Ransomware Attack: How Can Healthcare Industry be Shielded?


The first known malware extortion attack happened under the name “AIDS Trojan” which was written by Joseph Popp in the year 1989. The malware was pretty much ineffective due to design problems. Encrypted ransomware returned in the year 2013 when a crypto locker used digital currency Bitcoin to extort money from the infected users. According to the estimate around US$27 million was procured from the infected users. The next wave of huge attack came through in May 2017 when WannaCry Ransomware spread through the internet using the exploit vector for the Microsoft system. The attack infected more than 75,000 users in over 99 countries in 20 different languages. WannaCry demanded money in the form of digital bitcoins and for each system $300. The Shadow brokers-makers of WannaCry gave their victims 7-day deadline from the day their computers were infected.  The major infected users are FedEx, Deutsche Bank, many more companies which didn’t come forward in the fear of losing out on clients. The British National Health Service (NHS) was also affected due to ransomware which resulted in at least 16 hospitals to turn away the patients or cancel operations.

Despite Microsoft sending in the patch for the vulnerability a few months ago, the unpatched Windows XP and Server 2003 were the main software’s to be affected by the ransomware worm. It just took one-click of a link in an email to send the whole system to ransom vault.

Healthcare organization are particularly vulnerable to such attacks because of low awareness related to e-mail authentication. It just takes one-click from one of the employees to send the whole system into a loop of vulnerability. We encourage executives to ensure that the organization have proper email authentication. ” according to the CEO of VailMail CEO Alexander Gracia-Tobar

The recent WannaCry attack is an example that shows, how are some of the most important system vulnerable to attacks? We have to learn to lock our front doors for data safety, keep our operating system and anti-virus up-to-date.

Rick Hanson, executive vice president of Skyport Systems, “We have to increase the research and sharing factor of the digital intelligence. Building a shield to protect our most important applications and data. NHS which is dealing with the disastrous attack is now a wake-up call for the government and agencies. Protecting the critical services is important in the healthcare sector.”

Even with all precautions recently 7,000 patients record were comprised of Bronx-Lebanon Hospital Center in New York.  There has been a drastic increase in the breach of patient’s information this year.

Some of the most recent data breaches in the U.S. Healthcare services:-

  1. In March, urology Austin, PLLC had 279,000 patient records compromised during a hacking incident.
  2. In April, Harrisburg Gastroenterology Ltd had a breach of over 93,000 records due to the hacking of network server.
  3. VisionQuest Eyecare in Indiana had almost 85,000 patient data being stolen in the month of March.According to the Ponemon institute data breaches have cost around $6. 2 billion last year. So the threat is realistic and causing severe damage to the healthcare industry.

If you’re a victim of any such attack the Health and Human Services of United States (HHS) recommends that you contact a local FBI office immediately for the assistance. HHS also recommends that organization report the incident to US-CERT and FBI Internet Crime Complaint Center.

How can such threats be avoided?

The most common source of the ransomware is through a malicious file attached to link or attachment. Many hidden extensions that contain executable files or lead you to the malicious website. The best tactics to handle such threats is training your employees about the threat. Tell them to open emails if they are expecting any such emails from a source or from the person they know.  Hacking groups look for a single window into the system without any guard, tell your employees to have patience while opening E-mails from the unknown source.  The security engineers of healthcare industry need to keep updating their system and servers. Various security patches should be applied at data points were the data can be breached. An Anti-virus can come in handy to stop the phishing attack and corruption of the system.

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Urology Billing Surgical Supply: Growth and Market Share

Urology specialty is going under a colossal technology change with induction of robotic functionalities in surgeries to reduce the number of insertions and blood loss.  Now with advancement in the surgery methodology the need for physicians to understand the urology surgical market is imperative. The info-graphics below offers the recent development of different surgical equipment’s

  • Consumable accessories.
  • Guide wires & retrieval devices.
  • Ureteral devices.

Read through the following Infographic To know about the growth of Urology surgical equipment’s


Posted in Infographics, Medical Billing, Physicians/ Doctors, Practice Administration, Practice Management, Revenue Cycle Management (RCM), Urology Billing | Leave a comment

Steps to Follow to Get Reimbursement for Your Practice


Denied insurance claims—the healthcare revenue negating claims. The common occurrence of such denials is too unfortunate for the current scenario of the healthcare and medical billing service.

