Whenever a health care provider or a hospital plans to have a full fledged medical billing department with billing clerks, it is very essential to think twice and make sure to choose well experienced billing staff. Today fortunately, outsourcing the entire medical billing process is a cheaper option that is available.
Quite often there have been instances when the in-house billing staff does not have the sufficient experience and does not possess the sufficient in-depth knowledge about coding. This will result in loss because claims cannot be made properly and may require rebilling. Moreover, instances of many scandals in this area of health sector have been rampant. Considering the various risks it is a must to outsource the medical billing to a trustworthy and reliable professional billing company.
Before signing a contract for outsourcing of medical billing with a company a proper enquiry about the company and its history is essential. Also checkout the following information from the outsourcing company and see how good they are.
* Do they provide reports?
* What is their collection rate?
* What is their specialty?
* Do they use a HIPAA-compliant format?
* Are they well staffed?
* Do they code also? (not preferred)
* What percentages are accounts receivable?
* Do they follow up on delayed /denied claims?
* Have they had face to face meetings with clients?
Encounter forms are usually completed and sent to the billing company along with the insurance card, registration cards on a weekly or daily basis. Most of the medical billing companies have medical billing software to prepare the bill and then submit it for claims. Bills to Medicare and other bigger insurance companies are generally sent via a clearing house. Many companies use doctors to scan the encounter forms.
How much does medical billing service cost for a physician? Billing companies charge doctors a percentage of what they collect and the rate depends on the doctor’s specialty. Specialists are charged lesser than the primary doctors because specialists mean lesser claim and bigger amount.
Above article publish on http://www.mymedicalbillingoutsourcing.com/outsource-medical-billing-care/
Showing posts with label Medical Billing Coding. Show all posts
Showing posts with label Medical Billing Coding. Show all posts
Monday, May 31, 2010
Friday, May 7, 2010
How To Evaluate Medical Billing Services
By, Chris Thorman
We recently penned a post, “Should You Outsource Your Medical Billing,” which compared outsourcing the revenue cycle management process to managing that function in-house with medical billing systems. Assuming you go for the former option – outsourcing – this post will help you make the right choice of medical billing service companies.
How can a provider tell the difference between a fly-by-night medical billing company and one to which they can hand overtheir patient’s medical information with confidence? If a physician knows what criteria by which to judge a medical billing service, they’ll be able to select a company that will significantly decrease their time spent on billing issues and increase their time spent on patient care.
To choose correctly, a provider will need to evaluate these five key criteria when choosing a medical billing company:
* Level of service;
* Industry experience;
* Use of technology;
* Pricing model; and,
* Capacity to take on new clients.
What Functions Will a Billing Service Perform?
Before getting into the selection details, let’s quickly review how a billing service fits into the medical billing process. A medical billing company will be able to take over most billing functions in a provider’s office.
To see a substantial benefit, a provider needs to select a medical billing service that performs at least these functions:
1. Claim generation and submission;
2. Carrier follow-up;
3. Payment posting and processing;
4. Patient invoicing and support; and,
5. Collection agency transfer services.
These functions are the “guts” of medical billing. Following up with insurance carriers and pursuing denied claims are two areas where medical billing services typically excel versus a provider’s in-house staff.
Other services that may be offered include credentialing, medical coding, transcription, insurance eligibility verification and appointment scheduling.
Naturally, as the number of services increases, fees will increase. A provider will want to strike the proper balance between cost and service by honestly evaluating their own capacity to perform these functions.
Criteria #1: Level of Service
In addition to the basics of medical billing mentioned above, there are more details a provider will want to be clear on before choosing a medical billing service. Here are some important functions that a provider and billing service should delineate before they enter into a partnership:
Function
Possible Issues
Pursuing denied claims Will the service pursue denied claims or will the provider have to? If they do pursue denied claims, a provider will want to know what procedures the company has in place to do so to ensure they aren’t being paid lip-service.
