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Welcome to the ClaimCare Medical Billing Blog. We strive to provide content that improves the overall quality of medical billing efforts across the US. If you have any specific topics that you would like to see addressed in this medical billing blog please post the topic in the Medical Billing Questions & Answers Forum. If you have an article that you would like considered for publication in the medical billing blog then please email your article to resources@claimcare.net.

MEDICAL BILLING BLOG

Three Reasons You Should Outsource Your Medical Billing Services

Posted by Carl Mays on Wed, Sep 26, 2018 @ 04:03 PM

3 reason to outsource your medical billingThe majority of the chief financial officers (CFOs) involved in the 2018 CFO Outlook Performance Management Trends and Priorities in Healthcare listed cost reduction as their no. 1 priority.

Among them, 50% expressed the desire for easier report creation, better dashboards and visuals, and enhanced ability to understand the report and data statistics. Also, a staggering 90% have shown their concern over the online payment security of their accounts. How can outsourcing your medical billing services address these concerns? Is this even possible?

How Outsourcing Your Medical Billing Service Can Help Your Practice

Outsourcing your medical billing services can bring numerous benefits to your practice including:

Increased Revenues and Reduced Labor Costs

Approximately, 8% to 10% of medical collections are spent on the medical billing process. However, with an outsourced medical billing, you can:

  • Reduce overhead costs
  • Increase reimbursements
  • Decrease claim denials and rejections

In an orthopedic billing case study, the group reported a 73% increase with their billing revenue within six to eight months. This was due to the improved contracting and exiting unprofitable procedure lines implemented in their medical billing process.

In most instances, physicians and office medical managers even realize a 96% claim payment upon the first submission in less than 45 days. All because they have moved their medical billing services to a third party provider.

Easy to Read Dashboard Reports and Data Statistics

Now you can focus more on your patients rather than spending long hours analyzing and interpreting your medical billing reports, with the help of an outsourced medical billing provider.

Third party providers have medical billing online dashboards that easily show the issues with your medical account at a glance. Also, the data can be tracked on a weekly, monthly, or annual basis according to:

  • Patient volumes
  • Procedure mixes
  • Collections
  • Days in AR

This makes it easier for your staff to handle your patients’ financial matters and results in a less time-consuming experience for them.

Safe and Secured Data Infrastructure

Last year, DataBreaches.net shared a data compilation revealing that 477 healthcare breaches affecting 5.579 million patient records were reported to the US Department of Health and Human Services (HHS).

Choosing the services of a well established third party medical billing company can protect your patient records through 100% secure medical billing processes. These HIPAA-compliant providers offer a secure and transparent billing process that ensures your data remains confidential at all times.

Now you can say goodbye to those unwanted cyber hack attacks without having to pay extra for cyber-security protection. These are all taken care of by your third-party provider. All you need is to find a medical billing third-party provider who can deliver the medical billing services you require.

Why Choose ClaimCare for Your Medical Billing Services?

ClaimCare has more than 25 years of experience in medical billing. It has a proven track record of increased customer collection reaching all the way up to 25% (the average increase is approximately 5%) and days in AR under 40 for your collectibles.

Let's talk. Complete our online form or call us toll-free on (855) 376-7631, today.

Tags: medical billing education, medical billing operations, general medical billing questions, medical billing resources, medical billing services, medical billing companies, Reasons to outsource medical billing

Impact of Medicare 2019 E&M code changes on a physician compensation package based on RVU

Posted by Carl Mays on Mon, Sep 24, 2018 @ 04:55 AM

2018 09 22 - Imact of medicare changes on RVU based comp

The Centers for Medicare & Medicaid Services (CMS) just issued a proposed ruling to the Medicare Physician Fee Schedule (PFS) last July 12, 2018. This will take effect on or after January 1, 2019.

This article discusses the impact this will have on the physician's relative value unit (RVU) based on their practice (directly and indirectly), and a list of potentially misvalued services to watch out in 2019.

Why is it important for physicians to know the upcoming RVU calculation changes in the proposed Medicare 2019?

