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.

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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.

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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.

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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.

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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.

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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.

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Lean Thinking With Focus on Medical Billing and Coding Services

Lean thinking is about mindset or the way of thinking of organizations to achieve a totally waste free operation that focuses on customer value. It involves cross functional orientation within organizations to improve efficiencies and achieve waste free operations. However, it is easier told than practiced!

It needs a house of lean tools laid on stronger organizational commitment to improve their level of service to the customers. It is more so challenging on the services industry when compared with the manufacturing since the process maturity levels on the services industry are still evolving. However setting aside the challenges, one would still find surprising similarities between services and manufacturing, that both involves complex interlinked processes managed by personnel to accomplish their tasks to yield end value to customers. Hence it necessitates a need to cognitively approach the success stories on the manufacturing side and apply those best practices with more rigor.

In the context of Medical Billing & Coding Service

To maximize value and reduce waste in the context of medical billing and coding services, the first step is to create a unit with lean thinking. It needs lots of communication from the strategic management team to the line personnel on the objectives of lean. This shall create a sense of belonging and brings down uncertainty around job losses. It needs to carry a strong and meaningful message that services differentiators can be accomplished only with personnel.

At a next level on the process side, the starting point need to be defining the critical to quality parameters for their customers that includes but not limited to,

* Expected financial accuracies and processing accuracies * Turnaround time requirements * Rework percentages

It is important that organizations assess themselves on their standings with respects to these parameters so that they will be able to define road maps. This includes doing a value stream mapping of their processes that will list the steps involved in accomplishing the end value desired by the customer.Being a federally regulated process, it becomes mandatory that organization assess their process efficiencies to identify and isolate value added processes from non value added processes. Imbalances here shall definitely create friction within the system. It needs classification of processes into,

* Core repeatable processes * Core non repeatable processes * Support and repeatable processes * Support and non repeatable processes

Define Implementation approach to a successful lean program

It begins with defining a program charter to roll out and institutionalize a lean program. It involves programs to 1. Improve Quality, Eliminate wastes through Training Integrated Quality Assurance Framework.

It involves rolling out a training integrated quality framework. This includes combination of statistical tools and methods that results in identifying and isolating defects / wastes from the process. Statistical tools are extensively adopted to perform

1. Pareto analysis - to identify the vital few 2. Define Corrective and Preventive Actions (CAPA) 3. 5 Why Analysis and 4. Time Trend Analysis

This QA framework helps in accomplishing the process within its control limits. However organizations need to appreciate those statistical tools assists only in identifying and isolating the outliers. But to improve quality, there needs to be very active participation from the training function since variations within billing and coding processes are very high.

2. Improve Quality, Eliminate wastes through Technology

Define claims scrubbing mechanisms on top of claims data so that common and more frequent errors can be automatically detected. This shall increase the velocity of the process and also reduce rework. For instance a claim for male insured with a diagnosis code related to gynecology is obviously incorrect and this can be caught upfront in the system instead of allowing it to traversing through different processes within the overall system and finally getting rejected for payment. This saves lot of payment rejection upfront. Hence a good lean program shall leverage the expertise from IT and operations team to define solution. Hence it becomes imperative that the medical billing and coding team to understand the way adjudication systems on the insurance companies work so they can build upfront claim scrubbers and pre edits.

3. Optimize Process overheads

It involves operations unit to do a comprehensive time trend analysis on operations data. This shall include incoming volume data, capacity utilization levels, throughput, TAT compliance etc. With proper incentive and remuneration program, organizations need to do plan for running the process with optimal utilization levels that shall remove over allocation of personnel to the processes. This approach reduces process overheads. Organizations need to understand overproduction is equally bad as under production.

Conclusion

Lean thinking is not new. However the dynamics of Health Care Industry keeps continuously changing and it places a need on the organizations to keep striving for innovations so they perform exceedingly well on customer satisfaction index. Innovations cease to exist if organizations fail to ask one fundamental question on an ongoing basis - Why am I doing it this way and am I doing it right?

