<img alt="" src="http://www.poiuy12.com/102832.png" style="display:none;">
    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.


    The Rise and Fall of Offshore Medical Billers

    Posted by Carl Mays, ClaimCare President/CEO on Thu, Aug 13, 2020 @ 06:00 AM

    The Rise and Fall of Offshore Medical Billers

    A trend began several years ago for practices to move billing and coding offshore to save money, which has often led to crippling the practices rather than adding any advantage in terms of being more effective, efficient and productive. And money has often been lost rather than saved.

    A January 2019 “For The Record” article titled Is Offshore Coding Dead in the Water? tells of a two-year study involving six hospital systems. In an apples-to-apples comparison of USA coders and offshore coders, the offshore coders were less accurate and productive than the USA coders. There was a higher denial rate and lower reimbursement resulting from a lower case mix index. Additionally, offshore coders required longer onboarding.

    In the end, the savings realized from employing lower-wage offshore coders was lost to productivity issues and lower reimbursements. All variables considered, offshore coders cost hospitals $3.10 per hour more than their American counterparts.

    The study, which was presented in detail at the 2018 American Health Information Management Association (AHIMA) Convention was the first of its kind, and it appears the findings are the first solid numbers supporting a move away from offshore coding solutions. However, warnings from various sources existed long before the study was begun. Law firms, healthcare organizations, publications and IT groups were among those sounding alarms. 

    Offshore Medical Billing Poses Security, Legal Issues

    As far back as 2012, the Liles/Parker Law Firm, which specializes in Healthcare Law, warned of security and legal issues arising from the use of offshore groups in an article titled Overseas Outsourced Billing and Coding – Compliance Risks. The article opens with, “Thinking of sending your medical billing and coding functions out of the country? You better think twice. While overseas outsourced billing is growing in popularity for medical office functions, this practice represents a unique set of problems for both physician practices and 3rd party billers. And the news is just getting worse." Some points made in the article include:

    • You have no guarantees that a coding and billing business overseas is HIPAA compliant or even understands the law at all.
    • Providers are responsible not only for their practice, but also for the acts of their business associates and their respective subcontractors overseas.
    • Obtaining a judgment against an offshore entity is next to impossible, takes a substantial amount of time, and costs a lot of money.
    • Liles/Parker writes, "We had previously reported that the backlog for having a case heard in India was nearly 20 years. But recent estimates by the National Bar Association of India put that figure closer to 350 to 400 years."
    • Offshore workers have extorted providers over PHI records. In one case, an employee of a Pakistan billing company contacted the hospital on whose records she was working. She demanded a significant sum of money from the hospital or she would release the medical records on the Internet and anonymously contact United States authorities. Given the legal case backlog information above, the hospital had no option but to pay.

    Supreme Court Stepped In After Liles/Parker 2012 Article

    The 2013 HIPAA Omnibus Rule prevents medical providers from enforcing HIPAA laws in foreign countries. Providers are responsible for improper disclosures and breaches with business associates and their respective subcontractors overseas. Thus, if a provider offshores billing or EMR the provider is responsible for all HIPAA fines, which could be as much as $10,000 per violation. 

    There are some so-called "USA-based" medical billing companies that have home offices in America, but offshore the majority of their work. These companies are dependent upon their foreign workers, but as American companies they have to answer to their clients when problems arise offshore. 

    Publications Report Offshore Horror Stories 

    A 2013 "Fierce Healthcare" article titled 32,000 Patient Records Exposed On Contractor's Unsecured Website tells of a Tennessee-based hospitalist and intensivist group that contracted with an India company to transcribe care notes dictated by physicians. The contractor was supposed to store protected patient health information on a secure website, but its firewall was down between May 5 and June 24 before the Tennessee group discovered the problem.

    Health information on 32,000 patients across 48 states was exposed. Compromised patient information included patients' names, dates of birth, diagnosis description, treatment data, medical history and medical records numbers. According to U.S. Department of Health and Human Services records, it was the second HIPAA breach for the Tennessee group.

    The article reports that according to the Ponemon Institute, considered an eminent research center dedicated to privacy, data protection and information security policy, 94% of 80 participating healthcare organizations polled had experienced at least one data breach that they were aware of in the previous two years. Those breaches cost organizations a total of $6.78 billion annually.

