Outsourcing medical billing to a dedicated third-party company can have huge financial benefits for most medical practices. However, what are the specific pros and cons for your practice? Read the article below to find out if you’re in the right spot to switch your medical billing to a third-party.
The big bulk of a medical services provider’s loss is in its payment denials because of certain factors like non-identification of the patient, terminated or unverified health insurance policies, invalid medical codes, wrong database inputs, duplicates and lack of payment credentials. These small mistakes can affect the financial aspect of a medical provider which is why reliable and accurate medical billing services are required whether you are an independent provider or a medium to large medical services provider.
Working with a competent and accredited medical billing services company will help you hash out problems that lead to payment denials through effective medical billing procedures and a set of smart skills backed by years of experience.
Dedicated and experienced medical billing services companies prevent denials by:
Having a Backup System of Electronic Health Records
Medical billing services companies would always keep a backup server with millions of records of patients and safeguard that information at any cost. With everything in the medical industry being automated, highly secure servers and state-of-the-art software are used in compliance with the Health Insurance Portability and Accountability Act (HIPAA) and other government-mandated standards.
Verifying and Sorting Individual Information
Medical billing companies work with medical provider staff to assist and train them in medical administrative tasks like registering patient and processing documents with medical billing codes. The company also measures the percentage of claims against denials and investigates on each denial to solve the problem. The company regularly communicates with staff for maintenance of records and releasing of regular financial reports.
Keeping Informed of New and Revised Medical Standards or Insurance Policies
As an expert in the medical practice, medical billing companies ensure the efficacy of the medical billing procedures that they implement to each medical provider by being regularly informed of industry updates, changes in policies and any other additional requirements for medical billing.
Doing a Thorough Inspection on Claims
More than just communication with healthcare staff, the company addresses issues on claims by creating strategies that appeal to the payer like sending out a reminder email or calling for verification etc.A good medical billing company also keeps up-to-date of payer’s policy and authorization.
Daily Management of Denials and Compliance to Deadlines
Review of denials are part of the medical billing company’s daily grind; they closely monitor the percentage of denials and implement strategies that can solve the problem. They also comply to deadlines in tax returns and other financial requirements.
To look good is to feel good. This saying is so applicable for most men and women. Regardless of age, most people today are so concern on how they look. Not totally focusing to flaunt the physical appearance but when a person looks good, he/she feels good and it gives this positive outlook in life.
Some are naturally born with the good looks (thanks to their genes!) but some wish to have better body part like this or that. So their solution? Plastic Surgery.
Having one of your body parts enhanced is truly accepted in this generation. As the young people depend on social media, they witness the physical changes their idols would have. From tummy tuck to lip enhancement and breast augmentation. Confidence gets boosted together with self-esteem.
Why Tackle Plastic Surgery Industry?
Statistics show that as young as 13 years old, Cosmetic Plastic Surgery is being availed and even 55 years old and above still undergo a cosmetic procedure. Mostly among females with 92% of the total population who have undergone surgery, while the 8% for males. Here are some helpful information according to the Plastic Surgery Statistics Report 2016 by the American Society of Plastic Surgeons.
Percentage change 2016 vs. 2015
17.1 million cosmetic procedures – up by 3%
1.7 million cosmetic surgical procedures – up by 4%
15.4 million cosmetic minimally-invasive procedures – up by 3%
5.8 million reconstructive procedures – no change
2016 Top 5 Cosmetic Surgical Procedures 2016 vs. 2015
Breast augmentation (290,000) – up by 4%
Liposuction (235,000) – up by 6%
Nose Reshaping (223,000) – up by 2%
Eyelid surgery (209,000) – up by 2%
Face Lift (131,000) – up by 4%
With these figures, it only goes to show that Cosmetic Surgery is still a booming industry. With millions of cosmetic procedures being done, focus on medical billing is the utmost concerns not only by medical practitioners but also by patients.
Outsource Your Medical Billing
As medical practitioners focus on the outcome of their patient’s enhancement, the medical bills pile up and need to be done in the best possible way. When you outsource to a billing service, it decreases the number of rejected claims typically and it’s faster to receive the payment from a client.
Let’s be real. Some medical practitioners are not techy. Instead of spending the time to educate themselves with the new technology, medical practitioner’s update themselves with the latest in the medical world where they are familiar of. To attract more people who would like to undergo enhancement, medical practitioners have to put themselves upfront in order for them to practice to specialization. Now, if a medical practitioner doesn’t want to deal with software upgrades, any issues that may arise on the software, or to even worry about clerical work that needs to be done for any billing concerns and mainly focus on his career, by then it’s better to get the services of the medical billing company which can provide all its client’s needs and hassle-free.
