Category Archives: Medical Billing

How Streamlining the Medical Billing Cycle Maximizes Revenue

The medical billing cycle starts as early as the patients register with a provider and demographic details and insurance plan information are entered. Then it moves to eligibility process, entering billing codes for the services, payment follow-ups and posting the payment details.

Medical Billing Revenue Cycle

However, critical leaks coming in the way of this billing cycle can severely affect the revenue of the providers. To complete this billing cycle productively, it is important to scrutinize all the stages, identification of gaps and leaks, setting up of revenue goals and deciding a strategy to achieve it.

Here are a few steps to streamline the medical billing cycle:

Review the current workflow

Before starting to restructure the billing workflow, evaluate current work practices, only then it’s possible to identify loopholes in the system. Gauge the competency of the billing staff and their understanding of the recent updates in coding and billing. Analyze the supporting IT infrastructure and software tools and look for required upgrades.

Identify the revenue leaks

Payment denials and poor follow-ups can be classified as the two major reasons for revenue loss. Calculate clean claims and denied claims ratio, dig deeper and bring out the reasons for payment denials. Similarly, jot down clearly the major causes of payment denials and what can be done to avert the objections from the payers.

Integrate billing processes and automate

Integrated practice management system or electronic medical record system combined with computer based coding and billing tools bring accuracy to the processes. Patients’ health records available at a centralized database provide better context to billing staff. To expedite the billing process, automation of the system is a must.

Managing billing resources

The staff responsible for billing should be trained and proficient in the latest changes and upgrades. For instance, any changes in HIPAA electronic transaction standards or upgrade in coding version could cause disruption in the payment process. Therefore, make sure that the system and the staff are up-to-date.

Improvements in the backend billing processes

Accurate coding and submission of clean claims to the insurance carrier covers only half of the billing cycle. The current billing system requires a consistent two-way flow of communication between the provider and the payer. The payment capture, A/R follow-ups, posting payments received, providing the required documents and appealing of denied claims are some of the back end billing chores, fine-tuning which bring positive results.

Reporting gross revenue

“If you can’t measure it, you can’t manage it”, said a management consultant. It is important to set achievable performance indicators, plan a strategy and then compile weekly, monthly or annual performance reports. If these reports are supported by statistical comparisons from the previous financial reports and elaborated in graphs and charts, it helps to analyze and identify glitches in the cycle.

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Medical coding and billing tweaks for Revenue Cycle Optimization

In the current health care system, it has become very important for the physician practices to ensure smooth and timely returns for the services they provided and it is an obvious fact that more than anyone else providers are themselves in charge for the efficient reimbursements.

There are multiple reasons that can bring down the revenues of a physician practice, for instance, payment denials by the insurance carrier due to objections on documentation or on the wrong billing codes. There might be patient eligibility objections or the payers not responding due to a weak payment follow up mechanism.

In the expert opinion of SequelMed billing professionals, there are a few areas of practice, optimizing which can contribute to an increase in the revenues.

Switch to an electronic coding and billing system

A computer assisted coding and billing system is one simple but most effective way to optimize revenues of a medical practice. It expedites the billing process through an increased efficiency in entering the billing codes, compiling billing documents and sending for payments. It is better to use a billing system that is bundled with a practice management application or an EMR/EHR system. In that case, supporting details for billing become accessible and available at one centralized location and provide a comprehensive view of patients’ health records which help in taking better billing decisions.

Take patient eligibility in advance

Getting a patient’s eligibility provides a comprehensive view of the type of insurance plan, details of coverage, dates, copays etc. Taking a patient’s eligibility details makes the case obvious that what medical services can be offered to patients and what is their financial responsibility.

Use online billing and payment portals

Online payment solutions are quite helpful in getting paid within 30 days. It facilitates the patients to pay through electronic payment solutions. Sending bills, reminders, managing copays and payment follow-ups are handy tools of getting paid through online payment portals.

Complete billing documents

Majority of the physician payments are denied because of incomplete billing documents. It is vital to complete patient health records, such as, progress notes with comprehensive details about preexisting conditions and proving necessity to perform a medical procedure which would support billing documents. Staff responsible for patient registration, lab, medication, etc. should fill in every bit of patient health information for accurate coding, billing and payment claims.

Update your billing system to latest regulations and standards

Keep on checking randomly that your billing system has been updated to latest regulatory changes and check that all transactions are HIPAA compliant.

Efficient Payment follow-ups

A continuous two-way communication between the payer and payment claimant is a must to close the loop of a proper payment follow-up. A payment denied should not send the claim in limbo rather denial management should follow-up. Monitor claims that are denied, underpaid or getting no responses, flag them and communicate with the payer for a fix to the problem.

Explore SequelMed’s feature-rich electronic medical billing services for billing companies and healthcare providers.

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Adding More to the Medical Billing and Coding Tips Sheet

Medical billing and coding has always remained an area of interest for us as a healthcare IT solution provider for billing companies and physician practices. Lately, we have discussed on this blog the ways to improve billing and coding practices and how ANSI 5010 compliance is changing face of medical billing.

On the hunt for finding better ways to achieve accuracy in the medical billing and coding process, we came across a valuable piece of advising on the topic, extended by Susan Kreimer at The Hospitalist.

The highlights of the tips on improving billing and coding practices are:

Document elaborately: every aspect of a patient’s health history

Thoroughly document patients personal and medical information on initial visit. Do no skip sections like family history and history of present illness. Enter into the electronic medical record system the review f systems and the chief complaint.

Jot down social history of the patients in progress notes

Ask your patients about their lifestyle. For instance, if their smoking status, eating preferences, alcohol and drug use. In some cases, the information about educational level and occupation can serve as supporting details.

