Health Insurers Need to Work With Physicians To Reduce Administrative Costs

Apr 18, 2011

Delays in physician payments by health insurers add to the cost of healthcare. These delays can affect patient care as medical office staff spends time and effort managing administrative obstacles set by insurers. Payment delays can be limited by the creation of standard claim submission processes, and improved claim automation and integration.

The financial impact of payment delays to medical offices and medical billing service companies by insurers may improve as a result of recent proposals aimed at automating healthcare practices and administration through economic incentives provided by the federal government.

Wide variations in policies and procedures related to the submission of claims and payments by insurers, creates systematic confusion lending to inefficiencies in the system and higher costs for medical offices and physician billing services. Standardized policies and procedures would streamline claims submission and greatly benefit the system as a whole by reducing administrative red tape and healthcare costs, ultimately improving patient care.

Improved technology integration between the physician office and claims processing that truly automates work flows and prevents duplication of labor between the physician office, medical billing service and the health insurer’s claims adjudication process should be included in healthcare stimulus programs.

Additional healthcare savings could be provided with Health insurers staffing levels required to provide adequate staff to promptly provide claim assistance, follow up and feedback to physician offices. Healthcare facilities have a requirement to maintain adequate staffing to provide service to patients.

Provider manuals with up to date policies and procedures should be available from the health insurer. Provider manuals available online at the insurers’ website could be extremely helpful and a cost effective way of assuring information is always up to date for the physicians’ office.

Selecting the Right Medical Billing Service – A Process Cheat Sheet

Apr 11, 2011

Choosing the right Medical Billing Company from all the Medical Billing providers available is one of the most crucial business decisions a physician, practice manager or facility administrator must make. In practice, with over 7,000 Medical Billing Companies in the US, the decision making process can be rather difficult. Therefore a number of factors are important to consider:

  1. Experience: Spend time analyzing the company website for information on processes, track record and scope of the organization.
  2. Data Protection: Bills submitted by a reliable medical billing company should have full audit trial without a delete option. This will protect data in the submitted bill and reduce the possibility of fraud or mismanagement.
  3. Performance and Service: All medical billing companies claim to provide higher reimbursement levels and shorter lead times on reimbursement. Select a company that highlights an institutionalized process model. Additionally select a company that manages the billing process from A to Z. Companies responsible for the entire process chain are generally more accountable than companies that only handle one aspect of the billing process. The process includes, Data entry and submission (The importance of a fast and accurate process management cannot be overestimated; a good service provider will submit the bills within 48 hours of receiving claims), Payment Posting, Patient Billing, and Denial Follow-up.
  4. Location: In today’s global economy the possibility of providing medical billing services on a cross boarder basis is now a reality. While many overseas companies are more than adequate to perform the task, keep in mind that your patient population will frequently interact with your medical billing company.
  5. Reporting: Select a medical billing company that provides frequent reports to help track both practice and the billing company’s performance. Ideally select a company that provides internet access to their practice management system. This live interface will help you monitor the how the company is working for you in real time.

Based on these ‘must haves’, the following list provides a good process template for running your search process. Remember hiring a medical billing company is no different than hiring an employee or any other service provider. The same attention to process and detail should be given.

  • Shortlist: Create a shortlist of possible Medical Billing Companies. Given the number of medical billing companies in the US, finding candidates won’t be an issue; start with 5 to 10 candidates based on the high-level criteria listed above.
  • Criteria List: Develop a criteria list that defines your key concerns and primary issues which have caused you to seek third party services; identify your needs, wants and have not’s.
  • Interview: Contact and interview the Medical Billing Companies on your list. Use your needs and have not criteria to refine your short list to a handful of companies. Ask for a reference list and take time to thoroughly check all references.
  • Negotiate: Review Contracts and negotiate deal terms with your top selection. Key terms include contract duration, termination triggers and procedures, services you may desire that are not part of the core price, and mutually agreed performance standards (average days in AR etc.), as well as price. Keep in mind that price should not be your defining decision maker. A good company charging a higher percentage is always better than a poor company charging a lower percentage.

