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Why Choosing a Large and Successful Outsourced Billing Service is Critical to Your Billing Success

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I’ve been in the speech recognition business for 15 years, and have watched as thousands of physicians have utilized Dragon Medical, and have adopted it to their personal medical practice. Each one has his or her own speech patterns, and as Dragon makes mistakes they individually correct each mistake, making it much less likely that the same mistake will occur again… in their office and on their computers.

Similarly, I’ve been a practicing physician for 25 years, and have watched as each medical office that bills for its medical services scrupulously scrubs the data returning from dozens of payors, and corrects their fee schedules, their algorithms and billing methodologies depending upon the payments as indicated by the EOBs received from each of the varied payment sources.

Each of these phenomena have a lot in common, most critical of which is that in each instance, very similar activities are being replicated across tens of thousands of offices around the country. This leads to a significant amount of potential inefficiency, and as an Orthopedic Surgeon, efficiency is top priority.

There are not many alternatives to this workflow when it relates to speech recognition software such as Dragon Medical, in part because each individual physician has, by definition, unique characteristics in speech patterns, in dictation and in language usage. There are, however, clear alternatives when it comes to medical billing, as the individual unique genetically induced differences are absent in this field.

Any individual outsourced billing company that is billing for more than one office is capable of, and in fact should be utilizing the knowledge from each and every EOB that it receives to improve the services it provides to every single office for which it is billing.

In this fashion, there is a tremendous advantage in utilizing the services of an outsourced billing company that is providing billing services for thousands of physicians. You will not need to pay your staff to learn something new each time there is a change in a fee schedule, a change in a payment parameter or any other rules change, because there is a very high probability that this knowledge will already be available to the outsourced billing company you have chosen. In this fashion it is exceedingly likely that you will be able to collect a meaningfully higher percentage of your billing, freeing up your office staff to concentrate on patient care, and making the few percent of collections that are being charged a true bargain.

The Benefits of Outsourced Billing Services: Optimize Your Operational Workflow

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The complexities of the current economic scenario aggravated by the constantly changing or evolving rules for insurance claims, as well as new policies promulgated by the HIPAA, have made it difficult for healthcare professionals and providers to optimize their workflow.

In line with this, several practices and medical institutions have already shifted from the traditional system of maintain billing and healthcare reimbursement facilities in-house and moved to external providers. Many have already gained from the benefits of outsourced billing services, allowing practices and institutions to focus fully in their core function – and that is to provide proper patient care.

Operational Problems Encountered with Traditional In-House Billing Systems

Before delving on how outsourced billing services can help optimize the healthcare workflow processes, one must first understand the pitfalls that are usually associated with the traditional in-house billing systems.

  • Unless the medical institution is large enough to have an internal billing department that is solely focused on medical billing work, the practice will have the tendency to lose full control of the billing process as medical staff would be divided between rendering their core medical functions and performing administrative work. This increases security risks and the possibility of rejected reimbursement of claims due to erroneous data.
  • Hiring your own medical billing personnel means an increase in overhead expenses plus the additional operational expenses incurred due to the required maintenance of a dedicated office, equipments and supplies. Other operational expenses include software upgrades, personnel training expenses, and employee benefits.
  • The practice or institution should also ensure that their internal medical billing services are up-to-date with the latest government and insurance regulations, the condition of the financial marketplace, and new advances in technology. Failure to comply with these policies and trends would make it more difficult to maintain a profitable practice.

These and other problems associated with traditional medical billing services provided the deciding factor why practices and institutions opted to outsource to medical billing providers and reap the benefits of outsourced billing services.

How Can the Benefits of Outsourced Billing Services Optimize Operational Workflow?

The following discusses one of the main benefits of outsourced billing services, and especially focuses on how these providers help medical professionals and practices optimize their workflow processes.

  • Medical billing providers have trained and expert staff in this field and utilizes the latest in billing tools, technology and software to make the process as efficient as possible. This allows a faster cycle time for claims reimbursement, which can be eventually translated as higher revenue.
  • These medical billing service providers maintain special relationships with insurance companies on top of their proven and effective leveraging strategies allowing better and faster results from reimbursement claims.
  • One of the most important benefits of outsourced billing services is the elimination of interruptions in the workflow process due to medical staff leaves, vacations and other workflow delays as all these aspects will be directly handled by the billing service provider.
  • Patient inquiries and phone calls can disrupt the workflow and eat up valuable time however, these should still be address. Outsourced billing services can handle this function and more.
  • Medical practitioners and staff are relieved of the responsibility of maintaining administrative staff which, although a critical aspect in the business, can drive them away from performing their core healthcare responsibilities. Given more time, they can now pace through their workflow in a more focused and relaxed atmosphere that is critical in this industry.

Medical practices and institutions who have gained much from the benefits of outsourced billing services have seen how this shift can affect a radical improvement in their bottom line. On top of that, these professionals are more successful and more effective in rendering proper healthcare and give value to their patients.

The Benefits of Outsourced Medical Billing Services: Features You Can Use

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More and more healthcare professionals, practices and institutions have moved from the traditional in-house billing facilities and slowly reaped the benefits of outsourced billing services. This tactical approach in the healthcare industry resulted in more streamline medical operations particularly in the efficient and professional management of medical billing. Physicians, surgeons, and healthcare organizations have benefited much in terms of time and cost savings, thereby allowing these professionals to render their time in more value-added patient care.

To gain much from the benefits of outsourced medical billing services, healthcare professionals and organizations should clearly understand all the features that are inclusive in service packages to guide them in the decision process. This is very significant particularly if the practice or institution is still in the selection stage for an outsourced billing service. The following describes some of the more notable features and related benefits that clients can derive from an outsourced medical billing service.

Features and Benefits of Outsourced Billing Services

There can be a considerable listing of all the benefits of outsourced billing that medical practitioners and institutions can gain from, some of which can be realized immediately upon implementation of the service. Most important among these benefits include those that affect the bottom line, particularly in terms of cost savings as well as higher revenues in a shorter span of time. Aside from that, here are the additional features that one should look for in outsourced medical billing services.