Billing follow up If a patient doesn’t pay their bill, who follows up? Many medical billing services will correspond with patients regarding billing issues, which for many providers is a necessary function to outsource.
Complying with regulations By handing over a patient’s medical information to a third-party, a provider becomes responsible for the third-party’s compliance with the Health Insurance Accountability and Portability Act (HIPAA). The billing service must protect patient privacy to the same degree that the provider does.
Reporting and analysis One of the other benefits of a medical billing service is that they’re going to have business insight that a provider doesn’t. Will the service provide feedback about how to improve the practice? Or just send a one-page financial statement each month?
It’s important that a provider and a billing service agree on the level of service before they get started. If the right level of service isn’t chosen, a provider won’t reap the full benefits of outsourcing their medical billing.
Criteria #2: Industry Experience
When a provider evaluates a medical billing service’s experience, they need to look beyond the number of years the company has been in business. Experience includes not only time but also familiarity with certain specialities. Billing certification plays a key role here as well.
Billing procedures will vary by medical speciality, so a provider will want to choose a billing service that is familiar with their specialty. Experience with billing to Medicare and Medicaid will be a huge plus, in any speciality.
Choosing a service with staff members that are certified by the American Medical Billing Association (AMBA) is important as well. The AMBA offers a Medical Reimbursement Specialist certification designed to promote professional medical billing.
The certification implies that the recipient is knowledgeable in the areas of:
* ICD9, CPT4 and HCPCS Coding;
* Medical Terminology;
* Insurance claims and billing, appeals and denials, fraud and abuse;
* HIPAA and Office of Inspector General (OIG) Compliance;
* Information and web technology; and,
* Reimbursement.
Even with a certified staff, the proper procedures and technology will need to be employed to maximize benefits of the provider/billing service relationship.
Criteria #3: Use of Technology
Software for medical billing is allowing billing services to accomplish more with less. However, just because a company is using sophisticated billing software doesn’t necessarily mean they’re going to do an efficient job. They need to have the proper procedures in place to take advantage of everything the billing company software offers.
Most importantly when it comes to technology, a provider will want to know about a company’s information sharing, data security, recovery procedures, data backup procedures.
Here are some potential technology issues in those realms that will need to be addressed:
* How will superbills and claims be shared?
* How does billing service fit with the provider’s electronic health record (EHR) strategy?
* Does the service have an integrated EHR?
* How does the service ensure data security?
* What are the disaster recovery procedures?
* Where and how is backup data stored?
* Will a provider need to install and maintain software or access the system online?
* Is the technology HIPAA compliant?
Choosing a medical billing service company that employs technology in a way that effortlessly bridges the gap between provider and biller can mean the difference between profit and loss. By choosing a medical billing service that integrates with a provider’s EHR (or provides their own EHR), that gap can be closed even more.
Criteria #4: Pricing Options
When dealing with practices whose revenue is in the millions of dollars, the cost savings between pricing models can be in the hundreds of thousands of dollars.
There are three pricing options offered by medical billing companies and we’ve broken them down in the table below:
Description
Pros
Cons
Percentage-based The service will charge a percentage of collections or they will charge a percentage of gross claims submitted or total collections. The success of the billing company is tied to the success of the practice. Small claims may not be pursued as aggressively due to lower payoff.
Fee-based With this model, the billing services charges a fixed dollar rate per claim submitted. This model is potentially more cost effective. Less incentive for the billing service to follow-up on denied claims.
Hybrid With this model, the billing service charges on a percentage basis for certain carriers or balances and charges a flat fee for others. This model is potentially more cost effective. Less incentive for the service to follow-up on certain claims.
Percentage-based models are most common on the market today. Fee-based models are the next most common option with the hybrid option appearing with less frequency. Many billing companies offer two or three of these options.
Criteria #5: Capacity to Take on New Clients
Finally, a provider will want to get into the nitty gritty of a medical billing company’s performance to evaluate whether the company has the capacity to take them on as a client. Remember, much of the payoff in hiring a billing service comes from the pursuit of denied claims and fee collection. A billing service that doesn’t have the capacity to effectively follow up with outstanding bills will provide minimal benefit.
