handling of claim rejections
• Sixth is filling HCFA and UB92 claim.
• Last is explanation of benefits.

Online billing is a process which has interactions with patients under HIPAA and sends most of the bill claimed services through electronic means. The software checks the patients eligibility for the required services along with patients insurance companies. The ground of medical billing is gone through variety of changes and improvements daily, through different technologies.

The new software technologies require some kind of format training. Hence those who are looking forward to work in medical field and want to earn a degree in medical billing, they need to join courses which are specialized for the same. The new technology has a reporting module which adds up to more than two hundred financial and statistical report for med soft. This med soft has charts and graphs which have the ability to provide information's like payment trends, charges trends and appointment trends.

This software improves the management information's and makes it easily accessible to the physicians and the office manager and allows the medical offices to speedily and effortlessly print chart labels ,print the address labels and the appointment reminder cards.

The online services also have facility to make arrangements for scheduled reports which can be printed or delivered through email on the scheduled basis. It prints the reports, collate them and delivers them in the negligible time because of this efficiency the common monthly reports are programmed to be delivered to the physician's office and office staff automatically.

There are various of these type of degrees online and they can be earned faster than the traditional degree programs. For this you need to work with top billing companies and get updated to the most recent software. The advantage of online is that you can sit at home, check and get your bills cleared.

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

Medical Billing Specialist Training

2009-10-21T22:49:00.001-07:00

A person who works with a medical company and is in charge of the medical billing, claims processing, charge entry, and collections is said to be a specialist and to become a specialist in this field one needs to have accuracy and attention in detail. Each specialist also performs insurance verification; he/she also prepare and maintain patient charts and schedules appointments. Healthcare industry is having high demand for people having the knowledge of medical office operations.

A person who has a strong interest in the health field and who does not like working with patients directly then this career is ideal for him/her. For working as a medical billing specialist you need to have a proper training and advanced certification which you can get easily as there are many schools which provide such programs to train and educate you. You can choose either online program for medical billing specialist where you can learn everything at your own pace or a regular class where you will complete the training in few semesters. To get a better knowledge and proper training it is better to get admitted to an accredited college and obtain an associate's degree in this area.

While in training you will learn the skills to perform the coding, proper reporting functions, and secure health information management. The training prepares you for entry-level medical and insurance office jobs. A medical billing specialist undergoes an intensive medical billing program. This training also ensures that medical billing specialists possess the very latest information about the industry and produce excellent quality results. During training you will have to study and topics like medical terminology, physiology, human anatomy, medical law, ethics, medical coding and medical billing. The specialists also get trained in administrative topics like accounting basics, professional development, business communication etc. After this the students are trained in evaluating and interpreting health records and reports so that they can accurately code diagnoses and procedures which is in accordance with the recognized classification systems.

Once the training is complete then the specialists are equipped to read and interpret records of medical documentation to identify diagnoses and procedures for data capture and billing. They are equipped to assign diagnostic and procedure codes for reimbursement and statistical purposes according to the guidelines They can also easily abstract information from patient records to complete the insurance claims for them and have the knowledge of different reimbursement methodologies.

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

Filing Medicare Claims

2009-10-05T06:54:00.001-07:00

When submitting professional claims to Medicare part B, there are some things that Medicare requires that differ from other insurance carriers. If you do not follow these guidelines or rules, you will find that your claims will be rejected.

First of all, most Medicare carriers are requiring that claims be submitted electronically, even if Medicare is secondary. If you are not capable of submitting your claims electronically you can apply for a waiver. An office with less than 10 full time employees can obtain a waiver granting them permission to file on paper. The CMS requires you to obtain a waiver certificate "demonstrating extraordinary circumstances". If accepted by Medicare, they can then file claims on paper. If you do not qualify for the waiver then you must find a method to submit your claims electronically.

If your software is not capable of electronic billing, which in this day and age would be unusual, or if you just do not want to go thru the expense or trouble, you can get a free software from your Medicare carrier. The biggest problem with using the free software is that it many times is cumbersome to use, and it requires double entry of the claims. However, if you do not submit a lot of Medicare claims it can be a viable option.

Another little quirk with Medicare is that they require you to enter the word "none" in box 11 (or the equivalent of box 11 if submitting electronically) on the CMS 1500 form. We have had many providers over the years contact us because "Medicare won't pay!" when it was all just because they didn't have the "none" in box 11.

Whenever we train a new employee that is one of the things we try to drill into their head! "Don't forget the 'NONE'!" There is nothing more annoying to me than getting a rejection to find that the only problem is that 'none' was missing. We are working with a company who is building a rules engine to prevent problems like this from getting thru. The claims scrubber will alert you to the missing word before you submit the claims!

Then of course there are the modifiers required only by Medicare such as the AT modifier for chiropractors or the GP modifier for physical therapists. These modifiers are not used by any of the other carriers, but without them Medicare will not pay.

Another thing Medicare requires is referring dr name and NPI number for simple in office services such as EKG's. So if one of my doctors decides to do an EKG on one of his patients, I have to put HIS name and NPI number in as the referring doctor, even though he provided the service. Seems kind of ridiculous to submit a claim for Dr. Smith doing an EKG where Dr. Smith referred the patient to himself. But if I don't put it in, the EKG is denied.

Another Medicare quirk is that many Medicare carriers (maybe all) require that you do not put the NPI number in box 24J if you are filing a claim for an individual provider who bills using just their individual NPI number. When the NPI number is in 24J for an individual provider, the claims are rejected. However, if you are filing a claim for a group, the individual NPI # must be listed in 24J and the group NPI# must be listed in box 33A.

When a claim is denied by Medicare or any other carrier, it is important to identify why the claim, or service, was denied. If the denial on the eob is not clear, call to get an explanation. If you do not agree with the reason for the denial ask what the process for appealing the denial is. If the claim was denied for something simple that you can fix easily, make the correction and resubmit the claim. If you do not understand the denial even after getting an explanation from a customer service rep, you can always Google it, or post a question on a good medical billing forum. The important thing is to take care of the denial and not to ignore it.

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

How Mandatory Electronic Claims Submission Affects Us

2009-10-05T06:53:00.002-07:00

Recently the state of Minnesota mandated that all medical claims are sent electronically by July 15, 2009. If you are not from Minnesota, you may not feel that this affects you, but it does. It affects us all.

Costs are definitely cut down with electronic billing. Both insurance companies and the government would like to see all claims sent electronically. If Minnesota is effective with instituting the electronic mandate, you can be sure that other states will follow. It is just a matter of time.

A very small percentage of medical offices or billing services are capable of sending all their claims electronically. Many small insurance carriers are not yet capable of accepting claims electronically. So how will we accomplish this major undertaking? The real question is how will this affect the individual providers and billing services.

The providers in the state of Minnesota will have to at the very least have a computer with internet access in the office or they will have to hire someone who can submit the claims on their behalf. Don't laugh! We still find offices that don't have a computer. They won't have to purchase an expensive practice management system if they don't want to. They may have a good way of tracking their claims on paper but hopefully they are tracking claims. Anyone who has been in this business for any length of time knows of the office that looses thousands of dollars or tens of thousands of dollars by not tracking claims to make sure they are paid.

The Trade Association of State HMO's (The Minnesota Council of Health Plans) has contracted with an independent company who is building the software that will be available to medical offices and billing services in the state of Mn. to submit the claims online. The biller will go to the site and enter the claim information and send it to the insurance company. The only problem with this is that the information will have to be entered again for tracking purposes. If the office has a practice management system, any claims that had to be sent through this new system will also have to be entered into the practice management system.

We don't know how this affects the smaller insurance companies in Minnesota who were not yet capable of receiving electronic claims submissions. I presume they are scrambling to get ready. Not only has Minnesota mandated that medical insurance claims be submitted electronically, but they have also mandated that all insurance carriers use ERAs or electronic remittance advices (electronic eobs). This is huge too. Electronic remittances make posting payments much quicker and easier if you have the means to post them automatically.

At any rate, it will be very interesting to see how this all works out. All eyes are on Minnesota. We would be interested in hearing from anyone in Minnesota and how it is affecting them.

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

Chiropractic Billing Systems Open Doors For New Doctors

2009-10-05T06:53:00.001-07:00

Traditionally, young chiropractors have three options when they enter the chiropractic profession. They can associate with another doctor in hopes of learning how to run their own practice; they can independent-contract (that is rent office space from another chiropractor and use their office staff while they try to build a practice); or they can try to open their own office upon graduation from chiropractic school. The overwhelming majority of young doctors will choose to associate for a time because they lack the knowledge and skills in the areas of billing, compliance, and record-keeping. Chiropractic schools do a good job of preparing young chiropractors on how to provide quality care for their patients, but unfortunately they do not teach the students on how to run a profitable practice.

What many new chiropractors do not realize is that they can open their own practice immediately because there is very useful billing and practice management software available that makes billing, compliance, and record-keeping a snap. The software is designed by chiropractors to make the transition from school into practice as smooth as possible. Chiropractic billing software will guide the new doctor through the entire process. It's like having a practice management group and a billing department in your office as soon as you open your doors.

The software allows you to: finish SOAP notes before the patient gets off the table, perform electronic scheduling and monitor missed patient visits, bill insurance companies at each visit, and use the most recent compliance information to help avoid insurance audits. And new doctors especially, are susceptible to accidental insurance fraud because they are still learning the process. Billing software helps eliminate this concern because it is the new "gold-standard" in transparency. Off-site billing companies are using web based systems that allow the doctor to enter claims directly into the system at the end of each patient visit. These paperless systems allow the doctor to track claims and see how the insurance company is handling the claims as they are being processed. This results in total transparency and eliminates confusing monthly or bi-monthly reports. Thus, the doctor can provide outstanding patient care to build the foundation for the practice of their dreams without the headaches of paperwork and collections.

Unfortunately, many young chiropractors think that their only option is to go and work for another doctor until they "learn the ropes" of the profession. This is simply not true anymore. With the arrival of chiropractic billing systems, doors for recent grads are being opened like never before. Why learn the hard way when there are systems out there that can help you avoid all of the bumps in the road that were previously inevitable?

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

Re-Engineering Your Practice

2009-09-25T02:53:00.002-07:00

Before implementing a chiropractic billing and practice management system, it is important to examine all of aspects of your practice from an efficiency and cost perspective. The purpose of this article is to provide some insight into how a practice should be examined before implementing a practice management and billing system.

Financial Analysis- First, you should take a look at your practice from a financial perspective to determine if there are areas where the financial performance of your practice can be improved. Here are examples of the areas you should research and the types of questions you should ask:

1. How timely is your submittal of claims? Are claims immediately submitted after a patient is seen or is there a time lag between when a claim is submitted and when the patient is seen?

2. What is the rejection rate of claims submitted that could be remedied by better coding?

3. Are you fully maximizing the reimbursement rate for claims? If not, why not?

4. Of the available patient hours in your practice to see patients, what percent of available hours are you actually seeing patients? How could this be improved?

5. Are you adequately controlling overhead costs? For example, through more efficient management, can you reduce the number of staff hours required to operate your practice?

Operational Analysis. As a first step in operational analysis, workflow diagrams should be developed. For example, a flow chart of patient processing should be drawn showing what happens with an existing patient from the beginning of the visitors to the end of the visit. Other workflow charts that should be developed include how clerical procedures are handled such as processing of a new patient, submittal of claims, and patient recordkeeping.

After the flow chart is developed, the following key questions should be answered:

1. Is this step necessary or can it be eliminated?

2. What is the cost of this step? For example, considering the salary of the person performing the step, what does this step cost? Could the step be performed more cost effectively? If yes, what is the most cost effective approach?

3. Could this step be performed more efficiently? If so, what would be a better way to perform this step?

Important to note is that buying and installing a chiropractic practice and billing system is not a "magic answer" for improved profitability and efficiency. Of course, any good software package will result in improvements, but you will not realize the full benefits of a chiropractic billing and practice management system unless you examine your current practices and procedures first and determine how you might improve those areas. Careful analysis and planning before implementing a chiropractic practice billing and management system will provide the most benefit to you.
There are many benefits of installing a good chiropractic practice management and billing system including reduced audit risk, improve management of receivables, reduction in missed appointments, and maximization of revenue. All of these benefits and more can be optimally achieved with a close examination of your practice first.

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

Chiropractic Software - How Automation Can Help With Patient and Office Flow

2009-09-25T02:53:00.001-07:00

What should a chiropractic office management and billing system provide in terms of front desk processing? Since the front desk is the first point of contact with a patient, this is an important question.

First, front desk software should provide an effective, low cost way to intake existing patients. One successful approach that a software package provides is that patients are given a scanning key tag which they simply scan at a desk for entry. This scanning process automatically initiates setup and processing of the patient's visit. The key tag is often used in other ways such as one key tag being used for an entire family. From a marketing perspective this software company provides the capability to custom imprint a practice's key tag with a logo or important contact information about a chiropractic office.

When the patient scans his tag, if necessary, front desk action notifications occur to alert office staff of a situation that needs to be addressed. For example, if a bill is yet to be paid that can be flagged or if the patient is out of compliance with his practice plan. At the front desk, notifications can be handled as the patient stops by the front desk as instructed at the check-in station.

Other information which could be provided is the number of days left on a care plan, days left in a precertification or care plan, number of insurance visits left, number of cash visits, number of free visits. In effect with the system like this, only the patients will be stopped that actually need to see the front desk after a system checks and verifies over a hundred different variables related to a patient's records.. This frees up staff for other work and provides for a more efficient overall patient flow in the office.

The benefits of using automated patient check in with a key tag are significant. First, less labor is required to process the patient visit. Second, there is less chance of errors that could impact collections, coding mistakes, and other problems. Third, automated check in, often not requiring office staff to be involved, reduces the labor cost associated with check in and also helps to eliminate long waiting periods for patient check in during peak hours for patients.

With a fully automated system such as the one we've described a practice can see anywhere from a hundreds visits a week to a thousand visits a week. The number of visits, of course, a practice sees will significantly impact profits. That's why the payback from investing in chiropractic software can be so substantial.

If you are considering a chiropractic billing and practice management system, you should carefully consider what capabilities you are looking for, read about the features each system offers, and decide what features are important to you. This will help you select software that is a best fit for your practice and software that meets your own budget guidelines.

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

Chiropractic Billing Software - The Benefits at the Adjusting Table

2009-09-25T02:52:00.000-07:00

A good chiropractic billing and practice management system supplies comprehensive support for all aspects of patient processing and record handling. Such a system should be easy to use, be oriented to providing a high level of service for interacting with the patient, and should reduce paperwork and manual processing as much as possible. The system should also have controls, flags, warnings, and built in processing methods to reduce the chance of an audit- an often costly and time consuming process for a chiropractic practice.

Besides that Chiropractic Billing Software (CBS) can help at the front desk of a practice where patients check in, there are huge benefits at the examining table. In fact, for existing patients, the front desk can be completely eliminated and the patient can be handled by the doctor right at the adjusting table. Bottom line, if implemented correctly, the chiropractic office can be made totally paperless.

How does it work? Quite simply information is directly recorded at the table. From that table the following information can be entered or viewed/accessed:

· Patient images which can be compared period to period to note treatment progress
· Word documents can also be attached and uploaded for easy reference
· Intake documents that have been scanned for electronic access
· Compliance measurement to see if the patient is complying with the recommended visits. If he isn't, this can be discussed with the patient to encourage more regular visits- this improves revenue for the practice.
· Visit history
· Scheduling of the next visit
· Appointment types can also be recorded. In addition, visits that are cash or insurance can be noted.
· Start and end date of the care plan
· Diagnosis and procedure codes

As information is entered, a good billing system also flashes warning such as state or payor related, warnings about problems with procedure codes, and warnings if a modifier or diagnosis link is needed. A good system will also automatically check to make sure documentation supports the billing level of coding on a claim. The system should also allow for the SOAP note to be broken down into subject, objective activities and should allow for recording daily living activities. The system should also allow the doctor to enter his own narrative about a patient visit with the system automatically documenting that.

Another huge benefit of a chiropractic billing and practice management systems is that information entered by the doctor at the adjusting table automatically bills and submits claims for the visit. This is a huge time saver, insures accuracy, and also speed in processing claims. Of course, the system would allow for exception processing such as allowing the doctor to flag visits for later updating by the doctor.

The best practice billing and management systems are not those built primarily by programmers but, rather, those systems that have chiropractors, compliance officers, compliance attorneys, physical therapists and other experts heavily involved in the design and development of a system. Involving a programmer primarily risks the development of a system that isn't designed for the realities of a chiropractic office.

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

Is Your Practice Medicare RAC Ready? - The Answer Lies in Your Documentation

2009-09-17T04:53:00.001-07:00

The three year Medicare RAC demonstration that was conducted in California, Florida and New York demonstrated that one of the biggest areas where improper payments were identified was due to improper documentation by the physician.

As a practice administrator you may wondering how to ensure physician documentation leads to proper coding in the billing cycle. You may also be wondering how to go about improving the documentation of the physicians that work in your practice. Proper training and education is critical to ensure that physician documentation is compliant and that it leads to accurate coding and billing.

As the Medicare Recovery Audit Contractors (RACs) roll out nationwide, it's now more important than ever that your practices administrative and physician staff work together to assess documentation risk areas that may be a potential audit risk to your organization. That way once these areas are identified, you can implement proper training and education for your physicians so that any documentation weaknesses will improve and your audit risk will be reduced.

During the demonstration period, approximately one third of improper payments identified by RAC auditors were cited as improper due to the fact they did not meet Medicare's medical necessity criteria for a particular service. Another significant amount of claims were identified as improper was due to the fact there was not enough documentation on requested medical records or information could not be gathered in time to respond to the RACs request. During the demonstration, through March 2008 improper payments totaling more than $391 million were recouped due to medical necessity criteria not being met, with another $74 million being recouped for insufficient documentation.

