The Good:

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

The Bad:

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Relying heavily on technology can be risky if there are system failures, technical glitches, or if the software becomes outdated.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

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

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

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

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

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

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

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

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

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

Point of Service Collections

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

In order to

Patient billing is a significant problem for patients and providers.

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

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

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

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

For Example:

Don’t Ask: CAN you can pay today?

Ask: How WILL you pay today?

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

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

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

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.

No two billing and coding outsourcing firms are the same. As the healthcare market becomes more complex and competitive, it’s becoming increasingly crucial to choose the right firm for your needs.

We’ve compiled some key traits to look for when choosing a quality outsourced medical billing solution.

Transparency

False promises, claims generation delays and irregular follow-ups from medical billing firms can create major upsets in the financial health of your practice. Only choose to work with companies that are completely transparent about their policies, regulations, and history so you can understand and trust that they are a reputable company with a history of success.

Additionally, firms that utilize cloud-based technology to allow you to view your financial data whenever you need should be your first priority. Cloud-based firms provide an opportunity for clients to view their data in real-time, including denials, charges, collections, filed claims and payment summaries.

Technology

Pay close attention to a medical billing and coding firm’s technology. What technology are they using? Is it modern, capable technology that blends different practice management solutions to effectively manage your unique financial needs?

Most importantly, when deciding between firms, ask questions about how each firm’s current technology will help streamline your current business model. If your practice is fully digital, is this firm capable of onboarding your data effectively (and without snags)? Or, if your practice uses paper charts and documents, how will a firm handle that data and develop a secure and compliant process for your sensitive information?

Security

If choosing to use a cloud-based medical billing firm, make sure they are using every possible metric to secure your data, whether while in transit (moving across networks) or at rest (stored).

Because patient data is highly-sensitive, HIPAA compliance is crucial. Ask potential firms about their HIPAA compliance so you’re aware of your patient’s future security with this firm. Without question, do not settle for firms that can’t prove, with documentation, their level of compliance for risk potential. Also, do not use firms without a reliable track record of trained professionals handling compliance policies.

Competitive Pricing

Choosing a firm for its low price-point may seem like a wise financial decision, but what possible services could you be losing out on for that lower rate? Conversely, choosing a firm with a higher rate might not translate to better, more robust services.

With any financial decision, spend time analyzing the value and cost of each potential firm. Compare each firm’s rate and offered services and find the best value for your unique healthcare practice. Don’t get sacked into a higher (or lower) rate that isn’t delivering the metrics you need for financial success.

Prepare Questions For Outsourced Healthcare Solutions

Finally, prepare any questions that might not be immediately answered in an FAQ or email introduction.

Ask questions about

• follow-ups
• price points
• compliance policies
• security/encryption
• claims
• willingness to adapt to your processes
• payment turnarounds

Whatever you’re curious about, this is the opportune time to ask before signing paperwork you might not fully understand. Doing the upfront work of asking important, relevant questions specific to the improvement and performance of your revenue cycle management, will ensure you’re happy with your medical billing and coding firm in the long-term.

At MEREM Healthcare Solutions, we want to be your strategic healthcare solutions 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 specialty providers and practice owners with issues associated with EMR and medical billing.

MEREM Healthcare Solutions is a Birmingham, AL-based company that has been providing exceptional medical billing and coding services to physicians and specialty healthcare practices 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 You Need a Medical Billing Firm – Have You Considered These Qualities? appeared first on MEREM Health.

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

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

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

Tip #1 – Set Up Custom Monthly Performance

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

Key Performance Indicators

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

Tip #2 – Compare Trend Reporting

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

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

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

Tip #3 – Consider Outsourcing Your Custom Reporting

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

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

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

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

In fact, if healthcare practices are not careful, they could be losing revenue even as more patients come walking through the door. But why does this occur?

Where Does the Money Go?

There are many reasons behind a healthcare facility losing revenue while still seeing a great number of patients, including:

Inaccurate Coding

One of the most common reasons behind a medical practice losing money is inaccurate (or inadequate) CPT coding input.

