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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

    5 Solutions to Common Medical Billing Errors

    Posted by Carl Mays on Thu, Jul 18, 2019 @ 02:01 PM

    5 Solutions to Your Common Medical Billing ErrorsDenial of claim is defined in the Health Insurance Glossary as “the refusal of an insurance company or carrier to honor a request by an individual (or his or her provider) to pay for health care services obtained from a health care professional.”

    This is one of the most pressing problems the healthcare industry is facing today, resulting in a reported loss of net patient revenue ranging from 1 to 5% for your practice, or around two to three million dollars yearly for an average 300-bed hospital.

    Although these denials can be appealed and reworked, physician practices spend approximately $25 cost per claim just for this to be completed. Sadly, the success rates for these appealed claims vary from 55% to 98% depending on the capability of a practice’s medical denial management team.

    A bird’s-eye view of just how much money can be lost by denied claims is posted in the chart below, supplied by the American Association of Family Physicians (AAFP):

    Screenshot 2019-07-18 20.06.49

    How to Fix Common Medical Billing Errors for Increased Revenue

    You can reduce the rate of your medical billing denials with these following recommendations:

    1. Complete all the necessary fields of your medical claim.

    61% of initial medical billing denials and 42% of denial write-offs are due to submitting a medical claim with missing or incorrect demographic information and incorrect plan code. Thus, it is important for your staff to perform due diligence when submitting your claims. This means verifying that all the information needed in the form is filled out properly.

    Do this faster and more efficiently with a scrubber that can check the coding, bundling, and procedure information on your claim prior to submitting it to the payer.

    2. Never resubmit claims on the same date.

    Resubmitting claims on the same date to the same provider for the same beneficiary, even if all entries are complete, is one of the biggest reasons for a Medicare Part B claim denial. Avoid this by encouraging your staff to double-check if a claim has already been submitted before filing another.

    Motivate them to practice this protocol by choosing software with a user-friendly interface. This makes it easier for them to track and check the status of your claims.

    3. Ensure your patients' insurance coverage information is updated.

    Some medical billing denials are a result of your staff's failure to check the details of a patient's insurance eligibility. Thus, you end up filing for a claim that is not covered by the payer.

    Regularly update a patient’s insurance eligibility, as well as his or her basic profile information to ensure you have the most updated information.

    4. Use an alert system to ensure all claims are filed on time.

    There is a limit to the number of days a medical claim can be submitted to a payer. Know the grace period for this, which includes the time you will take to rework any rejections.

    As needed, incorporate into your workflow an alert system that will notify your staff of any medical claim that is approaching the time limit.

    5. Choose the right billing codes.

    Some claims are considered reviewed but denied or reduced by the payer due to an incorrect choice of billing codes, which could either be:

    • Upcoding (assigning a bill to a more expensive medical procedure)
    • Undercoding (failure to include the services you've performed)
    • Insufficient code specificity

    The best solution for this is to have a comprehensive patient record. This includes the laterality, severity, and accompanying conditions of the service provided. This is most helpful to your medical billing staff when assigning the proper codes to it.

    About ClaimCare

    ClaimCare offers a complete medical billing solution for your practice. This includes an EMR, Instant Payment Program, an upfront insurance verification, and a patient collection tool to help improve your practice's revenue. Call us toll-free at (855) 376-7631 or Contact ClaimCare to see how we can improve your profits so you can focus on medicine instead of medical billing.

    Tags: medical billing, medical billing services, improving medical billing

    There Is A Significant Difference Between General Billing & Medical Billing

    Posted by Carl Mays on Tue, Jul 02, 2019 @ 11:00 AM

    Final-puzzle-piece (003)We recently discovered that a new client had just hired an office worker who had a good knowledge of general billing but no experience whatsoever with medical billing. This posed a problem that we solved by meeting with the office worker and explaining some medical billing specifics.

    Following the meeting, we sent her links to six of our blogs to help guide her in comprehending more fully the medical billing process. These links will continue to help her handle more smoothly the front-end billing procedures and assist us in handling the back-end billing operations.

    Since this is not the first time we have encountered such a situation in our 30-year history, we think it is a good idea to share these six links with all of our current clients and potential clients.

