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When to Hire a Medical Practice Consultant

Jose Carreras - Wednesday, October 18, 2017

Sometimes, you may find yourself in a situation where you need assistance with your medical practice in terms of solving a particular business problem or figuring out a way to maximize your return on investments. However, you may not want to take on additional employees for these purposes, nor do you want to outsource any work due to the costs and lack of control involved in doing so. In such a case, you should consider hiring a medical practice consultant.

What is a Medical Practice Consultant?

A medical practice consultant is a person or company that can analyze certain problems or situations concerning your medical practice and offer up advice in the form of solutions to those problems or ideas that can benefit your business. Good medical practice consultants usually have a lot of experience working with healthcare practices and have a strong understanding of the business. The difference between hiring a medical practice consultant and outsourcing is that consultants typically are highly specialized professionals. They provide targeted and measureable results within an established period of time, which makes them a good fit for short-term and/or project specific projects (e.g. Practice and/or Billing assessments).

Determining if You Need a Medical Practice Consultant

If you find yourself needing professional advice or assistance for a short-term project, such as strategic business planning, practice assessments, practice startups, insurance contract negotiations or coding audits, to name a few, you could benefit from the use of a medical practice consultant. Not only can medical practice consultants bring their experience and expertise to the table when dealing with such situations and projects, but they bring a fresh eye as well. If you're facing a particular problem that you're having trouble solving, it's often because you're too close to the practice to be able to view the problem objectively. A medical practice consultant could identify the source of your problem immediately as well as suggest effective solutions.

Utilizing a Medical Practice Consultant

When hiring a medical practice consultant, you should resist the temptation to simply dump the problem onto the consultant's lap and let them take care of it. While this can be possible, it's a better idea to work with the consultant as a partner by collaborating with them closely. This will ensure that the work being done is consistent with what you want and what you need. Because the consultant is going to be someone that you'll work closely with and that you are going to trust an important part of your practice with, it's important that you hire a medical practice consultant that is reputable. The following are a few tips for finding a good medical practice consultant:

Find out how long they've been in the business - The longer they've worked as a medical practice consultant, the more effective they'll be. Not only is their experience a strong indicator of their quality, but it also means that they can recognize certain situations and problems and will know what solutions will work.

Find out what types of practices they tend to consult - Make sure that the experience that they have is relevant to your practice. The medical field is very broad, after all.

Determine if you get along - You'll want to work with someone you like and respect.

If you are in need of medical practice consulting services, be sure to contact us at ProMD today.

A Guide to Medical Practice Management from ProMD

Jose Carreras - Wednesday, October 11, 2017

3 Tips for Effective Medical Practice Management

By learning more on the steps your healthcare business can take to streamline its operations in the coming months, you can find new avenues for business growth. Our team at ProMD Practice Management has many years’ experience helping healthcare firms improve their operations by reducing costs and improving productivity, and in this latest post, we’ll help guide your organization forward with 3 tips for effective medical practice management.

1. Undergo a Practice Assessment

The first step in ensuring the long-term success of your organization is to undergo a structural assessment to determine where opportunities exist for improvement. It’s important that your organization undertakes a practice assessment to better evaluate its current processes and to learn where costs can be reduced throughout its infrastructure. The assessment firm will look at areas such as IT performance and billing cycles to determine how quickly bills are being paid and how effective your billing systems are at ensuring full payment in a short timeframe. This is just one area that can be improved in the assessment process.

2. Look for Billing Services

One of the most difficult challenges associated with management of a modern medical practice is having to digitize billing records for patients and ensuring that bills are paid quickly while following the latest regulations. Your medical staff have limited time to take on this process, and this means that they must turn to a specialist to ensure that billing work is completed professionally while they take on their medical work. Specialist billing service providers can also look to find ways in which to eliminate costs within the billing process and to ensure that patients pay their bills within a consolidated timeframe.

3. Follow the Latest Staffing Requirements

The needs of today’s medical services providers are continually changing. One week the company might be solely focusing on bringing in a new piece of equipment, the next they could be looking to integrate a new billing solution. It’s important that the company’s staffing matches their requirements. You should try to ensure that all staffing needs are met with precision. Look for open roles within the firm and for opportunities for expansion and then speak with local consultants about the types of staff needed to fulfill the company’s objectives in the long-term. To discover more on medical practice management strategies, contact our expert team at ProMD Practice Management directly!

Impact of ACA on Medical Billing

Jose Carreras - Wednesday, October 04, 2017

When the Affordable Care Act (ACA), which is also commonly referred to as Obamacare, was passed, it was obvious that it was going to have a big impact on all facets of the health insurance industry. A few years have since passed, and this has proven to be true - even when it comes to medical billing. So how exactly has the Affordable Care Act affected medical billing? 

How the ACA Has Affected Medical Billing

The Affordable Care Act wasn't supposed to make things like eligibility verification, pre-certification, medical billing and coding tougher on medical practices, but it did. The following are a few of the issues that have resulted from the ACA: 

More claims need to be processed - If the ACA has been successful at achieving one thing, it's to increase the number of people that have insurance. This is obviously a good thing. However, it also means that fewer people are paying for medical services out of pocket. More people have health insurance now, which means that practices need to file more claims. This, in turn, means that the billing process has become much more involved for most practices as a pure result of an increase in insured patients.

Coverage has changed - Almost all insurance plans have changed in one way or another as a result of the ACA. This means that there have been modifications in patient reimbursement rates and allowances. This has proven to be problematic in instances where the insurance companies have not communicated clearly with their customers, resulting in patients not realizing that the medical services that they've obtained may no longer have been covered or may only partially covered. This, in turn, has meant that more patients have needed to set up payment plans in order to pay off their balances.

