Protecting Your Practice Against RAC Audits With the Help of Efficient Medical Billing Practices

Efficient medical billing practices can make or break your medical practice and if anything can verify this statement, it is an RAC audit. RAC audits of Recovery Audit Contractor audits are nothing short of a nightmare for any healthcare provider.

Medicare and Medicaid are two healthcare carriers that provide coverage and reimburse physicians and hospitals for the services they provide to patients covered under these carriers. However, medical practitioners are known to receive over-ayments due to incorrect claims or erroneous coding at the time of medical billing. In essence, government tries to ensure patients’ best interest and control the rate of fraud, error or wastage by putting RAC audits in place. But the resultant inconvenience caused to a medical practice in the event of an RAC audit is nothing short of disastrous.

Not only is error-free coding and meticulous book keeping of paramount importance, subsequent adjustment of office accounts can play an important role in case an RAC audit actually happens. To protect your practice against RAC audits, you must put efficient medical billing practices in place –

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• Follow correct coding for services –If a medical service is incorrectly coded for the sake of avoiding internal confusion or due to oversight and the incorrectly coded service is reimbursed by Medicare or Medicaid; then your practice can be in for an RAC audit. Transparent and efficient medical billing practices help you monitor coding of services on a regular basis and avoid simple yet latent disasters, hence with a little more attention, you can save your practice a lot of money and hassle.
  
• File claims for correct payment amounts – Scrutinizing the final claim statement filed with healthcare carriers is of paramount importance. If the government settled an incorrect payment amount to your practice, as long as five years ago (as per recent healthcare reforms, the RAC audit period for overpayment has been extended from three years to five years) then your current financials can suffer drastically. Diligent book-keeping is a medical billing practice that can help you avoid this scenario altogether.
  
• Avoid duplicate services – It may not be fraud at all, but mention of duplicate services is rarely ever seen as an honest human error by an auditor. A prudent medical billing practice is installing audit software or enlisting the service of a compliance auditor, to fix your errors before an actual audit.
  
• Don’t claim for non covered services – Services that are not necessary and reasonable under section 1862(a) (1) (A) of the social security act are not meant to be reimbursed by Medicare or Medicaid. Avoiding inclusion of the same in your claim amount can save you from a potential audit.

Medicalbillersandcoders.com an expert in medical billing and coding serving the healthcare industry for more than decade now can help protect your practice from potential RAC audits by offering immaculate medical billing consultancy and services.

RAC auditors conduct audits on providers in response to insider information or complaints, upon diagnosing irregularities in billing and coding practices as per the CERT or other CMS analysis. With comprehensive and efficient medical billing practices in place with the help of our experienced medical billers and coders, our client’s practices are well equipped with all the required defenses in place to protect themselves against an RAC audit.

Streamlined Medical Billing and Coding Helps Increase Physicians Revenue

Are denials, ignored or lost claims, inaccurate coding and underpayments making it difficult for you to collect the revenue you have earned? Physicians have a busy schedule and with the doctor patient ratio getting disproportionate across the US, handling the task of medical billing and coding has turned into a daunting task.

• Complexities of coding can take a toll on your revenue
  A huge problem can occur in case of coding errors. If your staffs happen to give the wrong code, claims will either be paid incorrectly to the wrong provider or not paid at all. Coding is getting complex with revisions in CPT and HCPCS Level II code annually and with the growing number of patients, just an in-house medical coding facility won’t make your task easy.
  
  
• Wrong information
  Filing insurance claims is already a daunting task and in case of wrong information not only will the claim will be denied but you might end up losing or ignoring the claims and not procure significant part of your revenue.

Moreover if you delay claim submission or fail to follow up, you can lose revenue. Can you afford to lose payments every time such an issue occurs?

How to make revenue procurement easier?

Accurate medical billing and claim processing is the only key to obtaining and maximizing revenue for your practice. There is no need to end up underpaid or leave your revenue uncollected just because it is a tedious task.

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• Updating documents as per the coding revisions-
  you will have to ensure that your clinical documents are updated according to the coding changes or revisions so that no error occurs. CPT coding guidelines will have to be applied to cut down the risk of denials
  
  
• Resubmissions of denied claims-
  don’t let denied or lost claims leak your revenue. You will have to make sure that claims are resubmitted accurately
  
  
• Follow ups with insurance companies-
  getting payment from insurance companies is a time-consuming process. You will have to keep following up with them regarding the procedure and resubmitting or making changes till the correct details are not provided to them
  
  
• Proper training to the medical billing and coding staff:
  if you want to rely on your in-house billing system, it is necessary to keep your staff trained and updated about the changes in the health care industry on a time to time basis

Is it too much to handle?

