How Critical is Credentialing and Contracting in Urology Practice


Credentialing or Insurance Enrollment alludes to, the tedious, delay-filled, disappointment producing need, and is often the last thing on an Urologist’s mind when running a practice. Tragically, it is frequently ignored by your staff and could truly be a capital punishment to your practice.

The Regressive Effect of incorrect Credentialing:

A solitary rejected, or missed, re-credentialing or revalidation application could result in thousands of unpaid claims. What number of patients does an Urologist see every day? In seven days, during the month? What kind of medical billing and coding requirement is to be followed in case of incorrect credentialing?

Now envision having each one of these claims rejected as a result of a revalidation error or re-credentialing oversight. Each related claim will be set on hold until the revalidation is finished. This postpones reimbursement and each claim need to be resubmitted and more repayment delays. The additional time that goes in the wake of seeing the patient, more is the probability that some event will make the claim be denied. All of this results in more delays and denials, all in light of the fact that, credentialing was not up to the mark.

An Expensive Scribe

A new Urologist who can’t see patients because of credentialing is as valuable as a scribe. As a new physician in the field of Urology, you should expect the credentialing & contracting to take at least 90 days, and a month or so longer for a graduating resident or fellow. This is around four to five months of payroll costs of an expensive employee without the benefit of incoming revenue to offset it. Every delay in gathering data, submitting it, and needing to correct medical billing and coding errors, serves to push the timetable back even more.

Rejected Claims Shoot up

Denials soar in light of participation issues. At the point when an Urologist’s status is being referred to on account of credentialing or re-credentialing, the reaction to claims can differ. The post result of which is an increasing count of denied claims. Limit this by taking care of all credentialing or re-credentialing in an opportune, exact, and capable way.

With so much at stake in regards to credentialing and re-credentialing, every mistake, delay or billing error has significant monetary repercussions that harm the Urology facilities bottom line in a negative manner. Don’t take a risk on this critical step by turning it over to well-meaning staff, which try their best but often encounter unexpected problems or are simply stretched in too many directions.

Rather turn it over to specialists who spend significant time in credentialing, doing it consistently throughout the year for a large number of healthcare services experts around the country. You’ll be doing yourself and your association a huge support. Urology Practice Specialists in the current business scenario have to face undue losses, which is not appended to their core work, but related to the core services, which the additional healthcare service experts. Right from filing the appropriate insurance claim, to pin-point accuracy in credentialing and contracting, one simple mistake leads to delayed or denied claims.  To keep up the pace of your revenue cycle, it has indeed become a necessity for Urologist to hire and attain the services of expert Urology billers and coders who are specialists in tailoring all claims appropriately, ensuring there are no delays and denials in reimbursement due to incorrect coding and billing, credentialing and contracting.

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How Can Outsourcing Help You Achieve Great Return on Investment in Ob-Gyn Billing

How Can Outsourcing Help You Achieve Great Return on Investment in Ob-Gyn Billing

Encompassing aspects like pregnancy, delivery, prenatal and postnatal care, the OB GYN practice serve women at all stages of life. Understanding of the changing medical billing environment is necessary to ensure prompt and effective reimbursement for services. The key to harness attractive return on investment in an Ob-Gyn practice lies in the efficiency of billing. Outsourcing the billing and coding procedures is the day’s preferred trend due to its aid in bringing the cost of functioning down. Being reimbursed for services you provide requires your medical billing company to be up to date on all new coding updates, billing techniques and other filing mechanism. Here are ways to achieve considerable return on investment from outsourcing your Ob-Gyn practice:

By Cutting Out On Office Management Expense

Outsourcing the medical billing procedures to a Billing and Coding specialist can be an ideal way for an Ob-Gyn practice, in view of the massive amount of paperwork that it requires. The billing and coding companies’ employee specialized medical billing software’s to efficiently manage the patient inflows, their information and billing procedures. Thus, a practice observes an overall decrease in employee costs when it decides to outsource the management procedures to the experts.  Outsourcing is a good way to avert the overhead staff expenses like office management training, paid vacations and sick leaves. Going paperless and embracing digitalization in the form of specialized software’s designed to handle a practice’s revenue also saves on office expenses. This decrease in cost can be a contributor towards a handsome return on your investment in OB-GYN practice.

