Things to Consider When Outsourcing to a Medical Billing Company

Choosing a medical billing company is a big decision, as it plays a vital role in the efficient management of records as well as submission of claims. With outsourced medical billing services, you can gain maximum reimbursement from your medical billing. As there are a number of medical billing service providers in the market, it is quite challenging for you to choose the one that best fits your need. This article will guide you in selecting a reliable medical billing outsourcing firm that can ideally meet your needs.

Some Important Tips

You have to carry out a complete evaluation in order to locate reliable Medical Billing Companies. The following tips will help you identify the right medical billing provider.

• Ensure that the firm has enough years of experience to meet the requirements of your medical facility.
• Evaluate the number of employees who support the account.
• The practice management system provided by the company must be useful and user-friendly.
• Check whether they provide a comprehensive medical billing package
• The company must provide easy access to information such as outstanding claims, charge data, user notes, follow-up information, and payments.
• Check whether they use the most up-to-date software such as NextGen, IDX, Medisoft, Inception, and Lytec.
• In addition, assess the security features the firm us
• Make sure that the billing company you approach will provide you the maximum returns.
• Check whether they follow HIPAA regulations and ensure strict confidentiality of data.
• Ensure whether the service provider provides timely billing.
• Ensure custom medical billing solution is available.
• Reports should be provided on a daily, weekly or monthly basis.
• Ensure that there are no hidden charges
• Figure out the quality of service
• Check for the provider's obligation to regulatory compliance
• Confirm the file transfer is done securely

Choosing the right firm based on the above factors will help you find the right billing partner for your service.

A medical billing company will work for any type of practice no matter what specialty in medicine you practice. Physician groups, individual physicians, free standing diagnostic facilities, clinics, long term care facilities, acute care facilities, multi specialty groups, hospitals and many others can benefit from Medical Billing Services.

Outsource your medical billing requirements to a reliable and professional medical billing company. Having the support of a professional medical billing outsourcing firm will not only reduce operating costs, simplify workload, cut down denials, increase reimbursement, save your valuable time and enhance your office efficiency but will also help you maintain a strong relationship with the clients and insurance companies.

Article Source: http://bill.ezinemark.com/things-to-consider-when-outsourcing-to-a-medical-billing-company-7d35c1a6ae03.html

ICD-10 codes and its Impact on Denial Management

The transition from ICD-9 codes to ICD-10 codes presents a huge challenge for medical billers and also affects health care delivery system and physicians’ revenues. The staggering number of additional codes makes the learning process complex. Moreover, the scope for error increases which is exacerbated by a harder denial management process. Insurers have a distinct opportunity to target the increased volume of ICD-10 codes for finding ample mistakes to postpone payment.

Here are some of the basic  impacts of the transition from ICD-9 to ICD-10 codes pertaining to denials:

Basic Difference

The basic difference between ICD-9 codes and ICD-10 codes is that they are more compact even when carrying in-depth information about the case. This helps in identifying the correct rules to be applied as far as reimbursement and insurance policies are concerned. Quantitatively there are more ICD-10 Codes compared to ICD-9 and this also means that the newer codes help in further clarifying the information at hand. However, denial management would face problems due to the increased scope of errors by insurance companies due to the new codes.

Insurance Companies

Claims and reimbursements may be delayed or rejected due to several reasons by insurers due to – differences in the codes sets that cannot be accounted for because of unavoidable compromises in the conversion, conscious efforts to take advantage of the more precise ICD-10 code set; hence Physician practices will be wise to include ICD-10 in their payer agreement negotiation discussions to decrease their risks concerning compliance errors and claims denials.

The Time Factor

The time factor can play a crucial role in deciphering the codes since the volume of ICD-10 codes is high compared to ICD-9 codes. This might mean longer waiting periods for reimbursements and more number crunching for medical billing and coding companies. Another hurdle facing a clinic or a provider is that medical billing and coding is a highly demanded profession and this transition of codes would make it more competitive, making it costlier than before.

The Impact on Patients

ICD-10 codes have been used in numerous countries and the United States was one of the few developed countries to use ICD-9 medical coding system. Although denial management consists of correcting errors and other important functions, the new health care reform has almost ensured that insurance companies and payers cannot deny claims on the basis of errors which can reach a staggering 19.7% out of total claims submitted. This high percentage of denial of claims is one of the biggest hurdles in denial management and it is difficult to predict whether ICD-10 codes would work in favor of denial management and if it would impact patients favorably.

For more information about denial management, EMR and EHR implementation, consultancy, revenue cycle management, please visit medicalbillersandcoders.com, the largest consortium of medical billers and coders in the United States. Medicalbillersandcoders.com billing and coding professionals are charged up for the change and to further this trend Medicalbillersandcoders.com is offering a training program to all medical billers and coders through this platform to a career revamp ensuring transition to ICD-10 with confidence.