     

    Link 1. Medical Billing Allowables: Why Charge More Than You Expect To Collect?

    In most businesses, if you bill $100 you expect to collect $100. In the healthcare business, a bill for $100 is often sent out with the expectation that only $50, $30 or even less will be collected. Why? This article answers the question and delves into (1) Revenue Enhancement (2) Comparability and (3) Compliance.

    Link 2. Medical Billing Allowables: How To Set A Practice’s Fee Schedules

    This article focuses on setting the overall fee schedule for your practice once you know your allowables, emphasizing: (1) Be consistent (2) Don’t leave money uncollected and (3) Don’t scare away patients. This has been ClaimCare’s highest-viewed article overall.

    Link 3. Medical Billing Allowables: How They Affect EOBs and Medical Billing Reports

    This article focuses on how your allowables and fee schedules shape the EOBs and the reports you will see every day, emphasizing: (1) The main impact you will see on your EOBs is from contractual adjustments and (2) You will see two main impacts on your reports due to the interaction of your fee schedules and your allowables.

    Link 4. Medical Billing Allowables: Understanding Your AR With Medical Billing Yields

    This article deals with how to use the knowledge gained through the first three links to understand better the true value of a practice’s AR. Understanding the concept of “yield” is the key behind understanding the value of a practice’s AR.

    Link 5. Medical Billing Allowables: Predicting Expected Medical Billing Collections

    After having read and absorbed the previous four articles, you are ready to learn how to predict your practice’s month-to-month cash flow. In its simplest form, predicting collections can be done by taking your practice’s average charges per month over the last year and multiplying by your weighted average practice yield. However, in this article you will also gain insight into how to deal with month-to-month variations to get a better handle on your cash flow situation.

    Link 6. Addendum: Allowables and Medical Billing Yields – A Few Additional Thoughts

    The previous article in the series of five outlined why yields are important and how to calculate them. This article follows up with seven tactical points concerning medical billing yields. Yields are a critical component of medical billing and practice management. These seven tactical points should help you become a “power user” when it comes to medical billing yields.

    To receive ongoing information regarding medical billing and to view previously-posted articles: Subscribe to our blog. To learn more about what ClaimCare can do for you, visit ClaimCare – The Medical Billing Professionals, or you may phone us at (855) 376-7631.

    Our mission statement: “To collect the maximum revenue for your practice as fast as possible while helping to alleviate costs and hassle for your organization.”

    About ClaimCare

    Healthcare Tech Outlook named ClaimCare as one of the nation’s “Top 10 Medical Billing Companies” in 2018. This honor follows previous such honors, including being ranked in the “Top 5” by the online magazine, Money & Business. We have a proven track record of increasing client collections by 10 to 20 percent.

    Tags: medical billing services, medical billing resources

    3 Major Benefits of Outsourcing Your Medical Credentialing Process

    Posted by Carl Mays on Tue, Jun 18, 2019 @ 11:30 AM

    3 Major Benefits of Outsourcing Your Medical Credentialing ProcessIn dealing with the complexity of the medical credentialing process, some healthcare providers still rely on spreadsheets, checklists, and makeshift programs without an expert to verify these entries. This results in several enrollment errors and delays.

    Some practices have no dedicated team to handle the credentialing process. Thus, their staff is left juggling their intended responsibilities with other tasks, which only results in inefficiencies and delayed enrollments.

    Outsourcing your medical credentialing helps eliminate these problems while offering the following benefits:

    • Reduced operating and administrative costs
    • Reduced errors in the enrollment and credentialing process
    • More time to focus on building your practice

    Recent ClaimCare blogs provide in-depth information on why Proper Medical Credentialing is a Vital Necessity and How to Avoid Delays and Mishaps in the credentialing process of verifying your medical staff information regarding:

    • Education and certifications
    • Training and work experience
    • Other professional qualifications

    This is vital because unless a physician is enrolled your practice cannot file medical claims for the services he or she delivers. This means no revenue generated for your practice or facility.

    Medical Credentialing and the Rising Administrative Costs in the HealthCare Industry

    The administrative expense in the US accounts to 8% of healthcare costs. This includes activities related to planning, regulating, and managing health systems and services such as medical credentialing.