Here are a few steps your organization can perform to ensure that you will be RAC ready.

Identify Any Risk Areas

The first step is to assess your practice's documentation to identify any areas of risk. By examining past medical records, your practice can identify any areas of risk and the things your physicians may need additional training and education on. This review can be conducted internally if you feel that you have qualified staff that can conduct an independent review of your physician's documentation.

If you don't feel competent about your internal staff performing the review, it is definitely worth considering hiring a qualified third party audit firm to come in and do a base line audit of all of your physician's documentation to identify any compliance issues.

The key whether you do this internally or utilize a third party is to make sure and involve both your clinical staff and administrative staff. Everyone needs to be informed of any defined goals, progress and issues identified so that everyone will buy into doing whatever it takes to correct the identified issues and bring your organization compliant.

Provide Education and Training

If issues are identified, your physicians must be open to receiving training and additional education so that they can learn how to properly document patient encounters. This will greatly reduce your organizations audit risk in the future.

Make sure and also include your administrative and billing staff in the education process. Make sure and use real-world examples from your practice in you training as this is vital to ensuring your organization's documentation is thorough enough for clinical and billing needs.

Training and education should be provided by certified professionals that have the coding and documentation knowledge relating to your specialty.

Education and training should not be a onetime thing but an on-going practice that is implemented into your organization's goals and objectives. The rules and regulations of compliance are constantly changing so it's critical that your organization continued to obtain proper education to ensure that your organization is current with compliance requirements.

Engaging both your physicians and staff in the process of RAC preparation is critical because it ensures that your organization will be as prepared as possible should the RACs select your organization for an audit.

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

The Right Way of Approaching Medical Billing Work

2009-09-17T04:51:00.001-07:00

Medical billing work is a very popular work-from-home option. This line of work is a very profitable career, but also a demanding opportunity. However, if you approach medical billing the right way, you can earn anywhere from $30,000 - $100,000 per year.

One of the main aspects to be aware of in the medical billing field is the large number of illegitimate companies trying to sell you junk. These companies disguise themselves and go to great lengths to appear legitimate. At times, some are legitimate too. The problem with many of these legitimate companies is that they will over-commit and under-deliver.

At times they will sell expensive specialized software, and other times, they will promise you lists of doctors seeking medical coding and billing service providers. Unfortunately, many of these lists are completely made up. No one wants to hand over their hard-earned money to a scammer or careless and unreliable companies, for practically nothing in return. So do your research on any company you are considering purchasing materials or services from.

This line of work does have some requirements, including: a personal computer, special billing software and sound understanding of industry terminology. In order to locate the most effective medical billing course, find out the individual prices for the software and the training.

The medical billing codes are the most important knowledge asset required for this line of work. The codes are assigned to practically everything, such as diagnoses, procedures, health professions etc. Apart from the codes, other important billing details include what to do if the accounts collectible are not paid by the patients or by their insurance company etc.

If you are willing to undergo a training and acquire the appropriate billing software, and are eager to work independently, medical billing might be a good fit for you.

Time is the biggest constraint when it comes to medical billing. In fact, it is common that medical bill review professionals work 10 plus hours per day. However, don't be too aggressive in taking work, as too much work may turn into a problem in itself.

The good about medical billing is that it can free you from having to report directly to a boss. If you decide to become an independent bill review professional, you will be able to work at home, close to your family, while still earning money for your household. In many instances, you will be able to earn more than with a nine-to-five job, since you will be deciding how much work to take on. If you are personally motivated and have ambitions, medical billing might be right for you.

How much work can you expect? Well this varies from company to company. Some companies require 30-50 medically coded invoices per week, others require more or less. Basically, if medical bill review is your sole income, you can decide to take as much work as you wish.

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

Steps to Finding the Right Medical Billing and Coding Training

2009-09-17T04:46:00.000-07:00

Medical billing and coding training courses costs a lot, that is why it is very important to find the most valuable course. This article will describe the vital aspects of an effective training course.

A good course will get you up to speed with everything required to become a successful medical billing professional. The majority of the training can be completed online. Online courses are more convenient, and are usually preferred by most people. A thorough training course usually takes about 6 to 12 months to complete. More extensive training, such as an associates' degree programs or bachelors' programs, may be up to 2 to 4years, respectively.

Before you spend your hard earned money, make sure that your training course is accredited by one of the following organizations and bodies: Commission on Accreditation of Allied Health Education Programs, American Health Information Management Association or Regional Accrediting Bodies.

A solid training course will provide you with the necessary expertise for medical billing and coding. This includes being comfortable with registering patients' information, performing an insurance verification, preparing and posting transactions, charging patient accounts, coding and billing insurance claims and collecting patient payments.

By the end of the training, the students usually have a solid understanding and substantial knowledge of the medical terminology and abbreviations, communication techniques, various insurance plans (Commercial, State, Federal insurance plans, etc.), the Accounts Receivable cycle (i.e., registering patients, accounting transactions posting, insurance claim forms' completion, collections, etc.), as well as medical coding and billing itself.

The requirements for the majority of the training courses include: keyboarding proficiency, basic understanding of Microsoft Word, and a good command of written English. Students are usually not required to have any health care work experience.

It is a good idea to take a course provided by a local university or college. The overwhelming majority of these courses are accredited so you don't have to worry about whether your education will be acceptable. Registration takes place at the university or college where medical billing course is being offered. Registration can at times be done over the telephone or online. These courses are usually conducted online, and students may be completely saved from the trouble of traveling to school. Therefore, it's a good idea to search out a university or school which offers the best courses at the lowest fee, without worrying about how far it is located.

A big advantage of medical billing training courses is that they are usually self-paced. You can complete the course at your own pace. For most of the courses, you will get at least 6 months to complete the it (depending on the course). However, if you think you need more time, you can usually extend your course by at least another 6 months.

Some bill review courses may qualify for federal aid, while others don't. If you require financial aid, you should immediately seek additional information at the school or university, where you plan to register. However, there are courses which provide a loans for their students. You should also check with a particular course provider, to find out whether they provide student loans.

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

How to Improve Your Chiropractic Collections at the Front Desk

2009-08-23T06:30:00.002-07:00

In today's economy and health care marketplace, chiropractic offices frequently face challenges when collecting co-pays, deductibles, co-insurances and other balances due from patients. Unfortunately, ignoring the problem only makes it worse. Learn how to set up some simple systems for collecting the right way, every time from your chiropractic patients.

It used to be that if you failed to collect money from patients, that you either lost out on income and/or created collections issues for yourself. Asking for money is now an absolute necessity for two reasons: 1) lost income and 2) failure to ask for money that a patient owes the practice could lead to a breach of your chiropractic provider participation agreement as well as potentially creating a False Claim to the insurance carriers.

Unfortunately, in the 80's, many chiropractors created a monster in that we allowed patients believe that their coinsurance was optional. I don't personally know any clinics that are still stupid enough to engage in this practice; however, the stigma still exists.

To make collecting even more challenging, some patients believe that you, the chiropractor, make enough money and that you do not need the extra $20 or $30 bucks. They claim financial hardship and proceed to drive off in their Lexus, while you are so undercapitalized that you give your practices loans to make payroll.

You want another laugh? Many MD's over the past few years have sought other ways to make up for lost revenues by adding ancillary services to their service mix. Take, for example, the Obstetrics and Gynecological practice that now offers weight management, laser hair removal or skin resurfacing. Interestingly enough, these services are paid in cash, in advance, before the services is even rendered.

What's worse is that some of the very same patients who are lined up to pay cash for these cosmetic services (which usually total in the hundreds or thousands of dollars) are the same patients who gripe and complain when it comes to paying their $20 coinsurance or their $250 deductible.

Certainly, I am not stating that there are not financial hardships. When you run across a chiropractic patient with a legitimate financial issue on hand, you should have written policies in place to handle that. What I AM trying to convey is to eliminate excuses that patients use for non-payment. In short, be very cautious about allowing your patients to dictate how you run your practice.

Doctor (and staff), Heal Thyself
Sometimes, we (and our staff) are the biggest threat to good collections.

Ever watch your Chiropractic Assistant try to collect a co-pay? I have some seen some staff members ask a patient to pay their co-payment and literally duck as soon as the words come out of their mouth so as not to be hit by a thrown object! Bad sign, my friend. Get that person away from the front desk.

Another common problem is the attitude we use when collecting patient copayments. What do you think happens when your staff says to the patient "Would you like to pay now or should we bill you? What on earth do you think they are going to say? "By all means, bill me!" Don't blame the patient. It's the attitude of your staff that is the issue - they are acting like payments are optional. Train this person quickly or liberate them to find another job.

The Biggest Collection Problem in the Chiropractic Practice
Where does the biggest source of collections problem typically lurk in our practices? The Doctors -- of course! What do most of us say when a patient gripes or complains to them about what they are having to pay out of pocket to come and see them? "Don't worry about it, I'll handle it!

If we heard one of our staff members say this, we would go ballistic; yet these very words spew out of our mouths frequently when it comes time to discuss money!

The Golden Rule for Collections
Ok, here is Tom Necela's "Golden Rule" regarding collections, you ready for this? Get your highlighters and pens ready because this is the pay-off for the entire article. Ready? Are you sure? Last chance to get the highlighter!

Here it goes, "Never let the doctor get involved with a patient face to face or on the phone over finances." Period. The end!

Doc, this is the beginning of the end for good collections procedures. When the chiropractor gets involved, it forever alters the physician/patient relationship and you can never get that back. In addition, this is where your billing manager and your staff -- who are charged with the responsibility of collecting from the patients -- get permanently discredited.

Yes, I said permanently. Why? You tell me, doc! If your well-trained staff tries to collect and YOU let the patient slide one time -- what's to prevent them from repeating the same behavior in the future?! Don't do it. Train your staff well, train them often, give them consequences for non-performance and performance based bonuses.

And then, let them do their job!

Chiropractic Soup Nazi Beware!
Now, I know there are those of you out there who say, "Not in my practice Cowboy!" We collect from EVERYONE! Although this is typically less of a problem, I do have to address the other "extreme" of collections.

I do believe there are offices that are a little too efficient at collections. There is also a problem with this. I have seen how some of your staff handle your patients collections and they are like Seinfeld's famed "Soup Nazi" -- no soup for you!

You have what I refer to as the "bull dog" sitting at the check out area and when a patient tries to leave without paying their portion they attack like a dog going after a piece of raw meat! You know the type, they will literally wrestle the patient to the floor before letting them slide on a payment.

I once was at a chiropractic clinic where I literally watched in amazement as an incredibly rude, mean, and just plain scary front desk C.A. frightened patients into paying. She was totally consistent, but the vibe was way wrong. In fact, one of the patients in the waiting room witnessed her behavior and joked: "These docs must be making a lot of money. They got a bodyguard at the front desk to protect them!"

Yes, these offices get the money, but it's bad for business, folks.

Find Happiness in the Middle
In short, collect everything you can. Give patients many possible ways to pay. Do this all while being nice about it and they will pay you.

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

Making the Decision to Outsource Your Chiropractic Billing

2009-08-23T06:30:00.001-07:00

The topic of outsourcing a chiropractic office's billing brings up much controversy in chiropractic circles. Although, there is no right answer for everyone, let's take a look at the issue in detail to find the best answer that may suit you.

The Issue of Control
Chiropractors who are big fans of keeping billing in-house typically cite "control" as a factor of why they are in favor of in-house billing. While it may appear that you have more control over your billing by having an employee who works in your office handling your claims, your employee may have too much control.

That is, they can get to know patients and let overdue accounts slide. They can dislike certain tasks (calling attorneys, for example) and decide to ignore them. One of the biggest negative of in-house control is the fact that when your biller is sick, goes on vacation or is doing less than a stellar job, they have effectively controlled your ability to get paid. "Control" is not always a good thing.

Are Employees More Sensitive to Patient Concerns?
Another common reason that I hear in defense of in-house billing is that they wish to be more "sensitive" to patient concerns. Yes, it is true that an outsourced biller who is paid on a percentage of collections may not really care whether Ms. Jones can truly afford her co-pays, mainly because the biller does not know the patient. Billers want to collect - period. And when Mr. Smith's claims go straight to the deductible, again, the billing agency wants to be paid.

Again, look to the bottom line here before you conclude that you need this sensitivity from your billing department. Generally, these are the exact types of situations that will get you into accounts receivable trouble in the long run and are easy temptations for the in-house biller who wants to be liked. Down the line, the little incidents that your in-house billing employee has let slide will cost you money.

Still On the Fence? More Reasons to Outsource!
Given the requirements of today's billing processes, it takes the specialized skill of a medical billing professional to be successful and compliant. Billing should not be something someone does to fill in the time between scheduling patients and pulling their charts.

A decade and a half ago, billing was much simpler. Payers changed the rules once a year and informed practices in plenty of time so they could adjust their processes. Denials averaged less than five percent of total claims. Today, it's not unusual to have a 30 percent or higher claim-rejection rate, which requires extensive follow up.

The challenges that internal billing operations are faced with on a regular basis can lead to collection shortfalls or non-compliance.

Here are some more reasons why outsourcing to a billing company makes sense:

• Regulations change constantly, which means that dedicated personnel must be assigned to read bulletins, interact with payers, and attend industry seminars.

• In large organizations, Billing and Coding are separate departments. Most chiropractic offices don't have the resources to dedicate personnel who have the responsibility for ensuring that documentation and coding is compliant with federal regulations should also be certified by one of the accredited organizations. Outsourcing may enable you to achieve this.

• Implementing and maintaining a compliance plan can be expensive for an individual practice; with a professional billing company, the cost of a compliance plan and the compliance officer can be spread across many clients.

• Technology is a huge cost center for an individual practice. For example, in addition to the initial purchase price of payment-tracking software to ensure proper payment according to the appropriate fee schedule, there is the ongoing cost of keeping payment tables accurate. Denial management tools are also required to track and eliminate the root cause of why denials are occurring in the first place.

• Lack of follow-up relating to unpaid claims is the single biggest problem I encounter when consulting with most chiropractic clients. Follow-up is burdensome and time consuming. Because it seems to be the last thing folks get around to, it leads to lost revenue due to the various payers' "timely filing" requirements.

• It is getting harder to attract and retain competent billing personnel. The Society of Human Resource Management states that the cost of recruiting, hiring, and training a new employee is $3,500. Utilizing a professional billing company eliminates this expense in its entirety.

• Professional billing companies offer economies of scale, which makes their services less costly than if a practice tries to run its own internal operation.

When Outsourcing Does Not Make Sense
As I stated at the outset, I do believe outsourcing makes sense most -- but not all -- of the time. Typically, outsourcing may not be the best choice from a financial perspective if your chiropractic practice is at one of two extremes.

For tiny practices who have very few patients or for practices that are mostly cash-based, outsourcing may appear expensive and time consuming rather than just doing it yourself or in-house. Use caution here to make sure you or your employee know what they are doing before coming to this conclusion.

The other extreme is very large practices. The typical percentage an outside billing company may want as a fee for their service may not make financial sense if the practice has a qualified employee(s) who may be able to be amply compensated to do billing full-time.

Again, use caution here in not trying to save too much. Sure, you can probably spend less on your employee's salary than you may have to spend with an outside billing company. However, remember the issue of follow-up. Is your staff going to be able to handle it? If not, the extra money is worth it.

KEEP YOUR GOALS IN MIND
When looking at the big picture, it is important to keep the ultimate goal in mind.

For most, the goal of any chiropractic billing company is to maximize collections and ensure compliance. With the plethora of regulations that now affect billing and collecting, practices need full time professionals to handle their billing.

Today most chiropractors are working harder than ever before and making less due to additional regulations and declining reimbursement. The question they should be asking is, "Why should I have the additional burden of running a billing operation?"

As you can see, there are many good reasons to outsource your chiropractic billing and, likely, the scales are tipped in favor of outsourcing. Either way, now you can make an informed choice!

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

Medical Billing Training and Support Technology - Three Key Components

2009-08-20T00:03:00.001-07:00

As medical billing system complexity and functionality grow in step with growing number of users, the number of training hours per month grows by two orders of magnitude, as a product of increasing training frequency and increasing number of training hours required for each user. The development or billing managers, who must juggle training and support in addition to their main responsibilities, reach a point of over-extension, where none of the responsibilities are delivered well enough. A new, better scalable training and support approach is needed to meet the additional requirements.

The typical scaling up path for training and support includes a three-pronged approach:

* Introduction of formal training and support tracking systems,
* FAQ analysis, and
* Development of knowledge repositories aimed at reusing training and support expertise according to the results of the analysis stage.

First, a formal tracking mechanism for both training and support provides continuously updated information about frequently asked questions (FAQ), individual training and support workloads, response delays, and customer success in absorbing instruction. Predictably, the analysis of most frequently asked questions and answers often shows that a comprehensive and effective initial training eliminates a significant number of help requests. Moreover, customers can find answers up to eighty percent of FAQs immediately and directly by using some sort of a shared knowledge repository, e.g., wiki. Most billing companies using Vericle billing network, follow a two-step approach: first, they create a shared knowledge repository for instructional and support-related material, and second, they establish a training department, staffed with instructors who are able to develop a minimal set of training classes for various user categories (providers, front office managers, billers). The classes typically address various functional parts of the practice management system, such as Help system, Initial Patient Intake, Workbench, Scheduling, SOAP notes, Reporting, Billing, Personal Injury, Care Plans, etc.

The shared knowledge repository gradually accumulates educational mass, starting with frequently asked questions and answers, and with time adding videos of instructional sessions and various support email threads. The instructors move away from ad-hoc individual classes to a predetermined monthly schedule of live daily classes over the Internet (webinar format). In spite of the concern about diminished personal attention, subsequent surveys confirmed that majority of clients valued their own time more than personal handholding, and preferred the immediate automated response to a delayed personal conversation over the phone.