  • Billing and coding staff will be totally under the responsibility of the service provider, so that the healthcare professional or institution would not have to worry about manpower related issues like salaries, sick leaves or vacation leaves. Also, there will be no related state and federal tax requirements, as well as unemployment claims, which is important considering the current economic situation in the country.
  • Software upgrades are handled by the service provider and would ensure that they use the most updated software available. In relation to that, changes in the coding or billing requirements from insurance companies are assessed and assimilated by the service providers themselves.
  • Reimbursement of claims should be processed within 2 weeks, instead of the usual 90 days maximum processing time that traditional in-house billing facilities experience. This is one of the most notable benefits of outsourced billing that professional and healthcare institutions can enjoy. This is due to the more focused responsibility of billing service providers, as well as their existing special relationships with insurance companies.
  • The following are some of the basic key areas that are inclusive in the medical billing service packages offered by most service providers:
    • Handling of patient inquiries related to billing
    • Handling and processing of claims within 48 hours of receipt
    • Submission and monitoring of insurance claims
    • Follow-up of delinquent claims within 45 days after submission
    • Handles physician billing and coding
    • Insurance verification and reconciliation of accounts
    • Accountsand activity updates including delinquency and status reports
  • Outsourced medical billing service providers use customized software that can extract, chart and analyze all medical and billing data in a more comprehensive way, thus allowing performance indicators to be monitored in real time so that critical business decisions can be made systematically and accurately.

These and other features of outsourced billing services can help medical professionals and practices deliver their best focus and services related to patient care. This in turn will benefit not only the patients who receive better quality healthcare, but it can also impact the bottom line, resulting to a more profitable profession of healthcare business.

Choosing The Right Medical Billing Software For Your Practice

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If you have an in-house medical billing system and the necessary staff to handle the workflow, using medical billing software can dramatically improve the productivity and revenue cycle of your practice. Software can help automate the labor-intensive parts of the medical billing process and considerably speed up time-consuming (and error-prone) tasks such as patient data entry, claims submission, and payment application.

There are many good software applications that are available on the market and choosing the right one can be a daunting task if you don’t know what to look for.

Below are some features to check for when doing your research:

Medical Codes

One of the biggest advantages of using billing software is that you can eliminate cumbersome paper manuals on coding. Medical billing software gives you and your staff the ability to quickly search and insert billing codes with the simple click of a mouse. This vastly simplifies the process of claims preparation.

It is important however, to ensure that the medical billing software comes with an exhaustive and updated list of CPT, ICD, and HSPCS codes with a reliable system for periodically updating this list. Most software companies provide annual updates that can be bought for a small fee and installed either through a disc or downloaded from an online location.

It is also advisable to test-run the software to check for ease of use. The software should ideally offer a simple graphical interface for creating claims with easy search options and point-and-click functionality for choosing codes from a list.

HIPAA compliance

Apart from improving efficiency and reducing the number of errors, medical billing software can also help your practice meet HIPAA regulations related to individual privacy and security of healthcare information. There are many tools employed by different software development companies to meet these regulations. While these tools may not make your practice 100% HIPAA compliant, they can make a significant contribution. Most good medical billing software applications have several or all of the following tools built in:

Data encryption – This ensures that any information transferred online is intelligible only to the authorized recipients. 128-bit encryption is considered the industry standard.

Multi-level user authentication – This includes measures such as password protection, role-based access to restricted areas of the software/database, and automatic (timed) log off in case a workstation has been idle for some time.

Audit trails – Audit trails are records of all system activities including login information, files accessed, changes made to patient data, etc. These records are crucial for internal security audits.

Scheduled backups – These are necessary to prevent data loss. Most medical billing software comes with scheduled backup systems that allow you to periodically download critical patient data onto your hard drive or other secure location.

Claims Management
Electronic claims transmission not only speeds up the payment cycle but also reduces the number of rejected claims. Medical billing applications come with several time & cost saving features that can help practices improve their claims management system.

Visual Editors
Visual editors allow users to create and edit insurance claims forms through a graphical interface. Users can quickly add notes, make changes and submit claims at the click of a mouse.

Error Correction
This feature helps in minimizing rejected claims by highlighting missing information, mismatched ICD/CPT codes, and invalid insurance policy numbers, etc. before a claim is submitted for processing. This is a big time-saver and naturally reduces the possibility of claims being declined due to incorrect/incomplete forms.

Claims Submission
Submitting claims electronically can save hours of labor, reduce the number of rejected claims, and also speed up claims processing. Some insurance companies delay paper claims to up to 28 days, while electronically submitted claims can take just 24-48 hours.

Depending on the medical billing product you choose, there are several methods available for submitting claims electronically. One option is to send all claims to a clearinghouse. The clearinghouse will then forward the claims to the appropriate insurance carriers. This may, however, turn out to be expensive because of the per claim fee charged by the clearinghouse. Costs can be reduced by submitting claims directly to Medicare and Medicaid and processing the remaining through a clearinghouse.

Another option is direct online billing at the websites of the insurance carriers. Although there are no additional fees involved in this method, you must be an in-network provider with the relevant carrier to be able to submit claims at the carrier’s website.

Revenue Management
Medical billing software can significantly improve the payment cycle of any practice. This is through the account receivable module that comes with most software applications. This module helps practices keep track of payments received and payments outstanding. The software application also helps with faster payment applications to specific claims/charges, tracking how much of a payment remains to be applied, reporting payments receivable, automatic calculation of the write-off amounts, tracking billing, and other activities for improving the A/R cycle.

When choosing medical billing software, it is advisable to look for applications that either have these accounting features built-in or allow for easy integration with external accounting software such as Quicken or Peachtree. It’s also a good idea to thoroughly test the software to see if it has all the features required for your particular practice.