Determining capacity involves collecting a number of metrics about the company’s performance, including:
* Years in the business;
* Number of employees and reporting structure;
* Number of clients by specialty;
* Gross number of billings; and,
* Number of claims processed annually.
Knowing this information will help a provider determine the level of service a billing company will be able to provide to their practice. Getting even more detailed, a provider will also want to delve into a number of “quality” metrics about billing companies. These include:
* Average number of days in A/R by specialty;
* Coding, submission and follow-up delay metrics;
* By what percentage they’ve been able to increase revenues for existing clients; and,
* By what percentage they’ve been able to reduce payment delays.
How a medical billing service performs on each of these metrics will significantly affect a provider’s bottom line.
Above article publish on http://www.mymedicalbillingoutsourcing.com/evaluate-medical-billing-services/
We recently penned a post, “Should You Outsource Your Medical Billing,” which compared outsourcing the revenue cycle management process to managing that function in-house with medical billing systems. Assuming you go for the former option – outsourcing – this post will help you make the right choice of medical billing service companies.
How can a provider tell the difference between a fly-by-night medical billing company and one to which they can hand overtheir patient’s medical information with confidence? If a physician knows what criteria by which to judge a medical billing service, they’ll be able to select a company that will significantly decrease their time spent on billing issues and increase their time spent on patient care.
To choose correctly, a provider will need to evaluate these five key criteria when choosing a medical billing company:
* Level of service;
* Industry experience;
* Use of technology;
* Pricing model; and,
* Capacity to take on new clients.
What Functions Will a Billing Service Perform?
Before getting into the selection details, let’s quickly review how a billing service fits into the medical billing process. A medical billing company will be able to take over most billing functions in a provider’s office.
To see a substantial benefit, a provider needs to select a medical billing service that performs at least these functions:
1. Claim generation and submission;
2. Carrier follow-up;
3. Payment posting and processing;
4. Patient invoicing and support; and,
5. Collection agency transfer services.
These functions are the “guts” of medical billing. Following up with insurance carriers and pursuing denied claims are two areas where medical billing services typically excel versus a provider’s in-house staff.
Other services that may be offered include credentialing, medical coding, transcription, insurance eligibility verification and appointment scheduling.
Naturally, as the number of services increases, fees will increase. A provider will want to strike the proper balance between cost and service by honestly evaluating their own capacity to perform these functions.
Criteria #1: Level of Service
In addition to the basics of medical billing mentioned above, there are more details a provider will want to be clear on before choosing a medical billing service. Here are some important functions that a provider and billing service should delineate before they enter into a partnership:
Function
Possible Issues
Pursuing denied claims Will the service pursue denied claims or will the provider have to? If they do pursue denied claims, a provider will want to know what procedures the company has in place to do so to ensure they aren’t being paid lip-service.
Billing follow up If a patient doesn’t pay their bill, who follows up? Many medical billing services will correspond with patients regarding billing issues, which for many providers is a necessary function to outsource.
Complying with regulations By handing over a patient’s medical information to a third-party, a provider becomes responsible for the third-party’s compliance with the Health Insurance Accountability and Portability Act (HIPAA). The billing service must protect patient privacy to the same degree that the provider does.
Reporting and analysis One of the other benefits of a medical billing service is that they’re going to have business insight that a provider doesn’t. Will the service provide feedback about how to improve the practice? Or just send a one-page financial statement each month?
It’s important that a provider and a billing service agree on the level of service before they get started. If the right level of service isn’t chosen, a provider won’t reap the full benefits of outsourcing their medical billing.
Criteria #2: Industry Experience
When a provider evaluates a medical billing service’s experience, they need to look beyond the number of years the company has been in business. Experience includes not only time but also familiarity with certain specialities. Billing certification plays a key role here as well.
