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.