Why Should You Outsource Your Medical Billing?

Whether or not to outsource your billing can be a tricky decision for medical practices, especially if they are small or mid-sized. This is so because medical billing and medical coding go hand in hand, and unless the billing company you partner with has required knowledge and expertise to identify the correct code, it can commit billing errors that may disrupt your cash flow and wreak havoc on the financial health of your practice.

On the other hand, when done properly and precisely, outsourcing your back-office operations can be a stress and hassle-free process that gives you more time to focus on your core business.

Hiring a medical billing company can be beneficial for you and your practice in many ways, some of which are explained below.

Error-Free Claim Submission:

Specialists at medical billing companies thoroughly check all the necessary data of any patient sent to them and make necessary corrections if any errors are found. They submit the claims only once they are sure that everything is intact and error-free.

Consistent Follow-up of Claims:

Medical billing companies have dedicated specialists to keep up on the submitted claims to make sure that they are getting proper attention from the insurance companies to expedite crucial applications in the least possible time to ensure a fast closure.

It helps the practices prevent their patients from unnecessary waiting time if they need the claims to be settled quickly for bills and treatment. Besides that, these specialists also stay in touch with the patients who have any outstanding payments.

Organized and Efficient Operations:

A component revenue management company can effectively and efficiently manage various aspects of your clinical operations, including billing and coding, revenue report generation, payment tracking, and financial report crafting. Streamlined processes also significantly improve communication throughout your office and boost the morale of your employees.

Qualified and Dedicated Workforce:

By partnering with a trusted billing service provider, you don’t have to go through the cumbersome process of recruiting and training medical billers as you have a skilled and dedicated workforce on your side to manage your operations.

Medical billers harness their expertise to maintain and improve the financial status of your practice, which ultimately leads to higher profits.

Fast Claim Processing:

Automating routine administrative can make your practice more efficient and productive.

Unlike typical paper-based claims, which may take several weeks to move through various channels before you get reimbursement, automotive claims are submitted on the same day, thereby greatly strengthening your cash flow.

Expediting a claim that is optimized for maximum reimbursement and has EHR-support improves the probability of full payment in seven to fourteen days.

Designated individual Account Executive:

Many medical billing companies dedicate designated account executives to their clients, assuring you peace of mind that you are dealing with someone very familiar with the processes of your company and to whom you don’t have to explain and brief the training and requirements of your business.

Additionally, since both parties are familiar with the way they do the business, the probability of a misunderstanding between them is minimal.

Keeping Track of Changing Regulations:

Keeping tabs on the ever-changing rules of the healthcare industry can be a daunting task. Fortunately, you can avoid breaking your head on the job by outsourcing your processes to a billing company. Professional medical billers have expertise and resources to figure out how new rules should be applied in compliance with laws and guidelines that keep changing periodically.

Reduced Labor Costs:

Studies show that billing processes eat up around 30 to 40 percent of the billing revenues of a practice. Outsourcing your billing processes can help to save on the costs that you otherwise would have to incur on hiring an in-house billing staff, training the employees, and acquainting an extra space to accommodate them.

No Capital Investment

By outsourcing your billing operations, you don’t have to invest in billing software and the latest equipment. You can also save the money that you would have to spend otherwise on maintaining and updating software and hardware. In this way, you can set up your business without any initial capital investment.

More Time for Patients

By handing your insurance claims processes, follow-ups, and administrative tasks to a third party, you can focus on core competencies like quality patient care, which in turn will greatly increase patient satisfaction level and enhance the reputation of your practice.

Conclusion:

In today’s constantly evolving healthcare environment, it is advisable to outsource your back-office operations to minimize your operating expenses and improve your revenue cycle management.

People at billing companies are industry specialists whose core job is to ensure billing is done properly and in line with up-to-date medical codes to guarantee increased reimbursements that ensure higher revenues and profits and make a practice thrive.

Seven Popular Healthcare Provider Fraud Schemes

Healthcare fraud has skyrocketed in the United States over the last decade, with billions of dollars being paid on false or improper claims every year. 

It is estimated that the economic cost of fraud related to this industry in the country is three percent to ten percent of all its overall spending of $2.6 trillion.  

There are countless ways fraudsters can defraud the system to generate illegal profits. While many of these frauds occur unintentionally as the result of poor billing practices, many others are intentionally committed by dishonest individuals, small and medium-sized healthcare practices and large healthcare organizations for illegitimate reasons.

Types of Healthcare Frauds:

Following are some of the most common healthcare frauds. 

