Courses For Medical Insurance Coding

Medical insurance coding is a very interesting subject that deals with coverage policies, health billing as well as categorizing the claims according to the different policies. Check to see whether there are classes in your town which offers the course. Remember that the lesser the cost that you pay, the less likely you would be exposed to the areas of physician credentials and the likes of it. You must be able to fork out a little bit of your savings to ensure quality education.
Some of the subjects which you can expect when are Network Contracts, Reimbursement and Denial Analysis. These are imperative areas in the education course study outline. Be sure that you are accurate and are meticulous to the fine prints of the coverage of the patients before charting the bills.
Professional medical insurance coding course training can be attained at a local college or vocational school. The course requires its students to be attentive to the different policies in existence. There are also instances where payroll and accountancy are given light during the training.
The complexity of this course is intense and it is advisable for the students to have an immense amount of interest in mathematical subjects. The calculation is somewhat confusing to the point that even the health practitioners are not equipped with the expertise of summing up the medication and treatment fees for their respective patient.

The coverage policy plays a vital role in determining the precise claim points which shows the extent to which the policyholders are entitled for reimbursement. The denial for reimbursement can occur for so many reasons such as omission of employer's name in the policy form or not updating relevant details as required by the form. Sometimes the rules and regulations by the doctor's clinic can be contradictory the coverage reimbursement and mutual policy.

Medical Record Coding Co-Payments

Medical record coding is a category which is related to the calculation for specific insurance policies. The co-payments made by the patient can be decided by the biller after applying the medical record coding.
Health information-certified professionals are fully capable of extending their duties to the tricky calculation which involves impeccable health insurance policy knowledge. The biller must acquire the relevant policy's terms and conditions in order to fully apply their expertise to the summation of costs.
Reimbursement and denial of reimbursement are two widely-focused topics which have subsequence importance for the billers where co-payment is involved.
The technicians are responsible for completing the patient's chart and personal health information. First the health information is separated by the category of diagnosis and treatment basis. Then, there is specific computer software which is used for the data storage for the distinctive categories.
The grouping of data is stored within the database or institutional computer system, for documentation purposes. It is crucial that the health documentation to be accurately completed and managed according to procedure.
Be wary of the common mistake when data storage is involved. Save a back up copy of the input in a separate disk or database in a different hardware. Other than that, understand the release of information for hospitals and other health institutions. The officers at the hospital must be able to retain the confidentiality of the clientele data. These are proof of excellent judgment in character.

This information must be managed in proper order so that it can be reviewed later by other health consultant. Examples of the data stored in the list are health history, observations, diagnoses, treatment outcomes and surgical interventions. It is important for the patient to have a proof of documentation regarding his or her health history in order to collate data when the occasion calls for it.

Medical Insurance Coding and Billing Training

Medical insurance coding and billing is a field which is a familiar territory to accountants, book keeping and payroll attendants. Summation of all health assurance premiums as well according to the codes is the general function of the billers.
Those who are interested in getting a profession in this medical insurance coding and billing must have had professional training from either a college or vocational centre. If you are interested in a career in this field, it is absolutely imperatively important involving the computer systems which are conventionally-used in the procedure.
There are many mathematical-approach subjects which is compulsory for the students wrap-around their hands with. Not only that, the study includes the comprehension of the scientific and health terminology. They must be able to assess the patient health check up chart to list down the exact amount of costs involved in the treatment.
Not only that, there are two other areas which the medical insurance coding and billing is related with which is computer skills and accountancy. The biller must understand that the patient usually visit doctors with a health coverage therefore the patient is covered by insurance. However not all health treatment is covered by the policy provided by the insurance company. The fine prints in the terms and conditions section must be read in detail to properly ascertain the limitations of the health policy.
Hence, the payment is subsidized by the premium and the charges differ depending on their personal premium rates. This is considered as a co-payment because the cost is accepted by the coverage agency and not entirely by the patients themselves.

