The Commonwealth Fund states that in 2007, 72 million Americans either experienced problems paying medical bills or accrued medical debt. Billing errors are often at the root of this problem, creating medical bills that patients can’t afford. Interpreting a hospital bill can be complicated and reviewing it line-by-line can be time-consuming and overwhelming.

It pays off to be informed. There are medical billers, medical coders, doctors and other health care professionals involved in each hospital stay. Miscommunication on any part can lead to mistakes. What can you do? Start by following these tips:

1. Plan ahead if possible – If your hospital stay is planned, make sure you double check your coverage before your hospital stay. This will enable you to verify the cost of any procedures and the amounts that will be covered.

2. Don’t leave the hospital without an itemized bill – Once you’re discharged, it is harder to obtain, so make sure you have it in your hand before you leave.

3. Keep track of everything – It is important for you to know who is treating you and exactly what they are doing. Make sure you ask questions and take names. Note: if you are unable to keep track of this information, have a spouse, family member or friends do it for you.

4. Don’t immediately pay the bill – Make sure you take the time to carefully go over the bill and understand what the charges are for. Once you pay the bill, it will be harder to re-coup your money if there are mistakes.

5. Make the hospital accountable – Don’t let the hospital ignore the erroneous charges and assure you that your insurance company will pay for it. Mistakes are mistakes and the hospital needs to correct errors.

Source: http://www.medicalbillingcourses.com/blog/2009/10/5-tips-to-stay-on-top-of-your-hospital.html

There is no denying technology from creeping and seeping into our daily lives. Everyday, better and more powerful systems are being put in place to help streamline and automate business processes. Medical practices are no exception. To run a medical practice properly, the right medical billing software has [...]]]> By, Harry T Selent

There is no denying technology from creeping and seeping into our daily lives. Everyday, better and more powerful systems are being put in place to help streamline and automate business processes. Medical practices are no exception. To run a medical practice properly, the right medical billing software has to be installed. Let’s take a closer look at this issue. First, let’s assume that there is no proper billing software in place. What do you think will happen? Of course, there must be some sort of method to help deal with the billing issues. The traditional way, is to do everything manually. Send invoices manually, track payments manually, submit claims manually, and so on. Now this is all fine if the medical practice stays small. But there are other concerns. Sometimes, it is not up to the practice whether to stay small or not.

A medical practice is also a business. And like all businesses, it is not immune to market changes. For example, if the practice runs into cash flow problems, it may go under. This is rare and unlikely, but it does happen. From a purely business point of view, the practice has to grow in order to survive. When similar medical practices start to adopt technological systems to help streamline processes, they are actually reducing their operational costs. In other words, they are able to enjoy better margins.

With better margins, they enjoy more profits, and can afford to invest more money back into improving and growing their practice. Eventually, those who refuse to grow will not be able to compete. It does sound a little bleak for those who have been procrastinating. But it is the truth, and it’s how reality works. Businesses that fail to evolve, improve and grow will be eliminated.

Just take medical billing software as an example. When a medical practice refuses to install a reliable billing system, the business cannot scale. That is mainly because the staff will be too caught up with manual billing processes. If there is any attempt to grow the practice, the current system will eventually collapse under the weight of heightened pressure. And then everything goes back to square one.

The features of medical billing software are important because they help to automate many manual tasks. Thus, the business can scale without having to worry about additional pressure. For example, you can submit claims quicker using the Visual Claim Editor (available for Medical Claim Billing Software). You can also manage and schedule appointments and revenue. Other features include prescription writing, custom report writing, medical and financial alerts, and more. In addition, the software also helps graphical representations of what is happening within the practice. For instance, line, bar, and pie charting is available. Using such graphs, the practice owner can easily spot trends and make better business decisions.

Source: http://www.reducemydebtnow.com/electronic-medical-billing-software-to-help-streamline-the-work-flow-of-medical-offices.html

We recently penned a post, “Should You Outsource Your Medical Billing,” which compared outsourcing the revenue cycle management process to managing that function in-house with medical billing systems. Assuming you go for the former option – outsourcing – this post will help you make the right choice of medical billing service [...]]]> By, Chris Thorman

We recently penned a post, “Should You Outsource Your Medical Billing,” which compared outsourcing the revenue cycle management process to managing that function in-house with medical billing systems. Assuming you go for the former option – outsourcing – this post will help you make the right choice of medical billing service companies.

