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Should I outsource my medical billing out of state?

From the Atlantic to the Pacific: Using an Out-of-State Medical Biller When it comes to organic produce, local is probably best. Looking for a plumber? Using a guy from your zip code is probably the way to go. However, when it comes to outsourcing medical office services such as billing and credentialing it can prove to be very cost effective to search outside of your local area. The first question medical offices may have is this: Is it even legal to use an out-of-state service? As a matter of fact, it is absolutely legal and many medical offices choose non-local service providers. When shopping for a remote medical biller, be certain to convey to the service that you expect them to be knowledgeable about any and all related statutes that may apply to your state, outside of federal guidelines.

The reasons for using an out-of-state service are varied. It may be that that you can get a more reasonable rate with a non-local company or the service level that you can receive at a distant company may be better than what you are able to get locally. Additionally, many practices would rather that their immediate medical community (including billing services) not be privy to their financial information, client base or revenue stream. In some areas these communities are fairly tight-knit and information may flow in ways in which physicians do not approve. Another reason can be the additional services that a remote company may be able to provide to your medical practice. While simply getting the billing piece out of your hair is great, perhaps you also want someone to work on credentialing, create web content or tackle other administrative duties. Frequently, wrapping up a package deal is much cheaper than using several vendors for a variety of functions. Also, an off-site company may have unique expertise in your type of specialty and utilizing them may maximize your reimbursement from payors. This may hold true for an allergist, anesthesiologist, specialty surgeon or chiropractor. In some of those cases, there can be bundling or benefit issues that a particular biller may be savvy about. Thus, using them is healthy for your bottom-line. Finally, perhaps you live in part of the country where medical billing services are not on every corner the way Starbucks are jumping out at you on every street in New York City. For those in the Upper Peninsula of Michigan, isolated Alaska or mid-South Dakota medical biller resources may just not be there. In those cases, off-site is a very logical choice.

How to Make the Most of Medicare Reimbursements in 2011

How to Make the Most of

2011 Medicare Reimbursement

Every summer, medical practice office managers as well as physicians anxiously await the release of Medicare reimbursement rates for the following year. While reports leading up to the big reveal usually let them know which way the scale will be tipping, in these tough economic times financially based predictions are something of a carnival game.

Even if the medical practice has a very low Medicare patient base as a whole (think: Pediatricians or Pediatric Sub-Specialties), many payor contracts utilize a Medicare based schedule. For instance, your contracts may provide for Medicare + 10% or something along those lines. Thus, even those contracts will be affected by fluctuating Medicare rates.

In very early 2010 Medicare Payment Advisory Commission (more commonly known simply as MedPAC) recommended to Congress a one percent increase in Medicare physician reimbursement. At first blush, this seems like a very low figure especially when you consider the cost of living yearly increase is at least triple that amount.

Thus, depending on Medicare alone to float the budget of an individual medical office is not sage financial advice. While it is true that the economy is rebounding, once Medicare rates are secured for 2011 medical offices will be stuck with those figures for 12 full months. Further, Washington lobbyists who advocate for the best interest of physicians will continue to assert that Medicare reimbursements are sub-par but even those efforts are bigger picture and will not affect your A/R in the next quarter.

As a physician practice you need to get creative with ramping up income as a way to mitigate any low Medicare rates that apply to your practice. The easiest way is to renegotiate your payor contracts. If your current contract is Medicare based, appeal with the payor to move instead to a standardized fee schedule. Some of the larger groups such as Blue Cross/Blue Shield utilize this methodology.

If you are paid via capitation, you need to make certain that the payor shows you each year what you are making as compared to Medicare. In many cases, the HMO or medical group will provide standardized reports showing the value of services the practice provided (typically affixing a Medicare rate) and compare that to capitation paid.

Be sure to look at these reports carefully and be certain that your office is being paid the capitation dollars that it deserves. If you are falling at or below Medicare then it is time to hit the table for a serious negotiation session.

Credentialing – Keeping it In-House vs. Outsourcing

Credentialing:

Keeping It In-House vs. Outsourcing

Credentialing and recredentialing can be a major headache for many medical practices. The process can be tedious, time-consuming and frustrating. Further, most offices do not have the staffing to dedicate one employee to the entire process. In some cases, these credentialing responsibilities are very “hit and miss”. It is only once claims get denied or you get a very formal looking and somewhat intimidating letter from a health-plan or your states Department of Insurance that folks start to take the process seriously.