Physicians can earn up to 7% of their Medicare Part B payments in 2021 based on their Medicare 2019. Here is what the vice president of public policy of the American Medical Group Association (AMGA), Chet Speed has to say about it:

"When you think about incentives, generally, you need both a carrot and a stick to make change. With Medicare moving to a value-based system, you need a carrot, in the form of higher payments for doing well, and you need a stick, if you don’t do well, you have less reimbursements. "

How will this impact your practice? Here are some of the calculation changes and adjustments that will take effect on your RVU:

Practice Expense Methodology Calculation Changes

Medicare 2019 will be incorporating two new specialties, which will affect hospitalists and advanced transplant cardiology and heart failure physicians.

Calculation Changes to Direct PE Inputs for Specific Services

Standardization of the following specific services is expected in the proposed Medicare 2019:

  • Clinical labor tasks
  • Balloon sinus surgery kit comment solicitation
  • Scope systems' equipment recommendation
  • Existing direct PE inputs updated prices

This includes an update on the prices of the following supplies and equipment:

EQ370: Biopsy guidance software and breast MRI computer aided detection

SA036: Transurethral microwave thermotherapy together with the kit

SA037: Transurethral needle ablation together with the kit

SK050: Neurobehavioral status forms

SL140: Wright's Pack (per slide) and the stain

Calculation Changes to the Indirect PE of Certain Office-Based Services

The indirect PE RVUs for those working in a non-facility setting is expected to increase due to the direct PE costs applied to them. This is because the greater value between the clinical labor costs and the work RVUs in relation to the direct costs of these services will be the value selected in determining their RVU.

List of Potentially Misvalued Services for 2019

Aside from changes to the practice expense methodology calculation, the General Accounting Office and MedPac have also listed the following "potentially misvalued services." This is based on a high volume of codes submitted for review by their office to the CMS.

  • Colonoscopy w/lesion removal (45385)
  • CT head w/o contrast (70450)
  • EGD biopsy single/multiple (43239)
  • Electrocardiogram complete (93000)
  • Revision of heart chamber (92992)
  • Total knee arthroplasty (27447)
  • Total hip arthroplasty (27130)
  • TTE w/doppler complete (93306)

An additional 72 separate code groups for specific codes are currently on review by the CMS. This is after it has taken a closer look at the rationale provided by the American Medical Association/Specialty Relative Value Scale Update Committee.

Comments on these proposed new valuations are welcomed by the committee. You may submit yours on or before September 10, 2018 for it to be considered.

Impact on Specialty Specific Health Sectors

Those working on specialty specific health sectors, such as the following medical professionals, are also most likely to experience the following adjustments in their overall payment:

  • 3% increase for nurse practitioners
  • 4% increase for gynecology/obstetrics
  • 3% decrease for oncology/hematology
  • 4% decrease for dermatology

Given these changes, surprise medical bills and price transparency remains to be the issues facing suppliers and providers.

Would you like more updates about the Medicare 2019 E&M code changes?

Subscribe to our blog to remain posted. Share the knowledge and hit the share buttons.

Tags: medical billing coding, medical billing education, medical billing resources, 2019 Medicare Changes

Buyer Beware: EHR System Vendor Agreements & Its Impact on Your Billing

Posted by ClaimCare Resources on Thu, Sep 20, 2018 @ 05:06 AM

Medical Billing Services

 

Have you ever experienced signing an EHR vendor system agreement only to later realize you also transferred your medical billing tasks to the vendor? How about the nightmare of migrating your data from the previous system vendor to the new one? 

This was experienced by Daniel Goodman, MD of Atlanta. He is a solo internist who had to pay approximately $10,000 to $12,000 just to get his data from the previous vendor into the new one. This is not to mention the 50% disruption of usual workload from his practice for an entire week.

Learn the importance of thoroughly reading your EHR system vendor agreement before signing up to avoid these scenarios, surprises, and inconveniences.

Basic Things to Consider Before Signing an EHR System Vendor Agreement

Titus Schleyer, DMD, PhD, the director of the Center for Biomedical Informatics at the Regenstrief Institute in Indianapolis, Indiana gave a very interesting comment for anyone who wishes to sign a new EHR system vendor agreement.

“Switching to a new system is a big investment, and you’re impacting practice viability if you’re laying out hundreds of thousands of dollars every few years for a new system. So, you need to be very careful and prepare for your switch well.”  

You definitely need to do your homework before making that switch. To ensure you are making the right choice, include the following questions to your potential EHR system vendor:

  1. How will the data be migrated to the new EHR system?

Migrating data from your current EHR to a new EHR system is a huge task.

