5 Tricks in Medical Practice’s to improve your Accounts Receivable

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 AR. 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.

Posted in Accounts Receivables, Claims Denials, EMR / EHR / Health IT, Health Insurance, Healthcare Reforms, ICD-10, ICD-10 Coding, Insurance / Payer, Medical Billing, Medical Billing & Coding jobs, Medical Coding, Medical Equipment, Physicians/ Doctors, Revenue Cycle Management (RCM) | Tagged , | Leave a comment

Standardize your Oncology Documentation to Maximize and Sustain Medicare Reimbursements

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More than 1.6 million people are diagnosed with cancer each year in the United States. The growth in the number of people living with cancer is projected to increase from 14.5 million (2014) reaching 18.1 million in 2020. Oncology (surgical, medical and radiation) is that branch of medicine that deals with diagnosis and treatment of cancer. Due to the high figures of cancer diagnosis it becomes even more important and crucial for oncology practices to have an up to-date and standardized medical system so that all claims are reimbursed in time and that no inconvenience is caused to the patients who are facing life threatening diseases. It also contributes directly to revenue targets for a medical practice. Increased reimbursement equals increased revenues. Moreover, practices spend significant efforts in reworking claims denials to the tune of $15,000 every year in addition to millions of dollars not being paid due to faulty reimbursement processes.

So what does it take to standardize documentation process, especially with respect to the Oncology specialty?

It needs to be remembered that every step in the process of the oncology practice, needs to be documented either on pre- formatted forms or captured digitally for smooth functioning.

  1. Scheduling of Patient appointment: Here every visit including the first visit needs to be documented to capture the diagnosis and treatment to be accorded for the right codes to be billed.
  2. Eligibility and Verification: This is the most crucial part of the first phase- right from the name of the patient to the insurance coverage and what has been covered or not. Patient has to be guided, given that not everyone expects to be diagnosed with cancer and its only after diagnosis does this get established and processed for treatment.
  3. Coding: stringent coding needs to be followed. All notes by the physician need to be reviewed thoroughly and checked when codes are inserted. Laterality should be observed when taking notes or if and when recorded. If transcriptionists are being involved in the process of documentation then every word needs to be transcribed carefully noted when it comes to laterality- anatomy of the body should be thoroughly known when documenting diagnosis and treatment. Coding classifications is very crucial as it informs about the coder if the primary site has been removed or eradicated and whether that site is currently being treated- the distinction between the primary site of malignancy and any secondary (metastatic) sites
  4. Administrative Documentation: This is very crucial for the claims process. Right from first time visit through tests, surgery, treatments, claims processing and follow-ups, all these phases involve numerous documentations. Following industry standards of documentation is essential not only in medical billing and coding, it also a significant factor to reducing claims denials and having a healthy audit outcomes for the growth of the practice or organization. With the healthcare transformation in the recent past from a fee-for-service to a fee-for-value system model, it is essential to follow the best practices in documentation.
  5. Clinical Documentation is not just for administrative purposes but clinical documentation is very critical- descriptive and accurate diagnosis along with acuity and severity is essential; linkage and relationship between causal factor is a must; supporting documentation from other specialty is very necessary in certain cases; specifying what was present on admission and what has been ruled out has to be documented with clarity; clarity should be provided when a patient is admitted only for chemotherapy or radiation therapy, since these have unique admission codes and the malignancy is not considered the principal diagnosis.

For effective documentation, a medical care practice/organization should use

  1. An efficient electronic health record (EHR) system that is comprehensive enough to include charting, ordering, drug management, recording plan of care, nursing documentation, prescription management, etc.
  2. Practice Management: All workflows and processes should be automated and centralized for easy checking and auditing purposes
  3. Outsourcing core processes: You also benefit from consulting an expert medical biller and coder as they provide comprehensive solutions and crucial services like eligibility and benefit verification, preauthorization, electronic and paper claims submission, accounts receivable maintenance, insurance Billing, Insurance follow up, appeal management, denials review and re-processing. They ensure usage of the latest billing codes (ICD-10) and modifiers published by CMS(Centers for Medicare and Medicaid Services) to the highest level of specificity so that there are minimal claims’ denials and drive a sustainable reimbursement process.
  4. Follow-up Teams: this is essential even if some core processes are outsourced. To ensure the A/R collections are meeting the correct number of days, ensure that claims denied are being appealed and followed up with the right documentation as proofs, as these serve not only for claims denials but even for audits and reports as per the new rules & regulations

Oncology documentation should always ensure that the “medical necessity” is recorded in the EHR as it is one of the common reasons for denials especially given that different payers have different reimbursements coverage. Automation can streamline the overall and detailed documentation process. Standardized billing systems incorporate all the latest codes, modifiers and insurance policies into their systems so that practices do not have to spend efforts in tracking all codes and policies every time.