Copays are more - Many insurance plans require larger copays or even require patients to pay a percentage of a medical service instead of a set copayment. This means that medical practices have had to get in the habit of communicating with patients before scheduled appointments to discuss or set up payment plans in order to avoid a growing outstanding balance.

Medical billing processes have gotten more complicated overall due to the ACA, which has led many medical practices to outsource their medical billing.

For information about our medical billing services, be sure to contact us at ProMD today.

A Guide to Minimizing Claim Denial

Jose Carreras - Thursday, September 28, 2017

4 Tips for Minimizing Claim Denial 

A claim denial can prolong the payment process and may even prevent your organization from achieving payment from the insurance company. One of the best ways to avoid a claim denial is to follow the guidelines offered by experts in the billing marketplace. Our team at ProMD Practice Management has decades of experience in the industry, and in this latest post we’ll highlight our four tips for minimizing claim denial.

1. Ensure Staff are Properly Trained

Your staff should be properly trained to respond to all billing demands within the office. They should know how to submit clean claims and how to follow all the latest legal guidelines while going through the claims process. For example, they should know how to select the right procedure and diagnostic code within their billing. They should also be able to verify the eligibility of patients before scheduling appointments. This can help to streamline treatment.

2. Choose Quality Claim Scrubbing Software

Claim scrubbing software can be critical to the success of a medical service provider. The claims scrubbing software helps to associate the patient with the code in the billing process. It works to identify any demographic information mistakes within the claim so that the claim can be processed normally by the insurance provider.

3. Outsource the Billing and Collections Process

Your medical team has a significant workload without having to tackle billing and collections work. They also might not have the expertise to complete billing and collections processes successfully. This might mean that your organization is missing out on billing revenue in addition to team productivity. Turning to a billing and collections specialist ensures that resources are used effectively throughout the organization. The process will help your business reduce billing errors and make sure that bills are paid promptly.

4. Have Regular Meetings on Billing Issues

You should meet with your staff on a regular basis to discuss billing issues and to determine how best to foster an understanding on billing and claims processing. Make sure that any challenges are met with a precise solution and that your billing company has an understanding on the current issues you face. Our team at ProMD Practice Management is here to guide you in reducing claim denial events. To discover more on your options, call us today!

Timekeeping & Payroll Recordkeeping: Legal Compliance for 2017

Jose Carreras - Wednesday, September 20, 2017

Keeping your medical practice organized is essential to making sure that it runs effectively and efficiently. An important element of this is keeping track of all of your records. This doesn't just refer to your patient records, but also to the work records of your employees. Timekeeping and payroll recordkeeping are incredibly important, especially when it comes to legal compliance.

Reasons Why Timekeeping and Payroll Recordkeeping Are Important

The following are some of the reasons why it's so important to keep accurate records of how long your employees are working and how much they are being paid: 

  • Over the past 20 years, the number of employee wage and hour related lawsuits have skyrocketed throughout the country. In 1995, there were roughly 1,500 Fair Labor Standards Act (FLSA) cases. In 2015, that number hovered closer to 9,000.
  • These cases are being driven by new rules as well as poor recordkeeping.
  • A higher salary threshold could end up making millions of workers eligible for overtime pay, which could result in millions of new potential claims. The higher salary threshold is currently frozen in court, but that doesn't mean that you can ignore it.
  • Even if the new overtime rules don't go into effect, at this point more interest has been raised in regards to the status of employees throughout the country, such as whether they should be treated as employees or independent contractors and whether they are exempt or nonexempt. This new interest is going to result in a lot of employees filing more inquiries and lawsuits in regards to how employers have classified their employees.
  • There has been more workplace scrutiny as a result of the Obama administration having invested millions of Department of Labor budget dollars into increasing wage-and-hour enforcement. There are no signs that the current administration is planning to rescind any of these initiatives.
  • The IRS budget has increased, which has resulted in the hiring of roughly 700 new enforcement agents. These new IRS agents will most likely be tasked with performing payroll audits since this is one of the main and easiest sources of money for the IRS.
  • Due to a U.S. Supreme Court ruling last year, employees can now make use of sampling to justify their timekeeping lawsuits. This provides employers with an incentive to make sure their time records are flawless.

How ProMD Can Help Your Practice

As you can see, it's absolutely vital that your timekeeping and payroll records are accurately kept. Otherwise, you may open yourself up to potential lawsuits as well as audits. Here at ProMD, we can help you avoid such lawsuits and audits, which can not only be costly and time-consuming but which can hurt your reputation. 

One way that you can reduce your payroll and timekeeping needs is by outsourcing some of your practice's tasks, such as medical billing and collections. Additionally, we offer medical practice assessment services, which involves a comprehensive on-site analysis and review of your practice and its operation that includes a thorough inspection of staffing and salary.

We also remain up to date on all rules and regulations regarding timekeeping and payroll recordkeeping and any changes that are made, allowing you to make the necessary adjustments in order to remain compliant and avoid potential lawsuits or audits. For more information on how we can help you stay compliant with regards to your timekeeping and payroll recordkeeping, or for information concerning our other services, be sure to contact us at ProMD today.