As Daniel experienced, he had to focus on manually encoding the data on the system for an entire week just to ensure it was accurately transferred. That meant temporarily closing his practice during that time.

To prevent this from happening, properly plan for your data migration. Seek answers to the following questions in the EHR system vendor agreement:

  • How long will it take to complete the migration? Can the data be migrated in stages?
  • How does the system ensure that the data has been migrated correctly into the new vendor system?
  • Does the vendor have the capacity to integrate data from the billing system, LIS, RIS, PACS, and medical devices?

If the answers are not clearly stated in the agreement, then it is best to clarify these questions directly with the vendor.

  1. How will the billing be done using the new system?

A billing system is the heart of any practice. If it gets disorganized or disrupted, your entire operation may be in jeopardy. Thus, it is very important to know if the following items are clearly discussed in the agreement:

  • Billing capabilities
  • Training procedure
  • Data integration

Software training and data integration are key factors in effectively using a new vendor system for your practice. If not provided, additional outside help from a software consultant may be necessary just to integrate the new EHR system and the medical billing system. This means more expenses for your practice.

Think twice! Carefully read your vendor system agreement because...

Some system vendors automatically assume the responsibility of handling the billing system of your organization after you have shifted to their service. Should you wish this to be handled by a different provider, immediately inform them upfront about it and amend the agreement stating such.

What can ClaimCare do for your practice?

ClaimCare provides various medical billing services. ClaimCare can work on yoru current Billing system or provide you with one if needed. For more information and how you can benefit from ClaimCare Medical Billing Services, contact us.

Tags: medical billing education, medical billing operations, general medical billing questions, selection process, medical billing

Top Three Impact of Medicare ID Card Changes on Medical Billing Services

Posted by Carl Mays on Mon, Sep 17, 2018 @ 07:05 PM

ClaimCare Medical Billing LightsIn the interest of improving security, Medicare has released new cards meant to prevent identity theft among its users.

The Centers for Medicare & Medicaid Services (CMS) have given physicians and medical billing companies 21 months to fully implement the necessary changes to their medical credentialing and medical billing services. The announcement was made to allow companies the chance to fully comply with the newly implemented Medicare ID card requirements.

The question is, what kind of impact will these new changes have on your billing system and services? What would be the best way to go about this transition? Let’s start by understanding the major changes with the new Medicare ID card--

There are three primary differences in the new Medicare ID card that should be taken note of:

  • The removal of the Social Security Number (SSN)
  • The replacement of the Health Insurance Claim Number (HICN)
  • The use of the Medicare Beneficiary Identifier (MBI)

What’s the major difference between the Medicare Beneficiary Identifier (MBI) and the Health Insurance Claim Number (HICN)?

Previous Medicare cards used to have the SSN based Health Insurance Claim Number (HICN) and used it as a primary identifier for card holders. However, due to rising incidence of identity theft and fraud risks, the Medicare Access and CHIP Reauthorization Act required the CMS to remove the HICN.

Instead, Medicare card-holders will now be provided with a NEW Medicare Beneficiary Identifier (MBI) that features an 11 character-long combination of numbers and uppercase letters (except for S, L, O, I, B and Z), separated by dashes.

It is a unique, non-intelligent and randomly generated sequence of numbers and letters that do not have any special meaning whatsoever.

How will this impact doctors and medical office managers' billing and compliance services?

Currently, the new Medicare cards are already being mailed and distributed to recipients. This means that cardholders will soon be visiting medical offices with their new cards, asking for further clarification about the changes, and seeking assistance for its use. It’s important,  therefore, that you are fully prepared to address their concerns, inquiries, and demands.

With this in mind, here’s are the top three concerns or challenges that you need to take note of given this new policy--

1. Eligibility Verification of the New Medicare ID Card

With the new card, one of the primary concerns that you will have to face will be verifying its authenticity and validity. 

New-Medicare-Card-Banner-Image

The new card shares the same white, blue and red color like the previous one. However, take note of the new Medicare Number and how it is comprised of uppercase letters and numbers alone. Thus, it is most important for doctors and medical office managers to learn how to identify a valid Medicare ID card from a fraudulent one.

This sounds simple, right? But wait a minute. This is just the tip of the iceberg. There is more information pertaining to the patient’s screening process that has to be verified. This includes:

  • Effective dates
  • Benefits and calculations
  • Administration, follow-up and plan execution

Should there be a need to verify the validity of the card, doctors and medical office managers can check and verify using Medicare Administrative Contractors (MAC's) secure portal, beginning June 2018.