Medical Scheduling
Many software packages come with medical appointment schedulers that allow for easy management of patient appointments. Multiple features such as making or editing appointments, viewing daily, weekly, monthly appointments, viewing relevant patient demographics along with appointment details, scheduling recurring/multiple appointments, etc., can make these schedulers very useful for busy practices.

Trial period and Training
Most medical billing software developers offer trial versions of their software. Some also include on-site training for staff members who handle billing for a practice. These features give you the opportunity to not only check if the software has all the features advertised but also to test the suitability of the application for your particular practice. The usual trial period is of 30 days and provides you ample time to thoroughly test the software.

Technical support
As with all software applications, you and your staff would need ongoing technical assistance for the correct use and maintenance of the medical billing software. It’s therefore important to choose a vendor who can provide the necessary installation, training, and technical support. Most vendors provide an initial period of free support and then monthly or annual paid services.

There are many other features that can be compared and considered when deciding on the perfect medical billing software for your practice – software applications are constantly evolving to include more and better functionalities – but keeping these basic features in mind can help you make a reasonable choice.

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Managed Care: Low Cost Health Care for People

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Health is perhaps the most important aspect of our lives; most people invest much time and money to ensure good health for themselves and their family members. However, even with health insurance coverage healthcare does not come cheap. Given the increasing demand for healthcare services today, it has become essential to reduce the costs in order to make healthcare services available to all. This need for reduced healthcare costs coupled with the need to regulate healthcare services provided by healthcare professionals, has led to the creation of managed care, which helps regulate and optimize services provided by healthcare professionals at comparatively low costs.

What is Managed Care?
Managed care includes processes by which delivery of proper healthcare is managed and maintained at very low costs. The primary aim of managed care is to limit the per capita spending on healthcare by individuals, which in turn reduces the amount spent on healthcare in the country. Managed care can be defined to include either of the following two components:

  • Techniques that help reduce the cost of providing health benefits while improving the quality of healthcare to those organizations using such techniques or providing them as services to other organizations; or
  • A system whereby people who are enrolled, can avail of healthcare services as well as financial aid for such services, which are regulated and covered by managed care concepts.

History of Managed Care
It is interesting to note that the concept of managed care actually started back in the 19th century, where the system was introduced to take care of the health needs of specific groups like rural residents and lumber, mining and railway workers and their families. In those early days, the enrollees paid a fixed amount to the doctor who then provided healthcare services under a specific agreement. This fee could be charged monthly or annually, and would cover certain health services provided by professionals. This concept, however, was not accepted by the American Medical Association, which fought it tooth and nail and ultimately managed to limit its popularity, even despite a Supreme Court judgment upholding the value of such contracts.

It took until the 1970s for managed care to regain popularity and respect amongst both the doctors as well as the populace. The popularity was largely due to the increasing concern regarding healthcare costs, which led to the search for cost-effective healthcare services. Additionally, the increase in competition in the healthcare market prompted many healthcare organizations to use this route to increase their profits, which incidentally led many to misconstrue the exact meaning and value of managed care.

Goals of Managed Care
With the increasing popularity of managed care, most people, especially opponents to this concept, felt that this was solely a moneymaking opportunity, whereby healthcare providers can get away with providing cheap and irrelevant services and the people are always left for wanting more. However, nothing could be more wrong than this as the chief goals of managed care include the following:

  • The primary goal is to provide adequate and the best healthcare to all enrollees at reduced or controlled costs
  • Secondly, it aims to ensure that the healthcare so provided is adequate and required by the medical condition of the patient
  • Ensuring that such services are provided by appropriate healthcare providers
  • Lastly, to ensure that the entire process as well as the environment is not restrictive in any way

Different types of Managed Care Programs
There are three different types of managed care programs available today with varying levels of restrictions and unique features and processes. The three different types include-

  • Health Maintenance Organizations (HMO)
  • Preferred Provider Organization (PPO)
  • Point-of-Service (POS) plans
  1. Health Maintenance Organizations (HMO)
    The following steps and features characterize this managed care plan:
    • The HMO enters into contractual agreements with healthcare providers to form a network, which will be accessed by people enrolled with the HMO for healthcare services.
    • Members enrolled with such plans can only access those healthcare providers who are part of the network in order to avail healthcare benefits.
    • HMO will not pay for any services rendered by professionals who are not part of this network.
    • The first stage in this managed care plan is the appointment of a primary care physician, who is also called a gatekeeper. This primary care physician is the main person responsible for providing, arranging, coordinating and authorizing the healthcare needs of any member.
    • The primary care physician is also the sole authority under the scheme to provide referrals to specialists. Without obtaining such referrals, specialist consultations will not be covered and paid by HMO.
    • This plan is considered to be highly restrictive by many as it restricts the health service providers you can actually visit. However, having said that, it is important to add that this managed care plan is perhaps the least expensive of all plans in terms of out-of-pocket expenses.
    • Additionally, this plan does not require much co-payment from the enrollee as most of the payment has to be made well in advance.
  2. Preferred Provider Organization
    This is very similar to HMO and uses the same principle of creating a network or panel of health service providers, who can be approached for healthcare by people who have enrolled in this scheme. The main features of this scheme include:
    • Creation of a panel of health service providers who form what is called a provider network. However, this is not as restrictive as the HMO plan as it allows people to approach providers outside the network for healthcare services.
    • There is no gatekeeper or referral agent in place who directs and manages your health care needs.
    • Incentives are given to those enrollees who approach in-house service providers and these include higher reimbursements, lower co-payments and lower deductibles.
    • Lastly, while out-of-network service provider is not forbidden, the enrollee may have to pay as much as fifty percent of the healthcare service costs provided by such healthcare service provider
  3. Point of Service Plans
    This is a beautiful blend of both the above-mentioned plans, namely the HMO and the PPO, where the enrollee gets to choose the kind of plan he or she wants to opt every time he or she requires healthcare services. Given the increased flexibility and freedom of choice provided by this plan, it is slowly increasing in popularity.
    • The primary feature of this plan is that the enrollee gets to choose as per his or her requirement and is assured of healthcare services, irrespective of his/her choice.
    • There is a network of healthcare service providers, from which the enrollee can choose.
    • The option of appointing a primary care physician is given to the enrollee as also the choice of using such gatekeepers for providing referrals.
    • If the person uses in-house network services, deductibles, co-pays and co-insurance is low; but if the person uses out-of-network services, then the cost of these aspects increases.