In summary, the increased scale of medical billing systems generates more sophisticated training and support requirements, which can be characterized as:

1. Training and support proximity: High - The separate training and client support departments converged as billers outside of the training department grew more comfortable with shared knowledge bases and began contributing instructional material and answers to FAQ;
2. Degree of personal accountability and transparency: Significantly improved accountability and transparency generated important requirements and prepared the content for the next step; and
3. Efficiency: High - The Internet infrastructure provides the minimal level of scalability that enables a single training session delivered remotely to handle an unlimited number of users, liberating the development and billing managers to focus on their own tasks.

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

Technology and Software in Today's Chiropractic World

2009-08-20T00:02:00.001-07:00

In today's world technology is always changing. The evolution of technology is making its way into the lives of Chiropractors who now have new software to use in their offices. Billing services have taken the opportunity to use the software that has been born out of new technology.

The biggest rewards that the software used by billing services has given Chiropractors is ensuring the happiness of their patients and giving patients better results . By using new computer software, billing services have allowed Chiropractors to stay on schedule and not loose rack of their patients. The computer software used by billing services has the ability to check if patients are keeping up with their appointments and coming into the office regularly. This helps them maintain a healthy lifestyle and ultimately betters their life.

Because of the computer software used by billing services, patients feel taken care of. Chiropractors are able to stay focused on their patients and never loose track of a patient and their appointments. Patients are not going to get lost within a system because the computer software used by these billing services are keeping track of patients for Chiropractors. Technology is helping Chiropractors to stay focused with computer software.

Patients can be tracked throughout multiple offices with the computer software used by billing services. All of their information from their appointment time to an x-ray they have had taken is in the computer's system thanks to this software. Chiropractors now have an easier time knowing the care plans of patients and when their last care plan took place. A patients history is now easier to access and organized. Now chiropractors can click a few buttons and it is in front of them on their computer screen. It is also easier for Chiropractors to add or subtract information to a patient's care plan and keep up with that information to keep insurance companies satisfied. SOAP notes can be sent to insurance companies right away and Chiropractors will not have to worry themselves about whether or not they are done correctly.

Computer software used by billing services allows Chiropractors to work in real time. They can work on a patient and use the software at the same time to ensure that they are documenting everything at the right time and getting all of the details so they don't have to go back and try to remember them at a later date. Computer software allows a very thorough documentation of each patient visit.

As patients get better and see an improvement in their health, along with the attentiveness shown by their doctor, Chiropractors are seeing them continue to return. Patients want to stay with the practice longer and are bringing in more referrals for the practice. With more patients, revenues rise and practices blossom.

Computer software used by billing services is an easy solution for Chiropractors. This software will keep patients on track and therefore keep Chiropractors more focused. Technology is now helping secure healthy patients for Chiropractors and in turn healthy patients are helping practices to flourish and operate at their best.

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

What to Do When Your Chiropractic Exams Are Downcoded

2009-08-20T00:01:00.000-07:00

What to Do When Your Chiropractic Exams Are Downcoded

If you are having trouble with exam downcoding in your chiropractic billing - in other words, you bill for a 99204 but the insurance only pays for a 99203 or you bill for a 99213 and the insurance pays for a 99212 - keep reading because this article can potentially put thousands back in your pockets!

Trends in Downcoding
Downcoding is not new, nor is it a passing fad. The practice of an insurance company paying you lower fees and at a lower code that you billed is also not unique to chiropractic.

Basically, from the insurance perspective, here's the inside scoop on how downcoding occurs. (As many of you already know, I fully admit that I used to work as an insurance claims analyst and so I have an intimate knowledge of their methods!)

Everyone is NOT Downcoded
Rest assured, insurance companies do not try to downcode every possible E/M or exam code for every provider every claim. However - certain E/M codes are highly audited in the chiropractic profession and subject to near constant downcoding.

Which ones? For chiropractors, the biggie is 99205. In fact, there are many even within the chiropractic profession who will go on record and state that DC's have no business using that code.

Downcoding 101
While exam codes such as 99205 are pretty much automatically flagged in the chiropractic world, most insurance companies employ sophisticated software tracking systems to determine which codes under which circumstances they will target for downcoding.

How does one get on such a hit list?
Easy. Your coding trends are significantly outside the "normal" values that your peers submit.

Let's look at it this way: if your peers bill 99203 20% of the time and 99202 80% of the time but you bill the reverse - 99203 @ 80%, the software at your friendly insurance carrier is programmed to "kick you out." Once labeled an "outlier" your claims are tracked and either immediately or periodically subject to downcoding.

In other words, the insurance company will try to bring your claims back to the middle - what they consider "normal" patterns.

The Real Issue With Downcoding
No one likes to be an outside, but the real meat behind the issue of downcoding is dollars lost! Every time your claims are downcoded, you are forced to fight to defend your care. Every time you fight, you lose some $$$ just because of staff time spent fighting.

Now, one solution is to not fight back. Bad idea. Call me crazy but I believe that if you truly perform a 99203 then you should be paid for a 99203!

The other solution is to "play it safe" or stay under the radar and downcode yourself. I know many DC's who use this strategy and while it is true that they aren't audited as much, they are also losing thousands of dollars each year by not asking the insurance companies to pay them for what they do.

My Solution
My solution is rather simple: know your stuff and be paid for everything you do.

Knowing your stuff is a problem for some DC's not because they are bad chiropractors, but because they know virtually nothing about billing and coding!

The Most Common Error in E/M Coding
When I audit one of my client's claims or exam notes to determine if they are compliant and correct, here is one near universal mistake that I repeatedly see DC's making.

Neglecting the Review of Systems is by far the easiest way to perform a sub-par exam that will get downcoded!

ROS, the Key to Highly Paid Exams
As you know, each E/M code has criteria - history, exam medical decision making - that you have to meet in order to merit a particular level of exam code.

In other words, you can't bill out a 99205 (the highest level E/M code) while performing a brief exam worthy of a 99202 and expect to be paid fully!

For many DC's the stumbling block that virtually causes their claims to be downcoded is the ROS.

A Complete ROS
For a complete Review of Systems, it is necessary that you cover and document ten (10) individual bodily systems in your examination.

Cover less than this and you will not be eligible to report a complete examination and thus, you automatically pull yourself out of certain billing levels.

Nearly all coding books (if you don't yet have one, get one) have a section detailing which E/M codes require complete exams or more detailed documentation to merit the code.

Frequent Downcoding or Audits
If you are getting dowcoded or audited frequently, chances are your Review of Systems is lacking.

If you are performing a complete exam but not getting paid for it, thereis a high degree of likelihood that your documentation is the problem.

Either way - you are losing out on money for things you are doing - not good in my book!

The Good News
Here's the good news, doc.

Fix your Review of Systems and you are on your way to "earning" the right to code for higher level examinations and also on the right track for reducing your exposure to audits by billing incorrectly!

It's easier than you think and does not require you to spend loads of time in your exam performing every test known to man. You just need to be able to know what the requirements are - and satisfy them.

Now, go back to the office - review your ROS and get paid for EVERYTHING you do!

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

Medical Billing Software - Increase Office Management Efficiency

2009-08-15T01:45:00.001-07:00

With so many challenges to face daily, it has become more and more difficult for practices to free time to focus on what is most important; the patient. Thankfully, medical billing software has given practices worldwide the tools they need to take the challenge out of office management. Offering numerous features and capabilities, medical billing software has helped medical practices manage revenue, productivity, and allows the patient to again become the focus.

Over the years, medical billing software has been continually adjusted to meet the needs of an ever-changing health care profession. Medical billing software has helped practices worldwide to save substantial money by lessening expenses and run at peak efficiency. Time means money for most businesses. The right software can handle time consuming tasks, and free up the needed time to focus on improving patient care and reaching your practice goals. Many offer the flexibility to customize to meet your exact office needs, and allow office staff to work on separate tasks simultaneously.

Some people believe medical billing software has to be expensive to be quality, but this isn't necessarily true. There are a variety of affordable options offering advanced features perfect for any budget. Taking the time to evaluate your office needs can help you to narrow down the search. You can also save a lot of time by first getting an accurate idea of which features would best benefit your practice. You can see firsthand if the software will work for you by participating in free demos or free trials. It is very important that the company you choose offers excellent customer support.

Be sure to involve your staff in your software decision, as the medical billing software you choose will affect all members of your practice differently. Whether a nurse, receptionist, physician or office manager; each has unique needs to be addressed. Listen to all the concerns or ideas you staff have now and save frustration and problems in the future.

Save substantial time on insurance billing with medical billing software. Most software will allow you to bill electronically to the insurance companies, saving considerable time and stress. No more sending and resending claims which wastes precious time; many notify you of errors before the claim is even sent. You will also receive payment faster as well.

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

What is the Difference Between Medical Billing and Coding

2009-08-15T01:44:00.002-07:00

Medical billing and coding are vital parts of the billing process. From the time a doctor sees a patient to when the paperwork is forwarded to the insurance company, there are important steps that need to be performed. Every doctor visit results in the utilization of medical coding and medical billing skills - both are necessary for doctors and health care facilities to be properly reimbursed for services.

Here's how it works:

Medical coding includes the process of using specific codes to identify procedures and services for private billing, health insurance companies, government health programs, workers' compensation carriers, and more. A coder reads all documentation, such as a medical chart or transcription of doctor's notes, and assigns the right universal code based on their coding knowledge. The codes are entered into a form on their computer system.

Medical codes are based on diagnoses and procedures. Codes exist for all types of services, tests and treatments provided by a healthcare provider in a medical office, hospital, or clinic. The diagnosis is translated into an ICD-9-CM code; while the procedure is translated into a five-digit CPT code. Medical codes can encompass anything from a stomach ache to a broken arm - there are codes for everything!

Once the diagnosis and procedure codes are determined, the medical biller transmits the claim to the insurance company for payment. Medical billing includes the process of submitting and following up on claims to insurance companies in order to receive payment for services rendered by a health care provider. A billing specialist ensures that the patient and health insurance company are properly billed for all procedures. Approved claims are reimbursed, while rejected claims are researched and amended.

Under the Health Insurance Portability and Accountability Act (HIPAA), billing specialists are required to send claims for reimbursement via electronic means. This has resulted in faster, more accurate payments from insurance companies. The use of billing software has also enabled medical billers to perform accounting duties and manage billing practices more effectively. Patient records, open claims and outstanding invoices are a mouse click away!

Medical billers and medical coders ensure that the billing cycle is smooth - from patients being billed the correct amount to doctors getting paid. Without them, there would be no way to complete, track and manage medical claims. Both billers and coders are essential to the financial well-being of an organization and the health care industry as a whole.

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

Fighting Back When Insurance Companies Bundle Charges

2009-08-15T01:44:00.001-07:00

Insurance bundling is the process where a payer will often lump separate charges together to pay your practice less.

For example, lets say you have a patient that comes in for evaluation of high blood pressure and you notice the patient has two suspicious skin lesions - one on their left arm and one on their stomach. You then make the determination to excise one and perform a biopsy on the other.

You code 99214 with modifier -25 (E&M for patient with high blood pressure); 11403 (stomach lesion excision, benign, 3.0 cm); 11100 with modifier -59 (biopsy of arm lesion).

Modifier -25 is to be appended to a CPT code that is a separate and distinct service that is provided during the same visit. If modifier -25 is not added to the evaluation and management code (99214) both lesion codes could be denied, or the 99214 code itself might be denied. Modifier -25 identifies to the payer that the codes are truly separate services that were rendered.

Modifier -59 is to be utilized for a distinct procedural service and alerts the payer that two services that usually would be bundled into the lesion code should be reimbursed separately because the biopsy (11100) was performed separately. The two lesions that were examined were definitely separate, distinct and unrelated to each other.

If the insurance company does not pay for each service and is ignoring the modifiers -25 and -59, ultimately they are bundling.

The best way to fight back against bundling is to track your claims submissions and check them against your explanation of benefits forms to ensure that all services are paid.

The following are indicators your payers may be bundling your services:

* An E&M code is indicated but no payment was made because the carrier bundled the charge with that of an unrelated service.
* When the charge is listed but no payment was made because the payer bundled the charge with an unrelated charge for another diagnosis. When this occurs you will often see the following denial code, "Payment for this service is included in the fee for the procedure."
* When the modifier is listed but the payer omits the service modifier (such as the -25 or -59) and no payment is made.
* When the code is totally omitted from the EOB as though the service was never rendered. For instance, you coded an E&M code and a minor outpatient surgery on the same day. The claim was filed using the -25 modifier. When the EOB's are received, the only charge noted is the surgery code. The E&M code is not included.

Certain explanations on your EOB's may also indicate that the payer is bundling some of your charges. Examples are as follows:

* Medical visit not allowed for separate reimbursement
* The procedure code submitted on your claim has been changed to one that better represents the services performed by your physician.
* Payment for one or more billed procedure codes has been denied because it is considered a component of this billed procedure code.
* Payment for this service is included in the fee for the procedure.
* This service is a component of a primary procedure. Payment for the primary procedure includes reimbursement for the related procedure.

Make sure and analyze your EOB's for an extended period of time to identify if any of the issues above exist in your practice. Make a list of the payers that are attempting to bundle and what CPT codes and procedures they are bundling so your staff will be aware of this and keep an eye out for it moving forward.

Once you identify any charges that are being bundled, go ahead and immediately appeal those with the payer. It's imperative that you address it immediately as each payer has a deadline in terms of when a claim can be appealed.

The bottom line is to not accept what the insurance company pays but to ensure that payment has been made in accordance with your contract and that no bundling is occurring.

Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, and other general medical practice consulting services.

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

Medicare's E-Prescribing Incentive Program

2009-08-08T10:09:00.002-07:00

The Medicare e-prescribing incentive is a new initiative authorized under the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA).

The program starts January 1, 2009 and offers incentives for eligible providers that meet certain criteria. The e-prescribing Incentive Program is currently based on one e-prescribing quality measure that is currently included in the Physician Quality Reporting Initiative (PQRI). Beginning in 2009 the e-prescribing quality measure will be removed from the PQRI and it will become the quality measure used in the e-Prescribing Incentive Program.

For 2009 the e-prescribing incentive amounts will be 2% of the total estimated allowed charges for professional services covered by Medicare Part B and provided by an eligible professional during the reporting period. To be a successful e-prescriber, you must report the e-prescribing quality measure through your Medicare Part B claims on at least 50% of applicable cases during the reporting year.

To participate in the e-prescribing incentive program you must use a "qualified" e-prescribing system. There are essentially two types of systems: a system for e-prescribing only (a "stand alone" system), or an electronic health record (EHR) system with e-prescribing capabilities.

To get the incentive in 2009, you have to report on the e-prescribing quality measure with one of the three appropriate G codes on more than 50% of applicable cases within your practice.

Eligible providers that are not "successful e-prescribers" by 2012 will be subject to a differential payment (penalty) beginning in 2012.

To learn more about Medicare's e-prescribing program, visit the following URL: www.cms.hhs.gov/ERXIncentive/.

It's certainly worth any practice that bills a substantial amount of Medicare to enroll in the e-prescribing program in order to reap the financial benefits and in essence, improve efficiency within your practice.

Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, and other general medical practice consulting services.

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

Who is Auditing Your Billing Company? - Part 2

2009-08-08T10:09:00.001-07:00

Dr. Brian: OK so let's start with Automated Reporting. What is that?

Automated Reporting

Erez: We need to track the quality of five key roles of the overall team on a continual basis and the reports need to come to us automatically. This is the opposite of manually spot checking and tallying up numbers to grade the performance of each one of these roles in the billing team.

1. Individual auditor performance - claims audited, errors found, and audit quality (errors found in auditor's samples)
2. Operator performance
3. BPO performance
4. SPOC performance
5. Overall quality - SPOC Manager

Dr. Brian: So now I understand who need to be audited and that there will be reports automatically generated to help you see the quality, but what is really being measured and, how can you trust that auditors are not making mistakes?

Multiple Audit Levels

Erez: To make sure that the auditors do their job properly, we need to do two things:

1. Measure audit progress
2. Audit the auditors

We envision four levels of independent auditors: 1st level auditor, 2nd level auditor, SPOC, and SPOC manager. The technology samples the claims for the audit automatically and allocates them in the corresponding audit workbench. For instance, the technology selects the claims for second-level audits by a random probability defined in the audit-risk database from the claim sample already selected for the first-level audit. Second-level auditors would in turn be audited automatically by the SPOCs, and the SPOCs would themselves be audited by the SPOC Manager.

The claim sample selected for a second-level audit increases whenever the independent QA team finds mistakes or oversight on the part of the first-level auditing teams. In this way, a single claim may be audited by up to four independent auditors. If one of the auditors finds a mistake, the entire chain of auditors and the processor who made the initial mistake will all have their "audit-risk" increased so that more of their claims are audited.

Dr. Brian: So Kind of like an immune response? The more mistakes the bigger the defense?

Erez: Something like that.

Dr. Brian: I understand how there are different levels of auditors but they still need to go and randomly select claims right? How can you be sure that they are selecting random claims and not ones that look like they will be easy to audit?

Workflow Management

Erez: As in standard billing processing, with automated problem discovery and manual resolution, the technology automatically selects the claims for audit and populates the audit workbenches with those claims to ensure audit task completion. Auditors get a list of claims with the notes entered by the processing teams, and then:

1. Audit the claim completely (including calling the insurance company or checking status online to make sure the information obtained by the operator is correct)
2. Record errors or mark the claim as clean

By working from a workbench, the audit teams will be able to do their job faster. More importantly, the technology will automatically measure the auditors' progress and productivity to make sure that all sampled claims are getting audited.

Dr. Brian: The system tells the auditors what and when to audit and also measures how clean the claims are?

Erez: Yes

Dr. Brian: What exactly is fair game for auditing?

Automated Audit Sampling

Erez: The operator actions subject to audit include EOB posting, a follow-up action, or a request for info to the provider. Every action performed by an operator is automatically compared to a "audit-risk" database that determines the chances that the action will be audited. The "audit-risk" is configured in the technology by entering a percentage chance of auditing an action, for an individual operator, an auditor, or an entire team.

