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heavily on technology can be risky if there are system failures, technical glitches, or if the software becomes outdated.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

We asked our expert coders:

“What is the #1 thing that can be done immediately to increase reimbursements?”

You may be surprised by the answer: 

Improve Documentation.

Your clinical documentation is the key to your reimbursements and the profitability of your practice. The simple answer to how you can make sure you are maximizing reimbursements for your practice is by improving your clinical documentation and detailing every surgical dictation… the end result can literally take your coding to the next level.

Detailed documentation is imperative.

You know what procedures you performed but remember, you can only get paid for what your notes say you performed. 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. By making sure you include the 4 following details in every dictation, Coders can determine the correct level codes are claimed so that you are reimbursed adequately.

Your time matters – Make sure to state the amount of time spent with the patient in the plan portion of the dictation. For example, “I’ve spent __ minutes face-to-face with the patient.” Having that time included could bump your visit code to the next level.

Classify treatment plans – State clearly if a fracture is seen and being treated either conservatively or surgically. This cuts down on addendum’s and corrected claims and helps get paid faster.

Detailed Dictations – State chief complaints, ROS, HPI, PFSH, and Physical exam clearly in dictation.  One extra detail could mean a higher level!

Erroneous diagnosis dictations cause delayed claims – Watch out for dictation mistakes on the diagnosis level.  For example, if a patient comes in for right ankle pain and the x-rays are dictated as left ankle x-rays which continues to the plan of care section, the coder will have to put the claim on hold and get an addendum made to clarify which ankle was actually examined.  Coding errors could delay the claim timely if not done promptly. 

How to improve accurate and timely coding

We believe Specialty providers deserve specialty coders.

At MEREM Healthcare Solutions, that is what we provide to Orthopedics and Sports Medicine practices. Every client deserves the expertise of experienced CPC coders. That is why we employ COSC coders for their specialized knowledge pertaining to complex orthopedic surgical cases.

CPC certification by the AAPC has become the gold standard with additional specialty certification available such as AAPC’s COSC (Certified Orthopedic Surgical Coder).

Get reimbursed faster by turning to an experienced team of certified professional coders to improve accurate and timely coding for your practice. Whether you scribe dictations or utilize an intuitive EMR, MEREM Healthcare Solutions tailors our coding strategy to fit the specific process used for your specialty physician documentation and will also assign and develop our coding staff around your specialty.

Charge Optimization

Working to implement the standard of including as much detail as possible is the first steps toward documenting iron-clad operative reports. Op notes are never written in stone, but the sooner they are finalized with as much information as possible, the sooner it can be coded and paid.

Improved documentation results in revenue improvement. Accurate coding results in faster reimbursement. With detailed documentation, coders don’t have to rely on addendums and delay processing claims. The turn around is quicker and more effective for the physician to be paid.

The coding team at MEREM Healthcare Solutions is trained to help your practice maximize billed charges. By reviewing every encounter note and operative report, our specialty coders will prevent under-coding and over-coding to ensure that every billable procedure performed is correctly reported. Additionally, our consulting team can help you increase charges by maximizing your clinic output and improving documentation quality.

The post Next Level Coding Begins with Improved Documentation appeared first on MEREM Health.

For physician specialties, CMS is proposing to revise the current five levels of reporting patient office visits into two levels, one for new patients and one for established patients.  This proposal would also change the documentation required to support the billing of E&M codes. 

This proposal would eliminate separate billing of E&M codes when those visits are furnished in conjunction with other procedures, by applying a multiple procedure payment adjustment in those circumstances.

The proposed add-on code for specialists is temporarily called GCG0X. The code would represent additional costs for resources in specialties that have E&M visits as a big percentage of the allowed charges. These specialties typically report level 4 and 5 visits. They often use E&M codes rather than separate codes for the treatments provided to the patient.

The specialties for the add-on codes include Endocrinology, Rheumatology, Hematology/Oncology, Urology, Neurology, OB/GYN, Allergy/Immunology, Otolaryngology, or Interventional Pain Management-Centered Care. The add-on code would be listed separately in addition to the E&M visit code.

The proposed value of the code was based on 75% of psychiatric evaluation/psychotherapy code +90785.  Medicare has made the decision for the primary RVU to be the same as the specialty, which means the new proposed RVU is 0.25 with a physician time of 8.25 minutes.

Trust the coding experts at
MEREM Healthcare Solutions.

Accuracy in medical coding is the life-blood of all medical practice. It takes a knowledgeable and experienced coding staff to maximize your billed charges while maintaining strict compliance with CMS and CCI guidelines. That is why these add-on codes will be something we watch for in 2021 within these specialties. Trust the coding experts at MEREM Healthcare Solutions.

The post Add-On Codes That Physician Specialties Need to Know Before 2021 appeared first on MEREM Health.

