Medical Billing Outsourcing » Medical Billing Businesses

Medical billers worried about ICD-10, HITECH Act

admin — Wed, 30 Sep 2009 13:06:05 +0000

By Anne Zieger

Want to know what’s on medical billers’ minds? Largely, they’re in a stir over the implementation of ICD-10 5010 and compliance with the new HITECH Act, according to speakers at a national conference for the industry.

Panel members speaking at a session of the National Conference of the Healthcare Billing and Management Association note that while CMS has vowed that it won’t relax its ICD-10 deadline, it still may be virtually impossible for the industry to prepare adequately.

In fact, even the commercial payers aren’t going to convert completely by the deadline, noted Holly Louie, compliance officer at Practice Management, Inc. “They plan to use crosswalks, mapping and internal translation tables for an indefinite period of time,” Louie told Healthcare Finance News. That could be a nightmare for billers, however, as it could make claims processing more complicated, she notes.

Meanwhile, billing companies are struggling with meeting the security requirements imposed by the HITECH Act, she said. Smaller companies are having a hard time finding encryption programs to protect their electronic data, and smaller, rural companies may be at a loss as to how they’ll protect their paper documents. What’s more, there’s the issue of training employees adequately to address security issues. All told, dealing with HITECH will be a huge challenge, she suggests.

Above article published on

http://www.fiercehealthcare.com/story/medical-billers-worried-about-icd-10-hightech-act/2009-09-24#ixzz0SZx70qQo

Health experts urge insurance, pay changes

admin — Fri, 04 Sep 2009 15:54:00 +0000

By Susan Heavey

WASHINGTON (Reuters) – U.S. lawmakers returning next week to work on major healthcare legislation need to focus on insurance market reforms, consumer rebates and other measures that will curb soaring costs over time, economic and health experts said on Tuesday.

The group of academics outlined dozens of changes in their report, from restructuring payments under the Medicare insurance program for the elderly and disabled to providing doctors incentive payments for helping avoid costly treatments or complications.

All of the proposals, some of which are already included in various congressional plans, together will help provide better care for patients while lowering costs over time, said Dr. Mark McClellan, a former economic official under President Bill Clinton and health official under President George W. Bush.

“We turned away from focusing just on short-term, isolated individual measures. While those small things like cutting Medicare prices across the board can have some short-term benefit, we don’t think steps like that are sufficient,” said McClellan, head of the Engelberg Center for Health Care Reform at the Brookings Institution, a Washington think tank that led the group.

Much of the national debate over efforts to reform the U.S. healthcare system and provide more Americans access to health insurance has centered around whether the government should provide its own alternative insurance plan and how much the overhaul will cost.

President Barack Obama, who made reform efforts a cornerstone of his campaign, has said he wants to pass a plan this year.

STRUCTURAL CHANGES

With congressional Democrats and Obama set to renew their pitch, the group said lawmakers need to ensure that final legislation includes various steps aimed at structural changes and payment incentives to reduce costs even decades from now.

While some of the group’s proposals are not new — such as promoting electronic health records and research that compares rival treatments — they join a chorus of other recent reports and comments that could help focus the debate.

“We believe that legislation needs to support a set of individual changes to help us get there,” McClellan told reporters in a conference call to discuss the report.

Among the recommendations are insurance industry changes that would make it easier to pool consumers who do not get health coverage from their employers, according to the group’s members, who hail from Harvard University and the University of California as well as other universities and think tanks.

Limits to employer tax breaks for insurance as well as a bidding process for private Medicare plans would also help foster insurance competition and lower costs, they said.

Robert Zirkelbach, spokesman for the industry group America’s Health Insurance Plans, declined to comment on the recommendations but said the group supports efforts aimed at containing costs and making insurance more affordable. The group represents Cigna Corp, UnitedHealth Group Inc and Aetna Inc, among others.

McClellan’s group also said payment changes are needed for doctors and other healthcare providers such as lump-sum, or “bundled,” payments for a treatment that would discourage costly mistakes rather than payments for each service.

