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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.


    Buyer Beware: EHR System Vendor Agreements & Its Impact on Your Billing

    Posted by ClaimCare Resources on Thu, Sep 20, 2018 @ 05:06 AM

    Medical Billing Services


    Have you ever experienced signing an EHR vendor system agreement only to later realize you also transferred your medical billing tasks to the vendor? How about the nightmare of migrating your data from the previous system vendor to the new one? 

    This was experienced by Daniel Goodman, MD of Atlanta. He is a solo internist who had to pay approximately $10,000 to $12,000 just to get his data from the previous vendor into the new one. This is not to mention the 50% disruption of usual workload from his practice for an entire week.

    Learn the importance of thoroughly reading your EHR system vendor agreement before signing up to avoid these scenarios, surprises, and inconveniences.

    Basic Things to Consider Before Signing an EHR System Vendor Agreement

    Titus Schleyer, DMD, PhD, the director of the Center for Biomedical Informatics at the Regenstrief Institute in Indianapolis, Indiana gave a very interesting comment for anyone who wishes to sign a new EHR system vendor agreement.

    “Switching to a new system is a big investment, and you’re impacting practice viability if you’re laying out hundreds of thousands of dollars every few years for a new system. So, you need to be very careful and prepare for your switch well.”  

    You definitely need to do your homework before making that switch. To ensure you are making the right choice, include the following questions to your potential EHR system vendor:

    1. How will the data be migrated to the new EHR system?

    Migrating data from your current EHR to a new EHR system is a huge task.

    As Daniel experienced, he had to focus on manually encoding the data on the system for an entire week just to ensure it was accurately transferred. That meant temporarily closing his practice during that time.

    To prevent this from happening, properly plan for your data migration. Seek answers to the following questions in the EHR system vendor agreement:

    • How long will it take to complete the migration? Can the data be migrated in stages?
    • How does the system ensure that the data has been migrated correctly into the new vendor system?
    • Does the vendor have the capacity to integrate data from the billing system, LIS, RIS, PACS, and medical devices?

    If the answers are not clearly stated in the agreement, then it is best to clarify these questions directly with the vendor.

    1. How will the billing be done using the new system?

    A billing system is the heart of any practice. If it gets disorganized or disrupted, your entire operation may be in jeopardy. Thus, it is very important to know if the following items are clearly discussed in the agreement:

    • Billing capabilities
    • Training procedure
    • Data integration

    Software training and data integration are key factors in effectively using a new vendor system for your practice. If not provided, additional outside help from a software consultant may be necessary just to integrate the new EHR system and the medical billing system. This means more expenses for your practice.

    Think twice! Carefully read your vendor system agreement because...

    Some system vendors automatically assume the responsibility of handling the billing system of your organization after you have shifted to their service. Should you wish this to be handled by a different provider, immediately inform them upfront about it and amend the agreement stating such.

    What can ClaimCare do for your practice?

    ClaimCare provides various medical billing services. ClaimCare can work on yoru current Billing system or provide you with one if needed. For more information and how you can benefit from ClaimCare Medical Billing Services, contact us.

    Tags: general medical billing questions, medical billing operations, medical billing education, medical billing, selection process

    ClaimCare Named One of the Nation's Top 5 Medical Billing Companies

    Posted by ClaimCare Resources on Wed, Jan 25, 2012 @ 10:41 PM

    best medical billing companiesIn kicking-off 2012, Money & Business, the online magazine that provides comprehensive coverage of business and personal financial matters, named the ClaimCare Medical Billing Company among the top five online medical billing companies. Independent researcher/writer Michele Wyan, listing the top five companies in alphabetical order, was impressed with ClaimCare’s track record, extensive experience and proven ability to serve all medical specialties nationwide.

    The researcher, mirroring ClaimCare’s mission “To collect the maximum revenue for your practice as fast as possible while helping to alleviate costs and hassle for your organization,” spotlighted a couple of ClaimCare’s many positive attributes:

    1. A guarantee that 85% of charges will be resolved within 60 days and that 95% of charges will be resolved within 120 days.
    2. The submission of claims within one weekday of receiving documentation of a patient encounter. If ClaimCare misses a claim submission deadline, the client is reimbursed for the missed claim.

    ClaimCare’s CEO/President Carl Mays II says, “This recognition is greatly appreciated because it reflects the dedicated hard work and the consistent, conscientious attention to detail that ClaimCare employees provide in order to serve our clients and to accomplish our mission. We are also quite proud of the fact that we have the ability to work on all major medical billing systems such as Centricity, eCW, NextGen, eMDs, Sage, Greenway, Misys, etc.”

                                                            *      *       *

    Copyright 2010 by ClaimCare Inc. The author, Greg Weremowicz, is VP of Sales for ClaimCare Medical Billing Service, one of the largest medical billing companies in the United States.

    Tags: medical billing, medical billing companies, ClaimCare News, medical billing services, selection process, best medical billing companies, improving medical billing

    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

    Make Sure Your Billers Watch Your AR - Not the Clock

    Posted by Carl Mays on Sun, Dec 21, 2008 @ 07:29 PM

    Outsourcing medical billing to the correct medical billing company can insure that they have the same incentives as you do.

    Almost all medical billing companies are paid a percentage of what they collect. This means they are only paid when you are paid. It also means the more they collect for your practice, the more they are paid. Internal medical billers, on the other hand, are almost always hourly employees. They are paid based on showing up in your office, not based upon how well they perform your medical billing or how much money they collect for your practice. This is not an alignment of incentives.

