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heavily on technology can be risky if there are system failures, technical glitches, or if the software becomes outdated.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

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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.

Therefore, while we don’t want to take away from the amazing work of physicians, nurses, front desk employees, etc., our team at MEREM Healthcare Solutions also wants to make sure medical billers and coders receive the recognition they deserve for the critical role they play within the healthcare industry.

What Do Medical Billers and Coders Do?

While your patients might not see them during their visit to your medical practice, medical billers and coders are there every step of the way—from the initial examination to diagnostic tests to the overall treatment of the patient. Medical billers and coders are responsible for translating the entire patient visit into special ICD-10 codes for proper billing.

But, before you start thinking, “How hard can that be?” did you know there are more than 140,000 ICD-codes? And each ICD-10 code has its own purpose. For instance, there isn’t just one code for “pain.” Rather, there is one ICD-10 code for pain in the arm that is unspecified. Then, there is another code for low back pain, and so on and so forth.

Not only is it vital for these specific codes to be known, but it is also vital that they are used correctly, as one wrong code entry could cause a delay in billing and payment, which can hurt a medical practice’s profitability.

The Unsung Heroes – Off-Site or Outsourced Medical Billers and Coders

Although some medical practices try to utilize their front office staff to assist with the medical coding and billing of patients, this practice of sharing responsibilities is not as conducive for the profitability of the medical practice as outsourcing the billing and coding to a third party.

For example, a patient walks into your medical practice. Depending on your specialty, your patient might already be high-anxiety. When they walk in, the front desk person isn’t able to welcome them warmly because he or she is on hold with an insurance company. All the patient has done at this point, is walk into your practice, and everything is already off on the wrong foot.

However, if your medical practice outsourced your medical billing and coding, not only can you reduce your chances of errors when it comes to cash flow, you can also allow your front office staff and medical team to focus directly on the patient, which can both improve patient outcomes and patients reviews—which is a win-win!

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. In addition to outsourced medical billing and coding, we offer a wide range of solutions which include auditing, consulting, credentialing, payment posting, practice management, and pre-collections training. Check out our website or feel free to call us at (205) 329-7519 to see how we can help run your practice like a well-oiled machine.

The post Don’t underestimate the integral role medical billers and coders play in the healthcare industry appeared first on MEREM Health.

MEREM Health ranked among the Top 30 Medical Billing and Coding Blogs, Websites, and Newsletters to follow in 2018

According to Feedspot.com, MEREM Health was recently recognized as one of the Top 30 Medical Billing and Coding Blogs, Websites and Newsletters To Follow in 2018 because we are actively working to educate, inspire, and empower our readers with frequent updates and high-quality information.

These blogs selected in the list were ranked based on the following criteria:

• Google reputation and Google search ranking
• Influence and popularity on Facebook, Twitter, and other social media sites
• Quality and consistency of posts.
• Feedspot’s editorial team and expert review

Meredith Tibbs, Director of Coding for MEREM Healthcare Solutions was excited to be recognized among many of the organizational blogs that she follows and considers it a great achievement to be recognized among our peers. She said, “I use a lot of those other sites to keep updated within our industry!”

Anuj Agarwal, the Founder of Feedspot shared, ” This is the most comprehensive list of best Medical Billing and Coding blogs on the internet and I’m honored to have you as part of this! I personally give you a high-five and want to thank you for your contribution to this world.”

The post Top 30 Medical Billing and Coding Blogs To Follow in 2018 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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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.

Coders are trained to identify noncompliance and fraud. Part of a coder’s job is to have sound knowledge in detecting ambiguous or suspicious documentation that could lead to fraud as a false claim if not detected before being submitted to insurance and being paid.

Fraud, in regard to medical coding, is when a false claim misrepresenting the facts is intentionally submitted to insurance in order to receive payment.

Examples of Financial Fraud are:

• Billing for procedures that were never done
• Knowingly billing for services at a different level than what was performed
• Falsifying information in the medical record to satisfy the medical necessity

“You can’t code what is not there” – Meredith Tibbs, Medical Coder at MEREM Healthcare Solutions

Abuse happens when patients are treated with services that are not medically necessary

Examples of Financial Abuse are:

• Billing for medical services that are unnecessary
• Upcoding and Unbundling
• Overcharging for supplies and services

Common terms of Fraud and Abuse in the coding world are:

Upcoding:

Reporting a higher level of service than what is supported in the dictation

Unbundling:

Reporting more CPT (procedure) codes than necessary to increase payment

• Some higher paying procedure codes include smaller procedures in their code descriptions, so you can’t code both. You would only bill the one code that includes both procedures in the description.
• It is very important for a coder to be familiar with these codes and stay updated when these change because they frequently do change and update these codes.

Medical Necessity:

• The doctor must have a legitimate medical reason to perform tests and procedures
• There are certain diagnosis deemed necessary for medical necessity attached to certain procedures. These have to be documented, you can’t make these up to satisfy the medical necessity

It is VERY important as a coder to be knowledgeable and confident in their field, so they are able to detect any potential risks that could negatively impact the facility and/or physician they work for as well as educate the people around them that don’t know.

“Staying up to date through compliance training either on their own or through their organization is of the utmost importance. Coders work too hard to earn their certifications and, in this field, honesty is ALWAYS the best policy.” -Meredith Tibbs, Medical Coder, MEREM Healthcare Solutions

Auditing can provide areas for improvement for your coding staff. Even a well-trained staff must be checked, therefore every practice should have an audit performed annually. An audit can recognize under coding, bad unbundling habits, and code overuse. Coding staff will then be able to bill appropriately for documented procedures.

MEREM Health specializes in auditing and can provide education, consultation, reports, and recommendations for improvement. The feedback and recommendations provided by our external auditors are valuable to the improvement of each practice.

Contact Merem Health today to find out how our auditing services will provide support for your practice!  

MEREM Healthcare Solutions is a Birmingham, AL-based company that has been providing exceptional medical billing and coding services to physician practices and ambulatory surgical centers since 2008.  We pride ourselves on not just maintaining, but exceeding, the level of accountability, communication, and customer service that is valued in traditional, on-site billing departments.

Please check out our other blog posts, or contact us to learn more.

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