Health care is always changing. With that, medical billing codes also continually change. Therefore, if the billing professionals within your medical practice are not staying up-to-date on coding, the revenue can be lost due to denied claims or reduced reimbursement.

However, under-coding can play a large part in revenue lost, too. Many times, if the billing department is unaware of what occurred during a patient’s exam or surgery, they can “undercode” for the services used because they just don’t know what exactly went on within the exam room.

It is estimated that a medical practice loses a minimum of $10,000 each year due to only undercoding. Thus, it is vital for the lines of communication to be open within a medical practice, especially when it comes to quarterly coding education and reimbursement protocols.

Poor Billing Practices

Within a healthcare facility, every department needs to follow best practices, especially billing. When poor billing practices occur, the result can take a huge toll on the medical practices’ finances.

Most of the time bad billing happens not because the people within the billing department are purposely making mistakes. But, just like in coding, if your employees are unsure about the what they are supposed to be doing in billing, financial losses in your medical practice can (and will) happen.

It’s critical during the interview process that you are using professionals who are competent in medical billing to fill your positions within the department. In addition, receptionists and other positions should be able to properly know how to file patient insurance and services so that the billing department receives accurate information to help prevent billing issues, as well.

Insurance Plans

Unfortunately, even if you perform the two tasks above well – bill correctly and code accurately – loss of revenue can still occur. How? Because of the insurance plan your medical practices do business with daily.

While some insurance companies are great about their reimbursement practices, other insurance companies will hesitate to reimburse what is due or might have a low reimbursement schedule.

If you happen to work with one of those insurance companies, it is easy for payments due to your medical practice to fall further and further behind in payments until they usually stop paying you altogether, resulting in loss of revenue. Therefore, be careful of the insurance companies you do business with to ensure they are not the reasons behind your loss of revenue within your practice.

Is your business losing money? Contact the professionals at Merem Health to learn about our consulting, outsourced billing, collections, and revenue cycle management services.

The post Is Your Healthcare Facility’s Revenue Moving in the Wrong Direction? appeared first on MEREM Health.

The Centers for Medicare & Medicaid Services (CMS) recently released the April 2018 code pair tables for providers to review before filing claims. CMS developed the national correct coding initiative (NCCI) to promote correct coding methodologies and to control improper coding that leads to inappropriate payment on Part B Medicare claims. NCCI procedure-to-procedure (PTP) code pair edits are automated prepayment edits that prevent improper payment when certain codes are submitted together. These edits also include Medically Unlikely Edits (MUE) updates and are updated and published by CMS each quarter.

To simplify, PTP edit pairs represent CPT/HCPCS codes that cannot be reported together for the same patient on the same date of service, while an MUE represents the maximum units of service that a provider would report under most circumstances for a single beneficiary on a single date of service.

NCCI PTP code pair edits are presented in the Column 1/Column 2 Correct Coding Edits table available via the CMS website. If a provider submits two code pair edits for payment for the same beneficiary on the same date of service, the Column 1 code is eligible for payment and the Column 2 code is denied. However, if both codes are clinically appropriate and an appropriate NCCI-associated modifier is used, the codes in both columns are eligible for payment. Supporting documentation must be in the beneficiary’s medical record.

Click the link below to download the code pair tables.

Quarterly Additions, Deletions, and Modifier Indicator Changes to NCCI edits for Physicians/Practitioners (column 1 / column 2 edits and mutually exclusive code edits) Effective April 1, 2018  – External Link Policy-Opens in a new window

In short, these are things you can implement today:

• Check CCI to know if a PTP edit exists before appending a modifier
• When a modifier is required, audit the documentation to verify it is supported
• When in doubt, refer to your complete code descriptions

A final point that must be mentioned, not all carriers are created equal. This information is based on NCCI edits developed by CMS. Some commercial and third-party payors have their own edits in place, so it is important to know your payors guidelines before submitting claims to ensure you are maximizing reimbursement.

