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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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 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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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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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 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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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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