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A place to discuss the latest private medical practice trends and how to increase revenues for physicians and their operations.

Time to Outsource Your Medical Billing?

Jose Carreras - Wednesday, June 21, 2017

Is it Time to Outsource Your Medical Billing? 

Does your medical practice have the resources to maintain a full-time staff to handle coding, billing, contracting and claim denials? Many small practices do not and try to get by with a limited and overworked staff. Depending on the size of your practice and the volume of patients seen, you may not be able to staff a billing department fully so that it can get claims out the door efficiently and deal with all the other details involved in a medical practice’s revenue cycle. 

Revenue cycles have become increasingly complicated. To truly eliminate any risk of non-compliance, a medical practice can expect to hire and maintain a team of certified coders and billers as well as a knowledgeable staff, current on all government regulations and payer requirements. It can be done, but the cost, in time and money, may not be worth it.

Greater Efficiency 

By contracting a qualified billing and collection company, you are putting a team in place that you may not be able to hire as full-time staff. A good billing company makes efforts to stay current on government regulations as well as insurance company rules and requirements. You can expect properly coded claims to go out on time and error free, and claim denials to be appealed and followed up on. Outsourcing your billing can decrease your risk of non-compliance. A practice without the resources to maintain a billing staff fully trained on the latest regulations may expose itself to compliance issues that can seriously impact revenue. 

Removing the burden of billing operations will allow your existing staff to shift their focus back to performing more pressing tasks that will make your office run at a higher efficiency. Furthermore, you can expect your practice’s collection rate to increase. Customers of ProMD’s billing services, for instance, enjoy collection rates as high as 98%.

Finally, a billing and collection company can offer a variety of financial performance reports that will help you to maximize your workflow and efficiency. With data rich reports on your practice’s performance, you will be able to recognize trends quickly and act when opportunities arise.

What to Look for in a Billing Service 

Not all billing companies are created equal. When researching a medical billing and collections company make sure they are offering a complete set of services that you would not be able to easily put in place in-house. Find out if they employ certified coders and whether provider enrollment, contracting and credentialing is included. A full service medical billing company should provide the following services: 

  • Charge posting
  • Billing
  • Collection
  • Denial appeals
  • Payment posting
  • Billing and collection reporting
  • Account receivables analysis

If you are ready to outsource your medical practice’s billing, consider ProMD Practice Management. ProMD offers full service billing and collection solutions. With our proven processes and infrastructure, we are able to offer our clients higher claim payments in a shorter amount of time.

Call us today to learn about our full line of billing services.

Preventing Cash Flow Problems

Jose Carreras - Thursday, June 15, 2017

The healthcare insurance industry is in somewhat of a flux at the moment, which can cause problems for any practices that aren't paying careful attention to what's going on. For example, patients are being held more responsible for health insurance costs than insurance payers, which is evidenced by the rising co-payments and deductibles.

This can be a problem for medical practices due to the fact that patients tend to pay much slower than insurance payers, which means that if they aren't careful, their cash flow could decrease.

Preventing Cash Flow Problems

Because patients are being forced to pay higher costs, it means that more of your cash flow is dependent on your patients than on insurance companies. According to the National Center for Health Statistics, 25% of families have an unpaid healthcare bill, 10% of families have medical bills they can't pay at all and 20% are on a payment plan to pay off their bills over time.

As you can imagine, this could affect your cash flow drastically, especially if the co-payments and deductibles of your patients continue to go up. Fortunately, there are a few steps that you can take to help keep your cash flow from declining. The following are a few such steps:

Collect payment upfront - Don't allow patients to pay after their appointment. Make it a practice to require payments up front. Have a sign that states this and post it on your website. Make sure your staff reminds your patients that they will need to pay their co-payments whenever they call them to remind them about their scheduled appointments.

Take multiple forms of payment - To encourage patients to pay what they owe upfront, offer them a number of ways to pay, such as with cash, by check, by credit card or by debit card. This way, your patients can't use the excuse that they don't have cash on hand to pay.

Keep patient credit card info on file - One way that you can reduce unpaid medical bills is by keeping patients' credit card information on file and getting them to agree to allow you to automatically bill their card for what they owe. You will need permission to do this, of course, and you'll have to make sure you take security precautions to keep their credit card information safe.

Provide an incentive for paying upfront - Some patients may try to pay later. While this is preferable to not being paid at all, you can get some of these patients to pay upfront with incentives, such as a small discount for paying before their appointment instead of after.

These are a few tips to help prevent cash inflow problems. But there are also cash outflow issues you should look into as well. The following are a few ways you can limit cash outflow:

Analyze your staff - Figure out how much time your staff spends working. If they have a lot of downtime, then you may be overstaffed.

Outsource billing and collections - Outsourcing medical billing and collections services can help to not only improve your collections, it could allow your office to run much more efficiently and effectively, and may even allow you to reduce some of your staff.

These are just a few ways that you can improve your cash flow and prevent potential cash flow problems that might arise as the healthcare insurance industry is in the midst of potential change. For information about our billing and collection services, be sure to contact us at ProMD today.

3 Steps to Increase Profitability

Jose Carreras - Friday, June 09, 2017

We can count on the cost of providing quality medical care to continue to rise even while having to face forces that lower reimbursement to providers in the healthcare industry. It is easy to get caught up in the day to day operations of your medical practice management and lose your focus on the financial health and trajectory of your practice. Take some time every month to examine the bottom line affect of the systems that are in place in the office. Try to be objective as you review your own routines and habits as well as those of your staff. What follows is a non-exhaustive list of areas to consider as well as suggestions on some steps to take to increase profitability. 

Examine the Revenue Cycle

There are a number of steps between collecting a patient's insurance information and closing their account as paid in full, each of which can have an affect on a medical practice's net income. Each month, take a look at the overall revenue cycle to insure there are no obvious snags or bottlenecks that could slow the flow of income. Then, each month, decide on a particular element to delve into further. It could be a review of the insurance verification procedure or the process for resubmission of denials. Sit down with the person responsible and ask them to walk you through their task. Encourage their input and work together to fix problems and implement new ideas.

