Average Single Specialty practices cater to 42-49 percentage of Medicare Populace!

That means nearly half of your total patient population comprises of Medicare beneficiaries.  And, you could have remained indifferent as long as Medicare’s reimbursements continued to be as normal as private health insurance reimbursements.

While physicians’ have remained immune to its impending backlash thus far, they may not be so lucky henceforth; the Federal Government, unable to contain the exploding Medicare expenditure, has finally pressed the panic-button which physicians had been feared of –

Medicare reimbursements cut and their effects:

Approximately 4-5% cuts expected each year through 2012, – can result in a substantial erosion of practice revenues

Practice will find it hard to compete, sustain, and grow – on marginal revenues from private insurance reimbursements

Extreme possibility – the cumulative effect of such Medicare cuts may even bring practices on the brink of sell-out or closure

Ways to off-set the adverse impact of the imminent Medicare cuts:

Maximize your Medicare reimbursements – error-free billing, coding, and submission

Being eligible for Medicare bonuses and incentives – adopt ACO model of medical care dispensation and compliant EHR practice

Focusing on getting as many reimbursements as you can from – other sources (private health insurance reimbursements and fees)

Get credentialing services for your practices

Outsourcing your billing to dedicated specialists could be the key!

Specialization as their lone concern is to maximize their clients’ revenues from reimbursements

Voluminous operations – helps in reducing the cost of medical billing services

Market-orientation –  ensures that clients’ medical billing practices are compliant with the evolving industry standards

Tackling Medicare as well as other reimbursements with MBC …

Medicalbillersandcoders.com – by virtue of being the leading consortium of medical billers and coders across the U.S – is uniquely poised to play the defining role in this regard. Combining its unique legacy with a comprehensive process of medical billing RCM–Patient Scheduling and Reminders, Patient enrollment, Insurance Enrollment, Insurance verification, Insurance Authorizations, Coding and audits, Billing and Reconciling of Accounts, Account Analysis and Denial Management, A/R Management, and Financial Management Reporting – Medicalbillersandcoders.com additionally offering value added services like consultancy and credentialing promises to guide physician practices through these testing times.

Medical Billers and coders (MBC) is one of the leading Medical Billing Companies  in USA & help doctors to shortlist Medical Billing Companies, Medical Billing Services  according to their preferences of specialty, city, software and services performed.

When was the last time your clinic checked the fees schedule? Streamlining your Medical Billing

Optimizing Fee Schedules for Physicians: An Overview 

The fee schedule for any physician practice is an important pecuniary factor that affects not just your revenue but also the way in which healthcare is delivered to the patients. Many practices fail to update their fee schedules on a regular basis which can affect the profitability and the revenues in the long run. The relation between Accounts Receivables, Collections, and fee schedules is undeniable and therefore it becomes important to set fee schedules that are optimized in order to secure profits and avoid long term losses. 

Here are some factors that affect the way in which fee schedules are set and their effects on the overall revenue of the physician and the clinic: 

• Collections – The collections process is one of the most important aspects in the financial health of a clinic and any uncollected fees or revenue which is written off affects the efficiency of the fee schedules set by a clinic. Collections are not just limited to those received by payers but also apply to co-pays which are collected by patients when they visit the clinic. This co-pay may seem to be a small amount but has immense importance in the long run and affects the efficiency of the working of fee schedules for providers.

• Setting the Correct Fee Schedule – Setting the correct fee schedule can be a complicated task that requires patience and dedicated effort in order to guarantee optimization of financial benefits for the clinic in the long run. Fee schedules should be such that they reflect the complete value of the services that are provided and ensure that the providers are paid a meaningful amount of remuneration in order to avoid losses.

• Discounts and Sliding Fee Schedules – There are many cases where the patient may not be able to pay a part of the amount and needs a discount. In such cases a sliding fee schedule can be set up if the patient falls under the poverty line and these can be set up so that they are set at an amount lower than the actual fee schedule and increase over a period of time. This procedure can give you the accurate amount of fees collected by such patients and assist in correct evaluation of revenues and profits.

• Time and Costs – The actual costs of the service provided and the time that you dedicate for a certain procedure are also important factors that influence the financial efficiency of your fee schedule. If you believe that the time and costs of the procedure is high compared to the remuneration that you are being provided by the payer then there is certainly a scope for negotiations in order to ensure increase in the fees and optimization of revenue as well as optimum utilization of time.