Just like coverage premiums, the biller must be capable of analyzing the denial of reimbursements for certain perspectives involving the treatments and medications. The biller ascertains on whether the patient is allowed to claim coverage for the treatment at the health institution.

Medical Insurance Claims Editing - What Does it Mean to Scrub an Insurance Claim?

During the rigorous training physicians undergo to learn their craft, very little education is received on how to deal with submitting claims to insurance companies. It's unfortunately a necessary evil, as physicians who contract with insurance companies rely on that reimbursement as the lifeblood for practice survival.

Receiving payment from insurance payers involves submitting claims after providing treatment. Whether it's in an office setting, emergency room, or an operating room, filing a claim involves supplying the appropriate procedure and diagnosis codes along with any appropriate modifiers pertaining to the treatment performed. However, simply filing a claim does not assure that it will in fact be paid.

The policies of insurance companies for accepting or rejecting claims change often. A claim that got paid last month may be currently denied without notice depending on carrier specific modifications. This results in a large batch of denied claims for physicians performing many of the same procedures. Not only is it confusing for a practice to attempt following up on these adjustments, it can result in lengthy days in accounts receivables along with rollercoaster collection periods.

Is there a secret weapon physicians can use to assist with streamlining claims to maximize acceptance? That's where claim "scrubbing" enters the picture. The term "scrubbing" refers to an intricate cleaning of a claim prior to submission. Over the past 10 years, automated claims editing has been developed which helps to validate that a claim is appropriate and accurate for submission.

There are two components in scrubbing claims. As the most common error for denied claims is data entry errors, the patient demographic data is reviewed for the most common mistakes. For instance, keying in an incorrect procedure code that is age specific would make the claim invalid, and the scrubber flags those types of errors for correction prior to submission. This is the easy part of the automation.

The complicated portion of scrubbing involves a thorough review of the codes and modifiers to ensure complicity with carrier specific guidelines. This is commonly referred

to as the "rules engine." In some fashion, every data element of the claim is analyzed. If a physician submits a claim for a hysterectomy and the scrubber sees a male gender it will obviously be flagged. The scrubber verifies that a procedure performed is associated with a diagnosis code that justifies the medical necessity of that procedure along with variables such as gender, age, date and place of service and any required modifiers.

The complexity of scrubbing should not be underestimated. By the time one multiplies the total number of Medicare local and national coverage determinations, along with data from the Correct Coding Initiative (CCI), ICD-9 codes, and modifiers the potential numbers of editable combinations surpasses ten million. Advanced claim scrubbers, though, can review about ten claims per second.

By including national and local coverage determinations from all of the Medicare geographical regions in every state along with data from the Correct Coding Initiative (CCI), approximately 35% of existing CPT codes are represented as a baseline in claims editing programs. There is no Medicare medical necessity guidelines for the remaining 65% of codes, therefore claim scrubber software companies hire clinicians and nurses who work full time evaluating up to the minute medical necessity data posted by insurance carriers around the country on their website as mandated by law. In addition, procedure codes are matched with all feasible diagnosis codes that are believed to be clinically defensible for claim acceptance. As one might expect, this is a costly endeavor so most claim scrubbing software companies license this portion from the few companies performing the research.

So how good are existing claim scrubbers? There's a wide range available, either as a standalone product or integrated with practice management software. Often the billing company utilized will incorporate a scrubber. The best ones will routinely achieve over 95% claim acceptance on the first pass. Practices who were previously performing manual edits typically find that after instituting the technology the scrubber flags over 30% of claims. This means about 30% potential claim denial prior to scrubbing, which drags out the revenue cycle. By having the scrubber flagging problem claims, changes can then be made instantly prior to submission, rather than waiting weeks for a denial. As a result, the practice will see more reimbursement and receive those funds faster. There will also be less back-end work secondary to denied claims.