How can a provider tell the difference between a fly-by-night medical billing company and one to which they can hand overtheir patient’s medical information with confidence? If a physician knows what criteria by which to judge a medical billing service, they’ll be able to select a company that will significantly decrease their time spent on billing issues and increase their time spent on patient care.

To choose correctly, a provider will need to evaluate these five key criteria when choosing a medical billing company:

• Level of service;
• Industry experience;
• Use of technology;
• Pricing model; and,
• Capacity to take on new clients.

What Functions Will a Billing Service Perform?
Before getting into the selection details, let’s quickly review how a billing service fits into the medical billing process. A medical billing company will be able to take over most billing functions in a provider’s office.

To see a substantial benefit, a provider needs to select a medical billing service that performs at least these functions:

1. Claim generation and submission;
2. Carrier follow-up;
3. Payment posting and processing;
4. Patient invoicing and support; and,
5. Collection agency transfer services.

These functions are the “guts” of medical billing. Following up with insurance carriers and pursuing denied claims are two areas where medical billing services typically excel versus a provider’s in-house staff.

Other services that may be offered include credentialing, medical coding, transcription, insurance eligibility verification and appointment scheduling.

Naturally, as the number of services increases, fees will increase. A provider will want to strike the proper balance between cost and service by honestly evaluating their own capacity to perform these functions.

Criteria #1: Level of Service
In addition to the basics of medical billing mentioned above, there are more details a provider will want to be clear on before choosing a medical billing service. Here are some important functions that a provider and billing service should delineate before they enter into a partnership:

It’s important that a provider and a billing service agree on the level of service before they get started. If the right level of service isn’t chosen, a provider won’t reap the full benefits of outsourcing their medical billing.

Criteria #2: Industry Experience
When a provider evaluates a medical billing service’s experience, they need to look beyond the number of years the company has been in business. Experience includes not only time but also familiarity with certain specialities. Billing certification plays a key role here as well.

Billing procedures will vary by medical speciality, so a provider will want to choose a billing service that is familiar with their specialty. Experience with billing to Medicare and Medicaid will be a huge plus, in any speciality.

Choosing a service with staff members that are certified by the American Medical Billing Association (AMBA) is important as well. The AMBA offers a Medical Reimbursement Specialist certification designed to promote professional medical billing.

The certification implies that the recipient is knowledgeable in the areas of:

• ICD9, CPT4 and HCPCS Coding;
• Medical Terminology;
• Insurance claims and billing, appeals and denials, fraud and abuse;
• HIPAA and Office of Inspector General (OIG) Compliance;
• Information and web technology; and,
• Reimbursement.

Even with a certified staff, the proper procedures and technology will need to be employed to maximize benefits of the provider/billing service relationship.

Criteria #3: Use of Technology
Software for medical billing is allowing billing services to accomplish more with less. However, just because a company is using sophisticated billing software doesn’t necessarily mean they’re going to do an efficient job. They need to have the proper procedures in place to take advantage of everything the billing company software offers.

Most importantly when it comes to technology, a provider will want to know about a company’s information sharing, data security, recovery procedures, data backup procedures.

Here are some potential technology issues in those realms that will need to be addressed:

• How will superbills and claims be shared?
• How does billing service fit with the provider’s electronic health record (EHR) strategy?
• Does the service have an integrated EHR?
• How does the service ensure data security?
• What are the disaster recovery procedures?
• Where and how is backup data stored?
• Will a provider need to install and maintain software or access the system online?
• Is the technology HIPAA compliant?

Choosing a medical billing service company that employs technology in a way that effortlessly bridges the gap between provider and biller can mean the difference between profit and loss. By choosing a medical billing service that integrates with a provider’s EHR (or provides their own EHR), that gap can be closed even more.

Criteria #4: Pricing Options
When dealing with practices whose revenue is in the millions of dollars, the cost savings between pricing models can be in the hundreds of thousands of dollars.

There are three pricing options offered by medical billing companies and we’ve broken them down in the table below:

Percentage-based models are most common on the market today. Fee-based models are the next most common option with the hybrid option appearing with less frequency. Many billing companies offer two or three of these options.