• Medicare Fee Schedules – The Medicare Fee Schedules are calculated by the formula [(Work RVU x Work GPCI) + (PE RVU x PE GPCI) + (MP RVU x MP GPCI)] x CF, where GPCI is the Geographic Practice Cost Indices, work RVUs are the relative levels of time and intensity that are associated with a Medicare service and account for 50% of the total payment amount associated with that particular service, PE RVUs are the Practice Expense RVUs that are associated with the costs of maintaining an office such as renting of equipment, buying furniture etc, MP RVUs are the Malpractice RVUs, and CF is the conversion factor. The CF is updated every year and stands at $24.6712 for the year 2012 and is calculated based on factors such as medical inflation, the probable expansion in the domestic economy, projected growth in the number of recipients in Fee-For- Service Medicare, and changes in regulations and laws.

One-stop Solution 

The complexity and the various laws and regulations that govern the fee schedules make it a difficult task to check the appropriateness of fee schedules on a regular basis. The only method of ensuring that your fee schedule is efficient and accurate is outsourcing this task to professionals who are aware of the latest changes in not just fee schedules but also the other factors that influence it. Medical billers and coders who are experienced in not just revenue cycle management but also efficient in handling practice management solutions and other aspects of billing and coding can ensure that fee schedules are checked regularly and any lacunae and errors removed so as to optimize the revenues of providers in the long run. 

Medical billers and coders at Medicalbillersandcoders.com are capable of not just checking fee schedules but are also the largest consortium of medical billers and coders in the United States that provide various other important services such as research, effective interaction with payers, accounts receivable analysis, practice management solutions, and efficient revenue cycle management services that aim to streamline such various functions for smooth and competent fee schedules for your practice. 

Medical Billers and coders (MBC) is one of the leading Medical Billing Companies  in USA & help doctors to shortlist Medical Billing Companies, Medical Billing Services  according to their preferences of specialty, city, software and services performed.

Growing trend in medium size clinics referring to medical billing outsourcing

Small and Medium size Clinics: Great Expectations 

Small and Medium sized clinics face unique type of challenges in almost all functions of physicians and staff such as administration, revenue cycle management, Electronic Health Records (EHR) implementation, and the challenge of keeping pace with the recent health reforms. The nature of the core functions as well as the other departmental processes that were efficient in a small clinic are found to be lacking in mid-sized and growing practices due to various reasons. However, the most important factor that has influenced the need for change in almost all the processes in a medium sized clinic is due to the reforms in addition to the change in the structure of the clinic or practice. 

The Overdose 

The recent health reforms aim to insure almost 32 million uninsured Americans and this demand overdose is one of the reasons for adoption of EHRs and stress on a paperless office and such other changes. Moreover, the increase in the aging population, lack of specialized geriatric physicians, and a booming population has added fuel to the flames. What is more, coping with such increased pressure even with EHRs and the incentives is a difficult and cumbersome task that requires training and a paradigm shift in the way various processes are carried out in clinics, whether small or mid-sized. 

Under the Microscope 

Small & Medium sized clinics usually have simpler administrative processes and these become more and more complex requiring a microscopic analysis of such processes in order to understand the errors and pitfalls that may bring about gloomy financial outcomes for providers. Areas such as EHR implementation, medical billing and coding, and other back-office functions also become complex and voluminous requiring the support of professionals who can provide adequate assistance in the form of training, the streamlining of various back-office processes and the handling of various pecuniary concerns such as Accounts Receivables, and Collections. Small mistakes can cost growing clinics a big chunk of their remuneration and therefore requires a microscopic study and a scientific approach towards various back-office functions including interaction with payers and error free coding. 

Developmental Care 

The health industry in the country is changing at a rapid pace and it becomes important for physicians to ensure that the stress caused by financial or administrative errors does not affect their core functions and to an extent require “Developmental Care” in order to cope with the financial as well as core aspects of their practice. Such care can be provided by back-office professionals, and medical billing and coding companies that are backed by various other professionals carrying out functions such as RCM, consultancy and research in order to create an ideal environment for small clinics to operate efficiently and thrive under such a dynamic environment. 