Medical decision making drives the level of office visit

The medical decision-making portion of evaluation and management guidelines is what ultimately determines the level billed. Higher complexity in decision making justifies higher levels.

Evaluation and Management visits have three main components:

1. History
2. Physical exam
3. Medical decision making.

For established patients, guidelines state that only two of these three need to be met for a given level. The Center for Medicare and Medicaid Services advises to let medical decision making drive the visit.

What does “Medical decision making should drive the visit” really mean?

This is such a grey area in the guidelines that it is causing practices to over-bill or undercharge, which will ultimately cause them to fail an audit.

CMS stated, “It would not be medically necessary or appropriate to bill a higher level of evaluation and management service when a lower level of service is warranted. The volume of documentation should not be the primary influence upon which a specific level of service is billed.” (Medicare Claims Processing Manual 30.6.1)

Many practices are so confused about what this means, that they just pick the middle level and call it a day. Those practices need clarification and education on how to get to the correct level for the service performed. MEREM can help!

Below are some examples to remember when choosing the level of an office visit to the bill.

• If the provider is seeing an established patient who is coming in for a recheck, ask yourself is the patient’s diagnosis improving or worsening?

– If the problem is improving, the level of service will likely be a level 2 (99212).

⁃ If the problem is worsening, the level of service is likely a level 3 (99213).

• For established patients coming in with a new problem, these level of service is likely a level 3 (99213) or level 4 (99214). The final level for this patient will depend on the diagnosis and treatment performed during the service.
• Code 99215 is used to report High MDM. 99215 is reserved for those patients who require extensive workup regarding Chronic Illnesses with severe exasperations or acute illness or injuries that threaten loss of life or bodily function. Management options for these patients may include IV drug therapy, Emergency Surgery or a DNR status because of poor prognosis.

Let MEREM Health help you conquer the challenges of coding your office visits. Call us to get a free quote at 205-329-7519.

The post What drives the level of office visit codes? 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.

Incorrect medical billing issues and misleading claims ranked in the top 10 complaints on the Consumer Federation of America report released on July 27th, 2017. The specific complaints related to patients receiving an incorrect bill for: 

• services they did not receive
• services that weren’t billed to their insurance company
• services that should have been covered by their insurance
• services that the patient had previously paid

One of the numerous examples the report gives is specific to a practice located in Georgia. According to the NACPI report on July 27th, 2017, “Numerous consumers contended that the practice billed them for services for which they’d already paid or failed to submit claims to their insurers in a timely manner, resulting in the claims being denied.” (p. 16)

These types of instances happen often when clinical and billing staff are not educated on how to determine when and if a patient owes a bill. Here are a couple of questions all of your staff should be able to answer in order to correctly bill your patients.

Why does the patient owe the practice?

Most of the time, there are only three reasons a patient should owe a bill. These reasons are the patients benefit specific copay, coinsurance, and/or deductible. Clinical and billing staff should be trained and tested on explaining patient responsibility.

Why did the insurance company deny the charges?

Unfortunately, a lot of times, untrained staff will send a denied charge straight to the patient. When an insurance denies a charge the denial should always be reviewed, corrected, and resubmitted. Insurance companies only allow a short time frame to correct or appeal medical claims. If you miss your chance to resubmit the claim, you are stuck writing off the charges that the provider rightfully earned. When this happens you have no appeal rights and may NOT bill the patient per the provider’s contract with the insurance company. Not only is this losing money for the provider, it is also incorrectly billing their patient.

Was the contracted adjustment taken off of the balance?

When a provider is contracted with a payer they agree to a set fee schedule (payment) for services.

For example, Dr. X’s payer contract states that he will be paid $65.00 for an injection procedure. Dr. X bills the insurance company a set $150.00 for the injection. When the insurance processes the claim they pay their agreed-upon $65.00 and tell Dr. X to adjust off the remaining balance of $85.00. Per Dr. X’s contract with the insurance company, he may NOT bill the patient for anything because the entire contracted amount was paid.

 

Can Your Staff Correctly Identify Contracted Adjustments?

Front desk staff, billing staff, and other support staff should be able to correctly identify and know what a contracted adjustment is.

These days, more often than not, insurance payments are posted electronically into the practice management system. This means the payment is automatically applied, adjusted, and transferred to the patient with the click of a button. For this reason, medical practices and billing departments must have good internal controls and processes in place to prevent inappropriate adjustments and inaccurately billing the patient.

For more information on how MEREM Healthcare Solutions can help you with your practice improve their revenue cycle and enhance practice performance, visit us at www.meremhealth.com or call 205.329.7519. Founded by healthcare executives as a solution to their on-going billing and coding problems, MEREM Healthcare Solutions has been providing exceptional medical billing and coding services to physician practices and ambulatory surgical centers since 2008. For nearly 10 years, we have been working to provide our clients with superior, off-site medical billing management services.

The post Does your staff know how to correctly bill patients? 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.

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