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.

Subscribe by Email

Your email:

Medical Billing Blog Requests

If you have  specific topic or question you would like to see covered in this blog then please post the question on the Medical Billing Question & Answer Forum.

If you have a question about ClaimCare's Medical Billing Services please utilize the form below.

Contact Us

How do you wish to be contacted? *


MEDICAL BILLING BLOG

Current Articles | RSS Feed RSS Feed

Cardiology Billing: 2013 Cardiology Coding Changes

  
  
  
  
  
Cardiology Billing CodingMany significant coding and billing changes have been introduced in 2013 for cardiologists. The ClaimCare Medical Billing Company has created a 23 minute training video to bring cardiologists and cardiology practice staff members up to speed on the key 2013 Cardiology 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 Cardiology Coding and Billing Changes - (23 minutes)

For more insights concerning cardiology billing, please check out the following collection of articles: Cardiology Billing Articles.

You can download this presentation by visiting  the following page: 2013 Cardiology Coding Changes.

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.

ClaimCare Named One of the Nation's Top 5 Medical Billing Companies

  
  
  
  
  
best medical billing companiesIn kicking-off 2012, Money & Business, the online magazine that provides comprehensive coverage of business and personal financial matters, named the ClaimCare Medical Billing Company among the top five online medical billing companies. Independent researcher/writer Michele Wyan, listing the top five companies in alphabetical order, was impressed with ClaimCare’s track record, extensive experience and proven ability to serve all medical specialties nationwide.

The researcher, mirroring ClaimCare’s mission “To collect the maximum revenue for your practice as fast as possible while helping to alleviate costs and hassle for your organization,” spotlighted a couple of ClaimCare’s many positive attributes:

  1. A guarantee that 85% of charges will be resolved within 60 days and that 95% of charges will be resolved within 120 days.
  2. The submission of claims within one weekday of receiving documentation of a patient encounter. If ClaimCare misses a claim submission deadline, the client is reimbursed for the missed claim.

ClaimCare’s CEO/President Carl Mays II says, “This recognition is greatly appreciated because it reflects the dedicated hard work and the consistent, conscientious attention to detail that ClaimCare employees provide in order to serve our clients and to accomplish our mission. We are also quite proud of the fact that we have the ability to work on all major medical billing systems such as Centricity, eCW, NextGen, eMDs, Sage, Greenway, Misys, etc.”

                                                        *      *       *

Copyright 2010 by ClaimCare Inc. The author, Greg Weremowicz, is VP of Sales for ClaimCare Medical Billing Service, one of the largest medical billing companies in the United States.

ClaimCare is Alive and Well

  
  
  
  
  
ClaimCare Medical Billing CompanyMark Twain is attributed with saying, “The reports of my death are greatly exaggerated.” We at ClaimCare can now relate to how he must have felt! A small company by the name of Claim Care that helped patients with denied claims (and not associated with us in any way) closed their doors in September 2010. We were not even aware of the group until someone phoned us this week to see if we were still in business. Be assured – ClaimCare is alive and well – and going strong!

Not only are we alive and well – we are continuing to keep on the cutting edge of information and key technologies to collect the maximum allowable revenue for our clients while alleviating costs and hassles for their offices. We look forward to continuing to serve all of our existing and new clients in 2011 – and beyond!

                                 _________

Copyright 2010 by Carl Mays II. Carl is President and CEO of ClaimCare Medical Billing Service, one of the largest medical billing companies in the United States.

Medical billing offices need a helping hand every now and then

  
  
  
  
  
old ar clean-up denial managementMedical billing offices / Managers often find themselves in need of extra "helping hands" for a variety of reasons including:
  • The loss of a key employee (either temporarily or permanently);
  • A backlog of old AR that has become so large that no one is quite sure how to tackle the problem;
  • Growth of the Practice, but the billing staff is the same size.
  • Expanding / opening a new office location;
  • Problems with current billing system or installing new EMR/system that causes extra work.

In these types of situations it is critical that the medical billing office / Manager and the medical Practice become willing to seek help - even if it's just temporary, short-term help.  Trying to claw out from under these situations without outside help can be overwhelming.   And the strongest billing offices / Managers know there is no shame (in fact there is great wisdom) in asking for a temporary "helping hand" during crunch times.