Use of proper coding

Coding errors and under coding are often primary causes of income loss in medical practices. Proper coding speeds and maximizes reimbursement while reducing costly and time wasting payment denials. Make sure that all providers and relevant staff are up to date on coding changes when they go into effect in October.

Outsource your Medical Billing

One sure and quick way to increase your medical practice income is to hand the medical insurance billing to a professional billing company. Customers of ProMD Practice Management's billing services enjoy collection rates in the high 90's.

Most medical practices do not have the manpower to achieve the results of a dedicated billing company.

Maximizing Collections and Improving Billing Performance

Jose Carreras - Tuesday, May 30, 2017

When it comes to the differences between struggling medical practices and successful medical practices, it often comes down to billing and collections efficiency and not the actual quality of the medical services. Maximizing your collections and improving billing performance will help to bring in more revenue, but it's something that a lot of medical practices have trouble actually doing.

Demand co-pays up front - Make it known to your staff that you cannot bill your patients later for their copays. They should be trained to ask the patient for their copay. Don't forget to let the patients know as well so that they have no excuse for not being able to pay for their copay upfront. Put your policy up on your website where patients can clearly see it as well as at your reception desk. Have your staff remind patients about their copay when they call them to remind them about scheduled appointments. 

Check insurance eligibility - Train your staff to check the insurance eligibility for every patient before their scheduled visit so that you know exactly what they owe when they show up for their appointment. This ensures that they not only have active insurance but that you can charge them for the appropriate co-pay up front.

Provide multiple payment options - Make it easy for your patients to pay and they won't have an excuse not to. For example, if you only accept cash and they only have a credit card, you'll be forced to bill them later. Accept as many forms of payment as possible, including cash, credit cards, debit cards and checks, so that they have no excuses for not paying.

Set up payment plans - Patients that are unable to pay what they owe at the time of their visit or who have a balance past due should be placed on a payment plan. Document the plan and have the patient sign it. Payment plans are an effective way to get patients with past due balances to begin paying what they owe since otherwise, they may end up not paying at all.

Use urgent language on patient statements - Get rid of any casual deadlines on your statements, such as those that read that they must pay within 30 days. Instead, the first statement should read "Due Now" and any additional statement should read "Past Due." When you send out final notice letters, do so at least two weeks before sending their balance to collections. 

Remove old data - As you update your system with the new data of your patients, including insurance card data and personal information that should be validated on every visit, you should also go through the patient information you have and remove the data of patients that have left a long time ago. Some of these patients may have outstanding balances that still need to be paid. If they are small, you should consider writing them up as a loss instead of wasting resources continuing to bill them. 

These are just a few of the strategies that you should consider implementing into your practice policy in order to maximize collections and improve billing performance. As you can imagine, it does take a lot of time and effort to keep track of collections, which is why you might want to consider outsourcing your collections and billing.

Outsourcing can not only help you maximize your collections as well, but will free up time and make your office run more effectively and efficiently, which in itself can help you improve your revenue. For information about our billing and collections service, be sure to contact us at ProMD today.

Check Your Billing Performance

Jose Carreras - Thursday, May 25, 2017

Check Your Billing Performance

To have a financially healthy medical practice you need to keep an eye on a number of indicators and compare those to industry standards. Billing benchmarks are a great way to compare your practice’s financial performance with the standards for the industry. What follows are some best practices and practical tips that can help keep your practice performing in league with the best. First, take some time to evaluate where your practice stands on some important benchmarks.

Industry Standards

How does your practice’s performance compare to these industry benchmarks?

Avg Days A/R – Best Practice is < 40
Avg Days A/R Over 120 – Best Practice is < 12-15%
Days from TOS to Billing – Best Practice is < 3 days
Net Collection Rate – Best Practice is > 96%
Denial Rate – Best Practice is < 3-5%
Claims Paid in < 45 Days – Best Practice is 85-90%

The adage is true, to manage you must measure. In the business world, one way to measure financial health is to compare your data with how the rest of the industry is doing and to established standards that define where performance should fall. The process is called benchmarking. It is a continuous process that measures and compares performance internally and externally. The benchmarks listed above are some of the most important and the ones that should be monitored at the very minimum. You want the numbers for your practice to be equal or better than each benchmark. First, you should work at getting the numbers where they need to be, and once everything is working optimally, try to surpass the benchmarks.

Accounts Receivables

It is no accident that the first two benchmarks are related to accounts receivables. Management of accounts receivable is important in any business. Not only do they represent money you are owed and have not been paid, but, in the healthcare field, the longer a bill goes uncollected, the less likely it is to ever be collected. For that reason, the two most vital accounts receivable benchmarks are the average number of days your receivables go uncollected, and how many of your receivables are over 120 old.

If your practice’s numbers are not hitting these benchmarks, then that is probably the place to start examining your revenue cycle. A low days in accounts receivable number means that the collection processes you have in place are working properly. Similarly, if too many of your unpaid claims are over 120 old, it is time to concentrate on getting those bills paid earlier.

Setting Future Goals

Although the ideal is to meet or exceed each of these benchmarks, do not consider your practice a failure if they are not. Instead, look at benchmarks as where you want your practice to move toward. Reaching these goals may take some time and maintaining those numbers will take effort as well. Start by concentrating on one or two benchmarks and move to the next one when you start to see improvement.

Benchmarks are a great tool and a great way to stay informed about your practice’s financial health. Invest in your practice by contracting with ProMD to perform a billing assessment. ProMD will analyze your historical performance as compared to industry benchmarks to determine areas in which you are doing well, but more important it will identify areas of improvements that will maximize results. 

ProMD's own performance as a billing company surpass those of the MGMA published benchmarks. Call us today to learn more how we can increase your overall collections.

How to Achieve Optimum Billing Performance

Jose Carreras - Friday, May 19, 2017

Billing can be a very complicated process, but it's one that is vital to the success of your practice. There are a number of potential problems that can result in claim denials, which will, in turn, hurt your ability to maximize your collections.