Get Billing Services from ProMD

Jose Carreras - Tuesday, September 12, 2017

Enhance Returns with Billing Services from ProMD  

By working with an external specialist, medical companies can improve upon their returns for their billing processes. It’s important to work with a company that has experience in billing services and payment management, to ensure payments are made quickly and to gain a higher return from past due bills. Working with a specialist such as ProMD allows medical companies to focus on their care work while ProMD plays an important payment management role. Within this latest post, we’ll explore more on the benefits of choosing the company’s experts for billing work.

Identifying Payment Issues 

One of the foremost reasons so many companies are now hiring ProMD is our company works to identify the payment issues the client is having, and then can resolve these issues with a clear understanding on the marketplace. The team at ProMD will look for inefficiencies within the payment processing structure. For example, they’ll look for bottlenecks in which communication between the billing team and the patient has stopped, and then build new procedures that ensure prompt payment is received.

Detailed Billing and Collection Reports 

Companies work with ProMD because we have experience in crafting comprehensive reports on all data related to medical billing revenue. The detailed monthly reports completed for clients by the ProMD team will help organizations see the tangible benefits of optimizing their billing processes. All patient payment data will be compiled within the system so that any outstanding issues can be identified and then resolved in the short-term. This means that companies don’t miss out on potential revenue from their current patients.

Reduce Billing Errors 

Billing errors can prevent the organization collecting revenue from patients, and may lead to any further collection claims being turned down by the patient’s insurance company. It’s essential that the data within the billing system is completely accurate. That’s why companies turn to ProMD for their billing services. The ProMD team works tirelessly to ensure the data within their clients’ billing system is accurate and that both payment information and patient details are confirmed before moving forward with the collections process. Ensuring this level of accuracy helps mitigate the need to send out new bills to patients’ due to incorrect details, and improves speed of collection significantly. 

Our team at ProMD is here to guide you in improving your billing cycle and maximizing practice revenues. To discover more on our billing services, or book a consultation, contact us today.

Expert Collection Services with ProMD

Jose Carreras - Wednesday, September 06, 2017

The Elements Required for Effective Billing and Collection Services 

Your practice can run more efficiently with guidance from trusted billing and collection services providers. But oftentimes it can be difficult to find that ideal partner for managing the billing cycle within you practice. To guide you on the available options and on how to make the right decision for your firm, our team at ProMD highlights the elements required for effective billing and collection services, in this latest post.

Account Receivable Analysis

The collection services that your firm chooses should be able to offer comprehensive account receivable analysis. This analysis will be important in determining the financial standing of the organization and in looking at the current revenue streams for areas of improvement. During their analysis, the company will review sources of revenue and how long it takes for accounts to be paid by patients. The goal is to reduce payment times and ensure higher revenues over the long-term.

Billing and Collection Reporting

The collection services company should also be able to offer dynamic data on the billing and collections cycles. The data included should help your firm to learn more on the types of items being billed for and the trends within the billing cycle. The collection services company can then help your team to predict the schedule for billing and collection and build the ideal process to ensure a predictable, reliable revenue stream.

High Collection Rates

There’s little benefit of having an optimized collection service without then achieving higher collection rates from past patients and their insurance companies. So, it’s important to work with a collection services provider that has proven collection rates within the marketplace. The team at ProMD ensure clients achieve a collection rate of between 90 and 98%, which is among the highest within the industry today. This ensures that you’ll achieve the ideal return on investment in working with the company.

Finding that ideal collections services company can make a significant difference to your practice. To learn more on why so many are now outsourcing the collections process to specialists, contact our team today!

Common Causes of Claim Denials

Jose Carreras - Wednesday, August 30, 2017

Claim denials have a big impact on the bottom line of medical practices. Even though it's estimated that roughly two-thirds of all denials can be successfully repealed, repealing those denials requires a lot of time and effort. Such resources can be better used elsewhere. Instead of wasting resources trying to repeal denied claims, practices should focus on preventing them from happening in the first place. In fact, 90 percent of all denials can probably be prevented, thereby greatly improving the revenue of the practice.

Common Causes
of Claim Denials

The following are some of the most common reasons for claim denials:

Data entry errors - Basic data entry errors, such as misspelling a patient name or misidentifying their gender, can result in a claim denial.
Patient ineligibility - A claim will be denied if the patient wasn't eligible for the service that you provided because their health care coverage ended.
Non-covered services - Services not covered by the patient's health care plan can result in a claim denial. They may have exceeded the number of sessions for certain services that their health insurance will cover within a certain period of time as well.
Missing authorization - It's important that you obtain authorization for any service that requires it. Most payers have online tools that allow you to obtain pre-certification to make this process easier.
Coding errors - Coding errors are one of the leading causes of claim denials. This is because the CPT (Current Procedural Terminology) and ICD (International Classification of Diseases) are quite complicated. Common coding errors include missing or misused modifiers, using non-specific codes, using the wrong procedure codes, not linking diagnosis codes to the CPT codes, using CPT codes that are outdated, and using the code for a nurse visit instead of another service code. Because coding errors are so easy to make, it's extremely important that you use someone who is knowledgeable in the use of codes and that you use a claim scrubbing software to review the codes and modifiers you are using.
Billing errors - Like coding errors, billing errors are a common reason for claim denials. Some of the common billing errors include missing information, duplicate claims and claims that are not billed on time.

Preventing Claim Denials

Knowing the causes of the denials is the best way to start. Once the causes are known, you can begin taking steps to eliminate the errors and prevent claim denials. 

