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Relying heavily on technology can be risky if there are system failures, technical glitches, or if the software becomes outdated.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.

By utilizing an experienced team of medical billers and coders who are knowledgeable in various specialty medical codes and trends, you can rest assured that things are being handled properly behind the scenes while you and your medical team can take care of patients upfront.

Chances are what first brought you into the healthcare industry was wanting to help others. You wanted to make a difference in people’s lives and give them more quality years. However, as you started your own private medical practice, you probably saw it was filled practice management tasks leaving you with less time with patients and more time behind a desk dealing with insurance and other revenue cycle demands. 

Be More Proactive in Your Medical Billing and Coding

According to Healthcare Business & Technology, more than 80% of medical bills contain errors. Medical billing errors are the biggest reason for the disruption of cash flow in a physician practice. 

Fortunately, by making sure everyone on your team is on the same page when it comes to documentation (as well as having a strong medical billing and coding team), you can greatly reduce these errors so that cash flow in your medical practice continues to move in the right direction.

No Errors Allowed!

As you well know, most medical billing errors are due to:

• Incorrect patient information, which includes insurance provider information
• Duplicate billing
• Poor documentation
• Unclear claim numbers
• Wrong codes being used

However, by putting the proper training in place and outsourcing your medical billing and coding services, you can ensure that a majority of your claims will not be denied. 

When these medical billing and coding errors take place, claims come back denied. Resubmitting a fixed claim denial with the correct information can take weeks for review and approval on the other end. In addition, this puts a delay in not only payment from insurance but also slows down the payment received from the patient. 

Medical billing errors add up quickly. Before you know it, your medical practice is starting to lose money rather than gain. However, by utilizing an experienced team of specialized medical billers and coders who are knowledgeable in various medical codes and trends, you can rest assured that things are being handled properly behind the scenes while you and your medical team can take care of patients upfront. 

Give Your Patients the Experience They Deserve

Even during a normal health care checkup, a patient’s anxiety can be high. Therefore, having a warm welcome can make all the difference in starting the patient’s experience off on the right foot within your medical practice. 

Allow our team to handle the billing and coding services behind the scenes so that your front office staff, along with other members of your medical team, can focus on the patients walking through your door and providing them with the best experience possible! 

Remember, happy patients will not only return. The chances are high that they will bring friends! 

Discover how our team at MEREM Healthcare Solutions in Birmingham, AL, can help your medical practice avoid medical billing and coding errors. 

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.

The post Outsource to Avoid Medical Billing and Coding Errors! appeared first on MEREM Health.

When it comes to active healthcare claims processing, it is essential to create a process that maximizes efficiency to handle denied claims. Most medical practice administrators get worried when it comes to working claims, particularly when the claims are denied. It is essential to identify the potential income loss and begin an effective medical claims management process for handling these claims.

The good news is that every small improvement will make a significant impact on the cash flow of your practices revenue cycle. Here are some tips on how to accurately process denied claims and increase the overall performance of your revenue generation.

Track All your Claims

This may seem like basic advice, but the fact is that many healthcare providers do not track all their claims. The only way to define the problem is to use an effective method that will help teams keep track of denials so that they do not lose a single claim.

Complete Your Denials in a Week

If a claim was submitted incorrectly it will get returned or denied, then it needs to be corrected and promptly submitted again. Many health insurance companies place time limits to re-file their denied claims. By making denials a high priority and actively addressing them quickly you can ensure that they are not ignored or lost.

Identify the Problem Within Your Claims Denials

Monthly, you should look over all the denials and try to locate any trends that might be a cause for errors on a large scale (global errors). By identifying a specific issue that several denials have in common, the problem can lead you to take practical steps to rework the claims and to avoid future denials. This can protect your Time, Money and Effort.

What happens if you find out an excessive number of mistakes are being made? Do you take the time to re-educate your staff, or do you choose to outsource?

Check out our blog on how to combat claim denials.

Outsource your denial management process

A good solution will be outsourcing your denial management process to an expert company that focuses on Revenue Cycle Management solutions. When you outsource medical billing, you are handing over your revenue cycle management to individuals with extensive training. If you have a cavity, you go to the dentist. Similarly, if you have trouble with your medical revenue cycle, you outsource medical billing.

When choosing an outsourced healthcare solution to use, there are a few questions you should ask like,

• Do they use expert teams that are highly skilled in working with insurance systems?
• What are their turnaround times to get the denials addressed?

By outsourcing your denial management process to a medical billing company, you will have more time to focus your attention on patient needs. Interested in learning more? Check out this overview of MEREM Health’s medical billing services.