The following are some of the common billing issues that practices run into and how they can be resolved in order to achieve optimum billing performance: 

The claim is for uncovered services - You won't be able to collect on the claim if it's for a service that's not covered by insurance or if the insurance of the patient has been terminated. To avoid such problems, you should always make sure that patients are fully insured and covered before you provide them with medical services. 

The claim is missing information - Any time a claim is missing certain information, it can be denied. This includes information such as the date of the accident, the date of the medical emergency and more. The person filing the claim in your office has to be diligent about writing it to avoid such simple errors or it could end up costing you. 

The claim isn't filed on time - In accordance with the Affordable Care Act, you have to submit a claim within 12 months of the time that you provided the service. It must be received by the end of the 12-month period - not sent out by that date. If the claim isn't received on time, it may be denied. To ensure that this doesn't happen, you have to make sure that your billing process is streamlined and organized. 

The claim used incorrect patient identifier information - This could be as simple of a mistake as misspelling the patient's name. For every claim you submit, you need to make sure that all of the patient's information is correct, including their name, their date of birth, their insurance payer and their policy number. 

The claim isn't specific enough - Every claim that your practice submits must contain a diagnosis that is coded to the highest level for that code. For example, the code for diabetes is four digits, but a fifth digit is required to specify the type of diabetes. If you only include the four digit code, your claim is likely to be denied. 

The claim uses the wrong code - If the wrong code is used, then the claim can be denied. Make sure that you not only use the right codes, but that your coding book is up to date. Otherwise, you'll have to appeal the denial, which requires more resources and will make the process of getting paid take even longer.

The claim doesn't properly support medical necessity - In some cases, a payer won't adjudicate a claim unless you provide certain medical records proving that the service you provided was necessary to the patient's health. In such a case, you may need to provide the physical reports, medical history, discharge summaries, consultation reports and more.

To avoid being unable to meet these requirements, always keep documentation that supports the necessity of the service you've provided. These are some of the most common billing related issues that can hurt your ability to maximize your collections.

One way to make sure that you avoid all of these problems is by outsourcing your billing services. For information about outsourcing your billing services in order to achieve optimum billing performance, be sure to contact us at ProMD today.

3 Steps To Insure Your Practice is Complying with Medicare's ABN Guidelines

Jose Carreras - Thursday, May 11, 2017

ABN's Will Help You Get Paid When Medicare Denies a Claim

There are instances when Medicare may not pay for services that are normally covered or that it does not consider medically necessary. If there is a reason to suspect that Medicare may not pay for a particular service, it is important to have the patient sign form CMS-R-131, the Advance Beneficiary Notice of Non-coverage (ABN). Do this before providing the services to insure that there is not confusion on the patient's part. Remember that ABN's do not apply to commercial insurance companies.

An ABN makes it clear to the patient that they may have a financial obligation if Medicare denies the claim for payment. Furthermore, without a signed ABN, the medical practice will be unable to collect payment from the patient and will have to write off the claim as denied by Medicare. There are three steps that should be taken to insure that your practice is complying with Medicare's ABN guidelines.

Determine When to Use an ABN 

Medicare rules do not allow a practice to simply issue an ABN for every single service they perform. For this reason, you should figure out when the form is likely to be needed. A simple review of past claim denials and coverage determinations will reveal what procedures Medicare might not pay for in the future. After that, put together a list of typical procedures that have been denied by Medicare for reference.

Properly Complete the Form 

The ABN form can be found on Medicare's website. In order to be valid it must be filled out properly. Otherwise, it will be denied just like the original claim. The form includes fields for the patient's information including name and medical record number. There is also space for the providing physician's name, address and phone number. In addition you must provide a reason why the claim may be denied by Medicare and an estimated cost for the procedure.

Review the ABN with Your Patient 

One of the primary purposes of the ABN is to inform the patient that they might be financially responsible for the service they will receive. Carefully go over the form and insure that the patient understands it's purpose and their responsibility if Medicare declines to pay. The patient's signature demonstrates their desire to receive the service even if they will have to pay for it. It also alerts Medicare of the patient's acknowledgement that the procedure was provided. The ABN form can also provide some protections to the patient. It gives them the opportunity to decline the services. Refusal to sign protects the patient from unwanted financial responsibility. With the ABN, the patient can also appeal in the event that Medicare denies the claim and the bill is passed to them.

ABN's are Sometimes Not Appropriate. 

ABN's are not needed for services normally excluded from coverage by Medicare. This would include things like annual examinations. They also do not apply to patients that are covered by a private insurance company's Medicare product and not directly enrolled with Medicare. Finally, the ABN must never be given to a patient who requires emergency treatment or a patient under duress of any kind. 

You can turn to ProMD for assistance with ABN's or any other Medicare or billing issue your practice might face. We offer a variety of consulting, training and billing services that can help your office be compliant with Medicare billing regulations and reduce the number of claim denials you receive. Call us today to schedule an appointment with one of our professionals.

Tips to Avoid Bottlenecks and Manage Your Patient Flow

Jose Carreras - Thursday, May 04, 2017

Running an efficient medical practice is very important to your ability to treat all of your patients in a timely fashion. Unfortunately, bottlenecks can occur during any day that can put you massively behind schedule. When this happens, you can end up dealing with a lot of annoyed patients who are waiting around well past their appointment times while your staff struggles to keep up with their work - and when you and your staff are running around trying to get things done frantically, there's more risk for potential error, which can compromise your ability to effectively treat your patients.

The following are a few tips to help prevent bottlenecks from happening and to manage your patient flow: 

Get rid of no-shows- No-shows can be incredibly irritating since they represent gaps within your schedule during which you could be getting work done. Try to eliminate no-shows by calling scheduled patients a day ahead of time to confirm the appointment and by charging no-show fees. When a gap in your schedule shows up because of a no-show, have a list of tasks ready that you can complete, such as phone calls and prescription refills. Just make sure these tasks don't bleed into your next appointment.

Prevent late appointments - Patients that show up 30 minutes late throw your entire schedule out of sync. It causes other patients to have to wait well past their own appointment times, which will cause them to grow annoyed. Consider setting up a 15 minute window after which patients must reschedule and after which they must pay a fine. You'll find that those patients will never be late again.