Not all Medical Billing Services (MBOs) work for a specific practice. For instance, if you’re an orthopedic clinic with 4 doctors servicing around 200 patients a week, you’ll need an Electronic Medical Record (EMR) that not only stores every patient’s medical record, but also performs tasks like sending notifications of claims deadlines and denials, and most importantly, it has the ability to restore encoded data lost in a power interruption or server glitch.
A lot of software offer features suited to the convenience of the medical institution, group or individual, but you don’t always need a full-service medical billing company. Some tips you can use to find the best medical billing services company that suits your practice are:
Ask About the Company
How has their service benefitted their existing customers? What medical billing solutions do they offer? It helps to ask more than just the price, so you get a good glimpse of how well the company can handle all kinds of issues in medical billing.
Agree on Transparency
Before agreeing on rendering medical billing services, you have to make sure that you receive a copy of reported claims or denials at real-time, so you can also monitor the state of your organization’s financial health. Other data that you need to see would include posted payments, write-offs, open charges and charges on hold and adjustments.
Spot Accreditations
One way of knowing that a medical billing company is operating under state laws, is checking their track record and permissions. You can validate their credentials using this guide questions:
Are they a Certified Professional Biller?
Do they comply to the Health Insurance Portability and Accountability Act (HIPAA) and Healthcare Common procedure Coding System (HCPCS)?
Are they registered with the Better Business Bureau?
Learn About Their Pricing
It pays to know the functions of the service package you will get from the medical billing company. There are three payment models that medical billing companies offer to medical professionals or institutions which include:
Partly Fixed Model – In this model, the company charges a flat fee for carriers. This model is cost-effective on your part, but MBOs seldom use this model.
Percentage Model – This model is widely used by most companies; this model allows companies to charge a percentage of the total claims.
FIxed Fee Model – This model allows the company to charge a fixed price on each claim they submit. This is believed to be a less costly method of payment.
Train Your Staff on Proper Usage
Although you are outsourcing services to a medical billing company, it is the role of the agency to provide training to your staff whenever they need to access the system for verifying records or making their own reports to the management or as simple as entering new patients’ record and insurance policy number.
With these tips in mind, you can lessen errors in medical billing and focus on taking care of your patients.
Is your healthcare organization’s financial status in the dumps? Needing expert skills in handling revenue management, staffing services, medical billing outsourcing, coding and HIPAA Compliance? QuestNS offers complete and comprehensive services that smoothly streamlines all tasks and responsibilities needed for effective medical billing.
QuestNS is trusted by over 35 states in the U.S. and has an extensive knowledge in handling specific medical practices such as Pediatric, Cardiology, Urgent Care, Urology, Hospitalists, Family Practice, OB/GYN and more.
Here are the specific medical billing benefits you get when you sign up for QuestNS’ medical billing services:
1. Complete and Detailed View of Payments
From posting of patient’s bill to triple-checking summary of services acquired, QuestNS gives you an accurate list of procedures that the patient underwent along with medications administered to the patient. The list is made available real-time in your server.
2. One Month Settling Period for Account Receivables
Our professionally-trained staff will help you increase your financial health in your practice as they ensure smooth communication with medical insurance agencies and settle account receivables within a period of one month from the date that the claims were sent.
3. Fully transparent and Easy-to-Understand Weekly and Monthly Financial Reports
QuestNS gives you a clear and concise summary of claims and all other transactions made within the week or month so it’s easier to track volume of patients in a week or month and assess your productivity in your practice or clinic.
4. Automatic Generation of Patient’s Statements
This helpful feature captures data of patients’ breakdown of costs and collates them into one statement of account that will be sent to automatically to the patient’s email inbox, and he or she will also receive a phone call once the statement has been released.
5. Weekly Calls With Your Account Manager
Be totally assured that your medical billing duties are well-attended to by our Account Manager through scheduled weekly conference calls with the AE to get updates on progress of claims and denials and other customer inquiries.
More benefits are in store for you when you subscribe to QuestNS’ medical billing packages which includes Back-end, Premium and Fully Customized Plans if you want a medical billing task that’s not included in our two previous plans. Need more specific info? You may contact us at 1-888-783-7818 for a free analysis on your needs or email us at info@questns.com.
A timely and accurate payment is crucial to be able to provide the thorough health care and attention each patient deserves. Pay systems also help fuel health institutions – so it’s a bummer for everyone if ROIs aren’t met due to billing inaccuracies.
How can you make sure that your medical billing is being managed accurately?
Proper Documentation
Billing becomes inaccurate if codes are not properly documented. From the name of the procedure up to the medications administered, everything should be logged in meticulous detail. Even information such as the administering physician or vital signs and ongoing monitoring notes – everything must be documented.
Medicare Restrictions
If Medicare fails to cover certain procedures, the patient needs to be informed right away and presented with options so as not to cause any delay in treatment.