By Enhancing Efficiency

Specially trained to understand fee schedules, commercial payer regulations, and Medicare/Medicaid guidelines obstetrics and gynecology medical billers make sure that they process bills, enter data, and initiate follow-ups on patient claims that are pending on a timely and recurring basis. This in depth knowledge also helps them answer the patient queries regarding billing, that helps a clinic retain patient trust. With help of the knowledgeable biller you can narrow down the billing cycles to shorter periods by streamlining the whole procedures and employing more resources on accounts receivable. Outsourcing also means that the clinic can now handle denials in a better way through dedicated revenue management. Shouldering such important responsibilities the specialized billers take significant burden off the office staff, giving them time to focus on patient care. Dedicated service to patients is a direct factor promoting customer loyalty thus bringing forth great returns on investment.

By Showing Proficient at Billing and Claim Handling

Obstetrics and gynecology (ob-gyn) is one specialty that involves tedious and lengthy claims filing. Certified to carry out the billing and coding exercises, the outsource company ensures that the practice generates optimum profits while it functions.  Efficient billing tricks include a number of things that a practice can do to prepare their billing claims in the transition to ICD-10 that is known to improve payment and reimbursements.

Denial Management is another important of Ob-Gyn Medical Billing. Billing errors like lack of information, duplicate claim and non-covered charge(s) among various others become the most common reasons for denial by an insurer. Denials faced due to reasons like these can seriously delay reimbursement for services rendered and in some cases reduce the overall payment amount. Outsourcing services for OB/GYN medical billing by a highly qualified and experienced company can eradicate the rates of these types of denials. Keeping abreast with the coding updates, once outsourced the billing procedures will see a sharp decline in claim denials and other disruptions in cash flow. The staff trained to carry out the billing is also well-versed at handling denials; if in case they occur. This ensures a hefty return on investment and a thriving Ob-Gyn practice.

Posted in Accounts Receivables, EMR / EHR / Health IT, Healthcare Reforms, HIPAA / ACA / ACO, ICD-10, ICD-10 Coding, ICD-10 Testing, Infographics, Medical Billing, Medical Coding, Medicare Medicaid, OB Gyn Billing, Ob Gyn Billing, Ob Gyn Billing & Coding, Ob Gyn Billing Companies, Ob Gyn Billing Guide, Ob Gyn Billing Guidelines, Ob Gyn Billing Outsourcing, Ob Gyn Billing Providers, Ob Gyn Billing Services, Ob Gyn Billing Vendors, ob Gyn Coding, Ob Gyn Coding Services, Ob Gyn RCM Outsourcing, Ob Gyn Revenue Management, Practice Administration, Practice Management, Revenue Cycle Management (RCM), Why Outsource Medical Billing Services | Tagged , , , , , , , , , , , , , , , , | Leave a comment

Things You Don’t Know About Orthopedic Billing. Ask The Experts !

Things You Don't Know About Orthopedic Billing. Ask The Experts!

No matter what the nature of your specialization is, medical billing for Orthopedics is an uphill task. Most generally, orthopedic practices thrive on efficient billing practices that help in streamlining revenue cycle management by cutting out delays and minimizing stress on cash flows. However there are other things that when managed can help you grow your business.

Here are some pieces of advice from experts:

Tip I: – Track Key Management Measures for Your Orthopedic Practice

It’s important for both physicians and administrators to have the knowledge about the progress of the business. A monthly report that tracks key management measures pre-determined by your orthopedic practice helps you look at the clear picture of where you are in terms of reaching your goals. This report is made up of critical measures that give an idea about the growth of the business.  It needs to clearly dictate what factors are working in favor of the practices and what areas require a change. Factors like billing amount, cash collections, collection rates, and average wait time for a patient appointment, non-physician cost per patient and payer mix are some important measures that are important for an insightful report. Once prepared, you should compare it to reports from previous months/quarters and also with reports from same period previous year.