Can relying on an experienced coder achieve the same acceptance rate? In all likelihood, no. As mentioned, scrubbers check demographic information along with the codes. Also, if a payer changes a filing guideline on its claim form or a medical necessity requirement, a certified coder would probably not be aware of it in a timely fashion. If a physician is contracted with a large amount of carriers, the chances of being subjected to rejected claims increases dramatically without a way of continually monitoring these myriad and often complex requirements.

Embracing an advanced claim scrubber, whether directly or indirectly, will allow one's practice to effectively combat the convoluted world of insurance claim rules and regulations. Practices that incorporate claim scrubbing rarely move away from the process. When the bottom line receives a significant boost along with peace of mind from knowing the latest technology is in their back pocket, why would they?

Why Work in Medical Billing and Coding?

If the field of medical coding and billing sounds interesting to you then check out these reasons as to why one should work in this area? The reasons are:
• One of the reasons why the field of medical coding and billing is so lucrative is the fact that anyone can learn it within a year or so. Depending upon the course and school you choose you can pass with a diploma in medical billing and coding in a year or even have a certification in 2 years.
• This career path allows you to work from home. You can either start your own medical coding and billing company or can work for some other company. In both the cases the rewards are very high. Clinics and hospitals do not handle the medical insurance documents on their own and normally require the services of medical coding and billing companies. Working from home is a great option for freelancers who enjoy working from home or for housewives who have the zeal to work but were not able to do so because of other responsibilities.
• The job of medical billers and coders is just the starting point for these medical billing and coding professionals. With experience and expertise in the medical field you can diversify your career and go in for various other job designations.
• Once you have gained some experience working as a professional medical biller and coder you can opt to quit your job and start your own company. Starting a company is a big step and this decision should not be taken lightly.

• Due to the everlasting increase in the demand for health care facilities one can be sure that going in for a medical billing and coding course will give you the much needed job security.

Hospital Bills - Plan Ahead to Avoid Costly Mistakes

Understand your insurance policy terms and hidden rules before choosing a hospital for an upcoming medical need. If your circumstances dictate the need for an out of network hospital understand the practices behind usual customary and reasonable charges - or you may find yourself in the poor house.
I recently underwent a surgery that required a five night hospital stay. The final bill from the hospital sheds light on an often misunderstood and potentially crippling aspect of medical billing: usual customary and reasonable charges. If you are considering being treated at an out of network hospital, make sure you understand your possible financial obligations.
Many insurance plans provide in network and out of network reimbursement. The typical plan pays a higher percentage of charges for in network hospitals, and a lower reimbursement percentage for out of network providers. What many people fail to realize is that reimbursement levels are based upon usual customary and reasonable charges. If your hospital bills you above these standard rates you may be left with a big problem.
My surgery was performed at an in network hospital, and my insurance paid 100% of the "allowed charges", after I made a daily co payment. The total hospital charges were $61,000, while the allowed charges were only $13,000. The hospital credited a $48,000 contractual adjustment - that's a 78% discount off the retail cost!
When you use out of network providers you lose cost containment: the contractual rate. If this hospital was out of network my insurance would have paid 80% of the allowed charges - or $10,400 leaving me with an unpaid hospital bill of over $50,000. The contractual rate is equivalent to usual customary and reasonable fees and medical providers are free to charge and collect on any differences. In many cases the difference can blow your mind and your budget.

For many, an out of network hospital may be the best option for a healthy outcome. Make sure you know the real cost before making your choice. Hospital indemnity insurance can help as well, and long as your coverage begins before you need it.