The post Tips For Improving Your Denials Management appeared first on MEREM Health.

Surgical cases are often complex, requiring multiple procedures to resolve a patient’s ailments. This is particularly true in the field of Orthopedic Surgery. Our bodies are complex biomechanical structures and can be affected by numerous conditions requiring surgical intervention.

Your patients deserve the relief that your expert surgical treatments provide, and you deserve to be fully reimbursed for all necessary and separate procedures as far as reimbursement guidelines will allow.

The simple answer to how you can be sure you are maximizing reimbursements on your surgical cases is by turning to an experienced team of certified orthopedic coders. CPC certification by the AAPC has become the gold standard with additional specialty certification available such as AAPC’s COSC (Certified Orthopedic Surgical Coder).

“Specialty providers deserve specialty coders.” At Merem Healthcare Solutions, that’s what we believe and that is what we provide to Orthopedics and Sports Medicine practices. We believe that every client deserves the expertise of experienced CPC coders; additionally, we employ COSC coders for their specialized knowledge pertaining to complex orthopedic surgical cases.

We asked our expert coders: “What is the #1 thing surgeons can be doing to increase their surgical reimbursements?”

“What is the #1 thing surgeons can be doing to increase their surgical reimbursements?”

You may be surprised by the answer: Improve Documentation. Your documentation is the key to your reimbursements and the profitability of your practice.

Documentation such as the operative report and op notes are the only way a coder can translate the procedures performed into billable revenue via (CPT codes). Incomplete or vague documentation can lead to a major loss in billable revenue. You know what procedures you performed but remember, you can only get paid for what your notes say you performed.

In our experience working with practices across the country, we have seen that some surgeons are in the habit of providing their staff with the codes they want to be billed.

For some surgical cases, these codes may be accurate and supported by the documentation. Although in some cases, if not reported correctly, this act can be seen as healthcare fraud or abuse.

Could you be leaving money on the O.R. table?

1. What if there are additional codes that could have been billed?
2. What if the documentation does not support the codes given and the payer performs an audit?

The answer to both questions is –Revenue Loss. 

After reading and coding thousands of surgical operative notes, the medical coding experts at MEREM Health have provided five examples you can reference to ensure you are maximizing reimbursement while maintaining billing and coding compliance.

Five Orthopedic Procedure Examples For How To Maximize Reimbursements & Maintain Coding Compliance

#1   Abrasion Chondroplasty – 29879 – 19.05 RVUs

A chondroplasty is often performed in conjunction with a meniscectomy; so much so, that NCCI guidelines will not allow for a traditional chondroplasty (29877) to be billed when performed with a meniscectomy on the same knee on the same day.

This is where accurate and descriptive documentation comes into play. If the chondroplasty is performed using a microfracture/osteochondral drilling technique, the procedure can be billed as an abrasion chondroplasty increasing your case’s billable RVU total by 19.05.

The key to correctly documenting and billing this procedure is that your op note must support that the debridement/microfracture/drilling went down to bleeding bone. Absent this key phrase, the chondroplasty cannot be coded as 29879 while maintaining compliance.

#2   Extensive Synovectomy vs Limited Synovectomy

It is important to think of Extensive/Limited or Major/Minor as a quantitative description rather than a qualitative description. It is all about the number of compartments.

To appropriately bill an Extensive Synovectomy (29876), the documentation must clearly support that synovium was excised from at least 2 compartments of the knee.

Additionally, for either synovectomy code to be reported, the documentation must support the necessity due to a pathological disease process and not simply for visualization purposes. For this procedure, your incomplete dictation could cost you anywhere from 4.69 to 18.92 RVUs.

#3   Mumford Procedure (Distal Claviculectomy)

With a distal claviculectomy procedure, it is important to note the size of the bone that is being removed. Per CPT and AAOS guidelines, this procedure is reportable as 29824 (19.15 RVUs) if 8-10mm or more of the clavicle is removed.

If less than that amount is removed, or if the size is not reported, the procedure would only qualify as a debridement. This error could cost 2.76 RVUs.

#4   Bankart and SLAP repair (same session)

Per AAOS, capsulorrhaphy (29806) for a Bankart repair, and SLAP repair (29807) are reportable on the same date of service when documentation supports the repair of type II or type IV SLAP lesion, in addition to the Bankart repair. Failing to document the grade of the SLAP tear, 29806 would not be separately reportable at a cost of 30.58 RVUs.

# 5ORIF of a Distal Radius Fracture

It is important to document if the fracture was intra-articular or extra-articular. You will also need to document how many fragments were fixated.

