The Good:

1. Efficiency: Billing software can significantly increase efficiency by automating repetitive tasks, such as data entry and invoice generation. This can save time and reduce the risk of human error.
2. Accuracy: Modern billing software is designed to be highly accurate, reducing the likelihood of billing errors that can lead to financial disputes or regulatory issues.
3. Cost Reduction: Using billing software can reduce the need for extensive manual labor, leading to cost savings in terms of employee salaries and operational expenses.
4. Data Security: Good billing software often includes robust security features to protect sensitive financial data from breaches and cyberattacks.
5. Analytics and Reporting: Many billing software solutions come with built-in analytics and reporting tools, allowing companies to gain insights into their financial performance and make data-driven decisions.

The Bad:

1. Cost of Implementation: Implementing billing software can be expensive, including the initial purchase cost, training, and potential customization to fit the company’s specific needs.
2. Learning Curve: Billing software can be complex, and employees may require training to use it effectively. This learning curve can lead to temporary disruptions in operations.
3. Dependency on Technology: Relying heavily on technology can be risky if there are system failures, technical glitches, or if the software becomes outdated.
4. Security Concerns: While billing software can enhance security, it can also be vulnerable to hacking and data breaches if not properly protected and maintained.
5. Lack of Customization: Some billing software may not fully meet a company’s unique requirements, necessitating additional development or workarounds.

Regarding the billing company’s usage of the software, it’s crucial for them to:

• Understand the Software: The billing company should have a thorough understanding of the software’s capabilities and limitations to maximize its benefits.
• Employee Training: Adequate training programs should be in place to ensure that employees are proficient in using the software efficiently and securely.
• Procedures and Compliance: The billing company must establish procedures that align with industry regulations and best practices to ensure compliance when using the software.
• Regular Updates: Keeping the software up to date is crucial for security and taking advantage of new features or improvements.
• Data Backup and Recovery: Robust backup and recovery procedures should be in place to protect against data loss.

In conclusion, while billing software offers numerous advantages, it’s essential for billing companies to carefully consider both the advantages and disadvantages and take steps to mitigate potential pitfalls. Proper education, training, and procedural safeguards are crucial for harnessing the full potential of technology in billing operations while minimizing risks. Fortunately, Merem Healthcare Solutions encompasses ways to mitigate both the bad and good in technology, so you don’t have to worry about anything related to your revenue cycle management operations.

The post Technology: The Good and The Bad appeared first on MEREM Health.

The motto for getting paid is to Ask Early and Ask Often for Payment.

The fact is, the further into the collections process you go, the less likely a patient is to pay in full. If your practice’s patient collection efforts only go as far as issuing statements and generating “bad debt” reports of accounts that are turned over to collections, it’s likely that less than 50% of those collection balances will be recovered.

If this describes your practice, an improved strategy for Patient “Pre-Collections” that is both aggressive and fair should be implemented. Revenue for services rendered is the lifeblood of any facility, and if patients need to foot 40% of the bill, you can’t afford to miss out.

• Discuss payment expectations when you discuss procedure and appointment setting. If unable to pay in full, collecting a nominal portion the day before or the day of may make it worth proceeding.

• Collect a portion of co-pays upfront from patients. This isn’t always possible in the case of many emergency room admissions, but it is for specialty services such as elective surgeries and ancillary procedures.

Point of Service Collections

Point of service collections is just as important as insurance collections. Missed co-pays can quickly add up to a significant revenue loss. In the long run, point of service collections helps to cut down on statement costs and patient AR.

In order to

Patient billing is a significant problem for patients and providers.

ensure patients understand their coverage and are aware of their responsibilities — and that you get paid. Develop a self-pay policy, communicate it clearly to both staff and patients, and self-pay collection will become an integral part of your practice workflow.

People are not aware of their deductibles for specific procedures but when the time comes, it’s often the front office staff that has to educate patients about their insurance and the agreed-upon patient responsibility. Oftentimes, patients who hold high deductible health plans and other aggressive patient cost-sharing models are unpleasantly surprised with they find our they are ultimately responsible for their surgery. Patients who need to pay out of pocket for some or all of their medical care are frustrated by difficulties understanding what’s covered and what they owe, the lack of options for payment plans, and the poor timing of bills and communication around the process.