Lean thinking facilitates organization to ask these fundamental questions, as it did before!

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Medical Billing - Reduce Your Health Care Costs by Making the Most of Your Doctor's Appointments

You may think as a patient, collector is the last person you want to see at the doctor's office. Why? Patients are afraid to deal with their medical bill that their insurance don't cover. Patients' think medical biller is just to collect payments from them. Patients don't want to find out what their responsibilities to pay the services they received from the physicians.

Biller is the best person to help patients and physicians to understand the benefits of having insurance. They are the one that verifies eligibility, insurance coverage for specific visit or procedures. Patients may not know who's the doctor that participate in their insurance or what facility that has contract with their insurance and this is where medical biller comes in. Medical billing services in doctor's office is a big help in everyday venture. They are there to help physicians and patients to focus on what's important- Health care. Before doctor's see the patients. patient services will collect insurance information, call insurance to verify for coverage, if patient has copay for each visit or even authorized for services. This will eliminate disturbance between doctors and patients time. Doing this ahead of time will be better in office set up. The doctor and patient relationship will focus on the treatment for what is important. It is less waiting time to see the doctor, less time sitting in the waiting room area of the doctor's office. It will put a smile on patient's face.

Now with changing world, there's a multiple physician's specialty, multiple insurance between HMO and PPO rules and policies to deal with. Medical Biller is an expert in dealing with this issues or challenges that comes between patients and doctors. They help in figuring out where patient can go to see a family physician, a specialist, verify what kind of benefits that patient has, what is covered and what is the share of cost for the services. It will give them peace of mind knowing the details of their visit and what to expect after the visit.

As you can see the importance of this position in the flow at the doctor's office or other health care facilities. They help facilitate a better way to handle issues with insurance, file claims in timely manner, verify eligibility before patients get to see the doctor. It eliminate health problems and stress after receiving medical bills. They are there to smooth and ease the flow in the office. It is a better way not to waste time preparing paperwork and use the time in patient care.

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How to Handle Medical Billing Code Changes

Medical billing codes change on a yearly basis. When they become outdated, insurance companies cannot accept them any more. Your claims could be denied because of outdated codes.

There are few ways in which you can keep up with changes in medical billing codes.

The first thing that you can do to keep codes updated is to use Current Procedural Terminology Code Books. These are billing code books that have an explanation for each medical billing code. They list the codes alphabetically and by number.

The codes in the CPT books are updated annually. The changes may be minimal at times, while at other times they may have a lot of changes. The books also contain a list of modifiers which indicate that a service was changed in a certain way from the stated current procedural terminology without changing the definition.

By making that you have the new books each year, you'll be able to keep up with any billing code changes that have taken place.

You can also handle code changes by using ICD-9 code book (International Classification of Diseases, 9th Revision). This is a coding system that groups related disease procedures and entities for the reason of reporting statistical information. ICD-9 books also list diagnoses both numerically and alphabetically and the codes are updated on a yearly basis.

The other way to handle code changes is to purchase medical coding software, which is a good alternative to code referencing books, which you need to update on a regular basis. Medical billing software (if it's a good package...) will update the codes for you!

The other benefit of medical billing software is that you don't need to consult books in order to code a medical procedure correctly. Software also provides online searching capabilities - something you don't get with reference books.

Getting medical office software is the best way to handle changes. Medical offices that use online coding and billing software will find it easier to transition from the old codes to the new codes - the software will handle much of the work. By keeping up with code changes in this way, your billing practice will improve the quality of service that you deliver, improving your reputation and hopefully getting you more clients!

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Obamacare, The Press, and Reality

The first casualty of war is truth - Hiram Johnson

I have been deeply disappointed with most aspects of Obamacare, both in the legislation itself and the manner of its passage. However, the most contemptible actors in this drama may well be the press, both mainstream and otherwise. Major news outlets, such as the New York Times, and the Washington Post have supported the legislation based upon some quixotic notion of realized hope and change. The Wall Street Journal, and numerous right wing publications, have opposed Obamacare by invoking market principles and some vague animus toward the framers of the legislation. The unifying principle behind both sides of the argument is a selective or absent reading of what is actually in the bill, combined with a refusal, or inability to understand the fundamental health care issues that underlie "reform".