Medical Billing - Do You Know How to Pick the Best Pricing Option For Your Health Care Practice

Medical billing services offer a myriad of options to compensate them for their services. Every practice is different and the right choice for you depends on the volume, type, and dollar amount of claims. Following is a list of billing services options available and some their advantages and disadvantages.
1. Percentage Based Fee
This is the most common type of medical billing service. You pay a percentage of the net collections or of gross claims submitted to the payer. Percentage rates vary from four percent to sixteen percent and depend on the services provided, amount of claims and volume. Percentage based agreements are suitable for almost all medical practices, especially if you turn over the whole operation to the billing service. Such compensation model provides an incentive to the billing service to maximize collections - a great benefit for the client. Only drawback of percentage based pricing is that the billing service may neglect smaller claims since the small payment may not justify the aggressive follow up required to collect. A good alternative is to pay a slightly higher percentage on the smaller claims to incentivize the service to collect on them.
2. Flat Fee per Claim
You pay a flat rate on each claim filed. The fee could range from $1 to $8 depending on the service. This option is suitable for medical practices that process low volume of claims, high payment claims or claims that are difficult to collect from a particular payer. Drawback of flat fee arrangement is that the billing service does not have much incentive to pursue the claims aggressively. This service is only useful if you demand follow up in the contract and release the fees only after the claim has been paid.
3. Hybrid Billing
Hybrid billing could be a good choice to get the best of both percentage and flat fee service. In a hybrid agreement, pricing terms are defined based on the type of claim and the insurance carriers. This sort of billing arrangement is suitable for any practice that has wide range of claim amounts and a moderate to high volume of claims. This also allows medical practices to comply with the flat fee regulations stipulated for Medicaid and Medicare claims in some states. The percentage-based fee is paid for the private insurance claims. The main drawback of hybrid billing is that it introduces billing complexity into practices that do not have a large volume of claims.

As you decide on the type of price structure with the billing service, carefully evaluate your billing volume, amount of claims and the type of payers. Ask the billing company to model your volume, amount of claims and payers so that you can estimate the amount you would pay under each type of billing contract. Consider your future growth before you choose the optimal payment contract. There is a billing service out there for every type of practice; it is just a matter of educating yourself and making an informed decision to hire the right service for your practice.

Need a Medical Coding Update? Audio Conferences Can Help You

In today's complex regulatory environment, what with healthcare resources stretched to the limit, you need to optimize your coding and compliance efforts. A good way to do so is by signing up for audio conferences. When you sign up for one, you will get a medical coding update, inside scoop on how to tackle the coding issues that are costing you money and putting you at risk for a bad audit, and lots more.
When you get onboard such a conference, you will get an idea where you are losing money, get the lowdown on the most common missed reimbursement opportunities, it'll help you get the latest update on regulatory issues, ways to analyze your billing performance and tips and tricks to make every appeal a success!
When you sign up for one, you will be able to save on your travel costs as you can listen to them from the comforts of your own office or meeting room. Such a conference provides multiple formats to fit your training needs. And the best part is such conferences can be had in CDs or PDF transcript.
One more advantage of audio conferences is that you can even gather around a speaker phone or computer and train your team at a small price. Post the conference, you can take active part in the Q&A session. And after every conference, the presentation materials are yours for keeps.

But the best part of such audio conference is that you can earn CEUs from them. So go sign up for one today!

