Medical Billing Outsourcing » Electronic Medical Billing

Medical Billing – Electronic Or Paper Claims

admin — Mon, 19 Apr 2010 16:10:00 +0000

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?

admin — Tue, 13 Apr 2010 13:55:48 +0000

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/

5 tips to help you save on health care

admin — Wed, 02 Sep 2009 10:27:45 +0000

By AMY HAMILTON

Being a savvy health care consumer has never been more important. With some people finding health care costs soaring as benefits dwindle, it pays to know how to make your coverage work for you.

Know before you go

It’s not enough to ask if a health care agency takes your health insurance. Your health care professional should be contracted with your insurance network. If you’re operating under a Preferred Provider Organization, or PPO, using a health care professional not on the list is going to cost a lot more of out-of-pocket dollars.

“You need to be very careful and definitely when you call to talk to a doctor ask if they are contracted with your insurance,” said Becky Weaver, office manager of Grand Junction dentist Scott N. Vandusen.

In general, Weaver said, clients are learning to check online or call their insurance companies before scheduling appointments.

However, health care professionals can move in and out of networks. If a health care provider moves out of your network, you’ll need to change medical providers or face paying more for the same services, Weaver said.

“People couldn’t understand why they kept having to pay so much even though they were insured,” she said about the misconception.

Save ER for emergencies

You should always go to a hospital’s emergency room during life-threatening situations; for example, if you believe you’re having a heart attack, experiencing a loss of consciousness, losing large amounts of blood, having seizures or convulsions, or experiencing numbness and paralysis, among numerous other serious conditions. However, not all afflictions require an emergency room visit, which can result in bills that are estimated to cost at least three times that of a primary care doctor’s visit.

“Sometimes you do need to go to the emergency room. In many instances, reasons for you to go to the emergency room could be handled at primary care,” said Kayla Arnesen, marketing director for Rocky Mountain Health Plans. “We have after-hours clinics that are very accommodating.”

Four urgent care facilities listed in Mesa County are: Med-X Urgent Care, 1060 North Ave. Suite N; Docs on Call, 3150 N. 12th St.; Family Health West Urgent Care-After Hours, 551 Kokopelli Blvd., Suite G, Fruita; and UCC of Montrose and Grand Junction, 517 N. First St.

Arnesen said it’s always a good idea to call your primary care doctor first unless your condition is so severe you cannot call.

Pediatricians, for example, typically have someone on call who can answer questions and potentially could save a costly trip to the emergency room. Arnesen called her pediatrician at 2 a.m. for advice when her child had a fever. She was advised to buy an over-the-counter drug.

“A $4 bottle of Benadryl solved the problem,” she said.

Focus on prevention

Many health care policies offer free or reduced-cost preventive services such immunizations, dental cleanings, eye exams and routine screenings such as prostate exams, mammograms, Pap smears, physicals and services for children. But don’t forget periodic screens for blood pressure, blood sugar and cholesterol, as well as testing for colon cancer and HIV.

However, if symptoms arise, it’s best not to try to ride out an illness in the hopes it will disappear, according to Dr. Dale Kliner of the Colorado Urgent Care Association. Waiting to seek treatment can sometimes result in worsening conditions that may require further medical care.

“More patients are being diagnosed with pneumonia after suffering minor conditions such as a cough, indicating that some patients are waiting to seek treatment, when their best interest is to act immediately,” Kliner said in a news release.

Go generic

The first question to ask your doctor after being prescribed a drug is whether it’s available in a generic form.

For customers of Rocky Mountain Health Plans, which make up 60 percent of Mesa County residents, getting a generic prescription can be a cost savings of 50 percent to 80 percent off name-brand drugs, said Kayla Arnesen, marketing director for the insurance company. Arnesen advised that patients first ask their physicians to prescribe a generic form of a drug, which may be easier than attempting to buy a prescription in its generic form once you get to the pharmacy.

“It’s a common misconception,” she said. “If generic drugs are available, they are just as safe as the brand name.”

Check your bills

Any number of mistakes on your medical billing could change the amount paid by your insurer or cause an insurer to reject the claim.

Be sure to check bills carefully for items such as correct account numbers, services administered and that the services were billed to the correct insurance company. Study your benefits booklet to be certain of your coverage.

If you locate a billing mistake, send a certified letter to your insurer and follow up in few weeks to check if it was corrected.

Don’t hesitate to call your doctor or insurance company if you have questions on a bill.

If your insurance company won’t pay for a service you feel is necessary, dispute it.

Above article published on http://www.gjsentinel.com/hp/content/features/stories/2009/09/01/090109_9a_Health_Five_things.html

Electronic Medical Billing

admin — Mon, 13 Jul 2009 13:52:22 +0000

By the editors of BuyerZone

Software to help medical practices manage their finances has been around for decades. However, today’s electronic chiropractic billing programs are more accurately called chiropractic practice management software and bears only the most basic resemblance to its older counterparts.