Fit patients in wherever possible - If an appointment is taking longer than expected, see if you can see another patient in between. For example, you could have a nurse draw blood work while you see another patient.

Be careful about scheduling - You don't want to double book anyone or you're going to fall way behind for the day. If you know a certain procedure is going to take a lot of time, make sure that you allow for it on your schedule. The last thing you want to do is create a bottleneck because you didn't schedule the day properly.

Schedule specific time slots for sales people - If you keep getting sales people at your door trying to get five minutes of your time, set aside two time slots in your weekly schedule for this purpose only. This way, you won't lose time listening to their pitch when they show up and you won't lose appointment time booking too many meetings throughout the week with these sales people whenever they pop up.

Identify the cause behind your bottlenecks - If bottlenecks seem to happen somewhat frequently, pay attention to the time at which they tend to happen and inspect all of the factors, including who all is on your staff and what their tasks are during this period. It could be because on of your employees is slow and needs to be re-trained - or it could be because you're understaffed during certain times of the day and you need to schedule another employee for that time period.

Emphasize teamwork - Make sure that everyone knows what your daily schedule is and inform everyone when you are beginning to lag behind. They'll be more likely to step up their efforts as a team. 

These are just a few tips for helping you manage your patient flow and to avoid bottlenecks from occurring. For more information on how we can help improve your medical practice, be sure to contact us at ProMD today.

Submitting Incident to Billing Claims

Jose Carreras - Tuesday, April 25, 2017

Submitting Incident to Billing Claims

To many physicians and medical practice staff members incident to billing can be a somewhat confusing concept. When billed "incident to" for services provided by a non-physician practitioner (NPP), like a nurse practitioners, physician assistants or clinical nurse specialists, the Medicare claim is submitted under the physician's National Provider Identifier (NPI) number, and not the NNP's. This results in reimbursement at 100 percent of the fee schedule instead of the 85 percent that is paid when billed under the NPP's NPI. 

There are criteria, of course. According the the Centers for Medicare and Medicaid Services (CMS), to be billed as "incident to" a service must be part of the patient's normal treatment course, a physician must have performed the initial service and the physician must remain actively involved in the patient's treatment. Furthermore, the physician must provide "direct supervision," which really means available in the office suite if needed. What follows are the specifics of the qualifying criteria, as detailed in the Medicare Benefit Policy Manual, Chapter 15, Section 60.

Incident to services must be performed in a non-institutional setting, which CMS defines as any place other than a hospital or skilled nursing facility. 

A physician with Medicare credentials must initiate the patient’s healthcare, and incident to services cannot be provided on the patient's first visit. If the patient develops a new symptom, or if symptoms worsen, the physician must conduct another evaluation and establish a diagnosis and treatment plan before the NPP can provide additional services that can be billed incident to. 

To qualify as incident to an NPP's care care must occur under the direct supervision of a qualified physician. In this context, direct supervision means that the physician is present in the office suite and available to provide assistance immediately if needed. The assisting physician does not have to be the one who initially saw the patient and is overseeing their treatment.

There must be a physician who participates actively in and manages the patient's treatment plan. In most cases the active participation requirements are spelled out by state licensure rules concerning NPP supervision. The physician and the NPP providing the incident to service must both be employed by the organization that is submitting the bill. 

If the NPP's service meets all of these qualifications, it can be billed as incident to under the physician's NPI, however, the submitted claim should include details about who performed the service and what physician was on hand to assist. 

Keep in mind that incident to billing only applies to Medicare and should not be used if the service performed has its own benefit category. ProMD Practice Management offers consultation services and staff training that could help insure proper billing procedures at your medical practice. Contact us today to learn more.

The Benefits of Using Our Medical Billing Service

Jose Carreras - Tuesday, April 18, 2017

If you are running a medical practice of some kind, then odds are you're forced to devote some of your or your employees' time to medical billing. This can be somewhat of an issue if you don't have a staff dedicated solely to medical billing. Most practices have a few employees who share that responsibility among others. Because of this, outsourcing your medical billing services to us at ProMD will allow you to free up valuable resources while also improving your medical billing service.

The Benefits of Using Our Medical Billing Service

The following are just a few of the benefits that your practice will enjoy if you decide to outsource your medical billing services to ProMD:  

  1. Your employees can focus more on other tasks - The employees who were in charge of your medical billing and collections will be able to focus on their other tasks, which will make your practice run much more efficiently and effectively. It also might mean that you won't have to have as big of a staff, which in turn can help to reduce your overhead.
  2. There will never be any medical billing delays - If the employee in charge of medical billing and collections takes a day off because they are sick, then your medical billing and collections services will be delayed, which means so will your ability to collect claims. When you outsource these services, claims will be filed as soon as possible without delay. If the person in charge of your medical billing and collections is out, another expert will be able to temporarily take their place.
  3. You'll have no trouble keeping up with growth - One of the challenges facing many medical practices is that when they begin expanding, they have trouble keeping up with medical billing and collections. When you outsource these services to us, we'll be able to keep up with the growth of your practice without missing a beat.
  4. Highly trained specialists will be in charge - The rules and regulations involved with medical billing and collections can be very complicated - and they're always evolving and changing. Keeping up with this information can be very time consuming for employees who have other work to do in addition to billing and collections. Additionally, a specialist will have a better chance of filing a successful appeal for any claims that were denied due to their expertise and experience.
  5. Increase control of your medical billing - One of the perceived drawbacks of outsourcing medical billing and collections services is that you lose control over that facet of your practice. However, this is a bit of a misconception. In a way, you'll have more control over it because it will become more organized. We will present you with monthly and annual billing and collection reports and comparisons so that you can track all of your numbers. Additionally, we provide in-depth but easy to read account receivables analysis.
  6. Maximize your collections - Our specialists are much less likely to make errors while filing your claims because of the fact that they are not only highly trained, but also because their job is solely to handle medical billing and collections. The fewer errors that are made, the fewer claims will be rejected, allowing you to collect more revenue quicker. 

As you can see, outsourcing your medical billing services to ProMD can help free up resources in your own practice while also improving your medical billing service as a whole, thereby reducing billing related issues, maximizing collections and achieving optimal billing performance.