There are three different codes: 25607 (extra-articular), 25608 (intra-articular fracture, with fixation of 2 fragments), or 25609 (intra-articular fracture, with fixation of 3 or more fragments). Depending on which code the documentation supports, RVU values range from 21.08 to 30.08.

These most common orthopedic procedure scenarios could be causing you to leave money on the operating table, but there are so many more.

At MEREM Healthcare Solutions, we believe that orthopedic surgeons and all of our clients should be able to focus on what they do best. While you focus on restoring patients to their best musculoskeletal health, detailed documentation is imperative. Let MEREM Health worry about your procedure codes!

Our Specialized Orthopedics and Sports Medicine Coding Solutions Include:

1. All clinical and surgical documentation reviewed by Certified Coders
   Coding completed within 48 hours from receipt of all source documentation
2. Coding experts that can educate your staff to ensure appropriate documentation and compliance
3. Regular internal audits to monitor coding performance, accuracy, and compliance
4. Quarterly reports on provider-level coding and documentation performance

Op notes are never written in stone, so from Day 1 our experts will ask you the right questions so that addendums can be made for your current cases, all while coaching you to documenting iron-clad operative reports.

Find out if you are leaving money on the operating table! MEREM Healthcare Solutions will make your orthopedic practice more profitable!

Contact the medical coding experts at MEREM Healthcare Solutions today for a FREE coding audit of 15 surgical cases. Call (205) 329-7519 or click here to learn more about our revenue cycle improvement and auditing process for orthopedic and specialty medical practices.

Request A Consultation with MEREM Healthcare Solutions today.

The post Optimizing Surgical Reimbursements for your Orthopedic Practice 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.

Below, our professional biller and coders have provided some information about the benefits of outsourcing your medical billing and coding.

Medical Coding and Billing Services – Why Outsource?

One reason to outsource your medical coding and billing is that it frees you and your staff up to care for your patients.

When your staff are rushed because you’re clinic is busy or running behind, it is easy to make mistakes. Your patients will be taken care of more effectively at your practice with billing and coding taken off of your staff’s plate. Outsourcing this time critical solution to our certified medical billers and coders will be able to dedicate their time fully to coding and following up on unpaid claims, resulting in more claims being processed in a timely manner with fewer errors.

Accountability for Coding Errors

The CMS modify codes on a quarterly and annual basis. Incorrect coding, or miscoding, is likely for any medical practice that does not implement ongoing CPT code training for their medical coders.  Medical coding errors may lead to major delays in payment reimbursements and payer audits, which hurts your practice. Failure to provide correct coding can cause these payments to be delayed, denied, or limited.

MEREM Healthcare Solutions has found that an alarming majority of claims are rejected or denied upon initial submission. The reimbursement for denied claims depends on a practice’s efforts for correcting and resubmitting claim denials. You can avoid this problem by outsourcing your medical coding to certified professionals who have already become familiar with the new coding system and pursue ongoing training for relevant CPT code changes that directly affect our practice specialties.

When practices utilize outsourced medical coding solutions,

1. fewer mistakes are made
2. better care is given to patients
3. and billing cycles run smoothly.

Certified Coders Do More Than Just Submit Claims

It’s not uncommon for people to have multiple insurance companies. A professional, certified coder will make sure that each claim is submitted properly. Our expert coders have the correct software and expertise necessary to submit claims to all of the responsible payers while staying compliant with CMS and payer guidelines.

If any of your claims are denied, our billers can also handle the appeal process. Outsourcing your medical coding will ensure your revenue cycle is always running as smoothly as possible. (Did you know in-house medical coding costs more? Outsource!)

Ready to Outsource Your Medical Coding?

MEREM Healthcare Solutions, located in Birmingham, Alabama offers medical coding, billing, and revenue cycle management services to clients across the nation.

We are familiar with all of the ICD-10 and ongoing CPT changes upheld by CMS and MEREM Health will provide you with superior service for a fraction of the cost of our competitors! Contact MEREM Health today or request a FREE revenue cycle audit to find out how your medical coding can be enhanced with our dedicated expert medical coding team.

The post Should You Outsource Medical Coding? Yes! appeared first on MEREM Health.

When the American Recovery and Reinvestment Act was approved, all healthcare providers (both public and private) were required to adopt the use of electronic medical records (EMR). Since January 1, 2014, EMR systems have assisted several healthcare organizations in maintaining health-related information on patients, as well as improving workflow and the quality of care provided to patients and their safety.

