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Friday, November 30, 2012

Medical Claim Payment Inaccuracies Cost $17 Billion

"The overall rate of inaccurate claims payments increased since last year among leading commercial health insurers, according to American Medical Association's (AMA) fourth annual National Health Insurer Report Card. Claims-processing errors by health insurance companies waste billions of dollars and frustrate patients and physicians. "

So begins a recent report from the AMA dated June 20, 2011. The report goes on to say that, on average, commercial healthcare insurers mis-pay 19% of all the claims they process. As shocking as this is, even more upsetting is that only UnitedHealth showed improvements in its claim payment accuracy in the past year. The mis-payment rates ranged from United's 10% to Anthem's 39%.

Also troubling is that these results overall are 2% worse than the previous year, meaning the insurers are not getting better at paying claims accurately.

The AMA valued the impact of this service level to be over $17 billion per year. That means if the payers could eliminate all of their payment mistakes, the cost of healthcare could decrease $17 billion. Complete elimination of payment errors may not be reasonable, but a 25% improvement would mean a savings of over $4 billion in the next year alone.

Imagine other industries with this level of accuracy...

What if a cell phone dropped 19% of its calls on average and one carrier dropped nearly 40%? This is unimaginable. In the financial world, what if an ATM dispensed $110 instead of $100 or gave out $60 other times? That's beyond comprehension. Or the airline industry. What if planes landed at the wrong airport 19% of the time? No one would fly and there would be no industry.

So how does the healthcare industry continue with this type of performance?

Several reasons are propagated, including: the complexity of the "system"; the multiplicity of the provider billing and payer claim software; the lack of transparency; the detached consumer (patient); the extensive coding required for diagnosis, procedure, payment, government mandate variation, etc., etc.

All of those contribute to the problem, but an overriding reason for the existing state of payment accuracy is the actual cost incurred to process a claim. Claim adjudication accounts for less than 5% of a healthcare insurer's total operating cost.

Medical cost typically runs 80-90% of an insurer's cost to operate. Other administrative costs such as overhead, call center operations, insurance, software maintenance, hardware leases and profit make up the difference along with the cost to process a claim.

With the cost to process a claim such a minute line item on the Profit and Loss statement, management is usually focused on the larger expense drivers and does not recognize the opportunity in the claim operation.

To reduce the industry's woeful 19% mis-payment rate, management has to dive deep in the weeds of its claim operations. In the weeds lie the opportunities to improve payment accuracy, lower operating expense, reduce overpaid claims and improve provider relations.

Medical Billing Coding Certification Is Necessary to Reduce Bogus Charges and Improve Reimbursement Medical Billing - Front End Strategies Bare Essentials of Medical Insurance Medical Insurance Quotes - Things That Can Affect Your Premiums How To Keep Up With So Many Changes in Medical Billing Maximize Your Medisoft! (Unknown and Underused Functions of Medisoft)

What Is the Work Environment When Working As Medical Biller and Coder?

The number of hours a medical biller and coder works is 40 hours per week. However, overtime may be needed to finish certain assignments. Depending on the health facilities you work with, you can work in the day, evening and night shifts. To become a medical biller and/or coder, you will need to have an associate's degree or bachelor's degree. You can have better opportunities if you have passed a certification exam, such as Registered Health Information Technicians (RHIT) certificate. As regards to the nature of work for this profession, you will be spending all your day assigning codes, entering information into a database, and filling insurance claims, among others.

Working condition for medical billers and coders

Medical billers/coders work in a typical office set-up where they work with computers, printers, and phones. As mentioned earlier, these professionals will have a 40-hour workweek. However, they also work extra hours when needed. Additional pay is applied for extra hours. To know about work schedule options, you should verify them with your prospective employer before working as a medical biller and/or coder.

There are different jobs and responsibilities of medical billing/coding professionals. They may need to interact with patients who are sick and contagious.

Traits or skills required for medical biller/coder

In order to succeed in this field, you must possess the following skills:

• Excellent oral and written communication skills

• Excellent computer software knowledge

• Ability to work with the cutting edge technology for medical billing/coding

As regards to traits, you should have a keen eye for details. This is to prevent entering incorrect information of a patient that can affect patient's health.

You should also develop the ability to have an attention to detail because it could lead to exorbitant bill for patient or lost revenue for the insurance company and the medical facility.