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


Time to Outsource Your Medical Billing?

Jose Carreras - Wednesday, June 21, 2017

Is it Time to Outsource Your Medical Billing? 

Does your medical practice have the resources to maintain a full-time staff to handle coding, billing, contracting and claim denials? Many small practices do not and try to get by with a limited and overworked staff. Depending on the size of your practice and the volume of patients seen, you may not be able to staff a billing department fully so that it can get claims out the door efficiently and deal with all the other details involved in a medical practice’s revenue cycle. 

Revenue cycles have become increasingly complicated. To truly eliminate any risk of non-compliance, a medical practice can expect to hire and maintain a team of certified coders and billers as well as a knowledgeable staff, current on all government regulations and payer requirements. It can be done, but the cost, in time and money, may not be worth it.

Greater Efficiency 

By contracting a qualified billing and collection company, you are putting a team in place that you may not be able to hire as full-time staff. A good billing company makes efforts to stay current on government regulations as well as insurance company rules and requirements. You can expect properly coded claims to go out on time and error free, and claim denials to be appealed and followed up on. Outsourcing your billing can decrease your risk of non-compliance. A practice without the resources to maintain a billing staff fully trained on the latest regulations may expose itself to compliance issues that can seriously impact revenue. 

Removing the burden of billing operations will allow your existing staff to shift their focus back to performing more pressing tasks that will make your office run at a higher efficiency. Furthermore, you can expect your practice’s collection rate to increase. Customers of ProMD’s billing services, for instance, enjoy collection rates as high as 98%.

Finally, a billing and collection company can offer a variety of financial performance reports that will help you to maximize your workflow and efficiency. With data rich reports on your practice’s performance, you will be able to recognize trends quickly and act when opportunities arise.

What to Look for in a Billing Service 

Not all billing companies are created equal. When researching a medical billing and collections company make sure they are offering a complete set of services that you would not be able to easily put in place in-house. Find out if they employ certified coders and whether provider enrollment, contracting and credentialing is included. A full service medical billing company should provide the following services: 

  • Charge posting
  • Billing
  • Collection
  • Denial appeals
  • Payment posting
  • Billing and collection reporting
  • Account receivables analysis

If you are ready to outsource your medical practice’s billing, consider ProMD Practice Management. ProMD offers full service billing and collection solutions. With our proven processes and infrastructure, we are able to offer our clients higher claim payments in a shorter amount of time.

Call us today to learn about our full line of billing services.

Preventing Cash Flow Problems

Jose Carreras - Thursday, June 15, 2017

The healthcare insurance industry is in somewhat of a flux at the moment, which can cause problems for any practices that aren't paying careful attention to what's going on. For example, patients are being held more responsible for health insurance costs than insurance payers, which is evidenced by the rising co-payments and deductibles.

This can be a problem for medical practices due to the fact that patients tend to pay much slower than insurance payers, which means that if they aren't careful, their cash flow could decrease.

Preventing Cash Flow Problems

Because patients are being forced to pay higher costs, it means that more of your cash flow is dependent on your patients than on insurance companies. According to the National Center for Health Statistics, 25% of families have an unpaid healthcare bill, 10% of families have medical bills they can't pay at all and 20% are on a payment plan to pay off their bills over time.

As you can imagine, this could affect your cash flow drastically, especially if the co-payments and deductibles of your patients continue to go up. Fortunately, there are a few steps that you can take to help keep your cash flow from declining. The following are a few such steps:

Collect payment upfront - Don't allow patients to pay after their appointment. Make it a practice to require payments up front. Have a sign that states this and post it on your website. Make sure your staff reminds your patients that they will need to pay their co-payments whenever they call them to remind them about their scheduled appointments.

Take multiple forms of payment - To encourage patients to pay what they owe upfront, offer them a number of ways to pay, such as with cash, by check, by credit card or by debit card. This way, your patients can't use the excuse that they don't have cash on hand to pay.

Keep patient credit card info on file - One way that you can reduce unpaid medical bills is by keeping patients' credit card information on file and getting them to agree to allow you to automatically bill their card for what they owe. You will need permission to do this, of course, and you'll have to make sure you take security precautions to keep their credit card information safe.

Provide an incentive for paying upfront - Some patients may try to pay later. While this is preferable to not being paid at all, you can get some of these patients to pay upfront with incentives, such as a small discount for paying before their appointment instead of after.

These are a few tips to help prevent cash inflow problems. But there are also cash outflow issues you should look into as well. The following are a few ways you can limit cash outflow:

Analyze your staff - Figure out how much time your staff spends working. If they have a lot of downtime, then you may be overstaffed.

Outsource billing and collections - Outsourcing medical billing and collections services can help to not only improve your collections, it could allow your office to run much more efficiently and effectively, and may even allow you to reduce some of your staff.

These are just a few ways that you can improve your cash flow and prevent potential cash flow problems that might arise as the healthcare insurance industry is in the midst of potential change. For information about our billing and collection services, be sure to contact us at ProMD today.

3 Steps to Increase Profitability

Jose Carreras - Friday, June 09, 2017

We can count on the cost of providing quality medical care to continue to rise even while having to face forces that lower reimbursement to providers in the healthcare industry. It is easy to get caught up in the day to day operations of your medical practice management and lose your focus on the financial health and trajectory of your practice. Take some time every month to examine the bottom line affect of the systems that are in place in the office. Try to be objective as you review your own routines and habits as well as those of your staff. What follows is a non-exhaustive list of areas to consider as well as suggestions on some steps to take to increase profitability. 

Examine the Revenue Cycle

There are a number of steps between collecting a patient's insurance information and closing their account as paid in full, each of which can have an affect on a medical practice's net income. Each month, take a look at the overall revenue cycle to insure there are no obvious snags or bottlenecks that could slow the flow of income. Then, each month, decide on a particular element to delve into further. It could be a review of the insurance verification procedure or the process for resubmission of denials. Sit down with the person responsible and ask them to walk you through their task. Encourage their input and work together to fix problems and implement new ideas.