    Kevin Schulman, a professor of Medicine at Duke and co-author of the "Administrative Costs Associated with Physician Billing and Insurance-Related Activities at an Academic Health Care," shares the reason behind this in the following statement:

    "The extraordinary costs we see are not because of administrative slack or because healthcare leaders don’t try to economize. The high administrative costs are functions of the system’s complexity."

    One source of this complexity is the multiplicity of payers in the American health system. This includes private insurances and several public health programs such as Medicaid and Medicare.

    With the variety of processes required by these payers resulting in increased administrative costs, the healthcare industry needs to consider all the possible cost-reduction solutions for operational efficiency. This includes choosing a third-party provider to handle your medical credentialing process.

    Medical Credentialing Outsourcing for Reduced Administrative Costs and Better Patient Care

    Below are three ways on how medical credentialing outsourcing can benefit your practice:

    1. Reduced Operational and Administrative Costs through Medical Credentialing Outsourcing

    In an article published in the Harvard Journal of Medicine, David Cutler Ph.D, Elizabeth Wikler B.A., and Peter Basch, M.D. shared that streamlining your electronic transactions, standardizing your reporting requirements and provider enrollment, and the credentialing system is one of the best solutions to your cost concerns.

    How much savings are we talking about? It is estimated to be $29,000 per physician in a year.

    2. Reduced Errors Resulting in a Faster Medical Credentialing Process

    With a third-party provider, you are working with expert medical staffers who are skilled and knowledgeable regarding all the recent updates on the medical credentialing process. This ensures your enrollment submission has minimal to zero errors.

    As a result, you have a faster enrollment process that allows your practice to earn more revenue.

    3. More Time to Focus on Building Your Practice

    On average, a U.S. physician spends an average of 43 minutes each day on health plan administrative functions. This is equivalent to 261 hours of saved time in a year (365 days).

    Now you can say goodbye to these administrative functions because an outsourced medical credentialing provider will do it for you. Your time can be used to focus on building your practice while delivering better services to your patients.

    About ClaimCare

    ClaimCare is one of the largest medical billing and medical credentialing providers in the United States. Its medical credentialing staff is thoroughly screened, well trained, and provided with the best tools and proper incentives to ensure you are given the best services. For more information about the services we deliver, phone us at (855) 376-7631 or subscribe to our Medical Billing Blog.

    Tags: medical billing operations, credentialing, medical credentialing

    Outsourcing is Influencing the Revenue Cycle of the Healthcare Industry

    Posted by Carl Mays on Fri, Jun 07, 2019 @ 08:00 AM

    How Outsourcing is Influencing the Revenue Cycle of the Healthcare Industry"Approximately 98% of hospital leaders are determining whether to work with third-party vendors for cost-efficiencies in both clinical and nonclinical functions and allowing hospitals to focus on value-based programming."

    The above statement came from the results of a survey conducted by Black Book Market Research LLC in 2014. Today, third-party medical billing providers are still on the rise. A few have even heightened their bundled services in response to the various challenges of the healthcare industry.

    With various specialists and named by Health Tech Outlook as one of the nation’s “Top 10 Medical Billing Companies” in 2018, ClaimCare Medical Billing now provides full-service revenue cycle management, including: consulting, credentialing, compliance, coding assistance, AR collections, and other services that go beyond our basic medical billing focus.

    How exactly is outsourcing changing the revenue cycle of various practices?

    The Increased Valuation of Revenue Cycle Management Outsourcing

    Last July, The Market Reports projected that global healthcare RCM outsourcing is expected to reach $23,000 million by 2023, an increased Compound Annual Growth Rate (CAGR) of 11.9% from its previous valuation of $11,700 million in 2017.

    This boost is due to the increasing demand from healthcare providers for a perfect solution to their need of providing quality healthcare services at a lower price. Dough Brown, author of the Black Book Research LLC, stated:

    "... hospitals look for ways to reduce costs, outsourcing is a valid strategy to achieve a financially healthier organization."

    With value-based care reforms putting more pressure on hospitals to decrease inpatient volumes while providing cost-effective care, the need to balance patient satisfaction and cash inflow becomes even more inevitable.

