MEDICAL BILLING BLOG

"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.

According 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.

No 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.

Are 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.

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.

An 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.

The 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.

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

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

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

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

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

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

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

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

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

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

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

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

1. Eligibility Verification of the New Medicare ID Card

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

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

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

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

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

2. Coordination of Benefits with the New Medicare ID card

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

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

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

3. Submission of medical claims using the MBI

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

Bottom line…

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

ClaimCare provides doctors and medical office managers a complete medical billing solution to manage this transition.

Claim Care:

• provides the top service level guarantee in the industry
• offers best-of-breed technology
• is based 100% in the USA
• an air tight medical billing process
• provides actionable reporting and broad experience
• 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 (855) 376-7631 or visit the ClaimCare Medical Billing Company website.