Posted in Medical Billing, Optometry Billing, Practice Administration, Practice Management, Revenue Cycle Management (RCM) | Leave a comment

How Medical Billing Companies Must Respond If ACA Repeal?

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The healthcare industry has evolved with significant changes in the last few years, and it looks like the winds of change continue to blow in Trump Administration.  With more and more legislation, policies, and tech advancements changes witnessed, there has been a lot to talk about “ACA repeal” effect on medical billing companies.

 Here’s a quick rundown on how recently healthcare changes impact on medical billing and coding careers.

ACA – The Affordable Care Act

The Affordable Care Act widely known as ACA was passed on March 23, 2010, with a primary motive to make medical care accessible to all the Americans, including those previously uninsured.

With more insured people come more medical procedures and therefore more coding and billing. What a great time to be a medical coder and billers; all thanks to ACA, as they were an instant hit the moment it was launched.

However; ACA has put strict documentation rules in place, so medical billing professionals need to be 100% accurate when coding patient procedures. Inaccurate coding often leads to denial of insurance or billing delays, creating more work and frustration for patients, facilities, and providers.

Medical Billing Companies and ACA

It’s now been more than 4 years since the Affordable Care Act “ACA”,  also known as “Obamacare”, officially went into effect in the United States.

The scope of changes that were witnessed was:

  • Outsourcing work to medical billing companies increased
  • The number of medical billing professionals grew dramatically
  • The negative aspects of errors and delays diminished over the time
  • Upsurge in medical billing job
  • Medical billing companies ensured that their staff are fully trained on the new procedures

 The Controversy Now

ACA is kept solvent by an individual mandate that requires Americans who do not receive medical insurance through their employers, or free healthcare from the government, to buy such coverage through government run websites widely known as marketplaces.

There approximately 20 million Americans who now have health insurance under the law. But the program has been rocked by the new administration which is yet to sketch out new plans.

The Present Scenario

As of now, it is estimated that about 35 million Americans are expected to gain healthcare insurance under ACA, and with that there will be a healthy sizeable health care professionals to be working to meet the increased demand.

The healthcare industry is already facing a critical shortfall of health professionals over the next decade. And with the new president, new reforms are talked out. News about ACA repeal is already making rounds.

Republicans have put forth a variety of different replacement plans, but it is still unclear what the final version will look like. And the path to get to the implementation of a replacement could take many forms.

What should Medical Billing companies do, if ACA is repealed?

Here are some strategies that medical billing company should be prioritizing in the coming months:

  • The upside of repeal and replace is that some ACA taxes that have been levied. The significant downside, though, is that medical billing companies will lose major chunk on health insurance.
  • It also prohibits insurance companies from denying coverage or charging higher premiums to those with pre-existing conditions.
  • Medical billing companies are likely to lose money on individual coverage sold on public exchanges.
  • In 2019, Medicaid, private insurance, and household spending on health care would fall by $145.8 billion, and an additional 30 million uninsured people would seek $88.0 billion in uncompensated care.

Final Thoughts

ACA Repeal will certainly have an enormous impact on the medical billing companies. Reports finds there would be a huge spike in the cost of care sought by people who can’t afford to pay for it if Obamacare is partially repealed by Congress. Well, we all have to just wait and watch till there is an official announcement.

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Is your Facility Abreast with these Changes in for Medical Coding?

Is your Facility Abreast with these Changes in for Medical Coding?

The Healthcare industry at the beginning of 2017 has been hit by sudden regulatory changes in the form of CPT codes for certain billing procedures in Optometry specialty.  Changes in Current Procedural Terminology (CPT) will mark the introduction of the 22nd release of CPT code changes, which will see a few additions, cancellations, and adjustments made to the current list.