If you are considering seeking extra / temporary help, what type of help should you pursue?   You want help that meets the following important standards:

  1. The extra help can be given quickly, but does not require a long-term commitment on your part. In other words, when you are out from under the immediate crisis, you can stop using the outside resources / medical billing company.
  2. The extra help team members are true experts in the medical billing industry and they have access to the most current billing codes and requirements. In other words, don't hire "Aunt Matilda who does medical billing part-time out of her home office now and then for a little extra cash."
  3. The "extra hands" help causes minimal interruption or risk to your current cash flow and processes. For example, it is very high risk to use "pinch hitters" to do your up-front data entry work. If they fail, then your cash flow for the Practice will stop. On the other hand, applying "extra hands" on older claims and AR minimizes risk and complications because this work requires less system access, does not jeopardize the new claims that are going out daily, and requires less familiarity with the nuances of the Practice's operations.
  4. The help provides EXTRA value beyond the immediate crisis, and gives you the best bang for your buck. True medical billing Experts bring a fresh eye and state-of-the-art knowledge about the billing industry. They can give you honest feedback and keen insights about your Practice that enable you to improve collections, test out new technology to assist your staff, and provide a general level of relief that will allow the Practice to avoid future pitfalls and crises.

The best way to achieve these objectives is to find an outside company who will work the AR that is over 60 days old.  This will:

  • Allow the Practice's current billing staff to keep getting current claims out the door fast and clean to ensure the Practice's revenue remains steady and strong;
  • Pin-point the source of much lost cash flow and give relief to the Physician's greatest point of aggravation - old AR. No medical billing Manager ever gets in trouble with the physician because all of the AR is under 60 days!! But many a medical billing office / Manager had to face the wrath of a Physician because a large backlog of old AR has started to build up in the 120+ bucket.
  • Give the Practice / Office Manager a lot of valuable feedback on the specific issues that led to the old / high AR in the first place. Are certain codes or payers causing issues? Is there a credentialing or system set-up issue? Are there denials that are not being properly pursued? Are there denials being left on the books that will never pay and are simply creating "false AR?" The feedback from the Old AR clean-up can be invaluable in helping the Practice and the medical billing Manager make changes to prevent the old AR from ever becoming a problem again after it is cleaned up.
  • Demonstrate new reports and follow-up tools to make it easier for the billing office / Manager to do their job well. Most of the medical billing companies who provide Old AR clean-up services also utilize sophisticated reports and follow-up tools that are valuable to the Practice. Seeing firsthand how these tools work may provide insights into how the Practice could leverage them to prevent future crises.

In summary, knowing when to seek help and being strategic in the type of help you employ can turn a potential disaster in to a triumph that will delight physicians, provide immediate relief for the medical billing office / Manager and set the Practice up for on-going medical billing and collections success.

Follow this link to see an example of an AR clean-up and denial management service that can assist medical billing offices in crisis.

_____________

Copyright 2010 by Carl Mays II. Carl is President and CEO of ClaimCare Medical Billing Service, one of the largest medical billing companies in the United States.

Medical billing collections will suffer no matter what Congress does

  
  
  
  
  

medical billing companiesEveryone in the medical billing field is hopeful that Congress will act to defer (and ultimately eliminate) the proposed 21% fee reduction for Medicare.  Keep in mind, however, that March 2010 collections will likely suffer a delay even if the fee cut is deferred.  The coming months will be a challenging time for medical practices and medical billing companies.

In January 2010 Medicare had a 2 to 3 week delay in processing claims because they needed to update their system after Congress deferred the 21% Medicare fee reduction.  As of today, Medicare is still catching up in their claims processing (a fact that have not officially acknowledged).  ClaimCare found that as of February 23, 2010, Medicare was still at least a week behind in their typical claim processing time frame.  And this level of a delay happened when Medicare had plenty of advance warning concerning the deferral, so you can imagine what delays could result when they have less advance notice.  In addition to this delay, Medicare had a system problem that resulted in multiple weeks worth of secondary claims not crossing over properly.  This Medicare system problem has compounded the delay in collections.

There is every reason to expect another delay in Medicare payments in March 2010 if Congress issues a last-minute deferral of the 21% fee reduction.  Based upon past evidence and experience, if Congress does issue a deferment, we anticipate a 2 to 3 week delay in the Medicare claims processing and payments.  Therefore, when thinking about your cash flow for March 2010, you should plan for at least an additional 2 to 3 week delay for Medicare payments.

If Congress decides to delay the fee reduction for only 30 to 45 days (as they are considering), then this problem will be repeated and exacerbated in April if they pass yet another last-minute deferral.  Practices and medical billing companies need to plan on Medicare collections being less predicable and fairly erratic over the next few months.  As I stated earlier, this is a challenging time to be a medical practice or a medical billing company.

_____________

Copyright 2010 by Carl Mays II. Carl is President and CEO of ClaimCare Medical Billing Service, one of the largest medical billing companies in the United States.