2. Coordination of Benefits with the New Medicare ID card

The major change happening with the new Medicare ID card is the use of the MBI number. CMS is not expecting any other major changes aside from this, unless there are disputes on an individual's account.

Another issue you may encounter is - your patients not being able to receive their new Medicare ID card due to a change of address. How should you handle this, if they visit your office and continue to hand-over the old Medicare ID card?

To that end, doctors and medical office managers should be proactive and update their records. This is to easily and quickly claim their payment while avoiding unwanted mishandling of client records in the future.

3. Submission of medical claims using the MBI

The issuance of new cards was driven by a need to protect users from potential identity theft and fraud. This basically means that the new Medicare IDs will still require doctors and medical office managers to thoroughly process claims. It’s important, therefore, to ensure that the process and submission of these medical claims are accurate, otherwise you will leave yourself vulnerable to payment delays.

Bottom line…

To help you with this transition, you need to have an efficient system set up that can handle new information, securely handle data, and manage operational efficiencies easily.

*       *          *

ClaimCare provides doctors and medical office managers a complete medical billing solution to manage this transition., Claim Care provide the top service level guarantee in the industry, and offers best-of-breed technology, an air tight medical billing process, actionable reporting and broad experience and can work on its clients' medical billing systems. For more information contact ClaimCare Medical Billing Services by email at sales@claimcare.net , by phone at (55) 376-7631 or visit the ClaimCare Medical Billing Company website.

Tags: medical billing education, medical billing operations, general medical billing questions, medical billing resources, medical billing services

Medical Billing News: CMS Releases 2013 Incentive Payments

Posted by ClaimCare Resources on Thu, Oct 16, 2014 @ 06:22 PM

Medical ReimbursementsCMS announced on October 1st that the 2013 PQRS (Physician Quality Reporting System) and eRx (e-prescribing) incentive payments are now available for eligible professionals and group practices that successfully submitted data for these respective Medicare Part B programs.  The payments will be paid based on services rendered and reported between Jan. 1, 2013 and Dec. 31, 2013. 

The incentive payments will be issued by MAC’s (Medicare Administrative Contractors) with remittance advices and identified as separate payments under these programs. MACs will use the indicator of LE ("Levy") to indicate federally mandated payments.

LE will appear in the PLB-03-1 segment of the 835 electronic remittance advice. In an effort to further clarify the type of incentive payment issued, LE will appear on the remittance, along with a 4-digit code to indicate the type of incentive and reporting year.

As medical billing reimbursement shrinks across the industry it is critical for practices to take advantage of the opportunity to participate in any of the CMS incentive programs.  It does take a great deal of effort, but the reward can be a great healing injection to your cash flow!

About ClaimCare, Inc.

ClaimCare Medical Billing Services stands out from the crowd of medical billing companies. ClaimCare offers a complete medical billing solution, has the only service level guarantee in the industry, offers best-of-breed technology, an air tight medical billing process, actionable reporting and broad experience and can work on its clients' medical billing systems. For more information contact ClaimCare Medical Billing Services by email at sales@claimcare.net , by phone at (877) 440-3044 or visit the ClaimCare Medical Billing Company website.

Copyright 2014, Carl Mays II and the ClaimCare Medical Billing Company

 

Tags: medical billing resources, Physician Reimbursement, Medical Reimbursement

Big Medical Billing Changes Are Coming for Modifer 59

Posted by ClaimCare Resources on Wed, Sep 03, 2014 @ 02:04 PM


modifer 59 changesBig medical billing changes are coming for t
he frequently used and often abused modifier 59. It is critical that all coders and providers be made aware of the changes to the utilization of Modifier 59 (Distinct Procedural Service) that will go into effect January 1, 2015. Additionally, as a medical billing company, we often find that clients will set up their billing systems to have an automatic default that adds Modifier 59 to specific codes. Starting January 1, 2015 that will no longer be the appropriate utilization and will no longer be applicable.