Have regular staff meetings - Discuss billing and coding issues with your staff on a regular basis. If they know what the problems are behind your claim denials, they'll be more careful to avoid errors in the future. Communication is key.
Ensure that the staff is properly trained - Your staff should be thoroughly trained on how to submit clean claims, why claims are often denied, how to document properly, how to select the right procedure and diagnostic codes. Your front desk staff should know how to verify the eligibility of your patients before scheduling appointments as well.
Use claim scrubbing software - Claim scrubbing software allows you to review patient demographic information to avoid data entry errors.
Outsource billings and collections - You can greatly reduce your billing errors, thereby reducing claim denials by outsourcing your billing and collections. Doing so will also free up resources within your practice that can be focused on other pressing matters.

These are some of the common reasons why claims are often denied and how you can reduce the number of claim denials your practice receives. Find out how our medical billing and collections services can help to reduce your claim denials by contacting us at ProMD today.

Ways to Increase Profitability and Efficiency of a Medical Practice

Jose Carreras - Wednesday, August 23, 2017

What are the ways to increase the profitability
and efficiency of your medical practice? 

The financial viability of your medical practice depends on the efficiency and effectiveness of its billing process Providing excellent service and patient care is a priority for a medical practice.

Running a profitable and efficient business as well can become a juggling act if you do not have the right staff and systems in place.

Want to know if your practice reaching its full revenue potential?

Begin with a complete medical practice assessment that will allow you to look at every aspect of your practice and determine what areas need attention. This should include an operational audit and practice improvement assessment. In particular, you will need to look closely at your financial standing, your practice management system and your billing and collections practices.

With a proper medical practice assessment you will receive:

  • Complete Practice Audit
  • Financial, Accounts Payables, and Bookkeeping
  • Practice Management System
  • Contracting Audit Office Fee Schedule Analysis
  • Accounts Receivable Management
  • Staffing & Salary Analysis 

With the information gained from the assessment, you will be able to determine what areas of your business are running well and where you can implement changes. The driving goal is to enhance your practice's effectiveness and cost efficiency while always continuing to provide quality medical care to your patients.

ProMD Practice Management offers a menu of a la carte Practice Management services custom tailored to your specific needs and designed to make your Practice more efficient and profitable.

ProMD is a leading medical practice management, consulting and medical billing company. Contact Us to REQUEST a Billing Assessment to determine whether a Medical Practice Assessment is right for your practice.

Smart Practice Management

Jose Carreras - Wednesday, August 16, 2017

As a medical professional, you may feel like you want to control every aspect of your practice. However, doing so may not always be possible since attempting to manage your practice on your own could stretch your resources. This is why you should look to a professional practice management service to help ensure that your practice is being run as efficiently and effectively as possible, and we'll do just that here at ProMD.

What Does Smart Practice Management Entail?

When it comes to running your practice, there are three keys to ensuring smart practice management: efficiency, effectiveness, and adaptability.

Efficiency - Make sure your practice runs efficiently is vital to its success. There are many different aspects of a practice's management that affect its efficiency. For example, you should be properly staffed at all times, meaning that during slow periods, you won't want staff members sitting around without anything to do, whereas you won't want to be understaffed during peak hours.

Effectiveness - You'll need to make sure that your entire staff is effective at their jobs. If just one person is unable to meet the demands of their position, it could end up hurting your practice overall. This is because their inability to perform could hurt certain processes or reduce the efficiency of your practice because other members of your staff are forced to pick up the slack.

Adaptability - Your practice may be running relatively smoothly at the moment, but if you receive a sudden influx in patients, you will need to be able to adapt on the fly.

How Can ProMD Help Improve Your Practice Management?

There are a number of ways in which we can help to improve the efficiency, effectiveness, and adaptability of your practice. The following is just a glance of some of the practice management services that we offer:

Consulting services - We can do a full audit of your practice to determine where resources are being wasted, where resources are needed and how the efficiency and effectiveness of your practice can be improved.

Operations oversight - We can provide weekly on-site evaluations by one of our expert account executives or even place a full-time office manager and support staff in your office. With our operations oversight service, we can offer medical office staffing solutions and more to improve practice management.

Billing assessment - We can audit your billing and collections service in order to determine how efficiently it's being run and what areas can be improved; and most important how much monies not collected for services provided. 

Billing and collections services - By outsourcing your billing and collections services to ProMD, you'll not only improve efficiency and effectiveness by reducing billing errors and improving your collection rate, you'll also free up resources that can be used towards improving other areas of your practice. You also won't have to worry about becoming overwhelmed by additional patients since our service will be able to adapt to any growing needs.

Free practice management software - Our practice management software will allow you to streamline your billing efforts, raise your collection rates and increase the profitability of your practice.

Our practice management services here at ProMD can go a long way in helping to make your practice run more efficiently and effectively in addition to becoming more adaptable to future needs. For more information about our practice management services, contact us at ProMD.


When to Hire a Medical Practice Consultant

Jose Carreras - Wednesday, October 18, 2017

Sometimes, you may find yourself in a situation where you need assistance with your medical practice in terms of solving a particular business problem or figuring out a way to maximize your return on investments. However, you may not want to take on additional employees for these purposes, nor do you want to outsource any work due to the costs and lack of control involved in doing so. In such a case, you should consider hiring a medical practice consultant.

What is a Medical Practice Consultant?

A medical practice consultant is a person or company that can analyze certain problems or situations concerning your medical practice and offer up advice in the form of solutions to those problems or ideas that can benefit your business. Good medical practice consultants usually have a lot of experience working with healthcare practices and have a strong understanding of the business. The difference between hiring a medical practice consultant and outsourcing is that consultants typically are highly specialized professionals. They provide targeted and measureable results within an established period of time, which makes them a good fit for short-term and/or project specific projects (e.g. Practice and/or Billing assessments).

