Medical Billing Outsourcing

Outsource Your Medical Billing with Care

Whenever a health care provider or a hospital plans to have a full fledged medical billing department with billing clerks, it is very essential to think twice and make sure to choose well experienced billing staff. Today fortunately, outsourcing the entire medical billing process is a cheaper option that is available.

Quite often there have been instances when the in-house billing staff does not have the sufficient experience and does not possess the sufficient in-depth knowledge about coding. This will result in loss because claims cannot be made properly and may require rebilling. Moreover, instances of many scandals in this area of health sector have been rampant. Considering the various risks it is a must to outsource the medical billing to a trustworthy and reliable professional billing company.

Before signing a contract for outsourcing of medical billing with a company a proper enquiry about the company and its history is essential. Also checkout the following information from the outsourcing company and see how good they are.

Do they provide reports?

What is their collection rate?

What is their specialty?

Do they use a HIPAA-compliant format?

Are they well staffed?

Do they code also? (not preferred)

What percentages are accounts receivable?

Do they follow up on delayed /denied claims?

Have they had face to face meetings with clients?

Encounter forms are usually completed and sent to the billing company along with the insurance card, registration cards on a weekly or daily basis. Most of the medical billing companies have medical billing software to prepare the bill and then submit it for claims. Bills to Medicare and other bigger insurance companies are generally sent via a clearing house. Many companies use doctors to scan the encounter forms.

How much does medical billing service cost for a physician? Billing companies charge doctors a percentage of what they collect and the rate depends on the doctor’s specialty. Specialists are charged lesser than the primary doctors because specialists mean lesser claim and bigger amount.

Above article publish on http://maryanngarth.easyworldwidemall.com/2010/05/15/outsource-your-medical-billing-with-care/

Physician Billing Companies — the Best Option for Your Physician Practice

Deciding to incorporate medical financial services into your health practice’s workings isn’t a small action to take. It is a significant subject, considering that it comprises an extensive list of benefits, many of which will help your business to run better and increase your profit margin. Cut down on those worries and pressures and automatically ensure that your physician practice is meeting all of the government’s rules. If you’re still not convinced, let us tell you why you should utilize a reputable finance management company. The key advantage of working with this sort of service is the serious amount of time it will save you. Just think of all the time spent, every single week — consider the tracking, invoicing and handling and all of the related jobs that feature in a medical clinic’s organization. Sometimes it slows down the care of patients. Handing such responsibilities over to an experienced finance management service allows them to take care of all these concerns, not to mention several additional matters. For instance, data storage, collection and delivery services and copying. The provider’s duties may also go as far as setting up payment programs, or possibly handling compensation for workers. By choosing to hand off these requirements, you will allow your staff to focus on their key objective — taking care of clients in the most effective and efficient manner. All this could save you expense and take all that worry about those jobs off your mind. Medical professionals have better things to be concerned about and we should not require them to know about complex developments in billing industry regulations. Professional medical billing services will concentrate entirely on these specialist areas. They are the best people to consult with on concerns about any and all rules, technologies and procedures governing established medical financial matters. In addition to saving money, time and effort, it’ll reduce almost any risk of you confronting legal problems.

It is really essential to pay attention to detail when it comes to finance management work, and when you commission a professional company, you will benefit from peace of mind, knowing that measures are established to catch and resolve any unfortunate mistakes just as they occur. Commissioning dedicated businesses such as these is an intelligent financial investment for medical professionals such as doctors, dentists and GPs, and facilities like health centers and clinics. Although, just make sure you don’t make issues such as costing and size the main aspect of your choice — make sure you hire a business which can provide the best results for your billing requirements.

Above article publish on http://talentagency411.com/archives/2010/05/12/physician-billing-companies-the-best-option-for-your-physician-practice/

How To Evaluate Medical Billing Services

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:

Function	Possible Issues
Pursuing denied claims	Will the service pursue denied claims or will the provider have to? If they do pursue denied claims, a provider will want to know what procedures the company has in place to do so to ensure they aren’t being paid lip-service.
Billing follow up	If a patient doesn’t pay their bill, who follows up? Many medical billing services will correspond with patients regarding billing issues, which for many providers is a necessary function to outsource.
Complying with regulations	By handing over a patient’s medical information to a third-party, a provider becomes responsible for the third-party’s compliance with the Health Insurance Accountability and Portability Act (HIPAA). The billing service must protect patient privacy to the same degree that the provider does.
Reporting and analysis	One of the other benefits of a medical billing service is that they’re going to have business insight that a provider doesn’t. Will the service provide feedback about how to improve the practice? Or just send a one-page financial statement each month?