Coding services are the life-blood of your practice. That is how the services you provide are transformed into billable revenue. It takes a knowledgeable and experienced coding staff to maximize your billed charges while maintaining strict compliance with CMS and CCI guidelines. Trust the coding experts at Merem Healthcare Solutions.  At MEREM, we don’t just provide services, we deliver solutions. 

The post National Correct Coding Edits – Effective April 1 appeared first on MEREM Health.

Spine and orthopedic surgery practices often face revenue building challenges due to billing and coding errors. The culprit is simply confusion in changes to procedure or misunderstanding of the strict guidelines and CPT coding criteria.

MEREM Healthcare Solutions offers insight for practice administration to improve their revenue through detailed coding and accuracy in the billing process. Providers must take ownership to analyze, investigate, and interpret the new coding changes as it will affect healthcare reimbursement and delivery moving forward.

3 Ways to Overcome Billing and Coding Reimbursement Loss for Orthopedic and Spinal Surgery Providers

1.  Understand and apply new CPT code changes for

a.  procedures such as bone grafting for aspiration only versus spinal arthrodesis.

b.  the growing number of medical devices used in spinal procedures and detail how and which are used for each procedure.

2.  Develop an overall understanding of higher payer scrutiny for procedures such as spinal discectomies.

3.  Provide detailed support documentation. The increasing complexity of shoulder procedure codes require support documentation about the type and number of parts of the shoulder involved in the procedure.

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.

Healthcare economics, Medicare, reimbursement, spinal surgery

The post Identify and Overcome Billing and Coding Reimbursement loss 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.

After talking to over 100 orthopedic surgeons in the last month (mostly at AOSSM this past weekend), there seems to be some commonality that many are experiencing in their practices…..increasing accounts receivable.

Since 2005, High Deductible Health Plans [HDHP] have become increasingly more popular among employers. So much so, they have increased by almost 600% over the past twelve years, and half of all patients are expected to be covered by these plans by 2018. [Note: HDHPs are defined as plans with greater than $2,000 annual deductibles]. In addition, according to an analysis by the Advisory Board Company, patients with a $2,000 or above deductible are delinquent on paying their responsibility greater than 39% of the time, while that number grows to greater than 50% if their deductible is over $3,500.

So what does this mean for us as physicians and practice administrators? With patient responsibility on the rise, we have tio take a closer examination of our processes, and how we operate from the front line [Patient Registration] to Surgery. So how do we do all of this, keep a busy practice operating, and make this a manageable task that we can both review but also hold our teams accountable? Try this:

Diagram your patient intake and flow

• Identify the points with which you can collect dollars from patients, and identify what percentage you are currently collecting at those points.
• Test your staff on their knowledge of:
  • Insurance Verification
  • Identifying how much patient deductibles are and how to identified what’s been applied against them
  • Role play with your staff in collecting from patients, and provide them the training they need to compassionately work with these patients while focusing on the bottom-line needs of the practice.
• Identify your insurance rejections, and create a tracking system which will allow you to review these at least twice monthly to make sure your staff is focusing on these dollars. [Note: Insurance industry data show that 20% of all filed claims are rejected, and 65% of those claims are never resubmitted].

Provide patients with a cost estimate of services

• We know what services will cost generally, and provide this to your patients. [Note: Think of yourself in this role, would you ever let the plumber come to your house and just provide him an open checkbook to ‘fix’ things without knowing their cost?]
• According to multiple surveys in healthcare, only 55% of specialty practices require deposits when scheduling surgery. Ideally, the pre-surgery deposit will account for half of the deductible
  • Be willing to work with patients to collect these deductibles. There are alternative options [carecredit©, automated recurring payments, and securing a personal guaranty with a promissory note]. There’s never an excuse for losing a patient to a deductible, they’ll have the same deductible no matter where they seek care.

Identify Accountability

• No matter how you decide to tackle these items, create a way for you to track these opportunities, and hold yourself and your staff accountable to make sure these hard-earned dollars make it to where they are supposed to!

For more information on how we can help you with your revenue and practice, visit us at www.codecollect.net or call Lindsey Wingate at 205.329.7514.

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