My main impetus for writing this article is to address the factually incorrect, politically motivated, confusing, lazy, and inflammatory reporting that dominates both sides of the struggle over Obamacare. Peripheral, relatively easily addressable issues such as "donut holes" in drug coverage, use of Electronic medical records, and insurance company loss ratios, were brought to the forefront of the "debate", as if they truly mattered. Right wing pundits attempt to incite their followers with fanciful chimeras such as "death panels". The real problems, including the demographic crisis that will doom medicare and the perverse and misaligned incentives that drive excessive and abusive care, have been ignored.

The supporters of the bill made many promises including increased coverage and lower costs. Major news outlets supported these goals, and backed the bill without fully understanding that the legislation will not actually do what it has promised. Now that the bill is law, the ramifications are becoming clear, even the NYT is beginning to realize that their political zeal is not enough to change the laws of nature. The latest article raises the points I have been trying to make from the beginning. Obamacare will lower coverage and increase costs. In their own words:

Consumer advocates fear that the health care law could worsen some of the very problems it was meant to solve - by reducing competition, driving up costs and creating incentives for doctors and hospitals to stint on care [Pear, 2010].

What they fail to mention is legislation was never designed to address these issues, but rather was written by a coalition of unions and large corporations to limit their liabilities. The full impacts of this legislation will be long in coming, and will fall unequally upon the people of America. Like the injuries of battle, the scars may be painful for years to come.

Reference: Robert Pear, Consumer Risks Feared as Health Law Spurs Mergers, New York Times, November 20, 2010

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Your Practice Task Management System - A Guide to Office Staff Productivity

Ever wake up at 2am and remember you forgot to do something important at work? What are your chances of getting back to sleep?

"Centralized task management not only affords my staff and I the ability to track things in one place, it allows complete transparency to who is getting the job done for our clients," says Jason Barnes. "You know who is sitting on tasks and who is actually completing them."

Sixty percent (60%) of voters on a recent LinkedIn Poll agree with Jason. Only 11% use memory or paper to manage their task, while the remaining 29% use email.

What are the specific benefits of a centralized task management system?

David Allen, a management consultant and the author of "Getting Things Done: The Art of Stress-Free Productivity," provides insights into attaining maximum efficiency and at the same time relaxing, to focus energies strategically and tactically without letting anything fall through the cracks. His workflow management plan has two basic components: capture all the things that need to get done into a workable, dependable system; and discipline yourself to make front-end decisions with an action plan for all inputs into that system. In short, do it (quickly), delegate it (appropriately), defer it, or drop it.

Teamwork

The most basic aspect of any task management system is task capture, or documentation. An undocumented task is not worth tracking or talking about. Unless we capture all the tasks in a single system, we will have to rely on multiple tools, hurting our efficiency and efficacy. A centralized task management system also enables transparency. If your documented task ticket is placed in a central task repository then every member of our team sees its status.

That level of transparency across the board creates peer pressure and offers an opportunity to build a framework for formal accountability. If you have to attend regular meetings with your team to review your backlogs, your entire reputation and credibility hang on the timely completion or update of every task that was assigned to you.

These two features, transparency and accountability, formalize the concepts of teamwork and of team player. In an organization that uses a centralized task tracking system, teamwork means eliminating backlogs and a best team player is the member with a smallest backlog. Additionally, when a team member fails to complete a task, the other members know precisely who and when needs help. Teamwork takes specific meaning in terms of helping a specific member accomplish a specific task at a specific time. A centralized ticketing system eliminates the fluff that is usually associated with the word "teamwork" and offers a simple way to measure the degree of teamwork.

Patient Relationship Management

"If you really want to get things done I recommend you go to IQtell" says Bryan Koslow, MBA. "The best task management system that is integrated with email, calendars, and Evernote."