Being task-oriented is also essential when working as a medical biller. This trait will enable you to work alone with total focus while completing projects the soonest possible time without affecting accuracy.

Multi-tasking skills are also important. The reason for this is that medical coder has to deal with large amount of data from different sources and take care of the billing concerns of different patients.

You should also have organizational skills to keep the medical facility running smoothly and well-organized.

Training

Certain education training program is important if you want to work as a medical biller and coder. In this way, you can read and understand the contents of a patient's record. When you seek out a program for this profession, make sure that it includes the following topics:

• Basic math

• Medical terminology

• Medical billing software

• Medical documentation evaluation

• Administrative duties

You can obtain education training program for medical billing and coding from community colleges or universities. For your convenience, you may also enroll in one of the online schools that offer medical billing/coding education training programs.

The Benefits Of Medical Claims Billing To Staff And Clients Alike

Medical claims billing is a detailed procedure. It is the way in which the qualified portion of a medical clinic's staff submits claims to different insurance providers. It might sound cut and dry, but there are several complex tasks involved. Filing claims with an insurance provider alone involves more detail oriented tasks than just about any other job in the practice.

The number of differing insurance companies alone is astounding, but when you have to totally change how you operate according to each different policy and program things get hectic. The person who works with claims needs to understand all of these setups inside and out in order to keep claims from being rejected. Insurance companies are extremely particular about the way a claim is written up and will send a claim back for the smallest detail. The more rejections a staff member faces the more troublesome their task becomes as revisions are then necessary and they are required to do double work.

The continuous rejections as a result of minor details can be straining, so a computer program was developed to manage all these details and information seamlessly for the people filing claims. With this form of software they are able to submit documentation to insurance providers more quickly and efficiently. The programs are continuously updated, since companies are often changing what they will or won't cover. Often a claim submittal has to be resent several times before it is taken due to human error, vague wording, or a change in policy. These computerized systems work to reduce the amount of claims that are rejected by providers. Nearly every single claim that is filed through this type of software is accepted on the first try thanks to a complete checker system. Before these programs were invented this level of success was almost impossible.

Patient satisfaction is necessary to operating a quality medical office, so it is good to know that these billing programs can also have an amazing affect on them, too. Rarely do patients require the long waits that they once had to deal with when finding out if their coverage is going to take care of a specific procedure or not. This isn't just advantageous to their peace of mind and wallet it can also benefit their health. The wait times would be so long in a few cases that patients would simply give up and leave without the treatment they needed.

Thanks to the new PC programs this chore isn't the hassle it once was. Now the work goes by much quicker and everyone involved benefits greatly from the results. Software that assists with medical claims billing is yet another step in the right direction for modern healthcare facilities.

Medical Billing Coding Certification Is Necessary to Reduce Bogus Charges and Improve Reimbursement Medical Billing - Front End Strategies Bare Essentials of Medical Insurance Medical Insurance Quotes - Things That Can Affect Your Premiums How To Keep Up With So Many Changes in Medical Billing General Overview of the Medical Billing and Coding Process

How to Audit Your Hospital Bill

Many people in the United States do not have adequate insurance, or have no insurance at all. This leaves a large percentage of people unable to pay their bills in traditional ways. With the average ER hospital bill over $1,000 now it is extremely difficult for a family who is already cash strapped. Insurance companies pay less then half of what an individual pays.

It is very important to at least work with the hospital to make sure your account does not go into collections. Having your bills go into collections hurts your bargaining power, and can effect your credit score (which hurts job prospects potentially), in addition to that if you have open collections the cost of borrowing on anything from car car loans to credit card rates will rise.

So if you are uninsured or under-insured and want to lower your medical bills, your best start would be to audit your medical bills. The first step would be to request an itemized receipt of your bill, and look for any obvious errors or double charges. Once you have the bill in hand you can spot these errors contact the billing department of your medical provider.

Sometimes working with medical providers, especially the billing department can be a tedious process, they are trained to get the most money out of patients and do this all day. If you are not comfortable negotiation with people and feel you still want to audit your medical bills getting a professional to do the job is also an option.

The Deal With Find-A-Code Medical Billing Code Database

There is a new face on the online medical resources block and his backpack is full of all the latest gadgets medical coders asked Santa for. Find-A-Code, the newest web-based medical billing code reference library just burst onto a field traditionally crowded by publishers and old-school desktop applications. They brought with them a shiny new website that is deceivingly powerful.

