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heavily on technology can be risky if there are system failures, technical glitches, or if the software becomes outdated.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

• Reduce labor costs.
• Increase availability for patient scheduling
• Eliminate the cost of recruiting and training
• Improve accuracy and reduce claims denials
• Lower continuing education expenses in your medical billing and coding departments

Improvement in just one area of your medical practice can mean a significant improvement to your revenue cycle. However, with the many outsourced healthcare solutions that MEREM Health delivers to specialty medical practices, our experienced team can become a great asset to the overall productivity of your practice.

As an outsourced healthcare solution specializing in the areas of coding, billing, revenue cycle, and education, we see the benefit of having more knowledgeable people in the field with billing and coding to support practices. As an outsourced solution, and practice management consulting partner, we can help reduce the overspending and waste when it comes to the healthcare operations.

When to Consider Outsourcing?

Typically, a practice manager considers outsourcing their billing for one of two reasons.

Either their collections are too low, or their overhead is too high.

Chart A

When to Consider Outsourcing

Outsourcing your billing and collections is a valuable investment for a practice manager pursuing timely collections and a streamlined front office.

If you are unaware of the current state of your medical practice’s financial health, or if you are seeking an annual industry benchmark comparison, you may find it valuable to request a Revenue Cycle Audit.

These assessments help practice owners identify areas of weakness within their revenue cycle process.  And that information can be used in assessing and selecting the right outsourced solution to meet the needs of your practice.

5 Steps to Conducting an Assessment of your practice versus an Outsourced Medical Solution

1. Analyze net collection ratio, length of time it takes to receive payment for services provided and the way staff manages claims that are denied.
2. Review the number of employees to determine if additional staff is needed and whether your practice is willing to pay for the additional training, technology costs, and benefits.
3. Compare outsourcing services to determine what sets them apart.
4. Ask outsourcing vendors if they charge a fixed monthly fee or if they are paid based on a percentage.
5. Evaluate and compare your current cost for collections to the cost of outsourcing.

Once you have successfully completed your assessment, you will need to factor in your practice’s actual and allocated costs (payroll, benefits, training cost, etc.)  To calculate your internal costs as a percentage of billing and collections, take your total billing and collection costs and divide that by your annual collections (Chart B). Compare your results with a vendor to see what works for your practice.

Chart B

Calculating Internal Costs to a Percent of Collections

Annual Collections

$4,000,000

Salary, Wages & Benefits

$198,149

Statement Costs

$13,800

Server Costs

$2,175

Software Costs

$10,980

EDI Costs

$5,125

Training Costs

$5,000

Staffing Turnover Costs

$4,000

Communication

$3,000

Real Estate Occupancy

$12,000

Lost Revenue as Result of 5% Errors

$150,000

How Can I Outsource?

If your practice is interested in outsourcing your medical billing, collections and credentialing, please contact MEREM Healthcare Solutions for more information.

Outsourcing medical billing and coding significantly increase a physician’s confidence that the billing is handled accurately and efficiently. Merem Healthcare Solutions eliminates time, frustration, and expense associated with building and maintaining skilled professionals needed to achieve optimal reimbursement in the ever-changing and very challenging insurance industry. Above all, Merem clients know their business interests are in the hands of competent committed professionals.

The post Why Should I Consider Outsourcing My Medical Billing & Coding? 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.

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.