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.

Direct billing versus incident-to Billing

“What is the difference in reimbursement?” is the number one question we are asked by practice administrators. The simple answer is, mid-level providers generally get paid 85% of what the physician is paid when billing under their own NPI (direct billing) versus billing under their supervising physicians NPI (incident-to).

Some providers think they should always bill incident-to because of this reason. However, you must know the rules before making the decision on how to bill for your mid-level provider.  To learn more about Medicare billing requirements, you can reference our blog explaining Incident-to Billing.

In order to satisfy Medicare requirements, the PA must work with a physician who is responsible for the direction and management of the mid-levels activities and for ensuring that the services provided are appropriate. The physician supervisor does not need to be present when the PA furnishes a service unless state law states otherwise. If the physician is not present, he or she must be immediately available to the PA for a telephone consultation. However, even if the physician is immediately available, that does not mean you can bill under the physicians NPI (incident-to). If the patient is following the mid-level provider’s plan of care and the physician has never seen the patient, then you must bill under the mid-level for most insurances. This means in most cases the mid-level will receive on average, 85% of the physician fee schedule.

On the other hand, if the mid-level is following the physician’s plan of care and they are in the same office suite, then you can bill under the physician (incident-to) and receive 100% of the fee schedule.

Example: Billing Incident-to

After evaluating the patient the physician decides to bring the patient back to their office for an injection. If during that visit the mid-level provides the injection under the direction of the physician it can be billed as “incident-to” for most payers and be paid 100% of the physician’s fee schedule.

Note: The provider must cosign the medical record for the visit.

For more information on mid-level billing and physician billing, contact Merem Healthcare Solutions. Your practice or facility will have a skilled and experienced partner providing comprehensive management of your revenue cycle from Charge Entry to Payment Posting and Patient Statement Submission. Let us worry about billing guidelines while you focus on your patients!

The post Billing for Mid-level Providers appeared first on MEREM Health.

A friend of mine had a bill from a lab for $1,200. As a nurse practitioner herself, she knew there was no way a routine lab could cost $1,200 (that’s crazy!).

She emailed us with this, “Hope everything has been going well for you. I had a quick question and thought you may be able to help me. So, I went to my MD for some routine blood work because I had been having some weird headaches and I get this bill in the mail for $1200 for the blood work because my insurance straight denied the claim. They said the diagnostic codes were coded incorrectly but wouldn’t give me any more information? When I talked to the doctor’s office, they didn’t have any clue on how to fix it. I know you all have experience with this. I was curious if you may have any ideas on what went wrong? I can send you a copy of my bill if you need to see it. I’m at my wits end here!”

This is what feels like the thousandth message like this I have received this year. “Yes, I can definitely help! This happens often when visits are inaccurately coded. What type of insurance do you have?”, I replied.

She replied with, ” Here is the bill I got…” I am not disclosing her personal information for obvious reasons, though I have her consent to share this story.

As a Certified Coder, I knew this was incorrect. Most doctors do not perform procedures, diagnostic tests, etc. unless there is an indication for it (medical necessity).

Together, we called the billing office that had sent this outrageous bill. With her consent, I was able to talk to the billing office. I said, to the nice billing representative, “ma’am, she is being billed because the insurance is not covering these charges stating they are non-covered. What diagnosis was billed for this blood test?”. I asked this question because, being in the billing industry for some time, I knew medical necessity (non-covered) denials come from inaccurate diagnosis coding.

She responded, ” The diagnosis billed was for hair loss”. My friend immediately chimed in, “but I never said I had hair loss nor have I ever had hair loss.” I knew right then, we had found the issue…. Inaccurate coding.

So often, billing offices and practices put more attention to procedure coding because it drives revenue, but they still must be accurate in diagnosis coding. My friend, referenced in this article, will likely never go back to this lab. It’s not because of bad customer service, and not because the facility could have been nicer. It’s not because of anything other than they didn’t look competent due to inaccurate billing. Your billing office reflects on your practice, whether you like it or not.

About 30 days after I helped this friend resolve her bill, she called me to share the outcome. Apparently, instead of owing $1,200, she owed part of her yearly deductible ($115.87). We essentially saved her over $1,000! I can only imagine what would have happened had she not asked MEREM Health for some friendly assistance.

Make sure you have the right billing staff in place! Call us today to see how MEREM Health can help your practice.

The post Are your patients receiving inaccurate bills from your billing office? appeared first on MEREM Health.