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.

‘Pay-as-you-go’ as a value-based medical billing service model

While we are not alien to the term ‘pay-as-you-go’, it is something that is catching the imagination of physicians opting for outsourced medical billing services. Unlike in the past, when ‘pay-as-you-go’ was sporadically availed by a few physicians, it is now emerging as a viable alternative to long-term contractual medical billing services. Well… what is this ‘pay-as-you-go’ service model after all and what makes it so affable to physicians opting for outsourced medical billing services? Much true to its name, ‘pay-as-you-go’ service model’ is a niche medical billing service wherein physicians are obliged to pay their service provider (usually a percentage of the eventual reimbursement) only when they approach for getting their bills reimbursed. Usually, a percentage is worked out prior to soliciting ‘pay-as-you-go’ medical billing services from prospective medical billing companies. The reason why the present-day generation physicians deem ‘pay-as-you-go’ service model’ appropriate is primarily because of their restrictive financial ability as well as being able to transact on value-based system. 

The surge in the demand for ‘pay-as-you-go’ service model’ has its roots in a combination of factors – spiraling cost of contractual billing services, continuous fall in reimbursement rates, rapid increase in stand-alone or small physician practices, and less incidence of insurance-backed medical services, popularly known as cash-based services. The thought of countering this adverse impact on physicians’ revenues through in-house medical billing seems to have lost its significance amidst the monumental cost associated with switch over to mandatory EHR, and the ensuing ICD-10 & HIPAA 5010 compliant clinical and operational mandate. While physicians are convinced of the efficacy of ‘pay-as-you-go’ service model’ in countering their sagging revenue fortunes, service providers need to be equally responsive to such demand from physicians. Notwithstanding it being an additional service portfolio in the medical billing companies’ service offering, many medical billing companies are apprehensive of the future of the contractual model. But, their reasoning may not be true. 

The main reason why they may not be true in assuming ‘pay-as-you-go’ service model to be detrimental to the future of the contractual model is the fact that large hospitals, clinics, multispecialty groups, and more importantly the ACOs will continue to drive the demand for contractual model of medical billing services.  Therefore, ‘pay-as-you-go’ service model will not come in the way of their main service portfolio, but will only evolve to be an additional revenue source. In view of such scope for additional portfolio of service, medical billing services would do well to strategically expand their ‘pay-as-you-go’ service model to the areas where challenges faced in medical billing are rampant. On the whole, it puts both physicians as well as service provides in a win-win position. 

While most of the medical billing companies are still analyzing the pros and cons of ‘pay-as-you-go’ service model, Medicalbillersandcoders.com (www.medicalbillersandcoders.com) – by virtue of being the largest consortium of medical billers and coders across the U.S – has already begun to reach to the physician practices in need of ‘pay-as-you-go’ service model. The strategic spread of its diverse medical billers and coders across the regions dominated by stand-alone practitioners makes it easily accessible and affordable.

The growing emphasis on Medicare-specific medical billing services

Medicare, which continues to remain as the nation’s largest public health insurance scheme covering nearly half the United States’ population in its health insurance ambit, has gone through considerable reforms over the years. In fact, the evolution of Medicare can be defined as:

1. Phase-I when it actually used to reimburse physicians the actual cost of medical services
2. Phase- II when it introduced Fee Schedule formula to marginally discount the reimbursements
3. Now when it is linking reimbursements to the level of Physician Quality Reporting System (PQRS) adopted by physicians

While the Federal Government believes that Physician Quality Reporting System (PQRS) will complement its endeavor to curb the sky-rocketing Medicare expenditure, which has already overshot the Sustainable Growth Rate (SGR) by nearly 25%, the response from the physician community has been a mixed one.

• A recent report by the Centers for Medicare & Medicaid Services shows that fewer than 200,000 physicians, out of the more than 600,000 who were eligible for the incentive program, reported PQRS measures
• More than 125,000 physicians reporting as individuals met enough of the requirements to share a total of nearly $400 million in bonuses, but hundreds of thousands of eligible doctors did not attempt to meet the pay-for-reporting criteria
• More than 50,000 tried for the bonuses but did not report enough quality measures to hit the minimum

Judging by these statistics, PQRS is still a long way from witnessing cent percent voluntary participation from the physicians across the nation.