The updates in the CPT codes for ophthalmology and optometry practices will change the way you report fluorescein angiography and retinal repair. This makes it important for both ophthalmology and optometry practices to refresh and update themselves with code changes, and also look into the fact that their in-house billers are abreast with it. However, if they are not competent enough, you always have the option of allocating the services to an offshore medical coding and billing company.

Let us take a look at the coding changes that have come in to effect this year.

Look out the Changes to ‘1 or More’ Retinal Repair

Previously, when a retinal repair detachment is repaired, 67101, is charged once, irrespective of the number of sessions performed. In any case, now CPT has expelled the designation for 1 or more session from 67101. Since 67101 is likewise the parent code of 67105, the update will affect both 67101 and 67105.

The following is a breakdown of how the two codes should be applied now:

  • 67101: Repair of retinal detachment, including drainage of sub-retinal liquid when performed; cryotherapy.
  • 67105: Photocoagulation

The change would imply that CMS may now permit practices to report numerous code units for more than one session; in any case, no coverage decision have been issued up to this point which clarifies the catalyst behind expelling at least 1 session from the code descriptors.

Angiography Codes are Bilateral now

CPT 2017 has likewise updated two angiography codes clarifying that the codes apply for both unilateral and bilateral procedures as follows:

  • 92235: Fluorescein angiography (incorporates multi-outline imaging) with elucidation and report, unilateral or bilateral.
  • 92240: Indocyanine-green angiography (incorporates multi-frame imaging) with elucidation and report, unilateral or bilateral.

This code change if not applied appropriately can lead to cut in repayment for ophthalmologists. Since, modifier 50 (Bilateral procedure) or modifiers LT (Left side) and RT (Right side) can be attached to 92235 and 92240 when billing respectively, it permits collecting higher payments for bilateral administrations. If the code changes go through as demonstrated, it is likely that you will just report one unit of 92235 or 92240 even when you perform the angiography benefit on both eyes.

Additional Changes:

  • 0444T – Initial arrangement of a medication eluting ocular insert below one or more eyelids, including fitting, training and insertion, unit or bilateral.
  • 0445T – Subsequent placement of a drug-eluting ocular insert under one or more eyelids, including re-training, and removal of existing insert, unilateral or bilateral.
  • 0446T – Creation of subcutaneous pocket with insertion of implantable interstitial glucose sensor, including system activation and patient training.

Deletion Changes:

  • 0289T – Corneal incision in the donor cornea made utilizing a laser, in arrangement for penetrating or lamellar keratoplasty (Listed independently with addition to code for essential system)
  • 92140 – Provocative tests for glaucoma, with interpretation and report, without tonography.

Revised Codes:

  • 0333T – Visual evoked potential, screening of visual sharpness, automated with report.

In any case, it ought to be noticed that the updates in ophthalmology and optometry CPT codes are based on the preparatory list of code modification, and changes may happen even after the new codes are being used. If you want your Optometry practice to streamlined with the new codes, aligning your services with an experienced medical billing and coding organization will help a lot in terms of faster reimbursements, without you being worried about the coding updates.

Posted in Health Insurance, Medical Billing, Medical Billing & Coding jobs, Medical Coding, Medical Equipment, Optometry Billing, Physicians/ Doctors | Tagged , | Leave a comment

Helping Urology Practices in Enhancing Reimbursement by Avoiding Compliance Issues

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A medical practice is not just a service that physicians provide various individuals with, it’s also the bread earning work that you do to support yourself and your family. Talking about Urology practice, the billing and coding undertaking attached to it is a complex and constantly changing process. Urology practices today are faced with the need to confront declined payments and increase patient responsibility.

In order to reduce operational costs and therefore increase profitability, urology offices must tie-up with top-notch medical billing and coding organizations. It’s important for these practices to consider issues such as payer payment differences, HIPPA guidelines, ICD-10 codes modifications, EHR and EMR compliance’s and most importantly urology medical billing and coding errors.

In a highly competitive economic environment, outsourcing medicinal billing prerequisite appears like loss of control in their work administration. However, in actuality, outsourcing billing to the right organization improves the doctor’s control over billing process; it also has additionally been appeared to amplify profits, efficiency, and patient fulfillment.

Here are some real time benefits of letting an offshore entity to undertake your urology billing and coding requirement.