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.

Advocating and Practicing Best Practices in Medical Billing

For years, Medicalbillersandcoders.com has been synonymous with medical billing management – helping medical practitioners not only realize their medical reimbursements fully but also optimize their clinical and operational efficiency. While the medical billing complexities have consistently been escalating – owing to unprecedented increase in insured population and the risk associated with managing insurance reimbursements – we have been able to off-set its effect through consistently remodeling our medical billing Revenue Cycle Management (RCM) to the benchmarked industry standards. As a result, time and again, our ingenious medical billing processes have come to fore in mitigating adverse impact on our clients’ medical bill reimbursement, and ensuring optimal realization of reimbursements, clinical and operational efficiency.

Here is a rundown of the “Best Practices in Medical Billing” that we have been advocating and practicing in ensuring optimal realization of reimbursements, clinical and operational efficiency, and compliant processing of medical claims as per the Federal Healthcare norms:

• Eligibility Verification or Pre-Screening is the foremost on list of Best Practices in Medical Billing; the objective is to determine the patients’ eligibility for the insurance coverage for which the medical intervention is sought. Further, it also ensures knowing in advance what is covered or what in not before a patient is registered and admitted for clinical management.
• Understanding Coverage:  Understanding how the respective insurance carrier would reimburse the eventual cost of medical services is as important as verifying the patient’s eligibility for the insurance coverage for which the medical intervention is sought. As it is the insurance company that ensures the reimbursement on behalf of the patient, there should be clear communication and clearance from the respective insurance bearer.
• Billing Competence: Often medical coding and claim submission can go wrong owing to inherent errors while preparing medical bills for the medical services concerned. Therefore, due vigil needs to exercised while preparing bills that form the basis for eventual coding and claim submission.
• Coding Compliance and Competence: As much as billing competence, coding too hold its importance in flawless claim submission and realization. As the outcome of a medical bill largely hinges on coding compliance and competence, medical bills should invariably accompany ICD and HIPAA compliant coding procedure for medical procedures.
• Electronic Claim Submission and Follow up: As the system of IT-enabled claim submission and follow up becomes more common, medical claims submission need to be managed through electronic medium for seamless and faster realization.
• Managing the Revenue Cycle: As the incidence of claim submission become too voluminous, your claims may take a little while for realization. But, as the sustenance and growth of your practice largely hinges on your ability to minimize the Accountable Receivable days as less possible, an effective and efficient Revenue Cycle Managementbecomes inevitable. Medicalbillersandcoders.com’s (www.medicalbillersandcoders.com) ingenious and credible RCM – comprising Adjudication, Follow Up, Re-submittals, Payments, Adjustments, Secondary Claims, Denials and Appeals – invariably proves to be indispensable to successful Revenue Cycle Management.

The credibility earned from being perpetually committed to “Best Practices in Medical Billing” has been instrumental in expanding our reach to the length and breadth of U.S. Our diverse pool of qualified and competent medical billing professionals has been able offer result-oriented medical billing practices to diverse clientele (ranging from small practices to multi-specialty groups) in varied specialties including Allergy & Immunology, Ambulance Transportation, Anesthesiology, Behavioral Health, Cardiology,  Chiropractic, Dental, Dermatology, Family Practice, Gastroenterology, General Surgery, Hospitalist Billing.

As the success of investing in any business turnaround exercise is measured by the degree of its impact clients’ cost-optimization and revenue maximization, Medicalbillersandcoders.com (www.medicalbillersandcoders.com) too had to verify its executed solutions against actual benefits for its client. Remarkably, the transformation made by our “best practices” has been quite impressive with:

• HIPAA compliant medical coding ensuring highest authenticity
• Reduced operating costs
• Regular monitoring and auditing
• High accuracy in coding
• Feedback & custom reports
• Multi-level quality assurance
• Quick turnaround
• Reduced claim denials
• Faster reimbursement
• Accelerated revenue generation
• Ample scope for intensive focus on medical care

Therefore, if you are a medical practitioner seeking to turnaround your practice’s clinical and operational efficiency, Medicalbillersandcoders.com may well be your source.

Coping with diverse medical billing challenges in different States

Like in any service sector, medical practitioners’ sustenance and growth has always hinged on their ability to adapt and reinvent themselves to the evolving market scenario.  While they have been quite enterprising enough to demonstrate the requisite character, the magnitude of healthcare reforms unleashed by the Federal Government, and its possible impact on their revenue generation has compelled them to add a new dimension to the usual scheme of adapting and reinventing.  And, majority of physician practices are beginning to realize that new dimension in business expansion – strategically expanding facilities to the areas that offer clinical and operational advantages.  While U.S. is abound with endless opportunities – the imminent expansion of Medicare population and an ever-growing demand for medical services in remote and sub-urban regions being the main source of opportunities, the physicians will have to contend with some unusual operational barriers. And, these operational barriers stem out of the diverse rules prevailing across the 50 states.