Billing procedures will vary by medical speciality, so a provider will want to choose a billing service that is familiar with their specialty. Experience with billing to Medicare and Medicaid will be a huge plus, in any speciality.
Choosing a service with staff members that are certified by the American Medical Billing Association (AMBA) is important as well. The AMBA offers a Medical Reimbursement Specialist certification designed to promote professional medical billing.
The certification implies that the recipient is knowledgeable in the areas of:
* ICD9, CPT4 and HCPCS Coding;
* Medical Terminology;
* Insurance claims and billing, appeals and denials, fraud and abuse;
* HIPAA and Office of Inspector General (OIG) Compliance;
* Information and web technology; and,
* Reimbursement.
Even with a certified staff, the proper procedures and technology will need to be employed to maximize benefits of the provider/billing service relationship.
Criteria #3: Use of Technology
Software for medical billing is allowing billing services to accomplish more with less. However, just because a company is using sophisticated billing software doesn’t necessarily mean they’re going to do an efficient job. They need to have the proper procedures in place to take advantage of everything the billing company software offers.
Most importantly when it comes to technology, a provider will want to know about a company’s information sharing, data security, recovery procedures, data backup procedures.
Here are some potential technology issues in those realms that will need to be addressed:
* How will superbills and claims be shared?
* How does billing service fit with the provider’s electronic health record (EHR) strategy?
* Does the service have an integrated EHR?
* How does the service ensure data security?
* What are the disaster recovery procedures?
* Where and how is backup data stored?
* Will a provider need to install and maintain software or access the system online?
* Is the technology HIPAA compliant?
Choosing a medical billing service company that employs technology in a way that effortlessly bridges the gap between provider and biller can mean the difference between profit and loss. By choosing a medical billing service that integrates with a provider’s EHR (or provides their own EHR), that gap can be closed even more.
Criteria #4: Pricing Options
When dealing with practices whose revenue is in the millions of dollars, the cost savings between pricing models can be in the hundreds of thousands of dollars.
There are three pricing options offered by medical billing companies and we’ve broken them down in the table below:
Description
Pros
Cons
Percentage-based The service will charge a percentage of collections or they will charge a percentage of gross claims submitted or total collections. The success of the billing company is tied to the success of the practice. Small claims may not be pursued as aggressively due to lower payoff.
Fee-based With this model, the billing services charges a fixed dollar rate per claim submitted. This model is potentially more cost effective. Less incentive for the billing service to follow-up on denied claims.
Hybrid With this model, the billing service charges on a percentage basis for certain carriers or balances and charges a flat fee for others. This model is potentially more cost effective. Less incentive for the service to follow-up on certain claims.
Percentage-based models are most common on the market today. Fee-based models are the next most common option with the hybrid option appearing with less frequency. Many billing companies offer two or three of these options.
Criteria #5: Capacity to Take on New Clients
Finally, a provider will want to get into the nitty gritty of a medical billing company’s performance to evaluate whether the company has the capacity to take them on as a client. Remember, much of the payoff in hiring a billing service comes from the pursuit of denied claims and fee collection. A billing service that doesn’t have the capacity to effectively follow up with outstanding bills will provide minimal benefit.
Determining capacity involves collecting a number of metrics about the company’s performance, including:
* Years in the business;
* Number of employees and reporting structure;
* Number of clients by specialty;
* Gross number of billings; and,
* Number of claims processed annually.
Knowing this information will help a provider determine the level of service a billing company will be able to provide to their practice. Getting even more detailed, a provider will also want to delve into a number of “quality” metrics about billing companies. These include:
* Average number of days in A/R by specialty;
* Coding, submission and follow-up delay metrics;
* By what percentage they’ve been able to increase revenues for existing clients; and,
* By what percentage they’ve been able to reduce payment delays.
How a medical billing service performs on each of these metrics will significantly affect a provider’s bottom line.