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:

	Description	Pros	Cons
Percentage-based	The service will charge a percentage of collections or they will charge a percentage of gross claims submitted or total collections.	The success of the billing company is tied to the success of the practice.	Small claims may not be pursued as aggressively due to lower payoff.
Fee-based	With this model, the billing services charges a fixed dollar rate per claim submitted.	This model is potentially more cost effective.	Less incentive for the billing service to follow-up on denied claims.
Hybrid	With this model, the billing service charges on a percentage basis for certain carriers or balances and charges a flat fee for others.	This model is potentially more cost effective.	Less incentive for the service to follow-up on certain claims.

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/

Simpler medical billing saves $7 billion

BOSTON, April 29 (UPI) — Simplifying and standardizing administrative procedures for medical bills could save about $7 billion a year, U.S. researcher’s estimate.

Bonnie B. Blanchfield of Massachusetts General Hospital in Boston and colleagues have created a hypothetical model for medical billing that involves a single set of payment rules for multiple payers, a single claim form and standard rules of submission.

If doctors’ offices used the streamlined medical billing system they would save 4 hours a week of physician time and 5 hours a week of staff time, Blanchfield said.

The researchers analyzed the billing system of a physician’s group affiliated with a large, urban, academic teaching hospital. The researchers found 12.6 percent of submitted claims are initially rejected, but 81 percent are eventually paid — after using considerable staff time.

“The savings from reducing administrative complexity could be translated into decreased costs in general,” the study authors said in a statement. “Mandating a single set of rules, a single claim form, standard rules of submission, and transparent payment adjudication-with corresponding savings to both providers and payers-could provide system wide savings that could translate into better care for Americans.”

The findings are published in the journal Health Affairs.

Above article publish on http://www.upi.com/Health_News/2010/04/29/Simpler-medical-billing-saves-7-billion/UPI-11921272519563/

Using A Medical Billing Software Can Increase Your Revenues Overnight

By Gen Wright

Health facilities are busy places and one error in the request-handling queue can be disastrous for the day’s business. This is when everything goes haywire and nothing quite works out. Clients are screaming about the mismanagement and the staff is trying desperately to fix things and find the missing report. Has this ever happened to you? It happens to database intensive businesses like medical centers time and again. If it hasn’t happened to you, you are still running a risk of this impending disaster happening right in front of you. Taking such avoidable risks are not a good idea. You should upgrade to a good medical billing software and streamline your operations. It makes a lot of business sense to do this. First, you can take care of those screaming patients by eliminating the chances of all such problems happening. You can control the entire process from a central server and everything can be automated. So when a query is sent, the data is retrieved from your central computer and everything goes smoothly. There is no waiting to see if a slot is empty. Cancellations are handled automatically and the person next in line is upgraded to get the appointment. You have no loss of time, money or resources and most importantly, patients are kept happy and satisfied. They keep on coming back to you and your business grows. After installing the medical billing software, you can finally digitize a lot of your data and you can finally get rid of those mountains of paperwork regularly. Not only will it save your tangible operational costs, it will also make your establishment eco-friendly by giving you a smaller carbon footprint. This can easily be another point for marketing your health care facility and it might earn you some good reviews as well. The medical billing software works efficiently and at a very high-speed. So you can speed up the entire operations process, giving your staff and yourself a much needed relief. And still, you will be able to handle more queries per day than ever before. Here is another opportunity to make your business grow. It will allow you to grant your patients a world-class medical service that they deserve and still be able to keep your margins high and thus make the entire establishment more profitable. With medical billing software in place, you can also aim at a strategic downsizing of your establishment. This is because the new-age medical billing software needs fewer operators than your older system. Thus, you can save more costs that way and it will add to your overall revenue. The medical billing software supports full customization and branding of your receipts and slips. You can use the same template as you were using before without any problem whatsoever. You thus get to keep your branding intact and still be able to upgrade to a much more advanced system. So if you own a health care and/or medical facility, what are you waiting for? This is the missing key to your exponential growth and success. Get medical billing software today!