Determining if You Need a Medical Practice Consultant

If you find yourself needing professional advice or assistance for a short-term project, such as strategic business planning, practice assessments, practice startups, insurance contract negotiations or coding audits, to name a few, you could benefit from the use of a medical practice consultant. Not only can medical practice consultants bring their experience and expertise to the table when dealing with such situations and projects, but they bring a fresh eye as well. If you're facing a particular problem that you're having trouble solving, it's often because you're too close to the practice to be able to view the problem objectively. A medical practice consultant could identify the source of your problem immediately as well as suggest effective solutions.

Utilizing a Medical Practice Consultant

When hiring a medical practice consultant, you should resist the temptation to simply dump the problem onto the consultant's lap and let them take care of it. While this can be possible, it's a better idea to work with the consultant as a partner by collaborating with them closely. This will ensure that the work being done is consistent with what you want and what you need. Because the consultant is going to be someone that you'll work closely with and that you are going to trust an important part of your practice with, it's important that you hire a medical practice consultant that is reputable. The following are a few tips for finding a good medical practice consultant:

Find out how long they've been in the business - The longer they've worked as a medical practice consultant, the more effective they'll be. Not only is their experience a strong indicator of their quality, but it also means that they can recognize certain situations and problems and will know what solutions will work.

Find out what types of practices they tend to consult - Make sure that the experience that they have is relevant to your practice. The medical field is very broad, after all.

Determine if you get along - You'll want to work with someone you like and respect.

If you are in need of medical practice consulting services, be sure to contact us at ProMD today.

A Guide to Medical Practice Management from ProMD

Jose Carreras - Wednesday, October 11, 2017

3 Tips for Effective Medical Practice Management

By learning more on the steps your healthcare business can take to streamline its operations in the coming months, you can find new avenues for business growth. Our team at ProMD Practice Management has many years’ experience helping healthcare firms improve their operations by reducing costs and improving productivity, and in this latest post, we’ll help guide your organization forward with 3 tips for effective medical practice management.

1. Undergo a Practice Assessment

The first step in ensuring the long-term success of your organization is to undergo a structural assessment to determine where opportunities exist for improvement. It’s important that your organization undertakes a practice assessment to better evaluate its current processes and to learn where costs can be reduced throughout its infrastructure. The assessment firm will look at areas such as IT performance and billing cycles to determine how quickly bills are being paid and how effective your billing systems are at ensuring full payment in a short timeframe. This is just one area that can be improved in the assessment process.

2. Look for Billing Services

One of the most difficult challenges associated with management of a modern medical practice is having to digitize billing records for patients and ensuring that bills are paid quickly while following the latest regulations. Your medical staff have limited time to take on this process, and this means that they must turn to a specialist to ensure that billing work is completed professionally while they take on their medical work. Specialist billing service providers can also look to find ways in which to eliminate costs within the billing process and to ensure that patients pay their bills within a consolidated timeframe.

3. Follow the Latest Staffing Requirements

The needs of today’s medical services providers are continually changing. One week the company might be solely focusing on bringing in a new piece of equipment, the next they could be looking to integrate a new billing solution. It’s important that the company’s staffing matches their requirements. You should try to ensure that all staffing needs are met with precision. Look for open roles within the firm and for opportunities for expansion and then speak with local consultants about the types of staff needed to fulfill the company’s objectives in the long-term. To discover more on medical practice management strategies, contact our expert team at ProMD Practice Management directly!

Impact of ACA on Medical Billing

Jose Carreras - Wednesday, October 04, 2017

When the Affordable Care Act (ACA), which is also commonly referred to as Obamacare, was passed, it was obvious that it was going to have a big impact on all facets of the health insurance industry. A few years have since passed, and this has proven to be true - even when it comes to medical billing. So how exactly has the Affordable Care Act affected medical billing? 

How the ACA Has Affected Medical Billing

The Affordable Care Act wasn't supposed to make things like eligibility verification, pre-certification, medical billing and coding tougher on medical practices, but it did. The following are a few of the issues that have resulted from the ACA: 

More claims need to be processed - If the ACA has been successful at achieving one thing, it's to increase the number of people that have insurance. This is obviously a good thing. However, it also means that fewer people are paying for medical services out of pocket. More people have health insurance now, which means that practices need to file more claims. This, in turn, means that the billing process has become much more involved for most practices as a pure result of an increase in insured patients.

Coverage has changed - Almost all insurance plans have changed in one way or another as a result of the ACA. This means that there have been modifications in patient reimbursement rates and allowances. This has proven to be problematic in instances where the insurance companies have not communicated clearly with their customers, resulting in patients not realizing that the medical services that they've obtained may no longer have been covered or may only partially covered. This, in turn, has meant that more patients have needed to set up payment plans in order to pay off their balances.

Copays are more - Many insurance plans require larger copays or even require patients to pay a percentage of a medical service instead of a set copayment. This means that medical practices have had to get in the habit of communicating with patients before scheduled appointments to discuss or set up payment plans in order to avoid a growing outstanding balance.

Medical billing processes have gotten more complicated overall due to the ACA, which has led many medical practices to outsource their medical billing.

For information about our medical billing services, be sure to contact us at ProMD today.

