Tag: medical billing

Medical Billing Needs To Catch Up with Modern Medicine

By Darren Ghanayem and Maria Turner, managing directors, AArete.

America boasts the greatest advancements in medical research in the world: more Americans have received the Nobel Prize in medicine than Europe, Canada, Japan, and Australia combined, which together have twice the American population. America has potential to lead the globe in cutting edge medical care, delivering service that is paid for fairly, accurately, and efficiently. It’s time our payer system caught up with our world-class talent and facilities.

The process of connecting the American healthcare ecosystem’s 3Ps (Payer, Provider, and Patient) has been marred with inefficiencies and inconsistencies. Nowhere is this more evident than in the billing area, where inaccuracies and disputes are commonplace. Resolving these issues is both time consuming and labor intensive—payers often have to jump through hoops to get to the real essence of a provider’s claim and translate accurately the real costs to providers and what to collect from patients. Such billing challenges, or even simple opacity, are not isolated instances—they are embarrassingly prevalent. A 2016 study by the Medical Billing Advocates of America found errors in three out of the four bills they reviewed.

These inefficiencies have added to a fractured, disconnected healthcare ecosystem; patients harbor animosity toward health insurance payers when they are billed more than they expected, while payers and providers are in constant dispute over reimbursement and shared payment arrangements. As a result, the tension can be felt across all constituents.

What’s behind these billing errors? Provider administrators sometimes enter incorrect procedure and diagnostic codes. A simple typo might exponentially increase the cost of the claim. For example, with a single misplaced or misread digit, an X-ray on an ankle might incorrectly register as an image of the blood flow to a brain. Many of these inaccuracies can be attributed to well-meaning human error—and payers need to develop strategies to combat these relatively benign mistakes. They must move forward and work together with providers, because playing the blame game harms every facet of the delicate healthcare ecosystem. But this doesn’t completely rule out the possibility of fraud. In some cases, providers have generated inflated revenue by intentionally using the wrong billing code (a practice commonly called “upcoding”) or incorrectly using modifiers to bypass the review process (e.g., the use of Modifier 59 to report distinct procedural services not normally reported together).

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Price Transparency Puts Healthcare Consumers In The Driver’s Seat

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By Christine Cooper, CEO and member; and Jack Towarnicky, member, aequum LLC.

Effective healthcare consumerism requires timely access to accurate provider and hospital fees and estimated out of pocket costs of services – before receiving care. Price transparency puts employer-sponsored benefit plans in the driver’s seat, empowering participants with information that helps them be more prepared, involved and informed in proactively making cost-conscious decisions about their health care options and utilization.

This empowerment is especially important in today’s economy. Many workers are “financially fragile” and have not set aside savings specifically earmarked for out-of-pocket medical expenses, including regular cost sharing – deductibles, copayments, coinsurance. As healthcare continues to see rising cost inflation, price transparency is more in the spotlight, triggering a (re)introduction of healthcare consumer strategies. By taking advantage of price transparency, making comparative cost and quality information available, and capitalizing on cost containment opportunities, plan sponsors and their participants can fully optimize the value of their health benefits plan.

Taking Advantage of Price Transparency

There is complexity in healthcare due to a lack of price transparency. This is especially prevalent in medical billing. Health policy changes have been enacted to make cost information in the healthcare industry more easily available to consumers with the expectation that price transparency will provide better metrics for healthcare spending. The appeal of price transparency is based on the view that increased consumer choice and less information asymmetry will aid in achieving higher-quality, lower-cost health care.

Legislation is now in effect to better enable Americans with knowing the true cost of provider health services before receiving care and submitting a claim. Federal law now supports employer-sponsored health plan access to price transparency with added levels of protection and fairness. Executive Order 13877Improving Price and Quality Transparency in American Healthcare to Put Patients First, significantly expanded the requirements for hospital and other medical provider price transparency.

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How Do Laboratory Billing Companies Help You Overcome Revenue Hurdles?

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Most of the laboratory practitioners lose millions of dollars just because of inefficient management of lab billing services. Usually, it happens because of the lack of a sufficient workforce, equipment required for billing, and more importantly time. If you are finding it difficult to keep your claims process optimized then you must acquire the assistance of professional laboratory billing companies.

A reliable lab billing company stays well-versed with the recent evolutions in the healthcare industry. They provide a dedicated workforce that follows up on all claims. They try to collect maximum revenue for your practice to achieve mutual business success goals.

For this purpose, they implement every preventive measure to submit clean medical claims. When error-free claims are submitted in a timely manner,  you can get quick reimbursements. This leads your practice towards long-term financial stability. Moreover, you get complete control of your lab revenue cycle management.

In addition to this, you don’t need to spend your time on hectic and time-consuming consuming tasks of lab billing and coding. Because outsourced billing experts eliminate the responsibility of your laboratory staff. And you can also get rid of the constant monitoring of your staff.

