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

“Utilizing the NHIN’s standards and network will allow [...]]]> 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 them with periodic financial [...]]]> 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/

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

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

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

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

• Gross and Net Collection Ratio

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

• Days in Accounts Receivable

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

• Percent of Bills Past Due

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

• Patient Liability

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

• First pass pay rate

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

• Denial Rate

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

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

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

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 [...]]]> 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

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 [...]]]> 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

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 [...]]]> 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.

For the five annual billing cycles beginning September 2003 and [...]]]> 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/

The state of Minnesota is turning a corner that no other state has dared face in the same way.

A 2007 law takes effect today, requiring “electronic billing of all health care claims.”

The effort to eliminate paperwork, standardize billing terms and reduce errors will save [...]]]> By Jeff Hansel

The state of Minnesota is turning a corner that no other state has dared face in the same way.

A 2007 law takes effect today, requiring “electronic billing of all health care claims.”

The effort to eliminate paperwork, standardize billing terms and reduce errors will save an estimated $60 million per year, said David Haugen, director for the Minnesota Department of Health’s Center for Health Care Purchasing Improvement.

“We think the savings potential has been estimated pretty conservatively,” Haugen said Monday.

Mountains of paperwork pass through the nation’s health care system daily and, often, no two forms include the same definitions for the words written upon them.

Now, Minnesota has defined a standard set of terms that all health providers, including doctors, dentists, chiropractors and hospitals, must use when billing for a health care claim.

“Each year, more than 55 million medical bills, known as health care claims, from these health care providers are processed in Minnesota, resulting in significant transactions costs — and opportunities for savings,” the Minnesota Department of Health said in a statement.

The changes “may be especially challenging” for small health providers, Haugen said. Most offices already have begun implementing the changes.

“I’m sure it’ll save a lot of money and help everybody. Some offices will probably have a little harder time,” said Connie Reinhart, office manager at Amethyst Dental Care in Rochester. Her office has already been using the new system and is putting final touches in place. She has already noticed quicker turnaround on claims, both for patients and for the dental office.

“We do ours through a clearinghouse. You just send it and in seconds they’ve got it,” Reinhart said. She also expects to save postal costs.

It’s about twice as expensive to send paper instead of electronic forms, Haugen said.

“I think there’s growing interest and growing acknowledgment that there’s really some potential for savings,” he said.

What happens if a health provider prefers paper and ignores the law?

Haugen said the statute encourages voluntary compliance but allows fines of up to $25,000 per year. If every state saved as much as Minnesota expects to, more than $3 billion could be saved annually nationwide.

“I think we’re very hopeful that the country as a whole will take a look at Minnesota and expand that dialogue about how we can reduce these health care administrative costs and how we can streamline these health care administrative transactions,” Haugen said.

On Dec. 15, health providers and insurance companies will also have to electronically file “adjustments to or denials of” claims.

Above article published on http://news.postbulletin.com/newsmanager/templates/localnews_story.asp?z=2&a=407954

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?

1. 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.

1. 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.

1. 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.

1. 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%.

1. 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.

1. 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

If [...]]]> You are losing up to ten percent of your collections if payer underpayments are not being aggressively pursued by your outsourced medical billing company. It is simply a minimum requirement of being in business that medical billing services compare your payments to the amounts your payers have agreed to pay you.

If you make the decision to outsource medical billing or are currently outsourcing, then there are a number of critical tasks and process steps that your medical billing service should provide. These include scrubbing claims before they are submitted, systematic follow-up on submitted claims, posting denials, pursuing underpayments, using patient expected payment scores just to name a few.

This article focuses on just one of the key elements you need from your medical billing service: pursuit of underpayments. Pursuit of underpayments starts with a critical step: comparison of EOBs to your contractual allowables (the payment your payers have agreed to make for each CPT code). You cannot count on payment posters to catch underpayments with their naked eye; the comparison must be automated and systematic. It goes without saying that if you do billing in-house the comparison still should be done.

Payers have adopted underpayment techniques that are too difficult for a payment poster to spot on their own. Medical billing companies can design their process to battle payers underpayment techniques because they have an advantage over individual practices – they see EOBs for a given payer across multiple practices and multiple states. The enhanced scope allows medical billing services that pay attention to identify patterns that might be overlooked by individual medical practices.

A disturbing pattern that can regularly be seen by a medical billing company that is paying attention is one where a payer will select a set of procedures and underpay this set of procedures across a large number of providers (often by the same amount). This will continue for about 30 days and then the payer will resume paying the procedures at the correct amount and begin underpaying a whole new selection of procedures.

These underpayments are not huge (5 to 10 percent) but they add up quickly to big dollars for a medical practice. The combination of switching the codes being underpaid from month-to-month and keeping the underpayment amount “under the radar” can make the underpayments difficult for an individual practice to spot.

As you can imagine, these small underpayments switching from CPT to CPT would be difficult for a busy payment poster to notice. They will often spot the large underpayments (which occur with a much lower frequency than the small underpayments), but without automated comparisons the smaller underpayments are typically missed.

What does all of this mean to your top line? A medical insurance billing service that properly implements the pursuit of underpayments can increase your revenue by between 5 and 10 percent – and this is pure profit.

Spotting the underpayment is only part of the battle, of course, the billing service also needs to have a systemic process in place for pursuing the underpayments. It is critical to pursue event the small underpayment amounts. Once a payer sees that their resources are being tied up readjudicating claims because of a $5.00 underpayment, the underpayments will often cease to happen.

Above article published on

http://www.lynchmarketing.com/376/outsourced-medical-billing-must-pursue-underpayments/