Medical Reimbursement is All About Follow-Up

So here's how it works: You see a patient, your biller submits a claim, and you get paid. Right? The answer, of course, is "no." The ugly truth is that many claims are never adjudicated. Why not? The claim was never received, it was sent back to the plan for pricing, the hand-off from one clearinghouse to another didn't happen, the gatekeeper computers rejected it, it's being held for additional funding from a self-insured employer, the carrier changed its "edits" so their computer now rejects claims that it used to accept, and oh, this network no longer handles those claims.
Because the claim doesn't get adjudicated, you don't receive a denial, and you don't know there was ever a problem. Meanwhile, most billers are so busy submitting claims and posting payments, that as long as you're not asking about missing revenues, those lost claims stay lost forever. Granted, some billers faithfully hit the resubmit button every 30 days for unpaid claims, but if they didn't uncover and address whatever issue prevented adjudication in the first place, those resubmitted claims fall into the same black hole until the timely filing limits expire.
Which brings us to this: The three most important things about medical reimbursement are follow-up, follow-up, follow up.
If you want to get paid for those "lost" claims, your biller has to read reports and work the phone. Someone has to ask, "did you receive this claim, and if so why hasn't it been paid?" Unfortunately, most billers focus on writing appeal letters for denied claims-after all, having a denial in hand is a great impetus to action. However, if billing is done correctly, appeals should be rare. The bigger problem lies beneath the surface of unpaid claims, and here's how to follow up on those lost and unpaid claims:
Start with an insurance aging report. If your system allows it, select only claims older than 45 days, because anything newer may be either in the adjudication process or the payment could be in the mail.
Prioritize your work. Act on claims that are nearest their timely filing limit first, and act on large claim amounts before doing small claims. Just in case your biller cannot complete the follow-up, you shouldn't forfeit reimbursement to a missed timely filing limit, and if your biller runs out of time, it's better to let the small claims slide than lose payment on the big dollar claims.
Check your claims acknowledgment files. If you use a clearinghouse or submit directly to carriers, you may be able to check on an individual claim manually. Often electronic feedback that a claim had a problem is sent to you automatically. Sadly, most billing software is unaware of these claim acknowledgment files, and many billers simply ignore the files that are available. Some medical billing companies use sophisticated custom software to parse acknowledgment files daily so that they can act to identify and correct a problem claim as quickly as possible.
Make the call. If the clearinghouse or acknowledgment files don't provide the reason a claim has not been processed, it's time to call the insurance carrier. If the response is, "we have no such claim on file," your biller should verify both the mailing and electronic addresses for the claim. Otherwise, find out what went wrong, and ask as many question as it takes to fully understand what needs to change to get the claim processed. Simple fixes can often be made over the phone and the claim can be sent back for reprocessing. Other fixes may require more work. You might even find out that the claim was paid to another provider or a lost check needs to be reissued.

All of this takes time and the right personnel. Think of follow-up as an investment, and the payoff will be the difference between a practice that's just doing okay and one that's truly profitable.

How to Start a Home Based Medical Billing Company

If you have decided that starting a home based medical billing company is the best move for you, you are approaching a great opportunity to cash in on a high demand market. With physicians finding it harder and harder to collect on invoices, they need medical billing companies that are able to efficiently manage their billing and ensure that there is appropriate payment and claims filing for the revenues to be generated more effectively. There are some insurance companies that can send physicians for the ride of their life, and there are some medical programs that make it quite difficult and timely to collect payments. Most of this has to do with the billing process, and that is why you can be a very beneficial asset to many health care facilities and physicians in your community or service area.
Why Home Based?
A home based medical billing company is a great option for those that have daily lives, but still wish to enter the workforce with a strong head. There are more and more businesses these days going into internet based servicing and medical billing is a great industry for that move. Not only are most of the billing processed completed through computer software, but there is no need for excessive costs on building space if you aren't going to be seeing any clients or managing staff. You can definitely hire staff that works through a network, giving you an efficient team at less than half of the cost.
All the Necessary Software and Hardware
You want to get all your materials and tools together when starting a home based medical billing company. As the company is home based, you definitely want to have the appropriate communication portals open, whether through web conferencing, phone conferencing, or any other method that uses today's technology to avoid the need for physical presence. You will also need many other tools such as:
• Appropriate billing and invoice forms
• Fax and printer
• Appropriate accounting software
• Business licensure and registration
Having the right tools and materials will ensure that you are able to adequately perform the functions of the medical billing profession through your own home based medical billing company. Physicians will count on you to provide a steady cash flow, and with a home based company, you can provide this function for only a fraction of the costs of regular medical billing companies.

No matter which way you look at it, having an office is just an added expense that could be done without. With the great technology of the internet, you don't have to be bound by an office building that increases your service charges and causes your clients to pay for it in the services the obtain from you. You want to provide the most cost-efficient services which is possible by cutting your own costs and taking your business to the comfort of your own home, where you are known for your best ideas anyway.