Front office staff are intimidated to collect payments or have not perfected Point-of-service collections, the art of asking for payment.

collecting some or all of the co-pay upon admission or before services are rendered

For Example:

Don’t Ask: CAN you can pay today?

Ask: How WILL you pay today?

Make it easy for patients to pay. 9 times out of 10, patients say they want to be able to pay their medical bills online. Facilities and healthcare providers can help ease the burden for patients by setting up customized payment plans, using patients’ preferred payment methods — which helps ensure that bills will be paid.

We don’t just set up a payment framework and then walk away; we are committed to giving providers the analytics, technology infrastructure, clinical support, and other resources that increase their likelihood of success. We also try to understand and address their challenges; for example, knowing that cash flow is a big issue, we’ve worked to make billing cycles shorter and more predictable.

The post Principles of Improving Patient Procedure Collections appeared first on MEREM Health.

• When was the last time we reviewed our process or improved our technology?
• How accurate is our documentation?
• Can we improve

But it doesn’t have to be this way. Our team at MEREM Healthcare Solutions wants you to know how to be as prepared as possible in case your medical practice finds itself in the middle of a CMS audit this year. One of the best ways to avoid a CMS audit is to be prepared at all times, the best way to do so is by conducting internal audits within your medical practice.

When Was the Last Time You Reviewed Your Process?

Every medical practice has its own unique operations “process.” Is your process working for your medical practice as it should? Internal audits can be helpful in identifying areas of improvement such as your practice management software/technology and can highlight challenges within each step of your revenue cycle from documentation and coding, to billing and collections.

Technology is always changing to provide improved accuracy, especially when it comes to medical billing. If your medical practice is still using technology from years ago, then you may face a higher chance of errors in addition to your team being limited in their ability to work as effectively and efficiently as possible thorough streamlined pms processes.

Conducting an internal audit can allow you to see if the time has come to update your medical practice’s “process,” also known as “technology.”

An internal audit can also prevent revenue loss from occurring, as it can point to where issues are happening so that you can identify areas to focus on improving. For example, if your practice is facing a signifacant amount of claim denials due to coding mistakes, it might be better to consider outsourcing your medical billing and coding to a team of experts that have the experience,and ongoing training for coding within your specialty —like us!

If it has been a while since your last internal audit, you might want to conduct one sooner rather than later.

How Accurate Is Your Documentation?

When it comes to a patient health record, there is absolutely no room for error. Not only can it cause harm to the patient, it can also cause your medical practice harm and possible fines if caught while undergoing a CMS audit.

There should be no discrepancies whatsoever when comparing medical information, such as health records, which should be filled out properly throughout the entire process. Every detail is key.

MEREM Healthcare Solutions Is Here to Help!

A lot of concerns that we’ve discussed with potential clients particularly come from Pain Management physicians because they are a high risk for audits and they want to make sure everything is being coded and billed correctly and ethically to keep them off the grid from auditors.

As we explained earlier, one of the best ways to avoid a CMS audit is to be prepared at all times, which includes conducting your own audits within your medical practice. If you are noticing your medical practice is losing money or you do not have 100-percent faith in your team’s coding accuracy, it may be time for an internal audit! We can help you.

At MEREM Healthcare Solutions, you can feel confident that our knowledgeable and experienced team provides the coding accuracy your medical practice needs in order to keep insurance claims correct and get your medical practice paid for services provided.

Discover how our team at MEREM Healthcare Solutions in Birmingham, AL, can help your medical practice avoid and/or prepare for a CMS audit.

Merem Healthcare Solutions offers services for every step in a practice’s revenue cycle management. We can start from the beginning from credentialing and end with payment posting once an account has been satisfied. We offer a wide range of solutions which include auditing, billing, coding, consulting, credentialing, payment posting, practice management, and pre-collections training. Check us out on our website or feel free to call us to see how. Our customized healthcare solutions can help you run your practice like a well-oiled machine – (205) 329-7519.

The post How Can Your Practice Avoid An Audit? appeared first on MEREM Health.

If there is one thing we understand at MEREM Healthcare Solutions, it ‘s practice profitability. We’ve been working to improve the revenue cycle for orthopedic doctors a long time, and we want to share some of the revenue cycle setbacks they’ve overcome.