How does Managed Care Work?

Managed care can be availed for curing as well as preventing all kinds of diseases and therefore, is a very important part of overall health care of an individual. Irrespective of the kind of plan you have chosen, the following main areas of focus (as mentioned below), will be part of the managed care process once you have enrolled:

  • Choosing a primary care physician who will be a nodal point of reference for all healthcare problems and services.
  • Acquiring referrals from your primary care physician, if and when the need to see a specialist arises.
  • Acquiring prior authorization in some cases from the primary care physician and insurance company for any hospitalization or diagnostic tests that may be required.
  • Creating a treatment plan for those enrollees with serious or long drawn medical conditions.

Managed care plans and processes not only increase profitability of healthcare providers, they also strive to provide excellent and yet low cost healthcare services to individuals. While the actual impact of this system is debatable, one can safely say that this is one step forward in providing adequate and low cost health care to people.

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Stand Alone Practice Management Systems

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Automation has become an integral part of our society today, with almost everything being computerized and available online. Under these circumstances, it is obvious that the medical field will not be left behind for long but will also enter the race for automation. While there are several areas where automation can help the medical community, one major area of interference required is the area of scheduling and billing. Irrespective of whether your medical establishment is small or large, financial and administrative duties are time consuming and tedious. Usage of practice management systems in the medical field has considerably reduced the burden on the staff as well as the doctors.

What are Practice Management Systems?

Practice Management systems are defined as a comprehensive system that deals with the daily routine affairs of hospital management, which includes scheduling appointments for patients, compiling their demographic details, processing the billing of various patients, preparing and maintaining lists of those that are insured and the insurance agencies and last but not the least, preparing reports in the different forms that are required. Each and every one of the tasks mentioned above is time consuming and not conducive to cultivating quality and efficient healthcare delivery.

While talking about medical records and information, people tend to equate PMS with EMR and EHR without realizing the differences in each of the medical recording systems. It is essential to note that while practice management system can be integrated and used in cohesion with other software and reporting systems, most small medical establishments still use the stand alone practice management system, which deals exclusively with scheduling and billing. The main point of difference is that such systems deal only with the administrative and financial aspects of medicine and not with the medical aspect of the field. Stand alone practice management systems essentially ensure that payables and receivables are well defined, so that there is no loss to the healthcare facility.

Such practice management systems are of three types:

  • Desktop Variety, which is essentially meant for a single user or at the most, a handful of users within the precincts of the healthcare center.
  • Client Server Variety, which as the name suggests, uses its own server to allow multiple users to access, modify and manipulate data
  • Internet variety, where the data can be shared and accessed by multiple users through the net, without any separate server systems

Reliability and security of data is different with each type of system, as the chances of data being compromised is more when multiple users have access to the system from remote places. However, having said that, it is important to understand that such access can actually help in increasing productivity and support the interoperability of health information.

What are the chief components of Practice Management Systems?

It is essential to reiterate again that stand-alone practice management systems normally deal with only the financial and administrative aspects of healthcare. Hence, the main components of such practice management systems also deal with the relevant aspects. Information required for various financial and administrative activities will be the focus of such systems. It is also important to add that the exact features of your chosen practice management system will largely depend on your requirements and the size of your healthcare facility. The following are some of the main components found in all practice management systems or software:

  • Information regarding the patient
    This is perhaps the most important part of any automated system, as it records all details regarding the patient. Chief among the details required by this system under this category include details like name, address, age, birth date, contact information, employer details and ultimately, insurance details. This is the area where people tend to confuse PMS with EMR or EHR and it is important to add here that the difference lies in the kind of data contained in the three records. The practice management system contains basic data regarding the patient and has no information whatsoever about his or her medical history or details of current treatment.
  • Scheduling of Appointments
    This is an excellent way to ensure that all patients get the best treatment and do not have to wait for long hours at the healthcare provider’s facility. This allows you to easily schedule appointments while preventing someone from booking double. Moreover, it also allows your staff to know the exact nature of the appointments scheduled for the day, thereby making it easy for them to retrieve necessary case files.
  • Insurance claims and statements
    With increasing number of people being insured under various schemes, it often becomes very difficult for hospitals and other medical facilities to keep track of each patient. The practice management system eases this burden of the hospital staff by enabling them to enter the requisite data for claims, process it and also file it. Further, with the help of such systems, it is possible to separate claims that are not paid or partially paid, thereby making it easier to follow up, with both the patient as well as the insurance company.
  • Reporting
    In order to ensure smooth running of any healthcare facility, it is important to create regular reports, which allow you to monitor and modify all areas of practice. Financial reporting is essential to understand your profits as well as mark your future receivables. As the growth of any organization is dependent on its reporting, most practice management systems offer detailed reporting and analysis, including that of service, fee schedule, expense and other similar categories.

Advantages of using Practice Management Systems
There are several advantages of using stand-alone practice management systems and these include

  • The first and most important benefit of using such systems is the enhanced productivity that can be witnessed in any establishment. The system is so user-friendly and simple that it allows the user to finish his or her work in no time, leaving enough time to look into other matters, which would have been impossible otherwise.
  • Secondly, scheduling being one of the major aspects of such systems, it allows for flexibility in booking appointments as well as immediate retrieval of information. Both these aspects help keep patients happy.
  • The insurance facility of this system allows you to process claims faster than you would manually do. Hence, it allows for faster payments, which in turn means increased profitability every month.
  • Lastly, the program can allow for fewer mistakes to be made while billing. It allows you to immediately correct your mistakes and resend your claim in a matter of few hours, making life simple for both you and the insurance company.