What it Means to Decrease Your Medical Practice Accounts Receivable by 33%

As the 21st Century begins to fully set in, so has reality with the state of medical practice revenues. Medical reimbursement has stagnated or decreased substantially in both real dollars as well as after inflation adjustment, making it more difficult for providers to cover their overhead adequately and have much left over. If a medical practice can continue its current patient care volume and medical billing, yet decrease its Accounts Receivable (AR) by 33%, what would that mean for the practice?
Let's look at a sample medical practice called All-City Medical. The practice utilizes an in-house medical biller with concerns over whether collections are being adequately pursued.
All-City had annual gross collections of 1.2 million dollars in 2009.
Their Accounts Receivable at the beginning of the year, 1/1/09 = $250,000
Their Accounts Receivable at the end of the year, 12/31/09 = $350,000
The average AR therefore is 250,000+350,000/2 = $300,000
The accounts receivable turnover rate is calculated as gross collections divided by average AR: 1,200,000/ 300,000 = 4 times. This means that in a full year the accounts receivables are collected and closed 4 times for the practice. How many AR turnover days will it take to complete one cycle of collecting and closing? 365 days/4 times = 91 days for AR to turn over. This means that in 91 days patients receive medical treatment, charges are posted and medical claims are processed through the clearinghouse, and payments are received from either the insurance companies or patient payments, with the receivable accounts closed. How does a medical practice decrease its AR? Once that goal is accomplished, what does that mean? The way to do it is to increase the turnover ratio. If All-City Medical increases the turnover ratio to 6 times, that means it will only take 61 days (365 days/6 times) for the AR to turn over. With this improvement All-City Medical's average AR outstanding decreases from $300,000 to $200,000! 1,200,000 collections/turnover ratio of 6 = $200,000 average outstanding AR The end result is that All-City Medical now has $100,000 more cash on hand to either: 1) Distribute to the Partners 2) Pay Expenses 3) Invest in Capital Equipment to make more money for the practice.

No matter which option the practice decides on, the bottom line is they have freed up hard money for the practice.

CPT 99213 - Learning the Basics of E & M Coding Guidelines

CPT 99213 is defined as: Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components:
• An expanded problem focused history;
• An expanded problem focused examination;
• Medical decision making of low complexity usually, or straight forward as the presenting problem(s) are of low to moderate severity.
A physician will be left with the options of billing E/M for either code 99211 thru 99215 for an established patient. Usually, the correct level of CPT code (ignoring coding by time) can often be narrowed down to two or three choices by a proper evaluation of the patient and documenting the office visit correctly. The usual choices that remain for the physician at the end are 99212, 99213, 99214.
There might be times when the physician wants to put a code down without really understanding the complexities of the coding system and that will end up leaving money on the table which we are trying to avoid.
For example:
If an established patient presents for a second follow-up of a single complaint such as chronic cough and it is decided that it is stable or improving, a CPT 99212 may be warranted.
However, in the evaluation of the patient, if the provider takes an expanded history and the physical exam is re-evaluated to include performance and documentation of at least six bulleted elements from one or more organ systems or body areas. Then it will qualify as an expanded problem focused exam. That being said, if your History and Physical Exam meet criteria, then the Medical Decision Making is not needed in the calculation of the level and you may capture your 99213.
Remember, in an established patient, you need only meet two out of three criteria; History, Physical Exam and Medical Decision Making to qualify.
That being said, we certainly will be making a medical decision, but according to the 1997 guidelines (which I prefer to use for a variety of reasons) we capture our 99213 as long as the medical necessity is apparent.
In another example, If the same patient has a single straightforward new complaint to discuss with the examiner, during the follow up for the chronic cough, such as an orthopedic complaint that is worsening, a CPT 99213 and even a CPT 99214 depending upon the complete exam fulfilling two out of the three main components (that being History Physical Exam and Medical Decision Making (MDM) may be appropriate. Of course, medical necessity is required to substantiate the level of service billed.
As a physician, if you consider billing by time then a 99213 requires an average of visit of 15 minutes in which at least 7.5 minutes or 50% of your time was spent in counseling or coordinating care.
Remember, CPT 99213 requires documentation of at least one system when you compare it with CPT code 99212 and an expanded problem focused (EPF) history is required as well for a 99213.