    How does your practice respond to these challenges?

    Braving the Challenges through Revenue Cycle Management Outsourcing

    Knowing these challenges, third-party providers like ClaimCare have introduced a simplified front-end to back-end revenue cycle management that can help cut the administrative costs of your practice. This includes:

    • Assisting with medical coding
    • Qualifying patients for Medicaid
    • Processing the medical credentialing of your physicians
    • Documenting, reviewing, and collecting patient records and receivables
    • Scrubbing and submitting medical claims and enrollments

    Some are even providing bundled services that are relevant to inpatient groups and hospitals such as clinical services, cyber security, IT, health facilities management, and analytics. Others have decided to focus on servicing healthcare clients alone.

    The practices and facilities who have chosen to outsource their revenue cycle management function, which includes their medical billing processes, have experienced significant improvements in:

    • Revenue
    • Collection rates
    • Patient satisfaction rates
    • Denial resolution efficiency

    Does this mean you should also implement the same for your practice?

    It is tempting to join the bandwagon and choose a third-party provider to handle your medical billing process. However, before you get excited about establishing a relationship with one, here are some factors that can influence your decision to outsource your medical billing process:

    • Cultural fit between organizations
    • Start-up costs and maintenance
    • Accountability and autonomy in operation
    • Performance goals and improvement expectations
    • Patient satisfaction regarding your employee population

    Consider these factors before transferring your medical billing services to a third-party provider. Perform the necessary due diligence to determine whether or not they can deliver on your practice's unique requirements. Subscribe to our blog or call us toll-free on (855) 376-7631 to learn more about revenue cycle management outsourcing.

    About ClaimCare

    ClaimCare offers the best-of-breed technology, delivering a comprehensive revenue cycle denial management system to various healthcare providers. This includes software databases that track, quantify, and report all denials of your payers. We provide an airtight medical billing process with actionable reporting. To learn more about our services, complete our online form.

    Tags: medical billing, medical billing services, Reasons to outsource medical billing

    3 Medical Billing Tips Guaranteed to Maximize Your Revenue

    Posted by Carl Mays on Sat, Jun 01, 2019 @ 08:00 AM

    3 Physician Billing Tips Guaranteed to Maximize Your RevenueAccording to a Healthcare & Business Technology report regarding medical billing, almost $125 billion in uncollected revenue happens each year due to:

    1. medical billing errors, and

    2. failure to stay up-to-date on medical billing rules and regulations.

    This becomes even more alarming when realizing that a Modern Healthcare article stated nearly 80% of patients owe more than $500 to their healthcare providers while 51% owe more than $1,000.

    With this data to consider, maybe you should take a closer look at your medical billing situation to see if you have a mission statement similar to the one we have at ClaimCare Medical Billing, Inc.: “To collect the maximum revenue for your practice as fast as possible while helping to alleviate costs and hassle for your organization.”

    As you strategize to maximize revenue and alleviate costs and hassle, here are 3 medical billing tips that can help your billing process become more efficient.

    1. Create a clear billing and collection process

    Improve your revenue cycles through an established step-by-step billing and collection process. Do this by:

    • Establishing clear terms with your patients, which includes getting their permission to leave voicemail messages regarding billing matters, reminding them about co-pays, and discussing their different payment options.
    • Gathering and verifying patient information, which includes their phone number, email, workplace, and billing address. If you are not already doing so, require them to bring a photo ID to accompany their insurance card at their initial visit. This can be very helpful in case their bill has to go to a collection agency in the future.
    • Drafting a sequence of letters to remind them about their bills, which includes when their bill is due, when it will be overdue, and when it will be turned over to a collection agency.

    With these 3 bullet points above in place, you can experience a more efficient physician billing process with less delinquent payments.

    2. Properly manage your claims

    HealthCare & Business Technology revealed that almost 80% of all medical billing contains errors. When errors occur, the result is a longer cycle revenue for your claim collection process, which undergoes an initial submission, rejection, editing, and resubmission.

    Why go through this longer cycle if it can be done more efficiently by inputting the correct information and double-checking the claims before submitting them the first time?