The site's databases contain more than ten million medical reference codes and summaries, and serve codes from authoritative as well as more obscure code sets. They are one of the first to offer the complete set of ICD 10 Codes. At first look the website looks much like any other online reference library, but one glance certainly does not do it justice. In searching the site a little you quickly see the powerful technology cranking away in the background. Advanced filtering options along side color coded search results, reverse code lookup, and the code building feature all make life a little easier in front of the screen.

An area of slight controversy lies in the fact that similar services have begun switching to private-label versions of Find-A-Code and serving basically identical information (and interface) on their own sites. Because there are few players in the space to start with, coding professionals may have even fewer options in the near future. Hopefully they like Find-A-Code, because if the current trend keeps up coders may have to learn to love it.

An interesting tid bit with regards to Find-A-Code is that they are closely affiliated with the Chiro Code Institute, a long-time publishing company of chiropractor resources also based in south central Utah. The partnership is ironic because of the complete difference in method to how each offers access to information. Some suggest that Chiro Code may be looking for assistance in snatching up some of the online market for the information and resources they already offer physically and may be gearing up to make a push on the internet.

For more information on Find-A-Code or the Chiro Code Institute, please visit their respective websites.

Getting Paid for PT/INR Office Testing With CPT Code 99211

Many doctors understand how to code properly for their time spent with a patient, but the waters become murky when it comes to coding for the time that their nurses spend on face-to-face visits. This is largely why CPT code 99211 is often underused.

As a general rule, CPT code 99211 is a "nurse code" that is used to bill for time that your practice's nurses spend with your patients. Some physicians wonder if it is appropriate to use CPT 99211 for face-to-face time spent with patients and, if so, how it should be used.

Using Code CPT 99211

According to the Medicare guidelines, even though CPT 99211 does not require a physician to be present in the room with a patient at the time of the visit, the service must be performed face-to-face with one of the physician's staff and the physician must be immediately available during this time. The visit must also have an impact on the patient's care, such as a change in medical regimen in order to be eligible for CPT 99211 coding.

To determine whether or not a visit can be billed for using code CPT 99211, there are some questions you should ask yourself:

1. Were you, the physician, on site when the visit with the patient was conducted?

2. Was the visit pertaining to a service that was medically necessary and was there a change in medical routine as a result of this visit?

3. Was the patient physically in your office (not on the phone) and did you or your staff have face-to-face contact with the patient during the visit?

Whether or not you can bill using CPT 99211 will depend on the answers to all three of these questions. If you can answer yes to all three of above questions, then the visit you are billing for will likely meet the requirements to capture revenue using code CPT 99211.

The following scenario is an example of when CPT code 99211 could be used effectively for PT/INR testing in your office...

Let's say you have a patient who is taking Coumadin/Warfarin Sodium. This patient comes into your office for a routine PT/INR test. You are in the office at the time of this visit, so the visit meets the first requirement for CPT 99211 coding.

Your nurse performs the PT/INR test and shows you the results of the test while that patient is still in your office. You see that the PT/INR levels shown in the test results warrant a change in the patient's prescription dosage. Because of this, the visit now meets the Medical Necessity requirement for CPT 99211 coding.

Your nurse then returns to the patient and informs your patient of the changes being made to their prescription dosage. The nurse then documents the patient's record while that patient is still in the office. The "face-to-face" requirement has been met, again meeting the requirements for CPT 99211 coding.

Using the scenario above, you would be able to bill for this visit using code CPT 99211. Now let's look at a scenario where you would not be able to bill using CPT code 99211.

The same patient comes into your office for a routine PT/INR test. You are in your office at the time of the visit, meeting the first requirement for CPT 99211 coding. However, the test results come back normal and there is no dosage or medical regimen change. Because of this, the requirements of CPT 99211 are not being met and you will not be able to use this code for billing for this visit.

Here is another scenario where CPT 99211 would not be used...

Let's say the same patient comes into your office for the routine PT/INR test. The patient leaves your office before you review the test results and you call back later to give the patient instructions over the phone. Because the patient was not in the office at the time the results and instructions were provided, the "face-to-face" requirement is not being met and you can not bill using CPT 99211.

Remember, you must be able to answer "yes" to all three of the criteria questions if you wish to bill using CPT code 99211. If you can answer yes to all three questions, then you should, by all means, bill using the CPT 99211 billing code in order to maximize the revenue generated for your practice.