Above article publish on http://www.mymedicalbillingoutsourcing.com/evaluate-medical-billing-services/
Thursday, April 15, 2010
Something for everyone to take note of: Medical Billing Companies
Thinking about integrating physician financial services into your future plans for your physician clinic isn’t a minor action to take. It’s a significant subject, covering an extensive list of benefits, all of which facilitate the effective running of your business whilst maximizing your profits. Cut down on those worries and pressures and ensure that you meet with each legal regulation. If you’re not already sure, let us tell you why you should make use of one of these billing services.
The key advantage of utilizing such a business is the serious amount of time it will save you. Just think of the hours spent, every week – consider the tracking, handling and invoicing and all those related chores which make up a medical center’s administration. Sometimes it even detracts from the care of clients. Working with an expert provider will mean that they take care of all these aspects, in addition to several other issues, for example copying, credit checking and collection and delivery services. Its duties might even include organizing plans for payments, or even processing compensation for workers.
Redeploying these tasks will give your medical staff the time to concentrate on what’s important – caring for clients in the most effective and efficient manner. It will cut back your costs and help stop you stressing out over those jobs. Don’t all clinic staff have more important things to be concerned about than billing industry methods? Professional medical billing services will concentrate totally on this special matter. They are experts in such rules, technologies and procedures involved with established medical billing processes. Not only will this save time, money and effort, it will rule out the likelihood of your health clinic confronting judicial issues. Accuracy is really important in billing services. However, when you work with expert help, you can relax, safe in the knowledge that standards are established to catch and resolve the infrequent unfortunate mistakes immediately.
Making use of specialist a specialist service like this is an intelligent financial investment for medical professionals such as GPs, physiotherapists and doctors, and services including health centers and infirmaries. However, concerns such as size and costing should not completely govern your choice from the various companies available – ensure that you search for the best company for your physician practice.
Above article publish on http://www.mymedicalbillingoutsourcing.com/note-medical-billing-companies/
The key advantage of utilizing such a business is the serious amount of time it will save you. Just think of the hours spent, every week – consider the tracking, handling and invoicing and all those related chores which make up a medical center’s administration. Sometimes it even detracts from the care of clients. Working with an expert provider will mean that they take care of all these aspects, in addition to several other issues, for example copying, credit checking and collection and delivery services. Its duties might even include organizing plans for payments, or even processing compensation for workers.
Redeploying these tasks will give your medical staff the time to concentrate on what’s important – caring for clients in the most effective and efficient manner. It will cut back your costs and help stop you stressing out over those jobs. Don’t all clinic staff have more important things to be concerned about than billing industry methods? Professional medical billing services will concentrate totally on this special matter. They are experts in such rules, technologies and procedures involved with established medical billing processes. Not only will this save time, money and effort, it will rule out the likelihood of your health clinic confronting judicial issues. Accuracy is really important in billing services. However, when you work with expert help, you can relax, safe in the knowledge that standards are established to catch and resolve the infrequent unfortunate mistakes immediately.
Making use of specialist a specialist service like this is an intelligent financial investment for medical professionals such as GPs, physiotherapists and doctors, and services including health centers and infirmaries. However, concerns such as size and costing should not completely govern your choice from the various companies available – ensure that you search for the best company for your physician practice.
Above article publish on http://www.mymedicalbillingoutsourcing.com/note-medical-billing-companies/
Friday, March 19, 2010
Medical Billing Service – HIPAA Compliance
Medical Billing Services ensure compliance of The Health Insurance Portability and Accountability Act (HIPAA) of 1996. HIPAA regulation protocols are issued to protect client’s information safely. It also encourages the use of electronic processing and data transferring through multiplexer, router or modem which ensure high degree of privacy. HIPAA has issued laws to release information confidentially. HIPAA complaint medical billing service is unique feature of medical billing company. Specialized billing procedures are:
• Insurance authorization and verification
• Cash posting and reconciliation
• Weekly or monthly evaluation
• Billing and enrollment
• Coding
• Updating anti-virus soft ware
HIPAA complaint software packages
HIPAA complaint medical billing software ensures easy way of sending electronic claims at a faster and cost effective way. It reduces claim rejection, increase collection and avoids delays. It provides a variety of functions like:
• Electronic medical billing
• Preparing patients ledger
• Processing billing information and insurance payments
• Claim submission electronically
• Rebilling of insurance claims
• Electronic medical records
• Covering patience insurance authorization
• Recording patients notes
• Medical coding
• Statement cycle billing
Hiring HIPAA Compliant Medical Billing Service
HIPAA compliant medical billing service provides track for patient statistics and diagnoses with security of health details. It provides medical billing and coding services, quick turn around time and high level of security. Those medical billing companies following HIPAA regulation protocols can assure services confidentially. So it’s better to hire a company that strictly follows all HIPAA protocols prescribed for medical industry. Such a medical company reduces work load and improve cash flow.