1. Misrepresenting the Type of Treatment  

It is one of the most common medical billing frauds that isn’t easy to detect. In this practice, a healthcare provider assigns a diagnostic code for a more severe condition than the one the patient actually has. For example, if a patient has come into the hospital to receive treatment for a sprained ankle, the healthcare provider may submit the bill to the insurance company for a broken ankle.

This practice increases the revenue of the practice because they get more money for serious conditions from the insurance providers.

2.     Misrepresenting Dates of Service

Since insurance providers usually consider each office visit as a separately billable service, healthcare providers might take unfair advantage of it by misrepresenting the date of the service that they provided to a patient to make more money. For example, they may report that they visited or treated the same patient on different days rather than one.

Most often, the healthcare providers list correct information about the services they provide to a patient on the claim forms; however, the dates are false because it is more profitable for them.

3.     Duplicate Billing

Though most of the healthcare practices use electronic billing software now a day for managing their billing processes, duplicate billing yet remains to be a big problem. As insurance companies manage heavy caseloads from so many business providers, it is a daunting task for the practices to identify all cases of duplication.

4.     Overutilization of Services

Since healthcare providers are paid more to do more, they may provide treatments, services, or drugs that are not really necessary for the patient. Unfortunately, hypochondriac and elderly patients become easy prey for unscrupulous doctors for this type of fraud.

Alcohol/Drug rehabilitation centers are ripe for this fraud.

5.     Billing for Fictitious Services

In this type of medical billing scheme, a practice bills for the services that were not actually provided. The patients involved in the scheme can be real or fake. Practices may either steal or purchase the personal information of real people to create fake patients, falsely list them as patients and bill for fictitious services rendered to them.

6.     Billing for Non-Covered Services/Items

Non-covered services and items are not reimbursable by the private insurance providers and the government. Medical practices often fraudulently label non-covered services and items as covered items in a bid to obtain reimbursement for covered services/items.

7. Waiving of Deductibles 

Most often, the medical practices and facilities are not allowed by the governments and insurance providers to waive the deductibles or copayments of their patients. The reason behind it may be that if the patients have to pay something from their pocket to see a doctor, they will only seek care when really necessary.  

Unscrupulous practices often waive deductibles or payments of the patients and then submit other false claims to insurance providers to make a difference in dollars. They may also add fictitious services to the claim form to maximize their illegal profit, and as they know that the patients are unlikely to complain when the out-of-pocket expense is really low or non-existent.  

Conclusion: 

All the healthcare frauds listed above are dangerous. Unfortunately, most of these fraudulent activities are committed by a handful of dishonest care practices that don’t have the best interest of their patients in mind. 

In response to increasing acts of healthcare fraud, several federal agencies, including the FBI, FDA, and EDA have joined hands to combat and reduce the threat of healthcare fraud in recent years. They are working with local and state agencies and private insurance providers to crack down on fraudulent practices. 

However, despite their efforts, healthcare fraud remains a big threat to the country’s economy and the patients individually. 

Medical practices need to put in place effective measures and processes to detect and prevent such fraudulent activities to avoid investigations that may not only cost them their reputation and revenue but also lead them to civil suits and criminal charges.

Precision7, Your Trusted Medical Billing and Coding Experts

Precision7 is a medical billing outsourcing company in New York that offers comprehensive and fully-integrated revenue cycle management solutions to help the medical practices cut down their expenses, maximize their revenue, reduce claim denial rate, and improve their productivity and efficiency.

We provide end-to-end medical billing management to the practices including patient pre-authorization, eligibility & benefits verification, claims submission, payment posting, denial management, AR follow-up, and reporting.

6 Things to Keep in Mind When Choosing a Medical Billing Company

Outsourcing medical billing and coding is a smart choice for many healthcare practices to enhance their performance and productivity, reduce operational costs, make their operations more organized and efficient, improve their cash flow and increase their profits.

However, for that to happen, it is immensely important to find an experienced and competent billing partner. Making the right choice will provide you with ease of mind and significantly boost your chances of achieving your bottom-line goals.

With countless options from around the world, choosing a company that is capable of competently handling billing processes has always been a challenge for the practices.

Here are some important things to keep in mind to choose a billing company that will care for the financial health of your practice, just like you care for your patient’s health.

1. Experience in Your Specialty:

Different medical specialties have their unique billing and coding requirements. Whether you specialize in nephrology, gynecology, pediatrics, or pain management, you need to find a billing company that has expertise and experience in managing your type of practice. Such a company will possess a better knowledge of the billing and coding challenges related to your specialty.