The decision concerning whether to delegate this duty to a third party really depends on the staffing of each individual medical office as well as the expertise level of the contracted party. After all, what you don’t want to do is hand over this task to someone else only to have it result in the same sort of disarray as it was in the home office.

Further, should the medical office fall behind in recredentialing duties with individual health-plans then there is a great likelihood that the physician will be decredentialed from the plan. This causes not only a denial of claims, but the physician usually is required to revert back to the credentialing process. This is much more time consuming than recredentialing and will provide a serious interruption in service for patients.

The advantage to outsourcing the spectrum of credentialing duties is that the professionals have experience and volume on their side. Additionally, they have standardized methods that allow for a streamlined process. The professionals also typically have direct relationships with payors (including HMO medical groups) and those relationships can provide for expedited processing.

Of course, the advantage to keeping credentialing duties in-house is the expense of a third party company. However, if you weigh that fee against the potential loss of income due to a provider being decredentialed (coupled with the resulting denial of claims) many offices find it to be a wise investment in their medical practice.

Patient Collections in a Dicey Economy

Show Me the Money:

Patient Collections in a Dicey Economy

Anyone who has sat in the lobby of a medical office is well aware of the awkward moment at the window when the receptionist is attempting to collect for medical services rendered. The uncomfortable exchange typically ends with an agreement to bill the patient at a later date.

Most medical practice consultants roundly disapprove of this system and emphatically encourage collecting fees at the time of service. In fact, many offices have gotten into the habit of collecting copayments prior to seeing the physician. It is further recommended that clear signage is in the lobby concerning payment expectations as well as reminding them at the time that the appointment is made, “It is our office policy to collect copayments or outstanding balances prior to being seen by the physician”. This simple extra step can work wonders.

For tertiary providers such as radiologists, pathologists or anesthesiologists, collecting at the time of service simply is not an option due to the nature of their business. In those cases, billing post-service is par for the course. Further complicating matters for these specialties are their inability pre-service to determine the patient’s correct health-plan and associated financial responsibility.

With many states facing double digit unemployment, foreclosures on the rise and general financial panic abounding it seems that getting prompt patient payment for medical services is a nothing more than an urban myth. If the choice for some of these individuals is food on the table versus a CBC from a year ago, the medical bill will remain unpaid.

The key to effective medical collections is, simply, not to let the balance go to collections. The decision to send an account to a collection agency is an individual preference per medical practice. And once the bill is sent off, the physician is likely to see only a small percentage of those funds ever returned to them.

To avoid that, offices should make every effort to collect from the patient on their own. This can mean a personal, empathetic phone call to the patient. It can also mean working out an extended payment plan. For those who have no insurance or are under-insured, the physician may want to take a deep discount on their charges which brings it down to at least Medicare level. In the midst of these collection efforts, it is a sound policy to operate with compassion and understanding, in lieu of hostility and unrealistic demands.

EMR

Even with the need for an effective and trustworthy process for handling medical information, a comparatively small percentage of medical organizations have implemented electronic medical record (EMR) systems. These medical care organizations have utilized their traditional, paper-based strategies for such a long time that they really do not think that there’s a very simple approach to make the switch to electronic medical records. However, you will find loads of benefits to an electronic medical records, generous support provided by licensed & HIPAA compliant EMR companies, and that they can more than outweigh the starting costs of the EMR system.

An electronic medical record is just a digital legal medical record that may be stored on a centralized location and easily shifted to a specified location when it is needed, whether it is in a modest, local practice or a huge medical center. This type of convenience and security helps to make an EMR a good choice for today’s medical practices.
Considering the present health care product, lots of people state it’s open to human error and doesn’t generate a sufficient amount of quality or safety. It also has contributed to greater costs plus more time squandered tracking down and making paper records. An EMR will be able to do away with a great deal of these problems and assist in saving a lot of money.
It will be much simpler to enter information, standardize forms, and keep information updated with EMR’s.
Storage needed for EMR’s is minimal compared to paper documents.

Upset over premium increases? Read on…

Thankfully, we have some news that does not include politics, what is or is not being built in Manhattan, the plugged oil well in the Gulf and the worst kept secret of the year, where is Chelsea Clinton getting married. We found some great news, sort of, on a pay cut for a CEO.

