This anecdotal frustration is corroborated by a new study published in Health Affairs. Led by [...]]]> “I’m at the office late every night taking care of mindless paperwork, just so the insurance companies can deny payment,” a physician colleague told New York Times columnist Pauline W. Chen, MD, for a piece titled, “Fueling the Anger of Doctors.”

This anecdotal frustration is corroborated by a new study published in Health Affairs. Led by Bonnie Blanchfield of Massachusetts General Hospital, a team of researchers analyzed the billing system of a physician’s group affiliated with a large, urban, academic teaching hospital, and found that 12.6 percent of submitted claims are initially rejected. After considerable staff time and effort, 81 percent of these are eventually paid. In some cases, the researchers report, providers miss a chance to collect billed revenue simply because of the initial rejections.

But the scenario could be turned around significantly, they discovered, by standardizing the Medical Billing system. Specifically, by using a single set of payment rules for multiple payers, a single claim form and standard rules of submission, physicians and staff could spend four and five fewer respective weekly hours on this administrative burden. Moreover, the hypothetical model revealed that such standardization could save U.S. physicians and their practices about $7 billion per year.

“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.”

Source  :   http://www.fiercehealthcare.com/story/streamlined-medical-billing-could-save-big-bucks/2010-04-30

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

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

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

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

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

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

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

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

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

Medical treatment of Business has changed significantly in recent years. It presents many administrative difficulties during the preparation of the insurance policy and procedures dealing with complicated claim forms. To avoid these complications, doctors seek help from outside. Hire and advise their representatives, attend seminars insurance company and provide [...]]]> Author: Pete Noland

Medical treatment of Business has changed significantly in recent years. It presents many administrative difficulties during the preparation of the insurance policy and procedures dealing with complicated claim forms. To avoid these complications, doctors seek help from outside. Hire and advise their representatives, attend seminars insurance company and provide them with periodic financial reports this process is known as medical billing outsourcing.

An efficient and precise medical billing service is of prime importance for the smooth functioning of any medical service provider. A comprehensive medical billing service will in turn secure speedy reimbursements for clients. Medical billing is the process of submitting and following up on claims to insurance companies in order to receive payment. It is useful for medical healthcare providers. Medical billing services also supports on-demand invoicing, batch claims processing and interactive electronic claims Submission and remission.

Medical professionals and medical companies, whether they are Small companies or big organizations, are benefited from medical billing services. This billing can be considered as a communication between Medicare providers and insurance companies.

One can get following benefits by using medical billing services:

Medical Data Entry – patient demographics, details like place date type of service, and referring physician, CPT and ICD Codes, and Modifiers are keyed into the billing system

Medical Claims Billing – electronic and paper

Appeals – make appeals for denials and incorrect payments

Payment Posting and Reconciliation Medical Claims Management Collections Management

Accessibility – 24 hours a day, 7 days a week

Medical billing business involves many other important services such as handling all patient billing inquiries, submitting reports to the doctor, posting payments, mailing patient’s statements and following-up all unpaid insurance claims.

Medical billing services assist physicians in saving money through payroll Generation, equipment reduction, eliminating shipping costs, and support software. Outsourcing to a Professional medical billing company is free from management problems. A number of leading outsourcing medical billing services companies offer medical billing assistance for medical billing needs. The company uses the database free of compensation, and established practice, and other Online.

Above article published on http://articlespile.com/medical-billing-services-how-it-is-useful-to-medical-company/

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 [...]]]> 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

Hernando Today

SPRING HILL – The Spring Hill fire district has collected at least 90 percent of its medical billing nearly every year since 2003 – a double-digit improvement compared to the county’s fire and rescue services.

By TONY HOLT

Hernando Today

SPRING HILL – The Spring Hill fire district has collected at least 90 percent of its medical billing nearly every year since 2003 – a double-digit improvement compared to the county’s fire and rescue services.

For the five annual billing cycles beginning September 2003 and ending September 2008, Spring Hill Fire Rescue collected 90 to 91 percent of its net charges for patients who were transported and-or treated.

On average, the district failed to collect less than $208,500 per year since September 2003, according to records obtained by Hernando Today.

“That’s not too bad. That’s actually a pretty good number,” said Rajeev Rajagopal, co-owner of Managed Outsource Solutions out of Tulsa, Okla. “Whenever you’re dealing with ambulance calls, you have a lot of patients who may not have enough money for medical bills. That definitely falls into play.”

