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heavily on technology can be risky if there are system failures, technical glitches, or if the software becomes outdated.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

When medical billing errors occur, you are not only causing billing issues with your patients, you are also causing hazards in the cash flow of your medical practice that can get your practice in the weeds. Here’s why you may want to consider outsourcing your medical billing.

The Masters of Outsourcing Your Medical Billing

Did you know that more than 51% of patients owe their physician at least $1000? Could you imagine what your medical practice could provide to your patients if your cash flow remained in the black month after month? New modalities? A better nurse to patient ratio? The benefits would be endless!

This is why it is important to make your medical billing department a priority—even if that means outsourcing your medical billing!

New Medical Codes Are Par For The Course

As a medical coder, there are three sets of medical codes you need to know:

• ICD codes
• CPT codes
• HCPCS codes

Within the aforementioned three sets, there are a number of medical codes, that may be updated and can change quarterly or annually, which can cause confusion if you do not have a knowledgeable and experienced team in place who is constantly staying up-to-date on medical code changes and fully comprehending what each code means.

At MEREM Healthcare Solutions, our medical coders are certified by the American Academy of Professional Coders (AAPC). We even have an AAPC-certified instructor on staff to provide on-going training to our knowledgeable and experienced team of medical coders to ensure we are always aware of coding changes in the medical billing industry so that claims go out with errors.

When a medical billing error occurs, it can contribute to a number of issues within your medical practice.

The Hazards Behind Medical Billing Errors

First, it can cause issues with your patient’s insurance. When an incorrect code appears on a patient’s bill, it can over or undercharge them. If the error is found, when re-filing the bill with a new code, it can cause the patient’s insurance company to reject the new bill, which makes it more difficult for you to get the money you are owed.  

Second, it can cause a concern of fraud when incorrect codes are placed on a patient’s chart that shouldn’t be there. As a result, it can put a “red flag” on your medical practice to where you are audited more frequently than usual.

Fortunately, with the right medical billing team behind your medical practice, these two issues never have to come into play. When it comes to outsourcing your medical billing, you can have full confidence that the job is being done right when choosing MEREM Healthcare Solutions for help!

Discover how our team at MEREM Healthcare Solutions in Birmingham, AL, can help your medical practice avoid and/or prepare for a CMS audit.

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 The Masters of Revenue Cycle Management appeared first on MEREM Health.

As we reach the end of 2018, a lot of reflection is happening from everyone – both personally and professionally. The team at MEREM Healthcare Solutions wants to help offer some tips or resolutions that your physician practice can make for 2019 in order to grow your medical practice and improve patient care. Where do you see your practice headed in 2019?

A New Year, A Fresh Start

Let’s take a look at three ways “New Year’s Resolutions” that your medical practice can make 2019 better for your patients, for staff, and for yourself!

Send Out Satisfaction Surveys

Does your medical practice put out satisfaction surveys for new and regular patients? While everyone has an opinion, patient satisfaction surveys can give you an idea of how your medical practice is performing as a whole.

Using the feedback you receive from patient satisfaction surveys can give you a starting point of things your medical practice needs to focus on, along with ideas on how you can improve in the future.

Make Deeper Connections with Patients

Although you are able to have close conversations with your patients during their appointment, it is also important to keep the lines of communication open and foster a relationship with your patients. The growth of technology has made it possible for communication to happen on a more frequent basis, especially when it comes to medical practices. Are you preparing for MIPS 2019 reporting?

For instance, your practice can utilize social media in order to host your own business page for your physician practice where you can:

• Post educational articles,
• Give updates on what is happening within the practice,
• Announce early office closures,
• And more!

By staying in touch with your patients on a more frequent basis, you can build their trust even more, as well as get in front of new, potential patients. In addition, you can provide an online portal for patients via your website that gives patients quicker access to their records. Patients want convenience. This is another way of giving them that when it comes to your medical practice.

Improve Your Referral Process

While social media platforms can help your physician practice to get information out there and stay in front of current patients. Testimonials and recommendations by word-of-mouth still play a vital role in growing your medical practice, but significant growth for specialty medicine comes from physician referrals. Therefore, be sure to continue to focus on your referral network.