For example, if we bring on a new follow-up team, we may configure their "audit-risk" at 100%, ensure that every action they perform on every claim will be audited. As the team proves themselves, we can reduce this "audit-risk" to 50% and later to 20%, as long as the auditors find few errors in their audits.

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

Who is Auditing Your Billing Company? - Part 1

2009-08-08T10:07:00.000-07:00

Most doctors I talk to today are worried about post payment audits but few of them ask the question, who is auditing my billing company? If they are looking for a billing company they should also be asking how that billing company measures quality and what the internal process is for this at that company. Below is an interview I conducted with Erez Lirov.

Most doctors I talk to today are worried about post payment audits but few of them ask the question, who is auditing my billing company? If they are looking for a billing company they should also be asking how that billing company measures quality and what the internal process is for this at that company. Below is an interview I conducted with Erez Lirov.

Erez's experience spans heading technology innovation for both startups and established companies in healthcare and financial services at Vericle, TradeMD, Sparta Systems, National Bank of Canada, PIMCO, and Harris Bank. Erez was awarded US patent 6,785,810 in data security. Erez also graduated with a BSc degree from Princeton University in1999.

Dr. Brian: Erez. When you started your billing company there were just a few doctors and hundreds of claims. Now there are hundreds of doctors and 80,000 plus claims/month. Some docs I talk to want a smaller company. Can you explain to doctors who are thinking about joining this "network" why they should see a big billing company as a positive thing?

Erez: A continuously growing billing network in terms of claim volume allows real-time audit of payer performance, timely discovery of underpayments and delays, reconstruction of payer's underpayment rules, and effective and informed follow up. However, the risks of errors and sabotage increase too in step with billing network volume because some data entry and most payment denial follow-up require manual processing.

Dr. Brian: So the bigger we grew the more error prone the things became and so more errors occurred?

Erez: Yes.

Dr. Brian: Why is that?

Erez: Early quality assurance (QA) processes, limited to occasional and random spot-check of data and follow up records, proved sufficient in discovering sub-standard data entry and follow up performance or saboteurs in small-size billing networks but failed to adequately mitigate error and sabotage risks in a larger size billing network. Accordingly, a billing network requires scalable audit processes to effectively catch and correct processing errors or sabotage attempts.

We need a way to be able to immediately pin-point problem areas so that they can be corrected. If an operator or an auditor is not improving their overall quality and continues to make mistakes, then they must be replaced.

Dr. Brian: How do you manage this problem across hundreds of operators and dozens of auditors?

Erez: The new and improved auditing process must make sure that it is:

1. Timely: We plan on a 24-hour turn-around-time
2. Comprehensive: Enough claims are being audited
3. Effective: Operators or auditors with a high error rate are flagged for retraining or replacement
4. Efficient: BPOs fund each level of increased scrutiny caused by their error

Dr. Brian: That is a huge task when we are talking about potentially hundreds of thousands of claims each month. How do you plan on accomplishing this?

Erez: Yes, and to accomplish this we have introduced our vision of a Multi-Level Quality Control (MLQC) program which is made up of four has four main improvements over the traditional, manual audit process:

1. Automated reporting (Pin-point "bad apples")
2. Multiple audit levels (BPO, QA Team, SPOC, SPOC Manager)
3. Audit workflow management (QA Workbench)
4. Automated sampling ("audit-risk" database)

See Part 2 coming soon!

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

Medicare Applications - Which Form is Used to Become a Medicare Provider

2009-05-31T06:09:00.003-07:00

Medicare requires that you complete specific forms put out by CMS when applying to become a Medicare provider. Sounds easy enough but have you seen the list of forms that they have? How are you suppose to know the correct form to complete and once you figure that out, what fields on the form do you need to fill out?

If you are a solo provider, can you bill under a tax ID number (EIN number) or do you have to use your social security number? Is it necessary if you use a tax ID number to apply for a group Medicare number? And why would you need to reassign benefits to yourself?

Well it's really not as complicated as it seems. If you are a solo provider and you are using your social security number for your tax ID number then you need to complete an 855I, 588 EFT, and a CMS 460. The CMS 460 is the participating provider agreement. You only need to complete this if you choose to be a participating Medicare provider. The 588 EFT is the Electronic Funds Transfer form. Medicare requires that you accept EFT and they will transfer your payments directly into your bank account. The 855I is the individual provider application.

If you are a solo provider who is going to bill under a tax ID number but you are a sole proprietor you also would need to complete the 855I, 588 EFT and the CMS 460.

When applying for a group, you will need to complete an 855B, an 855I for each provider in the group, an 855R for each provider in the group, a 588 EFT, and a CMS 460. The 855B is the group application and the 855R is to reassign the benefits of each provider to the group. If you are a solo provider but you have formed a corporation, you need to apply for a group application for the corporation.

The forms are available on the internet. You must complete the appropriate forms and send them in to the Medicare carrier for your area. It is crucial that you complete the forms correctly to avoid delays. If your application is not completed completely or correctly the carrier will request the additional or corrected information from you. If you do not respond or respond timely your application may be closed.

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

Medical Practice Management

2009-05-31T06:09:00.001-07:00

Tomorrow I am going to one of our new practices. It is an Urgent Care facility. I have a couple of tasks to perform and look forward to the time I will be there.

My first task is to discuss the S9083 Urgent Care Global code. When we took over this practice we found a lot of EOBs rejecting the code and a good many with other anomalies regarding the use of S9083. The medical billing personnel handling the claims before we took over, did not have a grasp for this type of facility. Primarily, for this practice, Aetna is the only company using the global code although they have contracts that state otherwise. When a patient came into the practice and utilized several services, their medical billing would use a line item for each service. For example, say the patient had lower back pain, so along with the E&M code they did a urinalysis and a lower back x-ray.

Now for a regular office visit we would have three separate charge items, the E&M 9XXXX, the urinalysis 8XXXX, and the x-ray 7XXXX and that works fine. What the billing had done was to use the old strategy but replace the above three codes with S9083 and they created three line items of S9083. Unfortunately they charged different amounts for the same code. For the office visit they charged $100.00, for the urinalysis they charged $20.00 and for the x-ray they charged $75.00. Well insurance companies being insurance companies, naturally they paid for the $20.00 charge and claimed the other items are duplicate charges which from the standpoint of the procedure codes, they do appear to be.

The practice should have only charge the SXXXX code in place of the E&M (9XXXX) code and utilized the other codes as they were represented in the CPT list. They would have at least gotten the $100.00 allowed and likely had the CPT codes rejected. Unfortunately, they are now out $80.00 with little chance of recouping the difference. The filing limit has passed. It would be okay if this was an isolated incident but it was ongoing. At the least we will put an end to the loss from that standpoint.

In addition to the S9083 code there is an S9088 add on code. Although most companies may not recognize this code and pay it, at least we should be asking for it. If we don't ask we will not get. So for those companies that accept the CPT codes rather than the HCPCS global code we will attempt to get some additional revenues by using the add on code. In addition, the practice needs input on when to refer the patient to ER and when to keep the patient in-house. Remember, the S9083 code is only generating $100.00 in practice revenues. It cannot therefore afford to spend a lot of its resources on patients that need greater services. These should be considered emergent care and not urgent care. There is a difference!

I am looking forward to helping this practice get a handle on the coding process and generate positive revenues.

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

Total Costs

2009-05-31T06:08:00.002-07:00

Have you ever fully assessed the total cost of what it takes for you to get your medical billing done? Likely as not you haven't. Most practices simply think that those costs comprise just the cost of the labor to key in the data. On the surface that could seem correct but nothing could be further from the truth.

Every day you key your own data, your software gets more obsolete. At some point it has to be replaced. That cost has to be incorporated into the formula. The same is true for your hardware. It has to be replaced and before it is replaced there are costs associated with maintaining it and with repairing it during its useful life. The office area set aside to operate your medical billing is also part of that overhead as well as your matching costs for social security, Medicare, unemployment insurance, and other general employee benefits which include but are not limited to vacation time, sick leave, and more. In addition, you have clearing house fees, ongoing software fees, postage for claims and patient statements, envelopes, cost of HCFAs and more. If you have a medical billing person, you are probably paying at least $10.00 per hour. That fee over a month's time equals $1720.00 based on the average of 4.3 weeks in a month. Add to that the matching benefits listed above and that almost equals another $170.00 for a total of $1890.00 per month just for the employee. Again this does not include any of the other overheads mentioned, but all of those figures pale in comparison to the true losses incurred by the practice during the month.

If you have a small practice that collects only $30,000.00 per month, odds are great that at least 10% of your revenues are being written off without your knowledge. That's $3000.00 per month--$36,000.00 per year! And that is in addition to the fees listed above. Your costs are now up to $4890.00 per month still not counting all of those other costs. In addition, you have paid up front for that employee.

If you had a medical billing company doing that work for you and they collected that same $30,000.00 at an average rate of 8%, your out of pocket would only be $2400.00! That is half of what you are paying now. And I guarantee that a competent medical billing company will be collecting that other $3000.00 your office failed to collect because they want that extra $240.00 and even after considering that it comes out as if they are actually paying you $460.00 just for the privilege of collecting your money for you. Your net revenues doing the work yourself was $28,110.00 and after farming it out it goes up to $30,360.00. A net increase of $2,250.00 not to mention the other associated costs and the stress on you of trying to see that the work gets done. Do yourself a favor and do the math.

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

EDI Health Claims

2009-05-31T06:08:00.001-07:00

How do most of your health claims travel? Are they still going by paper? How can you track that system? With few exceptions, our claims all go by an electronic method. Most go directly from us to the payer, but a few filter through a clearing house.

Early this week, WellCare alleged that some 27 claims that were dropped out of our system on September 2nd were not on file in their system. Had we sent those claims by paper there would be little we could do. These are recent claims so if they had gone by paper, we could get them back out the door. Fortunately for us though they did not go on paper. Wednesday I had my IT pull the report for that day's drop (it is transmitted back to us the next day). When we reviewed the report, low and behold, all 27 claims were listed as accepted by WellCare and gave a batch number for the claims as well as a tracking number for each claim. The review itself is just as easy. Once the file is located, a quick easy search using the software looking for that specific provider instantly located the claims in 29 pages of report. These tools simply are not available using paper.

Regardless of the outcome, we are able to demonstrate that the claims were sent, and that WellCare received our claims. The medical billing people have done their job.

How good is your office about tracking claims? If you do not have a system in place for keeping up with when the claims went out, when they were received and who got them, you are wasting valuable resources. Take advantage of all the resources available to you. Teach your staff to work smarter, learn to use the system to your advantage rather than allow the insurance company to hoodwink you.

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

Don't Leave Money on the Table - Use a Claim Scrubber

2009-05-24T04:40:00.004-07:00

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

Chiropractic Billing Index Gains 2 Points and Maintains 100 Percent of Its Membership in September

2009-05-24T04:40:00.003-07:00

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

Health Claims Processing

2009-05-24T04:40:00.001-07:00

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

Health Care Claims Appeals

2009-05-20T19:13:00.002-07:00

I often wonder how many claims (dollars!) per day are being rejected where providers do not appeal the adjudication. I imagine the numbers would be staggering!

The insurance companies know this little tidbit and use it to their advantage. Let's say an insurance company is paying out $1,000.000.00 per day in insurance claims. If they deny just 1/10% of those claims, it adds up to $1,000.00 per day. That's $1,000.00 per day that they get to keep that should have gone to you, the provider. Now let's project that out over the period of a year; $365,000.00!

That's not pocket change! In three years they have gained over one million dollars in revenues that should have gone to the providers.

I have been told that every time an insurance company has to physically touch a claim, it costs that company $150.00. Now, just think about that for a moment; if it cost them $150.00 just to touch a claim, don't you know they have done the math and know that more people do not appeal their decision than do appeal and they know that the cost of handling those appeals must be considerably less than the $365,000.00 they are keeping.

What's the answer? Appeal your claims! If every physician who had a rejected or down-coded claim appealed the claim, the insurance company's cost would rise. When it gets to the point of costing more than they can keep by shortchanging the providers, they will start paying the claims correctly.

Do not let the insurance companies take advantage of you. Appeal those claims. Have your medical billing staff set up boilerplate in your word processing software that will work with your practice management software, and merge those documents on each and every claim that is denied or down coded. Pretty soon, the insurance company will realize it cannot take advantage of you and they will adjust their software to see that you are paid correctly and take it from someone else who does not question their authority.

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

Medical Billing Services (The Facts) All You Need to Know

2009-05-20T19:13:00.001-07:00

If I decide to outsource my medical billing how will I keep track of it?

Many physicians today question whether or not outsourcing their medical billing to a professional medical billing service is the right way to go. These same physicians ask themselves if their medical billing is not in-house how they will really know the true status of their receivables. Prior to making a decision regarding your medical billing, it's imperative to locate a billing service with the necessary experience and with whom you feel comfortable working.

It's also very important to make certain that they provide you monthly reports that accurately reflect exactly what amounts they billed, how much was collected and what amount is still outstanding. Your accounts receivable should be worked on a weekly basis so that is does not go beyond the 90-day mark (there are some cases when the insurance companies take longer than 90 days).

Here are some questions you'll want to be sure to ask a prospective medical billing service:

* Do they post charges on a daily basis?
* Do they transmit claims on a daily basis?
* Do they post payments on a daily basis?
* Do they send out monthly statements to the patients?
* Will they credential any new physicians joining the practice and will they re-credential existing physicians?

I can't stress enough that when you decide to outsource your billing you'll want to be sure to have available a list of questions to ask the medical billing service representative with whom you speak, and insist that your questions are answered accurately and to your satisfaction. Also, don't be afraid to check out billing services outside of your state; the majority of medical billing services utilize the internet, fax machines and electronic claim filing, so it's no longer necessary to practice in the same state in which your medical billing service is located.

The key to making this decision is patience; it's highly recommended that you take your time, whether you're just contemplating outsourcing your medical billing or simply considering changing billing services. Remember, this is your income and what is ultimately best for your practice; both of these factors deserve considerable time and attention. I wish you the best.

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

Blame the Insurance Company

2009-05-20T19:12:00.000-07:00

Blame the insurance company is the mantra exclaimed by all, but does it really fit. I know they can give us a fit when trying to collect our money, but they really want to pay the provider, they just want the provider to play by their rules.

I know I will get a lot of grief by saying that they really want to pay the provider, but hear me out. The reason they want to pay is because they want more clients to insure. If they did not pay the providers, the providers as a group would stop seeing their patients, the patients would then not be able to utilize the coverage they are purchasing and would begin to flounder about looking for other coverage. The insurance companies do not want that! Now granted, the insurance company wants to keep as much money as possible, but they know, sooner or later they are going to have to pay the piper! It is a self balancing system that when left alone will right itself each and every time.

This subject came up last week because I was talking to a new provider about his billing. I had previously discussed his billing and he said he wanted to continue for a while with what he was doing. He acknowledged that all of his claims were not being paid and many of the rejections had to do with the billing staff. Sadly, he has now stopped seeing one entire group of patients that are associated with one of the CMOs handling part of the Georgia Medicaid program. This really hurts my heart, because of several reasons, not the least of which is the patient. They are currently locked into that CMO and cannot change, want to see this particular provider, but now are unable to do so. The added pain is that it his medical billing that is at issue and not the insurance company. You see, the billing personnel have convinced him that the insurance company is at fault with why they are not being paid. Nothing could be further from the truth!

My staff handle numerous claims that go through that company and those claims are getting paid. It is not magic, it is good old fashioned hard work of keeping up with what the payer wants, and passing that information through in the form of a claim. Day in and day out they are paid.

Do not allow your staff to point the finger at that unknown faceless giant called the insurance company when the billing staff does not do their job in getting your claims paid. Force them to take an active role in getting each and every claim paid! Do not allow them to get away with sitting back and blaming someone else. Working medical billing is an ongoing learning experience and anyone who is not willing to continue to learn and keep up should be moved out.

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

Medical Billing Books and E-Books

2009-05-09T22:38:00.001-07:00

Medical billing books are no longer available only at bookstores and by ordering from the internet. You can now download many medical billing books directly to your computer instantly. New technology has made it extremely easy to get medical billing information immediately by ordering with a credit card and downloading the book or "ebook" as it is now called directly to your computer. You can then save and store it or print it out.

Th ebook can provide a great solution to a problem when you need specific answers to questions immediately. If you are working in a new field such as the need to complete a UB04 form and all your experience is with CMS 1500 forms you may welcome the immediate download as you are not always willing to wait for the information. It is convenient to be able to look up the required information immediately rather than holding up the mailing of a claim form for a week waiting for the book to arrive.

The subject of medical billing books can range from books on medical billing and coding to books on how to start a medical billing business to specific instructions for medical claims billing. Books are now available for billing claims in many medical specialties.

Because both CPT codes and ICD9 codes change every year it is necessary to keep up with these changes. So new code books are introduced each year for both diagnosis codes and procedure codes.

In recent years there are many new books available on the beginning stages of starting a medical billing business and finding new clients and building the business. You can also find specific instructions for billing specialty medical fields such as mental health, chiropractic, physical therapy, optometry, etc. These books make it much easier for the beginning medical biller to learn new specialties quickly and less painfully than by trial and error.

As these new books become available it makes it easier for the person new to the field of medical billing to find the information they require. Whether you prefer your books in hard copy or to download them to your computer as an ebook you can find some great information on medical billing.

Alice Scott and Michele Redmond own and operate a Medical Billing Service and are responsible for billing for over 60 providers across the US. They've written several books on medical billing and starting a medical billing business. To read more about what a billing service offers, to see the books they have written or to sign up for their free monthly newsletter, visit their websites at Medical Billing Live and Solutions Medical Billing They also offer a forum where you can find the answer to many billing questions or leave your own question at Medical Billing Live.