Above article publish on http://customersoftware.mixedhome.com/using-a-medical-billing-software-can-increase-your-revenues-overnight/

Medical Billing – Electronic Or Paper Claims

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

Should You Outsource Your Medical Billing?

One of the many business questions physicians face is whether to outsource their medical billing to third-party medical billing services or do it in-house with medical billing software. Some physicians would assume outsourcing billing to a medical billing service makes the most sense. After all, they’re the experts with the resources to properly process your claims, right? Others might want to maintain control of collections and do it all in-house.

Hold on. Don’t make a decision before thinking it through. Both methods of revenue cycle management have benefits and drawbacks. It’s up to the individual practice to weigh the pros and cons before deciding which approach is best.

Software Advice has broken down in-house billing and outsourced billing in terms of cost and qualitative factors. You’ll need to weigh the differences carefully when assessing the needs of your practice and decide if outsourcing makes sense.

Cost Analysis

Billing staff costs.

IN-HOUSE: This was calculated by adding up the median salary of two medical billing employees ($80,000), healthcare costs for two employees ($9,000), federal and state taxes for two ($12,000), and training costs to keep the employees updated on the latest industry developments ($2,000). Finally, we’ve included $15,000 in ancillary costs for statement paper, office space, office hardware and other miscellaneous costs. OUTSOURCED: We factored in five hours of time per week required to manage tasks related to billing at approximately $15 per hour. Even the best medical billing service will require follow up from a practice about particular issues. That adds up to approximately $4,000 per year in administrative costs.

Software and hardware costs.

IN-HOUSE: We’ve factored in an annual cost of approximately $7,000 for practice management software (~$200 per month, per doctor) and another $500 for computer hardware costs. This does not include the upfront cost of a software system. OUTSOURCED: This reflects the computer and printer the practice would still need to interact with the billing service and print documents.

Direct claim processing costs.

IN-HOUSE: Clearing house fees for a provider submitting 20,000 claims per year would be approximately $300 per month ($100 per physician), or $3,600 annually. OUTSOURCED: A medical billing service usually charges a percentage of the amount collected as their fee. The industry average varies widely by specialty. We’ve used 7% for our primary care practice.

Percentage of billing amount collected.

IN-HOUSE: The percentage of revenue that a practice collects varies widely by specialty as well. Our hypothetical practice collects 60% of what it actually bills. According to industry experts, this describes an in-house billing department that is average at bill collection.

OUTSOURCED: A practice can expect a 5% to 15% increase in the amount they’re able to collect by switching to a billing service. We factored in a 10% increase in the amount of money collected by a billing service as an average between the two.

Our cost comparison favors outsourcing billing, mainly based on the ability of a billing service to collect a higher percentage of the billed amount. Of course, this introduces a BIG IF. That is, outsourcing makes more sense IF the billing service improves collections significantly (i.e. on the order of 10%).

But there are other factors – beyond costs – that a provider must consider in its decision making. Let’s examine the two approaches to compare advantages and disadvantages.

In-House Process

The in-house procedure for processing insurance claims involves a number of steps that are universal to every practice. First, employees enter information into the medical billing software program from a “superbill,” which is gathered during a patient’s visit. The superbill contains particular diagnosis and treatment codes, among other patient information, which the insurance company uses to determine if the claim is legitimate.

Via the practice’s billing software, the provider then submits the claim to a medical billing clearing house, which verifies the claim and sends it to the payer. The clearing house scrubs the claim for the errors (for a fee) before passing it on to the payer. By not submitting claims directly to a payer, the provider saves time, money and lowers rejection rates. The clearing house also has the ability to format and submit claim data en masse in the various insurance company formats.

Once the claim is rejected/accepted by the payer, notification of the claim’s status is sent to the clearinghouse, which updates the provider on the status of a claim. If a claim is rejected, the provider’s staff resubmits the claim once additional information has been gathered. The practice will be charge for each claim submission, even if it’s a correction.