A Guide to Minimizing Claim Denial

Jose Carreras - Thursday, September 28, 2017

4 Tips for Minimizing Claim Denial 

A claim denial can prolong the payment process and may even prevent your organization from achieving payment from the insurance company. One of the best ways to avoid a claim denial is to follow the guidelines offered by experts in the billing marketplace. Our team at ProMD Practice Management has decades of experience in the industry, and in this latest post we’ll highlight our four tips for minimizing claim denial.

1. Ensure Staff are Properly Trained

Your staff should be properly trained to respond to all billing demands within the office. They should know how to submit clean claims and how to follow all the latest legal guidelines while going through the claims process. For example, they should know how to select the right procedure and diagnostic code within their billing. They should also be able to verify the eligibility of patients before scheduling appointments. This can help to streamline treatment.

2. Choose Quality Claim Scrubbing Software

Claim scrubbing software can be critical to the success of a medical service provider. The claims scrubbing software helps to associate the patient with the code in the billing process. It works to identify any demographic information mistakes within the claim so that the claim can be processed normally by the insurance provider.

3. Outsource the Billing and Collections Process

Your medical team has a significant workload without having to tackle billing and collections work. They also might not have the expertise to complete billing and collections processes successfully. This might mean that your organization is missing out on billing revenue in addition to team productivity. Turning to a billing and collections specialist ensures that resources are used effectively throughout the organization. The process will help your business reduce billing errors and make sure that bills are paid promptly.

4. Have Regular Meetings on Billing Issues

You should meet with your staff on a regular basis to discuss billing issues and to determine how best to foster an understanding on billing and claims processing. Make sure that any challenges are met with a precise solution and that your billing company has an understanding on the current issues you face. Our team at ProMD Practice Management is here to guide you in reducing claim denial events. To discover more on your options, call us today!

Timekeeping & Payroll Recordkeeping: Legal Compliance for 2017

Jose Carreras - Wednesday, September 20, 2017

Keeping your medical practice organized is essential to making sure that it runs effectively and efficiently. An important element of this is keeping track of all of your records. This doesn't just refer to your patient records, but also to the work records of your employees. Timekeeping and payroll recordkeeping are incredibly important, especially when it comes to legal compliance.

Reasons Why Timekeeping and Payroll Recordkeeping Are Important

The following are some of the reasons why it's so important to keep accurate records of how long your employees are working and how much they are being paid: 

  • Over the past 20 years, the number of employee wage and hour related lawsuits have skyrocketed throughout the country. In 1995, there were roughly 1,500 Fair Labor Standards Act (FLSA) cases. In 2015, that number hovered closer to 9,000.
  • These cases are being driven by new rules as well as poor recordkeeping.
  • A higher salary threshold could end up making millions of workers eligible for overtime pay, which could result in millions of new potential claims. The higher salary threshold is currently frozen in court, but that doesn't mean that you can ignore it.
  • Even if the new overtime rules don't go into effect, at this point more interest has been raised in regards to the status of employees throughout the country, such as whether they should be treated as employees or independent contractors and whether they are exempt or nonexempt. This new interest is going to result in a lot of employees filing more inquiries and lawsuits in regards to how employers have classified their employees.
  • There has been more workplace scrutiny as a result of the Obama administration having invested millions of Department of Labor budget dollars into increasing wage-and-hour enforcement. There are no signs that the current administration is planning to rescind any of these initiatives.
  • The IRS budget has increased, which has resulted in the hiring of roughly 700 new enforcement agents. These new IRS agents will most likely be tasked with performing payroll audits since this is one of the main and easiest sources of money for the IRS.
  • Due to a U.S. Supreme Court ruling last year, employees can now make use of sampling to justify their timekeeping lawsuits. This provides employers with an incentive to make sure their time records are flawless.

How ProMD Can Help Your Practice

As you can see, it's absolutely vital that your timekeeping and payroll records are accurately kept. Otherwise, you may open yourself up to potential lawsuits as well as audits. Here at ProMD, we can help you avoid such lawsuits and audits, which can not only be costly and time-consuming but which can hurt your reputation. 

One way that you can reduce your payroll and timekeeping needs is by outsourcing some of your practice's tasks, such as medical billing and collections. Additionally, we offer medical practice assessment services, which involves a comprehensive on-site analysis and review of your practice and its operation that includes a thorough inspection of staffing and salary.

We also remain up to date on all rules and regulations regarding timekeeping and payroll recordkeeping and any changes that are made, allowing you to make the necessary adjustments in order to remain compliant and avoid potential lawsuits or audits. For more information on how we can help you stay compliant with regards to your timekeeping and payroll recordkeeping, or for information concerning our other services, be sure to contact us at ProMD today.

Get Billing Services from ProMD

Jose Carreras - Tuesday, September 12, 2017

Enhance Returns with Billing Services from ProMD  

By working with an external specialist, medical companies can improve upon their returns for their billing processes. It’s important to work with a company that has experience in billing services and payment management, to ensure payments are made quickly and to gain a higher return from past due bills. Working with a specialist such as ProMD allows medical companies to focus on their care work while ProMD plays an important payment management role. Within this latest post, we’ll explore more on the benefits of choosing the company’s experts for billing work.

Identifying Payment Issues 

One of the foremost reasons so many companies are now hiring ProMD is our company works to identify the payment issues the client is having, and then can resolve these issues with a clear understanding on the marketplace. The team at ProMD will look for inefficiencies within the payment processing structure. For example, they’ll look for bottlenecks in which communication between the billing team and the patient has stopped, and then build new procedures that ensure prompt payment is received.