• Do you have a referral program in place for your medical practice?
• How do you find and/or reach out to new patients?

Practice and Physician Liaisons network internally and externally as an important component for growing business, which is why improving your referral process should be one of the top three resolutions you set for yourself and your medical practice in 2019.

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 contact us to see how we can help run your practice like a well-oiled machine – (205) 329-7519.

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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.

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.

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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.

The post How Coders Can Help Prevent Healthcare Fraud and Abuse appeared first on MEREM Health.

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. Merem Healthcare Solutions works with independent specialty medical practices to help improve your medical practice as a whole. MEREM Healthcare Solutions is dedicated to providing physicians and healthcare organizations with a uniquely designed support system for revenue cycle and operations management needs.

We have found that an alarming majority of claims rejected or denied on their first pass are in result of data entry errors that occurred at registration. Additionally, a large percentage of patient AR accumulates that could have, and should have, been collected in the office. With Merem Healthcare Solutions on your side, we will help you identify areas of improvement and help you hold your staff accountable. This is just one of the ways Merem goes above-and-beyond to act as your strategic partner towards our mutual goal of improving your revenue.

Enhancing Practice Performance in these simple steps

The first three priorities for providers and practice administrators are to

1.   Review staff roles and responsibilities,

2.   Monitor front office staff accuracy with a denial analysis

3.   Revamp billing processes to accommodate the changing landscape.

The fourth and next essential step is to complete a financial performance review.

While other challenges may need to be addressed to further enhance your patient flow, following these tips will help provide an excellent patient experience and accelerate your journey to operational excellence.  As a result, your revenue and overall practice performance can improve, too.

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Do you have a large amount of Medicare patients? Have you noticed your Medicare reimbursements have decreased or delayed? Are you seeing a large amount of Medicare denials and adjustments with no reimbursement for your services?

It is a very high possibility that you are correct when believing your Medicare reimbursement is lower than it should be. Medicare offers a wide range of plans and the majority of those are not the traditional red, white and blue Medicare. As an outsourced medical billing, coding and consulting company, MEREM Healthcare Solutions is seeing an increase in denials and loss of revenue for our clients due to this particular issue.

Areas most affected:

• Delayed or loss of revenue
• Authorizations, Pre-certifications, and Referrals
• Copays, deductibles and time of service money are not being collected
• Eligibility is inaccurate
• Increase in denials
• Improper billing
• Inaccurate records within the practice management system

What exactly is happening here and who is to blame?

Is the patient responsible? Is Medicare responsible?

What about your staff or your outsourced billing company?

Without proper training of your staff and/or outsourced billing company, your practice could be losing money. This is affecting the majority of providers, surgery centers, diagnostic centers, and much more across the United States. Simply put, time is money. Reimbursements that typically take weeks, end up taking months if you are lucky because multiple employees have to work an account’s error due to lack of training.

Another significant revenue loss in reimbursement revenue occurs when services are not being pre-authorized and a majority of payers will not allow you to obtain an authorization after services have been rendered.

This Medicare reimbursement and revenue loss is a trickle-down effect that starts with the patient and ends with payment posting, but almost always depends on the accuracy of your staff’s benefit verification and up-front collections practices.

MEREM Healthcare Solutions can help.

We know exactly what each of your staff should look for in this case. Your front desk and scheduling must be able to catch this prior to services being rendered so that providers can feel secure in being reimbursed for their services. This will bring you a much faster reimbursement, fewer write-offs and an increase in revenue.

Whether you need to improve your front office processes, improve clinic output, or need further coaching on your encounter documentation, this is where the MEREM Healthcare Solutions consulting team comes in to help your staff (and your practice) reach their maximum potential. We offer both on-site and remote training, so there is a solution to fit any size staff and any size budget. With Merem Healthcare Solutions on your side, we will help you identify areas of improvement and help you hold your staff accountable. This is just one of the ways MEREM goes above-and-beyond to act as your strategic partner towards our mutual goal of improving your revenue.

Contact MEREM Healthcare Solutions Today at (205) 329-7519 if you are observing significant reimbursement loss and would like to discuss your revenue improvement.

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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

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