 

On August 15th, CMS released the final ruling for the appropriate use of Modifier 59 and the changes that will take effect January 1, 2015.  Transmittal 1422, CR8863 details new modifiers to be used in place of modifier 59.  The new modifiers will impact NCCI (National Correct Coding Initiative) edits utilized by CMS MAC Carriers. Studies have shown that the modifier 59 is both commonly used and commonly abused. According to the 2013 CERT report $2.4 BILLION dollars was paid on claims containing modifier 59 with a projected error rate of $450 MILLION. The error rate is not exclusively attributed to modifier 59, but if only 10% of those found to be in error were due to the modifier 59, that would represent a $45 MILLION dollar error.

 

CMS has established new HCPCS modifiers to define subsets of modifier 59 which was previously used to define a “Distinct Procedural Service” CMS will continue to recognize modifier 59, however due to the over utilization of Modifier 59, it should not be used beyond December 31, 2014. As a default, at this time CMS will initially accept either a -59 modifier or a more selective – X {EPSU} modifier as correct coding, although the rapid migration of providers to the more selective modifiers is encouraged. However, these modifiers are valid modifiers even before national edits are in place, so contractors are not prohibited from requiring the use of selective modifiers in lieu of the general -59 modifier when necessitated by local program integrity and compliance needs.

Thus, our recommendation for all providers, coders and medical billing companies is to prepare to replace utilization of Modifier 59 with the distinctive descriptors as follows:
  • XE Separate Encounter:  Service That Is Distinct Because It Occurred During A Separate Encounter 
  • XS Separate Structure:  Service That Is Distinct Because It Was Performed On A Separate   Organ/Structure     
  • XP Separate Practitioner:  Service That Is Distinct Because It Was Performed By A Different Practitioner 
  • XU Unusual Non-Overlapping Svc:  Use Of A Service That Is Distinct Because It Does Not Overlap usual components of the main service    

  

These modifiers, are referred to as -X{EPSU} modifiers, and define specific subsets of the -59 modifier. CMS will not stop recognizing the -59 modifier but notes that CPT instructions state that the -59 modifier should not be used when a more descriptive modifier is available. Our recommendation is to ALWAYS use the subset more descriptive Modifier EPSU’s. CMS will continue to recognize the -59 modifier in many instances but may selectively require a more specific – X {EPSU} modifier for billing certain codes at high risk for incorrect billing.

WHAT THIS MEANS FOR YOU

All practices should monitor the utilization of modifier 59 to ensure that it is currently being utilized in the appropriate manner.  In light of this major upcoming change, we encourage all Practice Administrators to check with your certified coder or medical billing service to insure they are prepared for this modifier 59 alteration.  Inform your providers.  Make sure that there are no defaults set up in your practice management system that automatically default modifier 59.  And above all, ensure that you are properly documenting any distinct service.  January 1st is just around the corner.  Stay on top of continuing updates and changes by signing up for our medical billing blog
 

About ClaimCare, Inc.

ClaimCare Medical Billing Services stands out from the crowd of medical billing companies. ClaimCare offers a complete medical billing solution, has the only service level guarantee in the industry, offers best-of-breed technology, an air tight medical billing process, actionable reporting and broad experience and can work on its clients' medical billing systems. For more information contact ClaimCare Medical Billing Services by email atsales@claimcare.net , by phone at (877) 440-3044 or visit the ClaimCare Medical Billing Company website.

Copyright 2014, Carl Mays II and the ClaimCare Medical Billing Company

Tags: medical billing education, 2015 medical billing changes, medical billing coding

HIPAA Compliance: Feed the Shredder

Posted by ClaimCare Resources on Tue, Jul 01, 2014 @ 12:19 PM

Please take a moment and look around you. HIPAA Compliance

Do you see a shred bin close to you?  Do you know where the shred bins are?  Have you been instructed by you Supervisor or Manager on what is to be disposed in the shred bins?  Shredding is a critical part of HIPAA Compliance.  Leaving documents where others can retrieve them, even if your intentions are good is a serious, and common, violation of HIPAA. 

Such was the case recently for a severe HIPAA Privacy Rule violation. In September 2008, Parkview Health Systems took custody of medical records pertaining to approximately 5,000 to 8,000 patients while assisting the retiring physician to transition her patients to new providers,
and while considering the possibility of purchasing some of the physician’s practice.

On June 4, 2009, Parkview employees, with notice that the physician was not at home, left 71 cardboard boxes of these medical records unattended and accessible to unauthorized persons on the driveway of the physician’s home, within 20 feet of the public road and a short distance away from a heavily trafficked public shopping venue. As a covered entity under the HIPAA Privacy Rule, Parkview must appropriately and reasonably safeguard all protected health
information in its possession, from the time it is acquired through its disposition.