EHR software – especially those EHRs with a integrated practice management system – has the potential to make in-house billing easier for a practice. EHR software, when integrated with a practice management system, will populate both system’s data fields. Diagnosis codes and other information needed for billing doesn’t need to be keyed into another system. This eliminates a second round of data entry. This tighter integration may be one factor that helps keep billing in-house.

Outsourced Process

The process for outsourcing billing is more straightforward for practice staff. Superbills and other documents are scanned and electronically sent or mailed to the medical billing service. The medical billing service takes care of the data entry and claim submission on behalf of the provider. Most billing services charge a percentage of the collected claim amount. The industry average is approximately a 7% charge for processing claims through a medical billing service.

The medical billing service takes care of much of the “dirty work” associated with the billing process. It will also follow up on rejected claims, pursues delinquent accounts, and even send invoices directly to patients. The convenience factor is a major reason that providers choose to outsource.

If a practice is using EHR software, then the process is even easier. Information from a patient’s superbill is stored in the EHR and electronically transmitted to the billing service. This eliminates the need to send paper records to the billing service. And because the EHR software eliminates an extra round of data entry, accuracy is also improved.

One possible issue here is data integration between the EHR software and the billing service. The type of data being exchanged between the provider and the billing service will need to match, or else the data will need to be converted to a different format. Depending on the billing service, data conversion may be an option.

Should You Outsource Your Billing?

Besides costs, there are other factors that would spur a provider to consider outsourcing their billing.

Your billing process is inefficient. If you’ve been watching your collections drop while the time to collect increases, you may have issues in your billing department. Outsourcing to a third-party billing service typically decreases the number of rejected claims and decreases the time it takes to receive payment from a payer.
You have high staff turnover. Turnover is an issue in any industry but turnover in a provider’s billing department is especially damaging. Claim processing is the economic life blood of a practice and a new addition or replacement in the billing department will inevitably lead to slowdown in the processing of claims.
You’re not tech savvy. Keeping your billing in-house will require an investment in practice management software. Add in training for your staff and the significance of this investment becomes clearer. If you don’t want to deal with software upgrades and occasional technical issues, outsourcing is probably a good choice.
You’re a new provider. New providers have plenty to learn and worry about aside from their billing. Outsourcing their billing right off the bat can give them much needed relief from the day-to-day stress of launching a new practice, without a trial by fire in hiring, training and managing employees.
You have different priorities. Many doctors are not strong on the business side of running a practice. They became doctors to help patients – not worry about the administrative/clerical side of the business. Outsourcing the billing process eliminates the hassle and frees doctors to concentrate on patients.

It’s important to note that a medical billing service isn’t a silver bullet for in-house billing issues. Billing services can vary widely in their efficiency and accuracy when processing claims. If a provider chooses a billing service that is lax and prone to errors, the headaches surrounding billing issues won’t get better – they’ll get worse.

Which Approach Should I Choose?

It’s important for a practice to factor in their individual costs and preferences when deciding whether or not to outsource their medical billing. In an apples-to-apples comparison, we found that outsourcing had the higher net income. However, cost isn’t the only issue practices should consider. There are plenty of other factors involved in this business decision that may be as – if not more – important than costs.

Above article publish on http://www.softwareadvice.com/articles/medical/medical-best-practices-advice/when-should-you-outsource-your-medical-billing-1032610/

Something for everyone to take note of: Medical Billing Companies

Thinking about integrating physician financial services into your future plans for your physician clinic isn’t a minor action to take. It’s a significant subject, covering an extensive list of benefits, all of which facilitate the effective running of your business whilst maximizing your profits. Cut down on those worries and pressures and ensure that you meet with each legal regulation. If you’re not already sure, let us tell you why you should make use of one of these billing services.

The key advantage of utilizing such a business is the serious amount of time it will save you. Just think of the hours spent, every week – consider the tracking, handling and invoicing and all those related chores which make up a medical center’s administration. Sometimes it even detracts from the care of clients. Working with an expert provider will mean that they take care of all these aspects, in addition to several other issues, for example copying, credit checking and collection and delivery services. Its duties might even include organizing plans for payments, or even processing compensation for workers.