We know from experience that so much income goes overlooked and undiscovered when it comes to medical billing and coding. However, there could be other revenue cycle components going on too.

When MEREM Healthcare Solutions was founded, we began by working with orthopedic healthcare executives as a solution to their on-going billing and coding problems. We’ve been working with orthopedic doctors and specialty health care clinics, and we have identified three obstacles that have helped them increase revenue and improve their practice performance over the years.

Bottom line: We want you to have a more profitable orthopedic practice and we can help you do that.

Could Your Orthopedic Practice Be Losing  Revenue?

Here are three common reasons why orthopedic practices lose money and 3 simple solutions that MEREM Health offers to make practices more profitable.

Reason 1.

High Volume Doesn’t Always Translate to Higher Revenue

We’ve learned that orthopedic surgeons are trained to think that the more surgeries they perform and the more patients they see, the more money they earn; however, this isn’t always true.

It is all about your RVUs. It is hard to keep the practice running on hammer toes or debridements.

• What if you are just missing out on RVUs due to your dictations?
• What does your payer mix look like? If all of your surgeries are being performed on Medicaid patients or a commercial payer with lower reimbursements than your revenue is sure to be lower than expected.

Solution: It is important to have certified coders experienced in Orthopedics reviewing each and every op report and office visit note.

At MEREM Healthcare Solutions, all of our coding staff are certified by the AAPC with years of Orthopedic experience. Many have been recognized for their specialty coding expertise through AAPC specialty certifications including COSC (Orthopedic Surgery). Additionally, we have a staff of practice consultants that can help you review your payer mix through a Revenue Cycle Audit and offer unique solutions for your orthopedic practice to maximize your time in the OR and in the clinic.

Reason 2.

Claims Consistently Denied Due to Inaccuracy

Billing is directly tied to your profitability. Income needs to consistently flow into the practice, which means your coding needs to be correct.

When there are mistakes in the billing and coding processes it could hold up claims for a long period of time. Even the best medical coders can make mistakes and, if they are overwhelmed, much can go overlooked.

Solution: Perform audits on a regular basis. When was your last coding audit?

Medical auditing can provide areas of improvement for your coding staff. Even well-trained staff can make mistakes. An audit can recognize under coding, bad unbundling habits, and code overuse. Once a coding audit is complete, your medical coding staff will then be able to bill appropriately for documented procedures.

Interested in A FREE tool to help you improve your current revenue process. Whether you currently handle your billing and coding in-house or outsource to another company, MEREM Healthcare Solutions can provide you with an unbiased industry comparison and revenue cycle audit report to assist physicians and practice managers with improving their practice performance.

Reason 3.

Inefficiency Due to Performing Too Many Procedures Outside of Your Specialty

More patients don’t always equate to more profits as we have already determined. If you’re performing surgeries you don’t specialize in, you’re likely to be much less inefficient with your time. This is where ultra-specialization comes into play.

Solution: Focus specifically on doing and being known for the procedures you are best at and refer out or perhaps join-in with other surgeons who specialize in other procedures.

Also, as you become more profitable and your practice grows, MEREM Healthcare Solutions can also help with credentialing any new provider enrollments with payors in your network and hospital privileging. Medical Credentialing is one area of the revenue cycle process where mistakes can cost your practice 10’s of thousands of dollars just by overlooking one letter or notice. Common credentialing errors cause scheduling delays, fluctuation in the revenue cycle, and much more. It’s important to take the appropriate amount of time necessary for credentialing, instead of waiting a month before a new physician arrives.

Let Us Handle Your Billing and Coding Needs

The day-to-day operation of running a busy orthopedic practice comes with many different challenges:

• Keeping up with appointments,
• Creating a reliable staff,
• And monitoring the expenses of running your practice.

We can take at least one thing off of your long-running list of day-to-day concerns AND make sure your practice remains profitable. Our team of professional coders and billers have the exact experience you need and we happen to specialize in orthopedics and surgery. Call MEREM Health today for a quote (205) 329-7519 or contact us to request a consultation.

MEREM Healthcare Solutions provides exceptional medical billing, coding and credentialing services to orthopedic surgeons and sports medicine physicians, hospitals, and outpatient centers. Take advantage of our coding expertise today!