Tip II: Know the Market Evaluation of Your Orthopedic Practice       

Market evaluations are keys to determining your clinic’s position in the marketplace, figuring your competitors, determining strategic payers and employers and other such things of importance. With help of some specifically designed software programs the task of plotting your location, drawing comparisons with competitors, and mapping the driven values against data from latest census becomes easy. All this assessment helps you figure the rate at which you are acquiring patients and the areas they are coming from. Market Evaluation helps you chart a direction towards which you gear up in the future for great success of business.

Tip III: Figure out The Long-Range Financial Projection of Your Orthopedic Practice

Projections are based on present performance in combination with practical assumptions of the future performances. Factors like inflation, expansion, revenue increases due to business growth and price of product in future are also counted while deciding on projections for the practice. This strategic tool helps to figure what strategic changes need to be made in the business to achieve desired goals.

Tip IV:  Develop a Strategic Plan

A strategic plan needs to very simply define the actions you need to take, answer the questions about what you want your business to be. It should answer questions surrounding size of the practice, services you intend to offer in the future and expansion plans etc. After outlining a strategic plan, and direction you need to finalize how you are going to accomplish that plan?  It is also important to review and update it annually.

Tip V: Diversify Your Revenue

When you are looking for brighter horizons in terms of revenues from your orthopedic practice, include diversified revenue streams in your practice. There are a host of related medical services you can provide that can fetch profit and diversify your revenue stream.

Tip VI: Focus On Marketing

You would stand surprised with the effect a proficient marketing strategy can have on your orthopedic practice. The bottom line is that you need to tell your story or share identity and work with your customers. Develop an effective marketing plan that caters to the kind of consumers you are looking for. Brochures, Email marketing, Door-to-door campaigning, representation at healthcare events in the area are some of the many marketing techniques that can be used to reach out to the customers.

Posted in EMR / EHR / Health IT, Healthcare Reforms, HIPAA / ACA / ACO, ICD-10 Coding, Infographics, Medical Billing, Medical Coding, Orthopedic Billing, Orthopedics billing & coding, Orthopedics billing companies, Orthopedics billing guide, Orthopedics billing guidelines, Orthopedics billing outsourcing, Orthopedics billing providers, Orthopedics billing services, Orthopedics billing vendors, Orthopedics coding, Orthopedics coding services, Orthopedics rcm outsourcing, Orthopedics revenue management, Practice Administration, Practice Management, Revenue Cycle Management (RCM), Why Outsource Medical Billing Services | Tagged , , , , , , , , , , , , , , , , , , , , , | Leave a comment

External Otolaryngology Billing Services Is A Great Way To Increase Your Profit !

External Otolaryngology Billing Services Is A Great Way To Increase Your Profit!

Otolaryngology Specialty clinics or what are more commonly known as ENT clinics play a multifaceted role catering to the diagnosis and treatment of disorders associated with multiple organs – ear, nose, throat, head and neck. Thus, otolaryngologists are involved in a constant exhaustive list of investigative and treatment procedures required for precise diagnosis.

Otolaryngology specialty billing is a tedious procedure wherein both surgical procedures and office visits are to recorded and billed.  The revenue cycle at ENT specialty clinics is often plagued with a common error i.e. the improper use of modifier 50. This flaw leads to discrepancies in insurance reimbursements during billing of bilateral procedures. Another widespread billing error observed at ENT specialty clinics is claim denials for CPT code 30520 (septoplasty) as these denials require appeals and additional medical documentation. Furthermore, introduction of ICD-10 system and HIPAA 5010 Version, the compliance coding and medical reporting procedures are going to be lengthy and complex.

Here is a list of reasons why external Otolaryngology Billing Services is a great way to increase your profit:

  • Boost Revenues

Outsourcing ENT billing implies that the accounts at your clinic are being handled by a team of qualified experts who work at streamlining your revenue cycle management. Once hired, the billing company takes over the otolaryngology billing as well as guides doctors and their staff through the process of medical billing; educating them about charge entry, patient enrollment, scheduling, insurance verification, insurance authorizations, scheduling and re-scheduling, coding, billing and reconciling of accounts, collections and denial management,  revenue follow-up etc. This helps in boosting revenues a great deal.