Redeploying these tasks will give your medical staff the time to concentrate on what’s important – caring for clients in the most effective and efficient manner. It will cut back your costs and help stop you stressing out over those jobs. Don’t all clinic staff have more important things to be concerned about than billing industry methods? Professional medical billing services will concentrate totally on this special matter. They are experts in such rules, technologies and procedures involved with established medical billing processes. Not only will this save time, money and effort, it will rule out the likelihood of your health clinic confronting judicial issues. Accuracy is really important in billing services. However, when you work with expert help, you can relax, safe in the knowledge that standards are established to catch and resolve the infrequent unfortunate mistakes immediately.

Making use of specialist a specialist service like this is an intelligent financial investment for medical professionals such as GPs, physiotherapists and doctors, and services including health centers and infirmaries. However, concerns such as size and costing should not completely govern your choice from the various companies available – ensure that you search for the best company for your physician practice.

Above article publish on http://fitnessinfos.net/archives/2010/03/28/something-for-everyone-to-take-note-of-medical-billing-companies/

10 Ways to Improve Your Healthcare Practice’s A/R

Receiving maximum reimbursement with quick A/R turnaround in any healthcare practice requires careful attention to obtaining, documenting and communicating information. From the time a patient schedules a visit until the charge is closed out, proper management of information to and from your billing representative means the different between fast reimbursement cycles and slow, drawn out A/R. Information about insurance coverage, demographics, diagnosis and status of claims – coming from virtually all areas of your practice – should flow clearly and efficiently to support clean claim submission the first time around. Here are 10 opportunities in the lifecycle of a patient encounter where efficient management of information will improve A/R.

Initial Patient Contact – Front office staff or the patient scheduler should capture ALL pertinent information when a patient calls to schedule an appointment. Capturing general information like name, phone number and reason for appointment is a good start, but make sure you’re catching payor information as well. Does the patient have insurance? If so, who is the carrier, what’s their plan number? If not insured, are they prepared to pay up front and have they been briefed on your payment terms? Either way, answers to these questions will help in the insurance verification step and/or set proper expectations for payment at the time of service.

Insurance Verification – Either the scheduler or billing representative should use the information from initial patient contact to confirm with carriers BEFORE the office visit. This opportunity offers the chance to confirm enrollment, coverage levels, co-pays/deductibles, etc. Traditional verification of benefits over the phone is effective but time consuming; remember that you can usually save a lot of time using on-line interfaces offered by many carriers today. If the result is “no coverage” for this visit, or the carrier is unable to verify coverage, a follow up call to the patient should yield updated coverage information or at least guarantee everyone is aware of payment responsibilities.

Patient Registration – When the patient arrives at the office, the receptionist or a member of the front desk staff should verify ALL registration forms are accurate and complete. If it’s an existing patient, the receptionist should re-confirm that records are up to date. This step is the key to obtaining/confirming the detailed demographic data required for insurance claim submission – if anything is incorrect or missing, reimbursements can be delayed as much as a month or more. It’s also helpful for front desk staff to reiterate co-pay or self pay obligations at this time to confirm the patient is prepared to remit payment once the visit is complete.

Provide Care & Document Services – While the patient is in the exam room, or immediately following the visit, all diagnosis and care should be clearly documented on encounter forms. Patient forms are then forwarded to the front to cross reference with information gathered during insurance verification in Step 2, and the bill for co-pays and self-pay patients is generated.

Collect Co-payment – All patients should be required to stop by the cashier or reception desk to remit payment for co-pays, self-pay, etc. BEFORE they leave. If preceding steps are completed properly patients will already be aware of obligations, so there shouldn’t be any surprises. A receipt can also be generated now for the billing representative to document exactly how much was remitted by the patient, should any later balance billing be necessary.

Claim Generation, Submission, and Carrier Review – Clean claim submission is not just dependent on the information gained in steps 1 through 5, but also on processes that manage data efficiently. A good practice management or medical billing software will address this need, but remember that you usually get what you pay for – it’s usually best to not cut corners. The alternative to spending thousands on software is teaming with a professional medical billing company for, usually, a nominal percentage of receivables. Either way, if information is missing at initial claim submission, denial can add several weeks to the reimbursement process. If all moves smoothly, reimbursements can be forthcoming in as little as 1-2 weeks!