Medical billing outsourcing 

Medical billers and coders at Medicalbillersandcoders.com are not just armed with the latest ICD-10 codes but are also backed by a team of research professionals who can find the errors in various medical billing processes and diagnose the problems leading to loss of revenue and also keep you up-to-date with the changes taking place in the health industry. With the assistance of cutting edge technology, experience, and skill,Medicalbillersandcoders.com also assist in placement of such medical billers and coders in small to mid-sized and growing clinics in order to assist in increasing the bottom line of such providers along with the quality of the care that is delivered. Clubbed with these functions are other vital services such as effective RCM, research, consultancy, payer interaction, and HIPAA compliance which can bring about a positive change in the various processes involved in managing a small to mid-sized clinic.

Advantages of Utilizing Medical Billing Services

These days most doctors prefer cost-effective medical billing services as opposed to maintaining in-house billing staff to obtain maximum profits. Out-sourcing their billing to a reputable and knowledgeable billing service allows them to increase their revenue without spending their precious time collecting insurance and patient balances. It is important to consider several items that will help you evaluate the contract between you and the medical billing service provider. Important points to keep in mind are the work quality, level of customer service as well as the pricing of these services.

A few advantages of out-sourced medical billing services are as follows:

• You can utilize billing services on a percent of collections which means that the billing company is motivated to collect for you as they too will increase their revenue.  It also means that the money you pay out monthly is solely dependent on the revenue generated, keeping billing fees in direct alignment with collections received.  In-house billing costs are hard costs as they are the same each month regardless of how well the collections are. Outsourcing also allows you to concentrate on your clinic and your patients’ care. Having a medical billing company which uses a team of knowledgeable people to complete your billing ensures accurate medical billing services that fit within your budget.

• Utilizing a medical billing company can lead to higher profits as such companies are skilled in reviewing billing for correct coding and reimbursement rates for CPT codes, reviewing EOBs for correct reimbursement and can be aggressive in collecting monies owed to the doctor.   Having more than one pair of eyes looking at your billing is essential in having a check and balance system for your billing.  A good medical billing company means many billers on the back end to manage your billing efficiently.

• Hiring medical billing services allows a physician to concentrate on their business.  When the worry of how the money is coming in to run the practice is eliminated, the doctor’s energy can be directed at patient care, which is why they became a doctor to begin with.

• Some billing services also offer consulting to help train in billing procedures and changes in coding and billing.  Such knowledge may help you to increase practice productivity and project a positive image to your patients thus encouraging an increased number of patients to visit your hospital or clinic.

• The patient interaction with the billing service is crucial.  Having a healthy billing service as part of your practice cannot be stressed enough.  Bad billing can inhibit current patients from returning and certainly impact new referrals.

 Source By : http://lasvegasmedicalbilling.wordpress.com

Inviting Medical Billers And Coders

Electronic Medical Billing, a preferred way improve your collections

As the insurance reimbursement environment becomes increasingly stringent, the incidence of denials, delays, underpayments, and lost or ignored claims seems to be on the rise. Consider this interesting statistics compiled by the Centers for Medicare and Medicaid Services (CMS: 70% of claims are paid the first time they are submitted; 30% of claims are either denied (20%) or lost or ignored (10%); 60% of denied, lost or ignored claims will never be resubmitted; 18% of claims will never be collected. Therefore, it is obvious that physicians are losing a substantial portion of their reimbursements unable to keep pace with medical billing challenges. But it is not a thing that can be neglected as medical reimbursements happens to be the life-line of medical practices.

While it is certain that the dwindling reimbursement rates are the resultant of inadequate medical billing and RCM practices, it is also true that physicians have not been fully responsive to web-based medical billing and practice management software, which are deemed to be far superior to manual billing practices. The fact that physicians can expect today’s medical billing technology to adapt to situational demands of medical billing reimbursements makes these web-based medical billing and practice management software indispensable to resurrect the dwindling reimbursements, which on an average aggregate to  $125 billion yearly.

The first step in claim realization begins with accurate coding without scope for denials. Therefore it is imperative that physicians’ medical billing is intuitive enough to forecast and adapt in such way that would negate the chance of denial. But, because billing staff’s ability is limited, billing software with proactive rules engine has become more reliable. The significant thing about proactive rule engine is that it can automatically identify claims that are likely to be denied and correct them before being submitted for claims. Consequently, you can expect an increase in first pass resolution rate, acceleration of claim realization, and considerable reduction in workload for your in-house staff.