Unfortunately, though, adoption of EMRs across America has been low, which is why it is vital for all healthcare organizations to realize the importance and extensive need of EMR systems in all medical practices within the United States.

Is Your Medical Practice Utilizing an EMR?

When it comes to patient care, there are many medical “players.” An EMR system allows for communication on a patient to be had in one, centralized location, which also includes all services billed on the patient by each medical professional.

“An EMR system is extremely important for billing purposes, especially since it provides an audit trail of all necessary documentation,” explains Jennifer L. Smith, CPC, Director of Billing Operations at MEREM Healthcare Solutions. “With so many people involved with the patient, it is easier to be able to electronically locate medical records, authorization/referral approvals, records release, and payment receipts. All paperwork involving the patient and his or her care should be accessible at any time by anyone involved with the care of the patient.”

The Benefits of an EMR

If your medical practice has yet to utilize an EMR for its medical practice, what are you waiting for? Particularly since there are several benefits associated with an EMR system, including:

• Easily accessible for all parties
• Provides an audit trail (if needed)
• Eliminates the need for paper charts since everything is electronic

It is important that when an EMR system is being used, the process and/or workflow designates a person(s) to upload documentation daily, including what type of documentation and where it should be uploaded.

Avoid EMR Issues with Our Help

As with anything, the EMR system has some cons. However, even with the risks associated with an EMR system, medical offices can prevent problems with billing, coding, and other areas by:

• Making sure to have signed documentation from the patient regarding release of information,
• Staying within HIPAA compliance, and
• Verifying all necessary information on accounts.

Of course, even with an EMR system in place, it is good practice to have a backup via a paper chart or a computer disc in the case of a power outage or technical failure.

“MEREM Healthcare Solutions can assist with issues associated with EMR and billing among medical facilities,” Smith explains. “Our team can help implement processes and workflows regarding your EMR, ensure your medical practice remains in HIPAA Compliance, and send out notifications regarding missing documentation.”

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 billing among your medical facilities.

The post The Vital Role EMR Plays in Medical Billing appeared first on MEREM Health.

Incorrect coding, or miscoding, is likely for any medical practice that does not implement ongoing CPT code training for their medical coders. It is important to understand the consequences of these coding errors and it may be a wise investment to consider outsourcing medical coding to an experienced service provider.

Coding Errors Impact Patient Care

It is the foundation of every practice to provide quality patient care. Inaccurate medical coding can interrupt that goal, leading to frustration and confusion and a potential breakdown of the relationship you have built with valued patients. Even though the consequences of incorrect coding rarely falls onto a patient, it does happen, and it is the most important consequence to try to prevent.

Failure to code correctly could directly impact a patient’s treatment.

A great example of this would be using an incorrect diagnostic code. Codes have slight variances between the specificity of a diagnosis. Inaccurate coding of the specifics during diagnosis could result in improper patient care at another practice, or for a particular service. A missing 2-digit modifier for a knee injury could result in having an MRI study conducted on the wrong knee. Or, imagine an incorrect diagnosis code causing an obstetrician to withhold pains medicine during a woman’s pregnancy. This would be an extreme case, but altogether terrifying and harmful for the patient.

If circumstances similar to the examples above have occurred in your practice, it may be time to consider outsourced medical coding in order to improve the accuracy of codes and prevent these serious mistakes from affecting your patients.

Outsourcing also frees up a great deal of time, allowing practitioners more time with patients. (Did you know in-house medical coding costs more? Outsource!)

Coding Errors Delay or Prevent Reimbursement

Medical coding is the life-blood of a practice. That is how the services you provide are transformed into billable revenue. Failure to provide correct coding can cause these payments to be delayed, denied, or limited. MEREM Healthcare Solutions has found that an alarming majority of claims are rejected or denied upon initial submission. The reimbursement for denied claims depends on a practice’s efforts for correcting and resubmitting claim denials.

A miscoded procedure’s reimbursement has the potential to differ by up to $15,000. Delayed reimbursements are also costly, as they are unexpected. A build-up of delayed reimbursements can cause a backup of paperwork, stress on your staff, overlooked coding errors, and even more incorrect coding to be filed resulting in loss of revenue for your practice.

This back up of denials due to coding errors requires focused efforts to catch up on claim denial and improve your revenue cycle. The healthcare revenue cycle/reimbursement cycle is a very particular machine.  All aspects need to work together just right and at the right time or the system breaks down.

Coding Errors May Lead to Fraud and Abuse Fines

As you can see, incorrect coding causes poor patient care and trouble with reimbursements, but what happens to those responsible? Practices and providers who have a history of coding mistakes may face fines and or federal penalties for fraud or abuse.