Detailed Billing and Collection Reports 

Companies work with ProMD because we have experience in crafting comprehensive reports on all data related to medical billing revenue. The detailed monthly reports completed for clients by the ProMD team will help organizations see the tangible benefits of optimizing their billing processes. All patient payment data will be compiled within the system so that any outstanding issues can be identified and then resolved in the short-term. This means that companies don’t miss out on potential revenue from their current patients.

Reduce Billing Errors 

Billing errors can prevent the organization collecting revenue from patients, and may lead to any further collection claims being turned down by the patient’s insurance company. It’s essential that the data within the billing system is completely accurate. That’s why companies turn to ProMD for their billing services. The ProMD team works tirelessly to ensure the data within their clients’ billing system is accurate and that both payment information and patient details are confirmed before moving forward with the collections process. Ensuring this level of accuracy helps mitigate the need to send out new bills to patients’ due to incorrect details, and improves speed of collection significantly. 

Our team at ProMD is here to guide you in improving your billing cycle and maximizing practice revenues. To discover more on our billing services, or book a consultation, contact us today.

Expert Collection Services with ProMD

Jose Carreras - Wednesday, September 06, 2017

The Elements Required for Effective Billing and Collection Services 

Your practice can run more efficiently with guidance from trusted billing and collection services providers. But oftentimes it can be difficult to find that ideal partner for managing the billing cycle within you practice. To guide you on the available options and on how to make the right decision for your firm, our team at ProMD highlights the elements required for effective billing and collection services, in this latest post.

Account Receivable Analysis

The collection services that your firm chooses should be able to offer comprehensive account receivable analysis. This analysis will be important in determining the financial standing of the organization and in looking at the current revenue streams for areas of improvement. During their analysis, the company will review sources of revenue and how long it takes for accounts to be paid by patients. The goal is to reduce payment times and ensure higher revenues over the long-term.

Billing and Collection Reporting

The collection services company should also be able to offer dynamic data on the billing and collections cycles. The data included should help your firm to learn more on the types of items being billed for and the trends within the billing cycle. The collection services company can then help your team to predict the schedule for billing and collection and build the ideal process to ensure a predictable, reliable revenue stream.

High Collection Rates

There’s little benefit of having an optimized collection service without then achieving higher collection rates from past patients and their insurance companies. So, it’s important to work with a collection services provider that has proven collection rates within the marketplace. The team at ProMD ensure clients achieve a collection rate of between 90 and 98%, which is among the highest within the industry today. This ensures that you’ll achieve the ideal return on investment in working with the company.

Finding that ideal collections services company can make a significant difference to your practice. To learn more on why so many are now outsourcing the collections process to specialists, contact our team today!

Common Causes of Claim Denials

Jose Carreras - Wednesday, August 30, 2017

Claim denials have a big impact on the bottom line of medical practices. Even though it's estimated that roughly two-thirds of all denials can be successfully repealed, repealing those denials requires a lot of time and effort. Such resources can be better used elsewhere. Instead of wasting resources trying to repeal denied claims, practices should focus on preventing them from happening in the first place. In fact, 90 percent of all denials can probably be prevented, thereby greatly improving the revenue of the practice.

Common Causes
of Claim Denials

The following are some of the most common reasons for claim denials:

Data entry errors - Basic data entry errors, such as misspelling a patient name or misidentifying their gender, can result in a claim denial.
Patient ineligibility - A claim will be denied if the patient wasn't eligible for the service that you provided because their health care coverage ended.
Non-covered services - Services not covered by the patient's health care plan can result in a claim denial. They may have exceeded the number of sessions for certain services that their health insurance will cover within a certain period of time as well.
Missing authorization - It's important that you obtain authorization for any service that requires it. Most payers have online tools that allow you to obtain pre-certification to make this process easier.
Coding errors - Coding errors are one of the leading causes of claim denials. This is because the CPT (Current Procedural Terminology) and ICD (International Classification of Diseases) are quite complicated. Common coding errors include missing or misused modifiers, using non-specific codes, using the wrong procedure codes, not linking diagnosis codes to the CPT codes, using CPT codes that are outdated, and using the code for a nurse visit instead of another service code. Because coding errors are so easy to make, it's extremely important that you use someone who is knowledgeable in the use of codes and that you use a claim scrubbing software to review the codes and modifiers you are using.
Billing errors - Like coding errors, billing errors are a common reason for claim denials. Some of the common billing errors include missing information, duplicate claims and claims that are not billed on time.

Preventing Claim Denials

Knowing the causes of the denials is the best way to start. Once the causes are known, you can begin taking steps to eliminate the errors and prevent claim denials. 

Have regular staff meetings - Discuss billing and coding issues with your staff on a regular basis. If they know what the problems are behind your claim denials, they'll be more careful to avoid errors in the future. Communication is key.
Ensure that the staff is properly trained - Your staff should be thoroughly trained on how to submit clean claims, why claims are often denied, how to document properly, how to select the right procedure and diagnostic codes. Your front desk staff should know how to verify the eligibility of your patients before scheduling appointments as well.
Use claim scrubbing software - Claim scrubbing software allows you to review patient demographic information to avoid data entry errors.
Outsource billings and collections - You can greatly reduce your billing errors, thereby reducing claim denials by outsourcing your billing and collections. Doing so will also free up resources within your practice that can be focused on other pressing matters.

These are some of the common reasons why claims are often denied and how you can reduce the number of claim denials your practice receives. Find out how our medical billing and collections services can help to reduce your claim denials by contacting us at ProMD today.

Ways to Increase Profitability and Efficiency of a Medical Practice

Jose Carreras - Wednesday, August 23, 2017

What are the ways to increase the profitability
and efficiency of your medical practice? 