Selecting a Medical Billing Company: Got Scale?

  
  
  
  
  

medical billing company successScale is key when selecting a medical billing company. By scale I mean that the medical billing company should have tens and hundreds of providers across whom large, necessary investments can be spread.

For instance, If a $150,000 per year billing system administrator is required, then a medical claims billing company with 200 clients only needs each of its client to carry $750 per year of that person's cost. If a practice of four providers employed this person, then each provider would need to carry $37,500 per year of that person's cost; this is the value of scale. A medical practice can achieve significant advantages by leveraging the superior scale of a mid- to large-sized medical insurance billing company.

A medical billing company should be deploying technologies and resources that a typical medical practice simply cannot afford or support. Examples of technologies and processes that lend themselves to scale include:

  • Advanced (and expensive) billing systems that offer state-of-the-art claim management and reporting abilities.
  • Pre-submission claim scrubbers that deal with the different rules for adjudication that every unique payer has.
  • A good billing system manager that stays updated with constantly changing claim submission rules from different payers. Sometimes claims can go several weeks before getting submitted, simply because many payers change their formatting rules so often. Medical billing companies are less susceptible to such tactics.
  • Advanced collection tools, such as predicting payment yields from patients (such as the amount the patient owes times the likelihood they'll pay).
  • A well-defined and managed billing process that will not grind to halt because a single employee is lost and eliminates errors before they propagate through the system.
  • A dedicated group of individuals that follow-up on claims that have not had a response from the payer within a reasonable time frame.

These and other advantages show that most medical practices can't afford the personnel and technology to match the services that a good, properly scaled medical billing company provides.

Most of the costs associated with the processes and technologies are fixed, and medical billing services spread these costs over their entire client base. A medical billing company that serves a few hundred physicians is more likely to provide better services than one that serves only a few practitioners. What's more, smaller medical billing companies struggle just to use processes and technology that is equivalent of what most practices already deploy.

The bottom line is that it's always a good idea to check the scale of your medical claims billing company. The bigger ones are better able to collect from insurance companies and payers, who tend to do whatever they can to keep their money.

Copyright 2009 by Carl Mays II

Make Sure Your Billers Watch Your AR - Not the Clock

  
  
  
  
  

Outsourcing medical billing to the correct medical billing company can insure that they have the same incentives as you do.

Almost all medical billing companies are paid a percentage of what they collect. This means they are only paid when you are paid. It also means the more they collect for your practice, the more they are paid. Internal medical billers, on the other hand, are almost always hourly employees. They are paid based on showing up in your office, not based upon how well they perform your medical billing or how much money they collect for your practice. This is not an alignment of incentives.

This issue, however, is often not fully understood or appreciated by many providers.  These providers frequently say: "the staff works directly for me in my office-- they are more loyal and will do a better job and I can see what they are doing".  Experience has shown, however, that this is often not true.   

Medical Billing

I recently spoke with a partner at a busy cardiology practice.  While one of the billers was out sick, some paperwork was required and the supervisor went looking for it.  When the supervisor opened the missing biller's desk, a stack of unfiled, old claims was discovered.  It turned out about $40,000 of them were past timely filling deadlines.  They were lost.  I repeat-the practice lost $40,000!  When the biller returned from her leave, she was "sternly" reprimanded.   Let me say it one more time-she was reprimanded.  Not fired, but reprimanded.  Either way, the practice lost $40,000 in just this one instance alone. 

Why wasn't more severe action taken? Because of concerns with upsetting the billing staff and exacerbating a staffing problem that existed. The biller was moved from follow-up to the front desk where she is now being trusted to collect the critical demographic information required to properly bill claims.

This volume of missing charges should not have gone unnoticed. There should have been multiple reports that could have identified such a problem. The practice, unfortunately, did not know how to properly utilize the capabilities of the billing system and so, the required reports were never run. Proper use of a billing system requires much investment in time and training, an investment that hourly employees often do not make. This $40,000 in unbilled charges is likely a proverbial roach of this practice - in other words, for the one you see there are likely hundreds you do not.

If you select the correct billing company you can avoid nightmare situations like this. Here are some of the key elements you should seek when looking for a medical billing company:

  • A fully integrated tracking system (charges by locations/provider and payments by source - lock box, office, PO Box) should be in place and you should have full visibility into the system at all times.
  • Your medical billing company should reimburse your practice for what you would have been paid by the payers based on your allowable for any claims that go past timely filing for reasons within the medical billing company's control.  What this means is that you never suffer financially if the billing company drops the ball.  Try to have your billers reimburse you if they drop the ball.
  • The practice should always (24 hours a day, 7 days a week) have access to the medical billing companies system. This allows the practice to see at any time exactly what is happening with their account.