Parkview cooperated with OCR throughout its investigation. On June 23, 2014, a settlement was reached. In addition to the $800,000 resolution amount, the settlement includes a corrective action plan requiring Parkview to revise their policies and procedures, train staff, and provide an implementation report to OCR. A card board box, full of patient information where the public could have retrieved it.  Pretty expensive box!

“All too often we receive complaints of records being discarded, left unattended, or transferred in a manner that puts patient information at risk,” said Christina Heide, acting deputy director of health information privacy at OCR. “It is imperative that HIPAA covered entities and their business associates protect patient information during its transfer and disposal.”

Have you made sure that you have pre-shred documents placed securely? Do you leave information sitting out where others could see it, take it, or use it in a manner that is not intended?  You may have a box near your desk where you put items that need to be shredded. Be diligent and make sure that those boxes aren't left for others to see. Empty it throughout the day.

The one thing no one needs is an $800,000 mistake wrapped in a card-board box.

Feed the shredder! 

About ClaimCare, Inc.

ClaimCare Medical Billing Services stands out from the crowd of medical billing companies. ClaimCare offers a complete medical billing solution, has the only service level guarantee in the industry, offers best-of-breed technology, an air tight medical billing process, actionable reporting and broad experience and can work on its clients' medical billing systems. For more information contact ClaimCare Medical Billing Services by email at sales@claimcare.net , by phone at (877) 440-3044 or visit the ClaimCare Medical Billing Company website.

Copyright 2009, Carl Mays II and the ClaimCare Medical Billing Company

 

Tags: HIPAA, Compliance

Medical Billing Benchmarks: Yield

Posted by ClaimCare Resources on Wed, Jun 04, 2014 @ 06:54 PM

PrMedical Billing Benchmarksactices and physician's constantly struggle with understanding how well their billing is working. This can be difficult to do because reliable medical billing benchmarks that can be easily applied are difficult to find. A great solution to this is the use of a Theoretical Yield (i.e., the amount you should collect for every dollar billed if your billing is working perfectly).

Understanding the concept of yield is the key behind assessing the billing performance using medical billing benchmarks.  From a medical billing standpoint, yield is the amount of a claim that should actually result in a payment versus a contractual adjustment. In other words, if your yield is 50%, then on a $100 claim you should received $50 in payments and will write-off the rest to contractual adjustments. In the first article in the series on allowables I discussed why you should set your fee schedule higher than your contractual allowables. Having fees higher than allowables is what results in yields that are less than 100%.

Calculating your practice's yield is straightforward. At its simplest level you take the allowable for a CPT and divide by the fee you charge for that CPT. Using the example above, if your fee for a given CPT is $100 and your allowable for that fee is $50, then your yield is $50 (what you should collect)/$100 (what you charge) = 50%.

This is a straightforward calculation. The complication arises because of the various payer contracts for a practice and the fact that the yield for a specific payer often varies by CPT (i.e., with BCBS you may have a yield of 50% for one CPT and 60% for another CPT).

This means that calculating your yield requires you to understand your procedure mix. To get a close estimate of your yield for a specific payer you can:

  1. Take your top 20 CPT codes and calculate the yield for each of these codes; and then
  2. Calculate a weighted average for the overall yield based upon the frequency of each of your CPTs;

To move from a close estimate to a more precise estimate your repeat the above procedure but instead of only using your top 20 CPT codes, you use as many as is required to cover at least 90% of your charge volume with each payer. Typically, however, the top 20 CPTs provide an accurate answer.

Once you have completed the above exercise for one payer, you need to repeat this for each of your top payers (you should do this for the payers that represent at least 80% of your payment volume). Once you have done this you can then get an overall yield for your practice by creating a weighted average yield for the practice based upon your charge volume (not payment volume) for the practice. The idea of a weighted average yield of the practice works well as long as your procedure mix and payer mix are stable.  If either changes significantly, then you need to recalculate your yields.

With a weighted average practice yield (or Theoretical Yield) in hand you can easily get an initial understanding of how well you medical billing is performing. This medical billing benchmark will provide significant insight into your true performance. If your practice theoretical yield is 50% and your actual performance is 42% - then you are leaving a lot of money uncollected (up to 8% of every dollar billed). There are a number of items that will keep you from achieving your full Theoretical Yield, but you certainly would expect to be within a few percentage points.