According to medical insurance experts “In most of the cases, the claims get denied due to the fact that there are simple errors in the coding process, while few errors happen during the time of claim submissions”.

This has resulted in many insurance companies currently denying settling claims during the first submission or a claim is lost during submission.

In such cases the medical billing team has to resubmit the claim or even go through the entire documentation process again looking at different flaws which had escaped their eyes. The revenue management process can be outsourced or have an in-house team of expert coders and billers.

Now getting your claim settled from issuers requires a tedious task of continuous follow-up. As the timeline of the claim settlement increases the hospitals can follow up with the insurance company and even get legal help to settle the claim.

Following are the points to look for before you appeal for your claim settlement

Preparing an appeal

If you are preparing for an appeal create an outline for the argument for which the claim should be honored by the insurer. Read all the policies mentioned in the claim settlement bond. Read the percentage of revenue which will be paid by the insurance company and then by the patient. One of the major reasons for the denials is that the physician’s overcharge than the amount mentioned to settle the claim.

According to billing experts, the insurance companies are very precise when the patient wants to buy the insurance. They only cover certain specific amount to be paid in cases of certain diseases which occur. The doctor’s office and the patient make a mistake of overcharging and claim goes into a cycle of resubmission. Now, this makes the process extremely complex for doctor’s office for settling the claim.

Navigating through the appeals process

One of the major reasons the claims are denied are due to simple fact they should maintain a simple and precise tone which the insurers can understand. Anything which doesn’t comply with our level of settlement we just dump them or provide them with an EOB. We are always processed to find a solution for claim denials.

When you are appealing for a denied claim one thing to keep in mind is to have cool and calm mind, while reading through the EOB. Interpret the words and the meaning behind them in accurate way. It’s important to remain cool and calm with the billing process.

Here are some tips to maximize the chances of billing success.

Stay organized

Keep every scrap of paper related to a patient with you. It’s important when it comes to documentation for medical billing. Whenever insurance companies gets your claims it might conduct a surprise audit of your total claims approved by a federal government. This might even require the documents related to the first appointment date and time. Your every consulting word should be documented by the date and time provided with simple token to help you with simple organization process.


Now this might take time for your revenue team to figure out but each insurance company needs different timeline to settle claim and for each claim different amount of communication. Now most insurance company contact through agents who represent the first line of contact. Usually when the claim is submitted over and over to same insurance company it’s always better that an insurance agent is fixed for you, which will increase your time efficiency.

How can medical billing process be organized and implemented by physician without any out-of-act effort? An outsource team of expert coders and billers will be implementing all the efforts required to get your claims settled. As a physician you only have to provide all the documents related to the patients nursing. A team of revenue managers and AR callers will provide you with end to end revenue management.

Posted in Medical Billing, Medical Coding, Practice Administration, Practice Management, Revenue Cycle Management (RCM), Why Outsource Medical Billing Services | Tagged , , , , , , | Leave a comment

Hospital Revenue: Looming Regulation Changes and Revenue Impact


New Taxation law from the new government looking to solve health care myth–A Looming Change for the healthcare industry.

U.S. healthcare is going under a constant change with regulations and different insurance laws. The different demographics and federal laws have added to the constraints. Still, the hospitals have done well financially in 2016 despite shifting the major volume of the patient to lower paying outpatient, rising operation cost of various specialty and regulatory burdening.

Low tax exemption for the bond costs and rising stock marketing in 2016 has kept the hospital above par for the revenue.   

Local Hospitals have been fighting forever to protect their interest from the payers’ i.e. insurance companies or even from patients who wrongly accused them of overcharging or wrong treatment according to the law. The present uncertainty is still clouding the future endeavors of hospitals.

Trump administration which is trying to push out Affordable Care Act (ACA) also known as Obama care. Last week only U.S. House of Republicans passed a bill that would change the majority of the provisions of 2009 health care law. In the current scenario, senate is still a high hurdle considering the opposition’s for various regulations which will be implemented under the new health care law.

After Trump came into power, the hospital and insurance company executives had strongly recommended to President Trump against changing the ACA 2009 radically. As the Obamacare business model is strongly rooted in the business model of healthcare system since 2010.