Despite a 6 percent pay cut, Aetna CEO Ron Williams’ compensation in 2009 was valued at more than $18 million, making his pay package $5 million higher than WellPoint’s Angela Braly. Braly, you may recall, was highly criticized for receiving a 51 percent compensation increase from 2008 to 2009 on the heels of controversial premium rate increases for individual policy holders.

On second thought, we might all want to stick to politics

EMR Feature Alert | .MD

Does your current EMR Software Offer HIPPA Compliant | SECURE EMAIL FUNCTIONALITY?

An August 11th article on iHealthBeat, Sending Text Messages to Teens With Diabetes Boosts Drug Adherence, shows how modern technology such as texting can improve patient’s health. With the .mdEmail package, practices have the ability to email messages and reminders from .mdEmail to patient’s cell phone. With the number of juvenile diabetes patients in America today, not only do the parents and the children have to know the signs to look for, but the teachers and nurses in the schools as well.

Sending Text Messages to Teens With Diabetes Boosts Drug Adherence

A small pilot study at Columbus, Ohio-based Nationwide Children’s Hospital found that adolescent patients with diabetes who received text messages related to their medication plan were less likely to miss treatment doses, Healthcare IT News reports.

The rate of non-adherence to medication regimens among adolescent patients is four times higher than the rate for adult patients.

In the study, Nationwide Children’s Hospital endocrinologist Jennifer Dyer sent her adolescent diabetes patients personalized questions and reminders tied to diabetes adherence. She also sent messages offering support to the patients. It is of utmost importance that the teachers of the adolescent diabetes patients know the questions and reminders of diabetes adherence for the child to maintain the proper insulin levels throughout the day.

Dyer’s questions touched upon patients’ glucose testing, meals and the frequency of high and low glucose levels. After three months, Dyer said patients who received the texts were three times less likely to miss a dose. As a nation, we need to make this standard operating procedure in all schools. It will not only be a health factor for the children but also an educational factor as well. When the child’s blood sugar levels are too high or too low, they can’t concentrate and thus, do not do well in class.

iPhone App

Dyer has applied for an internal grant to test an iPhone application she developed that would allow endocrinologists to send automated, personalized texts to several patients at a certain time (Merrill, Healthcare IT News, 8/10).

Final Rule Analysis – EMR

Here’s my analysis of the key changes in the Final Rule:

As we have recently stated, HHS has adopted the HIT Policy Committee recommendation to frame Meaningful Use as core requirements and discretionary requirements. In so doing, they have reduced the total number of requirements and introduced choice. There is still much to learn and implement prior to the CMS payments that begin May 2011.

Overall this final rule maintains a balance between the policy objectives sought and the technology changes possible that are achievable now. There will still be 3 stages of meaningful use and later stages will be more demanding. All the original stage 1 requirements will still be part of meaningful use by stage 2.

In January of 2011, the clinicians may begin the 90 day process of using a certified record per meaningful use requirements. Attestation of this use begins in April 2011. It is extremely important, prior to investing in a EMR product, that it not only meets the criteria of Meaningful Use but also supports the practices with the training needed to obtain the reimbursements from the government.

Are There EMR Incentives Outside of Medicare and Medicaid?

The short answer (at least for now) is not really. The ARRA EHR stimulus money is provided through Medicare and Medicaid programs as “bonuses” for those who show “meaningful use” of a “certified EHR.”

With that said, there are some grants available for special situations. For example, they have a beacon communities program which are given to organizations that will supposedly take EHR software to the next level and be examples for their communities of what can be done with IT and EMR software.

We’ve heard that there are other grants that practices can apply for also, but I’m not sure all of the details. We’ve also heared that there might be some EMR stimulus money available in the latest healthcare reform bill. For example, I read somewhere recently that the healthcare reform bill includes some stimulus money for long term care which has basically been left out of stimulus money as well.

Meaningful Use

At a news conference on Tuesday, where speakers included HHS Secretary Kathleen Sebelius, new CMS Administrator Donald Berwick, National Coordinator for Health Information Technology David Blumenthal, and Surgeon General Regina Benjamin it was announced that the $27.3 BILLION will now be a bit easier to gain access to for both providers as well as hospitals nationwide.

Thanks to some revisions, the “Meaningful Use Regulations” that providers must follow include 20 criteria under a formula that includes 15 mandatory quality measures and 5 others that can be choosen from a “menu” of 10. This change lightens up the otherwise “all or nothing” criteria that was previously set forth.