MEDICAL BILLING BLOG

On December 15, 2015, Jason Adam Townsend, owner of a medical billing company, was indicted on healthcare fraud and aggravated identity theft charges by the Charlotte Grand Jury.

Don't fall victim to these fraudulent medical billing companies. Know how you can select a reliable medical billing company for your medical billing needs.

When looking for a medical billing company, it is important to consider the following factors:

1. Service Level of the Medical Billing Provider

What are the services provided by your medical billing company? Does this include:

• Pursuing denied claims
• Billing follow-up
• Complying with industry regulations
• Reporting and analysis

Ensure you discuss these matters with the company before signing up for any of their packages. Doing so will confirm if they are the right service provider for you.

2. Years of Experience in the Industry

How long has the medical billing service provider been in the industry? On what medical specialties do they focus?

These are important questions to consider when choosing a medical billing service provider because it shows if they are knowledgeable in the following areas:

• Current medical coding system and medical terminology
• Insurance claims and billing, which includes the appeals and denial process, as well as fraud and abuse detection
• Information and web technology
• Reimbursement practices

3. Knowledge with the Use of Technology

One of the aims of medical billing is to accomplish more tasks with less time. This is done through the use of sophisticated billing software. But, it does not mean having to work on an entirely new system altogether.

While most medical billing companies have their own billing system, very few have the capacity to work with the existing system used by an organization. Thus, you are forced to migrate your data into their own. However, this makes the transition process longer and more complicated.

Rather than migrate your data into a new one, you may prefer a medical billing company  like ClaimCare that can work in your current billing system. In this manner, you don't have to worry about your data being transferred into a new system.

Thus, it is important to ask them the following questions:

• Are they willing to work in your current system?
• How knowledgeable are they with other billing systems?
• How long will it take to integrate with your billing system?

4. Security and Compliance

According to the National Healthcare Anti-Fraud Association NHAA, approximately tens of billions of dollars are lost to health care fraud. This makes it one of the most challenging problems among medical providers.

Avoid being a victim. Carefully select your medical billing company by inquiring if they perform one or more of the following safety precautions:

• Annual background checks on their employees
• Monthly annual checks with the OIG for excluded employees
• Anonymous methods on how to report employee violations
• Health Insurance Portability and Accountability Act (HIPAA) training
• Dedicated compliance officer to ensure your data remains protected

This will help you assess how much these medical billing companies value the confidentiality of all your records.

5. Medical Billing Service Efficiency

Check the performance of the medical billing companies you’re considering. Identify how much of the denied claims and fee collection they are able to deliver by asking for the following data:

• How many of their current clients match your specialization?
• How many claims do they process each year?

It is also helpful to know the following information:

• Percentage of reduced payment delays
• Increased revenues they deliver to their existing clients
• Average number of days in A/R by specialty percentage

Utilize all of this information when choosing a medical billing company. Remain updated with the current medical billing trends and issues. Subscribe to our blog or call us at (855) 376-7631 for any of your medical billing concerns.

About Claimcare

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.

Some of the crucial elements in the medical claims process happen during the medical coding and medical billing procedures.

This article discusses how these two procedures are essential in filing medical claims and why your medical claims are being denied.

How Medical Coding and Medical Billing Influence Medical Claims Approval

Medical coding is the process of accurately encoding written documents (e.g., a medical prescription or diagnosis) made by medical experts into a numeric or alphanumeric one. On the other hand, medical billing is the process of assigning a corresponding bill for the insurance or healthcare provider.

Any incorrect or incomplete coding and billing can result in a denied claim for the following reasons:

1. The coded information lacks detail or is not clearly rendered by the coder

There are codes for specific medical terms. It is important for the coder not to overlook even the tiniest bit of information contained therein. The code must be complete. If the coder neglects to input one number or includes an irrelevant one, the code is invalid.

For example, k35 is acute appendicitis while k35.80 is an unspecified acute appendicitis. Failing to indicate the right type of appendicitis of the patient may be the cause for a denial. Thus, it is important that medical coders and billers be very knowledgeable about these codes.