  • Save Money

Outsourcing ENT billing services can be a profiteering mechanism from a long-term perspective.  Money can be saved on staffing costs that includes salaries, benefits and insurance, as well as building up tech-savvy billing inventory comprising of computers, software and other necessary office supplies. A lot of money is also spent on training the in house staff which can be averted by outsourcing the Otolaryngology Billing.

  • Save Time

Technicalities of Otolaryngology Billing make it a time consuming exercise, in need of constant supervision. Most ENT practices run into massive losses due to delayed billing and shaky cash flows. However, outsourcing ENT billing to a team of qualified experts can save you a lot of time which in turn can be spent on focusing on patient care. You can utilize time to build and grow your practice which can increase your profit phenomenally.

  • Industry Compliant

Maintaining compliance standards that match the ever changing regulations and requirements is tough given the degree of complexity. Outsourcing ENT billing to professionals eases you off the responsibility as the billing company would take care of the rules, regulations and requirements of the medical industry. This helps you as a trained professional to be focused at what you know the best i.e. to cater to medical needs of your patients and boosts business indirectly.

  • Claim Tracking

Teams of billing professionals at the medical billing company are trained to handle the accounts at your Otolaryngology practice. They review and follow up all payments to ensure that the insurance carriers are paying the bills. Because all outstanding claims are tracked until they are paid in full, there often is seen a reduction in overhead cost, resulting in marked profit increase.

External Otolaryngology Billing services are designed for optimization of medical practices as well as improvement of the care standards provided at the clinics. Technicalities like the use of modifiers for checkups and surgical procedures can be confusing. At the same time there is a need to correctly bundle codes in order to secure the medical billing claims. Outsourcing is a great way to improve the revenue cycle management of Otolaryngology practice which lets the doctor focus on the healthcare standards and take the burden of paperwork off their shoulders.

Posted in EMR / EHR / Health IT, ENT, ENT Billing, ICD-10, ICD-10 Coding, ICD-10 Testing, Infographics, Medical Billing, Medical Billing & Coding jobs, Medical Coding, Otolaryngology, Otolaryngology Billing, Otolaryngology billing & coding, Otolaryngology billing companies, Otolaryngology billing guide, Otolaryngology billing guidelines, Otolaryngology Billing Outsourcing, Otolaryngology billing providers, Otolaryngology Billing Services, Otolaryngology billing vendors, Otolaryngology coding, Otolaryngology coding services, Otolaryngology rcm outsourcing, Otolaryngology revenue management, Practice Administration, Practice Management, Revenue Cycle Management (RCM), Why Outsource Medical Billing Services | Tagged , , , , , , , , , , , , , , , , , , , , , , , , , | Leave a comment

Why Physicians Consider ERISA (Employee Retirement Income Security Act) as Their Best Friend When Fighting Denials?


Established on September 2, 1974, the Employee Retirement Income Security Act is coded in the 29 USC, Chapter 18 and is a claimed federal law. As stated by this law, every individual is entitled to a sum of money after retirement that has to be provided by his employer, irrespective of any circumstances. Further, employee plan participants and their beneficiaries are also covered under this clause. Under the same clause, Employee Retirement Income Security Act or ERISA, it is a fraudulent activity if an employer denies his employee such amount, accounting to which a serious action may be taken against him and his organization.

In a country with an ever-growing economy, it is only expected that the costs of living will be staggering high. One of the major concerns that individuals face after retirement is controlling such costs and still being able to manage by themselves in their old age. Many also look forward to enjoying and relaxing at this stage of their life after a period of grueling work and hardships, but however, the stress of taking care of multiple expenses often diminishes such dreams and desires. When it comes to the medical industry, things are no different. A physician who have spent their years treating and looking after people now start worrying about their own health and start scrutinizing their options available. This is exactly where the Employee Retirement Income Security Act comes in place. The primary need of the law was to fulfill the protection required by employees even after they are retired and to make their journey a happy, safe and comfortable one.