It is strange yet true that practices are reimbursed far below than what they are entitled for. Moreover, the reimbursements tend to be different despite the procedure being the same. While these discrepancies in reimbursements rates may emanate from payer contracts, it is highly unlikely that physicians will be able to figure exactly which payer contract is yielding underpayment. Fortunately, they can turn to software that can automatically compare the actual payments received with the payments specified in each payer contract, and alerting them when discrepancies occur. Such software module that is capable of tracking discrepancies in reimbursements will eventually augment collection rates, promote physicians’ efficiency and growth, and make accurate financial prediction.

The efficiency of claim realization has always hinged on how best physicians handle A/R Management. Time factor is the crucial thing in A/R Management: less time your claims stay in A/R bracket, better your practices’ financial health. But, of late physicians have been complaining of their A/Rs consuming more than the admissible time limit of 90 days and eventually ending up as bad debts. Therefore, it is imperative that physicians respond to the challenges in A/R management through seamless integration of claim generation, submission, follow-up, and remediation. Electronic medical billing – built on sound Practice Management systems – promotes harmonious integration of claim generation, submission, follow-up, and remediation aimed at speeding up the Account Receivable Cycle.

While physicians contemplate on turning around their practices’ revenues with new found technological platform (electronic medical billing), cost and method of installation may be matter of immediate concern. Assistance from a medical billing service to help install an electronic billing system integrating with the areas most required by the practice and handle the A/R will help improve collections. Medicalbillersandcoders.com – by virtue of being credible, competent, and self-sufficient in offering cost-effective – comes across as a leading name. Its strategic partnership with leading PMS and EHR vendors lends its medical billing services the technological edge.

Medical Billers and coders (MBC) is one of the leading Medical Billing Companies  in USA & help doctors to shortlist Medical Billing Companies, Medical Billing Services  according to their preferences of specialty, city, software and services performed.

How medical billing services contribute to retaining patients at your facilities

The intense competition in the healthcare industry is triggering unprecedented benefits to the patient fraternity. While the quality of medical care has improved by leaps and bounds, patients now, have choices and alternatives just in case they feel deterioration in the perceived level of medical care. This sudden shift in favor of patients means physicians will now have to devise ways in not just attracting patients but also retaining.

One of the prime factors in patient-retention has always been the quality of medical care. However, with most of the physician practices conforming to the benchmarks in quality, support services are emerging as differentiators. Therefore, as much as keeping their quality of medical care unblemished, physicians will need to engage their patients with complementary services throughout their stay at the facilities. Consequently, a full-pledged and competent support staff becomes inevitable in complementing physicians’ efforts to promote retention and engagement of patients. Amongst chores of clinical and operational duties that these support staff attend, following are deemed more pertinent to the objective of patient engagement and retention:

• Scheduling an appointment:
  Patients often feel it difficult to schedule an appointment with their doctors owing to doctor’s busy schedule. While it may be true that doctors are always pre-occupied with some medical emergency or the other, yet it is the duty of the support staff to accommodate slots so that patient need not go disappointed with not having to schedule an appointment with the doctor/s they feel more secure with.
• Making their stay comfortable:
  Patients often complain of support services during their stay in the medical facilities. This will have a serious impact on patients’ decision to come back again. Therefore, support staff, along with administering clinical duties as per doctor’s advice, should also make patients feel at home.
• Follow up on the progress post discharge:
  Most physician support staff deems it complete once the patients are discharged from the facility. But, medical care concern goes beyond that; patients will be happy if they are enquired of the progress post discharge. Moreover, it kind of restores their faith in the medical facility from which they had derived medical care.

Physicians would not have been concerned if they had only to assign these services as part of their endeavor to engage and retain patients. But, the fact that most of the support staff’s energy is spent on billing and negotiating claims with insurance companies, there is a likelihood of adverse impact on physicians’ main objective of patient engagement and retention to augment dwindling practice revenues. The thought of expanding the base of support staff to augment medical billing too is losing its relevance owing to heavy implementation cost associated with mandatory EHR, and the ensuing ICD-10 & HIPAA 5010 compliant clinical and operational practices.