Inevitably, the CMS (Center for Medicare Services), which happens to be the governing body in the US, has made it clear that it will introduce penalties (along with the current system of incentivizing physicians meeting and surpassing the PQRS) beginning with 2013.  Consequently, physician community – which looked encouraged by Federal Government’s recent announcement of extending Medicare to every citizen – will have to contend with mandatory PQRS compliance to avoid getting penalized.

One of the first steps to comply by PQRS mandate is the implementation of an effective and efficient EHR implementation for clinical and operational excellence. Furthermore, such EHR implementation should be customized in a way that responds to Medicare’s PQRS requirement. Physicians, who are already faced with the monumental task of transiting to ICD-10 and HIPAA 5010 clinical and operational functioning, will surely be overwhelmed by the PQRS burden.

Therefore, in view of these inherent demands, physicians would do well to collaborate with service providers who not only specialize PQRS-specific EHR implementation, but also make it responsive ICD-10 and HIPAA 5010 compliant clinical documentation needs. Such collaboration with credible service providers would necessarily yield multiple results:

• Frees physicians from the burden of attending to non-core activities
• Qualifies their practices for incentives and bonuses along with maximizing their Medicare revenue generation
• Above all improves their goodwill, which might pave way for further expansion of medical services across multiple locations

As physicians seek to collaborate with external service providers for PQRS-specific EHR implementation, and ICD-10 & HIPAA 5010 compliant clinical documentation needs, Medicalbillersandcoders.com – with the requisite technical competence and professional excellence – should not only be able to ensure PQRS-specific EHR implementation, but also make it responsive ICD-10 and HIPAA 5010 compliant clinical documentation needs. The combination of strategic partnership with leading EHR vendors, a dedicated a team of Medicare billing & coding professionals, and a rapport with Medicare makes it the most sought-after Medicare billing service provider in the U.S.

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.

Leverage your business with excellent medical billing services

When people go to hospitals or clinics for treatment or to doctors for consultation, they are expected to pay the medical bills after the procedure has been completed. However, billing services can be difficult if the staff has to do the billing statements for several people at the same time. In most instances, the patient wants to leave the hospital or clinic quickly upon release and does not want to wait for the billing statements. Letting the patient go and mailing the medical bills later on can lead to many errors, inaccurate bills and delays in transmittal to the patient, resulting in high accounts receivable problems. More so, if the doctor is not financially stable and needs the payments to sustain his daily operations. This and other related problems can be resolved through efficient electronic billing services. Some establishments implemented electronic systems within their premises with notable success. However, medical institutions found that keeping pace with the volume growth and new technology increased their operating costs significantly. Studies showed that it was more cost effective to pay for outsource billing services.

There are companies that specialize on medical billing services. The institution submits the transactions to the outsource company who transforms the information to electronic data by encoding. The data is then compiled and printed on an invoice, and given to the patient for payment.  If the patient was covered by medical insurance, a claim form would be prepared and submitted to the insurer for claims payment. This was the initial simplified approach. But as outsource companies became more proficient and experienced in medical billing services, with the help of advanced technology, they were able to improve their processes dramatically.

Outsource companies had to ensure 100% accuracy and completeness in the medical bills. If the bills contained too many errors, the medical institution would not be paid immediately. There would be a time delay while people remediated the errors and omissions. There had to be sufficient details in the statement so people could trace the transaction and verify its correctness. People have to be trained and educated on the encoding and transcription of data. This resulted in a highly trained and competent team of billers and encoders within the outsource company. Also, outsource companies had to ensure the personal and related medical information was present in the medical bills. Data such as patient’s name, address, physician’s name and the nature of illness had to be encoded and maintained in database repositories. In so doing, a medical history of the patient was achievable. This and other improvements can make outsource companies provide excellent medical billing services to help your business prosper.

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