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    Welcome to the ClaimCare Medical Billing Blog. We strive to provide content that improves the overall quality of medical billing efforts across the US. If you have any specific topics that you would like to see addressed in this medical billing blog please post the topic in the Medical Billing Questions & Answers Forum. If you have an article that you would like considered for publication in the medical billing blog then please email your article to resources@claimcare.net.

    MEDICAL BILLING BLOG

    Medical billing offices need a helping hand every now and then

    Posted by Carl Mays on Sat, May 22, 2010 @ 10:37 PM

    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.

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    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.

    Tags: medical billing, medical billing companies, medical billing services, denial management, AR clean-up

    Medical billing collections will suffer no matter what Congress does

    Posted by ClaimCare Resources on Thu, Apr 29, 2010 @ 10:57 PM

    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.

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    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.

    Tags: medical billing education, 2010 medical billing changes, medical billing, medical billing companies, medical billing services, medical billing resources

    Selecting a Medical Billing Company: Got Scale?

    Posted by Link Grader on Fri, Sep 11, 2009 @ 03:54 AM

    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

    Tags: medical billing, medical billing companies, medical billing services, selection process, improving medical billing

    Medical Billing Services: Good ones fight rising healthcare costs

    Posted by www.claimcare.net Admin on Wed, Aug 13, 2008 @ 01:33 PM

    medical billing servicesEveryone hears about the fact that much of the cost of healthcare is driven by the expense of processing and adjudicating claims. What is often not mentioned is what is truly at the root of these expenses - payers that are attempting to withhold from physicians the money they are due. I mentioned in an earlier entry how ClaimCare Medical Billing Services constantly sees payers systematically underpaying claims. We also see claims that have been properly submitted and for which we have proof the claim was accepted simply "lost" by payers and the claims have to be resubmitted (sometimes multiple times) in order to secure payment. Now, here is a shocking fact - over 50% of claims that are "lost" or are underpaid are never pursued by physicians (and therefore the payers never have to pay the money they owe to the physician or facility). This means that payers have a powerful economic incentive to play games and make the medical billing process complicated. Here is another shocking fact - it costs the average insurance company about $25 each time a representative has to get on the phone and discuss a lost or underpaid claim with a medical billing specialist. A final key fact is that most payers "grade" each provider. The lower a provider's grade (i.e., a D versus an A) the more likely the payers are to lose or under pay the provider's claims. Why? Because these providers have no track record of catching these problems and pursuing them.

    So, how do all of these fact tie into my title about Medical Billing Services fighting the rising cost of healthcare? If each and every underpaid or lost claim is pursued (which is what Medical Billing Services should do because they have the scale to have groups of people that do nothing but follow-up on such claims) then eventually payers will lose all economic incentive to play games and make the billing process complicated and expensive. Imagine if every physician pursued every claim until it was paid in full. The payers would see their cost to adjudicate the claims rise and they would see their payments to providers rise because the lost/under paid claim games would no longer prevent providers from ultimately being paid. This combination would lead to each physician ultimately being paid quickly and without fuss because the insurance companies would lose significant money by playing games ($25 per extra phone call generated by the games) and they would gain nothing since payments would only be delayed, not avoided.

    There is lots of talk about the dream system where claim adjudication happens in real time and physicians immediately receive their reimbursements. Such a system will never happen until the economic incentive payers have to maintain a difficult, complicated and veiled system are removed. This, is what medical billing companies can do by doggedly pursuing each claim and insuring that every one of their clients is rated an "A" by all of their payers.

    For more information visit ClaimCare Medical Billing Services or go to the Contact Us page. 

    Copyright 2008 by Carl Mays II

    Tags: medical billing operations, medical billing, medical billing companies, medical billing services, improving medical billing, denial management

    Outsource Medical Billing Must Have : Comparison to Allowables

    Posted by www.claimcare.net Admin on Sun, Aug 10, 2008 @ 09:36 AM

    outsource medical billingIf you make the decision to outsource medical billing, then make sure your medical billing company compares your payments to your allowables. It goes without saying, that if you do billing in-house the comparison still should be done. One of the advantages a Medical Billing Service has is that it sees payment information and patterns across many clients for many payers. This allows medical billing services that regularly and systematically compare payments to contractual allowables to spot patterns that a single practice might miss. One that is seen at ClaimCare Medical Billing Services on a regular basis is the systematic underpayment of claims by payers. As we look across multiple clients we will see the exact same CPTs being underpaid by the same amount by the same payer in a given month across all of our clients. The following month we will see the same payer switch to underpaying a different set of CPTs. These under payments are not huge (5 to 10 percent) but they add up quickly to big dollars for a medical practice. The combination of switching the codes being underpaid from month-to-month and keeping the underpayment amount "under the radar" can make this difficult for an individual practice to spot. It is also difficult for a Medical Billing Service to spot if they are not comparing your payments to your contracted rates. At ClaimCare we have found that this single action (comparison of payments to allowables) can increase a medical practice's collections by 5 to 10 percent. This is why you need to insure this critical step is being completed no matter who is doing your Medical Billing.

    If you would like to learn more please visit ClaimCare's Contact Us page. 

    Copyright 2008 by Carl Mays II

    Tags: medical billing operations, medical billing companies, medical billing services, improving medical billing

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