In such a scenario, physicians would do well to entrust their support staff with only clinical functions, and outsource medical billing, and Revenue Cycle Management (RCM) services from competent and credible sources. Medicalbillersandcoders.com – being the largest consortium of medical billers and coders in the U.S – is resource-rich in dispensing valued-added services in medical billing and RCM. Its comprehensive suite of medical billing and RCM – comprising patient scheduling and reminders, patient enrollment, insurance enrollment, insurance verification, insurance authorizations, coding and audits, billing and reconciling of accounts, account analysis and denial management, A/R management, and financial management reporting – is ample proof of its competence.

Medical Billing Services: A Safe Passage for Denial and Delay Management

Payer denials and delays is a cause of worry for every doctor in the US. A denied or a delayed claim leads to loss of revenue for the physician. To top it all the physicians are now looking at an uncertain future working in the Medicare program due to introduction of reimbursement cuts. In the light of recent events, it is crucial that doctors be paid on time for the service they render to patients. Medical billing services have created a safe platform for medical institutes and doctors that manage end to end billing cycles and leaves medical practitioners to concentrate on their core responsibilities, i.e. to provide healthcare. 

Let’s review the current economic situation facing physicians before we begin to focus on how medical billing services can offer the much needed respite to the medical fraternity. 

The Current Economic Climate 

There is an atmosphere of ambiguity looming over the US healthcare industry. The Congress has initiated a 27.4 percent cut in doctors’ fees under the Medicare program. These cuts have been proposed to control and balance the healthcare budget. Though the physicians have received some reprieve until this legislation takes effect; the cuts have put an undue strain on the doctors practicing in private clinics. 

This economic crunch is forcing doctors to run their private practices by tapping into their personal assets. Generally a third of patients that a doctor treats are on Medicare. With private insurers also following Medicare rates the reimbursement amounts are further plummeting. Cuts proposed in this program will leave doctors in a difficult position. They will not be able to keep up with costs of running a private facility. This may lead to closure of private clinics thereby creating a shortage of medical resources available to public. 

Until the government finds a more permanent solution to fix this problem doctors and physicians have to focus on being reimbursed appropriately and timely by payers to ensure their practices stay afloat. 

Why Medical Billing Services? 

An assured way to guarantee accurate and timely payment of claims is to outsource the billing process to medical billing companies. It has been noted that medical billing companies can save up to 40% in costs for physicians and hospitals. To understand the benefits of medical billing services, it is important to first discuss why claims are denied or delayed by the payer. 

Issues surrounding delays and denials: 

• Incorrect patient or insurance details
• Lack of supporting documentation
• Incomplete claims
• Inaccurate Coding
• Doctor’s clinic submits claims to wrong insurer
• Lack of communication with the payer
• Not having an AR process in place to follow up on delayed claims 

Amidst all the mayhem besieging denial management, doctors’ income suffers a massive blow. Due to denials, hospitals’ lost proceeds accounts for 6% to 10% of net revenue nationwide. This figure specially looks bad because 90% of denials are actually preventable. Medical billing companies can manage billing requirements efficiently. It can fortify the financial condition of a clinic or hospital. Let’s evaluate the ways in which billing services adds value to the medical industry.

Advantages: 

• Dedicated team that specializes in denial management
• Coding specialists code the claims
• Client specific billing models put in place
• Work is done as per HIPAA compliance
• Fast and accurate methods deployed to submit claims
• AR team follow up claims in a timely fashion
• Use of pronounced billing software 

Cost reduction is a major challenge facing medical practitioners today. By seeking services from medical billing companies  issues ensuing from delayed and denied claims can be nipped in the bud. Medicalbillersandcoders.com is the largest consortium of billers and coders across the U.S that specializes in denial management. Their skills also extend to other areas of billing such as credentialing, managing accounts receivables, charge entry and payment posting.  MBC has perfected the art of medical billing because they understand the value of time and money.