Electronic medical billing software covers a wide range of functions including:

Tracking patient demographics, visits, and diagnoses;
Collecting, transmitting, and tracking billing information and insurance payments;
Managing appointment scheduling; and
Generating a variety of reports.

In addition, most billing programs will also bring you into compliance with the sections of the Health Insurance Portability and Accountability Act (HIPAA) that specify increased security standards, ANSI billing formats, and more. Note that we say “most” – some software may provide only partial HIPAA compliance. You should quiz vendors carefully about the HIPAA compliance of any software you are evaluating, particularly around electronic billing and security measures.

Wide-ranging benefits

Besides HIPAA compliance, there are several other important benefits to be gained from the right electronic billing software:

Improved staff productivity – easy-to-use software improves efficiency.
Increased patient and customer satisfaction – more flexibility in scheduling and better access to personal information.
Faster payment from insurers – paper claims usually take 30-60 days, electronic claims are usually paid in 10-14 days.
Fewer errors in billing and insurance.

How to investigate an electronic medical billing program

First, make sure you include the right people in the purchasing process. Physicians, office managers, receptionists, and billing managers will all have different viewpoints and important concerns: taking any major steps towards a purchasing decision without involving every role is likely to lead to problems down the line.

Next, see what practices similar to yours are choosing. Find offices similar to yours in size and specialty and visit their offices to see the software in action. While this may seem like an obvious tactic, it is highly effective.

Try to find software that matches your specialty and office size by asking these types of questions, as they apply to you:

Does the system handle scheduling quirks unique to your practice?
Does the system recognize all procedures and diagnosis codes your practice uses?
Can the system handle multiple offices and multiple doctors?
Can information be accessed from multiple locations?
Does it include inventory tracking or the ability to manage several separate accounts?

Of course, the best way to compare ease-of-use is to try it yourself. Many vendors allow you to log in to a sample account or will send you a sample CD to let you try out the software: take advantage of these opportunities. Have all the interested parties from your practice go through their most common activities to get a sense of how easy the software is to use – watching “canned” demos does not give you the same in-depth look at the products.

How to choose the right supplier

A successful medical billing software decision includes not only choosing the right software – but choosing the right supplier. Qualified suppliers will listen to your needs during the sales process, help your office run smoothly during and after the transition, and provide the training and support you require.

Above article published on

http://www.chiroeco.com/chiropractic/news/4423/675/Electronic-Medical-Billing/

What Are The Benefits Of Outsource Medical Coding?

admin — Thu, 09 Jul 2009 13:31:47 +0000

Most of the time Claim get decline because of improper medical coding done by medical coders. Without proper medical coding, it is very hard to get claim reimbursement easily. Medical coding is a process of giving special code to verbal description of disease, injuries and procedures. Insurance coding is one of the synonyms.

What are the Benefits of Outsource Medical Coding?

Cost Benefit: By outsourcing, you always gain cost benefits. You don’t have to spend on infrastructure, hiring people and purchase of latest technological equipment, if you go with outsourcing of medical coding. This will decrease your cost up to 60%. You can spend this savings to upgrade your main business.

Better Accuracy: Accuracy does matter for acceptance of reimbursement claim. Medical coding must be accurate to get clear idea about the process, tests done by patient. If it is not clear to the insurance company, there is always denial from them. So better accuracy will increase acceptance chances of your claim. Through outsource medical coding, you can achieve better accuracy.

Certified Coding Specialist: It is very hard to find certified coding specialist. You have to setup full infrastructure with enough equipment before hiring any coding professional. If you want to hire experienced certified coder, it will cost you a lot. It is wise decision that outsourcing of coding work and gets benefit of certified coding specialists at low cost.

Quality Audit: This feature makes your medical coding more accurate. Quality audit will increase the accuracy of coding. Through this type of services you get more accurate and speedy coding services. Your chance of getting compensation from insurance is near to 100%.

More Clean Claims: With the help of professional coder and quality audit you get cleaner claims. It becomes very easy to get the reimbursement from the insurance company. Through outsource medical coding; you get access of latest technology, trained coders, quality controller and proper environment for coding. All this helps you for clearing the claims cleanly.

Transparent Methodology: Most of the medical coding company offers transparent methodology. This type of services increases the trust of client for particular company. It also increases the reputation in the market.

There is always disadvantage of data theft while outsourcing but you can always come out of that by checking the reputation of firm in the market.

Above article published on

http://www.articledashboard.com/Article/What-are-the-Benefits-of-Outsource-Medical-Coding-/930644

Electronic Medical Billing Save Money by Improving Office Procedures

admin — Mon, 06 Jul 2009 14:56:32 +0000

Electronic medical billing makes life easier and collections more successful in a medical practice. Questions about medical bills can be answered before the bill becomes past due because of quicker response times. Complicated payment procedure for insurance companies will no longer overwhelm a billing office.