There are two kinds of task management systems:

General-purpose: a system integrated with email and calendars but not directly integrated with your existing practice management solution. Specialized: a task management system integrated with a patient appointment system, EMR system, and billing system, which turns your ordinary practice management system into a patient relationship management system.

To be operational and meet customer requirements, both kinds of systems must maintain a high degree of integration. The difference between the general-purpose and the specialized task tracking systems is defined by the sort of systems integrated with your task tracking system.

Getting back to practice management systems, a task tracking system integrated with patient appointment system, EMR system, and billing system, turns your ordinary practice management system into a patient relationship management system. How? The tickets can be automatically generated upon encountering a problem and directly attached to the patient records.

With a specialized system, every patient has a set of tickets distributed across multiple team members. The backlog pertaining to any particular patient defines the relationship management risk, while the backlog associated with every team member defines that member's teamwork quality. The total of all backlogs across all patients defines the current practice risk. The task of practice management reduces to ticket prioritization and to driving the ticket backlog to zero.

Pull versus Push

If you use a patient relationship management system for your practice management, you receive tickets on your workbench that pertain to your responsibilities. You do not depend on outdated reports and statuses. So if a patient owes you a balance, an integrated ticketing system will let you know about it when that patient is in front of you and without having you looking up her balance in the system. In other words, a centralized ticketing system turns your practice management system into a Just In Time Information System. The ticketing system flips the information delivery mechanism from Pull into Push, when the system is Pushing information on you instead of making you Pull it from the system.

To use David Allen's analogy, a Patient Relationship Management system downloads all those free-floating gotta-do's clogging your brain into an effective framework of action items. In other words, it's a system that pushes action items to you, frees your mind from minutiae while allowing you to focus on the big picture and important ideas.

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Medical Billing: How to Hire - And Keep - The Best Biller

Getting good results in billing starts with having the right employees. Getting a top-performing crew - and keeping it together - can be a challenge. Smart organizations know that hiring the wrong employee is costly - so costly, in fact, that it is well worth the extra effort to hire the right employee the first time around - every time.

Productivity, morale and, even, the organization's revenue are at stake in the hiring process. Here are important steps - both in hiring and keeping - the best medical biller:

Know where to look. Staff can help recruit, too, so ask them for suggestions. A current staff member may have a friend who would fit in well with your operation. More employers are offering small incentives - for example, a $200 gas card - to employees who suggest a job candidate who turns into a hire. Managers and employees alike can network with colleagues at local medical billers' associations. Many of these groups can also circulate the job posting. Turn to local training programs and community colleges when posting a position, as well as using advertisements in the local newspaper. Local community colleges and technical schools that train billing and office staff may be able to place interns. Internships can give you a view of how a potential candidate would fit with your team well before you ever need a replacement.

Get online. Online job listings like monster.com and careerbuilder.com can be expensive, but they will get the word out to a lot of people. Post the opening on your organization's website and don't forget about social networking. If your organization uses Facebook or Twitter, use them to spread the word about an opening. Staff might mention the opening to their online "friends" and "followers", too.

Put expectations in writing. A critical part of ensuring high performance is when everyone is on the same page. Set job expectations in writing. Go beyond the job's title, because "medical biller" can mean many things. Determine the responsibilities and tasks that you expect from this position and outline them. New and current employees should be able to read your expectations and understand where their job fits within the department - and within the overall organization. Medical billing changes constantly, so if you haven't updated job descriptions since 1993, it's long past time for a rewrite. Ask staff to help, too. Of course, don't leave out the important phrase "perform other duties as assigned." These five little words signal that you put high value on teamwork - and that change is inevitable.

Be patient. Yes, medical billing requires daily attention, but that doesn't mean that you should hire the first candidate who walks in the door. Take your time, and find the right person. Consider employment like a marriage - the cost of a failed one comes at a very high price. Plan how to handle work on a short-term basis because you may need to wait to get the right candidate. If you're hiring from another medical practice or billing service, the candidate may need to give two weeks' notice. Don't be put off by a top candidate's desire to leave their previous employer on good terms - it's a sign of respect. You'll appreciate the same consideration when your employees leave.