    Ensure you double-check the following before submitting your claims:

    • Patient information
    • Provider information
    • Standardized medical codes
    • Insurance information
    • Duplicate billings
    • Documentations

    What if you still get a denied claim after verifying the above information? How do you handle this?

    Denied claims are often provided with claim number references or denial codes, together with an attached Explanation of Benefits (EOB). If you don’t receive these, it is best to contact the representative of the company to request the items. If they can't be provided, you may directly clarify the errors with them to ensure your claim will be accepted the second time around.

    3. Track pending accounts payable and identify problem accounts

    Aside from doing due diligence in performing tips no. 1 and 2, it is also important for your practice to track the following:

    • Pending account receivables
    • Problem accounts

    Why is this important?

    Tracking your pending account receivables helps you properly evaluate the efficacy of your collection procedure, while identifying problem accounts can help you create a better approach in handling their non-compliance to your billing schedules. As needed, you may either increase the billing reminders for these patients or choose an outsourced collector to handle the collection for you.

    About ClaimCare:

    ClaimCare is one of the largest medical billing companies in the United States. We offer a complete medical billing solution using the best-of-breed technology, actionable reporting, and airtight medical billing process to ensure you have increased revenue for your practice. For more information contact us by phone at (855) 376-7631 or subscribe to our Medical Billing Blog.

    Tags: medical billing education, medical billing, medical billing services

    Avoid Medical Credentialing and Provider Enrollment Delays and Mishaps

    Posted by Carl Mays on Tue, May 21, 2019 @ 10:00 AM

    Competence_in_dictionaryNo enrollment means no payment.

    When a new physician joins your practice, it is of utmost importance for your practice to expedite his or her medical credentialing and enrollment process. Credentialing specialists at ClaimCare can help you do this effectively (doing the right thing) and cost efficiently (doing the thing right).

    Having a fast and reliable medical credentialing process is important.

    As you are probably aware, only after a health plan has awarded your new hire with an "effective date of participation" can this physician’s claims be properly submitted for payment.

    How much are you losing?

    A disrupted cash flow for your practice occurs when an “uncredentialed” physician cannot receive payments for claims while waiting for the practitioner to be enrolled with patients’ health plans.

    According to various reports, approximately $30,000 in lost revenue happens to an average primary care physician with just a month of credentialing delays. This amount increases substantially for higher billing specialties such as cardiothoracic surgery and orthopedics.

    3 reasons to outsource your medical credentialing and enrollment process:

    1. It helps reduce costs while safeguarding stored data.

    Allowing a third party medical credentialing provider to handle the enrollment and credentialing process lowers your expenses. It allows you to utilize top-rated hosting and security technology without the need to pay for the installation, implementation, and maintenance of servers and data encryption software.

    2. It brings better efficiency through robust Key Performance Indicators.

    Third party medical credentialing providers give your practice efficient tracking, trending and reporting data. This includes the following:

    • In-process charges
    • Department processing times
    • Provider process times
    • Days in Enrollment (DIE)
    • Quality measurements for updating payer follow-up notes

    This data allows you to easily establish performance baselines that can help improve your practice. This results in an expedited enrollment and medical credentialing process.

    3. It reduces medical credentialing and provider enrollment errors.

    Third party providers put the credentialing process into a single team that handles the centralized verification office. They are composed of trained, highly skilled, and knowledgeable individuals who are experts in completing your credentialing and enrollment process. This reduces the errors for your practice.

    The bulk credentialing approach of third-party providers also makes it easier for your organization to gain a "delegated status". Once acknowledged, you'll have an even faster enrollment and reimbursement process for your practice.

    So why continue to wait for 60 to 120 days before your credentialing process is completed if it can be done faster and more efficiently? Subscribe to our blog or call us at (855) 376-7631 to learn more about the medical credentialing process.

    About ClaimCare

    Healthcare Tech Outlook named ClaimCare as one of the nation’s “Top 10 Medical Billing Companies” in 2018. This honor follows previous such honors, including being ranked in the “Top 5” by the online magazine, Money & Business. We have a proven track record of increasing client collections by 10 to 20 percent. Talk to us to learn more about our medical credentialing services.