Improve your Revenue by Overcoming Hurdles in EMR implementation

There has been a definite improvement in the United States in the adoption of Electronic Medical Records (EMR) and its implementation in the last decade (2001-2011). A report by Centers for Disease Control and Prevention (CDC) states that 57 percent of office-based physicians in the country have adopted EMRs. However, 34 percent of physicians only have a basic system, which means that only 22 percent of physicians have a fully functional EMR system. Therefore, only 22 percent of physicians are qualified for the incentives and are demonstrating “Meaningful Use” (MU). The reasons for the poor adoption rate of fully functional EMR systems lie in the numerous functional hurdles faced by providers in successfully implementing a fully functional system.

The steep learning curve involved in fully implementing EMR/EHR systems is one of the biggest hurdles that are faced not just by physicians but also by their staff.

• The complicated process of complying with the “Core” and “Menu” objectives in the demonstration of MU is just the tip of the iceberg
• The technical support, training, maintenance, and cost of implementation are the hidden prerequisites that make the process of full EMR/EHR implementation a cumbersome and delicate process

Office-based physicians have found it more difficult to fully implement a functional and complete EMR even though they would benefit more from the incentives compared to hospitals.  The revenue of office-based physicians is definitely going to be affected after 2015 when health reform policies are fully implemented. The adoption of a universal health policy that insures almost 32 million uninsured citizens has added a new dimension to the hurdles faced by physicians in the adoption and implementation of fully functional EMR systems. Physicians are short of time are striving to streamline all the processes from scheduling to revenue cycle management in order to create a steady platform for demonstrating MU through efficient EMR/EHR implementation.

The health reforms have not just affected the core functions of physicians but have also impacted the way in which various other departmental processes are carried out. The migration from ICD-9 codes to ICD-10 codes, new insurance policies, expansion of the scope of medical coding procedures, adoption of innovative IT services, and the changing payment models implicate a paradigm shift in the way health care is delivered and the way in which providers operate.

In this scenario need for an active approach through a medical billing service towards payer interaction and denial management is being felt as the wheels of health reform start to turn, medicalbillersandcoders.com, catering to US physicians across all states for more than a decade now, offer not only medical billing and coding services but also provide better revenue cycle management, professional denial management services, effective payer interaction, fully functional EMR/EHR implementation consultation and other ‘back office’ services essential for boosting revenue and providing qualitative services to patients.

Medical Billers and coders (MBC) is one of the leading Medical Billing Companies  in USA & help doctors to shortlist Medical Billing Companies, Medical Billing Services  according to their preferences of specialty, city, software and services performed.

AR aging over to 120 days – Is it Prudent to opt for a medical billing service?

Accounts receivables (A/R) management is a vital element of revenues for physicians and forms a crucial part of a physician’s revenue because of the role of insurance companies and other similar entities in the whole revenue cycle process. There are several methods of managing accounts receivables and there are no common techniques of evaluating this aspect of a business.

One of the most sought after methods of calculating the A/R balances is utilizing a A/R aging schedule -by separating the ‘age’ of Accounts Receivables into “buckets “ from 0-30 days, 31-60 days old, 61-90 days old or 90 days and older. The most unwanted scenario would be where the A/R is 120 days old and this definitely means that a mistake has been committed either by the payer or the insurance company or during medical billing and coding. The chances of an error occurring or even deliberately made by an insurance company is one of the major factors that can cause such a delay in A/R and denied claims due to errors by insurance companies stands at almost 19% of all claims submitted.

The reluctance of insurance companies to pay is a factor that seems universal- however the key aspect is the efficiency of the medical billing and coding and how the back-office staff performs. A/R aging over 120 days is not uncommon and numerous hospitals, physicians and providers have at least 10% of their claims which have aged over 120 days. However, the dampener is that A/R over 120 days are usually not paid and the majority of these need to be written off.

The best method of ensuring 95-98% payment is to prevent the A/R or claims denied or pending to go over 90 days and this can only be done by following certain measures:

• Interaction with payers plays a crucial role in ensuring that delays are avoided and resubmission of claims is speedy enough to avoid the aging of A/R over 90 days
• The role of Health IT is also crucial in A/R since it reduces the time and days in A/R and also helps in reduction of errors since claim submission is increasingly becoming electronic
• Moreover, the reforms have also played an important role in that it has provided the opportunity for medical billers and coders to expand their coding base which allows for little room for errors and is also HIPAA compliant

However all these factors may come together to pave the way for increased volume of medical billing that is expected in the near future due to government policies, heightening the need of a stand-alone entity that follows aggressive collection policies and does not commit any errors in claim submissions. Hence some physicians find prudence in opting for medical billing service which either charges a flat fee for their services including A/R, while some charge the physician or the provider only when remuneration is procured.