A perfect score is impossible because sometimes the patients are deceased by the time the billing process is filed, said Spring Hill Fire Chief Mike Rampino.

“I’m very happy about it,” the chief said about the numbers from the past six years. “It’s something to be proud of. We’re doing the best we can with what we have, and I’m proud of what they do.”

Hernando County Fire Rescue’s numbers also are considered better than average. For the billing cycle from April 1, 2007, to March 31, 2008, the department collected 80 percent of what it charged. During the same period the following year, the county collected 74 percent, but that number is likely to increase as some patients complete their payment plans, said Hernando County Fire Chief Mike Nickerson.

“Our net collection rate of 75 to 80 percent is consistent with, or higher than, the regional average and is an improvement from the average 70 percent collection rate by our previous billing company, dating back to 2006 and prior,” Nickerson said.

During his presentation with county commissioners last year about medical billing, board members said the county’s collection rate was slightly better than the local hospitals, which were at 75 percent.

The district’s annual average of $208,500 worth of uncollected bills is still too high for Fire Commissioner Rob Giammarco.

“If we have money that’s outstanding, we need to get it,” he said. “We have to cover all the bases … We need to do better, especially in these tough fiscal times.”

Above article published on http://www2.hernandotoday.com/content/2009/aug/06/
ha-spring-hill-collects-more-on-medical-bills-than/

OCALA — For many doctors, the toughest part of the job isn’t the grueling work schedule or the never ending license requirements, it’s the bottom line.

Related Links:

“The hardest part of being a doctor is getting paid,” said Betsy Diago, [...]]]> By Jeff Brooks, Special to Ocala Business Journal

OCALA — For many doctors, the toughest part of the job isn’t the grueling work schedule or the never ending license requirements, it’s the bottom line.

Related Links:

“The hardest part of being a doctor is getting paid,” said Betsy Diago, owner of Ocala-based medical billing company The Claims Doctor Inc.

Health care is America’s fastest growing industry and currently accounts for 16.7 percent of the nation’s gross domestic product. In Florida, health care is a $100-plus billion industry with more than 56,000 licensed physicians statewide. With 78 million baby boomers approaching retirement age and needing increased medical care, doctors will be overloaded with patients, leaving little time to deal with insurance companies, HMOs and billing matters.

That’s one reason why more and more physicians are turning to companies like Diago’s.

“Billing is a full-time business and in many offices the doctors are trying to use somebody to do their billing who also have other duties,” said Diago, who started her business 14 years ago in Tampa before relocating to Ocala. “That’s very difficult for someone to do. It’s an extremely demanding part of a practice.”

Shirley Fernandez, owner of Dimond Billing Service, has been involved in medical billing since 1992. Her business is “booming” because with the current economy doctors are able to cut costs by outsourcing their billing.

“If the doctor doesn’t want to have a staff at the office, if they don’t have the space or don’t want to pay extra staff, they can get a contract for a fee or a percentage,” Fernandez said. “It gives them more time with patients. There’s less people calling into the office getting people distracted with the billing end. They focus on taking care of the patients and don’t have to deal with patients complaining about bills.”

Cyndee Weston, executive director of the American Medical Billing Association, has been seeing steady industry growth since she started the organization 11 years ago. Three years ago she had about 900 members. Today, that number tops 1,200 members.

“There’s always going to be sick people so there’s always going to be a need for claims to be filed,” Weston said. “Every other industry embraces outsourcing the services they’re not good at. Health care providers have been slower to embrace the outsourcing of their billing, but with the downturned economy they’re trying to save money just like everybody else. Billing is costly, especially when claims aren’t paid the first time.”

Dr. Karl Altenburger, a retired Ocala physician and immediate past president of the Florida Medical Association, said physicians are always looking for ways to be more efficient on the business side of the practice, which is one reason the FMA fought for assignment of benefits legislation requiring insurance companies to send payment to physicians rather than patients.

“Insurance companies are always trying to intimidate the doctors,” Altenburger said. “They don’t want to honor an agreement between a patient and a doctor when the patient freely gives assignment to the doctor so they’ll send a check to the patient and some turn it over to the doctor and some don’t. Then you have a collection issue and that takes time, adding to the cost of running your business. You don’t want to do that. You’d rather be spending those resources providing better services.”

Ronald Renuart, an osteopathic physician and first-term member of the Florida House who sits on the Florida House Health Care Services Policy Committee, said the Legislature heard the FMA’s concerns and responded.