Essential features of a good stand-alone practice management system

Having understood the importance and advantages of stand-alone practice management systems, it is important that you choose a good one for your establishment, especially if you really want to profit from using it. The following features are essential in any good practice management systems:

  • The first and most essential aspect of any system is that it should be easy to use, without requiring any great computer expertise. Look for systems that have a user-friendly, preferably graphic-based interface, which makes it easy to understand and use.
  • Always ensure that your chosen system is compatible with any other software you might be using, especially if you want to transfer the data into this software and do not want to retype the entire thing.
  • Never compromise on data security; choose a system that will enable you to store data safely.
  • Retrieval of information is very essential for any establishment; so, always opt for a system that allows easy retrieval of information, based on your needs and requirements.
  • Last but not the least, opt for systems that cater to your needs and requirements and do not charge you for any unnecessary feature, which you do not need. Hence, it is absolutely essential to make a list of your requirements and then opt for a system that caters to it. This will help keep costs in control while providing you with a useful system.

The Benefits of Outsourced Medical Billing

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Similar to trends experienced by most economies, the healthcare industry has become highly competitive and ultra fast-paced. Those who don’t keep up will definitely be left behind. With international players in the Medical Tourism industry offering extremely low prices using internationally competitive quality standards, local health professionals and providers have no option but to bring their businesses to the next level, which might mean considering expanded billing capabilities with their own or outsourced electronic medical billing and coding systems.

There are several small to large individual physician practices, hospitals, clinics and other healthcare institutions that have gained largely from the benefits of outsourced billing services, making it a primary option of choice among organizations planning to take this route in their billing systems. Such companies and billing services are staffed with highly competent billing experts and other related professionals that could quickly and efficiently deliver the maximum results at very cost-effective prices. The results: higher efficiency in the medical organizations operational process which can later be translated into higher revenues.

The Features of Outsourced Medical Billing Services

Before a particular healthcare professional or medical institution can reap the full benefits of outsourced billing services, they should first learn and understand the basic features that play an intrinsic part in such systems. The following describes some of these features that should be found in good outsourced billing services.

  • Should have a complete reimbursement system including but are not limited to:
    • Doctor billing
    • Filling of insurance claims and follow-up
    • Collections from patients
    • Accounting and Data Analysis
    • Online Financial Reporting
  • An established quality checking and proof reading system to countercheck errors in forms and data
  • All data, documents and other online information should be stored in a highly secured system or facility
  • Strict confidentiality should be maintained at all times
  • System is supervised by qualified medical experts and should strictly adhere to all HIPAA guidelines

The Benefits of Outsourced Medical Billing Services

There are several benefits of outsourced medical billing services from which medical professionals or institutions could fully gain.

  • Healthcare is a very critical service industry and one of the main benefits of outsourced medical billing services is to relieve medical professionals from this administrative task and allow them to concentrate more in providing better healthcare services for their patients.
  • Reduced operational costs for additional labor, computer and office systems, supplies and other operational expenses
  • Errors are widely minimized and chances for claim rejections would be greatly reduced, resulting in better turnaround time and higher revenues
  • Relieve medical staff from spending excessive time in answering billing inquiries and other related matters that keeps them off their main focus in providing optimum patient care

Each of these benefits will be discussed in greater detail in separate articles to come. This series of articles will help end users to understand the full implications and advantages of outsourcing their billing systems. The benefits of outsourced medical billing are quite considerable and will provide any healthcare professional or practice the leeway they need to finally improve on their billing systems, minimize on costs, and increase revenues for their practice or business.

The Benefits of Outsourced Medical Billing: Save Time for Medical Practices

Most industries grew more competitive in the current economic situation that the country and the rest of the world is facing , and the same is true for the medical professionals, providers, organizations and institutions that comprise the healthcare industry. Similar to any other industry, health professionals such as physicians and surgeons are responsible not only for the health and well-being of their patients, but also for every aspect of their practice. This includes maintaining and keeping their offices, taking care of payroll for their staff and handling all matters pertaining to medical billing. Such responsibilities can eat up all the valuable time that doctors should have spent on critical patient care.

This is probably one of the main benefits of outsourced medical billing services: to allow physicians to allocate more time away from administrative purposes and focus on providing healthcare. This is true not only for individual physician practices but also for a medical organization like hospitals and clinics as well. Insurance rules and HIPAA regulations are constantly changing and medical staff can only do so much to keep up and handle healthcare reimbursement and processing. Such a scenario can be quite complex and would be very difficult to maintain in-house. The medical institution can gain much from the benefits of outsourced billing services instead of doing these tasks on their own.

The following are some of the benefits of outsourced billing services that medical professionals and organizations can take advantage of and gain the very precious time that they can allot for providing healthcare.

  • Outsourced medical billing services can take care of all matters pertaining to insurance claims management and processing as well as dealing with insurance companies and other government agencies. This includes processing paperwork that will be submitted to the insurance company for processing.
  • Service providers can take care of performing medical checks in insurance forms and verify content for errors. This would greatly minimize rejection by the insurance companies that would not only be costly for the medical professionals or institution but would also prolong the lead time before reimbursements are received.
  • One of the main benefits of outsourced billing services is the use of online or electronic billing, coding and submission systems that would speed up the claims process and receive reimbursements in days instead of the traditional weeks or months. Electronic systems prevent the need to enter data and other information monthly.
  • Outsourced medical billing services make use of customized systems that would be appropriate for the needs of the medical professional. A dermatologist have different needs, systems and patients than a brain surgeon, and these billing service companies can streamline their system to cater to the operational needs of the medical professional.
  • One of the more practical benefits of outsourced billing services is to reduce the time allocated by medical professionals in keeping abreast with all the ever-changing laws, rules and other regulations pertaining to insurance, medical and other billing records. These service companies are updated with these regulations and have special relationships with medical insurers which can help speed up the processing of medical claim reimbursements even more than before.