The revenue captured from properly documenting a 99213 over a 99212 can add up to thousands of dollars annually. You want to make sure you are properly documenting your medical records and capturing the revenue you deserve based on the work you are performing. You do the work, get paid for what you do.

Tips For Improving Productivity in Your Billing Process

Apart from the patients, billing is the lifeline of the medical office. Whether your medical office's billing is done in-house or you've outsourced it to a medical billing company, there are specific things you should do that are crucial in maintaining a smooth billing process.
• Train the front desk staff. It is imperative that staff at the front desk has some type of introductory insurance and/or billing training. Make certain your staff is verifying insurance benefits prior to patients' appointments. Be sure to train new employees on the various types of health insurance; indemnity plans, HMOs, PPOs, and POS plans. Educate the front desk on authorizations and referrals. Explain the difference between 'Original Medicare', 'Medicare Advantage', and 'Medigap' in order for the correct co-payment/co-insurance to be collected and the correct health insurance cards to be copied for billing purposes.
• A thoroughly completed patient registration form is crucial in the billing process. Nothing frustrates a medical biller more than a missing insured's date of birth, a suffix missing from a Medicare HIC number, or a missing home phone number. Train your front desk staff to keep a watchful eye on the registration form to make certain all fields are completed! This tip not only helps with initial claims submission, but also assists in future collection procedures.
• A biller and only a biller! If your billing is done in-house, your billing should be designated to specific person/persons whose only job is billing. When the same person who is manning the front desk, putting patients in rooms, and answering all telephone calls is also the employee who is doing your billing-mistakes are bound to happen. These mistakes may be the very reason a provider will make the decision to outsource the practice's billing.
• Using a web-based application is especially helpful in improving billing productivity because it allows the provider and billing service to stay connected. For one thing, the medical office has access to patient accounts, which can be helpful in collecting outstanding patient balances during an encounter. On the other hand, the biller has real-time access to any patient demographics, diagnoses, insurance, or any other pertinent information needed to prepare claims for submission.

• Maintain your accounts receivable. Many a provider would be shocked if they knew the dollar amount in their 90+ column on their insurance aging report! Each state has prompt payment statutes which give the timeframe in which both paper and electronic claims are to be paid. If your billing is done in-house, take the time to ask your biller to print an A/R report. If you are unhappy with what you see, find out the exact problem. Is it that your biller does not have enough time to post charges, post payments, submit claims, and maintain the A/R by themselves? Are you the owner of a billing service whose billers are in charge of their own accounts for the entire life cycle of the claims? In either scenario, listen to your biller(s) and if they need help, hire a separate employee whose only job is maintaining the accounts receivable.

Don't Be Distracted by the Shiny Objects of EMR and HITECH Incentives

One of the blogs that I like to read, The Healthcare IT Guy, posted some good thoughts last week about the final MU rules for EMR and what physicians should do next. I liked his advice, which included:

• "Don't be in a hurry to make an EMR/EHR decision because of incentive payments; even if you start in 2012 you'll be eligible for full payments from Medicare ($44k over 5 years) and you can start as late as 2016 to get full payments from Medicaid ($66k+ over 5 years). If you're making EHR/EMR decisions based on other business benefits and not incentive payments then you should continue that research and decision-making process."
• "Do be in a hurry to use technology that helps with office automation first (like document management, patient relationship management, etc.). General office automation technology won't qualify you for incentive payments but it will help reduce your costs and you'll run your business better. If you use the proper technology you save more in one year than you'll get back from incentive payments in 5 years."