You and your healthcare staff can utilize the saved time in enhancing your patients’ encounters at your lab practice.  Sometimes, laboratory practitioners feel hesitation in hiring a third party for their financial management.

If you are one of them, stop thinking like this. Because you don’t lose control over your finances because professional laboratory billing companies keep you updated with regular analytical reports.

Moreover, hiring lab billing agencies can help you to drive maximum profitability to your business in the following ways:

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How Medical Billing Records Tell A More Complete Story of COVID Patients

By Devin Partida, technology writer and the editor-in-chief, ReHack.com.

Devin Partida

Medical billing records may help create a fuller picture of how the COVID-19 virus has impacted the country.

Researchers have started taking to repositories of claim and billing code data to learn more about patients — who they are, what challenges they faced and how they had to navigate the health care system during a pandemic.

Combined with other data on the financial impact of COVID, this research offers a much clearer view of how the pandemic has impacted patients and strained the American medical system.

1. Chronic Kidney Disease May Be the Most Common COVID-19 Comorbidity

In July, FAIR Health, a provider of health care solutions, released a report on how billing records could reveal more about COVID patients’ stories. Most prior case studies found that type 2 diabetes and hypertension were the most common comorbidities. Respiratory conditions, like asthma, COPD and sleep apnea, along with heart conditions, typically made up the rest of the top 10.

The billing data was mostly in line with these previous findings — but had one key difference. The No. 1 comorbidity was chronic kidney disease and failure, rather than hypertension or diabetes.

The FAIR Health report also diverged from other case studies in finding that anxiety was one of the top 10 comorbidities, coming in at ninth place.

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Why Transparency Is No Longer Optional In Medical Billing

By Terry Rowinski, president & CEO, Health Payment Systems, Inc.

Terry Rowinski

Almost a year into the COVID-19 pandemic, the stress surrounding the rising number of cases and the ensuing economic recession reminds high. Nearly half a million Americans have been hospitalized due to coronavirus, putting untold stress on patients, their families and hospital staff. Healthcare and health insurance costs are likely to rise after an unprecedented year, while millions struggle to meet their basic needs. 

On top of that, surprise medical billing can quickly spiral into large amounts of debt and even bankruptcy. Routine tests alone can result in thousands of dollars in uncovered charges; some hospitalized patients have received bills upward of $400,000. While the situation absolutely harms patients, it also negatively impacts health providers, insurers and the industry at large. 

Just as we’ve reevaluated the way we conduct nearly every aspect of daily life, we’ve also had to take a hard look at whether our healthcare systems are actually working. In order to make informed decisions about their physical and financial health, consumers need greater transparency throughout the healthcare experience. 

After years of mounting demand for a better consumer experience in healthcare, we’ve reached a tipping point. Transparency is no longer optional. 

Patients need to choose providers based on quality and cost

Consumers have long been frustrated with the status quo because it doesn’t provide them with a source of truth about healthcare costs and healthcare quality. It’s baffling that healthcare is the only consumer experience that doesn’t encourage shopping for the best option at the best price. We have a suite of easily available tools to help us shop for most items, evaluate their quality and compare price. Why isn’t our healthcare—which is much more important than the latest gadget—the same?

For example, even when patients know to search for an in-network provider, they struggle to select the right one. Many insurance carriers have some aspect of price or force ranking of providers on the ‘Find a Provider’ section of their website—but these aren’t exactly intuitive user experiences (perhaps by design).

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Top 9 Challenges For Physician Billing Services Are Expected To Face In 2020

The rise of this decade has brought new and complicated challenges that are accompanied by some other problems that left unresolved during the last decade. 2020 has come up with some unprecedented and unpredictable host of challenges such as global medical emergency because of the vast exposure of COVID-19 making its way from China to the US in a few days.

This global crisis has thrust upon a lot of burden on the medical practitioners, especially on physicians. In a physician’s office or any healthcare center, it has increased burden on both front-end and back-end departments of the healthcare centers and both seem to be in turmoil in such circumstances. Along, with these challenges physicians have to also suffer from the financial crisis due to changing rules and policies for physician billing services. It is the hardest challenge for physicians to align their financial policies with respect to the real-time changes in medical coding and physician medical billing services.

In this article, I have mentioned the following top 10 challenges for physician billing services that are quite difficult to encounter;

Excessive Administrative Burden

It has always been a cumbersome task for the physicians to handle the burden of excessive stress of managing both patients and physician medical billing services. This is not a new issue and physicians have been facing this issue all around America for decades. No matter their association with the private or public practice, no matter if they are practicing individually or on a large-scale healthcare center, they have to improvise administrative responsibilities.