Amongst such heterogeneous rules, the regional modification of Medicare happens to be a significant one. Despite Federal Government’s universal Medicare scheme, states are privileged to modify Medicare and Medicaid rules pertaining to coverage, pre-existing condition, and fee-schedule as per their socio-economic conditions. In view of this scope for regional interpretation of Medicare and Medicaid rules, physicians are advised to be knowledgeable of them before they undertake expansion to multiple states or regions with heterogeneous interpretation of Medicare scheme.

Add caption

Complying with state-specific practice registration is another equally important issue when you contemplate on expanding your practice.  Although you carry a valid Federal license to practice medicine, yet you may still need to be registered separately in each of the Federal states you intend to practice. Otherwise, apart from facing legal hassles, you may not be eligible to any of the reimbursement schemes.

Adapting to regional billing demands is another challenge. Certain states have their own Medicare-specific rules, and they employ varying degree of audit intensity. Moreover, in every state the rules are different regarding fee-splitting, corporate practice of medicine, and scope of practice. As these things would have a direct bearing on the revenue, practices should be mindful of them before embarking on expansion.

The important issue that hospitals of group practices will have to contend with is the restriction on certain combinatorial practices in some of the states. Therefore, you may have to restructure your physician composition prior to expanding your hospital or group facilities to the regions with such imposition on certain combinatorial practices.

While you seek to avert and adapt to these operational issues through timely intervention of healthcare legal advisors and medical billing consultants, finding those that can effectively and efficiently match up to the region-specific challenges can be a daunting one. Therefore, it boils down to carefully choosing the one with diverse capabilities.

Medicalbillersandcoders.com – being a credible source for medical billing management and allied solutions across the 50 states in the U.S – stands up to be reckoned as the leading consortium for such interventional advice. Its diverse pool of competent medical billing professionals is strategically spread across all the clinical destinations so that you can have instant access to their expertise.

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.

Are you filing claims and have one in every three rejected!

• Filing claims has become more complicated as health insurers tighten eligibility requirements, and the chances of claims being denied have increased substantially
• Hence when a claim is filed, there is a fair possibility it will be denied and most providers are struggling to balance their busy time schedules to implement additional care while filing claims

Industry Standards say…

“Average rejected claim rate is reported at 30-33%”

According to top ten biller’s investigation on all Healthcare provider’s the claims rejections rate is: 30% with Federal Insurance Payers 33% with Commercial Payers

This rejection rate is observed in Podiatry, Pediatric, Allergy & Asthma, Dental and normally all specialties- if proper EDI or clearing house and payer set-up is not done

Why do claims get rejected?

Claims may get rejected for just a simple mistake like – Inaccurate coding errors by untrained staff, change of address not supplied to insurer to something complex like – Medical procedure ruled “experimental” and not covered.

Few reasons why claims get denied by insurance carriers:

Ailment not being covered in the health insurance policy

Procedure deemed medically unnecessary

Incomplete documentation

Improper claim form filled

Claim not filed in time

Pre existing disease which was not disclosed

How does it adversely affect your practice?

As far as possible steer clear of rejected claims as only one rejected claim can put your revenue behind, and bring on additional tasks like:

Reopening patient’s folder – second review & research of the notes

Claims to be compiled again

Double checking of codes again to ensure usage of the latest codes

Re- submission of claim

Insurance carrier may also need to be contacted

Solution – Reading between the lines to increase your bottom line and revenue!

According to most of the patient-advocacy organizations between 50 – 70% of disputes are resolved through initial appeals made directly to health insurers.

However this could be rather time consuming and opting for outsourcing your medical billing claims to a third party partner could help you get rid of the hassles that a rejected claim can cause.

Achieve the following benefits with MBC:

Considerable reduction in average rejection rate to less than 10%, due to reduced errors Efficient handling of claims resulting in increase of approximately 25% of your reimbursements In house staff is hassle free of all paper work involving medical billing and in turn able to assist you in managing your practice better

MBC’s expert Billing & Coding team will be able to efficiently handle your entire billing process, medical being their core process, besides providing updates about new rules and changes for each specialty.

Medicalbillersandcoders.com has been assisting in revenue maximization for healthcare organizations through their revenue management model encompassing: 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. All this along with weekly reporting and consultancy ensures our physicians receive the revenue they deserve.

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.