Medicare Advantage Disenrollment Period – Until 14th February Instead of 31st March

Apr 10, 2011

According to Medicare.gov, recipients currently electing Medicare Advantage Plan, who wish to change, must do so by February 14th. The Medicare Advantage Disenrollment Period runs from 1st January, 2011 until 14th February, 2011 instead of 31st March. According to Medicare, the change in deadline was intended to create one clear enrollment period.

Plan recipients need to be aware that dropping a plan automatically means opting into government-run Medicare. Seniors are no longer granted the possibility of changing to another Medicare Advantage plan. In previous year’s participants were given additional time to evaluate a chosen plan and switch between plans at any time. Now members will have only one option – Original Medicare that offers fewer benefits than many Medicare Advantage plans. Recipients need to estimate their new drug plan costs, otherwise if the relative savings are not larger than the new plan’s monthly premium; they’ll end up spending more.

Prior to dropping the Medicare Advantage plan, participants must ensure that the coverage considered includes all neccessary benefits. Medicare Advantage often covers a share of doctor visits, as well as eye check-ups and other services. It is also important to ensure that physicians accept the new coverage. As for Original Medicare, it has cost-sharing requirements and other benefit gaps. Therefore some people, enrolling in Original Medicare acquire supplemental policies called Medigap. Medigap policy can be purchased from a private company with costs varying by policy and company. Employers/unions may offer similar coverage.

Original Medicare coverage and any Medicare drug coverage that is selected at this time will start the first day of the month after the recipient disenrolls. If participants switch to Original Medicare and their Medicare Advantage Plan included drug coverage, they have until 14th February to join a Medicare Prescription Drug Plan as well.

Medical Billing – Physicians Options

Mar 28, 2011

It’s no secret that the healthcare is inundated with paperwork. Many medical professionals claim they spend more time filling out forms than actually treating patients. A large portion of the endless pile of paperwork is related to coding, submitting and processing medical claims related to physician or medical billing.

With no end in sight to the volume of paperwork associated with managing a medical practice, more and more practices are outsourcing their billing function to third party companies. In this article we take a closer look at medical billing in general, issues related to medical billing and the types of service providers offering medical billing as a third party service.

Services and purposes

Generally speaking, medical billing is the process of facilitating payment from patients and insurance carriers on behalf of healthcare providers. More specifically, medical billing refers to the process of submitting medical claims to medical insurance carriers and patients in order for healthcare providers, to receive payment for services rendered. In addition to submitting claims for payment, medical billing includes the service of following-up on denied or non-adjudicated medical claims in order to rectify payment errors or total lack of payment.

Issues

One of the most common problems that healthcare facilities face related to physician billing is payment collection. Payment collection has historically been an issue for healthcare providers resulting from a complex system of rules, regulations and participants. Payment collection issues range from inaccurate coding or untimely submission on behalf of the physician’s office to patient population demographics and insurance carrier policies, procedures and practices. The overall result is a complex and inefficient system that frequently results in rejections, denials and underpayments of up to 50%.

Many medical offices are ill-equipped to manage the arduous task of billing and as is such turn to medical billing service providers for assistance.

Service Providers

There are over 7000 medical billing service providers in America, and as is such the sophistication and organizational structure of these businesses varies greatly. In general however, medical billing service providers can be categorized into 2 distinct groups; Home businesses and Practice Management companies.

Home business medical billing companies are typically small organizations with 1-2 employees. Many proprietors of these types of organizations received training and have past experience working in medical practices. These companies service between 1 and 3 clients and essentially act as an extension of the medical practice for which they provide billing services. The primary advantage of working with a home based biller is the high level of customer service they often provide. This however is highly correlated to the individual proprietor and not indicative of the group as a whole. The primary disadvantages to home based billers are the difficulties in servicing multiple clients simultaneously, limited knowledge base, and access to technology.

Practice management companies are generally larger institutions with between 10 and over a hundred employees. Practice management companies typically employ institutionalized processes to manage all aspects of medical billing. In addition to medical billing, practice management companies often provide additional value added services such as scheduling, coding, credentialing assistance and third party application interfacing. Practice management companies benefit from economies of scale that allow for high levels of technology and knowledge that can be distributed more easily across their client base. In addition, practice management generally have the ability to rapidly add and service new and multiple clients given the size and scope of their organizations.

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