These and other benefits of outsourced billing services can provide physicians, surgeons and other medical professionals and staff all the time they need to focus on providing proper healthcare for their patients, instead of spending all their valuable time on administrative tasks like billing and filing claims.

A Primer on Medical Insurance

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Health is perhaps the most talked about subject today, with more people increasingly striving for good health. However, with chronic stress, inability to access health care, and other concerns, maintaining good health is no longer simple. Chronic conditions, such as diabetes and heart disease, are on the rise, which results in increased healthcare expenses. Increased costs of healthcare often lead to many people not getting proper and adequate healthcare services. Under these circumstances, it has become very important to ensure that healthcare is both equitable and affordable. One such initiative taken by the government is the provision of health insurance or medical insurance to people. Medical insurance is a necessity in the U.S., as it helps people protect themselves against financial losses that may occur if a person or dependent needs extensive medical care.

What is medical insurance and why do we need it?

Medical insurance or health insurance is broadly defined as a program that pays for all medical expenditure such that it covers all costs related to the treatment procured by an individual. However, the catch here is that only people who have bought such insurance policies or are covered by various social insurance programs or government funded social welfare programs can benefit. In other words, you are protected from all future medical expenses that you may or may not incur. According to a census, nearly 85% of the Americans have medical insurance, out of which 60% have access to such insurance through their employers, while only 9% purchase such plans directly.

Understanding the concept of medical insurance brings us to the question of its need. Why do we need medical insurance and for what purposes?

  • To gain protection from future financial losses
  • To gain access to affordable preventive care and prescription medications
  • To lessen the burden of huge medical bills

History of Medical Insurance

Having established the need for medical insurance, it is important to understand the history of medical insurance and also the factors that influenced its growth. It is pertinent to note that way back in the 1800s, small companies started forming their own associations that looked into the medical needs of its employees, based on a payment made by the employee every month. Group health insurance was first started way back in 1875 by Montgomery Ward & Co., which then slowly picked up momentum.

However, the actual rise of medical insurance was seen much later after 1911, when Britain passed the National Health Insurance Act. Group prepayment for hospital coverage began in Dallas, Texas but was later popularized by the Blue Cross scheme, which added medical expenses to its existing group insurance scheme. The main problem with the earlier medical insurance plans was that it was great for small medical expenses but was inadequate for serious medical concerns, disability and long term hospitalization. However, the growth and popularity of medical insurance allowed it to cover a wider range of medical problems.

Growth of medical insurance over the years was influenced by various factors, namely

  1. Increase in population leading to increase in demand for insurance
  2. Rising costs of medical aid and care
  3. Rising demand for medical care
  4. Expanding economy led to various changes in the average American home, which in turn led to emphasis on insurance
  5. Collective bargaining and increased awareness of consumers
  6. Enactment of legislations protecting the rights of various classes with respect to health care
  7. Lastly, the tax benefits accruing to the people who get insurance

Different Types of Medical Insurance

There are different types of medical insurance plans available today for all to choose from. Most plans cover all kinds of illnesses and cater to specific requirements of individuals. Popular among medical insurance plans include:

  • Health Maintenance Organization (HMO)
    These are prepaid health plans, where you have to pay a monthly premium, and in return get access to total medical care for all your family members, including visits, hospitalization, emergency care, medicines, tests and all such incidental expenses. The best part of HMO is that it gives preventive care equal importance as it does to actual treatment of diseases. On the other hand, the main problem is that the HMO will choose a primary physician for you from its list of service providers, who will be your point of reference for all medical conditions, giving you limited freedom to choose independently.
  • Fee for Service Plans
    This is the traditional medical insurance plan where the insurance company pays for any services or treatment rendered by a healthcare service provider. Under such plans, you pay a premium to the insurance company, either annually or monthly, and based on the amount you pay, the extent of insurance is decided. Once you have acquired medical attention, you, or in some cases the doctor, can file a claim for getting paid for all expenses, including hospitalization and medicines. It is important to note that such plans pay only a certain amount of the expenses incurred while some part of it has to be paid by you. Similarly, there is a cap on the amount of medical bills that you can produce in a year. Additionally, if you are claiming payment for medicines, you will have to produce necessary bills.
  • Preferred Provider Organization Plans (PPO)
    This is the perfect blend of both fee for service plans and HMO, where you have the freedom of choosing from the network as well as choosing out of it and getting paid for all your expenses. However, when you choose out of the network, it is important to note that you might end up paying a larger chunk of the medical bills yourself.
  • Point of Service Plans(POS)
    This plan is similar to the HMO in that it has a network of healthcare service providers who can be contacted for any medical need and the payment will be done by the insurance company. The main point of difference, however, is that you can also opt for outside treatment and yet get reimbursed for your expenses, which was not possible in HMO.

What are the essential elements of a good medical insurance plan?

Given the myriad options that are available in the market today, choosing a good medical insurance plan can be quite a daunting task. However, the following simple rules will help in choosing the best plan:

  • The first aspect that needs to be understood before choosing a medical insurance plan is your requirement. It is has to be noted that health insurance involves money and while all insurance plans are good, some give more than others, but at the same time cost more. Understanding your needs and requirements would help you choose the best one in terms of both benefits as well as cost. Factors like
    1. How comprehensive is the policy?
    2. Is appointing a primary care physician acceptable to you?
    3. Are you comfortable with the limitations of the policy?
    4. Do you want to file claims yourself or would like the service provider to do it
    5. How convenient do you expect your healthcare to be?
  • All other similar questions should be answered well before choosing your plan.

  • The second aspect to be considered is the benefits being offered by your chosen plan. It is essential that you pay for what you get and do not end up paying more and getting less. Important benefits include:
    1. Doctor visit and examination
    2. Hospitalization
    3. Prescription drugs
    4. Care by specialists
    5. Specific care like vision, dental, mental health, gynecological assistance and treatment.
    6. Chiropractic and other similar physiotherapy treatments
    7. Preventive and experimental treatment
    8. Screenings and other tests

    A good health plan provides at lesat the above benefits.