Consumers, too, need added incentives to stay healthy such as rebates on their insurance premiums for meeting certain health goals or reducing their risk for disease by quitting smoking or other steps, it added.

Above article published on http://www.reuters.com/article/gc07/idUSTRE5805Z420090901?pageNumber=2&virtualBrandChannel=0

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

The Benefits of Outsourcing Medical Billing

admin — Thu, 23 Apr 2009 10:19:26 +0000

Outsourcing medical billing tasks is a crucial decision as this would greatly impact the way medical billing companies and physician offices operate.

For the past couple of years, difficulties were encountered by companies during their attempt to outsource their medical billing services. These challenges, from security issues to quality problems, have left some companies skeptical.

But despite all of these, the fact that more and more companies now outsource their medical billing tasks cannot be ignored. Companies are now tapping the numerous benefits of outsourcing through their partnership with the right outsourcing providers.

This strategic move empowered companies!

Outsourcing medical billing tasks provided companies access to highly-skilled resources and world-class technology. To add, significant cost reduction of 30-50% made companies embrace this move even more.

The headaches of medical billing such as the ever changing insurance guidelines, state laws, annual updates on ICD and CPT codes, denied, pended and unpaid claims, are taken out of the companies’ hands and minds. Submitting claims in a timely and accurate manner as well as making sure that optimum reimbursements are received are now the responsibilities of the outsourcing partner.

The above benefits helped physicians focus more on their core business which is providing care to their patients. Outsourcing also enabled medical billing companies possess the capability of investing on other areas such as business development and security improvement. And because of the improved capabilities of physician offices and medical billing companies, their quality of service is greatly enhanced as well.

It is true that difficulties were encountered by physician offices and medical billing companies from outsourcing their medical billing tasks but the significant and numerous benefits they obtained from this move, helped these companies realize and recognize that this is an effective and efficient strategic tool that has a positive impact on their overall success.

Above article published on: http://outsourcinginsider.blogspot.com/2008/07/benefits-of-outsourcing-medical-billing.html

Medical Billing Services: Choose the Type That’s Right for Your Practice

admin — Wed, 22 Apr 2009 15:12:18 +0000

Medical billing service providers come in many different shapes and sizes. At one end of the spectrum are large Practice Management Companies, with an extensive network of support but sometimes rigid and expensive. At the other end are small, home-based businesses. With more and more programs offered through local colleges, mail order and online, home-based businesses are popping up everywhere. Somewhere in the middle of these two extremes is what we’ll refer to as Professional Medical Billing Services. When considering your options, it is important to understand what each type of medical billing service provider has to offer and which is best for you. This article discusses these common types of medical billing service providers and some of the services they offer.

Home-Based Medical Billing Businesses vary significantly from one to the next in experience, ability and services offered. Many are small start up businesses with only one or two employees. Some offer extensive experience from previous employment in a doctor’s office, others may have only one or two clients. While these service providers can offer the highest levels of customization, a small, home-based business can sometimes run short of management knowledge and business acumen to be there for the long term. And what happens to practice cash flow when the solo biller decides to take vacation? Most provide the core services of medical billing (discussed later) and many have other personal experience to offer ancillary services.

Practice Management Companies are typically larger firms that may have 100 or more employees. Most true practice management companies take a holistic approach to supporting your practice, in that they seek to handle all facets of managing the business- including medical billing, marketing, staffing, and even patient scheduling. Although some providers might be excited about the opportunity of having a practice management firm take all the “trouble” off their hands, others find it stifling to have someone else running their business. While their offering can be comprehensive, those providers interested in working with a practice management company should read service agreements and contracts carefully to make sure they know exactly how their practices will be “managed.”

Professional Medical Billing Services fall in between the extremes of home-based medical billing businesses and the practice management companies, leveraging the strengths of both and eliminating the weaknesses. With a few dozen employees, Professional Medical Billing Services can offer greater flexibility than a practice management company, but more structure than the home-based service. Clients often find medical billing services have the sustained network of support to eliminate interruptions to cash flow from vacations or unexpected leave time, while simultaneously offering personalized services tailored to meet their needs.