Provide specific details about the diagnosis and the procedures performed

A disease cannot be classified accurately until the notes entered by the physician provide specific details of the problem. For example, diabetes can be type 1 or type 2, medical coders have to specify accurately the exact classification of disease. Moreover, each and every detail of medical procedures performed should be thoroughly documented along with the reasons providing explanations about the lab tests requested.

Take services of professional coders

In most of the cases, it has been observed that physicians leave clinical documents unfinished, either because they leave it for a later time to complete or during busy work hours they simply shift to next slot without properly closing the previous one. In this scenario, it is advised to take the services of a professional billing company or an individual who can complete the job for you. It is beneficial in many ways, for instance, it would bring in the expertise of a billing and coding professional who got years of experience in the field and is qualified for the job. Moreover, it would give a third person review to your documents and data entry practices.

Add personal notes and details to the health records of the patients referred

In the current health system, the cases of patient referrals are increasing. In this scenario, do not simply copy-paste the health records received from the previous provider, rather add a personal review to the patient notes again. Moreover, if the patient is internally transferred from one medical facility to another, there is a possibility of sending duplicate bills. To counter this scenario, make sure that all the procedures performed are billed combined.

Although, the automation of medical billing and coding achieved through electronic medical record (EMR) systems have improved the accuracy and has significantly decreased the occurrence of reimbursement denials. The medical billing and coding still needs the expert human input to successfully get paid for your services.

Hurricane Sandy aftermath – EMR and external injuries

As stories from the victims of hurricane Sandy have continued to surge, the most heart touching narrative came from the fabulous Dr. Sanjay Gupta who described the account of saving 13 days old baby girl Emma (a premature on ventilator) who had to be evacuated from NYU Medical Center because of the power outage. There were about 20 babies in neonatal intensive care when New York University Langone Medical Center lost generator power at the height of Sandy’s fury. On that harrowing night, baby girl Emma was miraculously saved by the care staff who hand-pumped air into her lungs and transported her 70 blocks away to The Mount Sinai Hospital.

The rescue of patients has not only portrayed the worst-case scenario for medical service providers, but also provided the picture of positive outcomes with coordinated efforts.

In the wake of hurricane Sandy, there are estimations of around $30 billion losses in property destruction, home damages, cars and to businesses and about $20 billion from suspended economic activity, according to Moody’s Analytics. But the numbers would fail to gauge the estimation of human sufferings, injuries and fatalities. Only one number corresponds to the disaster i.e. E908.0, the medical code denoting external injuries caused by the hurricane.

Hurricane related external injuries can be of varied types. Patients injured in hurricane Sandy could arrive at a medical facility after drowning due to storm surge, inflicted with head and skull injuries caused by flying debris, patients hit by a falling tree or out of control car, electrocutions, burn injuries, fall injuries and traumatic brain stress.

Dealing with these emergency conditions is very demanding and difficult for the physicians, nursing and paramedical staff. Physician specialties deal a limited range of medical conditions in their daily routines. In using an electronic medical record (EMR) system, they become well-versed in handling patients with the most common ailments, entering their diagnosis and care plan in the EMR system. However, treating hurricane victims can be a bit different. For instance, The External Causes of Injury have different codes ranging from E000 to E999 in the ICD-9-CM which are commonly known as E-codes.

It is very important to add E-codes in the EMR system along with other ICD-9 diagnosis codes while treating the patients with hurricane related injuries. It tells a patient’s carrier how the injury occurred and what follow-up was required. It would legitimate the services rendered and would ensure the reimbursements. EMR systems running on ICD-10-CM coding would find the hurricane code as X37.42XA .

Medical centers and physician practices in New York city which are powered by SequelMed EMR and EHR systems have been tested useful in these extreme conditions. This has further fortified our commitment to provide the most trustworthy health IT solutions and support. Visit ICD-9 data webpage for detailed view and classification of the external causes of injuries.

Clinical documentation, EMR and Medical billing

Complete and accurate clinical documentation can guarantee maximum reimbursements to healthcare service providers. Prior to electronic medical record (EMR) systems, clinical documentation was fallible due to many reasons, such as, incomplete information, wrong billing codes, unauthorized or wrong procedure quoted etc. However, the integration of clinical documentation and medical billing on EMR applications has streamlined it to a near perfection.

Completeness of data entered

Thanks to computerized physician order entry (CPOE) system that runs now as part of EMR applications. The system has significantly decreased the errors related to bad handwriting and it checks for incorrect and incomplete entries. EMR systems are capable of alerting the data entry operator if a field is left blank by mistake which is pertinent information. With that capability, errors and omissions are avoided at the very beginning. Clinical documentation on EMRs, comprehensively cover patient’s data, such as, personal information, reason for encounter, history of disease, etc., followed by diagnostic test results assessment and plan for care.

Accurate CPT/ICD coding

To claim a medical bill, physicians are required to encode in numbers the procedures followed for diagnosis and treatment of patients and ICD codes for the disease identification. Until now, it was difficult to transcribe accurate CPT/ICD codes and usually the task was outsourced to professional medical billing companies. The EMR systems have automated this coding process which not only contributes to cost savings, but also brings precision to clinical documentation. This consistency in data ultimately ensures settlements without objections by the payers.

Editable electronic copies of medical records

Clinical documents managed through an EMR system are easier to access and edit unlike health records on papers. Correcting a mistake on paper would involve many legal complicacies and adding new information or editing existing was impossible. EMR systems have provided flexibility to documentation handling; one can always edit or amend health records and can send it electronically in HL7 Clinical Document Architecture (CDA) standard format.

Accuracy in clinical documentation achieved through EMR systems has fine-tuned the medical coding and billing process. Alongside, it has alleviated standards of clinical care, bettered data flow across healthcare service providers and improved reimbursements.