The False Claims Act (FCA) is the enforcement tool used for false claims. The consequences could be a monetary penalty or a legal issue if the claim is named fraudulent. To prove fraud occurred rather than abuse, the upcoding or miscoding of an event must occur over time and across a large number of patients.

We recommend all practices be proactive in monitoring their claim denials by setting Industry Benchmark Goals for our clients and by offering a complete Revenue Cycle Audit.

Understanding the Outcome of Outsourced Medical Coding

Medical coding can be an excessive amount of work, and small errors can cause significant harm. When practices outsource their medical coding, fewer mistakes are made, better care is given to patients, and billing cycles run smoothly.

Are your ready to improve your revenue cycle while avoiding the consequences of coding errors? Contact MEREM Health today to discuss outsourcing your medical coding.

The post Consequences of Coding Errors appeared first on MEREM Health.

Heads Up for Healthcare – 

NEW E/M Coding Changes Coming 2019

We all know that change is the only constant in the Medical Coding world. This recent CMS release of coding initiatives in 2019 proposes a pretty significant change for Evaluation and Management (E/M) coding that can impact doctor visits for both the patients and the providers in a good way.

According to CMS Secretary, Verma Seema, “Patients are demanding more accountability from healthcare providers and payers, and they want to see what they’re getting for the high insurance and co-pay amounts paid.”

What patients see, is the attention and time spent with their physician. Physicians complain that the time spent inputting information cuts into face-to-face time with the patient. The pressure to increase patient loads requires providers to keep visits short but effective. Time is the common denominator that will be addressed through these coding changes.

What does that mean for you? Less is more.

The #PatientsOverPaperwork Initiative focuses on value-based healthcare by simplifying the complexity of required documentation during an office visit. This change will enable physicians to return to focusing on attentive, quality care by spending more time with the patient rather than spending their time documenting visit to meet the paperwork requirements involved.

E/M Visit Payment Changes & Reimbursement Rates

• E/M Coding levels 2-5 will be consolidated to a single reimbursement code and must meet the following requirements
  • EPF History (a chief complaint with 1-3 HPI elements)
  • 1 review of symptoms
  • And EPF Exam
  • And a Straightforward MDM

• Add on codes may also be applied for additional reimbursement and payment adjustments.

+     $5 for additional resources in complex E/M visits associated with primary care service

+     $9 for additional resources in complex E/M visits involving non-procedural based care

–      Multiple procedure payment reductions when E/M visit and a procedure are furnished on the same day

+     Add-on for a 30-minute prolonged E/M visit.

• E/M Level 1 rates will be adjusted
  • $24 for established patients
  • $44 for new patients

The proposed changes depicted above are in a 60-day comment period. CMS welcomes and encourages provider feedback as a critical part of the coding change process. This is to ensure that all coding changes benefit not only the patient, but the providers that treat them as well.

“As part of @POTUS‘s Cut the Red Tape Initiative, CMS launched our Patients Over Paperwork Initiative to reduce unnecessary and redundant regulations so that doctors could focus on their primary mission – taking care of their patients.” #PatientsOverPaperwork

— Administrator Seema Verma (@SeemaCMS) July 25, 2018

If you have questions or would like to provide feedback about how these coding changes may effect your E&M visits and reimbursement, you can join the conversation via Twitter using hashtag, #PatientsOverPaperwork and tweet to @SeemaCMS and @MEREMHealth.

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 NEW E/M Coding Changes Coming 2019 appeared first on MEREM Health.

A practice’s efforts to reduce claim denials should begin with an understanding of its greatest source of denials.

Run a series of denial reports over a period of time (3 weeks, or 3 months) that include:

• denial reasons
• procedure codes reported
• modifiers
• diagnosis codes
• payors

The results can be your greatest asset in identifying the source of denials. You can then sort the reports from each field to determine a particular coding issue and identify the greatest opportunity for your practice to focus on denials improvement.

Pay Attention to Timing

Although often unintentional, timely filing is a leading reason for denied claims. Each payor has their own filing deadlines that range from 90 days to 1 year. Failing to submit a claim within their assigned period will result in rejections that your practice may have to write off.

Even if denials have been reworked and claims adjustments have been resubmitted, the corrected claims must meet the original filing deadlines in order to be approved.

Poor management of claims can be detrimental to the financial health of a practice. Avoiding claims denials should be the responsibility of everyone in the practice. For more information about how MEREM Healthcare Solutions can help you combat claim denials, follow us on LinkedIn and check out future a continuation of this blog in the coming weeks.

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.

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