The biller has a duty to be thorough once Medicare stops paying on services by a specific provider. They need to investigate why Medicare payments ceased and resolve if Medicare has erroneously halted payments.
Patients should be fully educated on these restrictions. An efficient health care practitioner discloses this matter and tries to verify eligibility before appointment to ensure that the patient has coverage.
Summarizing the Bill
If vital information goes missing, expect a delay in insurer payments. Electronic health record software helps prevent delays by sending urgent alerts on any missing data. Payment summary only tracks collection of the patient copays and coinsurance. If the staff won’t be able to check if claims are billed out, it’s possible for them to be overlooked.
“Centers for Medicare and Medicaid Services (CMS) has already updated rules for EHR (electronic health records) so this means reducing reporting burden among providers. Most concerns relating to software implementation and information exchange readiness have already been addressed, and improvements in software capabilities are made every day.”
Working with Certified Electronic Health Record Specialists
With the increased use of EHR, there has also been a noticeable rise in Certified Electronic Health Records Specialists (CEHRS). They make sure to communicate with patients, keep track of vital information, and interpret terms related to new legal requirements, medical diagnosis or tests, and clinical procedures.
Most importantly, CEHRS focus 100% of their time on maintaining medical billing needs for providers and patients alike.
Wondering how else you might benefit from hiring a CEHRS? Other common tasks in their job description can include:
Managing patient visits
Arranging follow-up care
Issuing prescriptions
Explaining to patients the significance and use of medications for disorders and treatments
Successfully managing the medical billing process can be tedious, but it’s a necessity of a healthy healthcare practice, providing patients with an accurately-summarized bill and providers with a well-maintained revenue cycle to continue providing care.
As a medical company, you are constantly trying to find the balance between offering the best care for your patients and finding the most efficient way to do things. You want to focus on care for your clients but the hassle of medical billing just gets in the way of the things you would rather be focusing on. This is why you hire a professional to take care of these things for you. Instead of finding someone in house to take care of this, why not hire a medical billing company?
Benefits of Medical Billing Services
There are many benefits to outsourcing your medical billing needs. Among the biggest reasons for this is because it can save you money. One way it can save you money is by not having the headaches of constantly hiring and training new staff. This can be very costly because training takes time as well as money having extra people on staff during the training period. If you have a constant turnover of medical billing staff, a medical billing company could be your best investment.
Other reasons to hire an outside company for medical billing include:
The ability to focus on your patients rather than billing, especially if you are not as skilled with the financials.
You find that you are struggling to make any money and need to decide where this loss is coming from.
Ensuring that you have a highly trained staff.
Better control over your finances.
Often times, you will find that payments are processed quicker through an outsourced company.
You will find that a medical billing services company will relieve a lot of the stress that you may have when it comes to the financials of your practice.
These are only a few of the reasons as to why you should considering hiring an outside company to handle your medical billing.
Choosing a Medical Billing Company
Hiring an outside company for medical billing may seem like an unwise investment, but you will actually see a lot more transparency and efficiency. This is because they hire highly trained professionals that know how to use the best software available right now. If you choose an excellent company, you will notice a big change in your practice’s bottom line. A great medical billing company will not just be able to send out bills and work with insurance companies, but they can also boost the revenue of the practice.
If you are looking for a medical billing company, be sure to find a company that works with the latest software on the market today. The latest specialized software will better streamline the entire process for practices. You practice will greatly benefit from having a medical billing company that can more efficiently work through the billing process so that you can spend more time focusing on the needs of your patients. Outsourcing medical billing will only benefit your practice and your patients. Keep this in mind if you are wondering what you can do about your medical billing situation at work.
A cardiology practice faces special challenges when it comes to medical coding. Coders need to be able to transcribe physician notes and code with a high degree of accuracy. Failure to do so can affect patient outcomes and reimbursements, both of which can be devastating. In order to optimize coding in a cardiology practice, consider the following factors.
Automate Where You Can
Human error is the greatest enemy of accuracy when it comes to coding. When trying to manually record long codes with both numbers and letters, however, it’s easy to make a mistake that can cause claim denials or incorrect reimbursements. To bypass these types of errors, automate coding wherever you can and try to eliminate the need for double data entry.
Make Sure Your Coding Knowledge Is Current
Most medical coding and billing software updates automatically to reflect the most current coding guidelines. These can be extremely tough to keep up on if you have office staff that’s trying to stay up-to-date using books and the internet. Still, be sure to keep the most current books on hand for review purposes and make sure that staff members are reviewing updates to keep their knowledge current, even if only for back-up purposes.
Don’t Skimp On the Documentation
Failure to completely document the events of a patient visit can alter the code that is entered and the reimbursement that’s ultimately paid. When in doubt, it’s always better to document more than less. The amount of time that a patient visits, any procedures or examinations that are performed, and any conditions that are present should be noted every time.