 The law works to render the below-mentioned benefits to retired individuals:

  • Provides health plan benefit protection
  • Protects’ employees retirement plans
  • Protects their right to health insurance in case of a medical emergency or in case they suffer from medical conditions
  • Ensures support to retired employees by helping them keep their insurance active unless they manage to find alternative individual coverage
  • Also covers those who are distinguished in the healthcare industry due to certain conditions
  • Ensures pensions are protected and safeguards the money earned by employees by preventing any hasty decisions over transactions

The Employee Retirement Income Security Act has thus gone above and beyond the ordinary to make lives easier for retired individuals. Many times, folks also skip insurance and coverage after a certain period of time considering the payments that need to be made and under the impression that it will not be required since they have a clean health history.

However, it is a wise decision to ensure you have at least a minimum coverage to safeguard your money and more importantly to protect your health that is irreplaceable.

When it comes to the world of medical billing and coding, physicians are well aware of the benefits of insurance and consider it dearer than money. Thus, considering the act worthy and give it prime importance since it can go a long way in the way of fighting denials. With this enlightenment, many other individuals are now considering insurance and opting for medical coverage.

Posted in Accounts Receivables, Ambulatory Surgical Centers, Claims Denials, Medical Billing, Medical Coding, Practice Administration, Practice Management, Revenue Cycle Management (RCM) | Tagged , , , , , , , , , , | Leave a comment

Adhering to These 3 ASC Billing Best Practices Can Streamline Your Revenue Cycle Management


Offering enhanced billing and coding practices ASCs improve consumer loyalty, however it additionally expands profits and diminishes losses. A standout amongst the best ASC best practices for guaranteeing better practices is to contract specialists in both billing and coding. If you feel that the in-house accounts department is not up to the mark outsourcing to billing and coding agencies can help in the long run as well as present you with a healthy Revenue Cycle Management.

Better billing practices likewise include offering choices to patients. While numerous patients may have some sort of insurance, many of them will still be required to pay some amount of cash out of pocket. Address the issue of payment before the surgical procedures, requesting a segment of the payment in advance if possible. Offer alternatives that make it simpler for patients to pay. Two great examples are patient services department in some of Ambulatory Surgical Centers, which make live calls to offer payment programs and their patient portal for easy online payment. They train administrators to work with patients in a nonthreatening way, addressing billing issues without causing patients discomfort.

A characterized collection policy that is simple for patients to comprehend is of significant use, especially for Revenue Cycle Management. Working with patients to offer fast, simple payment alternatives is imperative, yet patients ought to likewise be advised of their duties and given a collection strategy, furnishing them with data on worthy payments, that constitutes a past due payment and how collections will be taken care of.

Three Best ASC Billing practices you need to adhere too

ASC billing and collection can be tricky for most of the ASC practices. Observing key performance indicators (KPIs, for example, AR days and income collection patterns is one way for your Ambulatory Surgery Center (ASC) to maintain the pulse of your financial wellbeing. In any case, monitoring and reporting won’t affect the results alone.

To upgrade your revenue cycle and achieve long term financial success, your center needs to follow some best practices, here they are:

Precision in Coding

An ASC’s billing staff needs to comprehend coding complexities that are particular to the business. In the event that a claim is coded inaccurately, it can result in postponed payment, the requirement for an appeal or sending a client into collections. In turn, this adversely impacts both AR days and income cycle. To better depict a code without changing its definition, many ASCs need to bill codes with modifiers. In the event that this is not done accurately, it may bring about a drop in revenue, as well as result in a fine if the incorrect coding conflicts with Medicare rules.

Gaining knowledge on the GO!!

Innovation and Technology go hand in gloves and is constantly advancing, so it’s basic to give your revenue cycle management handlers with in-depth knowledge to stay up with the latest on the most recent billing and coding prerequisites is a must. Enhancing work process through regular staff training, your centers billing and collection will pick up efficiencies and KPIs will enhance.