Pat McGuire, CFO of seven- hospital St. John Providence Health System in Warren “The biggest fear that we are worried of is the future of Medicaid because whether we have or we don’t have 670,000 people.” The major extent to which Obamacare is changed would have an effect, if totally altered it will have a devastating effect on many in the year 2019.

According to experts in the health care industry, we can say that if Trump totally alters the Obamacare which expands the Medicaid and private insurance coverage for non-profit hospitals this would create a negative impact on the patients of lower and middle level of income.

Here are some business data of hospitals

Beaumont Hospital

Eight hospitals strong Beaumont healthcare system the operating income increased by 43 percent to $200.6 million in the fiscal year 2016 from $140.7 million for the year 2015. For last three years, the operating margin of Beaumont has steadily increased 3.1% in 2014, 3.4% in 2015 and 4.6% in 2016. The net revenue grew by 6.7 percent that is by $ 4.4billion.

McLaren Health care

According to the data released for first six month covering the fiscal year 2016-2017, ending on March 31 had recorded an increase in 3.8 percent increase in profit. McLaren Healthcare a 12 hospital based operating cost to $ 67.8 million from $65.3 million in 2016. McLarens operating margin did rise to 3.6 percent from 1.8 percent in the half year period.

St. John Providence 

St. John revenue increased by 1.8 percent to $1.09 billion, while the expense also grew by 3.6 percent from $1.06 billion. The severity at which patients have been brought in health condition has led to increase in operating cost for the healthcare. The occupancy in intensive healthcare has also increased over time.

Growth in expense

Now many healthcare industry experts believe that at the modern time the cost of health care will go up so a channel has to be maintained so that the interest of both hospitals and payer are protected. Currently, the doctors are straining on the revenue point having an adverse effect on the physician who is practicing individually.

Higher wages for physicians, incentive cost to nurses due to the shortage, pension funds to healthcare workers, increased the cost of ASC. This all have been a cost of the healthcare system or we can say to maintain the healthcare system flowing.

One thing that has been certain for the hospitals is the need of admin department to handle the coding and billing process. To maintain the Revenue Cycle Management (RCM) process the hospitals are shifting their focus towards outsourcing the billing and coding process to save up the cost of Human resource and technology factors.

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Ambulatory Surgery Centers: A Great Alternative to Hospital Based Surgery. And Cost Effective Too!


Ambulatory surgery centers –ASCs are the health care facilities that offer patients the convenience of having surgeries and procedures performed safely outside the hospital setting. Since their inception which is more than 4 decades, ASCs have revealed a brilliant ability to improve quality and customer service while simultaneously reducing costs.

At a time when most developments in health care services and technology typically come with a higher price tag, ASCs stand out as an exception to the rule which could prove to be a great alternative to hospital-based surgeries and not to forget affordability at its best.

Why is ASC medical billing the most preferred one in today’s time?

Waits of weeks or months for an appointment were not uncommon, and patients typically spent several days in the hospital and several weeks out of work in recovery who saw an opportunity to establish a high-quality, cost-effective alternative to inpatient hospital care for surgical services.

Faced with frustrations like scheduling delays, limited operating room availability, slow operating room turnover times, and challenges in obtaining new equipment due to hospital budgets and policies, physicians were looking for a better way and developed it in ASCs.

By operating in ASCs instead of hospitals, physicians are able to gain increased control over their surgical practices. In the ASC setting, physicians are able to schedule procedures more conveniently, assemble teams of specially trained and highly skilled staff, ensure that the equipment and supplies being used are best suited to their techniques, and design facilities tailored to their specialties and to the specific needs of their patients.

To simply put what physicians are striving for and have found is that in ASCs there’s professional autonomy over their work environment and over the quality of care that has not been available to them in hospitals. These benefits explain why it is still preferred as a great alternative to hospital-based surgeries and obviously a cost effective option as well.

ASC medical billing health care delivery model enhances patient care by allowing physicians to:

  • Focus exclusively on a small number of processes in a single setting, rather than having to rely on a hospital setting that has large-scale demands for space, resources and the attention of management
  • ASCs are focused on a smaller space and a small number of operating rooms
  • Allowing patients the ability to bring concerns directly to the physician operator, who has direct knowledge of each patient’s case, then dealing with hospital administrators, who lack detailed knowledge about individual patients and their experiences
  1. ASCs medical billing is about a commitment to quality

Quality care has been a hallmark of the ASC health care since long. It is an independent initiative that was established voluntarily by the ASC community to promote quality and safety in ASCs which is committed in developing meaningful quality measures for the ASC setting.