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6 Benefits of EHR Software Integrated with A Medical Billing System

By Rekha Patil, founder, Bit2Sky

Rekha Patil

Medical billing is process of handling and managing claims, processing payments, and generating revenue. It entails various tasks – coding claims correctly, tracing them, following up and much more.

The medical billing task is challenging and demanding too. But, it can be made easy by integrating the billing system with an EHR software.

Let’s have a look at the integrated electronic health records benefits in medical billing process.

  1. Improve efficiency

When the billing process is integrated with an EHR, it becomes a comprehensive platform. You don’t need to input the data manually and repeatedly.

The integrated system also removes the need to fax or photocopy every billing sheet. This not only saves time and boosts productivity, but also minimizes human error during data transfer, saves paper and money.

  1. Enhance comprehensiveness

EHR becomes a comprehensive platform to perform a number of activities. Accessing data from a single place makes your process highly cost-effective and accurate.

  1. Build trustworthy relationships

Integrating your EHR and the billing system brings in transparency in the medical billing process. The EHR software seamlessly integrates with billing system to submit cleaner claims and schedule appointments more easily.

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The Key To Technology Adoption In Independent Medical Practices May Be Their Billing Companies

By Aaron Perreira, director of integrated marketing, Kareo. 

Aaron Perreira
Aaron Perreira

A nationwide survey conducted by Kareo reveals an interesting fact for everyone involved in healthcare technology. One of the primary sources from which independent medical practices get advice and information on adoption of new technology is their billing companies.

Independent medical practices remain the primary healthcare delivery system for patients in the U.S. Physician-owned practices see 990.8 million visits, or 3.1 visits per person in the U.S. each year. In contrast, hospital outpatient visits number 125.7 million per year, or .4 visits per person. At the same time, these independent practices – small businesses in most cases – are greatly impacted by the rapidly changing healthcare arena.

Regulatory changes, technology infrastructure demands and increasingly large administrative burdens have put pressure on independent practices in recent years, and they do not have the resources or economies of scale that larger hospital practices have to address them. Experts agree that the primary hope for independent practices thriving efficiently and cost effectively in the emerging healthcare landscape depends upon the effective integration of technology.

One of the steps many independent practices take to help alleviate some of their administrative burden is the outsourcing of billing. Nearly one-third (28 percent) of physicians and medical practitioners who do not currently outsource medical billing indicated that they plan to do so over the next two years. As a result, medical billing companies expect an average revenue growth of 12 percent during 2019 as utilization of outsourced billing by independent medical practices continues to increase. Of course, the primary service billing companies bring to practices is – billing.

The survey highlights that extensive revenue cycle expertise at the specialty level is a successful strategy for building a billing company to scale. Forty-seven percent of small billing companies specialize in order to differentiate themselves, while 58 percent of medium-sized businesses do. As might be expected, large billing companies tend to diversify across a wider range of medical specialties, responding to the rapid growth (11 percent since 2012) in multi-specialty medical practices.

Billing companies are also becoming specialists in patient collections because of the significant increase in high deductible insurance plans – the average deductible for employer-based plans reached nearly $1,500 in 2018 and the average deductible for individual A?ordable Care Act (ACA) Bronze plans was more than $5,800 in 2018. Of those surveyed, patient balances account for an average of 23 percent of total collections.

Significantly, billing companies have found an important path to growth in value-added services. Despite the rapid growth of healthcare technology solutions, many smaller practices are still slow to adopt new technology. Billing companies serving small, independent practices have the opportunity to recommend technology to help them improve efficiency, stay competitive in the healthcare delivery marketplace, and run a more profitable practice. Helping medical practices implement and leverage technology is something that 75 percent of billing companies report doing today, with the adoption of integrated EHR and billing software the top area of focus.

With the establishment of value-based payment models that tie reimbursement to the documentation of quality care, many billing companies are seeing the importance of having their clients use a certified EHR that is integrated into their billing platform. The current replacement rate for EHRs is estimated to be as high as 50 percent in the United States, presenting significant opportunity for billing companies to advise on replacement options that will streamline their revenue cycle management process. The survey shows 86 percent of high-growth billing companies are statistically more likely to recommend an EHR solution to their clients that integrates with their billing software/practice management solution.

The Kareo survey points to an interesting chain – the future of American healthcare depends on independent practices. The success of independent practices moving forward depends on technology. And the recent Kareo survey shows that adoption of technology by independent practices depends, to a great extent, on their billing companies.

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Preventing Medical Billing Cash Flow From Becoming A Flat Line

By Ethan White, MDVision.

From last few years, there have been significant modifications in the rules in addition to guidelines that medical coding and billing firms must achieve. The medical billing vendor that is fully compliant in all under HIPAA are authoritatively business associates of most ideal healthcare clients. This means they never reveal private information, take substantial deterrents with client data, and shield the uprightness of the client.