The increased productivity in billing can be directly linked to the different kinds of medical billing software. Client server (CS) and application service providers (ASP) make up two types. Management of a client server requires configuration, back up, restoration, and upgrades after it is initially installed. In addition it consists of a central server and terminals linked to a local network. For these reasons client servers are usually more expensive.

Application service providers assure the latest in technology. The central server is located with the vendor, and data is exchanged via the internet. This minimizes time needed for troubleshooting and downtime. Electronic medical billing training can also be conducted online. The vendor is responsible for managing the technology, recovery, restoration, installations, and upgrades.

Post-payment audits by insurance investigators are less frequent with electronic medical billing. Increased cash flows come with more accurate and easy billing. Cost and productivity savings, including fewer clerical errors reduced office workload, and improved coding come with electronic billing. And electronic billing software offers benefits such as compliance requirements, financial and work flow controls, and accurate procedure coding for patients.

Many medical offices choose application service providers instead of local client servers because IT staff and equipment expenses aren’t necessary. Yet further reasons for choosing application service providers are because of greater flexibility. The lack of equipment to install means the system is faster to implement, and the training of necessary personnel can be done online.

Electronic medical billing makes the billing process accurate and less susceptible to penalties. Built-in compliance protection prevents electronic billing software from committing fraudulent billing or coding practices or issuing duplicate bills. Federal and state enforcement agencies have brought legal action against medical billing offices. For this reason the compliance protection feature is crucial in the event that a post-payment audit triggers suspicion and causes a penalty to be accessed. Proper billing procedures and post payment audits are much easier.

Since technology often becomes outdated every three years the replacement costs of a client server needs to be considered. There are tax advantages to purchasing the client server equipment, but these may be offset by the reduced front end cash flow. An application service provider will charge a monthly service fee, but this is small compared to the sizable upfront investment needed to purchase a client server.

Electronic medical billing is a cost effective way to increase cash flow and guarantee billing compliance. Once you have decided on electronic billing, the next step is to choose which methods best suits your office. Both client servers and application service providers are a great way to get electronic billing onto your office

Above article published on

http://ezinearticles.com/?Electronic-Medical-Billing-Save-Money-by-Improving-Office-Procedures&id=2421041

Outsource Medical Billing Services

admin — Mon, 27 Apr 2009 13:06:26 +0000

The process of collecting fees for medical services is called medical billing. The medical bill which is issued by the physician is said to be a claim. Medical billing may be handled directly by the physician and his or her staff, or it may be administered by a third party. The third party is an independent contractor or company that specializes in handling medical billing. Once the patient service is complete, the respective staff begins preparing the claims and send to the physician or to a third party for billing. After accepting the patient’s signature as assignment of benefits, the claims are sent to process to receive the payment directly from the insurance company. This set of process is called medical billing.

Medical billing provides detailed information of Medical Billing, Medical Billing Software, medical billing services and more. Medical billing is affiliated with medical coding certification. Medical Billing services include the customer/physician in its process. Medical billing services saves time, resources and reduces rejected claims. Medical billing services include patient demographic entry, charge entry, claims submission, payment posting and reconciliation. Key benefits of medical billing are improved cash-flow, faster payments, and higher customer satisfaction. The benefits of medical billing outsourcing include less paperwork and lower employee cost, minimized error and faster revenue receives. For minimized error the perfect audition is done by the supervisor. After the approval of supervisor the claims are sent to the process of revenue. One of the major advantage of medical billing outsourcing is it assists the physicians in saving money through payroll generation, equipment reduction, elimination of postage, and with software service support. Outsourcing to a professional billing company frees you from administration problems. One of the important things has to be noted is while choosing the medical billing outsourcing the costs varies directly with the medical billing.

If the medical billing drops, the cost drops. So the usage of medical billing outsourcing is very consistent to change medical billing expenses from a fixed cost to a variable cost and to improve the ability to manage our business. A medical billing firm gives the detailed information that need to successfully negotiate a contract with a malpractice insurance carrier. The benefits of medical billing outsourcing include less paperwork and lower employee cost, minimized error and faster revenue receives. For minimized error the wonderful audition is done by the supervisor. After the sanction of supervisor the claims are sent to the process of revenue. One of the major advantage of medical billing outsourcing is it assists the physicians in saving money through payroll generation, equipment reduction, elimination of postage, and with software service support.

Outsourcing is made in the concern of minoring firm, conserving energy directed at the competencies of a particular business and resources. Most of the U.S. companies are outsourcing information technology and services to offshore locations to reduce costs and take benefits of global skills. Managers want to know which jobs are more conductive to global disaggregation. Outsourcing engages the relocate of the management and day-to-day execution of a complete business role to an external service provider. Outsourcing services in the companies are customer support and call center functions like market research, web development, engineering, ghostwriting, cad drafting, customer service, telemarketing, and content writing.

Above article published on http://www.articleclick.com/Article/outsource-medical-billing-services/1063269