    This issue, however, is often not fully understood or appreciated by many providers.  These providers frequently say: "the staff works directly for me in my office-- they are more loyal and will do a better job and I can see what they are doing".  Experience has shown, however, that this is often not true.   

    Medical Billing

    I recently spoke with a partner at a busy cardiology practice.  While one of the billers was out sick, some paperwork was required and the supervisor went looking for it.  When the supervisor opened the missing biller's desk, a stack of unfiled, old claims was discovered.  It turned out about $40,000 of them were past timely filling deadlines.  They were lost.  I repeat-the practice lost $40,000!  When the biller returned from her leave, she was "sternly" reprimanded.   Let me say it one more time-she was reprimanded.  Not fired, but reprimanded.  Either way, the practice lost $40,000 in just this one instance alone. 

    Why wasn't more severe action taken? Because of concerns with upsetting the billing staff and exacerbating a staffing problem that existed. The biller was moved from follow-up to the front desk where she is now being trusted to collect the critical demographic information required to properly bill claims.

    This volume of missing charges should not have gone unnoticed. There should have been multiple reports that could have identified such a problem. The practice, unfortunately, did not know how to properly utilize the capabilities of the billing system and so, the required reports were never run. Proper use of a billing system requires much investment in time and training, an investment that hourly employees often do not make. This $40,000 in unbilled charges is likely a proverbial roach of this practice - in other words, for the one you see there are likely hundreds you do not.

    If you select the correct billing company you can avoid nightmare situations like this. Here are some of the key elements you should seek when looking for a medical billing company:

    • A fully integrated tracking system (charges by locations/provider and payments by source - lock box, office, PO Box) should be in place and you should have full visibility into the system at all times.
    • Your medical billing company should reimburse your practice for what you would have been paid by the payers based on your allowable for any claims that go past timely filing for reasons within the medical billing company's control.  What this means is that you never suffer financially if the billing company drops the ball.  Try to have your billers reimburse you if they drop the ball.
    • The practice should always (24 hours a day, 7 days a week) have access to the medical billing companies system. This allows the practice to see at any time exactly what is happening with their account.

    Physicians are working harder for less as costs rise and reimbursements fall. This is exacerbated by selecting a medical billing approach that does not have the proper alignment of incentives to prevent disasters (such as $40,000 in unbilled charges) from occurring.

    It has been said that the definition of insanity is doing things the same way and expecting different results. This certainly applies in the story outlined above. The biller that left $40,000 in charges unbilled will likely continue to cost the practice money. Just because she works for the practice does not mean she represents their best medical billing solution.

    Selecting a world-class medical billing service that provides total visibility into their process and has incentives that are fully aligned with those of the practice is the most reliable road to outstanding medical billing and financial excellence.

    Copyright 2008 by ClaimCare Medical Billing Services

    Tags: medical billing services, selection process

    Outsourcing Medical Billing Tip: Best Practices For Reference Checking

    Posted by Carl Mays on Sat, Dec 20, 2008 @ 01:02 AM

    outsourcing medical billingThe path from deciding to outsource medical billing to selecting your medical billing company requires a well planned selection strategy. A cornerstone of this strategy is well thought out and executed reference checks.

    There are many critical stops to make in the journey towards your medical billing company selection. Reference checking is one of the most important stops along the road. There are several steps that must be taken to ensure through reference checking.

    Although today's write-up is geared towards creating an effective interview guide, this is far from the only ingredient of a successful medical billing services company selection. Other critical ingredients include outlining the minimum requirements of an acceptable reference (e.g., does it need to be in your state, what specialties are acceptable, etc), deciding if you want to speak with a former client, outlining the roles of the people with whom your wish to speak (e.g., lead partner, practice administrator, day-to-day billing contact, etc), creating the interview guide, call the references, and making the final go/no-go decision.

    Your interview guide will allow you and not the references to determine what topics are addressed in the reference calls. If you do not drive the calls, you may well end the process still unsure about your final decision. To kick-off the interview guide creation think about the worst things and the best things that could happen as a result of outsourcing medical billing. Keeping your mind on these best and worst cases develop questions that will help you determine where between these two extremes your potential medical billing company operates.

    Narrow questions are typically much better than broad questions for reference checks. Broad questions such as "Did you billing improve after you outsourced?" will not give you specific enough data to make an informed decision when your reference checks are completed.

    To insure you have the information you need at the end of the interview process use narrow questions such as "What were you days in AR before you outsourced and how did they change 3 months after you outsourced?" This gives you specific and actionable data.

    Have you ever taken notes during a call and afterwards had trouble deciphering them? If you have you are not alone. A good way to combat this is to leave about a quarter of a page after each question (and sub question) to make sure you can write the answers on the same page with the questions. You have one final to-do before you start making calls. Review your questions with the following thought in mind "Will I be able to make a go no-go decision after these calls?" If not, what questions are you missing? Once you know that you have all your questions in order start scheduling your reference checks.

    It is critical not to allow a good meaning but talkative reference to keep you from getting all of your questions answered. Make sure they know you have a pre-determined list of questions you need to address. Find out how long they have to speak with you and keep an eye on the clock to make sure you get all of the information you need. You should leave the door open for call backs by letting references know you may need to speak with them again.

    You may find that one of your references brings up a point you had not considered. If they do, add the relevant question to the end of your interview guide and call back any individuals with whom you have already spoken to get this additional information.

    Following the process outlined above will insure that you gather the factual information required to make an informed decision about your medical billing service.

    Copyright 2008 by ClaimCare Medical Billing Services

    Tags: medical billing services, selection process

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