Display the full compensation. Most job seekers focus on the hourly rate, but it's likely that you have much more to offer, such as vacation time, health insurance, and other benefits. You pay for those benefits, so why not focus the candidate's attention on them? Present the total value of your proposed compensation and benefits package - in writing - when you talk to job candidates. Benefits can make up 25 percent or more of your compensation package's total value.

Don't overlook references. Research shows that Americans have a propensity to stretch the truth on their resumes. Check all references. Be on the lookout for anything appears sketchy (for example, all of the reference phone numbers are cell phones, or the voice of the "reference" sounds the same on every call). Look carefully at the company name of the reference, then call the main number directly and ask for that individual. If they've never heard of that person, you know the job candidate is trying to scam you. Speaking of scams, don't skip the background check - essential in today's recruiting world - particularly for someone hired to handle significant sums of money. Finally, verify credentials directly with the accrediting body - the American Academy of Professional Coders, for example, offers an on-line confirmation process to determine if a candidate actually is a certified professional coder (CPC).

Give a test. Developing a simple test of knowledge can be remarkably revealing. Questions to test what every medical biller should know could include: "What does COB stand for?" or "What's the birthday rule?" Test also for basic (but essential) math skills, such as calculating 20% of $219.18. Black out the confidential information on an explanation of benefits from an insurance company that denied payment on the claim. Present it to candidates, asking them to walk you through how they'd handle it. If the candidate says he would write it off and call it a day, you know it's time to conclude the interview. Consider administering a short, basic test to weed out the unsuitable candidates before you spend time checking references and doing interviews.

Start retaining from the get-go. Employee retention is important, and it doesn't start at the employee's fifth-year anniversary. It starts from the moment you present the job offer. When hiring, a professional approach is the best - present the candidate with a letter outlining the offer and the start date. Upon acceptance, don't resort to email. Take the time to call the candidate and speak with him/her personally, showing your appreciation of their decision. Saying, "we're so pleased that you joined our team" demonstrates that you value teamwork and are excited about the decision. Looking for a special touch? Send the candidate who accepts your offer flowers and a note of welcome. In sum, make a great impression upfront - it will pay off in helping to retain your best employees.

Staff turnover costs money and not just in recruiting costs. Depending on your personnel policy, you may have the expense of paying out a departing worker's unused sick or vacation leave in a lump sum. Then there's the disruption to everyone's work as they cover for the vacant position while a new person is located. Then, after the hire, staff may have to scramble until the new person gets up to speed. And don't forget about all the time and effort everyone has put into creating teamwork in the billing office; you and the staff will have reinvest some of that time in the weeks and months following a new hire. Smart organizations look for the right medical biller when they hire - and make the effort to keep them around for the long haul.

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)   

HIPAA 5010 Implementation for Medical Billing

HIPAA 5010 was adopted to replace the current version of the standard that covered entities must use when conducting electronic transactions. Version 4010 is currently being used under HIPAA standards.

Although HIPAA version 5010 gets much less attention than ICD-10 medical codes,it is just as important and physicians, medical practices and other health providers, should already be working with vendors on the version 5010 implementation.

Testing with external trading partners began in January of 2011. It is very important that you test as early as you can and often.

Here are some important 5010 compliance testing dates to be aware of:

January 1, 2011 Level I compliance-ability to process 5010 transactions for testing and transition with able trading partners January 1, 2012 Level II compliance-all covered entities must begin using 5010 transactions

Simply put, transactions are electronics exchanges involving the transfer of health care information between two parties for specific purposes, such as a health care provider submitting medical claims to a health plan for payment. The Health Insurance Portability & Accountability Act of 1996 (HIPAA) named certain types of organizations as covered entities, including health plans, health care clearinghouses and certain health care providers. HIPAA adopted certain standard transactions for Electronic Data Interchange (EDI) for the transmission of health care data, as well. These transactions include, but not limited to:

claims and encounter information payment and remittance advice claims status eligibility enrollment and disenrollment referrals and authorizations

Unlike the current 4010 transaction standard, version 5010 is more specific in the type of data it collects and transmits over the course of a transaction. 5010 also has clear situational rules built in which will help enhance the understanding of claim corrections, reversals, recoupment of payments and the processing of refunds.