Hiring a company that does not have any prior experience and expertise in your specialty can commit coding mistakes, which in turn can lead to claim denials and will hurt your bottom line.

2. Support throughout Entire Revenue Cycle Management

Your medical billing service provider should be there throughout the billing cycle, right from the appointment of the patient to the reimbursement of claims. Therefore, make sure that the company you choose can excel at each aspect of the revenue cycle management, including patient enrollment, insurance enrollment, charge entry, system-based insurance eligibility, claims submission, payment posting, AR follow up and denial analysis.

3. Transparency:

Transparency is another crucial aspect to take into account when choosing a medical billing company. Delays in claim generation and irregular are some of the common problems that healthcare providers face by outsourcing their billing processes. Once you partner with a billing provider, you will have to rely on it to maintain the financial health of your practice.

Therefore, it is important to assess the reputation and transparency practices of your prospective billing service provider before settling matters. Speak to some of the past or present clients of the company and ask them whether they were satisfied with its operational transparency.

To make sure that your billing process is completely transparent, look for a company that provides cloud-based services.

A cloud-based billing system allows you to keep tabs on the complete financial data of your practice and let you check submitted claims, denied claims as well as the summary of charges and payments in real-time. This gives you peace of mind that your billing tasks are being carried out with utmost transparency.

3. Data Security

Since you will be entrusting private data of your patients to the billing company you partner with, it is important to ask them about their security system and processes to ensure that it is safe. Therefore, make sure that the processes of your prospective billing compare in line with HIPPA specifications.

Some billing service providers use rules-based software, built using artificial intelligence (AI), to check claims before filing. It is updated continuously based on its claim-filing experience with different insurance providers.

The use of AI also significantly reduces the claim denials and helps you to get the payment the first time around and prevent any unforeseen revenue loss.

5. Qualified Professionals

The medical billing company you partner with should have expert professionals. They should stay on top of the latest coding techniques to minimize the probability of claim denials and enhance reimbursement.

6. Responsiveness and Customer Support

Speed and availability are two critical factors to take into account when choosing a medical billing company. It is important because you may face an issue any time and your vendor should be able to offer quick response and fast customer support whenever you need it.

Therefore, make sure that your prospective medical billing company has capabilities to quickly respond to any concerns so that you can continuously make revenue and prevent your patients from being inconvenient.

Conclusion:

Outsourcing your billing processes is one of the most significant practices in management decisions. You need to find a company that suits the need of your practice.

Make sure that the company you pick is compatible with your business model and is available to help you throughout the entire revenue cycle management to avoid issues at a later date.

The key to a successful and long-lasting relationship between you and your billing company is seamless coordination.

The above tips will help you choose the right company that will help you achieve your bottom-line objectives.

Make sure that the company you pick is compatible with your business model and is available to help you throughout the entire revenue cycle management to avoid issues at a later date. Precision7 Inc . is an accurate, reliable Medical Billing and collection solution for your practice.

Four Strategies for Improved Denials Management

Managing claim denials is important for the ongoing success of healthcare organizations. Establishing an effective denial management process can significantly increase your revenue cycle and reduce your number of future denials. In 2012 National Health Insurer Report Card exposes that insurers deny up to 5% of claims on the first compliance. Even the best-performing medical practices have denials of 5%, according to the 2012 Performance and Practices of Effective Medical Groups report.  To avoid losing money on the table, you are required taking steps to improve your medical billing process and reduce your denials.

Follow these four strategies to denial management—identify, manage, monitor and avoid.

Retain your Denial Management Process

Losing track of denied claims is like leaving money from your back pocket. Once, it's frustrating. But as it keeps happening, you'll have a serious problem on your hands, as those denied claims have a method of piling up over time. If you don't have an organized system in place to retain track of your denials, you won't even know when they're missing in the first place.

Determine Patient Eligibility

Train your staff to gather pertinent info about every patient’s health insurance coverage and benefits eligibility. They need to remember to ask the patient about variations in insurance coverage, too. Your practice management system should have the ability to verify eligibility and advantages.

Reduce Coding Errors

Coding errors will likely lead to more denials. Take positive steps to reduce coding errors. Identify services usually provided by your practice, and then seek expert advice on how to code those services. Train your doctors how to document properly and select the correct codes. Use info technology (i.e., code correct software) to confirm the accuracy of the codes, either when the codes are selected.