Use of proper coding

Coding errors and under coding are often primary causes of income loss in medical practices. Proper coding speeds and maximizes reimbursement while reducing costly and time wasting payment denials. Make sure that all providers and relevant staff are up to date on coding changes when they go into effect in October.

Outsource your Medical Billing

One sure and quick way to increase your medical practice income is to hand the medical insurance billing to a professional billing company. Customers of ProMD Practice Management's billing services enjoy collection rates in the high 90's.

Most medical practices do not have the manpower to achieve the results of a dedicated billing company.

Maximizing Collections and Improving Billing Performance

Jose Carreras - Tuesday, May 30, 2017

When it comes to the differences between struggling medical practices and successful medical practices, it often comes down to billing and collections efficiency and not the actual quality of the medical services. Maximizing your collections and improving billing performance will help to bring in more revenue, but it's something that a lot of medical practices have trouble actually doing.

Demand co-pays up front - Make it known to your staff that you cannot bill your patients later for their copays. They should be trained to ask the patient for their copay. Don't forget to let the patients know as well so that they have no excuse for not being able to pay for their copay upfront. Put your policy up on your website where patients can clearly see it as well as at your reception desk. Have your staff remind patients about their copay when they call them to remind them about scheduled appointments. 

Check insurance eligibility - Train your staff to check the insurance eligibility for every patient before their scheduled visit so that you know exactly what they owe when they show up for their appointment. This ensures that they not only have active insurance but that you can charge them for the appropriate co-pay up front.

Provide multiple payment options - Make it easy for your patients to pay and they won't have an excuse not to. For example, if you only accept cash and they only have a credit card, you'll be forced to bill them later. Accept as many forms of payment as possible, including cash, credit cards, debit cards and checks, so that they have no excuses for not paying.

Set up payment plans - Patients that are unable to pay what they owe at the time of their visit or who have a balance past due should be placed on a payment plan. Document the plan and have the patient sign it. Payment plans are an effective way to get patients with past due balances to begin paying what they owe since otherwise, they may end up not paying at all.

Use urgent language on patient statements - Get rid of any casual deadlines on your statements, such as those that read that they must pay within 30 days. Instead, the first statement should read "Due Now" and any additional statement should read "Past Due." When you send out final notice letters, do so at least two weeks before sending their balance to collections. 

Remove old data - As you update your system with the new data of your patients, including insurance card data and personal information that should be validated on every visit, you should also go through the patient information you have and remove the data of patients that have left a long time ago. Some of these patients may have outstanding balances that still need to be paid. If they are small, you should consider writing them up as a loss instead of wasting resources continuing to bill them. 

These are just a few of the strategies that you should consider implementing into your practice policy in order to maximize collections and improve billing performance. As you can imagine, it does take a lot of time and effort to keep track of collections, which is why you might want to consider outsourcing your collections and billing.

Outsourcing can not only help you maximize your collections as well, but will free up time and make your office run more effectively and efficiently, which in itself can help you improve your revenue. For information about our billing and collections service, be sure to contact us at ProMD today.

Check Your Billing Performance

Jose Carreras - Thursday, May 25, 2017

Check Your Billing Performance

To have a financially healthy medical practice you need to keep an eye on a number of indicators and compare those to industry standards. Billing benchmarks are a great way to compare your practice’s financial performance with the standards for the industry. What follows are some best practices and practical tips that can help keep your practice performing in league with the best. First, take some time to evaluate where your practice stands on some important benchmarks.

Industry Standards

How does your practice’s performance compare to these industry benchmarks?

Avg Days A/R – Best Practice is < 40
Avg Days A/R Over 120 – Best Practice is < 12-15%
Days from TOS to Billing – Best Practice is < 3 days
Net Collection Rate – Best Practice is > 96%
Denial Rate – Best Practice is < 3-5%
Claims Paid in < 45 Days – Best Practice is 85-90%

The adage is true, to manage you must measure. In the business world, one way to measure financial health is to compare your data with how the rest of the industry is doing and to established standards that define where performance should fall. The process is called benchmarking. It is a continuous process that measures and compares performance internally and externally. The benchmarks listed above are some of the most important and the ones that should be monitored at the very minimum. You want the numbers for your practice to be equal or better than each benchmark. First, you should work at getting the numbers where they need to be, and once everything is working optimally, try to surpass the benchmarks.

Accounts Receivables

It is no accident that the first two benchmarks are related to accounts receivables. Management of accounts receivable is important in any business. Not only do they represent money you are owed and have not been paid, but, in the healthcare field, the longer a bill goes uncollected, the less likely it is to ever be collected. For that reason, the two most vital accounts receivable benchmarks are the average number of days your receivables go uncollected, and how many of your receivables are over 120 old.

If your practice’s numbers are not hitting these benchmarks, then that is probably the place to start examining your revenue cycle. A low days in accounts receivable number means that the collection processes you have in place are working properly. Similarly, if too many of your unpaid claims are over 120 old, it is time to concentrate on getting those bills paid earlier.

Setting Future Goals

Although the ideal is to meet or exceed each of these benchmarks, do not consider your practice a failure if they are not. Instead, look at benchmarks as where you want your practice to move toward. Reaching these goals may take some time and maintaining those numbers will take effort as well. Start by concentrating on one or two benchmarks and move to the next one when you start to see improvement.

Benchmarks are a great tool and a great way to stay informed about your practice’s financial health. Invest in your practice by contracting with ProMD to perform a billing assessment. ProMD will analyze your historical performance as compared to industry benchmarks to determine areas in which you are doing well, but more important it will identify areas of improvements that will maximize results. 

ProMD's own performance as a billing company surpass those of the MGMA published benchmarks. Call us today to learn more how we can increase your overall collections.

How to Achieve Optimum Billing Performance

Jose Carreras - Friday, May 19, 2017

Billing can be a very complicated process, but it's one that is vital to the success of your practice. There are a number of potential problems that can result in claim denials, which will, in turn, hurt your ability to maximize your collections.

The following are some of the common billing issues that practices run into and how they can be resolved in order to achieve optimum billing performance: 

The claim is for uncovered services - You won't be able to collect on the claim if it's for a service that's not covered by insurance or if the insurance of the patient has been terminated. To avoid such problems, you should always make sure that patients are fully insured and covered before you provide them with medical services. 