Physicians are working harder for less as costs rise and reimbursements fall. This is exacerbated by selecting a medical billing approach that does not have the proper alignment of incentives to prevent disasters (such as $40,000 in unbilled charges) from occurring.

It has been said that the definition of insanity is doing things the same way and expecting different results. This certainly applies in the story outlined above. The biller that left $40,000 in charges unbilled will likely continue to cost the practice money. Just because she works for the practice does not mean she represents their best medical billing solution.

Selecting a world-class medical billing service that provides total visibility into their process and has incentives that are fully aligned with those of the practice is the most reliable road to outstanding medical billing and financial excellence.

Copyright 2008 by ClaimCare Medical Billing Services

Outsourcing Medical Billing Tip: Best Practices For Reference Checking

  
  
  
  
  

outsourcing medical billingThe path from deciding to outsource medical billing to selecting your medical billing company requires a well planned selection strategy. A cornerstone of this strategy is well thought out and executed reference checks.

There are many critical stops to make in the journey towards your medical billing company selection. Reference checking is one of the most important stops along the road. There are several steps that must be taken to ensure through reference checking.

Although today's write-up is geared towards creating an effective interview guide, this is far from the only ingredient of a successful medical billing services company selection. Other critical ingredients include outlining the minimum requirements of an acceptable reference (e.g., does it need to be in your state, what specialties are acceptable, etc), deciding if you want to speak with a former client, outlining the roles of the people with whom your wish to speak (e.g., lead partner, practice administrator, day-to-day billing contact, etc), creating the interview guide, call the references, and making the final go/no-go decision.

Your interview guide will allow you and not the references to determine what topics are addressed in the reference calls. If you do not drive the calls, you may well end the process still unsure about your final decision. To kick-off the interview guide creation think about the worst things and the best things that could happen as a result of outsourcing medical billing. Keeping your mind on these best and worst cases develop questions that will help you determine where between these two extremes your potential medical billing company operates.

Narrow questions are typically much better than broad questions for reference checks. Broad questions such as "Did you billing improve after you outsourced?" will not give you specific enough data to make an informed decision when your reference checks are completed.

To insure you have the information you need at the end of the interview process use narrow questions such as "What were you days in AR before you outsourced and how did they change 3 months after you outsourced?" This gives you specific and actionable data.

Have you ever taken notes during a call and afterwards had trouble deciphering them? If you have you are not alone. A good way to combat this is to leave about a quarter of a page after each question (and sub question) to make sure you can write the answers on the same page with the questions. You have one final to-do before you start making calls. Review your questions with the following thought in mind "Will I be able to make a go no-go decision after these calls?" If not, what questions are you missing? Once you know that you have all your questions in order start scheduling your reference checks.

It is critical not to allow a good meaning but talkative reference to keep you from getting all of your questions answered. Make sure they know you have a pre-determined list of questions you need to address. Find out how long they have to speak with you and keep an eye on the clock to make sure you get all of the information you need. You should leave the door open for call backs by letting references know you may need to speak with them again.

You may find that one of your references brings up a point you had not considered. If they do, add the relevant question to the end of your interview guide and call back any individuals with whom you have already spoken to get this additional information.

Following the process outlined above will insure that you gather the factual information required to make an informed decision about your medical billing service.

Copyright 2008 by ClaimCare Medical Billing Services

Cardiology Billing Requires Deep and Focused Expertise

  
  
  
  
  

cardiology billingMedical practices lose money every single day (often over 20 percent of their realizable income) because they are not utilizing medical billing specialists, technologies, processes and management that can compete with insurance companies.

As physicians are taking into consideration the use of medical billing services to stop the hemorrhaging of cash from their practices, they are faced with a broad range of options. On the diminutive end of the spectrum are home-based medical billers. On the opposite end of the spectrum are medical billing companies that employ hundreds of medical billers and have thousands of clients.

In thinking through the billing options available, it is essential to understand that medical billing is complicated and requires deep expertise and expansive experience. When a specialty is involved, such as cardiology billing, the requirements for success become even harder to realize. Success requires that the medical billing company have a team that is knowledgeable in the complex rules utilized by insurance companies to judge cardiologists' medical claims.

With cardiologists facing ever increasing costs they must insure that money is not being left on the table because they have a billing company that is not a cardiac billing expert. Cardiologists must also be aware that that many billing companies that claim cardio billing expertise actually outsource their cardiovascular billing work to at home billers. Situations like this are fraught with risk since the remote workers are not working in a controlled and monitored environment.