Above article publish on http://www.mymedicalbillingoutsourcing.com/medical-billing-service-hipaa-compliance/
• Insurance authorization and verification
• Cash posting and reconciliation
• Weekly or monthly evaluation
• Billing and enrollment
• Coding
• Updating anti-virus soft ware
HIPAA complaint software packages
HIPAA complaint medical billing software ensures easy way of sending electronic claims at a faster and cost effective way. It reduces claim rejection, increase collection and avoids delays. It provides a variety of functions like:
• Electronic medical billing
• Preparing patients ledger
• Processing billing information and insurance payments
• Claim submission electronically
• Rebilling of insurance claims
• Electronic medical records
• Covering patience insurance authorization
• Recording patients notes
• Medical coding
• Statement cycle billing
Hiring HIPAA Compliant Medical Billing Service
HIPAA compliant medical billing service provides track for patient statistics and diagnoses with security of health details. It provides medical billing and coding services, quick turn around time and high level of security. Those medical billing companies following HIPAA regulation protocols can assure services confidentially. So it’s better to hire a company that strictly follows all HIPAA protocols prescribed for medical industry. Such a medical company reduces work load and improve cash flow.
Above article publish on http://www.mymedicalbillingoutsourcing.com/medical-billing-service-hipaa-compliance/
Wednesday, March 17, 2010
Efficiency Rates of Medical Billing Rise With Electronic Medical Billing Services
With the emergence of electronic medical billing, mistakes in medical billing have drastically reduced. Now that many if not most insurance carriers file claims electronically as do many hospitals, the paper trail of claims and bills is reduced or eliminated all together. Personal security and confidentiality is better protected this way too. Instead of doing medical billing and claims in-house, many physicians are outsourcing their billing to third party medical billers for better medical practice management. When physicians outsource their medical billing, they are reducing the stress and the work load of their staff. The front office waiting room personnel already have a lot of their plate, putting out fires in various ways from emergency care to basic office maintenance. Unburdening them from a stack of medical claims to enter into the system as well as file and mail gives them hours of extra time to dedicated to other important tasks. Outsourcing doesn’t mean physicians suddenly lose control of all of their patient’s billing- now with the Internet; anyone who is certified can log into the electronic medical billing system and watch the progress of a client’s claim from beginning to end. Here Are Other Benefits to Outsourcing Your Medical Billing HIPPA laws are automatically updated for you, so you can feel confident about new updates and requirements. Less paper handling mean fewer errors and more efficient billing Consistent legible handwriting because claims are typed in rather than written When bills are sent electronically, it is sent within seconds which means bills are being paid faster, physicians are collecting more money faster When physicians invest in an electronic medical billing service, they are also getting the other tools and products that come with the service. Physicians can run reports, set schedules, email and maintain an overall more efficient medical practice management with everything being accessed electronically. Even more, several physicians and or nurses can log onto the practice at one time and all have access to reports, claims and patient files.
Above article publish on http://www.mymedicalbillingoutsourcing.com/efficiency-rates-medical-billing-rise-electronic-medical-billing-services-2/
Above article publish on http://www.mymedicalbillingoutsourcing.com/efficiency-rates-medical-billing-rise-electronic-medical-billing-services-2/
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