    Tags: medical billing, medical billing services, medical billing resources, credentialing, medical credentialing

    3 Ways to Maximize Your Practice's Reimbursements

    Posted by Carl Mays on Mon, May 13, 2019 @ 03:00 PM

    3 Ways to Maximize Your Practice's ReimbursementsAre medical claims reimbursements getting more challenging for your practice? You are not alone. There are other practices that have suffered the same in past years, and are still struggling with this problem.

    "83 percent of Physician Practices with under five practitioners said the slow payment of high-deductible plan patients are their top collection challenge, followed by the difficulties that practice staff have at communicating patient payment accountability (81 percent)."

    Here are some tips and recommendations on how to avoid this problem and improve your medical reimbursements.

    1. Get to Know More About Your Patients’ Health Plans

    Not all health plans are the same.

    Your patients may be presenting you an ID card with the same logo or from the same healthcare provider, but it doesn't necessarily imply they share the same health plan. Plans may vary regarding:

    • Filing requirements
    • Rates
    • Benefits

    Thus, it is important for the front desk staff to familiarize themselves with each patient's plan.

    How is this possible?

    Ensure your current office staff are kept updated regarding the various plans provided by your payers. Or, hire the services of a highly knowledgeable medical billing company familiar with the varying coverage and benefit mandates of healthcare providers.

    2. Understand Your Market

    You will most likely coordinate with three or more insurance companies each year. Thus, it is best to develop a strong foundational knowledge of their industry practices and trends. This includes the following:

    Identifying the major payers of your practice

    Prepare a record of your prevalent employers, unions, and providers that work with your practice. Compile the plans, networks, and payers of these patients. Familiarize yourself with these to manage their accounts efficiently.

    Learn more about your managed care contracts

    You may have provided several discounts to certain payers because of the number of patients they have endorsed to your organization. However, be cautious of how these discounts will impact your revenue.

    Are these discounts providing enough revenue to your practice? If not, data can show you how much revenue these payers are adding to your practice. This will give you leverage when negotiating discounts with these payers.

    Never fail to verify

    This may sound elementary, but verifying your patients’ benefits, plan requirements, and eligibility is very important to any practice.

    Conduct due diligence. Invest in a system that allows you to easily track and monitor the medical claim reimbursement efficiency of these payers. In doing so, you will know who among these payers are making medical reimbursements more difficult.

    3. Be knowledgeable about the current trends associated with your practice

    Medical practices vary depending on specialization. This makes it important for your practice to remain updated concerning the different trends happening in your practice.

    This includes:

    Bundled Payments

    It is relatively common for some payers to combine the rates of facility and professional reimbursement, radiology, lab, and anesthesia into one payment scheme. Your medical billing team should be aware of how these should be handled.

    Price Transparency

    As more patients are demanding enhanced transparency on medical fees, practices are under added pressure regarding how their medical service fees are to be quoted. Know the various billing laws related to this matter to avoid encountering patient conflicts.

    Stay informed regarding the latest developments, changes, and challenges facing the medical billing and coding industry. Subscribe to our blog or complete our online form for any of your queries and concerns.

    About ClaimCare

    ClaimCare is composed of an incredible team of professionals, including: certified coders, practice managers, medical providers, credentialing experts, and experienced business professionals. We aim to make your medical billing more effective and efficient. Call us at (855) 376-7631 if you need help with any of your medical billing needs.

     

    Tags: medical billing, medical billing services, medical billing resources, Medical Reimbursement

    Meet the Two Culprits Behind Your Medical Billing Mistakes

    Posted by Carl Mays on Tue, May 07, 2019 @ 11:03 AM

    Meet the Two Culprits Behind Your Medical Billing Mistakes According to a Healthcare Business and Technology report, almost 80% of medical bills contain errors. This results in approximately $125 billion of profit loss for U.S. practices. If you have in-house billing, it is important to identify these mistakes and the reasons behind them in order to fix and avoid them in the future.

    The Two Most Common Reasons Behind Medical Billing Errors:

     

    1. The Complexity of the Medical Coding System

    The International Classification of Diseases, currently in its 10th Revision (ICD-10), will present ICD-11 at the World Health Assembly in May 2019, which will come into effect on January 1, 2022. “A key principle in this revision was to simplify the coding structure and electronic tooling – this will allow health care professionals to more easily and completely record conditions,” says Dr Robert Jakob, Team Leader, Classifications Terminologies and Standards, WHO.