The claim is missing information - Any time a claim is missing certain information, it can be denied. This includes information such as the date of the accident, the date of the medical emergency and more. The person filing the claim in your office has to be diligent about writing it to avoid such simple errors or it could end up costing you. 

The claim isn't filed on time - In accordance with the Affordable Care Act, you have to submit a claim within 12 months of the time that you provided the service. It must be received by the end of the 12-month period - not sent out by that date. If the claim isn't received on time, it may be denied. To ensure that this doesn't happen, you have to make sure that your billing process is streamlined and organized. 

The claim used incorrect patient identifier information - This could be as simple of a mistake as misspelling the patient's name. For every claim you submit, you need to make sure that all of the patient's information is correct, including their name, their date of birth, their insurance payer and their policy number. 

The claim isn't specific enough - Every claim that your practice submits must contain a diagnosis that is coded to the highest level for that code. For example, the code for diabetes is four digits, but a fifth digit is required to specify the type of diabetes. If you only include the four digit code, your claim is likely to be denied. 

The claim uses the wrong code - If the wrong code is used, then the claim can be denied. Make sure that you not only use the right codes, but that your coding book is up to date. Otherwise, you'll have to appeal the denial, which requires more resources and will make the process of getting paid take even longer.

The claim doesn't properly support medical necessity - In some cases, a payer won't adjudicate a claim unless you provide certain medical records proving that the service you provided was necessary to the patient's health. In such a case, you may need to provide the physical reports, medical history, discharge summaries, consultation reports and more.

To avoid being unable to meet these requirements, always keep documentation that supports the necessity of the service you've provided. These are some of the most common billing related issues that can hurt your ability to maximize your collections.

One way to make sure that you avoid all of these problems is by outsourcing your billing services. For information about outsourcing your billing services in order to achieve optimum billing performance, be sure to contact us at ProMD today.

3 Steps To Insure Your Practice is Complying with Medicare's ABN Guidelines

Jose Carreras - Thursday, May 11, 2017

ABN's Will Help You Get Paid When Medicare Denies a Claim

There are instances when Medicare may not pay for services that are normally covered or that it does not consider medically necessary. If there is a reason to suspect that Medicare may not pay for a particular service, it is important to have the patient sign form CMS-R-131, the Advance Beneficiary Notice of Non-coverage (ABN). Do this before providing the services to insure that there is not confusion on the patient's part. Remember that ABN's do not apply to commercial insurance companies.

An ABN makes it clear to the patient that they may have a financial obligation if Medicare denies the claim for payment. Furthermore, without a signed ABN, the medical practice will be unable to collect payment from the patient and will have to write off the claim as denied by Medicare. There are three steps that should be taken to insure that your practice is complying with Medicare's ABN guidelines.

Determine When to Use an ABN 

Medicare rules do not allow a practice to simply issue an ABN for every single service they perform. For this reason, you should figure out when the form is likely to be needed. A simple review of past claim denials and coverage determinations will reveal what procedures Medicare might not pay for in the future. After that, put together a list of typical procedures that have been denied by Medicare for reference.

Properly Complete the Form 

The ABN form can be found on Medicare's website. In order to be valid it must be filled out properly. Otherwise, it will be denied just like the original claim. The form includes fields for the patient's information including name and medical record number. There is also space for the providing physician's name, address and phone number. In addition you must provide a reason why the claim may be denied by Medicare and an estimated cost for the procedure.

Review the ABN with Your Patient 

One of the primary purposes of the ABN is to inform the patient that they might be financially responsible for the service they will receive. Carefully go over the form and insure that the patient understands it's purpose and their responsibility if Medicare declines to pay. The patient's signature demonstrates their desire to receive the service even if they will have to pay for it. It also alerts Medicare of the patient's acknowledgement that the procedure was provided. The ABN form can also provide some protections to the patient. It gives them the opportunity to decline the services. Refusal to sign protects the patient from unwanted financial responsibility. With the ABN, the patient can also appeal in the event that Medicare denies the claim and the bill is passed to them.

ABN's are Sometimes Not Appropriate. 

ABN's are not needed for services normally excluded from coverage by Medicare. This would include things like annual examinations. They also do not apply to patients that are covered by a private insurance company's Medicare product and not directly enrolled with Medicare. Finally, the ABN must never be given to a patient who requires emergency treatment or a patient under duress of any kind. 

You can turn to ProMD for assistance with ABN's or any other Medicare or billing issue your practice might face. We offer a variety of consulting, training and billing services that can help your office be compliant with Medicare billing regulations and reduce the number of claim denials you receive. Call us today to schedule an appointment with one of our professionals.

Tips to Avoid Bottlenecks and Manage Your Patient Flow

Jose Carreras - Thursday, May 04, 2017

Running an efficient medical practice is very important to your ability to treat all of your patients in a timely fashion. Unfortunately, bottlenecks can occur during any day that can put you massively behind schedule. When this happens, you can end up dealing with a lot of annoyed patients who are waiting around well past their appointment times while your staff struggles to keep up with their work - and when you and your staff are running around trying to get things done frantically, there's more risk for potential error, which can compromise your ability to effectively treat your patients.

The following are a few tips to help prevent bottlenecks from happening and to manage your patient flow: 

Get rid of no-shows- No-shows can be incredibly irritating since they represent gaps within your schedule during which you could be getting work done. Try to eliminate no-shows by calling scheduled patients a day ahead of time to confirm the appointment and by charging no-show fees. When a gap in your schedule shows up because of a no-show, have a list of tasks ready that you can complete, such as phone calls and prescription refills. Just make sure these tasks don't bleed into your next appointment.

Prevent late appointments - Patients that show up 30 minutes late throw your entire schedule out of sync. It causes other patients to have to wait well past their own appointment times, which will cause them to grow annoyed. Consider setting up a 15 minute window after which patients must reschedule and after which they must pay a fine. You'll find that those patients will never be late again.

Fit patients in wherever possible - If an appointment is taking longer than expected, see if you can see another patient in between. For example, you could have a nurse draw blood work while you see another patient.