2. Mistakes due to outdated coding

The coder must have an up-to-date book of codes. Documents coded using an outdated set of codes will only lead to an inaccurate output. The coder must be well informed regarding any changes in the coding system.

3. The claim forwarded to the insurance company is missing relevant information

Insurance companies are very meticulous. They review all the information required in the claim forms. Any missing information such as date of diagnosis, date of the accident, and any other relevant dates may be the reason for a claim denial. Thus, you should carefully review and ensure all the required information is properly incorporated in the claim forms.

4. Delayed filing of the claim

Submission of claims must be made within twelve months from the start date for Medicare. The start date can either be the date the medical service was performed or the date written on the “from” part of the claim form. The claimant may not be granted reimbursement if the filing is not made in a timely manner.

5. The patient’s personal information is incorrect

Your medical claims may also be denied if the personal information input into the system is erroneous. Name, age, sex, and other personal details of the patient must be correct.

Other relevant information such as the insurance company where the reimbursement is requested from and the policy number should also be valid. If the patient is not the insured himself/herself, be sure to state the relationship between the insured and the patient for the claim to be considered. Furthermore, the procedure performed on the patient must correspond correctly to the coded documentation prepared by the coder.

Are you interested in learning more medical billing tips? Subscribe to our blog to remain posted. You may contact us online for any of your medical billing problems and concerns.

About ClaimCare

ClaimCare has years of industry experience in delivering high quality and affordable medical billing services in the U.S. We assist in collecting the maximum revenue for your practice while helping alleviate the medical billing costs and hassle for your organization.

Is your in-house medical billing costing more than you can handle? How is this compromising your organization's efficiency?

Learn how much you are actually spending on your in-house medical billing and how outsourcing it to a third party provider may be a more efficient and better cost-saving solution for you.

Read on to know the details shared by The Physician's News Digest about medical billing costs in the US.

The Cost of In-house vs an Outsourced Medical Billing

Many practices believe that outsourcing their medical billing is more expensive. However, the analysis created by the Physicians News Digest shows it otherwise.

And, the information supplied by The Physician's News Digest is based on an “average” medical billing company. ‘The Medical Billing Buying Guide’ gives ClaimCare, with our 100% USA-based staff, an A+ rating.

Hypothetical Facts of the Practice Involved in the Physicians News Digest Analysis

The following information was considered when creating the analysis of in-house medical billing costs:

• 3 primary care physicians
• 2 medical billing specialists
• 80 insurance claims filed a day (̴20,000 per year)
• $125 is the average billed amount per claim

Employee Costs

A practice with the above-mentioned activity needs two medical billing staff with an average of $40k salary to perform these processes. Thus, the practice is spending approximately $101,000 on them, including their taxes and benefits.

With outsourced medical billing, there’s no need to think about the medical billing staff related expenditure. However, you would need to consider about five hours of time each week for managing tasks associated with billing at a rate of $15 per hour, which is equivalent to around $4,000 in administrative costs annually.

Technology Costs

This includes the following costs:

• Electronic Health Record (EHR) system
• Practice Management (PM) software
• Hardware ($500)
• Maintenance

On average, the cost per doctor for the practice management software alone may reach approximately $200 per month. Thus, if the organization has three primary care doctors, it would mean an annual cost of approximately $7000. This doesn't include the upfront costs associated with software purchase and installation. Along with the computer hardware costs of $500, the annual total cost would be around $7500.

With outsourced medical billing, you may only need to spend for a printer or the workstation that is required to communicate with the medical billing service provider.

Training Costs

Keeping your medical billing team updated with the latest coding and billing changes is a challenging task. On average, practices spend $2,000 on training alone. However, with a medical billing third-party provider, there’s no need to worry about this. It is their responsibility to keep all of their medical billing specialists knowledgeable with the latest coding changes. This ensures you always have accurate coding for all your billing services.

Direct Claim Processing Costs

The clearing house fees a provider needs to pay for submitting 20,000 claims is at $300 per month ($100 per physician) or $3,600 in a year. When outsourced, the fee is normally based on the percentage of the amount collected, which is normally at 7%.