His second point is especially important, from my point of view. Too often, we are entranced by the latest idea to generate revenue or build business, and we're distracted from the tried and true techniques for maximizing revenue we've already brought in the door.
A doctor I know has a good expression for it: "Stepping over dollars to pick up pennies."
A good example of this is that $44,000 incentive, which every EMR company is waving in your face. The $44,000 is a tantalizing figure, no doubt about it. But did you realize that you could earn a great deal more than that through improved medical billing and collections?
Let's start with the fact that it's not uncommon for medical practices to report a gross collection rate of 60 percent or less, according to The Physician Billing Process: 12 Potholes to Avoid in the Road to Getting Paid. That means for every $1 of services billed, the physician receives only 60 cents.
Then, consider the impact of denials: Gross charges denied by payers have grown over the last decade to 14-18% of all charges. That translates to $118,800 of lost revenue for the typical primary care physician. Some other food for thought:

• Denied, rejected, resubmitted and underpaid claims can cost you as much as $100,000 per month according to the AMA.
• Your practice could be losing more than $75,000 per year in denied claims that are never resubmitted, based on multiple studies confirming that many practices do not resubmit up to 50% of their denied claims.
• Underpayment of approved claims has historically been as much as 35% lower than the contract amount.

What all of this means is that you could be bringing more money to your bottom line-without adding a single new patient or working another hour longer-or chasing the EMR incentive. Naturally, we believe the best way to do this is by fully utilizing the best possible medical billing software and insurance claims processing best practices to insure that your claims are clean, your appeals submitted and collections are as high as possible. And if you do those things, you will not only put more in your pocket than you will with the HITECH incentives, but you will have a better-run practice overall, as The Healthcare IT Guy mentioned.
I'm not saying you should ignore EMRs and other technology. You should certainly seriously consider an EMR for your practice, if it makes sense for your practice.
We just don't want you to be distracted by that shiny object and miss out on money you've already earned-and deserve.

Because we believe you deserve the dollars...as well as the pennies.

Medical Billing and Coding - What is a Medical Insurance Specialist and What is the Salary Range?

If you've been thinking about going into the medical billing and/or the medical coding field you may be interested in becoming a medical insurance specialist. A specialist is usually knowledgeable in both billing and coding procedures.
A medical billing and coding specialist such as a medical insurance specialist works closely with patients, insurance companies and office staff. They handle charges, submit claims, respond to inquiries from medical insurers and do all the follow up for payments that are overdue. They know claims processing and billing regulations. They know how to appeal claims that are rejected by a medical insurance company or claims medical insurers only partially pay.
The specialist also is responsible for getting pre-authorization for certain procedures and post treatment reports.
Medical billing specialists are familiar with all the health plans that are offered in their geographic area. They can read medical bills and know what the costs are for various procedures.
Duties include discussing the patient's medical insurance coverage to determine what co pays may be due for a planned procedure, if any, or if the health insurance company or provider will pay all the costs. This is important so the patient will know what payment will be expected, if any.
The medical billing and coding specialist reviews charges, and submits claims to health insurance providers. It's important that this is done correctly. The specialist also works with the billers to make sure that the statements for services are billed correctly. If it's not done accurately it delays payment for the health care provider.
The specialist usually has good knowledge of medical coding although many times the forms will come to them already coded. This coding is standard and is used by all health insurance companies and medical billing services.
The medical insurance specialist makes sure that all the patient's medical records are accurate and up-to-date.
Medical billing and coding specialists or medical insurance specialists work for doctors' offices, billing services, hospitals, dentists, assisted living centers, skilled medical facilities, clinics, medical insurance companies and all types of medical and healthcare professionals and providers.
If you're interested in becoming a medical insurance specialist or medical billing and coding specialist make sure to do plenty of research and find the best training for you whether online or on campus. Check out what the salary range is because it may vary depending on whether you're working for a doctors' office, billing service, insurance company or hospital. Starting out it could be anywhere from $10 to $40 an hour or more depending on experience, knowledge and training.

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