Eliminating Claims Errors

Depending on expert medical billers and coders not only eliminate errors in billing, but also diminishes loss of income related with claim denials. Specialty medical billing service providers are aware of consistent changes in medicinal charging prerequisites, making it workable for them to incorporate appropriate modifiers and other coding on all claims being handled. A legitimate coding and claims submission consequently drives up income for your physicians’ facility.

Indeed, even in an impeccable billing condition, denials occur for various reasons. In a usual urology physician’s office setting, a denial costs you money because you pay staff extra time to find errors and resubmit claims. Most medical billing companies charge a percent of paid claims, so you don’t pay extra for work on denied or error claims.

Income cycle gets streamlined

When charging is done in house, it regularly takes a secondary position to other works. The in-house staff may divide the time between claims billing and patient centric duties, such as answering patient calls, and collecting all the required information. That implies claims could sit for a considerable length of time before being billed, and denials could take months to resolve.

When you outsource billing capacities, the professional working there doesn’t have to split time and look after the different workloads of the physician’s office. They are all certified and dedicated billers and coders that only concentrate on your urology practice revenue management, which is their first priority.

Augmentation in Patient Contentment

By aligning with offshore urology medical billing company, you free in-house staff up to help patients. Patients who are welcomed, spoken and greeted with a smile will probably come back to a practice and also refer others. Quick, exact claims processing from a specialist organization is another approach to augment patient contentment.

Get detailed reports on your facilities financial status

Medical billing companies provide reports and statuses that let you assess financial health for your medical practice. Creating the same level of visibility and reporting through in-house staff can be expensive and take away time needed for necessary functions. Being able to understand your financial status, including the amount and number of claims pending in various statuses, lets you make smart choices about expansion, purchases, or hiring in your office.

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

Is Ignorance in AR Management and Medical Coding Eating up Your Medical Practice’s Revenue?

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Claims Reimbursement is the backbone of a medical practice, but the last five to ten years have been impacted by various trends and healthcare industry changes. To name a few, Medicare and Medicaid have started reducing physician reimbursements; Third-party payers have negotiated fee-for-service contracts with physicians resulting in reimbursement at less than 100 percent of charges. Acts such as the Administrative Simplification provisions of the Health Insurance Portability and Accountability (HIPAA) have tightened claims data submission requirements. With new Federal governing rules set to impact healthcare, the emphasis on healthcare fraud and abuse, and compliance have heightened the importance of accurate billing and coding. Owing to such issues ignorance in AR management and medical coding is sure to eat your practice revenue.

AR Management and RCM

A disrupted revenue cycle management specifically influences income for the healthcare providers and practitioners predominantly because of the long cycle of collecting payments from the payers and the inconsistency related with it. An end-to-end medical billing and coding company manages the complete revenue cycle right from the patient’s admission, treatment and subsequent discharge, followed by submission of claims and billing.

For productive working of a physician’s facility, a timely Revenue Cycle Management is particularly fundamental. Expert medical billers and coders provide extensive and financially savvy Revenue cycle administration to clients spreading across various specialties. A dedicated coding agency can help you streamline your outstanding claims by following up on the insurance company and get speedy settlements. They leverage the expertise in medical charging and coding and increment the possibility of payment and increment the collection ratio.

Impacts of a Professional Billing company on your Income cycle  

  • Improved cash flow
  • Streamlined operations
  • Acknowledgment of quick revenue
  • Patient satisfaction on the rise

Overview of services in outsourced Revenue Cycle Management

  • Pre-admission process check
  • Eligibility verification for Insurance
  • Enrollment Affirmation
  • Administration of patient stay
  • Clinical documentation
  • Charge capture
  • Medicinal coding and billing
  • Claims audit
  • Payment posting
  • Denial Management administrations
  • Accounts Receivable services
  • Following up on outstanding claims
  • Analyzing the claims denials for better Revenue acknowledgment

Also, when you have aligned the services of an offshore billing company they also take care of various payers such as:

  • Medicare
  • Third Party liability
  • Medicaid
  • Repayment towards insurance providers
  • Favored provider company
  • Workers compensation and Managed care

As a component of RCM dedicated medical coding agency likewise submit customized reports of:

  • The Aging AR report.
  • Payer mix
  • Adjustments in payments

Follow-up of receivables, so your revenue isn’t eaten up

Professional medical billers embrace various ethical ways to recoup the receivables and exceed expectations in aging AR clean-ups and bad debt reduction. The services in Accounts Receivables include:

  • Handling the refunds
  • Filing the secondary claims
  • Follow up of insurer and the insured (patient)
  • Appealing for disputable claims
  • Indexing the claims and billing documents
  • Submitting personalized management reports

What will you as a medical practitioner gain from partnering with a billing company?