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Medical Claims Rejections

2009-05-09T22:36:00.002-07:00

Rejected medical claims come from many sources. The most common is likely keystroke error. That is usually a relatively easy fix and for our business it is also one that is easy to catch. The best method of catching some of these simple mistakes is to use a good scrubber for your claims.

Once the claim batch has been created, as it is processed through the intermediary software, it looks for little inconsistencies. Like an ending date that precedes a beginning date, just little things that can easily get entered out of sequence when you are processing a lot of claims.

Another easy one to get incorrect is term date for procedures and/or diagnosis codes. Once you have used a code in your medical billing system, you should not be able to remove it because of the relational database algorithms. Resultantly, it is easy to use an old code without intending to. Again, this is where a good scrubber comes into play. It can catch those pesky errant codes before the claim gets out the door. By using the scrubber, you are able to quickly get claims corrected, usually within a few hours, depending on how often you drop claims.

Issues with patient and insurance information should be taken care of before you see the patient. I repeat, before you see the patient. Your front office should know in great detail the probability of whether you are going to get paid on this patient. They should have done all of their homework by verifying each and every piece of information.

Some payers are particularly peculiar about not allowing more than one E&M visit in a day. Again, these are questions that can be covered prior to seeing the patient. Once it has been determined the patient may have already seen another provider, the front office can check the insurance company and get the applicable rules.

Coding issues should be non-existent, as the provider and staff should have an in-depth knowledge of what is current, what supports what, and should any modifiers be used to clarify the claim.

Do your homework before filing the claim and you will see better results.

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

E&M Medical Necessity

2009-05-09T22:36:00.001-07:00

E&M medical necessity denials, what can that mean?

On the surface, what could not be right about an E&M code?

A lot of the rejections come from an office visit and another procedure performed on the same day. In many of the practices where we take over the medical billing, the physicians have lost money by not following the right protocols and/or not challenging the EOB. If the visit results in the second procedure, there is a modifier that is supposed (tongue in cheek) to tell the insurance company that this is a separately identifiable service and both services are to be paid. That being said, it does not mean you will get paid. Other denials often come from "we do not pay for two of these on the same day". It is important for the front office to ask if the patient has seen another physician on this same date. If so, unless it is emergent care, find out the policy of the patient's insurance company before seeing the patient. Otherwise you may just be giving away your services. The point here is to one; do your homework, and two; don't simply take the EOB at its face value, challenge it! Most physicians do not and the insurance companies love them because the insurance company gets to keep more of the physician's money in the process.

I have been told that every time an insurance company touches a claim, it costs them $150.00. Now just imagine for a moment if every time a physician got a rejected claim each and every physician challenged that claim, what do you think would happen? If you answered fewer rejected claims go to the head of the class! So don't just take their word for it, challenge it.

When the Correct Coding Initiative (CCI) was implemented, we were assured that everyone would have to abide by the same rules. The reality is significantly different.

Lately, Blue Cross of Georgia has changed its review policy. In the past for a pediatric patient that presented for a sick visit and needed a well check visit, we could bill both and get them paid. BC of GA now says they are using Anthem BCBS edit rules and will reject one or the other, and the rejection usually depends on which of the claims pays the most. We are still in the process of sorting it out but the physicians are looking at the contracts to see what recourse is available.

The sad part is that once again, it is the physician who must jump through all the hoops, follow all the rules and then not get paid.

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

How to Reduce Rejected Medical Claims

2009-05-09T22:35:00.000-07:00

For a process that can be so simple, many make it so hard.

Let's start at the beginning. What software are you using to process your claims? That decision alone can solve a litany of problems. There is not enough space available to analyze all and it would not be fair to promote only one.

Is the software easy to understand? Does it allow you to make additions, corrections, subtractions, and other modifications on the fly? If you have to stop at one spot and back up to go to another just to make a simple change, it is not efficient and will cost you money. How much time does it take to get someone proficient on that software? This is where the old adage of KISS (Keep It Simple Sweetheart) really comes into play. Once you have selected an appropriate software, you need an interface between you and the insurance companies so you will be able to transfer your claims. Most claims now go electronically, but a few still drop to paper. You must have the correct address for the paper claim. That should come from the patient information. The electronic transfer should focus on a connection that is as direct as possible to the payer. Most software companies will attempt to get you to use a clearinghouse from an approved list. They want to continue making money from you after you purchased the software and that may not be what is best for you. It may be quick and easy, but it may not be as reliable as it is made out to be. I prefer to have direct connections with as many of my payers as is practically possible.

Next, your billing staff, are they adequately trained? I get a lot of applicants right out of technical school, and yes they have a smattering of knowledge, but they are not ready to begin keying data. I usually train them for at least another six months before they get their own accounts. Once I am confident they have an understanding of the basic architecture of the software, I then put them with a mentor while they work on their first account.

It is not easy to tell someone every nuance necessary to key every claim. They just have to be taught as the situation arises. Some things happen so seldom that you cannot cover every single aspect of what has to go into what spot. You must have someone on your staff who has spent several years keying data into a particular software before they are fully versed in the needs of filing each and every claim.

Now that we know we have software and data entry that can handle the day to day of filing claims, we need to focus on the front office. Are they adequately trained in getting the information necessary to get the claim paid? The front office must control the encounter with the patient. The patient profile form and releases must be complete to the extent that all information necessary to identify this patient is provided. The form must ask for and retrieve all of that data. The patient must fill it out. Do not allow a patient to skip over a portion or leave a portion blank.

If the patient does not have a secondary or tertiary insurance, require that they state so on the profile form. Have them write NONE on the space for secondary or tertiary. Many patients will object to having to give you all of the information, but you need to make a decision as to whether you are in the charity business or a practice that will sustain itself and provide a profit for you and your family. I have had patients come up to me and say "I don't have to give you all this information." I do not object, I simply agree and say "You are absolutely right, you do not have to give me all of that information if you wish to pay cash for today's visit. There will be deposit of $300.00, will that be cash or check? However, if you wish for me to file your insurance, you will need to provide me with the information on the form." They always back down and begin to fill out the form.

While we are on the subject of the form, make sure it is legible. If your front office cannot decipher what is written down, rest assured that the medical billing office will not be able to either. Make copies of all supporting documents (front and back); insurance cards, drivers license, and any other documents. Again, make sure those copies are legible. There is no better time to do that. You have everything right in front of you right now! If the copy is not legible have the front office physically write the numbers and identification information from those cards onto the copy paper and adjacent to the copy of each pertinent card.

Next, call the insurance company or go on-line and verify the coverage. What is the start date, what is the term date, is there a co-pay, is there a co-insurance, is there a deductible, what is the deductible and has it been met? Never trust the information on the card-verify. While you are verifying the payment information get the correct address to mail a paper claim. Even if you do not intend to file a paper claim, this is the time to get that information. You never know when you might need it. Your patients are asking you for credit and you must verify that they are creditworthy! Develop protocols and insist that your staff follow them. If they cannot follow them, you have the wrong staff. Try going to WalMart to buy an item with an expired card and see what happens. Their staff will not let you slide and neither should your staff.

Now that we have all the pertinent information, the task rests with you, the physician. Do your part; document, document, document. When you are filling out your encounter form, write down everything you do. Leave nothing out. If you do not ask for it, you will not get it paid. Your staff should know whether a modifier needs to be applied, but I encourage you to understand them as well. Today I saw a fee ticket where the provider put down an after hours code but had not listed an E&M procedure. After hours codes are in addition to the service performed. The current code under consideration was 99050. Next, put down a diagnosis code that supports the procedure(s) you performed. Make sure it is to the greatest degree of specificity. Give your staff copious ammunition to get you paid.

Once you have completed your task, turn the paperwork over to that well trained medical billing staff utilizing that efficient software and you are as good as paid.

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

Outsource Medical Billing Must Have - Comparison to Allowables

2009-04-14T06:06:00.000-07:00

If you make the decision to outsource medical billing, then make sure your medical claims billing company compares your payments to your allowables. It goes without saying that if you do billing in-house the comparison still should be done.

One of the advantages a Medical Insurance Billing Service has is that it sees payment information and patterns across many clients for many payers. This allows medical claims billing services that regularly and systematically compare payments to contractual allowables to spot patterns that a single practice might miss. One that is seen at large Medical Billing Services on a regular basis is the systematic underpayment of claims by payers. As billing services look across multiple clients they will see the exact same CPTs being underpaid by the same amount by the same payer in a given month across all of their clients. The following month they will see the same payer switch to underpaying a different set of CPTs. These under payments are not huge (5 to 10 percent) but they add up quickly to big dollars for a medical practice.

The combination of switching the codes being underpaid from month-to-month and keeping the underpayment amount "under the radar" can make this difficult for an individual practice to spot. It is also difficult for a Medical Insurance Billing Service to spot if they are not comparing your payments to your contracted rates. It has been demonstrated that this single action (comparison of payments to allowables) can increase a medical practice's collections by 5 to 10 percent. This is why you need to insure this critical step is being completed no matter who is doing your Billing.

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

Negotiating the Medical Bill You Receive From a Hospital

2009-04-14T06:02:00.000-07:00

Did you know you can negotiate the medical bill you receive from a hospital?

It's true.

A year or so ago I was in immense pain. My lower back hurt and then the pain spread to my groin.

It was unbelievable pain. So bad I couldn't drive. I asked my daughters to call their mom, my ex-wife, to get a ride to emergency.

On the drive I heaved my guts out into a bowl in her car. Once there I continued heaving through the check in procedure.

I have a doctor, but no health insurance.

They got my address etc. and then put me on a gurney in a corridor.

There I lay, moaning and groaning for an hour.

Nothing happened.

No care, except for my ex-wife, bless her heart.

Then the doctor appeared looking at a clipboard, told me he suspected it was a kidney stone, but wanted to do tests. A technician wheeled me away, told me I should stop moaning, and when we arrived at the room where the tests would be done told me to "get off the gurney," and then did a CAT scan. I remember telling him he should say "please. " He replied, "oh, yes, please," but he laughed when he said it.

An hour later they read the scan, saw the stone, and hooked me up to an IV and started the pain killer cruising through my veins. Twenty minutes later I was better.

"Stone got lodged going around a corner," said the kind doctor. "Should pass within twenty-four hours."

A little later we left.

My total stay in emergency was between three or four hours.

Then the bill arrived a month later.

$6000.

There were no details of what constituted the expenses, just the bill.

"We don't itemize anymore" said one hospital administrator I spoke with, "but if you pay the bill off within 14 days of receiving it we'll give you a 40% discount. That's what the insurance companies pay."

So now we were down to $3600.

That's $900 an hour for my stay at emergency.

But I thought I might be able to do better. I wanted to pay them something for their services, but I wanted to pay a fair market value.

"I want to negotiate," I said.

"I can't do that," she replied.

"Who can?" I asked.

She fidgeted, and gave me a name and a title.

The next day I met with the name and title.

She had power.

The power to negotiate bills.

We locked horns.

She was good.

So was I.

I'm sure you can imagine the conversation.

It was intense. She was fighting for the hospital, me for my checkbook.

One phrase that I kept repeating to her was, "I want to pay you something; you did help me, but I want to pay you a fair market value for services received."

I mentioned the technician, the stay in the corridor.

She mentioned all kinds of time payment plans, programs, and forms I could fill out.

Not my style.

Finally she said the words I was waiting to hear.

"What exactly did you have in mind?"

"A thousand bucks," I replied.

She scoffed.

The room was hot.

We were dead-locked.

We both took a breath.

"What's the best you can do?" I asked realizing she would have to answer to her superiors.

She tapped on her electric adding machine.

"$2300," she replied. "We have our bills to pay too."

I sensed she was growing weary, at the end of her rope. We'd been at it for fifteen or twenty minutes.

"Okay, I said, make it $2000 and you have a deal. I reached for my wallet to make my point.

She hit the buttons on the adding machine again. It clicked out a white cash register size receipt.

I held the credit card in front of her.

Visa. Platinum.

She glanced at the card, back at the adding machine, thought a moment, then smiled at me.

"I'll draw up the paper work," she said ripping the ticker tape out of the adding machine and taking the card from my outstretched hand.

Still, I wasn't completely satisfied. I wish I had gone longer, offered to split the difference between my $1000 and her $2300, but something told me that was as far as we were going to get.

I had received a 66% discount on my bill.

I haven't had health insurance since 1999, so that would have been six years of no premiums, which for me would be $800 a month, or $48,000 for six years. (Because I have a pre-existing condition, Graves Disease, insurance companies don't want to cover me unless they can charge these high premiums). If I calculate my $2000 bill, divide it by six years I arrive at $333. per year, or $27.75 a month.

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

What You Need to Know If You Are a Medical Practice Considering Outsourcing Your Billing

2009-04-14T06:01:00.000-07:00

More and more medical practices are outsourcing their billing which has become a viable business option due to rising operational costs, declining reimbursement rates and an increase in the cost of technology that is required if an in-house effort is pursued.

In short outsourcing can dramatically improve a practices financial results and allow them to gain operational efficiencies if the correct vendor is selected for outsourcing.

The key to successfully outsourcing your billing is to do your due diligence before selecting the firm that is going to handle your billing. A little work up front can mean the difference between selecting a firm that becomes a part of your team and produces positive results or a firm that could essentially negatively impact your bottom line.

Use the following criteria to assess prospective vendors:

Specialization - Make sure the firm you are looking at has billing experience in your specialty. Although as the provider you are ultimately responsible for the coding, you want a billing firm that is knowledgeable in your specialty so they can rework any denials and act as a coding reference for your practice.

Reports - Make sure the billing firm is going to provide you with 24/7 access to the practice management reports that you would normally have if doing your billing in-house. Some firms have been known to withhold such data from their clients because their work was sub-par and they did not want their clients to see the results of their work.

HIPAA - Discuss with the firms you are considering their policies and procedures they have in place to protect your patient information. The last thing you want is for your billing firm to expose your private patient information and ultimately ruin the relationship you have with that patient or even worse lead to a potential lawsuit.

Staffing - Inquire about the education level and experience of the billing firms staff. When was the last time they attended a coding seminar? Some billing firms are notorious for being understaffed which can lead to slow claim submission and therefore negatively impact your cash flow. Ask the firm how long it takes them to submit your claims once they are received. Generally speaking claims should be submitted within 48 hours of receipt.

Collection Benchmarks - Regardless of whether you outsource or do your billing in-house a few rules of thumb apply. On average you should be collecting between 95 and 100 percent of your adjusted charges within 60 days of submission. At any given point you should not have to much more than a months worth of charges outstanding with 10 percent of your total insurance A/R balance greater than 90 days.

How to do your due diligence

As usual ask for references and make sure and actually call them. It may even be worth going and visiting those references and talking with them face to face. Make sure and ask your references about these key points:

Collection results - Talk to that current client and ask them where they stand in terms of the benchmarks discussed above. If at all possible ask that client if you can see their insurance A/R aging. A quick look at the aging will tell you whether or not that billing firm is doing a good job.

Meetings - Ask references if the billing firm makes themselves available for face to face meetings. A billing firm should get together with their clients at least once a month to discuss any issues that need to be addressed.

Reports - Is the billing firm providing that client with their reports or is getting the reports like pulling teeth? If not, there may be an issue of just how good of a job that billing company is actually doing.

Staffing - Are the firms staff communicating with the clients office staff on a daily basis in terms of additional items needed to process claims? Do the staff educate the providers about coding issues that arise?

Agreement - Review the contract the firm has their clients sign and make sure it includes things such as services to be provided, costs of all services, confidentiality agreement, terms for termination and adherence to regulations.

Outsourcing your billing can be a huge benefit to your practice if done properly. If you follow the above steps, at a minimum, you will feel better about the firm you choose to move forward with and the overall experience will be both a positive and profitable one.

Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that is focused on helping business owners improve cash flow. Services include full service medical billing for healthcare providers, cost segregation studies for commercial property owners and an array of other services for general businesses.

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

Therapeutic Procedures - Explode Your Practice

2009-04-04T02:44:00.001-07:00

One of the more potentially volatile risk areas for health care practitioners today is the delegation of therapeutic procedures to unlicensed assistants, and billing for those procedures as though the practitioner personally provided the procedures. This practice activity is particularly prevalent and ever-growing in chiropractic!

Some practice consultants - with promises of increased income, coach chiropractors to integrate low-tech rehab and protocols into their practices. Chiropractors are advised that it is legally permissible for unlicensed assistants (e.g., chiropractic assistants) to perform the therapeutic procedures on patients that are billed (per "incident-to") as if personally performed by the chiropractor, who at the same time, is providing services to other patients who are billed for the chiropractor's services during the same time frames as the therapeutic procedures.

Does the regulatory board allow for delegation of therapeutic procedures to unlicensed staff?
Individual state health care regulatory boards establish their own state's administrative practice standards for licensees for the purpose of protecting the public from conduct that does not conform to their state's accepted standards of conduct. Such administrative regulations almost always include standards relating to the delegation of services to persons other than the licensed provider. In many states, chiropractic boards do not allow their licensees to delegate therapeutic procedures to unlicensed staff, and, as such it would be inappropriate in any and all circumstances for the licensees to engage in this conduct!

However, some boards opine that licensees (e.g., chiropractors) can delegate therapeutic procedures to qualified and properly trained unlicensed staff (e.g., chiropractic assistants) acting under a licensee's supervision consistent with the health and welfare of a patient so as to encourage the more effective use of the skills of licensees. It would appear prudent for chiropractors to gain clarification from respective regulatory agencies regarding the following:

What are the standards that must be met by chiropractors to ensure their unlicensed staff are "qualified and properly trained"?

What level of supervision (general, direct or personnel) is required of the chiropractor relative to unlicensed staff directing therapeutic procedures?

What is meant by "consistent with the health and welfare of a patient so as to encourage the more effective use of the skills of licensees"?