The financial viability of your medical practice depends on the efficiency and effectiveness of its billing process Providing excellent service and patient care is a priority for a medical practice.

Running a profitable and efficient business as well can become a juggling act if you do not have the right staff and systems in place.

Want to know if your practice reaching its full revenue potential?

Begin with a complete medical practice assessment that will allow you to look at every aspect of your practice and determine what areas need attention. This should include an operational audit and practice improvement assessment. In particular, you will need to look closely at your financial standing, your practice management system and your billing and collections practices.

With a proper medical practice assessment you will receive:

  • Complete Practice Audit
  • Financial, Accounts Payables, and Bookkeeping
  • Practice Management System
  • Contracting Audit Office Fee Schedule Analysis
  • Accounts Receivable Management
  • Staffing & Salary Analysis 

With the information gained from the assessment, you will be able to determine what areas of your business are running well and where you can implement changes. The driving goal is to enhance your practice's effectiveness and cost efficiency while always continuing to provide quality medical care to your patients.

ProMD Practice Management offers a menu of a la carte Practice Management services custom tailored to your specific needs and designed to make your Practice more efficient and profitable.

ProMD is a leading medical practice management, consulting and medical billing company. Contact Us to REQUEST a Billing Assessment to determine whether a Medical Practice Assessment is right for your practice.

Smart Practice Management

Jose Carreras - Wednesday, August 16, 2017

As a medical professional, you may feel like you want to control every aspect of your practice. However, doing so may not always be possible since attempting to manage your practice on your own could stretch your resources. This is why you should look to a professional practice management service to help ensure that your practice is being run as efficiently and effectively as possible, and we'll do just that here at ProMD.

What Does Smart Practice Management Entail?

When it comes to running your practice, there are three keys to ensuring smart practice management: efficiency, effectiveness, and adaptability.

Efficiency - Make sure your practice runs efficiently is vital to its success. There are many different aspects of a practice's management that affect its efficiency. For example, you should be properly staffed at all times, meaning that during slow periods, you won't want staff members sitting around without anything to do, whereas you won't want to be understaffed during peak hours.

Effectiveness - You'll need to make sure that your entire staff is effective at their jobs. If just one person is unable to meet the demands of their position, it could end up hurting your practice overall. This is because their inability to perform could hurt certain processes or reduce the efficiency of your practice because other members of your staff are forced to pick up the slack.

Adaptability - Your practice may be running relatively smoothly at the moment, but if you receive a sudden influx in patients, you will need to be able to adapt on the fly.

How Can ProMD Help Improve Your Practice Management?

There are a number of ways in which we can help to improve the efficiency, effectiveness, and adaptability of your practice. The following is just a glance of some of the practice management services that we offer:

Consulting services - We can do a full audit of your practice to determine where resources are being wasted, where resources are needed and how the efficiency and effectiveness of your practice can be improved.

Operations oversight - We can provide weekly on-site evaluations by one of our expert account executives or even place a full-time office manager and support staff in your office. With our operations oversight service, we can offer medical office staffing solutions and more to improve practice management.

Billing assessment - We can audit your billing and collections service in order to determine how efficiently it's being run and what areas can be improved; and most important how much monies not collected for services provided. 

Billing and collections services - By outsourcing your billing and collections services to ProMD, you'll not only improve efficiency and effectiveness by reducing billing errors and improving your collection rate, you'll also free up resources that can be used towards improving other areas of your practice. You also won't have to worry about becoming overwhelmed by additional patients since our service will be able to adapt to any growing needs.

Free practice management software - Our practice management software will allow you to streamline your billing efforts, raise your collection rates and increase the profitability of your practice.

Our practice management services here at ProMD can go a long way in helping to make your practice run more efficiently and effectively in addition to becoming more adaptable to future needs. For more information about our practice management services, contact us at ProMD.

About The Author

  

Jose Carreras, ProMDJose Carreras is Vice President and COO of ProMD. He holds a Master's Degree in Health Care Administration from Nova Southeastern University and has been in the health care industry for more than 20 years, including management positions at Jackson Memorial Hospital, PCA/CAC Medical Centers and United Healthcare. He was voted Best Practice Care Administrator by the readers of the South Florida Medical Business Journal in 2006.


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"ProMD conducted an on-site Practice Improvement Assessment of our Dermatology Practice and we were so impressed with their practice management knowledge that we engaged them to conduct twice yearly Assessment follow-up visits to monitor and ensure the findings and recommendations were being implemented. They have made a positive impact on our Practice operations"

- Steven Partilo, MD and Ana Licata, MD, Four Seasons Dermatology, Colchester, Vermont

"ProMD performed a Billing Assessment of our Practice and we were very impressed with their level of expertise, professionalism and overall knowledge of Practice Management principles"

- Dr. Tracy Novosel – Atlantic Dermatology, Virginia Beach, Virginia

"We hired ProMD to do our Billing & Collections 4 years ago and we haven’t looked back. They got to know our Practice and have exceeded MGMA’s 95% collection rate consistently. We have continued to grow our Practice and recommend other doctors to hire ProMD for their Billing & Collections. If you want to focus on proving quality medical services, let ProMD take care of the headache of collecting what you’re due."

- South Florida Infectious Diseases and Tropical Medicine, Miami, Florida

"ProMD’s billing services are going very well and have certainly increased my revenue for which I am very grateful"

- Jeffrey N. Thompson, DO, Dermatology Clinics Of Westmoreland County, Murrysville, Pennsylvania