This is higher compared to the clearing house fees doctors have to pay. However, given the percentage of billing collected through a medical billing provider, this amount will immediately outweigh its costs.

Billing Percentage Collected In-House vs Outsourced

Amidst the higher direct claim processing costs of third-party medical billers, it delivers an increased 10% billing collection to your practice compared to an in-house medical billing team.

Does this mean it is the right choice for your organization?

There are many factors for you to consider such as:

• Billing efficiency of your practice
• Staff turnover and their technical skills
• Years of experience in the industry

If you are a new provider and experiencing high staff turnover with poor technical skills, then it’s better to choose a third-party provider to help you with your medical billing.

Need help deciding? Call us at (855) 376-7631 or subscribe to our blog to learn more.

About ClaimCare

ClaimCare has over 80 years of medical billing experience. We serve virtually all specialties and help improve their billing collection. Learn more about our services. Most of our clients have experienced a 15 to 25% increase in collections and have days in AR under 40. Read more about us as reported by ‘Healthcare Tech Outlook.

Beckers Hospital Review has revealed that just a month in delay on an average primary care physician's medical credentialing can cost your practice $30,000. This could even be higher for specialists who handle orthopedics and cardiothoracic surgery.

Avoid this loss from happening to your organization. Learn the common issues associated with medical credentialing and how to solve them.

1. Lack of Organization and Bad Workflow

An efficient workflow will help you avoid medical credentialing problems and delays. Create a workflow to avoid lost money in handling appeals and reimbursements.

Hire an office coordinator who will be:

• In charge of your physician’s documentation process
• Send reminder texts and emails for documents that are not yet submitted
• Neatly compile these credentialing documents for easy retrieval

This will help lessen human error in your workflow. Thus, avoiding the need for a re-credentialing process, which will only lead to a longer medical credentialing process.

2. Lack of Timing and Physician Start Dates

It’s good to be optimistic, but with medical credentialing it is best not to put things at a minimum, especially with estimating the time needed for the approval of your physician credentialing request.

Gather all the needed credentialing paperwork on the day the employment offer is given. As needed, extend the start date of your new physician to a maximum to ensure you have properly reviewed and verified all of his or her credentials before joining your organization.

3. Private Background Checks and Maintaining Updated Contact Information

Medical credentialing is never easy. Payers will certainly use anything that can deny the payment claim. Therefore, it is important for your organization to diligently perform a private background check on your physician.

Verify the validity of all the forwarded documents including:

• License
• Training
• Employment history

Most importantly, ensure the submitted contact information is up to date. The medical credentialing process may take a while, approximately 6 weeks to 3 months. Thus, it is important to know how you can contact them if any additional documents are needed by the payer.

4. Adhering to All the Needed State Requirements

Be reminded that states vary with their needed medical credentialing requirements. Additional credentialing requirements may still be necessary even if the physician has successfully been credentialed in another state. Therefore, it is better to check on reciprocity agreements with the payer organization and the state before agreeing to immediately accept the physician into your organization.

Improve your organization's cash flow while providing quality healthcare to your patients. Do not let obscure state laws cause your office to lose productivity. Understand the laws of your state to make your medical credentialing process faster and easier.

Do you have more questions about medical credentialing? Subscribe to our medical billing blog or complete our online form for any of your queries and concerns.

About ClaimCare

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

Last July, the Centers for Medicare and Medicaid Services (CMS) released a proposed payment rule for the Ambulatory Surgery Center Association (ASCA) and Hospital Outpatient Departments (HOPDs) for 2019. These updates address several long-requested ASCA priorities, which include the following:

• Threshold for device intensive surgeries and clinic cost visits
• ASC covered procedures performed in ASC setting
• Quality Reporting Program

This article discusses how these points are addressed and the impact on your physician billing and ASC services.

3 Major Changes for ASC Services Based on Proposed 2019 CMS Payment Rule:

The changes to the CMS Payment Rule aim to deliver these ASC physician billing advantages:

1. Lower threshold for device intensive surgeries and clinic cost visits.

The ASC has long been requesting a lower threshold compared to the current 40 percent applied on its standard OPPS APC rate-setting methodology. Through the Proposed 2019 Medicare Changes, this can now become a reality.