How should the therapeutic procedures (supervised) by unlicensed staff be documented in the patient's clinical record?

How should the therapeutic procedures be reported to payers - especially those following Medicare standards, to avoid potential allegations of misconduct?

Is reporting therapeutic procedure codes for supervised procedures consistent with CPT?

Therapeutic procedure codes (97110-97546) identify the application of clinical skills and/or services that attempt to improve function that requires the physician or therapist to have direct (one-on-one) contact with the patient. These procedure codes do not indicate "supervised" services and to report them to payers in such a manner could result in allegations of misconduct. Consequently, it is imperative for the practitioner (e.g., chiropractor) to obtain prior approval for this billing practice from ALL involved payers notwithstanding the fact that this type of practice activity has previously been found to be consistent with state regulatory standards on delegation. The purpose of seeking the payer's approval is not to enable the payer to make determinations on what practices are legal and what practices are not; rather, it is to protect the individual provider from a payer's unilateral referral of the provider billing practices to law enforcement authorities who may have a differing interpretation of the acceptable standards of delegation that the provider's state regulatory board.

Current Procedural Terminology (CPT) is a listing of (a) descriptive terms and (b) identifying codes. The foregoing is used to report medical services and procedures, as well as to provide a uniform language that accurately describes medical, surgical, and diagnostic services. The use of CPT provides an effective means of reliable nationwide communication among providers, patients, and payers.

The listing of a service or procedure and its code number in a specific section is not restricted to any specific specialty group. Any procedure or service in any section may be used to designate services rendered by any qualified physician or other qualified health care professional. CPT indicates that the terms -"Physician or Therapist" and "Provider" as identified in CPT are interchangeable to refer to someone licensed to perform health care services.

Select the name of the procedure or service that accurately identifies the service performed that is adequately documented in the medical record. Do not select a CPT code that merely approximates the service provided, and that if no such procedure or service exists then report the service using the appropriate unlisted procedure or service.

Suggestions concerning introduction of new procedures, or the coding, deleting, or revising of procedures contained in CPT should be made by contacting the CPT Editorial Research & Development.

The Final Rule for transactions and code sets as part of the Health Insurance Portability and Accountability Act (HIPAA) identifies CPT codes and modifiers as the national standard for health care plans and providers to electronically transmit: Physician services; physical and occupational therapy services; radiological procedures; clinical laboratory tests; other medical diagnostic procedures; hearing and vision services; and transportation services including ambulance.

Does the involved payer reimburse for supervised therapeutic procedures?

Payers often set their own standards for reimbursement of health care services and determine what will be paid, who will be paid, and how much will be paid. Standards may vary from payer to payer, and may differ from those standards established by the provider's own regulatory licensing board. Accordingly, it is the responsibility of all practitioners (e.g., chiropractors) to be familiar with both the payer's billing/coding and their state board's standards and seek to abide by those standards that impose the stricter requirements when seeking reimbursement! By adopting a policy of compliance with the stricter standard the provider will always ensure that he/she is protected from claims of improper billing practices.

Medicare, and other payers following Medicare standards, indicates that therapeutic procedures supervised by (unqualified) unlicensed staff are not reimbursable! Payers with such standards do not pay for provider services, at provider rates, when such services are administered by non-providers. Further, these payers do not maintain that practitioners can not delegate therapeutic procedures to unlicensed assistants but are asserting that such services are not covered and, therefore, they are not reimbursable - BILL THE PATIENT! Medicare Benefits Policy Manual, Chapter 15, Sections 220 and 230 specifies:

Therapeutic procedures are medically necessary only when they require the professional skills of a qualified practitioner, are designed to address specific needs of the patient, and are part of an active treatment plan intended to achieve a specific goal.

Medicare pays only for skilled, medically necessary services delivered by qualified individuals, including therapists or appropriately supervised therapy assistants. Supervising patients who are exercising independently is not a skilled service.

Providers can not bill and seek payment for one-on-one codes (e.g., therapeutic procedures) administered at the same time as other procedures were rendered to the patient, or to other patients.

A physician may not delegate physical therapy services (e.g., therapeutic procedures) to unlicensed persons and report them as "incident-to" services unless that person has the education and clinical experience equivalent to a physical therapist.

Incident-to a physician's professional services are defined (Benefits Policy Manual, Chapter 15, Section 60) as services or supplies furnished by auxiliary personnel as an integral, although incidental, part of the physician's personal professional services in the course of diagnosis or treatment of an injury or illness that are billed to Part B by the physician as if they personally provided them.

Some within chiropractic have differing opinions as to the appropriateness of the delegation and billing of therapeutic procedures. Illustrative of this is the following written opinion of a chiropractor to whom a colleague was referred subsequent to requesting assistance from a State Chiropractic Association regarding the issue discussed herein:

The auditor is confused, to say the least. As a doctor, you can delegate to whomever you wish to perform those [therapeutic procedure] services. You simply must be in the building at the time services are rendered to supervise [sic]. You do not have to perform the treatment yourself, nor do you have to stand over them and watch. This auditor may be confused with what some insurance companies are pushing for and have proposed, i.e., they require the doctor to do it. However, as far as I know, no insurance company has any policy in place to prohibit you from delegating to staff. As far as statute goes in Xx, if an insurance company did write that into their policy, we would have to go to the Xx with complaint. The P.T.'s would love to have those rules in place as well. Short answer is the auditor is wrong. Maybe some other state he/she is familiar with has that as a rule. Not here though.

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

What Should Your Billing Service Be Doing For You

2009-04-04T02:43:00.002-07:00

Many providers today are choosing to outsource their billing. The billing process has become much more involved over the past few years and for many it makes sense to outsource. Between the software updates, required electronic filing of claims, NPI numbers, and other changes, it has become nearly impossible for providers to keep up.

However, if you have only ever used one biller, or one billing service, then you might not really know what you should be expecting from them. We have providers who use other services ask us sometimes "Should my billing service be doing this for me, or is it something I need to do in my office?"

It is good to clearly know what your billing service should be doing, and what your office will be responsible for. That way you can keep things running smoothly. Not all billing services do things the same way and that is ok, as long as you know what yours is doing and it works for you. We actually provide different services for different accounts depending on the needs of the office. For example, we do not normally get involved with obtaining authorizations, however we have a couple of clients who cannot handle getting them from their office so they pay us extra to take care of that for them.

But there are some things that all billing services should handle. Billing is not just the act of submitting the insurance claims and waiting for payment to come. A good billing service will submit the claims, electronically whenever possible, check electronic reports for denials and bad batches, and follow up on unpaid claims. They should also take care of any denied claims.

If they are not checking electronic reports and doing regular follow up then you are losing money and so are they. Electronic reports will notify you if there are issues with any of your claims or with entire batches. If they are not reading them then they are not fixing those issues. For example, an electronic report will return a claim if the ID number is not right. Maybe it is a simple typo, two numbers got transposed, but if the electronic reports are not being read it could be a big problem. What if it is a patient that comes in once a week? None of the claims are going thru because the ID number was not fixed.

Many insurance carriers today have time filing deadlines. Some are very short, like 60 days from the date of service. If regular follow up is not being done then money can be lost due to timely filing. Follow up reports should be run every 4-6 weeks and all claims over 30 days should be checked on.

There are other things that billing services can do to keep your accounts receivable running smoothly, but those are the basics. If you feel that your accounts receivable is not what it should be you might want to consider meeting with your billing service and asking what can be done to improve the situation. Tell them you would like a report of your accounts receivables. What are your figures over 30 days, over 60 days? They should be willing to provide you with reports of what is outstanding and why and it should not take more than a couple of days for them to make the reports available. If they are unwilling to provide you with this information then you need to consider why.

I am not trying to rat anybody out. I am just trying to make us all accountable to providing the best service possible so that billing services do not get a bad name. We hear too many stories of bad services and it makes providers leery of outsourcing when it is a viable option.

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

Medical Professional Liability Insurance - Claims Made, OccurrenceMedical Professional Liability Insurance - Claims Made, Occurrence

2009-04-04T02:43:00.001-07:00

Medical professional liability insurance is another name for medical malpractice insurance. There are two types of medical professional liability insurance, claims-made and occurrence policies. There are advantages and disadvantages to each of these types of policies.

Claims-made insurance policies are one year long policies that are renewed each year without interrupting the coverage. Any claims made during the claims-made policy period will be covered, no matter when the incidence actually occurred, as long as the incident occurred after the original purchase of the claims-made policy. This means coverage is retroactive back to the first policy. This type of medical malpractice insurance is cheaper in the first few years of coverage as it is less likely claims will be made in the first few years of coverage. Premiums increase each year up to five years, when the reach the approximate cost of the occurrence policies.

Once a claims made insurance policy is cancelled, no further claims are covered. However, tail coverage can be purchased to cover any claims that occur for a certain amount of time after cancellation.

Occurrence medical professional liability insurance covers all claims that occur during the coverage period, regardless of when the claim is made. Because there is no way of knowing how many claims will eventually be made due to actions occurring any given year, the premiums for occurrence medical malpractice insurance are not necessarily cheaper in the beginning like they are with claims-made policies. This type of insurance covers the doctor forever against claims that result from the period in which the policy was in effect.

Both of these forms of medical professional liability insurance are very expensive, so there are currently a lot of organizations working on proposals to solve the problem of compensating any patients with legitimate medical malpractice claims without doctors having to pay huge premiums for liability insurance.

Some of the proposed solutions for the medical professional liability include capping non-economic damages, trying medical professional liability cases in a tribunal system outside of the main court system, use a no-fault system for compensation, using alternative dispute resolution methods like arbitration and medication, and using screening panels to review cases and determine whether or not cases should proceed to court.

Doctors need to have medical professional liability coverage in order to protect them from medical malpractice claims, which could otherwise bankrupt them should they occur. Doctors can lose a lot of money even on medical malpractice claims where they are not at fault, as they have to prove this.

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

#1 State in Chiropractic Billing Performance Index in June is Illinois - The Blues and Medicare Lead

2009-03-27T23:46:00.001-07:00

In June, the Chiropractic Office Billing Precision Index (BPI) gained 4.2 points above its May mark - making up all of the lost ground in May and outperforming April. Overall, June BPI reached 17.6 outperforming the national average of 17.7 by 0.1, and 2.1 points away from its best record of 15.5 in March of 2008.

Breaking the pattern established in April and confirmed in May, the June index, replaced two participants, namely, GEICO and Blue Cross Blue Shield South Carolina, with Blue Cross Blue Shield Michigan and State Faarm - a veteran and a new index participant, returning at 14.9 and debuting 41.1, in the fifth and ninth place respectively. Both GEICO and Blue Cross Blue Shield South Carolina first gained their participation in May, only to be replaced in June. Medicare South Carolina managed to keep its participation in spite of losing score from 39.2 to 46.1 and dropping from eighth down to tenth position. Note that BCBS Illinois not only maintained its top placement but also improved the score from 4.5 up to 2.4, while Medicare Illinois and Aetna returned to their traditional second and third placed, pushing back down United Healthcare and CIGNA.

Billing Precision Index 17.6 - June 2008

1. Blue Cross Blue Shield Illinois 2.4
2. Medicare Illinois 10.5
3. Aetna 11.8
4. United Healthcare 13.3
5. Blue Cross Blue Shield Michigan 14.9
6. CIGNA 15.4
7. Blue Cross Blue Shield New Jersey 20.6
8. Medicare New Jersey 27
9. State Faarm 41.1 (new participant)
10. Medicare South Carolina 46.1

BPI is an important billing performance characteristic because it approximates the proportion of claims that are never paid. BPI = 17.6 means that the average of ten top performing payers, used by the patients of Billing Precision providers, reached 17.6% of Accounts Receivable beyond 120 days.

This welcome improvement comes at the same time as the nation's doctors are fighting to hold off a ten percent fee cut in Medicare payments that was slated to kick in on July 1. The Congress is given extra time to prevent the reduction by simply holding off the processing of the claims for the first ten days of July for July dates of service. If successful, this delay should have low impact on providers' overall monthly cash flow because Medicare claim payments take 14 days (29 days for paper claims) after the date of receipt. Meanwhile, all claims for services delivered on or before June 30, 2008, are processed and paid under normal procedures.

Chiropractic office managers use the rule-based index to benchmark their billing performance and guide its improvement over time. Rule-based benchmarking also allows for the identification of elite payers, those that perform best in comparison to every payer in the country, as shown by the index-driven ranking.

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

Professional Medical Billing Services

2009-03-27T23:45:00.000-07:00

Professional medical billing services are relevant and exist to ensure that practicing physicians, providing much-needed services, collect the highest reimbursement amount deserved for procedures performed. It's important to understand that hiring a results-oriented medical biller takes patience and time. You see, medical billing is not a profession which a prospective employee can just walk into; this position demands experience, knowledge and a complete understanding of the medical insurance billing industry.

If a physician isn't maximizing his accounts receivables, it is perhaps due to the fact that he is employing under-qualified personnel. This practice will negatively affect the physician's bottom line. If this is the case, consideration should be given to hiring a professional medical billing service; by doing so any such physician would ensure the business side of his or her practice is being handled properly.

Professional medical billing services typically offer a trained staff of individuals who can take care of every billing need for a medical practice.

Insurance companies are somewhat difficult with which to work if you do not know the "ins and outs" of how they function, and claims are often denied for just a minor reason. If a professional medical billing service is submitting claims, they are aware of the typical reasons for insurance claim denial, and therefore, assure that the claims are submitted accurately and promptly each and every time, guaranteeing a prompt return.

When a professional medical billing service is contracted with the practice, it will no longer be a burden on the physician and his staff, and therefore, they will be able to focus solely on patient care.

Professionals will work on the claims and submit them to the insurance company through electronic methods. Electronic submission will assure the claims are received by the insurance company within hours, thus allowing a speedy claim payment.

Professional medical billing services will also make sure that the claims go through the electronic process error and problem-free, consistently monitoring these claims to ensure there are no difficulties. If by chance a problem does arise, it can be corrected immediately and resubmitted. Please also keep in mind that professional medical billing services are known to have success rates of ninety percent or more.

Whether the practice is large or small, a professional medical billing service will assure that payment from the insurance company will be received swiftly; this could be the difference between success and failure. The majority of professional medical billing services will work for any type of practice, no matter the physician's medical specialty.

In summary, a physician owes it to himself to seriously consider a professional medical billing service and what this important decision could mean to his practice's health and well-being. I wish you the best for your practice's success.

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

Why Consider a Medical Billing Company

2009-03-27T23:43:00.000-07:00

When a doctor owns a medical practice it does not necessarily mean that they have a great deal of money. It is possible for a doctor who owns his own practice to be very wealthy, but on the other hand if the business end of the practice is not handled properly he may not. A physician does not necessarily have the skills required to handle the money part of his medical business. He can be the best doctor but it requires a different set of skills to handle business.

A doctor should understand this and hire the services of a medical billing company to handle the parts of his business that he cannot take care of.

A medical billing company will have a staff that is trained to handle every aspect of a medical practice's business. They are equipped to deal with the insurance end of the billing and the medical coding end.

Working with an insurance company can prove to be very hard. They tend to deny claims for the flimsiest of reasons and often use reasons that are borderline silly.

When a medical practice handles their own insurance claims will find that the insurance companies tend to deny claims a good deal of the time. When a practice makes use of a medical billing company this does not happen nearly as often.

For a busy medical practice that sees a lot of patients there will be a lot of insurance claims to fill out. Usually one person is required to fill out each and every one of those forms. They will need to write out each form individually and send them to the insurance company. If there is one mistake on the form then the claim will be denied by the insurance company. They will generally send the form back and require it to be filled out again.

This creates an overwhelming amount of work for the person that must fill out these forms.

Even if the forms are filled out correctly it can still be weeks or months before the insurance company will send the check. For a small practice this can be devastating. This is especially true if there are denied claims in the same period of time.

When a practice hires this service, all of this work is eliminated. The difficulties that are caused by the insurance company can be avoided when a medical billing company is used. Professionals working for this type of company are trained to handle the claims forms and will get them to the insurance company using electronic means. This means that the claims will not have to be filled out manually and sent in through the mail.

The professional at this company will also monitor the claim and make sure that it goes through the process without delays. They are constantly on top of each claim that they send in and will correct any problem that occurs. The success rates are higher than ninety percent.

When a claim is sent to the insurance company by electronic means it will be accepted immediately or denied immediately. The practice will receive their check in a matter of days instead of months.

This helps the smaller practice receive their money faster and will be a benefit to the budget of the small practice. The cost of this type of service is far lower than the cost to the practice that delayed and denied claims are.

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

NPI Numbers and Legacy Numbers - New Rules As of May 23, 2008 For Billing Medical Insurance Claims

2009-03-03T22:08:00.002-08:00

On May 23, 2008 insurance carriers were suppose to accept NPI only on all paper & electronic claims. Not only were you required to include the NPI number, but you were required to EXCLUDE the legacy numbers. Some insurance carriers were not ready for the deadline and applied for an extension (like NYS Medicaid). But Medicare was ready and if you include your PTAN (legacy) number on your claims they are being rejected.

For the insurance carriers who were ready for this deadline, you must make sure you do not have the legacy number in the shaded area of box 24J or box 32A & 33A. If your software is set up to automatically print the legacy number in this box you need to remove it. If you submit claims electronically, make sure your vendor has it set up to exclude the legacy number.

For the insurance carriers who were not ready and applied for an extension, you will need to continue including the legacy number until they have complied. This makes things a little messy. You need to make sure you are submitting the claims that require the legacy number with it, and the ones that do not allow it, without. Crazy, but it is what we billing people have to do to make sure the money keeps coming in.

Another little crazy thing to worry about is the NPI number entered in 24J. If you are set up with Medicare as an individual provider (not a group) and you only have a type I NPI, you must leave the NPI part of box 24J blank. You cannot include the individual NPI number here. If you are an individual provider and you put your NPI number in 24J, Medicare may reject your claims.