Schedule Your Free Revenue Cycle Audit Today!

The post Three Reasons Orthopedic Surgeons Lose Revenue appeared first on MEREM Health.

Now is the time to conduct a financial review of your medical practice’s 2018 financial performance. Whether you currently handle your billing and coding in-house or outsource to another company, MEREM Healthcare Solutions recommends that you should conduct an annual revenue cycle audit in order to:

1. Compare your practice’s performance against the previous year.
2. Compare against industry benchmarks.

Comparing year-end practice revenue and industry benchmarks

At MEREM Healthcare Solutions, it is our mission that all of our clients meet and exceed industry benchmarks. By following this mission, we are able to increase revenue by improving processes.

You should be looking at and comparing the following benchmarks and practice performance to the prior year. If applicable, net collections should be compared by payor as well as by provider or physician.

Consider reviewing national specialty surveys in order to determine if your practice is improving. If not improving year over year, a complete revenue cycle audit may highlight why.

Industry Benchmarks

Industry benchmarks we follow closely to set goals for our clients, include:

• Gross Collection Percentage
• Net Collection Percentage
• Days In A/R
• A/R Ratio
• A/R in Excess Of 120 Days Old (Our Client Standard Focuses On 60 Days.)
• Collection Rates by Payor/ Physician (Payor Mix)
• Coding Accuracy
• Clinical/Procedure/Ancillary Encounters
• Charges by Payor
• Payor Collections by Physician
• E/M Coding Comparison
• Increase Marketing Efforts to Improve the Ratio
• Front Desk Collection Success (Copayments and Patients With A/R Balances)
• How Quickly Visits/Procedures Are Billed
• How Long Does It Take To Get Paid By Payors
• Percent of Insurance Eligibility Verifications Vs. Total Scheduled Patients
• Average Number of Missing Charges Vs. Services Rendered (Actual & Cpt Mistakes)
• Percent of Denied/Rejected Claims Vs. Total Claims Filed
• Percent of Denied/Rejected Claims Appealed Successfully Vs. Total Denial/Rejections
• Average Days Between Receipt of Payment and Payment Posted
• Average Number of Unpaid Claims Resolved by Day Per Collector

AUDITING WITH NO FEAR, NO FRUSTRATION, AND NO FAULTS

If you are struggling to meet or keep up with these standards, a billing and coding audit should be performed in order to help you understand the key areas where your clinical operations are weak and can help you to identify priorities and set goals toward making improvements that impact your revenue cycle.

Billing and Coding Audits are valuable tools to help improve your revenue cycle and maintain compliance with CMS and other regulatory bodies. Consider MEREM Healthcare Solutions as an outsourced solution for conducting a complete revenue cycle audit. Our FREE Revenue Cycle Audit tool will help you stay on track with current industry standards and provide unbiased industry comparison and revenue cycle audit report to assist physicians and practice managers with improving their practice performance. Schedule Your Free Revenue Cycle Audit Today!

The post Where does your practice stand among industry benchmarks? appeared first on MEREM Health.

MGMA Stat from Sept 2018 shows an 86% increase in required prior authorizations.

To keep pace with changes to healthcare reimbursement, hospitals and healthcare organizations need to reduce inefficiency in their revenue cycle management.

One significant cause from revenue loss is claim denials due to lack of prior authorizations. You cannot work backwards to get retro-authorizations for most insurance companies.

Therefore, no prior authorization = no payment.

Take a deeper look…

How do your staff handle the ever-increasing demand for prior authorizations?

When prior authorizations for a procedure are managed, it’s often the front-desk staff or a nurse who fills out the orders and they are not often familiar with the medical necessity requirements set by each individual payer.

Also, doctors often think they know the payers’ medical necessity policies, but are not coding to the specificity that the payer requires.

Insurance must be verified prior to any service because pre-authorization is required for many plans.

While Medicare recently increased the demand for proof of medical necessity beginning Jan 2018, private payers have also adjusted their demands for individual policies resulting in confusion of requirements and increased claims denials. According to the MGMA poll in Sept. nearly 86% of practices polled said that they have experienced increased denials due to payer policy changes regarding prior authorizations.

