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heavily on technology can be risky if there are system failures, technical glitches, or if the software becomes outdated.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

Communication is the key to ensuring an excellent experience for your patients and is a vital foundation for a productive partnership with your outsourced billing department.

When working with an outsourced billing company, it is important that you notate accounts in your PM system for anything that is communicated with your patients, outside of the clinical documentation.

An Example of Communication Breakdown

Whether outsourced or in-house, your billing specialists work hard to communicate with patients in order to collect revenue on behalf of your practice. When there is grey area between clinical documentation and the PM system, there leaves room for confusion and aggravation for the patient, especially as time goes on between visits and payment collections.

Communication Tips

MEREM Health’s billing specialists communicate with patients daily and can only refer to information provided in the practice management system notes and patient record. Take time to make notes at checkout to ensure nothing is missed and that every detail can be re-communicated accurately.

If you are interested in outsourcing your medical billing and collections, contact us for more info by calling (205) 329-7519.

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Optimizing Patient Collections

Long gone are the days of $25 co-pays and $250 deductibles. With the increasing prevalence of high deductible insurance and patient cost-sharing plans, it has never been more important to the financial health of your practice to have an efficient patient pre-collections program in place. Less than 50% of these up front balances are ever recovered, placing a great burden directly on a clinic’s revenue due to “bad debt.”

At this year’s mid-year mark, can your practice afford your current record of unpaid bills in write-offs?

3 Steps Toward Optimizing Patient Collections

Clinical staff play a key role in patient collections. At Merem Healthcare Solutions, we work with our client partners to develop a Patient “Pre-Collections” strategy that is both aggressive and fair. Following these three tips will help your clinical staff to develop a Point-of-Service (POS) collections process to effectively collect more money up-front.

1. Constantly update a record of unpaid bills and review it with upcoming appointments.

Typical patient collection efforts only go as far as issuing statements and generating “bad debt” reports of accounts that need to be turned over to collections.

We can provide you with custom reports such as a payment plan list, to aid in POS collection efforts and to ensure patients meet their terms

2. Clearly communicate with your patients that outstanding bills are expected to be paid prior to their clinic visit.

When you can discuss these matters prior to the procedure date, patients are more likely to be receptive and proactive rather than distracted or caught off guard and agitated about any unexpected financial obligations. Also, you will help patients to better prepare financially for their visit and open the opportunity to provide payment options prior to sending to collections.

With MEREM Health, you will have the added support of a patient collections representative to support your billing team. Our patient collections reps work diligently to collect patient balances in full or to make payment arrangements within 90 days and will help you identify and transmit delinquent accounts to a third-party collections agency of your choice.

3. Train your clinic staff to prompt the patient for payment

This is a guaranteed technique in the effort to increase practice revenue but it requires a strategic and passionate approach. As you inform patients’ preemptively of what they will owe for their care, the more likely you are to get paid.

Discussion of a patient’s financial obligation should begin prior to receiving treatment. Many consumers lack a clear understanding of their insurance coverages and are often unable to determine their financial responsibilities themselves.

Keep explanations simple in order to help ensure patients understand what is expected of them and help avoid confusion or discourage them from listening to or reading information. Also, be sure your staff are prepared and available to answer any questions.

For more information about our Patient Pre Collections Services, visit our website. www.MEREMHealth.com

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 Optimize Patient Collections in 3 Steps 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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