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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.


    The Best New Year Resolution To Improve Your Medical Billing

    Posted by Carl Mays on Sun, Jan 18, 2009 @ 03:08 AM

    medical billing resolutions

    We are fast approaching the end of January and the point in the New Year when the majority of people's New Year's resolutions have already failed. This is, however, the time for renewed efforts to focus one's resources on achieving the desired goal. There are two keys to reaching your goals:

    1. Treat your set backs as temporary failures and not total defeat (i.e., just because you broke down and smoked a cigarette does not mean you should just say I failed on my goal to quit smoking); and
    2. Break your goal down into manageable pieces (i.e., I will lose 2 pounds in January; 2 lbs in February versus I will lose 25 pounds this year).

    These ideas do not only apply to personal goals, but to business goals as well. If you are trying to improve your medical collections in 2009, you should build upon these concepts. So, given these two points what is the best way to achieve a New Year's resolution of improving your medical billing? The best place to start is with the goal of getting your claims out the door clean.  This is a great starting point because it does many wonderful things:

    • It focuses you on the most critical aspect of billing. If the claims go out the door clean you will find that all of the rest of the challenges start to become much more manageable;
    • It allows you to focus on achievable, smaller goals (85% of claims go out clean in January, 87% go out clean in February, etc);
    • Set backs position you for better performance tomorrow. How? You look at the claims that did not go out the door clean and learn what went wrong. Do you have a problem at the front desk with gathering demographics? Do you have a problem with training your data entry people? Do you have one physician that consistently codes incorrectly? Do you have one payer that really dislikes one of your common procedures?
    • It lends itself to technology aids. Invest in a scrubber that will help you find coding problems before you submit the claims (see our blog entry on claim scrubbers). Invest in insurance verification tools that will make it easier to have clean demographics. Invest in coding tools that will help improve your data entry performance.

    So, as we approach the end of January this is the time to double down:

    • Measure your current performance level;
    • Set your medical billing goals high (96% of all claims will be paid on first submission);
    • Break them down into bite size pieces (I will improve clean claim submissions by 2% each month), and
    • Adopt the mentality that you will learn from your mistakes.

    With this approach you can make 2009 your best medical billing year ever.

    Copyright 2009 by Carl Mays II, President, ClaimCare Inc

    Tags: motivation, improving medical billing, scrubbing, 2009 billing changes

    Medical Billing Services Must Utilize Scrubbers

    Posted by ClaimCare Resources on Wed, Sep 17, 2008 @ 08:27 PM

    One of the most important things in billing is to create and follow a very structured plan that can be measured each step of the way. Remember, if it cannot be measured and monitored it cannot be improved!

    Clean claim submission can reduce average days in AR to less than 45 days

    claim scrubbingThe leading medical billing services operations utilize scrubbers that ensure your claims are clean before they are submitted to payers. These scrubs accelerate the speed of collections by avoiding denials and delays. They also increase collections by minimizing the volume of "re-work" and allowing billing staff to focus their efforts on pursuing true collections improvement opportunities and not simply resubmitting claims that should have been paid the first time. As a result of these scrubbers, over 90% of claims submitted are paid upon first submission. These "scrubbers" include:

    • Basic mechanical scrubber that assures that all claim fields have been properly filled with formatted data (social security number with 9 digits, date of birth etc), the NPI is in a proper field, there is a referring physician if needed, etc.
    • Scrubber that checks coding, bundling, and procedure information versus local Medicare and CCI rules. This scrub assures better coding, identifies overlooked procedures or codes.

    The truly great medical billing specialists can rely on medical billing specific know-how and business intelligence created over time through work with many medical practices and facilities in the given payer relevant geographic area.

    • Dynamic Proprietary Rule scrubber that checks for optimal coding and documentation versus the particular payer or plan's rules. This scrub assures that each claim is optimized for clean submission. When the payer or plan's rules change or when the billing office detects a systemic issue they can update the scrubber to filter and fix problems before claims go out. These specialized scrubbers can make a significant collections difference.

    At ClaimCare Medical Billing Services we have found that these actions can decrease the medical practice's collections cycle by up to 40-50 days. This is why you need to insure this critical step is being completed no matter who is doing your Medical Billing.

    Copyright 2008 by Carl Mays II

    Tags: medical billing services, scrubbing, clean claims

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