    Meanwhile, it is important to keep up to date on ICD-10, which has constant updates and changes, as exemplified on ClaimCare’s post: Impact of Medicare 2019 E&M code changes on a physician compensation package based on RVU.

    ICD was originally adopted by the U.S. to provide better data for research, a more efficient healthcare system, and quality, safety, and efficacy measurement of services - believing that it could reduce medical billing errors because of the specificity of services listed on each code.

    However, this has resulted in more errors for practices that have struggled to learn and remain updated with the coding system.

    Insurance companies have also become stricter with their medical billing and coding practices. The smallest mistake easily becomes a reason for your medical billing claim to be rejected.

    This results in a longer medical billing cycle, which may lead to several months of waiting before payment for services are released.

    2. Failure to Remain Updated with the Latest Medical Billing Rules and Regulations

    Another challenge facing medical practices is how to cope with the aforementioned constantly changing rules and regulations in the medical billing industry.

    The release of the Medicare 2019 E&M Code Changes meant another set of codes had to be remembered for your medical billing staff/personnel. The question arises, “Did your organization have the time and skill set to read and implement the changes?

    Kyle Haubrich, JD shared the following insights in his article, How the MIPS proposed rule could affect your practice:

    "Physicians are frustrated and are becoming burned out with all the regulations they currently have to comply with, so opting in might just be more frustration for them, and not worth the hassle."

    Are you feeling the same thing?

    Here's how you can get rid of these medical billing problems.

    Incorrectly, medical billing outsourcing may seem expensive to some practices and facilities that have never tried an efficient and effective medical billing company. However, the numerous benefits, including the reduced profit loss, will prove to be more beneficial than previously imagined for the practices and facilities that are hesitant to outsource.

    Teaming up with a medical billing company erases a need to worry about:

    • Changing medical rules and regulations
    • Medical claim submission and approval
    • Medical coding updates

    Most importantly, you don't need to spend on personnel:

    • Salary
    • Benefits
    • Taxes
    • Compensation

    You don't even need to think about turnover, training, and staff familiarization over billing software, procedures, and coding.

    With Medical billing outsourcing, you gain access to trained professionals, who only make money when you do.

    Reduce your profit loss. Consider your options and choose a medical billing company who can help you reduce these mistakes.

    Learn more tips and suggestions on how you can improve your medical billing process. Subscribe to our blog or call us toll-free at (855) 376-7631.

    About ClaimCare

    ClaimCare has over 80 years of combined medical billing experience in providing medical billing services to various specialties and states. This includes process engineering, information technology, accounting, and business management. Let's talk. Send us a message.

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

    3 Ways to Reduce Administrative Burdens of Your Practice

    Posted by Carl Mays on Wed, May 01, 2019 @ 08:00 AM

    3 Ways to Reduce the Administrative Burden of Your PracticeAn American College of Physicians (ACP) paper titled "Putting Patients First by Reducing Administrative Tasks in Health Care” estimated the annual costs for excessive administrative tasks total $40,069 per full-time equivalent (FTE) physician.

    The administrative tasks addressed include:

    • 2 hours for every hour a physician speaks with a patient
    • 3 to 5 hours of billing and insurance-related (BIR) activities
    • 6.5 hours per week on EHR documentation.

    Here are three strategies to help make these tasks more efficient:

    Strategy 1: Use a Cloud-Based Electronic Health Record (EHR) System Handled by Competent Staff

    According to the Center for Disease Control and Prevention (CDC), 78% of office-based physicians are using EHR systems. However, the efficiency in using these systems varies widely among practices and facilities.

    According to the National Center for Health Statistics (CDC-NCHS), it takes an average of 4,000 total mouse clicks or 43% of physician time just to document patient records and charting functions.

    You can reduce IT problems, increase efficiency, and speed-up your medical claim process through the use of a cloud-based EHR system handled by a competent administrative staff.