For example, HIPAA 5010 will increase the diagnostic field size to accommodate the increased size of ICD-10 codes. Some other changes include:

a version indicator that distinguishes between ICD-9 and ICD-10 codes format changes that will increase the number of diagnosis codes allowed on a claim

Interestingly, the 5010 format does not require the use of ICD-10 codes. However, it will be able to recognize and distinguish between the ICD-9 and ICD-10 medical code sets, which may help in a future with dilemmas of billing utilizing the dual code sets.

All health providers have to establish steps for preparing for 5010 Implementation and it might include the following:

Software must be modified to produce and exchange the new formats (e.g. trading partners must be able to read incoming 277CA transactions). Review business processes to ensure changes are not necessary to capture additional data elements not previously required (e.g. Impact of patient registration, billing, and claim reconciliation). Contact your vendor and/or clearinghouse to ensure products and processes are updated (e.g. license includes regulation updates, and will the upgrade include acknowledgement transactions 277A & 999). Trading Partners should contact their local Medicare-Fee-For-Service contractor (MAC) for specific testing schedules. 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)   

A Medical Billing and Coding Salary Comparison

Many people just starting to consider an administrative career in the healthcare industry are attracted by the fact that medical billing and coding is one of the fastest growing sectors over the past ten years. But once their research gets under way, it soon becomes obvious that aiming to earn a medical billing and coding salary isn't as straightforward as it seems.

The thing is, medical billing and coding, although closely linked, are in fact entirely separate disciplines. And once this fact becomes apparent, the inevitable question arises as to whether a medical billing salary is on a par with a medical coding salary, or whether one pays better than the other.

Comparison of a Medical Billing and Coding Salary

Firstly, we need to be clear as to what are the differences between the two areas. After all, if you are more comfortable dealing with numbers than people, then maybe you should aim to qualify as a medical coder.

Whereas, if you would rather pull your fingernails out than spend your working life manipulating numerical data, then you would be more comfortable with the duties of a medical biller.

Duties and Responsibilities

A medical biller is more akin to being a practice manager than a practice accountant. Whilst the task of compiling and submitting the required invoices to medical insurance companies or direct to patients, your job will involve patient liaison to a large degree.

From making appointments, greeting patients and their families to dealing with doctors, physicians and healthcare specialists, the job of a medical biller requires a far higher degree of people skills than maybe a medical coder does.

Certainly, a working knowledge of medical codes is essential for compiling patient records and accounts, but a specialist medical coder will be far more focused on data and numerical work than in dealing with doctors and patients.

So what is the implication for a difference in a medical billing and coding salary?

Initially, new employees in their first job after gaining their qualifications, be that in billing or coding, can expect to earn roughly the same amount. An hourly rate of between $10 - $14 is usual and is only influenced by whether the position is with a large or small organization and whether that organization is situated within a major city or rural town.

Once an amount of experience has been gained, the two disciplines begin to pull away from each other slightly. Certified medical coders with commensurate experience enjoy more satisfying salary levels than their unregistered and inexperienced counterparts. An average medical coder could reasonably hope to earn anywhere between $35000 - $45000 per annum.

A similarly qualified and experienced medical biller may find that their earning capacity is slightly lower at around $32000 - $43000 pa. However, those with specialization and experience encompass both areas are best placed to reach a salary level of up to $50000 pa or even higher. The inevitable conclusion to be drawn is that is you wish to earn a good medical billing and coding salary, then your best course of action is to qualify for both disciplines.

So before you make your choice whether to pursue a career as a medical biller or coder, you need to ask yourself whether you will be more comfortable dealing with people, number or both!

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)