Not all insurances are equal

Insurances have multiple plans that stipulate different coverages. Some plans only pay for specific services, some will only pay once a patient has paid down a specific amount, or after a certain length of time.

Regarding medical billing and coding, depending on the service, the coding/billing representative may need more information or historical documents in order to work the denied claim.

At MEREM Healthcare Solutions, we want to be your strategic partner in making sure your billing, coding, auditing, and other needs are met. Contact us today to learn how our knowledgeable and experienced professionals can help assist with issues associated with EMR and medical billing among your medical facilities.

The post How Do You Handle Prior Authorizations? appeared first on MEREM Health.

Reporting of a practices medical billing performance is more complicated today than ever before because the options for reporting are much greater. EMR programs collect and process so much data, that it becomes overwhelming and time consuming to manage and sort for most practice managers.

In order to truly measure specific practice performance processes that impact your revenue cycle such as medical billing, patient pre-collections, and claims denial corrections, custom reports are a necessary tool. Custom reporting presents a single source of data and metrics, that allows you to assess and compare billing and collection performance trends in a more effective way.

Instead of deciphering a plethora of monthly reports, consider custom medical billing reporting. Creating a fully customized report requires the understanding of Key Performance Indicators (KPIs) as well as analytical skills. Below are some tips for creating custom reports for a medical practice.

Tip #1 – Set Up Custom Monthly Performance

A monthly custom report is important to demonstrate basic billing processes that have occurred.  Comparing monthly reports can provide a clear indication of existing data trends. Can your current monthly reports identify these seven major Key Performance Indicators?

Key Performance Indicators

1. Beginning Accounts Receivable – unpaid money owed by customers at the start of the month.
2. Charges – total number of money spent on goods and services for practice.
3. Volume – the total number of services billed or rendered.
4. Adjustments – generally insurance allowances accepted. Learn more on claim adjustments.
5. Payments – total deposits made.
6. Collections – the total of previously unpaid money from customers, now paid.
7. Ending Accounts Receivable – end of the month total in unpaid money owed by customers.

Tip #2 – Compare Trend Reporting

While month to month reporting does a great job of showcasing your monthly spending, which is important for budgeting in the present, it does not do a proficient job of illustrating trends and overall revenue cycle performance.

In order to identify these larger, more important trends, you have to spread out the timeframe of your reporting. Three months, six months, and yearly custom reports are essential for evaluating your billing processes. This style of custom reporting puts each months KPI beside one another so that you can view the stability, or lack thereof, occurring within your revenue cycle.

Citing a major increase or decrease in any KPI between two months is cause for further investigation. If the shift is, in fact, troublesome and not caused by reasonable means, your practice can correct the problem and continue to monitor custom reports to see future finances stabilize. Longform KPI custom reports are crucial for assessing billing and cut down on time spent analyzing more confusing and exhaustive reports.

Tip #3 – Consider Outsourcing Your Custom Reporting

Because custom reporting guarantees exceptional analytics, it is important to do it correctly.  Medical practices run at a fast speed, meaning your coding and billing could easily become rushed, often resulting in significant revenue loss or delayed payments.

Outsourced professional medical coders and billers are able to dedicate their time fully to generating your custom reporting, and much more.  With an outsourced medical coding and billing company, you no longer need to worry about mistakes being made due to the fast-paced nature of a practice.  Instead, you can turn your focus to the patient and rely on MEREM Healthcare Solutions for accurate medical billing and coding. Our custom medical billing reporting helps our clients performance and hold our solutions accountable for their improved revenue cycle performance.  And let’s not forget: outsourcing medical billing saves money.

Are you interested in receiving custom reports for your medical practice?  Better understand your revenue cycle performance today. MEREM Healthcare Solutions is here to help. Contact us today!

The post Creating Custom Reports For Your Medical Practice appeared first on MEREM Health.

What could I gain from doing an audit? GOALS

The results from any audit are measured against industry benchmarks. If you are struggling to meet or keep up with these standards, a billing and coding audit should be performed in order to help you understand the key areas where your clinical operations are weak and help you to identify priorities and set goals toward making improvements that impact your revenue cycle.

At MEREM Healthcare Solutions, we call these standards, Industry Benchmarks, and it is our mission that all of our clients meet and exceed industry benchmarks.