    IT Companies Warn Against Overseas Medical Billers

    Scouring the Internet for multiple IT company remarks on offshore medical billing and coding, here are some summarized views:

    • There are always dangers of HIPAA security breaches and violations of patient privacy, but these dangers are intensified with offshore contractors, and immediate fixes are less tenable.  
    • Many offshore companies utilize a “bait-and-switch” technique. Initial workers assigned to you are what the company considers as their “best.” Later, these “best” are replaced by the company’s lowest-paid, inexperienced workers who use the login of the original worker. Errors increase, productively drops, and security suffers.
    • Low-paid offshore workers are enticed to commandeer ePHI (as referenced in the Liles/Parker information above). Such tactics provide a much greater risk than any possible savings afforded by cheap offshore work.
    • Offshore contractors may present a basic package of service, but then charge extra for services that are already bundled in initial agreements by a truly 100% USA-based company like ClaimCare.
    • Turnover rate is much higher offshore because employees are always looking for higher-paying jobs, whereas ClaimCare emphasizes medical billing "careers" rather than jobs. One of the things that entices quality people to seek employment at ClaimCare is the emphasis on personal growth opportunities within a company that grows annually.
    • Surveys have shown that offshore workers are less experienced than USA-based workers and have little or no understanding of America's complex and everchanging federal and state laws regarding healthcare. 
    • In general, without taking into account Daylight Savings Time, the time in India (which has only one time zone) is 10.5 hours ahead of USA central time. (The half-hour aspect arose when the meridians for the Indian subcontinent were created. New Delhi was in between the two and India chose to be 30 minutes between the two time zones.) This time element, along with the language element, affects client and patient contacts to a large degree. It also limits real-time access to patient accounts and revenue cycle management reports.
    • Whereas ClaimCare can work on clients' systems or its own, offshore contractors often work only on their own, which leads to lack of transparency in reports and data such as payment posting, collection efforts, charges, third-party payer claims and more.

    Groups Push Congress to Delegitimize Offshoring  

    Some USA-based groups are pushing Congress to strengthen the HIPAA laws by making offshore medical billing illegal. One such letter to Senators and Representatives contains:  

    "A foreign workforce is not accountable to the HIPAA laws, and since the HIPAA laws cannot be enforced overseas, we ask that you protect us by keeping medical billing within the United States. In addition to the security that comes with a USA-based labor force being held accountable to HIPAA laws, this move would also keep medical billing jobs in America. We need your presence in Washington to create and pass legislation that safeguards our sensitive data and preserves the medical industry. Do not work so hard to create safeguards within HIPAA only to see them undermined by offshoring."

    ClaimCare Rescues Providers, Facilities from Offshoring  

    With deep knowledge of offshore billing issues, ClaimCare steps in with distinctive elements and nuances as a professional medical biller to solve the majority of problems that result from the offshore billing and coding model. In doing so, ClaimCare brings unique solutions that are designed to support effective communication, offer up-to-date healthcare intelligence and security, deliver the right information at the right time and fulfill our mission “To collect the maximum amount for your practice as fast as possible while helping to alleviate costs and hassle for your organization.”

    About ClaimCare ®                        

    ClaimCare has 30 years of medical billing experience. We have an established 100% USA-based medical billing team that has been assembled through a thorough pre-employment screening. All personnel participate in on-going training and strong process management to ensure they deliver only the highest quality medical billing services to clients.

    ClaimCare has once again been named a Top 10 Medical Billing and Coding Company. The honor this time comes from "MD Tech Review." The magazine’s Augmenting Medical Billing and Coding Operations article presents solid reasons why ClaimCare has been chosen for this 2019-2020 recognition.

    For more information, contact sales@claimcare.net, or phone toll-free at (855) 376-7631, or visit the ClaimCare Medical Billing Company website. We can assist your practice and/or facility in numerous ways, including complete certification processing.

    100% USA-Based HIPAA-Compliant Medical Billing Company



    Tags: ClaimCare News, medical billing coding, Reasons to outsource medical billing, Off Shore Billing

    Outsourcing is Influencing the Revenue Cycle of the Healthcare Industry

    Posted by Carl Mays on Fri, Jun 07, 2019 @ 08:00 AM

    How Outsourcing is Influencing the Revenue Cycle of the Healthcare Industry"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.

    Tags: medical billing, medical billing services, Reasons to outsource medical billing

    Meet the Two Culprits Behind Your Medical Billing Mistakes

    Posted by Carl Mays on Tue, May 07, 2019 @ 11:03 AM

    Meet the Two Culprits Behind Your Medical Billing Mistakes 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.

    Tags: medical billing operations, medical billing education, medical billing services, medical billing resources, Reasons to outsource medical billing

    3 Ways to Reduce Administrative Burdens of Your Practice

    Posted by Carl Mays on Wed, May 01, 2019 @ 08:00 AM

    3 Ways to Reduce the Administrative Burden of Your PracticeAn 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.

    Tags: medical billing operations, medical billing, medical billing companies, medical billing services, medical billing resources, Reasons to outsource medical billing

    Three Reasons You Should Outsource Your Medical Billing Services

    Posted by Carl Mays on Wed, Sep 26, 2018 @ 04:03 PM

    3 reason to outsource your medical billingThe 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.

    Let's talk. Complete our online form or call us toll-free on (855) 376-7631, today.

    Tags: general medical billing questions, medical billing operations, medical billing education, medical billing companies, medical billing services, medical billing resources, Reasons to outsource medical billing

    Subscribe by Email

    Most Popular

    Browse the Medical Billing Blog by Tag

    Medical Billing Blog Requests

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

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

    Contact Us