  • The third aspect is cost. Cost of medical insurance plays a very important role in the final decision making. It is important that you pay for what you get. The amount of deductibles paid by you along with the copayment and other charges should be included in the overall cost of health insurance. Limits on payments and coverage of services are also very important factors that determine cost of insurance and must be taken into consideration before final decision.

Some additional aspects to consider:

  • Location of healthcare services needs to be taken into consideration before opting for any insurance plan. Convenience and ease of access are the most important aspects to ensure proper medical care.
  • Services offered by each plan along with the various limitations on services should be considered before making the final choice. It is important that you invest in an insurance plan that covers all possible diseases and medical situations.
  • Last but not the least, it is important to compare various plans and their features before deciding on the final one. This will give you an overall view of what is available in the market and enable you to choose wisely.

Medical Debt Collections

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The aging baby boomer generation, and increasing prevalence of chronic disease, health care is in demand. However, that not all who need medical care are adequately insured. In fact, there are many who are still not insured, largely because they cannot afford insurance. Under these circumstances, where the patient is not insured or adequately insured, the healthcare facility or service provider has to depend on getting paid for the services directly from the patient. Most healthcare facilities allow a certain time period for payment of their dues. In fact, most healthcare facilities send bills after twenty eight days of providing the service, which if not paid, is often followed by reminder letters.

The main problem faced by healthcare providers today is the nonpayment of bills, either willfully or unknowingly by the patients. There is a strong need to change the payment system or at least back it up with some strong methods to ensure correct and prompt payment. This situation has led to the development of medical collections, which could be done by the healthcare facility or through an external agency. Medical collections refer to the collection of unpaid debts from past patients for services already rendered by the healthcare service provider or facility. This involves collection of either full or part payment of the services rendered, depending on the extent of insurance, if any, held by the individual.

Need for Collections
Having understood the meaning of the term collections, it is now important to understand the need for such collections. The need for collections largely depends on the reasons for nonpayment of medical fees or debts to the healthcare service provider by the patient. The main reasons for nonpayment of medical debts include:

  • The first and perhaps the most important reason for not paying debts is the lack of money. Most people do not have insurance because they cannot afford it. So, it simply extends to the fact that such people cannot actually afford medical care and are therefore most likely not to pay their medical bills.
  • The second reason could be that they have sincerely and genuinely forgotten to pay their bills. This could happen if the mail with medical bills is lost in the sea of other bills and promptly forgotten.
  • The third reason could be that the patient has limited understanding of his or her insurance policy, where the patient assumes that the insurance company will pay for all treatment provided, which is actually not the case.
  • Fourthly, there are some patients who do not care or know much about the credit ratings and hence, do not think much about paying their medical bills.
  • Lastly, improper billing or inaccurate billing by the healthcare facility leads to problems with actual reimbursement, thereby increasing the need for collections.

Handling Collections Yourself versus Outsourcing
Given the fact that collections are a reality in the healthcare world today, it is important that all healthcare facilities prepare themselves to deal with the situation. There are various ways to ensure proper payment of medical bills at the appropriate time. Healthcare facilities can either handle the collections on their own or in the alternative, can hand it over to professional medical collection agencies. Both ways have their advantages and disadvantages and the choice of method of collections should solely depend on the requirement of the healthcare facility.

  1. In-house Collections System
    This is where the healthcare service provider sets up his or her own collection team to actually ensure proper and timely payment of debts. The following steps are taken by the in-house team to ensure collections-
    • There is a front desk that ensures collation of all details regarding the patient, like his or her name, address, contact details, insurance details, if any, including the insurance card number.
    • Next step is verification of the policy held by the person to ensure that the insurance policy covers the treatment.
    • Collection of copayment and coinsurance, if any, at the time of rendering the service.
    • If the healthcare facility policy does not require immediate payment, the facility should provide bill for the services rendered immediately.
    • In the alternative, the facility can send the bill by post within twenty eight days.
    • Follow up on the bill is also done by the in-house system till the money is paid.
  2. Medical Collections Agency
    These are outside groups that help healthcare facilities in collecting their outstanding debts from patients. In most cases, it is not possible or viable for a healthcare facility to actually appoint a team to look into collections and debt recovery on behalf of the facility. Under these circumstances, appointing an external agency to monitor and ensure payment of receivables by patients is easier and more effective. Such agencies are third parties representing the rights and interests of the healthcare facility and therefore will be able to collect receivables easily. Moreover, they have trained and fully equipped staff and offices, which is extremely essential for collections.


    It is important to understand that billing and collections are highly technical fields, which require a lot of investment in terms of both money as well as time, which most healthcare facilities cannot afford. Hiring the services of a good medical collections agency is the best option for such facilities. Moreover, such agencies are know about the exact debts that are receivable and the exact stage of each case of collection.

Simple steps to Improve Collections
Collections are definitely a reality of today but having said that, it is important to understand that lowering your debts and increasing the pace of your collections will ultimately lead to financial stability and even profitability for your healthcare facility. With the help of technology and the following simple steps, it is possible to improve your collections so that your facility actually profits:

  • The first and the most important step is to have a clear payment procedure. This is very essential because early communication of payment procedure will enable the patient to be well prepared. The payment procedure for your healthcare facility should be displayed in your office.
  • Accuracy of patient information is very important. Always ensure that you have all the requisite details regarding the patient, such as his or her name, address, contact details, insurance card number and details, and the like. This is very important for processing claims and for getting payments for services rendered.
  • Always verify and pre-certify the insurance policy details of the patient before rendering the service. Having a good front desk will ensure that this work is done smoothly and without any hassle.
  • Always state the payment responsibility of the patient clearly in all communiqués to the patient. This is very important, especially if the patient refuses or does not pay the debt and the matter has to be handed over to the collections agency. It is important to stress on the payment responsibility of the patient right from the beginning.
  • It is also important to understand the genuine difficulties of certain patients for paying their dues and allow them adequate time for paying them. Giving patients options like part-payment or payment in installments will allow them to come to you freely and also ensure regular flow of cash. Moreover, this will actually help you retain your patients.
  • Lastly, always know when it is time to let go of a debt and forget it or put it under the bad debts column.

