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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

    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

    Proper Medical Credentialing is a Vital Necessity

    Posted by Carl Mays on Mon, Apr 22, 2019 @ 08:01 AM

    Importance of Medical CredentialingMedical credentialing for all practitioners in your group is one of the first steps you should think of when starting your own medical practice. This is essential in dictating the financial stability of your organization.

    What is Medical Credentialing?

    Medical credentialing has been defined as: "the process by which insurance networks, healthcare organizations, and hospitals obtain and evaluate documentation regarding a medical provider's education, training, work history, licensure, regulatory compliance record, and malpractice history before allowing that provider to participate in a network or treat patients at a hospital or medical facility."

    Based on this definition, it is easy to see why skipping the process is a definite ‘no’ for any medical practice. Not obtaining proper credentialing can lead to lost revenues. This means not being able to collect your medical office bills for various services provided by the uncredentialed professional on your team.

    Various reports show that a month’s delay in credentialing for an average primary care physician can result in more than $30,000 in lost revenue. Thus, it is an absolute necessity for any medical practice to ensure the medical credentialing process is working efficiently.

    4 Tips for a More Efficient Medical Credentialing Process

    For a more efficient medical credentialing process, ensure the following are put into place:

    1. Get Adequate References (Preferably Five)

    Hospitals and other health systems often require three professional references before approving a medical practitioner.

    Dare Hartsell, RN, MSN, the vice president of clinical services for a large healthcare group, says their organization “requires three references from applying physicians. All three references must be physicians of the same specialty who are not related by blood or marriage, and none of the references may be members of the physician's practice.”

    However, the credentialing specialist who verifies the validity of these references will not waste time following-up a reference on file who is unresponsive. So, if you have listed only three references but one of them is hard to reach, it is most likely for your application to have a longer processing time.

    By giving five references, you are giving the credentialing specialist more references to consider. This results in a speedier processing time.

    2. Ensure Your Documents are Up to Date

    Guarantee that these documents are up to date:

    • Council for Affordable Quality HealthCare (CAQH)
    • Drug Enforcement Authority (DEA)
    • CLIA Certification
    • Any other ancillary services that require proof of accreditation
    • IRS Letter Confirmation of Established Tax ID Number
    • Articles of Corporation (LLC, PA, INC., etc.)
    • License
    • Malpractice Insurance

    If any of these documents have to be renewed annually, then ensure the document submitted to you by your physician is still valid.

    3. Start Early on Your Medical Credentialing Process

    It is normal for the medical credentialing process to last from 50 to 90 days from receipt of the initial application, but could take up to 120 days depending on the quality of the application and other circumstances. Thus, it is best to get your forms submitted early, especially during the start of the year.

    The earlier you do this, the sooner your physician can work for your practice.

    4. Know Your State’s Credentialing Requirements

    It is vital to know the medical credentialing requirements set by the state, especially for anyone starting a practice in a new location. This includes additional fees that may be required by:

    • Medicare
    • Medicaid
    • Tricare or V.A.
    • Durable Medical Equipment Regional Carrier (DMERC)

    Stay on top of things. Know the recent requirements set by your state to ensure a faster medical credentialing process.

    Final Thoughts on the Credentialing Process

    Sometimes, it is best to let a third-party provider handle the medical credentialing process for you. For one, these companies have established a long-standing relationship with payers. Thus, they already know the common mistakes and errors that slow down the credentialing process.

    For more tips on how to make a smoother credentialing process, subscribe to our blog.

    About ClaimCare

    ClaimCare delivers credentialing and contracting services to medical practices, including start-up practices in almost all states in the US. We guarantee 85% of your charges to be resolved within 60 days and 95% of your charges to be resolved within 120 days. Learn more about our Service Level Guarantee.

    Tags: credentialing, medical credentialing

    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: general medical billing questions, medical billing operations, medical billing education, medical billing companies, medical billing services, medical billing resources, 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?

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

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