What is a REVENUE CYCLE AUDIT?

A practice operation review tool used over a period of time to help you improve your current revenue process. We believe that routine, internal audits of your billing and coding processes are necessary. Every time an audit cycle is completed, there should be further improvement in patient care.

WHAT ARE INDICATORS THAT IT’S TIME FOR A REVENUE CYCLE AUDIT?

Is your practice losing money? – An audit will help you identify revenue loss and set goals focused on profit potential.

How quickly are your claims being followed up upon initial denial? – Efforts to reduce claim denials should begin with a revenue cycle audit to help you identify the source of denial trends.

Are you confident in your in-house/outsourced coding accuracy? – Coding services are the life-blood of your practice. That is how the services you provide are transformed into billable revenue.

A complete Revenue Cycle Audit includes:

• Coding accuracy audit
• Billing and accounts receivable audit
• Industry Benchmark Comparison for your individual practice

Conducting a revenue cycle audit in-house may take away from your daily responsibilities, and be a daunting task. Considering an outsourced solution for conducting your audit will help you stay on track and focused on continually improving your processes.

Whether you currently handle your billing and coding in-house or outsource to another company, MEREM Healthcare Solutions can provide you with an unbiased industry comparison and revenue cycle audit report to assist physicians and practice managers with improving their practice performance. Our audit results are always kept confidential for our client’s internal use only.

MEREM Healthcare Solutions is a Birmingham, AL-based company that has been providing exceptional medical billing and coding services to physician practices and ambulatory surgical centers since 2008.
We pride ourselves on not just maintaining, but exceeding, the level of accountability, communication, and customer service that is valued in traditional, on-site billing departments.
Please check out our other blog posts, or contact us to learn more.

The post Auditing With NO Fear, NO Frustration and NO Faults appeared first on MEREM Health.

What if your medical billing team went away tomorrow?

It’s happened to more than one practice.

Like many specialty medical practices, you probably have an in-house team that handles your revenue cycle management; From billing to coding, to auditing, collections, payment posting, claims re-submissions and dealing with payors. For some practices, this in-house arrangement works just fine, but have you ever thought about what would happen if your in-house team happened to fall apart, either because of employees finding other jobs or even retiring?

It’s every physician’s nightmare, but it doesn’t have to be. In fact, it might be time to explore another solution. A solution that would keep your revenue cycle management intact, no matter the circumstances of your practice.

Here are 2 significant advantages your practice would have if you considered outsourcing critical revenue cycle processes and leaving your team to focus on patient care and follow-up:

1. Many in-house medical billing and coding teams fail to keep up with changing regulations

Merem Healthcare Solutions Director of Billing Operations, Jennifer Smith, knows about this challenge intimately. She explains, “Carriers will change their policies and guidelines frequently. Without the proper knowledge and resources to stay up to date on these changes, this could be an extremely risky situation that could lead to lower reimbursement and an increase in denials.” Lower reimbursements and increases in denials obviously impact your practice’s bottom line in a big way.

When considering outsourced solutions, you will want to look for a strategic partner staffed with healthcare executives who have spent years in the physician practice space. These types of leaders have experienced these problems first-hand, and have developed proven solutions that have a mission of meeting or beating industry benchmarks, which are:

•  % of outstanding A/R = less than 120 days or -15% or less
• 30 days or less in A/R
• 97% or above net collection rate
• Coding accuracy above 98%

You should examine whether your existing office staff is currently meeting or exceeding these goals, and if they are not, you should consider outsourcing.

2. Many in-house medical billing and coding teams occasionally miss charges

Let’s face it, your in-house teams do a lot more than just billing and coding. In busy physician practices, they might also be asked to answer phones, do patient intake, and handle other tasks that interrupt their regular day-to-day jobs. It’s not their fault; it’s the nature of a busy, profitable physician practice. And when this multi-tasking is taking place, it stands to reason that employees are occasionally missing charges, among other things.

If this is the case at YOUR practice, you might consider an off-site outsourcing solution as a resolution to these issues that will invariably come up with an in-house staff. Jennifer Smith points out, “This is our team’s job every day, and they do it well. They have the resources available to locate and stop denial trends and/or carrier changes. They are not interrupted by other duties and responsibilities, as is what often happens within physician practices.”