Criteria #5: Capacity to Take on New Clients
Finally, a provider will want to get into the nitty gritty of a medical billing company’s performance to evaluate whether the company has the capacity to take them on as a client. Remember, much of the payoff in hiring a billing service comes from the pursuit of denied claims and fee collection. A billing service that doesn’t have the capacity to effectively follow up with outstanding bills will provide minimal benefit.

Determining capacity involves collecting a number of metrics about the company’s performance, including:

• Years in the business;
• Number of employees and reporting structure;
• Number of clients by specialty;
• Gross number of billings; and,
• Number of claims processed annually.

Knowing this information will help a provider determine the level of service a billing company will be able to provide to their practice. Getting even more detailed, a provider will also want to delve into a number of “quality” metrics about billing companies. These include:

• Average number of days in A/R by specialty;
• Coding, submission and follow-up delay metrics;
• By what percentage they’ve been able to increase revenues for existing clients; and,
• By what percentage they’ve been able to reduce payment delays.

How a medical billing service performs on each of these metrics will significantly affect a provider’s bottom line.

Above article publish on http://www.softwareadvice.com/articles/medical/how-to-evaluate-medical-billing-services-1042610/

Sometimes there are things in life that are very obvious. In the medical billing world, this isn’t always the case. Many on the outside would automatically think that electronic billing of claims is the sure pick over sending paper claims via the United States Post Office. And while electronic [...]]]> By: Michael Russell

Sometimes there are things in life that are very obvious. In the medical billing world, this isn’t always the case. Many on the outside would automatically think that electronic billing of claims is the sure pick over sending paper claims via the United States Post Office. And while electronic billing certainly does have its advantages, is it really the be all and end all of medical billing? In this article, we’re going to take a good look at each method of sending claims. Sometimes the grass is greener but sometimes it isn’t.

Let’s take a look at the facts of each type of billing. With paper claims, you have to either manually fill out the claims by hand, especially if you’re a small office and can’t afford expensive software, or at best you need the software to fill out the claims as they are printed off your dot matrix or laser printer. Most software products for this industry don’t support Inkjet printing. For that matter, most carriers won’t accept anything but laser quality anyway.

With paper claims, you also have the wait. Because insurance carriers are desperately trying to move on over to electronic billing, they process paper claims at a snails pace. It could be anywhere from 30 to 60 days to get paid on your paper claim. This is not a maybe. This is indeed a fact. Paper claims get paid slower.

Another fact of paper claims is that they carry the additional cost of having to keep forms in inventory. These forms are not cheap. Even if you get them included in your software package, the cost of billing a paper claim, at least on a per claim basis, is much higher than electronic transmissions.

Another fact of paper claims is that they have to be mailed. This adds the cost of postage to the already high cost of paper claim billing. Plus, with paper claim billing, there is always the chance that a claim can be lost in the mail. While this is not necessarily a given that it will happen, it is a definite possibility.

Now, let’s look at the facts of electronic billing. For starters, electronic medical billing is faster. The claims are literally transmitted to the insurance carrier in a matter of seconds, depending on how big the claim file is. Larger files do take longer, but for the most part, this is a much quicker process.

Electronically billed claims get paid faster. There is no question about this. Insurance carriers do this as an incentive for medical billing agencies to use electronic billing methods.

Electronic billing requires software and transmission hardware such as a modem or an Internet connection. This adds an expense to electronic billing that you don’t have with paper claims. This is a fact. There is no way to send claims electronically without some kind of software and transmission device.

Those are the facts of each. On the surface, it appears that electronic billing is the hands down choice. But before you make that decision, you must realize that unless you have a large enough client base to justify electronic billing, the cost of the software alone might make it unprofitable. Plus, with electronic billing, you’re going to have technical issues that you won’t have with paper claims, meaning you’re going to have to hire a networking staff and other technical persons.

Above article publish on http://www.soe2007.org/medical-billing-electronic-or-paper-claims

This initial pilot is planned to begin in mid-December 2009.

“Utilizing the [...]]]> The Department of Veterans Affairs (VA) and healthcare nonprofit organization Kaiser Permanente recently announced a pilot program designed to exchange EHR information using the Nationwide Health Information Network (NHIN) created by the Department of Health and Human Services (HHS).