Although developing yields can be tedious work, it is critical to know your practice's yield and use this medical billing benchmark to understand if your medical billing is working well.

About ClaimCare, Inc.

ClaimCare Medical Billing Services stands out from the crowd of medical billing companies. ClaimCare offers a complete medical billing solution, has the only service level guarantee in the industry, offers best-of-breed technology, an air tight medical billing process, actionable reporting and broad experience and can work on its clients' medical billing systems. For more information contact ClaimCare Medical Billing Services by email at sales@claimcare.net , by phone at (877) 440-3044 or visit the ClaimCare Medical Billing Company website.

Copyright 2009, Carl Mays II and the ClaimCare Medical Billing Company

Tags: improving medical billing, general medical billing questions, Medical Billing Benchmarks

HIPAA Compliance: Are you Ready for September 23rd?

Posted by ClaimCare Resources on Wed, Sep 18, 2013 @ 02:03 PM

HIPAA complianceGuess what day it is? No, it’s not hump day….it is HIPAA Day! Some providers are taken by surprise! Some practices are under the false impression that they are HIPAA Compliant.  Sadly, we are finding more and more that this is not the case.

September 23rd is the deadline to ensure that your practice is prepared for the finalized MEGA RULE and HI-TECH Regulations. Numerous updates and changes are required of covered entities. Have you updated your manuals,
the NPP (Notice of Privacy Practices), and all BAA’s (Business Associate Agreements)? Are you aware that the rules governing notifications for marketing and fundraising requirements have changed?  Are you ready? Did you know that if you are found to be NON-compliant, there are strict fines and penalties? 

Are you ready to start the requirement for reporting disclosures to HHS? Do you know what limitations have been applied to that ruling? The HIPAA HITECH, Mega Rule comes with more audits, hefty fines and penalties and not only will it impact YOUR practice, but the impact reaches to all of your business associates. Do your providers use mobile devices such as laptops, I-phones, tablets, or other access that is considered remote access? Think about it!  September 23rd is just around the
corner. So many questions!  Do you have the answers? If you do not feel prepared for the September 23rd deadline or the new, stricter HIPAA rules, there are many resources available to help you get where you need to be. If you have questions or need assistance, let us know. We have a team that can help get you HIPAA compliant quickly.

About ClaimCare, Inc.

 ClaimCare Medical Billing Services stands out from the crowd of medical billing companies. ClaimCare offers a complete medical billing solution, has the only service level guarantee in the industry, offers best-of-breed technology, an air tight medical billing process, actionable reporting and broad experience and can work on its clients' medical billing systems. For more information contact ClaimCare Medical Billing Services by email at sales@claimcare.net , by phone at (877) 440-3044 or visit the ClaimCare Medical Billing Company website.

 

Tags: medical billing resources, general medical billing questions, HIPAA, Compliance

Orthopedics Billing: 2013 Orthopedic Coding Changes

Posted by ClaimCare Resources on Fri, Mar 29, 2013 @ 03:11 AM

Orthopedic Billing and CodingMany significant coding and billing changes have been introduced in 2013 for orthopedics. The ClaimCare Medical Billing Company has created a 13 minute training video to bring orthopedic providers and practice staff members up to speed on the key 2013 Orthopedic Coding and Billing Changes they need to understand to insure they have no compliance, billing or collection issues as a result of these new rules.

2013 Orthopedic Coding and Billing Changes - (13 minutes)

For more insights concerning orthopedic billing, please check out the following collection of articles: Orthopedic Billing Articles

 

About ClaimCare, Inc.

 

ClaimCare Medical Billing Services stands out from the crowd of medical billing companies. ClaimCare offers a complete medical billing solution, has the only service level guarantee in the industry, offers best-of-breed technology, an air tight medical billing process, actionable reporting and broad experience and can work on its clients' medical billing systems. For more information contact ClaimCare Medical Billing Services by email at sales@claimcare.net , by phone at (877) 440-3044 or visit the ClaimCare Medical Billing Company website.

 

Tags: medical billing education, medical billing resources, Medicaid billing, medical billing companies, coding questions, 2013 medical billing changes, orthopedic billing

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