Collections will always remain a major problem in the healthcare world today. Therefore, it is absolutely necessary to meet it head on and deal with it. The above steps can be used by any healthcare provider to actually collect the unpaid debts but as mentioned above, it is important to remember never to waste too much of time or money on unpaid debts, as this could also lead to losses.

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Surgical Billing Services

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Computers, software and automation have simplified the way industries perform their otherwise complicated and utterly chaotic business operations. This automation has been extended beyond the technological and manufacturing fields into medical practices. Medical professionals, like doctors and surgeons, are technically adept in their respective fields, but they often lack the knowledge or expertise– not to mention the time or the personnel– to manage their cash flow systems as efficiently and as accurately as they would prefer it to be. What they need is an efficient and automated surgical billing service that will help them run their practice more efficiently.

The healthcare system’s environment is constantly evolving, leaving modern practitioners unequipped with the proper systems and resources. This is especially true in the complex arena of medical billing, and thus practices should hire people or service providers that have experienced-based expertise in dealing with insurance companies. These professionals should also be well-trained in the specific codes, rules and regulations of surgical and medical billing. Using these services can reduce the errors in their billing department, which in turn can cut significant financial losses that could amount to more than 20 percent of revenues from their clients’ practice.

This article on surgical billing aims to help surgeons and medical professionals understand all the important aspects of the field and select the most appropriate billing service for their practice.

What Is Surgical Billing and What are the Processes Involved?

Insurance companies have their own computerized systems and billing software that process medical claims and records from various patients, medical institutions and healthcare providers. These providers should ensure that they give the correct information and paperwork to the insurance companies; otherwise, their claims will be rejected and payment will remain unauthorized. Imagine doing all this paperwork manually, and then individually sending each claim to the insurance companies. That would be a very taxing and tedious process that takes a very long time to reach a conclusive end.

Surgical billing services are designed to solve these issues. In -house billing and coding specialists can be hired to handle all patient records including treatment information, insurance details and bills. The services also include encoding of the patient’s diagnosis and procedures. A request for payment is later sent to the patient’s insurance company or directly to the patient on non-insurance cases. These billing services can also be outsourced to service companies staffed with skilled medical billing and coding specialists using customized billing software, which transcribes all these records in standardized codes and formats as required and accepted by the insurance companies. They can also communicate directly to the patients regarding their billing statement and discuss what payment options would be used in the process.

An intrinsic part of this process is the proper organization of patient’s records, which ensures that error-free information is used for the coding process. During coding, the information related to disease, diagnosis and treatments as recorded by the surgeons are matched with the insurance policy information. The patient can then determine areas that are covered and those requiring additional payments.

Benefits you can get from outsourcing surgical billing services.

  • Surgeons and their staff are spared from the time-consuming complexities, frustrations and the headaches that go with managing surgical billing process. They can devote more attention on providing excellent healthcare and services to their patients.
  • Surgeons, clinics and medical facilities can save much on overhead costs by utilizing the services of surgical billing companies. Practices can forego hiring fulltime medical billing and coding staff to handle tasks such as transcription of medical records, billing processing, invoicing patients and filing insurance claims. They can save on salaries, taxes and benefits, which are basic requirements for fulltime staff. What’s more, practices can also save on operational expenses spent on maintaining billing office- papers, office equipment and other supplies.
  • Outsourcing billing services can also save practices the costs of providing specialized training to personnel that will handle medical billing and coding functions. Billing service companies make sure that their staffs are competent and fully trained in the billing and collection function. Their trained staff can easily handle billing issues like delinquent accounts, complaints and claims rejection.
  • Surgical billing services can also help spot underpayment of claims by insurance payers by looking into latest trends in the payment patterns and comparing them to practices’ contracted rates. Usually underpayments range between 5 to 10 percent, which would add up quite significantly and would be considered revenue loss on the part of the surgeon or the medical institution.

Practical Tips on Choosing the Best Surgical Billing Services

The following are some tips which can be helpful while searching for the most appropriate billing and coding services.

  • There are different surgical disciplines and specialties in the field of medicine, and it is thus advised to choose a surgical billing service that offers experienced-based expertise for your specific surgical field. One should remember that each specialty has its own corresponding insurance policies and regulations that cover procedures in making claims and payments.
  • If the billing service company claims they can provide services for your particular field, they should also be well-informed and updated on the constantly changing regulations in making claims. They should also have highly trained staff certified in the proper coding for claims submissions.
  • It has to be noted that Medicare has deemed illegal some practices or requirements made by some surgical billing services that insurance payments be deposited in their own account. Payments should be made to your account and you should never allow any services to control your cash flow or income.
  • Find a surgical billing service that waives or does not require a setup or startup fee. If your billing service is insisting that you pay such fees, move on and look for another billing company
  • The advances in communication have allowed billing services to operate from any state, allowing you to employ good companies located nationwide. This would allow you to choose more competent institutions to render these services. However, make sure that the companies are well familiar with the insurance companies and state regulations operating in your area.
  • The surgical billing and coding company you are considering should use modern equipment for electronic processing, including submission of claims to insurance companies. This allows for faster processing and shorter lead times in receiving reimbursement checks.
  • Gather statistics from sources regarding the billing service companies you are considering, including claim denial rates, length of service rendered for other medical institutions or professionals, and their turnaround time in obtaining payment for claims. The billing service company should also be compliant with HIPAA regulations.
  • The surgical billing service company should have an internal tracking and report system to keep you abreast of your claims and help you manage your accounts on a monthly basis.

The surgical field is a complex and challenging area of medicine, and this complexity is translated even to billing services and submitting insurance claims. Surgeons need all the help they can get to avoid wasting precious time in administrative work. They can be assisted by surgical billing services that help them receive proper compensation and deliver higher quality healthcare.