As you probably already knew, there are several “gotcha” moments in the lifecycle of in-house revenue cycle management, which adds up over time in terms of revenue lost, inefficient productivity, and lack of ongoing training. Simplify your practice and your life by considering the advantages that outsourcing brings, and spend more time focusing on the things that are really important to you and your practice.

Merem Healthcare Solutions offers services for every step in a practice’s revenue cycle management. We can start from the beginning from credentialing and end with payment posting once an account has been satisfied. We offer a wide range of solutions which include auditing, billing, coding, consulting, credentialing, payment posting, practice management, and pre-collections training. Check us out on our website or feel free to call us to see how we can help run your practice like a well-oiled machine – (205) 329-7519.

MEREM Healthcare Solutions is a Birmingham, AL-based company that has been providing exceptional medical billing and coding services to physician practices and ambulatory surgical centers since 2008.
We pride ourselves on not just maintaining, but exceeding, the level of accountability, communication, and customer service that is valued in traditional, on-site billing departments.

Please check out our other blog posts, or contact us to learn more.

The post What if your billing team went away tomorrow? appeared first on MEREM Health.

Coding services are the life-blood of your practice. That is how the services you provide are transformed into billable revenue. It takes a knowledgeable and experienced coding staff to maximize your billed charges while maintaining strict compliance with CMS and CCI guidelines.

Coders are trained to identify noncompliance and fraud. Part of a coder’s job is to have sound knowledge in detecting ambiguous or suspicious documentation that could lead to fraud as a false claim if not detected before being submitted to insurance and being paid.

Fraud, in regard to medical coding, is when a false claim misrepresenting the facts is intentionally submitted to insurance in order to receive payment.

Examples of Financial Fraud are:

• Billing for procedures that were never done
• Knowingly billing for services at a different level than what was performed
• Falsifying information in the medical record to satisfy the medical necessity

“You can’t code what is not there” – Meredith Tibbs, Medical Coder at MEREM Healthcare Solutions

Abuse happens when patients are treated with services that are not medically necessary

Examples of Financial Abuse are:

• Billing for medical services that are unnecessary
• Upcoding and Unbundling
• Overcharging for supplies and services

Common terms of Fraud and Abuse in the coding world are:

Upcoding:

Reporting a higher level of service than what is supported in the dictation

Unbundling:

Reporting more CPT (procedure) codes than necessary to increase payment

• Some higher paying procedure codes include smaller procedures in their code descriptions, so you can’t code both. You would only bill the one code that includes both procedures in the description.
• It is very important for a coder to be familiar with these codes and stay updated when these change because they frequently do change and update these codes.

Medical Necessity:

• The doctor must have a legitimate medical reason to perform tests and procedures
• There are certain diagnosis deemed necessary for medical necessity attached to certain procedures. These have to be documented, you can’t make these up to satisfy the medical necessity

It is VERY important as a coder to be knowledgeable and confident in their field, so they are able to detect any potential risks that could negatively impact the facility and/or physician they work for as well as educate the people around them that don’t know.

“Staying up to date through compliance training either on their own or through their organization is of the utmost importance. Coders work too hard to earn their certifications and, in this field, honesty is ALWAYS the best policy.” -Meredith Tibbs, Medical Coder, MEREM Healthcare Solutions

Auditing can provide areas for improvement for your coding staff. Even a well-trained staff must be checked, therefore every practice should have an audit performed annually. An audit can recognize under coding, bad unbundling habits, and code overuse. Coding staff will then be able to bill appropriately for documented procedures.

MEREM Health specializes in auditing and can provide education, consultation, reports, and recommendations for improvement. The feedback and recommendations provided by our external auditors are valuable to the improvement of each practice.

Contact Merem Health today to find out how our auditing services will provide support for your practice!  

MEREM Healthcare Solutions is a Birmingham, AL-based company that has been providing exceptional medical billing and coding services to physician practices and ambulatory surgical centers since 2008.  We pride ourselves on not just maintaining, but exceeding, the level of accountability, communication, and customer service that is valued in traditional, on-site billing departments.

Please check out our other blog posts, or contact us to learn more.

The post How Coders Can Help Prevent Healthcare Fraud and Abuse appeared first on MEREM Health.