Determine Medical Necessity

To avoid this frustrating condition, use software that edits charges for coverage determinations. Gather policies regarding medical need from all your insurers. Set your Electronic Health Record to alert you about services that have been deemed not medically essential or that have special requirements for establishing medical need. To appeal denials based on medical need, submit detailed documentation about the patient’s visit, as well as any current medical literature supporting the efficacy of the facility. Contact us to reduce your medical claim denials and thereby increase your income.

Are you interested in improving the denials management for your medical billing and coding practices? Try Precision7 for improving your ROI.

Processing a Medical Billing Claim

Healthcare system in the United States is a trillion-dollar industry, which consists of pharmacies, pharmaceutical companies, medical equipment manufacturers, and medical care services. Millions of Americans, running on a day-to-day basis relies on specialized professionals tasked with controlling these processes. One such system is the medical claims procedure. The processing of a medical billing claim can look like a long and difficult project; however, we are here to break it down into a simple and easy to understand some steps.

First Step:

The first step of the procedure begins with the patient. When the patient arrives at the provider’s office they will require to hand their insurance card over and then complete the doctor’s demographic form. It is essential that all their details are filled in correctly as the demographic form contains pertinent info regarding Social Security or driver’s license details; the name of the actual policy holder as well as any extra and essential information about the policyholder if they differ from the patient; and other basic info such as patient name, age, address and contact details. 

Second Step:

When the demographic form is complete – as well as any other essential paperwork – the patient then sees the specialist and the services required are administered. It is during this procedure that the doctor must record all the various billable services that they rendered to the patient. 

Third Step:

Once the provider has detailed all the billable services they administered the details are passed on to the coder who must then extract the applicable billable codes that will properly reflect the services rendered. 

Four Step:

Another step in the process is sending the billable codes to the medical biller. It is at this point that the codes are inserted into the appropriate medical claim form provided by the medical billing software. Once the codes are put into software, the claim is then mailed for payer reimbursement to what is well-known as a clearinghouse or even directly to the payer. 

Get more information on affordable medical billing services and latest information in medical billing industry at Precision7/.

Malware, Billing Company Theft Equal Health Data Breaches

What is malware? 

It is an umbrella term used to refer to a variety of types of hostile or intrusive software, including computer viruses, worms, trojan horses and other malicious programs. Malware can take the form of executable code, scripts, active content, and other software. 

Medical identity theft occurs when somebody steals your personal information such as date of birth, Social Security Number, health insurance ID. Anything from malware to sophisticated cyber attacks to theft laptops can lead to PHI being compromised. Workers need to be properly trained in healthcare data security measures, and facilities have to make necessary business associate agreements. It will assist put covered entities on the way to work toward prevention and to recover an incident. 

• Malware points out 981 patients’ information at threat 

Cleveland’s MetroHealth System has announced it has suffered a PHI breach after malware was discovered on three of its computers. 981 medical reports of patients who received cardiac catheterizations were potentially compromised in the risk. 

Cleveland’s MetroHealth System, a county-operated non-profit healthcare provider based in Cleveland, Ohio, discovered on July 14, 2014, to March 21, 2015, that malware had infected three Cardiac Cath Lab computers. The malicious software was removed the following day on March, 21.

Cleveland’s MetroHealth initiated an immediate investigation into the malware infection and potential records breach to determine how the software had been installed, the extent to which records had been compromised, the patients who had been affected and whether any records had actually been viewed or copied. While the malware was firstly thought to have been successfully removed, the forensic research revealed the highly sophisticated nature of the software. Some days into the research, it was open that in addition to the malware, a back door had been created allowing the maker of the software full access to the affected machines. That back door remained to unlock until March 21, after three days the malware was removed.  

• Medical billing company theft leads to potential health data breach 

A Medical Management Limited Liability Company worker, who no longer works for the company, copied certain items of personal info from the billing system over the past three years and then illegally disclosed that info to a third party, according to a UPMC report. Potentially compromised information consists of names, dates of birth and Social Security numbers. However, UPMC said there is no proof that information about medical histories or cures was disclosed.

University of Pittsburgh Medical Center has been informed by law enforcement authorities based on their ongoing research that more employee information was stolen than they originally knew, Gloria Kreps, a University of Pittsburgh Medical Center spokeswoman, composed in an email to the Pittsburgh Post-Gazette. This latest information has indicated that worker names, Social Security numbers, details, salaries, bank account numbers and bank routing numbers may have been accessed.

Get more information on medical billing and coding or interested in outsourcing medical billing practices, Precision7 is the perfect choice.