  1. ASCs are highly regulated to ensure quality and safety

ASCs are known for offering highly regulated safety and quality by federal and state entities. The safety and quality of care offered is evaluated by independent observers through three processes: state licensure, Medicare certification and voluntary accreditation.

  1. ASCs continues to lead innovation in outpatient surgical care

As a leader in the evolution of surgical care that has led to the establishment of affordable and safe outpatient surgery, the ASC industry has shown itself to be ahead of the curve in identifying promising avenues for improving the delivery of health care.

With a solid track record of performance in patient satisfaction, safety, quality and cost management, the ASC coding and billing company is already embracing the changes that will allow continuing to play a leading role in raising the standards of performance in the delivery of outpatient surgical services.

As always, the ASC industry welcomes any opportunity to clarify the services it offers, the regulations and standards governing its operations, and the ways in which it ensures safe, high-quality care for patients.

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5 Tricks in Medical Practice’s to Improve Your Accounts Receivable


Insurance companies are increasingly inventing complex and new set of rules for the medical procedure which has resulted into loads of denials and underpayment.  Doctors and pharmacist are increasingly finding it difficult under the ever-changing federal laws for practice and drugs. The recent data will also show the plight of doctors.

Unpaid Amount

Only 70% of the claims submitted are paid first time according to the research Center of Medicare and Medicaid (CMS). The other 30% denied claims are either lost or ignored or never resubmitted. Out of those 30% denied claims 60% claims are never resubmitted.

What’s more shocking is the fact that doctors aren’t even paid in full according to their contracts. The medical group management association (MGMA) estimates that payers are currently underpaying the doctors by almost 7% to 11%. So on average, a doctor is not paid 25% of their amount that they have earned by treating a patient. This has translated to a total of $125 billion left on the table by American Health Care industry.

Currently, doctors are shifting away from private practices as the sustainability on lone basis is difficult with the requirement of software’s and extra staff for revenue cycle management.

With unpaid and underpayment doctors are looking for innovative ways to approach the problem. Here are certain methods to use which you can amplify your ARs

Claim submission management

If the submitted claim is not paid up in the first submission cycle the likelihood that the claim will ever get paid also reduces drastically. One of the best methods to get paid when the claim is submitted is to identify the potential claim which might be rejected.

Identifying such claims using an intelligent engine that constantly adapts and updates according to the rules and regulation of payers. 

Using a software solution to constantly update and adapts after analyzing all the denied claim of the insurance company from all doctors.

Payment Tracking

One of the major problems with doctor’s payment is the underpayment. Now every doctor has a different contract with each payer or insurance company.

Now if four people come in with a same medical condition that needs same doctor but each patient has different medical insurance then each insurer pays a different amount.

For this, you need software to track all payments. You can allow the contracts which pay full payment or even used to predict future collections.

 Daily ageing of receivable

Traditionally receivable are tracked based on 30-day increment period. But now as each payer has a different schedule, they will need a different set of actions. Two receivables which are 30-day old could require different actions from different payers.

With no 30-60-90 days plan being followed a manual monitoring is needed for each claim. Practice can improve their days-sales-outstanding (DSO) with constant monitoring of all claims. The sooner practice follow-up with insurers the better chance you have of being paid than the claim being lost or ignored. Practice management software can help keep track of this without manually doing this work.

Work-flow management

From patient appointment scheduling to collecting reimbursement from payer requires a tedious process of documentation this all can now be done electronically with software. The manual work makes the process error prone and less efficient.

Every mistake in the documentation will be added on till the claim submission creating a bumpy ride for Accounts Receivable. Most efficient medical practices use practice management software to automate the workflow management.

Top notch software will schedule the patient visit for you, look through claim system for you and track all your AR from outsourced billers and coders. Send customized emails to patients informing them about their appointments.

Modern health care reporting and analysis

Modern health care industry is much based on making the right decision which can only be achieved with complete access, and well-organized data. Data can be your accomplice for growth if analyzed with purpose. Modern healthcare trends are important for achieving revenue growth.  This all can only be done when you have all your data at one place.