Use the Most Specific Codes Possible
Since coding has gotten so much more specific, there can be a plethora of codes for the same condition and procedure with slight variations. It’s important to review the documentation taken during the visit and carefully match the appropriate code. If applicable, use a diagnosis rather than a symptom to get a more specific and accurate code.
Establish Multiple Check Points
It can help to have multiple eyes on codes in order to spot errors. Having staff members, doctors, nurses, and those doing the billing and coding all double checking documentation and coding can help to reduce the likelihood that an error will be missed or that a non-specific code that can be made more specific will go unchanged. Making it a point to have different people review random codes at certain times can help to ensure greater accuracy.
If your cardiology practice could benefit from medical billing and coding services, call 888-783-7818 today.
Medical billing solutions like outsourcing and software are more popular now than ever before, and for good reason. Shifts in healthcare, insurance, and compliance have made billing more confusing and increased the demands for speedy and accurate information. Implementing software or outsourcing billing can help to keep practices competitive and prevent costly errors and penalties.
Changes in Patient Demands
Patients are better educated now than at any point in the past and expect to have more information at their fingertips. Medical billing software can help to update patient records faster than manual in-house billing. Patients may also have an easier time understanding medical billing when it comes from software or an outsourcing company.
Regulations and Compliance
Medical offices and hospitals are under pressure to comply with a whole set of regulations that is being altered and updated on a continual basis. The rapid shifts in compliance requirements can be difficult for an in-house billing team to keep up with.
When billing is outsourced, the billers and coders are experts. When billing software is used, the software automatically updates and both takes care of changes and educates staff.
ICD-10 Coding Switch
The ICD-10 coding switch was completed towards the end of 2015, but contained an overwhelming amount of information for many in-house billing and coding departments. Switching to outsourced billing or software may now save more time than before, which can be good for the bottom line.
Using these options can also help to prevent errors that may cost the office money, frustrate patients, or result in compliance issues.
Increased Patient Volume
With more patients having health insurance than ever before and a greater population of seniors than at any point in the country’s history, many practice offices have experienced an influx of traffic. Implementing medical billing software or outsourcing the service can help offices to deal with increased volume and spend more time on customer service. This could contribute to growth and expansion.
May Improve the Future of Care
Medical billing and accurate coding using the new ICD-10 codes make it possible for statistics bureaus and the Centers for Disease Control and Prevention to obtain more accurate statistics and data regarding medical health than disparate records. By being able to glean information about different health conditions, treatments, and outcomes using codes, it may be possible to extrapolate information that could assist with research and education.
If you are considering obtaining software or outsourcing your medical billing needs, call 1-888-783-7818 today.
Any medical practice depends upon its medical billing in order to generate revenues from the services rendered. Medical billing challenges can inhibit a practice’s ability to collect money owed, which can hamper the practice’s ability to grow and potentially put the practice in jeopardy. Understanding common medical billing challenges can help practices to solve them before they affect revenues.
Incomplete or Inaccurate Patient Information on File
If a patient’s correct insurance information and personal information are not on file, it can result in claim denials and make it more difficult for a practice to collect any money owed by the patient. It is very important that practices ask the right questions in order to collect all needed patient information. After this information is collected, it should be verified and input into the medical billing system immediately.
Failure to Provide Patient with Accurate Quotes for Services
Changes in the health insurance landscape have resulted in a huge shift towards insurance plans with higher deductibles. As a result of this shift, patient responsibility for medical bills is often higher than it was in the past.
Unfortunately, many practices have failed to adapt to this shift and provide accurate quotes for services based on the higher deductible amounts. When patients receive bills that are much higher than what a practice quoted for services rendered, patients are generally less likely to pay the bill promptly.
By taking the time to research what different insurance providers may pay, figure out what patient responsibility will be, and train front office staff to provide quotes accordingly, it may result in better collections. Bills should also be easy to read and closely reflect the way that a quote was given.
Patients that can rely on a practice to provide accurate quotes and not surprise bills will be more likely to pay their bills – and also to stay loyal.
Inefficient Claims Management Processes
Filing health insurance claims is a complex process that is constantly evolving. Relying on an inefficient claims management process can result in more denied claims while wasting staff time. Inefficient processes usually involve manual medical billing or outdated automated systems. Claims management processes can be made more efficient with outsourcing or medical billing software.
Medical Billing Errors
Medical billing errors are a common reason for claim denials, but can also make a medical practice more likely to be flagged for an audit and possibly cost a practice money if claims have been paid for codes that turned out to be erroneous. Since many codes have recently changed and there is now a much larger catalog of codes to be applied, automating medical billing can help to ensure medical billing accuracy.
Implementing medical billing software can help a practice to overcome many billing challenges. If you feel that medical billing software could benefit your practice, contact us today.