Insurance Reimbursement Received/Documented – Hopefully, all of the preceding steps have progressed smoothly and a clean claim was submitted. Our next step in managing claim information is proper documentation of reimbursements in the medical billing record. This step can often be simplified through electronic remittance and EOB notifications. If you’re not able to use electronic EOBs, then it becomes critical the billing representative is thorough in manual entry of all EOBs received. Keeping close eye on your EOBs – timing as well as reimbursement rates – can also identify which carriers are paying quicker and which might require a follow up call.

Patient Invoicing – This step is about communication with patients. Just like carriers, providing patients with thorough information will further help to reduce turnaround time and minimize questions. Be clear and note dates of service, insurance payments, fees collected at time of service, and total amount due. These statements should be sent out as soon as an insurance determination is confirmed. Many statistics have shown the sooner an invoice is sent, the more likely, and faster, it will be paid.

Enter Patient Payment – Upon receipt of the patient payment, the billing representative should enter payment information into the billing system and prepare to close out the charge. If payment is not received within a reasonable amount of time (i.e. 30 days), the practice should have clear policies in place for next steps. Small balances of say, under $5, might be taken as a write off; for larger balances a second invoice might be sent or the patient may be sent to a collections agency for further action. Regardless of your policies, don’t delay in taking action. A/R suffers most when these balances go unaddressed, carrying forward month after month.

Close Out Charge – Once final payment has been received, or a determination has been made to write off or send to collections, the billing representative should waste no time in closing out the charge.

These steps can generally be applied similarly with any patient visit in almost any specialty. Whether you have a staff of 20 or just one person, keep these opportunities in mind as you consider ways to improve the flow of information and reduce your practice’s A/R turnaround.

Above article publish on http://medicalpractice.touralive.com/10-ways-to-improve-your-healthcare-practices-ar/

Complete Medical Billing – Stay On Top of Business in Your Medical Practice

Medical billing software has helped decrease the amount of rejected claims due to human error while at the same time given patients…

Medical billing software has helped decrease the amount of rejected claims due to human error while at the same time given patients the assurance that they are not paying more than they need to. It has quickly become the staple to smooth running offices. So, what more could your office need? Staying updated and current in your medical billing software is just as important as maintaining your managerial efficiency. It is well known that wasted time can be murder to a medical practice. One of the surest ways to lose patients is by making them wait too long for an appointment or have overly long waits in your office. Appointment software is the surest way to avoid that. Create templates, easily find and fill open time slots, and keep better track of appointment status. With patient recall and waiting lists, missed appointments can be avoided and cancelled ones can be filled when you stay updated in your complete medical billing software. Don’t keep other patients unnecessarily waiting for a patient who’s not going to show. It is absolutely critical that a health care staff stay on top of every aspect of their practice. Medical billing software not only makes that possible, but more efficient. Insurance companies rely on the competence of your billing. To help them administer the best treatment possible, doctors rely on the accuracy and current status of their patients records. But, more than this, patients are entrusting their lives to your medical efficiency. Patients are assured of the correct treatment their health depends on, in any variable of difficulty, with timely communication and information. It is to be expected that medical billing software must progress along with how quickly technology and the medical world improves their capabilities. In fact, the Health Insurance Portability and Accountability Act, or HIPAA, actually places requirements that mandate many of the new features for medical billing software. Included in upgraded versions, for example, are the new NPI number requirements. It is nearly as important to utilize leading managerial equipment as it is to utilize state-of-the-art medical equipment. Fortunately, there are companies that bundle medical billing software into a complete managerial package that meets a wide range of medical office needs. And even if they don’t have a pre-determined bundle that meets all of your needs, they will tailor one for you that will. Keeping your office on top of the business side of the medical field can make all the difference in the world to the most important people you interact with, your patients.

Above article publish on http://www.reducemydebtnow.com/complete-medical-billing-stay-on-top-of-business-in-your-medical-practice.html