If the process to procure your payment is too much to handle while you struggle with lack of time and staff to attend your patients, why not outsource medical billing and coding services?

Medicalbillersandcoder.com has expert billers and coder who will not only improve your revenue collection but simplify each billing process to ensure smooth functioning of your practice. MBC deals with medical claim filing for physicians from more than 50 US states, relieving them from the headache of managing their funds and revenue cycle every month.

Inevitability of the Electronic Radiology Practice and Its Effect on Radiology Billing

The advent of digital technology has been quite a boon to healthcare industry, more so to radiology, whose role in clinical diagnosis and planning the right course of medical intervention continues to be more critical than ever before. Physicians and patients’ reliance on digital or electronic radiology interpretation is so much that it is virtually impossible to practice radiology without a full-pledged digital or electronic radiology infrastructure. As a result, PACS and other web-based technology have become indispensable part of every radiology practice. While electronic radiology medium considerably reduces turnaround time and greatly enhances quality of image interpretation, radiologists may have to find ways to deal with its impact on Radiology Billing on account of:

• Rules governing billing of electronic radiology services,
• Complexities involved in billing, coding, and realization of radiology claims, and
• Voluminous increase in electronic radiology cases.

In view of these intervening factors, electronic radiology practices may well have to devise billing system that is web-enabled, allowing them to print statements, view accounts and even view radiology transcription reports on-line. Moreover, they would need to get their billing system, custom-designed to have full access to every component of billing data. Within this broader operational frame-work, they should have a team of coders, A/R managers, accountants, radiology practice managers, and data processors to work collectively to ensure that each charge is captured and billed accurately and on-time. These staff should be encouraged to monitor and update collection protocols to keep pace with the shifting regulatory conditions. While contract negotiations remain a paramount concern, it is imperative that your billing is complete with:

Best practices related to procedural codes, including HCPCS and modifiers, to ensure that you are coding for the highest revenue.

Understanding of payer rules, including medical necessity and NCCI rules, to help minimize chances of an audit.

Sophisticated medical billing system/electronic health record with advanced claim scrubbing capability

Facility for submitting both UB04 and CMS-1500 claims.

Facility to follow on denials or delinquent claims

The benefits of having such a well-rounded Medical Billing system is that it

Can enable HIPAA compliant clinical and operational practices

Generates monthly reports specific to radiologists’ needs

Helps retrieve the required reports and demographic data computer system.

Enables electronic billing to Medicare or commercial radiology insurance payers

Can confirm receipt of all electronic claims and produce error reports to identify claims that are incomplete

Can correct claims immediately and resubmits them for processing.

Facilitates scanning all demographic data, charge and payment data and other correspondence into the system to help in efficient follow up, thereby creating a paperless system.

And more importantly, helps in implementing strong denial management systems to resolve the pending claims.

While it may seem a daunting task to have such a comprehensive billing mechanism in place to counter the demands of billing electronic Radiology Services, outsourcing should make it a lot easier. And, when it comes to outsourcing medical billing and allied services, Medicalbillersandcoders.com has stood out to be a reliable platform for sourcing competent and experienced billing professionals. With a nation-wide affiliation with radiology billers, we look forward to arm radiology practices across the 50 states in the U.S. with exemplary radiology billing solutions.

Are Medical Practices Moving Forward at the Same Pace as Healthcare Reforms?

Healthcare Reforms or Obamacare that had been facing a few political hurdles may have finally broken through all shackles and assumed greater acceleration. While healthcare reforms or Obamacare are largely perceived to pro-patient, physicians or medical practices have no option but to move with the requisite adaption. Amongst a host of reforms, the recommendation of the Affordable Care Act, which seeks to make medical care affordable to every US citizen, may possible be the most demanding adaption ever to have been undertaken by medical practices. This ominous burden plus the pulls of other reforms may have actually impeded their progress, which is currently way short of the expected. In fact, the industry sources believe that medical practices across the US are still struggling with implementation stage of adaptation to healthcare reforms mandates.

What makes these healthcare reforms so daunting is that:

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• Medical practices would find themselves treating more number of Medicare patients than ever before. The extension of Medicare to pre-existing cases as well as dependents under the age of 26 could prove to be exhausting of physicians, who are likely to be disproportionate or short against the patient population. According to a reliable estimate the extension of Obamacare could leave the primary care sector short by 90,000 physicians by 2020!
  