“One of the things we did accomplish for physicians was to change the rule on the assignment of benefits,” Renuart said. “Now, if a patient requests his insurance company assign benefits to the doctor, the insurance company will be required to pay the benefits wherever the patient decides.”

Renuart said the current Legislature is “very physician friendly” and would look favorably at any new ideas that would help decrease the burden on physicians to make collections.

“Right now, we’re coming up with ideas for bills for the 2010 session, but I haven’t heard of any new bills being filed to that effect,” Renuart said.

In his practice, Renuart is part of a large group of partners who pay a management fee, covering their billing and collections.

“It takes some of the headache away, but it is costly,” Renuart said. “By having a large group of doctors it keeps our expenses lower. Traditionally, when you left the doctor’s office you’d pay the bill. That’s kind of gone by the wayside because insurance companies pay certain percentages and it’s getting so complicated patients don’t know when they leave how much they owe.”

Folks at the Florida Agency of Health Care Administration understand how confusing and complex billing statements impact physicians and they’ve instituted a proactive, agency-wide program called AHCA-cellerate in an effort to reduce the amount of paperwork and administrative burdens the state places on physicians by utilizing an electronic health records system.

“There is electronic billing available to every physician in Florida,” said Christopher Sullivan, administrator of the office of health information technology for AHCA. “We are working with it on a contract to deliver Medicaid claims data to physicians. It’s a way physicians can get a history on a patient before a patient comes in as well as a medication history. That informs the physician of previous billing and previous procedures which would make a difference, we hope, in the quality of care a physician give a patient.”

Another idea being pushed is a health records system, which would be located in the physician’s office and would allow the physician to computerize all of his or her procedure codes.

“When you have a procedure, they put it in a laptop and it gets collated by the central server,” Sullivan said. “It not only assembles all the billing it determines the most appropriate procedures to bill for. Then it rolls it into a bill the physician can submit. It makes it easier to bill and maximize his work.”

Currently, Sullivan said, 35 percent of Florida physicians have electronic health records systems. Under the economic stimulus bill, physicians who see a lot of Medicaid patients will receive up to $25,000 to purchase a system and hospitals get a 100 percent reimbursement. They’ll also receive incentive payments to use the system.

“It will cut a lot of staff time,” Sullivan said. “It translates into lower health care costs and better health care.”

According to Robert Mills, a spokesperson for the American Medical Association, there is a great deal of non-standarized practices in medical billing and some health care plans are taking action so payment policies are more transparent. One thing being discussed is real-time claims, in which patients swipe cards and the physician can tell them up front what their payment obligations are and they can pay the bill before leaving the office.

Tom Menichino, chief executive officer of Family Doctors of Belleview, recently started using a similar system.

“We signed up with a company that allows us to do away with the actual credit card machine,” Menichino said. “Now, it’s all done at the computer where the checkout person is working. When the patient is ready to check out, we can get online and it will tell us this patient is a co-pay patient that owes us $25.00 or the patient has a deductible and they haven’t met their deductible. More importantly, it a patient has difficulty paying the whole account it will set up a schedule on how to debit their account.”

Menichino said because of their size, they do most billing in-house because they are familiar with the accounts, which helps them stay on top of things. He said that might not be the case for smaller practices.

“We can afford the overhead to do that as opposed to a solo doctor,” Menichino said. “They might not be in a position to spend resources to go after open accounts. Some small practices have outsourced to some of these billing companies. There are some pros to using some of these companies. The cons are you’re not in control so you have to work closely with those companies and be sure that they’re following your policies.”

As health care grows, many see medical billing keeping pace.

“I think it will definitely continue to grow,” Diago said. “For the individual practitioner especially, it makes a lot more sense to be able to have a professional that you know knows what they’re doing.”

In an industry where certification isn’t required and self-regulation is the norm, there is one aspect creating apprehension for Diago and others in medical billing: government regulation.

“As we see the changes that are going to be coming with regard to health care there will probably be more and more regulation.” Diago said. “I don’t agree with the proposals on the table right now, but I do recognize that one of the things the government seems to be intent on right now is more government control and regulation. I don’t think it’s necessarily a good thing. I think it’s important from a standpoint of doing things the right way, preventing fraud. As far as having more of the government in everybody’s pocket, it’s not a good thing.”

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Above article published on http://www.ocala.com/article/20090528/OBIZ/905289965/1357/obiz?Title=With-doctors-workloads-increasing-medical-billing-becomes-growth-industry