MEDICAL BILLING BLOG

 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

Revenue Cycle Denial Management has become a universal and often abused term in medical billing. Some use the term to describe a means of addressing claims denied for medical necessity. Others use the term to describe how some information is tracked for a specific payer, set of procedures or a place of service.  Still others try to use it to describe what they do daily in the physician's office.

If you were to ask your billing department or a current medical billing company (1) what is their Revenue Cycle Denial Management strategy; (2) what process do they use to methodically measure it and (3) what are the quantifiable results of it, you would most likely get a lot of blank stares.

Few billing departments appreciate the value a good Revenue Cycle Denial Management system can bring to a medical practice. A robust Revenue Cycle Denial Management system provides methodical management data for the billing process; the data are then used to (a) increase and (b) accelerate cash flow. The system accomplishes this needed service by tracking, quantifying, and reporting on every claim billed for which any payer denied the service. The reporting should be comprehensive, tracking all denials (not just selected denials). If used properly, the system can reduce first-time claim denials by over 50 percent. In our experience we've come across many practices with no way of monitoring if the payer is denying their claims at excessive or unwarranted rates, or even for what reason. These practices are probably losing 10-20 percent of their total revenue.

What is typically missing from troubled billing operations is the lack of the management-reporting expertise needed to extract the data in a concise and meaningful way coupled with a lack of methodical, measured billing process needed to correct mistakes.

ClaimCare Medical Billing Services' comprehensive Revenue Cycle Denial Management system has two main purposes. First, to provide feedback on why and how many claims are not being paid on the first submission to the respective payers. The second is to fix these issues. ClaimCare Medical Billing Services' Revenue Cycle Denial Management software databases have been designed to track, quantify, and report on all denials for all payers. The standard output tracks, by payer, the number of claims denied and the reason for the denials. This is coupled with our Dashboard reporting for a quick visual management. With these unique reports our team can easily identify which payers are inappropriately denying claims; we can also compare these payers to their peers for proper trending and follow-up. The unique output for each practice allows us to refine the payer specific rules and build our own rules to prevent future payer denials. Payers that are chronic violators are pursued to resolve how and when they intend to process and pay outstanding claims. If the issues persist, there may be grounds to charge penalties stipulated by the Clean Claim Law (to the extent it exists in the state). Only by quantifying and analyzing the problem can you discover how to improve on the process. A real Revenue Cycle Denial Management system gives you a way to optimize and accelerate cash flow. ClaimCare Medical Billing Services' system has a proven track record of improving revenues between 5-20 percent.

You can take advantage of ClaimCare's Denial Management success with our Old AR Recovery service.

Copyright 2007 by Carl Mays II

Everyone 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

If 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