If you are a group with Medicare then you need to continue putting the rendering providers individual NPI in box 24J and the group NPI (type II) in box 33A. If you are not sure if you are an individual or a group you can tell by your PTAN number. If you only have one PTAN number then you are an individual. If you have a PTAN for the individual provider and a separate PTAN for the practice name then you are a group. Just when you thought it couldn't get much more confusing!

If you want to keep your cash flow steady it is important to make sure you are submitting the claims correctly. If you have any question as to what a particular insurance carrier requires, give them a call. Better to have it right the first time than to have to resubmit!

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

How Do I Bill For Critical Care Services? What is Critical Care Service?

2009-03-03T22:08:00.001-08:00

Critical Care is the direct care of the provider rendered to a critically ill or injured patient who requires exclusive attention of the physician. This means a full attention of the physician to the injured or critically ill patient.

Critical Care services will require full personal management by the physician. It is an intervention with life and vital organ systems' critical condition, life threatening and deterioration. It requires the physician's full assessment and manipulation to prevent further life threatening deterioration in the patient's condition.

Critical Care involves High Complexity in Medical Decision Making to assess and manage the life threatening, clinically impaired and injured patient. Vital organs such as but not limited to: central nervous system failure, circulatory system failure, shock, renal, hepatic, metabolic or respiratory system failure.

Critical Care is NOT necessarily rendered in the ICU or CCU. Critical care is always based on the patient's condition as described above. Therefore, a stable patient in an ICU or CCU is not always a critical care service.

The rendering physician must devote his full attention on the patient and must not be interrupted by seeing other patients.

99291 - Critical Care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes

99292 - each additional 30 minutes (in conjunction with 99291)

The following procedures services are bundled in reporting Critical Care Services and are not billable during the critical care service provided on the same day by the same physician:

1. Interpretation of the Cardiac Output Measurements (93561, 93562)

2. Chest X-rays (71010, 71015, 71020)

3. Pulse Oximetry (94760, in computers ECGs, blood pressure, hematologic data (99090)

4. Gastric Intubation (43752, 91105)

5. Temporary Transcutaneous Pacing (92953)

6. Ventilatory Vascular Access Procedures (3600, 36410, 36415, 36540, 36600)

Medical Necessity Documentation:

Proper documentation must be recorded on the patient's records and proof of medical necessity why Critical Care Service is rendered.

Illustration on how to bill Critical Care Service:

Less than 30 minutes

Use the appropriate E/M Code

30 min to 1 hr and 14 min (30-74mins) - 99291 (1 unit)

1 hr 15 min to 1 hr 44 min (74-104 mins) - 99291 (1 unit)

+99292 (1 unit)

1 hr 45 min to 2 hr 44 min (105-134 mins) - 99291 (1 unit)

+99292 (2 units)

Modifier 25 and Modifier 24 can be used to bill with Critical Care Services codes (be guided with other procedures which are bundled with Critical Care Services - see above).

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

Medical Claims Electronic Billing - Don't Just Read the Verification Report - Read the Response Repo

2009-03-03T22:07:00.000-08:00

You thought Electronic Submission of Claims do not make any mistakes or error? You are absolutely wrong. It sometimes has glitch that you did not realize you have overlooked.

I have seen medical offices who ONLY relies on the Verification report. Well, this is a report being generated after you send your claims electronically. It usually shows you a "pass" or "reject" claims on the report. The truth of the matter is, based on my experience, I can not rely on these verification reports alone.

Getting on top of your Response Report is more essential than just relying on your verification report. What is this called "Response/Return Report"? This is the report that will show you every insurance company's reply or response for all the claims that were submitted to the clearing house and has been received successfully by the insurance payer. Each patient with its date of service will show you "accepted", "adjudicated", "received" payer status report. This is actually your real response report. This is where you can determine if your claims actually reached the insurance payer!

Bottom line, you should see two reports when you submit your claims by electronic, one for verification/confirmation/summary of the claims and the second report which usually takes after 2-3 days would be the Response/Return/Status Report on which it will actually tell you if the claims were received by the insurance payer.

When your claims get denied for untimely filing and your system shows you have submitted the claim electronically. The insurance company will require a PROOF. What proof are you going to give them?

Your Proof is the "response report" that indicates "accepted" or "received by payer". If you don't have this proof. There is no way you can appeal your claim. And your physician will not be happy for not being paid for the services he rendered to his patients.

So be very careful on this. It's important you pay attention on these reports.

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

How Medical Practices Increase Productivity

2009-02-20T01:40:00.001-08:00

A medical practice is more than just seeing patients. It is a business, and like all businesses, it has monthly bills to pay, and employees who want their paychecks. There are many different aspects to medical practices across the country.

A medical practice relies heavily on reimbursements from insurance companies to fulfill their financial obligations. However, filling out insurance claims for hundreds of patients each week can be very time consuming. The whole process can be a very frustrating experience.

A physician must either hire someone to perform this task, another expense that can be eliminated, or do it him or herself. Either way, it can be a grueling experience for the person filling out the forms. Often, filing the forms is another headache that can leave the person feeling a huge amount of stress.

If the forms are not filled out properly, the insurance company will reject them and the whole process is started all over again and often these claims are added to the stack of claims that are pending. This can cause financial hardships for many practices, especially small ones. Even when the claim is accepted, it can take several weeks or months for the insurance company to send the reimbursement check.

Many medical practices have found that by using a medical billing company, they have increased the efficiency in their office. The staff can concentrate on other areas of office work. Medical billing services have fast and secure methods of submitting claims to insurance companies electronically. This means that the claims are no longer lost in the mail or sitting in a stack on someone's desk waiting to be put into the system.

When a claim is filed electronically, it is either accepted or rejected immediately. The billing service then will make the necessary changes and re-submit the claim. Because the claim is accepted electronically, payment is sent within days instead of weeks or months.

Another benefit to using this type of company is that the personnel are highly trained in all aspect of medical billing. They are familiar with all of the rules and regulations and when they are updated or changed.

The medical billing service will also track each of the payments to make sure that the transaction is completed and that a check was sent. They will contact the insurance company and follow up on each claim that is not processed.

This gives physicians the time they need to treat more patients and to concentrate on them and not worry about when they will receive their payments.

Any type of medical facility can use medical billing services. It does not matter how big or small, the benefits are the same for all.

Many physicians are skeptical about using this type of service, especially small ones, however, the benefits of these services far outweighs any fees that they may charge because the reimbursement time is quick and the success rate of submissions is over ninety percent. This makes it very cost efficient for any medical practice.

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

Medical Coding & Billing And HCPCS

2009-02-19T21:47:00.002-08:00

Medical coding/ billing is today one of the ten fastest-growing allied health occupations. Health care insurers process over 5 billion claims for payment every year in the US. Therefore, Medicare and other health insurance programs have to make sure that that all claims are processed without mistakes and so this requires a standardized coding system. Medical coding and billing professionals are responsible for submitting the proper documents to the various insurance companies and federal agencies for reimbursement of the medical expenses. Medical coders use special codes to specifically identify outpatient and also inpatient procedures / services and this is very useful for billing of both private as well as public insurance companies.

HCPCS stands for Healthcare Common Procedure Coding System. It is a set of health care procedure codes based on the American Medical Association's Current Procedural Terminology (CPT). Established in the year 1978, HCPCS provides a standardized coding system for describing the specific items and services provided in the delivery of health care. This type of coding ensures that insurance claims are processed properly and is needed by Medicare, Medicaid, and other health insurance programs.

HCPCS codes exist in two levels.

* Level I is numerical and consists of the American Medical Association's Current Procedural Terminology (CPT)
* Level II codes are alphanumeric and meant for non-physician health services.

It is very essential for medical coders to keep in touch with the latest codes and changes. This is possible by the use of HCPCS books that contain the complete lists of HCPCS Level II codes with descriptions and guide the medical coder through current modifiers, code changes, additions and deletions.

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

Prevent Down Coding By Insurance Companies On Medical Claims

2009-02-19T21:47:00.001-08:00

Ever wonder why sometimes when you get reimbursed for a claim, the insurance company has "changed the code to a more appropriate code for payment"? You submitted the claim as a 99214 but they paid you for a 99213 or even worse, a 99212. This practice is called downcoding.

Do you have to accept it? Well in some cases you do. A lot will depend on the contract that you have with the insurance carrier. Some contracts will only allow providers to bill certain cpt codes. In that case, they can change a billed code to one of the allowed codes. Or the contract may specify that you can only bill a certain number, or percentage of claims at the higher codes.

But sometimes an insurance carrier will just downcode your claim and it is not due to contract specifications. In that case you can appeal it. We recently had a claim that the insurance carrier downcoded a 99214 to a 99213 and told us that they only allow a provider to bill a 99214 every 6 weeks for a patient. That is ludicrous. How can that guideline apply to any patient?

Sometimes we just have to remind the insurance carriers that the doctors are the ones who determine the patient's needs. In this case we sent in office notes and a letter advising them that we were appealing the processing of the claim. The doctor had met the requirements to justify the billing of a 99214 and their "guidelines" were inappropriate. We received payment for the difference about 10 days later.

So if you are having problems with your claims being downcoded, and they are not due to contract specifications, you should appeal. Do not just accept what the insurance carrier does. That is what they are counting on. Just think of how much money they save on the providers that do not do anything about it.

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

Medical Insurance - Insist On These Features

2009-01-31T00:54:00.001-08:00

It's a good thing to have a medical or health insurance policy. It's great to pay your rates as and when due. It's also soothing to know that your insurer is a reliable entity you can trust. However, it's a lot more important that you ensure your policy has features that will give the value you deserve. Why pay for stuff that leaves you inadequately covered? Here are a few things to insist on...

1. Make sure your medical insurance policy includes world-wide non-emergency coverage. The only people who this shouldn't bother are those who've vowed never to step out of their countries. But if you do intend to ever go on vacation abroad, you'll do well to ensure your health insurance plan will still cover you medical expenses there.

2. Make sure your policy has no coverage limits. Where this is NOT possible, look for one with a very high coverage limit. $1 million is a good limit per claim. And for lifetime coverage limits, look for something as high as $2 million. Remember, although you may pay a lot less for policies that offer very low coverage limits, you might be putting yourself or family in a financial mess if you ever need medical care that far exceeds that limit.

If you're one of those folks who rarely fall ill, then you might just go for a catastrophic health insurance policy. This policy kicks in when you have catastrophic health conditions that could literally render a person destitute. The cost per $100,000 coverage is quite low when compared with regular policies. And at the same time, you have the peace of mind that you are covered whatever happens.

3. It's also a good idea to ensure you can see whichever specialist you need to see without a referral. Yes, this will mean you will pay more but would you rather have to beg to see the right specialist if you or yours have a serious health condition that requires specialist and urgent attention?

These features will definitely mean higher rates. But do you know that you can still pay a lot less? All you have to do is get and compare many quotes from a wide range of insurers.

Different insurers have different loss histories and underwriting criteria and these affect rates you get. Therefore, good comparison shopping ensures that you find an insurer that has the best rates for your profile.

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

ICD-9 Coding Automation Software Saves Thousands Of Man Hours

2009-01-31T00:53:00.001-08:00

Custom ICD-9 Coding automation software saves clinics thousands to millions of man hours. The software reads the file of thousands of reports and fee sheets and separates them into collated exams. The parsing engine pulls information like procedure codes, doctor up-ins, POS, Dept, etc.. into a data file associated with each exam. This process happens nightly. The original source files are stored in a backup location.

In the morning, coders come in and are presented each exam in order of date, insurance type, and department (POS-DEPT). This saves hours in printing and sorting by hand. The coder need only look at the procedure code and skim the report to enter the appropriate ICD-9 code and hit next. If additional procedures need to be added, they can be on the fly. Data checks are performed before the exam is passed on to the next process. Coders can add a note to each exam for reference at other stages of the process. The report and fee sheet can be toggled for viewing with a single click of the mouse.

The exam then goes to enhancing for insurance and demographic verification. There are 2 virtual bins for exams that are missing information or have follow up exams associated with them. Fields can still be edited at this point for correcting up-ins and attending physician codes.

The exam goes to charging where it is presented again in sorted order. The exam can be entered into the charging software's fields manually or using a custom add-on, can be pasted with a single click of the mouse.

That night, all batched/charged exams are converted into pdf format and stored in a searchable history folder.

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

How Physicians Manage Their Practice With Medical Billing Services

2009-01-31T00:50:00.001-08:00

Physicians today have many responsibilities scheduling appointments, filing paperwork, upkeep of the office, and all done while caring for their patients It can seem like an insurmountable problem when the physician has to set time aside to bill their clients and insurance companies.

It may seem like all they have to do is just fill in the blanks and send it off, however there is a lot more involved and the physician has to take time away from his or her patients to get it all done.

When a physician has to take the time to sort through insurance paperwork, he or she has less time to spend with patients. This can lead to a physician turning away patients because he or she does not have the time to see them.

Medical billing services were developed to assist physicians in managing their medical practices. It allows physicians more time to care for patients and less time sitting in their office staring at stacks upon stacks of paperwork.

Statistics indicate that an average of thirty percent of all medical claims sent to insurance companies never get paid. The total amount that is never paid each year is staggering, however there is light at the end of the tunnel.

Medical billing services can guarantee up to a ninety eight percent return on the claims that they process, making it cost effective for even the smallest practice.

What many physicians do not take into consideration is that there is a cost to process each claim with an insurance company. This cost can reach as high as ten dollars per claim. A Medical billing service can reduce this cost to only a fraction of what is charged to physicians.

Another aspect of billing is that the physician must wait up to three months before the insurance company processes their claims. This can create serious financial hardships for the physician if he or she cannot meet their weekly or monthly financial obligations. Medical billing services file their claims electronically and monitor each one to ensure that the repayment period is days and not months. When a physician uses Medical billing services, the amount of errors and rejections are reduced to almost none.

The rules, regulations and laws regarding insurance and billing change or are updated frequently. This means that a physician who does their own medical billing has to struggle between keeping current with all of the updates and caring for patients. It can seem like an endless battle. Medical billing services can help because they are up to date on any changes that are initiated.

By using a medical billing service, the physician is free to care for more patients and give each one more of his or her attention.

One of the greatest advantages of Medical billing services is that any physician can use them. Whether it is a practice with a hundred doctors or just one, each physician will receive the same quality service.

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

Superior But Affordable Medical Insurance - Using The Internet To Your Advantage

2009-01-23T03:18:00.001-08:00

If you want to get superior but affordable medical insurance coverage, then you really need to look at the opportunities presented by the internet. To overlook them would be to deliberately opt to pay a lot more than you should. So in what ways can you pay less with the internet...?

1. You can get useful information that will both help you pay less and get the best policy for your peculiar needs. Look everywhere online. There are great articles on health insurance. All it will cost you is just the discipline to read through and make use of the great recommendations you get.

2. Has your health insurer NOT kept its own part of the deal? With the internet, you can easily make these big companies sit up. Just ask and you'll get Michael Moore's email address.

But more importantly, it only takes spending a short while in different health insurance forums for you to discover insurers to avoid in case you are just shopping for a policy.

Furthermore but more importantly, you also have your state's department of insurance or it's equivalent, BBB, standard and Poor's and other rating organizations to help you determine if an insurance company is worthy of your business.

3. The internet makes the entire process of comparison shopping far easier than it used to be. Could you imagine picking up the Yellow Pages, searching for agents in your area and then calling them one after the other for quotes?

With the internet all you have to do is visit a site, fill a short questionnaire and you'll receive quotes from five or more insurers.

But can you believe a lot of folks still don't make the most of this? They just get quotes from one site and based on that, they make their decision. That's wrong. Visit not less than five reputable sites for quotes. This will give you a very broad range of quotes from a wider range of insurers.

This will expose you to more exciting offers and make it a lot easier for you to pay far less for superior coverage.

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Medical Insurance - Insist On These Features

2009-01-23T03:17:00.000-08:00

ICD-9 Coding Automation Software Saves Thousands Of Man Hours

2009-01-23T03:16:00.000-08:00

Medical Insurance - Insist On These Features

2009-01-07T22:57:00.003-08:00

ICD-9 Coding Automation Software Saves Thousands Of Man Hours

2009-01-07T22:57:00.001-08:00

How Physicians Manage Their Practice With Medical Billing Services

2009-01-07T22:56:00.000-08:00

Physicians today have many responsibilities scheduling appointments, filing paperwork, upkeep of the office, and all done while caring for their patients It can seem like an insurmountable problem when the physician has to set time aside to bill their clients and insurance companies.

It may seem like all they have to do is just fill in the blanks and send it off, however there is a lot more involved and the physician has to take time away from his or her patients to get it all done.

When a physician has to take the time to sort through insurance paperwork, he or she has less time to spend with patients. This can lead to a physician turning away patients because he or she does not have the time to see them.

Medical billing services were developed to assist physicians in managing their medical practices. It allows physicians more time to care for patients and less time sitting in their office staring at stacks upon stacks of paperwork.

Statistics indicate that an average of thirty percent of all medical claims sent to insurance companies never get paid. The total amount that is never paid each year is staggering, however there is light at the end of the tunnel.

Medical billing services can guarantee up to a ninety eight percent return on the claims that they process, making it cost effective for even the smallest practice.

What many physicians do not take into consideration is that there is a cost to process each claim with an insurance company. This cost can reach as high as ten dollars per claim. A Medical billing service can reduce this cost to only a fraction of what is charged to physicians.

Another aspect of billing is that the physician must wait up to three months before the insurance company processes their claims. This can create serious financial hardships for the physician if he or she cannot meet their weekly or monthly financial obligations. Medical billing services file their claims electronically and monitor each one to ensure that the repayment period is days and not months. When a physician uses Medical billing services, the amount of errors and rejections are reduced to almost none.