Be careful about scheduling - You don't want to double book anyone or you're going to fall way behind for the day. If you know a certain procedure is going to take a lot of time, make sure that you allow for it on your schedule. The last thing you want to do is create a bottleneck because you didn't schedule the day properly.

Schedule specific time slots for sales people - If you keep getting sales people at your door trying to get five minutes of your time, set aside two time slots in your weekly schedule for this purpose only. This way, you won't lose time listening to their pitch when they show up and you won't lose appointment time booking too many meetings throughout the week with these sales people whenever they pop up.

Identify the cause behind your bottlenecks - If bottlenecks seem to happen somewhat frequently, pay attention to the time at which they tend to happen and inspect all of the factors, including who all is on your staff and what their tasks are during this period. It could be because on of your employees is slow and needs to be re-trained - or it could be because you're understaffed during certain times of the day and you need to schedule another employee for that time period.

Emphasize teamwork - Make sure that everyone knows what your daily schedule is and inform everyone when you are beginning to lag behind. They'll be more likely to step up their efforts as a team. 

These are just a few tips for helping you manage your patient flow and to avoid bottlenecks from occurring. For more information on how we can help improve your medical practice, be sure to contact us at ProMD today.

Submitting Incident to Billing Claims

Jose Carreras - Tuesday, April 25, 2017

Submitting Incident to Billing Claims

To many physicians and medical practice staff members incident to billing can be a somewhat confusing concept. When billed "incident to" for services provided by a non-physician practitioner (NPP), like a nurse practitioners, physician assistants or clinical nurse specialists, the Medicare claim is submitted under the physician's National Provider Identifier (NPI) number, and not the NNP's. This results in reimbursement at 100 percent of the fee schedule instead of the 85 percent that is paid when billed under the NPP's NPI. 

There are criteria, of course. According the the Centers for Medicare and Medicaid Services (CMS), to be billed as "incident to" a service must be part of the patient's normal treatment course, a physician must have performed the initial service and the physician must remain actively involved in the patient's treatment. Furthermore, the physician must provide "direct supervision," which really means available in the office suite if needed. What follows are the specifics of the qualifying criteria, as detailed in the Medicare Benefit Policy Manual, Chapter 15, Section 60.

Incident to services must be performed in a non-institutional setting, which CMS defines as any place other than a hospital or skilled nursing facility. 

A physician with Medicare credentials must initiate the patient’s healthcare, and incident to services cannot be provided on the patient's first visit. If the patient develops a new symptom, or if symptoms worsen, the physician must conduct another evaluation and establish a diagnosis and treatment plan before the NPP can provide additional services that can be billed incident to. 

To qualify as incident to an NPP's care care must occur under the direct supervision of a qualified physician. In this context, direct supervision means that the physician is present in the office suite and available to provide assistance immediately if needed. The assisting physician does not have to be the one who initially saw the patient and is overseeing their treatment.

There must be a physician who participates actively in and manages the patient's treatment plan. In most cases the active participation requirements are spelled out by state licensure rules concerning NPP supervision. The physician and the NPP providing the incident to service must both be employed by the organization that is submitting the bill. 

If the NPP's service meets all of these qualifications, it can be billed as incident to under the physician's NPI, however, the submitted claim should include details about who performed the service and what physician was on hand to assist. 

Keep in mind that incident to billing only applies to Medicare and should not be used if the service performed has its own benefit category. ProMD Practice Management offers consultation services and staff training that could help insure proper billing procedures at your medical practice. Contact us today to learn more.

The Benefits of Using Our Medical Billing Service

Jose Carreras - Tuesday, April 18, 2017

If you are running a medical practice of some kind, then odds are you're forced to devote some of your or your employees' time to medical billing. This can be somewhat of an issue if you don't have a staff dedicated solely to medical billing. Most practices have a few employees who share that responsibility among others. Because of this, outsourcing your medical billing services to us at ProMD will allow you to free up valuable resources while also improving your medical billing service.

The Benefits of Using Our Medical Billing Service

The following are just a few of the benefits that your practice will enjoy if you decide to outsource your medical billing services to ProMD:  

  1. Your employees can focus more on other tasks - The employees who were in charge of your medical billing and collections will be able to focus on their other tasks, which will make your practice run much more efficiently and effectively. It also might mean that you won't have to have as big of a staff, which in turn can help to reduce your overhead.
  2. There will never be any medical billing delays - If the employee in charge of medical billing and collections takes a day off because they are sick, then your medical billing and collections services will be delayed, which means so will your ability to collect claims. When you outsource these services, claims will be filed as soon as possible without delay. If the person in charge of your medical billing and collections is out, another expert will be able to temporarily take their place.
  3. You'll have no trouble keeping up with growth - One of the challenges facing many medical practices is that when they begin expanding, they have trouble keeping up with medical billing and collections. When you outsource these services to us, we'll be able to keep up with the growth of your practice without missing a beat.
  4. Highly trained specialists will be in charge - The rules and regulations involved with medical billing and collections can be very complicated - and they're always evolving and changing. Keeping up with this information can be very time consuming for employees who have other work to do in addition to billing and collections. Additionally, a specialist will have a better chance of filing a successful appeal for any claims that were denied due to their expertise and experience.
  5. Increase control of your medical billing - One of the perceived drawbacks of outsourcing medical billing and collections services is that you lose control over that facet of your practice. However, this is a bit of a misconception. In a way, you'll have more control over it because it will become more organized. We will present you with monthly and annual billing and collection reports and comparisons so that you can track all of your numbers. Additionally, we provide in-depth but easy to read account receivables analysis.
  6. Maximize your collections - Our specialists are much less likely to make errors while filing your claims because of the fact that they are not only highly trained, but also because their job is solely to handle medical billing and collections. The fewer errors that are made, the fewer claims will be rejected, allowing you to collect more revenue quicker. 

As you can see, outsourcing your medical billing services to ProMD can help free up resources in your own practice while also improving your medical billing service as a whole, thereby reducing billing related issues, maximizing collections and achieving optimal billing performance.

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

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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