It is important for being able to mine data when you are on the go, so you can create reports and have live analysis. The process of data mining can be eased using practice management software providing you with UX to access data.

Things you should look into your practice management software

  1. Automate Work queue

The work queue will simply automate and update as your front desk will update the patients’ appointment. The doctors can reschedule or provide confirmation on the same appointment. This requires minimum paperwork and more freedom for doctors to operate.

  1. Specialty routing

Specialty routing is a very important task for hospitals which deals with complex diseases which require the involvement of more than one specialty. With specialty routing all the doctors working on a patient can go through their medical history and reports without any manual paperwork using practice management software.

  1. Advanced tracking

The physician should be able to track all the claims submitted and the duration of the submission. The underpayments and denied claims will provide an idea to the doctor about the insurance companies’ policy. Now many insurance companies are providing doctors with online tracking facility which helps them to check the status of their claim. This also helps in planning the future endeavors of the practice.

  1. Denial tracking

Denial tracking will be one important part for you to minimize your denied claims in practice. The justification, coverage, authorization and many other aspects can help standardize the same category denied claims into different payers. Providing you with numbers and insights of denied claims.

Posted in Accounts Receivables, Claims Denials, DME Billing, Insurance / Payer, Insurance / Payer Underpayment, Medical Billing, Medical Coding, Payment Models, Revenue Cycle Management (RCM) | Tagged , , , | Leave a comment

Tips to Successfully Overcome Documentation Issues for Wound Care Procedures


Wound care physicians are frequently astonished at “How tons of documentation in a patient’s healthcare record can result in a precarious situation?” Documentation issues related to wound care billing procedures are many; however, jotting down the right codes with eligible codes should be the priority.

However, physicians and facilities need to be aware of the implications of coding. As healthcare data turns increasingly digital; through initiatives such as meaningful use, coded information not only impacts reimbursement but also are progressively used to represent the quality of care provided.

The ability of a wound care facility to obtain reimbursement is essential for its financial success. By ensuring proper documentation, providers can work with specialty wound care billers and coders so that facilities receive the reimbursement they deserve.

Here’s a closer look at how documentation and coding work in the context of wound care.

Documentation for Coding and Billing of Wound Care

Wound care procedures represent a major portion of reimbursement in terms of income for physicians and hospitals, according to latest reports. In numerous facilities, from a coding and billing viewpoint, payment /repayment for wound care administrations is an extraordinary challenge. Avoiding perplexity is vital, particularly regarding the documentation of particular wounds.

From a coder’s point of view, “wound care” includes wound treatment and additionally evaluation and management (E/M). The issue being referred to is, that of the national correct coding initiative (NCCI) alters. Whenever E/M administrations are performed alongside procedures, and when they are incorrectly charged and documented raises an issue. This incorporates facilities expecting to be paid separately for every administration performed (such as debridement) alongside an E/M service, even though debridement current procedural terminology (CPT) codes 97597 or 97598 include wound assessment and evaluation, paring and cutting of nails, Unna boot usage, and negative pressure wound therapy visits at the clinic when procedures are not performed.

Additional Coding and Documentation issues to overcome in wound care billing:

  • Unseemly utilization of modifier 25 (regardless of whether there is an independently billable administration);
  • Utilization of hyperbaric oxygen when all other injury administration modalities have failed not joined by doctor orders for the procedures (and if they are absent for claims processing, the claim can be denied);
  • Absence of or ineffectively documented wound measurements (this essentially impacts repayment, and if wound measurements are not documented for claims handling, the claim can be denied);
  • Confounding selective & nonselective debridement;
  • Coding and billing for multiple layers of wounds per site instead of coding the deepest layer for debridement needs precise documentation such as bone and muscle debridement cannot be coded together for the same site.
  • Coding E/M levels for cases requiring G0463 for Medicare-specific cases; and
  • Coding dressing of wounds separate from an E/M service.

Following the above documenting and coding regulation, wound care facilities can streamline the entire operations as well as income cycle. Plus, utilizing the services of dedicated and certified medical billing and coding company will ensure each claim processed has been precisely documented for reimbursement.

Posted in Medical Billing, Medical Coding, Practice Administration, Practice Management, Revenue Cycle Management (RCM), Wound Care Billing | Tagged , , , , | Leave a comment