As you consider each type of medical billing company, it’s also important to think about what services you need, which services you can handle in-house, and what expectations you have your medical billing professional. Each of the types mentioned above should be able to offer the following standard services; though service delivery, flexibility and customization can vary widely.

Standard Medical Billing Services

Standard services offered by medical billing companies are generally similar across the range of companies discussed above. There will be variations in the level at which those services are provided. Again, experience and size play a key role in defining where the variations might be. Regardless, the following list identifies the most basic services provided by any well organized medical billing company.

Claim Generation and Submission Claim generation includes entry of patient demographic, insurance and encounter information into medical billing software. Claim submission is the process of sending that data to the carrier, either electronically through a clearinghouse, or via paper submission in the mail. With electronic medical billing, services should apply one or more “scrubbers” to the claims (and manual quality checks to paper claims). Scrubbers are quality assurance checks of diagnosis and procedural codes for errors or mismatches typically integrated into premium medical billing software programs.

Carrier Follow Up Carrier follow-up is an integral part of the medical billing industry- arguably the most important aspect. The quality of a medical billing service is often defined by the level of follow up they apply to claims and will have an enormous effect on reimbursements. Through follow up, medical billing companies are able to isolate those claims that may go unpaid, or partially paid, and work with the provider and carrier to make sure edits and resubmission (if necessary) are clean.

Secondary, Tertiary and Workers’ Comp Claims These special claims usually require special consideration and handling as they often entail additional documentation. Service providers can sometimes get bogged down in the details required for these unique claims if not experienced and prepared.

Practice Reporting and Analysis Reports can be generated through almost any medical billing software, but how often and with what depth will your medical billing service provide these reports? Reports provide critical information about avenues for practice improvement such as directions for growth, cost savings and ways to increase profitability. The importance of reporting cannot be overstated for monitoring the health of the practice. Reports should be provided at least monthly, and experienced medical billing service providers should be able to make recommendations on how the practice can enhance profitability.

Patient Invoicing and Support Patient invoicing is a very detail-oriented process, but if done properly it can significantly enhance practice revenue. Nonetheless, balancing accounts, printing statements, stuffing envelops and applying postage can be very time consuming. And once patient statements are sent, someone will inevitably have a question about their bill. A good medical billing company has the infrastructure to support patient inquiries with customer oriented approach showing they understand their conduct is a reflection of your practice.

Other Services

As most medical billing services are well experienced in the inter-workings of a medical office, other services that may be offered. Some lateral practice services might include the following.

Credentialing Credentialing may be of particular importance to new practices. This process of “signing up” with carriers for the first time can be tedious and overwhelming, especially when just starting out. Credentialing services are also an asset to established practices as another way of growing into new business. Many medical billing companies bring the experience of working with carriers to help make your credentialing painless.

Medical Coding A natural extension of the medical billing service is medical coding. Coding is really the first step of the billing process, preparing the diagnosis and procedural information for entry into the medical billing software.

Transcription With wide experience in the medical practice support field, it is natural for many established medical billing companies to broaden their offering to include transcription services. The familiarity with HIPAA requirements and in-depth knowledge of the insurance industry support this natural addition to practice support services.

HIPAA Compliance The detailed requirements of HIPAA are not limited to healthcare practices, they extend to anyone handling patient information. Medical billing services well versed in the responsibilities outlined by HIPAA often develop programs to assist their clients in maintaining compliance.

Summary

Partnership with the right medical billing service is vital to your practice’s success. Just as with finding a good accountant or lawyer to support your practice’s needs, it is imperative you are comfortable with your medical billing service provider- they are the key to your revenue flow. There are many different types of medical billing service providers to choose from, each with its own set of pros and cons. The key is deciding what type of medical billing service provider you are most comfortable with and growing an open working relationship that will help you reach prosperity.

Above article published on http://www.buzzle.com/editorials/11-14-2005-81365.asp