A key battle ground in the struggle to collect all of the money due a cardiologist is appealing denied claims and answering extremely specific and technical questions about procedures and diagnoses. Success In this arena requires significant experience, the kind that is only gained from serving many cardiologists for many years.

A company that does not encompass a wide range of cardiovascular billing experience will find it difficult to track underpayments since multiple procedure rules and cardiovascular procedures have significantly more complicated contractual adjustments than a typical family doctor or internist's claims. In addition, the billing software and system design of a generalist billing company will often be insufficient for the more complicated requirements of reporting and insurance follow-up required in billing for cardiovascular practices.

The cardiology-driven difficulties of medical billing encompass patient billing also. A cardiologist's patient balance process is more challenging because most of the balances are quite sizeable. Coupling this with the difficulties of explaining to a patient their complicated Explanation Of Benefits and the cardiovascular terminology on their bills drives the need for patient collection specialists that have a strong expertise in cardiac billing.  If patients are not handles with care then cardiologists will see their patient collections fall and their patient complains rise - not a good combination.

To avoid all these billing related pitfalls cardiologists need to utilize specialized cardiovascular billing services. It is not advisable for an internist to perform heart surgery, similarly someone without training in surgical coding and surgical billing is not qualified to offer reliable billing services for cardiologists.

Copyright 2008 by ClaimCare Medical Billing Services

The Right Set of Medical Billing Tools Can Slash Start-up Costs and Working Capital Needs

  
  
  
  
  

medical billing With the correct set of non-traditional billing tools and programs you can drive down the initial working capital needs of a new or existing medical practice by 90% . These tools are quite unique to ClaimCare and go well beyond a pure medical billing service or an in-house billing department.

All of these tools will have a positive operational impact on how you think about staffing and/or cash flow management/financing in your practice. If these tools are implemented when the practice opens its doors it could dramatically lower working capital requirements and make the practice cash flow positive extraordinarily fast.

  1. ClaimCare Instant Payment Program - (Start bringing in the bulk of the insurance payments within 24 hours of opening the practice's doors) With this program you will receive the bulk of your insurance money within 24 hours of seeing a patient. This will significantly drive down working capital needs in the first few months of a new practice. In addition, the program can be dropped at any time, so it can be used purely as a bridge to get through the early days of a practice.
  2. ClaimCare patient checkout tool (Bring in the bulk of the patient responsibility - about 20% of practice revenue - in the day the doors open and lower staffing requirements at the front desk) - With this tool the practice can substantially increase cash flow quickly by collecting patient balances (not just the co-pay of $20 but the co-insurance which can add up substantially more than a co-pay). This will have a huge cash flow impact, since with this tool the bulk of the patient balances can be collected before the patient leaves the office instead of 60 to 90 days after the visit. In addition, since the tool automates insurance verification it can reduce the work load requirements of the front desk (and allow you to have fewer staff members).
  3. Vendor Instant Payment Program - (A free 60 day bridge loan to help minimize working capital needs for the first two months of the practice) This is another program that could help a lot with working capital needs - and best of all it is actually free. With this program all of your vendors are paid within 24 hours of an invoice being approved. As long as the practice repays ClaimCare within 60 days there is no charge for the service. If the practice pays within 30 days they actually get a discount off the bill. This works because ClaimCare negotiates a fast pay discount with the vendors. If we are paid back by the practice within 30 days we share the discount with the practice. If we are paid between 31 and 60 days we keep the discount. As you can see, in the early days of a practice this can give you a 60 day free float on vendor payments. Once you are out of the start-up mode this program will allow you to lower your vendor costs.
  4. Equipment servicing contracts - (Lower the cost of maintenance contracts) As the practice buys their equipment they can save a substantial amount on the maintenance contracts through our leasing service program. This program has a great track record and basically self-insures the maintenance agreements. With this approach we are able to save about 20 to 25% off equipment maintenance agreements. This can really add up for a medical practice. This basically applies to any piece of equipment that plugs into the wall.
  5. EMR -(Start paperless without the upfront investment in either an EMR or paper medical record storage system) With our EMR offering we can get a practice on an EMR right out of the gate without any upfront cost. This can save you money and improve operations since you will not need to spend the money on typically paper medical record supplies and will, of course, be able to see the benefits from an EMR with the big price tag.

Combining all of this with a world-class billing solution provides a powerful set of tools for starting a medical practice with much less working capital and lower cost.

Copyright 2008 by Carl Mays II

All Posts