The rules, regulations and laws regarding insurance and billing change or are updated frequently. This means that a physician who does their own medical billing has to struggle between keeping current with all of the updates and caring for patients. It can seem like an endless battle. Medical billing services can help because they are up to date on any changes that are initiated.

By using a medical billing service, the physician is free to care for more patients and give each one more of his or her attention.

One of the greatest advantages of Medical billing services is that any physician can use them. Whether it is a practice with a hundred doctors or just one, each physician will receive the same quality service.

Medical billing services are available to any type of physician whether he or she is a podiatrist or a pediatrician; Medical billing services can assist with all medical billing issues and concerns.

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

ICD-9 Coding Automation Software Saves Thousands Of Man Hours

2008-12-24T04:44:00.002-08:00

How Physicians Manage Their Practice With Medical Billing Services

2008-12-24T04:44:00.001-08:00

Physicians today have many responsibilities scheduling appointments, filing paperwork, upkeep of the office, and all done while caring for their patients It can seem like an insurmountable problem when the physician has to set time aside to bill their clients and insurance companies.

It may seem like all they have to do is just fill in the blanks and send it off, however there is a lot more involved and the physician has to take time away from his or her patients to get it all done.

When a physician has to take the time to sort through insurance paperwork, he or she has less time to spend with patients. This can lead to a physician turning away patients because he or she does not have the time to see them.

Medical billing services were developed to assist physicians in managing their medical practices. It allows physicians more time to care for patients and less time sitting in their office staring at stacks upon stacks of paperwork.

Statistics indicate that an average of thirty percent of all medical claims sent to insurance companies never get paid. The total amount that is never paid each year is staggering, however there is light at the end of the tunnel.

Medical billing services can guarantee up to a ninety eight percent return on the claims that they process, making it cost effective for even the smallest practice.

What many physicians do not take into consideration is that there is a cost to process each claim with an insurance company. This cost can reach as high as ten dollars per claim. A Medical billing service can reduce this cost to only a fraction of what is charged to physicians.

Another aspect of billing is that the physician must wait up to three months before the insurance company processes their claims. This can create serious financial hardships for the physician if he or she cannot meet their weekly or monthly financial obligations. Medical billing services file their claims electronically and monitor each one to ensure that the repayment period is days and not months. When a physician uses Medical billing services, the amount of errors and rejections are reduced to almost none.

The rules, regulations and laws regarding insurance and billing change or are updated frequently. This means that a physician who does their own medical billing has to struggle between keeping current with all of the updates and caring for patients. It can seem like an endless battle. Medical billing services can help because they are up to date on any changes that are initiated.

By using a medical billing service, the physician is free to care for more patients and give each one more of his or her attention.

One of the greatest advantages of Medical billing services is that any physician can use them. Whether it is a practice with a hundred doctors or just one, each physician will receive the same quality service.

Medical billing services are available to any type of physician whether he or she is a podiatrist or a pediatrician; Medical billing services can assist with all medical billing issues and concerns.

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

Health Savings Account Fundamentals - Asking For Cash Discounts!

2008-12-24T04:41:00.000-08:00

The purpose of this short, easy to understand report is to make you aware of the benefits of paying cash to your health care providers.

Health care providers are being educated to the benefits of catering to patients who hold HSAs. Health care providers are being bombarded with high service charges and huge reductions in payment because the giant health insurance companies and HMOs first take their portion and then typically don't pay the doctor or health care provider for 60 to 120 days or more for his/her services. The average health care provider typically has 2-3 people to administer and maintain this huge cumbersome insurance paperwork system. When you offer to pay cash immediately for health care services, you deserve and will receive a significant discount, many times 50% or more off of what you would normally pay. This is a very important thing to know. The average insured family spends less than $2000 annually for health care. If you get a 50% discount off that for paying cash, your out-of-pocket expense is only $1000 per year.

You will receive a statement with all of the proper coding that you will have for your HSA administrator if you wish a refund later. Your doctor saves dollars because he/she does not need to process your visit through their insurance department and your visit does not have to go through his/her billing department.

You must know and understand how your new HSA works so you can receive every benefit provided. Notify your health care provider before your visit of your intention to pay cash at the time of service and inform him/her that you don't have direct health insurance. Then ask for their cash discount policy. Simply ask what his/her cash service fees are in comparison to his regular fees. This applies to your dentist, doctor, chiropractor, you name it. It is to your benefit to know exactly at the beginning what your discount and cost for that service will be. The main benefit of having your HSA is that you are now in control of your health care. You are no longer tied to any one specific health care provider and you have the complete choice of who you use. Smart consumers shop for the best deals on everything else, why not health care?

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

Online Healthcare College Degrees

2008-12-08T02:53:00.001-08:00

A variety of online healthcare college degrees are available. The programs are structured differently, depending on the degree program you are seeking. Nursing, respiratory therapy, radiology, and medical assisting are just some of the degrees available online. Some offer the complete degree online, while others will require you to attend some classes on campus. You may have to complete required clinical hours in a local hospital. The school will help set this up with the hospital.

Advanced degrees in nursing are popular online programs. Nurses work unusual and varying hours, making attending classes difficult, if not impossible. More universities are offering Bachelor and Master degrees in nursing. Requirements vary, but most online healthcare college degrees accept certified Licensed Practical Nurses (LPN) or Registered Nurses (RN) into the programs. Some hospitals offer help with tuition to these schools.

It can be difficult to find online healthcare college degrees which can be entirely completed online. Many fields, such as nursing and respiratory care require clinical experience. You should expect to put in your hours in a local hospital for these programs. This experience is necessary to proper training in these fields. Some schools require students to attend on campus labs. Check with an admissions counselor to determine your school's requirements.

Some online health care programs are offered entirely online and require no on campus visits. Medical billing and transcription courses are examples of these certificate programs. The benefit of these programs is they can be completed fairly quickly. Medical assistant degrees are offered completely online too. These positions are more focused on office administration skills and don't require clinical practice.

If you have a health care degree, online healthcare college degrees can still benefit you. Many fields require continuing education credits to maintain a license. Getting the credits you need to maintain your license can be difficult with hectic work and family responsibilities. You can easily get these credits through an online college.

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Working At Home-which Job Will Suit You?

2008-12-08T02:52:00.000-08:00

Thousands of people each year earn there income by using legitimate work at home job opportunities. You can also enjoy the benefits of working the hours that suit you and keeping away from office politics, by gaining employment in legitimate work at home jobs. All you need to be is ready to spend few hours daily doing the work that will be required of you. These job opportunities are suitable for many people, such as stay-at-home parents who need to care their children, students, retired, disabled persons and those who need to take care of elderly or sick family member at home.

If you are unable to leave your home to get a job, but want to get relief from the stress of increasing bills, electric costs and ever rising inflation, then a work at home job would be ideal for you. There are numerous sites that act as intermediaries online. These sites can help you obtain suitable home based work that will earn you a decent income. The added benefit of seeking this type of employment would be you are able to select part time or full time jobs that will fit around your home life.

In order to start working at home, you need a modern computer with internet connection and a phone. Basic computer knowledge will be required. However if you want to do jobs like computer programming, web or graphic designing, then previous experience in the respective field will be needed. You can apply for many of these jobs and can get training online without even stepping out of your home. However take time while making a resume, since a good one can really help you land the job you desire.

Before starting a search for a work, you must understand that it is just like any other employment where you have an employer, requirements and sometimes even schedules that must be met.

Transcription, customer service, translation, medical billing, clerical and data entry jobs are most suitable home based legitimate work that can provide you a decent income. You can select any of these jobs according to your ability and how you wish them to fit around your home life. Most of the companies outsourcing this type of work, offer employment on a part time and full time basis.

This type of employment is ideal for those who want to change their financial situation without compromising the time spent with there family. This of work type is 100% risk free and so you can start applying for a suitable job, without worry. Another option open to you would be to turn your hobbies in to a legitimate home based business.

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Austin, Texas Medical Transcription Services

2008-12-08T02:51:00.000-08:00

With the increase in the number of patients approaching healthcare facilities in the US for various treatments, these firms are having a tough time in efficient manipulation and recording of patient treatment details. Effective patient treatments and timely processing of insurance claims all depend on how effectively and quickly, patient medical records are being processed by healthcare firms. To cater to such needs of healthcare firms including hospitals, clinics, acute care centers, and long term care facilities in Austin, Texas, medical transcription facilities in the state are now offering cost-effective and reliable services for their clients.

Apart from hospitals, individual practitioners and doctors also benefit from these services. With medical transcription services being outsourced, doctors and physicians can concentrate more on their patients and worry less about maintaining and keeping patient records. Since high expenses are involved in hiring transcriptionists and buying dictation equipments, having these jobs outsourced to state-of-the-art transcription facilities in Austin, Texas helps medical care facilities to save time and money. A number of medical transcription service providers are now operating in Texas and their services are available in all major cities in Texas including Austin, Houston, Dallas, San Antonio and Fort Worth.

Most of these medical transcription providers offer their services in a highly competitive and dedicated manner, with services delivered on the basis of individual client requirements. The availability of skilled and experienced transcriptionists working in these firms is a factor that helps clients to have their daily patient information management jobs done faster and in a thoroughly efficient manner. With HIPAA compliant operations provided at medical transcription facilities in Texas, all transactions involving patient medical records are safe and secure. These Texas based firms are also offering excellent backup and disaster recovery services for their client healthcare centers.

To have better accuracy maintained in processed patient records, most Texas based medical transcription firms are utilizing the services of experienced proofreaders, language experts and editors. They can double check and correct files for errors and thus most processed records coming from these transcription facilities maintain a high accuracy level of up to 99 % which is required by healthcare clients.

With medical transcription services being provided 24x7 by these Austin and Texas based firms, all client jobs are done in a time-bound manner and thereby healthcare providers can strictly avoid possible backlog situations. Quality and competitive pricing are also positive factors which enable healthcare clients to have their transcription jobs outsourced to these firms. Most medical transcription facilities are also providing related services such as medical billing and medical coding to help healthcare clients further in their daily patient information management operations.

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What Is National Medical Biller's Day?

2008-11-17T04:05:00.001-08:00

National Medical Billers Day is a new term and many outside the health care sector may not be yet familiar with it. It was only on March 27, 2008 that the first National medical billers day was celebrated. As years pass it will become a more and more popular event. Declaration of such a day was initiated by the AMBA (American Medical Biller's Association). Many may be unaware of the purpose and need for such a day!
It is a day to recognize and appreciate the professional medical billers. All the members of AMBA, as well as medical billers from across the nation will be officially recognized and it is a day for them to celebrate nationally. A State Governor's proclamation had the following points that clearly imply the need to recognize the work done by the professional medical biller. Here are some of the favorable points that mention the importance of medical billing professionals from the proclamation signed by the Governor of Minnesota.
Medical billers provide a much needed service to doctors and other health care providers and constitute a vital segment of the health care industry. Increasingly, health care providers rely on billing companies to assist them in processing claims in accordance with applicable statutes and regulations. Health care providers consult with billing companies for advice regarding reimbursement matters, as well as overall business decision-making. Medical billers strive to provide a high level of ethical and lawful conduct throughout the entire health care industry and offer expertise in program reimbursement requirements, help ensure that claims are accurately prepared, and free physicians and other practitioners from paperwork, enabling them to devote their energies to the care of their patients.
The American Billing Association's goal is to provide the medical biller's association members with resources to enhance knowledge and skills to develop new ideas and technology collectively increase and realize true industry growth and leadership. It also offers the Certified Medical Reimbursement Specialists (CMRS), an exam which is a voluntary, national credential for the medical billing profession.

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Factoring - Alternative Financing For Medical Transcription Services

2008-11-17T04:04:00.000-08:00

When an Arizona medical transcription service owner (MTSO) signed three new clients, things got a little hectic at the office. She was ecstatic about the new business and the growth opportunities it provided, but in order to meet these new demands, she would have to increase the size of her dictation system, have interfaces built, and recruit, hire and train new employees. She was going to incur meaningful start-up costs and her on-going expenses (mainly payroll and taxes) were going to increase tremendously. Meanwhile, it would be many weeks before her new clients would pay her for her work.
The president was now faced with a dilemma, despite her anticipated business growth. Instead of immediately launching into her new contracts, she would first need to spend the next couple of weeks looking for capital. This way she would be completely prepared to meet the demands of her new clients. Having already exhausted her ability to borrow from the bank, she instead went to a medical transcription accounts receivable factor for the money she desired. With the ability to use the receivables from her new clients as collateral, she would be able to quickly secure the cash needed to meet the expectations of these new clients.
But what exactly can a factoring company do for a medical transcription service? And how common, and more importantly, how wise is it to do business with this kind of finance provider?
The business of factoring has literally existed for thousands of years. Whenever someone owed money, there has always been an outside party willing to take a piece of the future income in exchange for providing the instant cash relief to the owed party. The most recognizable modern example of factoring is the credit card. In this case, the host bank pays a merchant immediately, before its customer pays the bill. The bank takes a percentage of the customer's payments in return for the advancement of funds.
Factoring works similarly to the use of the credit card. The factor provides capital in one of two ways: either by purchasing the asset value of a receivable (non-recourse) or by making a loan with the invoices as collateral (full-recourse). In the case of medical transcription funding, the factoring company buys the value of the receivables and takes the credit risk that the invoice will be paid. The client still retains the performance warranty on the work done for a customer. Before the factor decides to purchase the accounts receivable, the factor performs a thorough credit check on the customer. If a factor makes a loan against an invoice, which usually occurs when the customer credit is not favorable, its client will continue to assume their credit risk, and will also be liable for any non-payments.
When a prospect applies for a loan from a bank without having an adequate credit record or a profitable business history, it is not uncommon for the bank to recommend a factor since the prospect is not in the position to pursue conventional financing. The factoring firm can help provide the financial discipline that a prospect needs as well as the opportunity to secure short-term working capital. Banks often see factoring as an interim solution to inadequate credit, until the client is in a better position to secure a bank loan.
A good factor wants to see its client eventually move to a conventional banking relationship and avoids companies that would depend on them forever. Any company that cannot establish an exemplary credit history can eventually become a bad risk for any financial partner. Factors are as unlikely as any financial institution to invest money, and even time, into a risky company.
There is often a misconception that the only time to use a medical transcription funding option is when the company is going out of business, when, in fact, the complete opposite is true. Factors will research a prospect thoroughly before deciding to accept them or not. Since the factor will operate as a de facto partner or investor by assuming the risk of the company's receivables, it is in the interest of the factor to take on clients that are growing, solvent, and ambitious. A factoring company's ideal partnership would be with a new or reorganized company looking at a bright future ahead of them. Factors want to work with companies that are in the growth mode.
Until recently, working with a factor was thought to be a sign that the company was hitting rock-bottom due to financial troubles and viewed as the last line in a shaky financial defense for a business. This perception of factoring persisted largely because of the unregulated status of the factoring industry. Now, factors are shaking off that bad reputation because the shady players are being sorted out through a combination of competition and sound operating procedures. Factors watch each other closely and constantly interact, often providing assistance to one another as banks do, which in turn means better service to their clients.
Although account receivable factoring companies take on businesses that are unable to turn to banks, they will not take on every single company that asks for assistance. In order to establish the most effective business relationship with their clients, factors become experts in their clients' business and industry, for example dealing with only medical or only construction receivables.
It is vital that you work with a medical transcription factoring company that has a thorough understanding of you and your business plan. Since most factors are picky about their clientele a smart MTSO should be wary of any factor that gives the impression that they are willing to do business with just about everyone.
It is rather rare to find two different factoring companies that operate exactly alike. Each factor has its own methods for running the business, sorting out credit issues, notifying a client's customers, and verifying that the invoices are real and collectable. Generally, the factor discounts the full face value of an invoice by a certain percentage. Rates are most times determined by the risk and the volume of the invoices. Low volume, measured in dollars per month financed, is usually more expensive. If a client guarantees that it will need factoring for a specific amount of time or money, the rate can also be lowered for the client. Some factors may provide annual APR rates, which are tied to the amount of financing outstanding, while other factors will simply discount invoiced amounts.
There are definitely unique benefits to medical transcription factoring, and even the hardcore skeptics will admit to the benefits. The first of which is equity, which remains unchanged on the company balance sheet even when deals with a factor are struck. As opposed to a conventional bank loan or credit line, the factoring relationship does not appear as a liability on the business' books. Also with a factoring company, it only takes a few days from the time your start the application process to the time you receive capital. For companies battling a cash flow crunch (such as a growing medical transcription service), the immediacy of potential capital is often the dealmaker. High-growth companies benefit from the factor's flexibility. Rather than operating with a fixed line of credit, a factoring firm's credit line can be expected to grow as their clients' billings increase.
The World Wide Web makes it even more convenient for factoring companies to effectively provide account information to their clients. Some factors offer online services that enable their clients to view their key factoring reports over the Internet. With the use of this service, clients are able to check the status of their accounts at any time from any computer that has Internet access. This makes it easier for clients to keep a detailed tracking of their accounts receivable, giving them the freedom to focus their attention on growing their businesses.
Factors that offer an online service must ensure that the factoring reports can only be accessed with the highest level of security, manageability, and privacy for their clients. Factoring companies must also update client reports on a regular basis so that clients are able to view their most recent account data. The online reporting can help factoring companies serve their clients more efficiently by making their financial information conveniently available on a daily basis. This quick and easy access to factoring reports can help answer any questions that clients may have about their accounts receivables.
Just like the MTSO in this article, when an established company experiences cash flow problems due to some new, large accounts, medical transcription accounts receivable factoring can be the best solution to solve their problems. Rather than going through a total re-application of its bank line, the company can use a factor for short-term working capital until the new accounts become self-financing. The company may be surprised at how quick and painless the whole process can be by using a factor.
The flexibility that a factor can offer is one of the highest regarded aspects of the factoring business. Compared with the usually rigid practices of both your neighborhood and downtown bank, a factor can be just the fresh opportunity a medical transcription business needs to boom.

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