Under the proposed change, the threshold will now be reduced to 30 percent, thus allowing high-cost devices to be better recognized in ASC settings. Moreover, clinic visit costs would also be reduced from approximately $116 with a copayment of $23 to just $46 with a copayment of only $9. This means an estimated savings of $14 for each off-campus department visit of patients and a $760 million savings for Medicare in 2019.

2. Expanded ASC Covered Procedures List (CPL).

Part of the proposed 2019 changes entails the inclusion of "surgery like" procedures that are outside the current CPT surgical range (10000 - 69999) to the ASC CPL. However, these surgeries would be limited to the following conditions:

• Accepted surgical procedures that are expected NOT to pose any significant risk to the safety of the beneficiary (patient)
• Does NOT require an overnight stay when performed in an ASC
• Separately paid under the OPPS

If implemented, this would lead to a 2% increase rate for ASC, which is based on the combined 2.8% inflation update reported by the hospital market basket and the 0.8% mandated reduction by the ACA. However, it should be noted that this 2% increase will be code-specific, thus it will not be applied to all ASC procedures.

3. Easier ASC Quality Reporting Program.

Under the proposed 2019 Medicare, eight measures required by the ASC Quality Reporting (ASCQR) Program for their CY 2020 and CY 2021 payment determinations will be removed. This includes the following:

• Influenza Vaccination Coverage Among Healthcare Personnel (CY 2020: ASC-8)
• Patient Burn (CY 2021: ASC -1)
• Patient Fall (CY 2021: ASC -2)
• Wrong Site, Wrong Side, Wrong Patient, Wrong Procedure, Wrong Implant (CY 2021: ASC -3)
• All Cause Hospital Transfer/Admission (CY 2021: ASC-4)
• Endoscopy/Polyp Surveillance Follow-up Interval for Normal Colonoscopy in Average Risk Patients (CY 2021: ASC-9)
• Endoscopy/Polyp Surveillance: Colonoscopy Interval for Patients with a History of Adenomatous Polyps (CY 2021: ASC-10)
• Avoidance of Inappropriate Use; and voluntary measure Cataracts - Improvement in Patient's Visual Function within 90 Days Following Cataract Surgery (CY 2021: ASC-11)

This is because ASC's have demonstrated an outstanding performance in preventing serious adverse events. Thus, CMS has found it unnecessary to collect these above-mentioned data measures from them.

Conclusion: Who would benefit from these changes?

Ultimately, these proposed policy changes aim to create a better patient-centered healthcare system by providing greater:

• Price transparency
• Interoperability
• Significant burden reduction

This results in several benefits not only to the patients but also for both ASCs and hospitals. Patients are given more health care options at a minimal cost while ASCs and hospitals can operate with better flexibility.

Would you like more updates about the Proposed 2019 Medicare and its impact on your physician billing? Subscribe to our blog to remain posted or call us toll-free at (855) 376-7631 today.

About ClaimCare

ClaimCare is composed of skilled and knowledgeable medical providers, practice managers, certified coders, experienced business professionals, and engineers. This is to guarantee you receive effective and efficient team physician billing services all year round.

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

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

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

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

How to Fix Common Medical Billing Errors for Increased Revenue

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

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

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

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

2. Never resubmit claims on the same date.

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

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

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

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

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

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

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

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

5. Choose the right billing codes.

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

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

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

About ClaimCare

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

About ClaimCare

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

In dealing with the complexity of the medical credentialing process, some healthcare providers still rely on spreadsheets, checklists, and makeshift programs without an expert to verify these entries. This results in several enrollment errors and delays.

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

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

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

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

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

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

Medical Credentialing and the Rising Administrative Costs in the HealthCare Industry

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

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

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

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

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

Medical Credentialing Outsourcing for Reduced Administrative Costs and Better Patient Care

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

1. Reduced Operational and Administrative Costs through Medical Credentialing Outsourcing

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

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

2. Reduced Errors Resulting in a Faster Medical Credentialing Process

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

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

3. More Time to Focus on Building Your Practice

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

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

About ClaimCare

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

"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.