  
• The likelihood of reimbursements being progressively reduced for specialties – contrary to the general feeling of reimbursements improving with patient volume, the proposed Medicare cuts would reduce physicians’ reimbursements by as much as $700 billion. Because the Medicare and states-specific Medicaid account for nearly half of the nation’s health insurance, qualitative appreciation under ACO model of care can only help off-set the Medicare cuts with incentive-based collaborative healthcare delivery.
  
  
• The compulsory implementation of EHR under the HIPAA-5010 mandate, which is likely to disrupt operational flow, consume considerable capital expenditure, as well as train or source staff to conduct EHR systems in the way that best supports patients’ privacy and security norms.
  
  
• There could be considerable change in billing and coding under ICD-10. While ICD-10 may help in streamlining the entire process of reimbursements, physicians will still have to deal with coding-specificity.
  
  
• Fee schedules will get more and more constricted under the new healthcare reforms. While Medicare and Medicaid fees schedules will set the trend of rationalized fee-schedules, it may eventually be followed by the commercial payors as well. Physicians, amidst such dual-impact, may well be forced to optimize their billing efforts to avail maximum reimbursements. And, the process of migrating to a higher system of medical billing may be costly as well as gradual.
  
  
• Under ACO care model, physicians’ reimbursements will happen through bundled fee for services. Therefore, because ACO involves coordinated services among several doctors, there needs to be systematic appropriation of reimbursements based on the involvement of each of the doctors.

While it is true that the face of adapting to the healthcare reforms may have been and likely to be impeded by the reasons highlighted above, they can still be overcome with competent services. Medicalbillersandcoders.com – which offers inclusive Medical Billing Services to a range of medical practitioners across the 50 in the US –promises to help medical practices maneuver through, and adapt effectively and efficiently to the pace of healthcare reforms.

Billing Specialists to Look After Major Billing Issues Likely to Be Faced By Radiologists in 2013

Radiologists, who have been striving to maintain a balance between diagnostic priorities and operational compliance, may well find pulled further into a host of billing and compliance issues throughout 2013:

To begin with, they will have to discern the vital connect between diagnosis coding and procedural coding systems and the systems that have evolved to provide a common method of describing diseases, diagnoses, and procedures.

Second, like in other disciplines, they may be bound by the medical necessity clause while diagnosing high-cost tests. In fact, Medicare requires that the medical necessity of high-cost diagnostic radiology tests be proved and the extent to which they may be prescribed for beneficiaries by either primary care physicians or physician specialists. Therefore, radiologists need to be aware of both the medical necessity as well as the extent to which beneficiaries are entitled for radiology reimbursement under Medicare, Medicaid, or commercial health insurance plans.

Third, admissible radiologic expenses for Part B imaging services may be rationalized on par with industry standards. As a result, radiologists may see their reimbursements dropping or appreciation depending on where they stand vis-à-vis industry standards.

More importantly, radiologists may be under increased monitoring for billing errors, and irregularities. It could even lead to being black-listed for repeated history of billing malfunction. Therefore, it may require a concerted effort to stay clear of being guilty under Medicare, Medicaid, and other HHS programs or commercial health insurance plans.

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These ensuing operational issues may prompt radiologists to:

Screen medical necessity and ask for advanced beneficiary notices (ABNs) on Medicare patients. This could require radiologists to function in tandem with the facility staff at the patient’s hospital to ensure the ABNs are accompanied by component fee as well.

Be prepared for Recovery Audit Contractors (RACs) and Comprehensive Error Rate Testing (CERTs), which are integral to standard scrutinizing. This would call for tactical and shrewd documentation and explanation of the radiologic services billed for claiming.

Evaluate templates and exam titles in accordance with the prevailing standard of equipment, technique or procedure, and the admissible CPT codes as amended from time to time.

Establish smooth communication with billing processes during revision to equipment, techniques or procedures. This would ensure that the modifications are adequately reflected in coding and billing, and claims are devoid of either under-coding or up-coding.

Make provision for reporting discrepancies, such as number of views or extent of technical complexity. This could help radiologists recover maximum claims as well as minimize the chance of denials and auditing issues

Even as radiologists seek to implement tactical moves to counter the impact of billing issues, they may find themselves swayed more towards clinical focus. That is why it makes sense to hire Radiology Billing specialists for the purpose. Medicalbillersandcoders.com – having nation-wide affiliation with a chosen pool of radiology billing specialists – offers to deploy billing resources that are competent and experienced to address and maneuver radiologists through the billing issues likely to surface in 2013.