Aligning your medical billing goals with your Practice’s Goals!

A truly successful medical practice in today’s evolving healthcare industry is one that has its goals aligned with its medical billing goals. To a physician, however, it may seem like yet another time consuming task, but well determined objectives of a medical practice, if successfully translated into billing and coding practices can result in enhanced efficiency and greater profitability.

Many practices outsource their medical billing functions to third party experts, who work on pay-for-performance principle. This in-turn ensures that the billing experts work in sync with the revenue goals of the practice, for they get paid only when you get paid. Another way to go about medical billing is enhancing the in-house function; along with implementing performance based compensation to in-house staff may help do justice to your revenue goals.

Goal alignment has become the need of the hour for maintaining the competitiveness of your practice. The following steps can assist you in effective definition of practice goals and alignment of the same with medical billing goals –

• Identify your primary goals – Medical practice is built around the primary goals of patient care and service, which can resultantly improve revenues. Although profits and revenue are not primary goals, they are essential elements of every practice. Thus, it is crucial to write down goals in clear statements such as – “our goal is to maximize revenue while delivering unmatched healthcare and medical service to each and every patient” or “Assist patients in accessing healthcare service at reasonable costs and without wastage of time.”
  
  
• Communicate these goals to the medical billing staff – Once your goals are defined, make sure to discuss the same with your billing staff. Many physicians deign to indulge in the financial aspect of their practice and thereby lose out on a big chunk of their revenues. Medical billing goals are primarily focused on payment collection, correct coding, claim filing and reimbursements. Each activity takes new meaning if only practice goals are communicated well to the billing experts, whether external or internal.
  
  
• Monitor the gap in understanding and training – Keeping a track of staff activities and billing reports can effectively prove if medical billing goals and practice goals are aligned or if there is some gap in staff or consultant understanding. Regular interactions and consultations will lead to clearer goals and efficient achievement of the same.

• Update goals as per the changing industry scenario – HIPAA and HITECH guidelines, in addition to EHR regulations and RAC procedures have necessitated extreme caution and care to be applied while handling with patient data. Medical billing and coding goals are required to be more data and revenue centric rather than service oriented. However, a balance can always be established between conflicting goals.

Medicalbillersandcoders.com can help you define your practice goals and align them with medical billing goals. We can facilitate you in achievement of your financial and service objectives on a continual basis by understanding your practice objectives and applying them to your billing practices.

Our billing experts have been serving healthcare specialists in varied domains across all 50 US States for more than a decade now. We help physicians concentrate on patient care as we handle their entire revenue cycle process in line with their medical billing goal; along with assisting them in aligning their practice goals with the help of our experts’ in-dept healthcare industry knowledge.

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.