    Strategy 2: Outsource Your Medical Billing Tasks

    Outsourcing your medical billing is a great way to:

    • Reduce overhead costs
    • Expedite the medical claims process and increase net revenue
    • Focus on your core services

    Choosing a quality medical billing company with a proven track record of reducing administrative tasks, along with increasing your net revenue, allows you to focus on your core services and improve the quality of those services.

    Strategy 3: Prioritize and Delegate Tasks

    Emphasize individual and team responsibilities. NBA Hall of Fame coach Phil Jackson said, "The strength of the team is each member. The strength of each member is the team.” This aptly applies to your administrative staff.

    Know the skill set of your staff. Identify their strengths and weaknesses. Based on these qualities, assign the roles that will make them most effective. If needed, enlist the help of your medical billing company to assist in devising a strategic plan to improve your team's efficiency.

    Erase the idea of procrastination. Work as a team by choosing someone who will monitor the assigned tasks of each member. Strictly implement guidelines to insure tasks that should be done today will not be left undone until tomorrow.

    Challenge your excuses and act today on these tips and recommendations to help improve your medical billing process. Subscribe to our blog to receive more medical billing tips, news, and insights, or complete our online form to leave us a message.

    About ClaimCare

    ClaimCare aids you with your medical billing tasks through its complete medical billing solution. We offer the best-of-breed technology, including HIPAA compliant EHR System, and an airtight medical billing process with actionable reporting. For more information, email us at sales@claimcare.net or call (855) 376-7631.

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

    3 Types of Medical Billing Companies to Fit Your Needs

    Posted by Carl Mays on Fri, Apr 26, 2019 @ 11:01 AM

    3 Types of Medical Billing Company to Fit Your NeedsThe AMGA 2017 Medical Group Operations and Finance Survey reported that operating costs losses per physician jumped from a 10 percent loss of net revenue in 2016 to a 17.5 percent loss a year later. Thus, the total losses per physician during this two-year period went from $95,138 to $140,856.

    With these increasing revenue losses, to help reduce operational costs more and more healthcare providers are choosing to outsource their medical billing rather than keeping it in-house.

    If you are considering a move to outsource your billing, it behooves you to understand the 3 types of medical billing companies. This basic knowledge will help you decide which type best fits your needs, allowing you to focus on your core operations.

    Medical billing companies vary with the services they offer, and are categorized as such:

    1. Light Service Medical Billing Companies

    These are billing software vendors. Their services include handling of coding validation and working rejections due to authorizations, eligibility, and patient demographics.

    Due to the limited services such companies deliver, which include processing the front end billing process and processing your claims, they are designed for practices that have an expert in-house medical billing staff in place.

    2. Full Service Medical Billing Companies

    These are the traditional medical billing companies that initiate their services during the earlier stages of your revenue cycle. They are equipped and skilled to:

    • Provide your practice with technology tools and training for demographics, card issuance information, and eligibility verification, which is most helpful during the check-in process
    • Work with rejected claims and assist you on how to avoid this from happening in the future
    • Communicate with practices regarding how to manage rejections.

    They have the capacity to handle all of your medical billing concerns. This makes them the ideal choice for medium to large practices aiming to focus on their core operations.

    3. Boutique Medical Billing Companies

    Sometimes what’s required is a medical billing company that can provide more specific assistance to your specialized practice. This is where boutique types of medical billing companies are extremely valuable.

    Boutique medical billing companies can deliver customized services to specialized practices and facilities that wish to go beyond the common simple payment postings, claims submissions, and account receivables follow-up. However, this also means a higher service fee because of their unique customized approach to medical billing.

    Which type of medical billing company would best suit your practice or facility?

    It depends on your requirements. If you have a limited in-house billing staff, choosing a full-service or a boutique billing company would be ideal. However, if you have the resources to handle most of this on your own and only require a software to assist you, then a light service medical billing company could help you achieve your goals.

    About ClaimCare

    ClaimCare has over 17 years of medical billing experience with all employees being 100% U.S.A.-based. Our services include denial management, electronic medical record implementation, fixing of broken medical billing processes, and expedited billing service. Subscribe to our blog or call us toll-free at (855) 376-7631 for any of your medical billing queries and concerns.

    Tags: medical billing operations, best medical billing companies, improving medical billing, medical billing resources, Medicaid billing

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