Medical billers and coders at Medicalbillersandcoders.com serving the healthcare industry for over a decade has been managing the entire Revenue Cycle of various physicians across diverse specialties and all 50 States. MBC’s billers and coders easily integrate all factors like- HIPAA compliance, up-to-date knowledge of the billing industry along with the support of extensive research that helps in providing services that are attuned to a healthy A/R which in turn saves the physician lost revenue due to lesser denials and delays in claim submission.

Medical Billers and coders (MBC) is one of the leading Medical Billing Companies  in USA & help doctors to shortlist Medical Billing Companies, Medical Billing Services  according to their preferences of specialty, city, software and services performed.

Appealing a claim- Will a standard format work to improve your practice’s medical billing?

The procedure of appealing an insurance claim is intricate, although it can be successful if completed properly because there are many grounds for claims to be denied by an insurance company or a payer. The payer collects a lot of claims on a daily basis and the claim can be easily denied if there has been a mistake in analysis or Medical Billing and coding errors including many others. Furthermore, there is also a requirement to understand if the claim is of importance because a claim of a very small amount need not be appealed and can be written off but one which is worth a considerable sum needs to be scrutinized. However the physician’s office in this case may need to apply various measures considered the following challenges.

In Denial

The fact that a physician or practice receives the accurate amount of reimbursement even when the claim is not denied is a wrong assumption. Insurance companies may con a physician out of his or her fair share of reimbursements in many ways that are very difficult to detect and need a dedicated and keen professional to find the lacunae in the proper reimbursement of physicians since almost 19% of claims denied are due to errors of the insurance companies. This especially holds true in the case of private insurers due to errors made by the insurance companies in claims and detecting these errors requires skill and sustained effort. As a result some physicians and practices are reluctant to appeal denied or underpaid claims since this may increase the administrative work and expenses. However, nothing can be further from the truth when considering the long term repercussions of the monetary benefits that can be enjoyed even with 5-10% increase in revenue which can be a considerable amount.

The Impact of Reforms

In the face of reforms, revenues are set to increase dramatically along with administrative and billing process as 31 million uninsured Americans receive insurance. Appealing a denied claim is becoming voluminous but the new billing and coding procedures are aimed at making this process of reimbursement or appealing much smoother with the transition from ICD-9 codes to ICD-10 codes and adoption of the 5010 platform and emphasis on quality care and patient privacy through HIPAA compliance. The importance of time and money cannot be overemphasized and denied claims, especially for private insurance companies, have to be appealed within a stipulated period of time after the claim is denied. Therefore preventive steps to save time such as error reduction through analysis and a scientific approach in Revenue Cycle Management (RCM)  is required in order to sustain the low rate of denial over longer periods of time.

Vital Signs

Analyzing the pattern in which claims are denied by an insurance companies and finding out the most common false denials is a crucial part of the process of appealing denied claims. Denied claims can fall in various categories such as:

•    Errors in documentation
•    Services not covered
•    Mistakes in medical billing and coding
•    Technical difficulties involving Electronic Health Records (EHRs)
•    Not considered “medically necessary” by the payer

Arguing your case becomes more difficult due to the huge amount of laws, rules, and regulations that seem to drown the actual cause of the denial. Thus customization of claims becomes much easier when they can be categorized and scientifically solved within a given period of time.

Scientific approach

In this scenario appealing a claim may require more than a standard format and physicians short of time can benefit by acquiring services of a Medical Billing Service. Medical billing and coding experts at Medicalbillersandcoders.com not just perform basic coding and billing functions but are also backed by a team of research professionals who ensure efficient RCM, productive payer interaction, and a scientific approach towards collections with the “bucket” approach in Accounts Receivables (AR) and prompt reimbursements for physicians and practices all over the country with complete HIPAA compliance.

Medical Billers and coders (MBC) is one of the leading Medical Billing Companies  in USA & help doctors to shortlist Medical Billing Companies, Medical Billing Services  according to their preferences of specialty, city, software and services performed.