This initial pilot is planned to begin in mid-December 2009.

“Utilizing the NHIN’s standards and network will allow organizations like the VA and the Department of Defense (DoD) to partner with private sector healthcare providers to promote care for Veterans,” said VA Secretary Eric K. Shinseki.

Last week, the VA and Oakland, Calif.-based Kaiser Permanente sent a joint invitation letter to veterans in the San Diego area who receive care from both institutions to participate in this pilot program.

The pilot program connects Kaiser Permanente HealthConnect and the VA’s EHR system, VistA.

The program puts the highest priority on patient privacy and data security, and no exchange of information will occur without the explicit permission of the individual patient. Patient information will not be shared without first obtaining their consent.

The VA, DoD and HHS have been working closely to create a system that will modernize the way healthcare is delivered and benefits are administered. DoD will be included in the next phase of the pilot program in early 2010.

Above article published http://www.healthimaging.com/index.php?option=com_articles&view=article&id=19731:va-kaiser-permanente-invite-veterans-to-pilot-program

Collecting medical bills is an onerous task. The billing [...]]]> Outsourced Medical Billing has a remarkable potential to increase your collection rates by forty percent or more. However, how do they do it? Good metrics are the key to effectiveness of a medical billing service. Like any high performing business, they measure their performance with dependable metrics.

Collecting medical bills is an onerous task. The billing rules are extremely complex, terminology difficult and the deadlines very strict. There is no single billing procedure that could be applied throughout the billing process. Additionally, the medical insurance companies are notorious for trying to avoid paying the bills. Due to such complexity, reliable metrics become even more important to optimize the medical bill collections

If you are considering outsourcing your medical claims, carefully evaluate the performance measurement system of the medical billing company, and the process used to respond to any payment issues or holdups that may arise for collecting the bills.

Following are some of the most important performance measurement metrics that an effective medical billing service should track and report to you.

• Gross and Net Collection Ratio

Gross collection ratio is the amount paid to the practice divided by the total charges billed. This does not include any write-offs. This ratio depends on the practice and the payer mix. A higher payer mix consisting of Medicaid and Medicare may result in lower gross collection ratio. It is best to compare this ratio to practices that are similar to yours. Net collections is the ratio of payments to charges after the adjustments due to write offs. For a high performing service, this ratio is typically over 90%.

• Days in Accounts Receivable

Time elapsed between billing and collection is an important metric to evaluate efficiency of a billing service. Number of days it takes to collect a bill depends on the medical specialties but a billing service can affect it by timely follow up with the payer and quick rectification of any issues that may arise.

• Percent of Bills Past Due

It is important to track past due bills. Billing service should report this as number and percent of accounts that are 60, 90, 120 days past due. It should have effective analysis process to troubleshoot the reasons for accounts falling in past due status. A good billing service would constantly improve upon its processes to shrink the accounts getting past due.

• Patient Liability

Percent of Patient Liability is the ratio of patient responsibility to total billed charges. This is roughly equal to the patient deductibles. This metric is important to track the effectiveness of the front office function since the co-pay is generally collected by the doctor’s office before the service is rendered.

• First pass pay rate

This indicates the percentage of filed claims that are paid without any need of follow up. Obviously, higher the percentage, more efficient is the medical billing service. This metric should steadily show improvement. Any dip in first pass pay rate is a red flag and should be properly investigated.

• Denial Rate

Denial rates tell you about the claims that required a follow up during a given period. Billing service should regularly monitor this metric and troubleshoot the causes of denial to keep the denial rate as low as possible.

Medical billing is just too complex, a convoluted process that makes it almost impossible to measure efficiency unless there are good tracking metrics in place. Additionally, it is important to respond quickly to any inefficiency or deterioration in performance. Therefore, in this digital age a monthly paper statement listing the performance metrics is not an acceptable means of reporting. An efficient medical billing service will be able to track these performance metrics via a web portal and promises continuous improvement in performance. Hire an effective and transparent billing service and you would definitely see an improvement in collections. Remember to compare price quote from multiple medical billing companies before selecting the right vendor for your needs.

Above article published on http://www.lifemeanshealth.com/health-articles/medicare/medical-billing-%E2%80%93-do-you-know-the-key-performance-metrics-for-effective-management.html