Monitoring AR days is a must

A standout amongst the most critical KPIs for an ASC is AR days. Accounts Receivable are or should be regularly audited on a month to month premise, yet checking them more often as possible can make a proactive culture to help distinguish issues in a convenient way. Early detection of any errors or omissions is the core element in the best medical billing and coding best practices.

Posted in Accounts Receivables, Ambulance billing, Ambulatory Surgical Centers, Claims Denials, Medical Billing, Medical Coding, Medical Equipment, Practice Administration, Practice Management, Revenue Cycle Management (RCM) | Tagged , , , , , , , | Leave a comment

Trump’s Execution Policy: Crucial Things You Need to Know


Mr. Donald Trump; USA president has initiated a series of presidential actions since taking office on Jan 23, 2017. The directives touch on issues like the Affordable Care Act, new homeownership, federal hiring, and most controversially, immigration.

Some of the crucial presidential memoranda are mentioned below:

1. Reducing the Economic Burden of the ACA (Affordable Care Act) & Patient Protection

It is imperative for the executive branch to ensure that the law is being efficiently implemented, take all actions consistent with law to minimize the unwarranted economic and regulatory burdens of the Act, and prepare to afford the States more flexibility and control to create a freer and open healthcare market.

Carrying out the directives in this order would require revision of regulations issued through notice-and-comment rulemaking, the heads of agencies shall comply with the Administrative Procedure Act and other applicable statutes in considering or promulgating such regulatory revisions

2. Approvals for High-Priority Infrastructure Projects

Infrastructure investment strengthens economic platform, making America more competitive, creates millions of jobs, increases wages for American workers, and reduces the costs of goods and services for American families and consumers.

Often, infrastructure projects in the United States have been routinely and excessively delayed by agency processes and procedures. These delays have increased project costs and blocked the American people from the full benefits of increased infrastructure investments, which are important to allowing Americans to compete and win on the world economic stage.

Federal infrastructure decisions should be accomplished with maximum efficiency and effectiveness, while also respecting property rights and protecting public safety and the environment. To that end, it is the policy of the executive branch to streamline and expedite, in a manner consistent with law, environmental reviews and approvals for all infrastructure projects, especially projects that are a high priority for the Nation, such as improving the U.S. electric grid and telecommunications systems and repairing and upgrading critical port facilities, airports, pipelines, bridges, and highways.

All actions taken pursuant to this order shall be consistent with the requirements and authorities to protect intelligence and law enforcement sources.

3. Cut Taxes

Some taxes under ACA can be undone such as a tax on pharmaceutical companies and health insurance. The order encourages agencies to waive fee, taxes, and penalties under ACA. According to Trump his team will come up with the plan that is simple and offers a wonderful solution to failed disasters i.e, ACA.

Staying aware of the new healthcare policies, information and legislative transformation avert practicing from being unaware of the new healthcare reforms. Turning blind eye to these reforms are sure to affect health care reimbursement majorly.

4. Immigration Improvements & Border Security

Border security is important to the national security of the United States.  The recent surge of illegal immigration at the southern border with Mexico has placed a significant strain on Federal resources and overwhelmed agencies charged with border security and immigration enforcement, as well as the local communities into which many of the aliens are placed.

The purpose of this execution order is to direct executive departments and agencies to install all lawful means to secure the Nation’s southern border, to prevent further illegal immigration into the United States, and to repatriate illegal aliens swiftly, consistently, and humanely.

5. Creating Interstate Insurance Market

Execution orders to strive towards creating interstate insurance market, allowing buying of health insurance across state lines by the individual. Though the insurance sale is allowed across the state under ACA, Trump focuses on having replacement plan which is centered on patient along with improving healthcare.

Posted in EMR / EHR / Health IT, Healthcare Reforms, HIPAA / ACA / ACO, Medical Billing, Medical Coding, Practice Administration, Practice Management, Revenue Cycle Management (RCM) | Tagged , , , , | Leave a comment