But another utmost and instantaneous requirement is to influence the company’s profits as to make certain you file the medical claims as rapidly and swiftly as possible. For this determination, you can farm out the situation to a medical billing vendor as they promise to adhere to a strict round-the-clock turnaround for medical claim filing. Also, they have the real strength and aptitude to make available the flexible times for patient queries from outpatient ambulatory surgery centers to large hospitals.

Nonetheless to share your medical billing success story across healthcare landscape, some essentials should be think through in accordance of what’s being said, demonstrated and delivered at any stage:

Medical Bill Repricing Solutions

It is for this reason, the top medical billing vendor companies are certainly in a successful partnership attitude that lay emphasis on prompt, practical and a patron-centric billing approach. The objective ought to provide excellence attention to injured worker’s compensation claims and effectual charge clarifications. It always starts by real-time bill review besides fake finding for self-insured houses, third-party administrators in addition to insurance companies. Such practices prevent excessive payments and endorse an equitable repricing level for reimbursement.

Non-Network Negotiation

The non-network negotiations possibly will continue to establish the average for fair and reasonable reimbursement aimed at medical billing claims. But getting the substantial discounts on non-network claims and to regulate 100 percent in excess of provider sign-off to ease the risk is always an ideal method used by medical billing vendors. The supplementary healthcare cost suppression approach can be used for any other reporting type in delivering fair and equitable money to the paymaster and reasonable payment to the provider as well.

Fragmentation into coordination

An outsourced medical billing claim service means that you have a complete squad of professionals who make sure that your entitlements get treated swiftly and precisely, sendoff your practice minus at risk to interruptions in cash-flow. When a physician confidence the chosen billing service company and works self-possessed with billing prerogative team, they develop long-lasting benefits like.

Monitoring and Analytics

Your days in A/R, or revenue cycle period has a noteworthy impression on your bottom line. A medical billing service mete out their overheads transversely the all-inclusive client based on providing an economy of scale, monitoring and analytics. Thought, such medical billing vendors can have the funds to chartering with the best staff potential, so that you pay a smaller amount for the comparable and frequently complex collection percentages. In addition to the uninterrupted fiscal advantage of greater returns as well as decreased costs.

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Quick and Painless: Electronic Medical Billing

Guest post by Kristen Gramigna, chief marketing officer, BluePay.

Kristen Gramigna
Kristen Gramigna

Replacing a hard copy-based billing system with one that is electronic can help your healthcare organization realize the operational efficiencies, cost reduction and expedited accounts receivable rates that are critical to financial stability in healthcare. Here’s a look at the benefits of electronic medical billing, and why making a switch may not be as complicated or costly to your organization as it may seem.

Patient perception is critical to your organization’s survival. Though health care spending is projected to increase by an annual average of 4.4 percent from 2013 to 2017 in America, more insured Americans and an aging population mean that competition for patients is fierce. Patients have a choice when it comes to where they invest their health care dollars. Their brand perception of a health care organization is no less important than their perception of any branded service or packaged good.

In a recent Accenture survey, healthcare CEOs echoed their acknowledgement of this new industry reality: Nearly half of those surveyed ranked patient satisfaction as a top business priority for their organization in the next three years. Though employing reputable medical professionals, offering quality facilities and communicating a memorable brand message are important, the many interactions a patient has with the health care organization (including scheduling, medical care providers and billing departments) all shape their perception, which ultimately impacts the organization’s reputation.

Electronic billing is one simple way to enhance the odds that patients have the positive experience that leads to retention and referral to friends and family. In one study by TransUnion Healthcare, the impact that medical billing has on patient perception in both front-office and back-office functions was made clear. In that study, 85 percent of respondents who had a negative billing experience with a medical provider rated their overall experience with the organization as negative. Conversely, 80 percent who reported a high level of satisfaction with a healthcare provider and/or organization also had a positive billing experience.

Billing inefficiency carries a billion-dollar price tag. If your organization has failed to adopt an electronic billing system because of concerns with the costs and potential risks in implementation, the more important question may be whether it can afford not to leverage electronic billing. In a New York Times op-ed piece, healthcare policy expert Ezekiel J. Emanuel estimated that administration costs in the healthcare industry at large amount to about $360 billion per year; half of those costs are attributed to billing waste, including paper-based record keeping, processing and redundancy associated with paper forms. In one Black Book case study called “Top Physician Practice Management & Revenue Cycle Management: Ambulatory EHR Vendors” conducted among healthcare financial leaders, respondents indicated that the cost of moving to an electronic billing system was quickly offset by its benefits. According to the study findings, 81 percent of respondents were able to realize “basic and intermediate efficiencies” that resulted in a measurable return on investment within six months of implementation; 94 percent said they realized ROI benefits after one year.

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