  • You as a specialty practitioner can save up to 80% of operational expenses
  • You can benefit from end-to-end revenue management services of the medical billing and coding company
  • They fast pace your revenue collection with shrewd follow-up of outstanding bills
  • They follow proven processes for HIPPA consistence and deliver high quality revenue management
  • The efficient team will also provide a 24×7 customer service and quick turnaround time

Offshore billing and coding organizations stick to the business rules to deliver high quality revenue cycle management services with faster collections, minimum denials, and reduced accounts receivables. They deliver flawless revenue cycle management solutions to ensure revenue maximization.

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

Coding Rules for Modifiers 32 and 33 with CPT Codes in Medical Billing and Coding

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There are a couple of modifiers in medical coding that are very rarely used. Two such modifiers are 32 and 33. These modifiers can only be used when there is appropriate documentation supporting the case. Here are some pointers on how to use codes 32 and 33:

When should Modifier 32 be used?

Modifier 32 is used only whenever a service has to be extended to a third party entity or in the case of Worker’s Compensation or some other such official entity. However, modifier 32 may never be used when the patient wishes to seek a second opinion from a different doctor. Even in the case of a family member of the patient or a doctor seeking the second opinion, this modifier cannot be used.

The modifier 32 can only be used upon the service being mandated specifically. It may be an insurer seeking a report regarding the independent evaluation about the claim report filed by one of the workers. The insurer also has the right to seek a second opinion regarding the patient’s condition even before treatment or testing can commence. This is another occasion when modifier 32 can be used. However, as mentioned earlier, neither the patient nor any family member of the patient has the right to seek a second opinion or use the modifier 32 for that purpose.

Modifier 32 cannot also be used while seeking consultation from another doctor, or even when a physician goes for a patient evaluation with regards to medical clearance that may be required before a procedure can commence. Moreover, Medicare never accepts modifier 32, and no payment can be expected to be made for any service that is requested by any other provider. Modifier 32 is always used only for commercial or private payers. It is up to the third-party payer to waive any deductibles, which it usually does, along with the co-payment for the concerned patient, and the third-party payer usually makes a 100% payment for the service in such cases.

 When should Modifier 33 be used?

Modifier 32 was included by the American Medical Association (AMA) as a specific response to the Patient Protection and Affordable Care Act (PPACA). The act stipulates that all health insurers need to cover preventive services and immunizations on their own, without seeking or resorting to any sort of cost sharing options. Modifier 33 is specifically meant to identify such preventive services that are bereft of any specific CPT code. The modifier also allows the payer to take the initiative to waive all deductibles associated with co-payment or co-insurance. The modifier 33 may be used while identifying any preventive service that may have started off with a mere diagnosis, but may have later called for a more detailed therapeutic service.

U.S. Preventive Services Task Forces (USPSTF) has graded preventive services as grade A and B:

Grade A: This includes services that have a high certainty regarding substantial net benefits.

Grade B: This includes services that have high certainty ranging from moderate to substantial net benefits.

  • It includes routine immunizations for kids, adolescents and adults, which are recommended by the Advisory Committee on Immunization Practices for Disease Control and Prevention
  • It also includes preventive care and other screenings specifically for children, which are recommended by the American Academy of Pediatrics or Bright Futures, Newborn Testing (American College of Medical Genetics) as stipulated by the Health Resources and Services Administration
  • It includes preventive services extended for women, which haven’t been included in the recommendations of the Task Force. They are included in the comprehensive guidelines stipulated by the Health Resources and Services Administration

Do remember that modifier 33 cannot be used with Medicare insurance, and it can only be used with commercial or private payers. Medicare never accepts modifier 33.

Modifier 33 may also be used when a patient is provided with multiple preventive Medical Billing Services by his or her physician the same day, where the modifier 33 is used to describe the preventive services carried out for the particular day.

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