Brookline Medical Billing

09
Dec
2013

HIPAA OMNIBUS RULES AND BUSINESS ASSOCIATES

As of September, 23rd of 2013, covered entities should have updated their HIPAA Compliance programs to comply with the final HIPAA Omnibus rules. The final rules became effective on March 26, 2013 but gave covered entities 180 days to comply with the rules. Covered entities that have not updated their compliance programs to comply with the final omnibus rules requirements need to do so immediately. Covered entities that have not updated their compliance to meet the new requirements run the risk of being found in willful neglect by the Department of Health and Human Services (HHS) and risk the chance of having to face a full HIPAA audit and pay high fines. According to Leon Rodriguez, director at the HHS Office of Civil Rights the final Omnibus Rules bring “the most sweeping changes to the HIPAA Privacy and Security Rules since they were first implemented”.

An important aspect of updating the HIPAA compliance program to meet the final Omnibus Rules requirements is to review and update business associate agreements. A business associate is an entity who has access to protected health information when providing a service to a covered entity. Business associates play roles such as: receive, store, maintain or transmit protected health information (PHI) on behalf of a covered entity. Good examples to help illustrate who are a business associates are: a medical billing companies, an information technology companies, shredding companies, copy machine companies, etc. Covered entities have until September, 23rd of 2014 in order to update their business associate agreements to comply with the final HIPAA Omnibus rule. Business associate agreements that have not been modified or renewed between March, 26, 2013 and September 23, 2013 will be considered compliant until the need to be renewed or until September 22nd, 2014.

The American Medical Association states that the kinds of individuals and entities that can be treated as business associates has expanded with the Omnibus Rules. These organizations include: patient safety organizations, health information exchanges (HIE) systems and EMR or HER companies. Medical practices need to determine who they need to enter a business associate agreement with.

Covered entities must ensure that the business associates that they work with are HIPAA compliant. As part of the final omnibus rules, business associates are liable for any violations that occur and they are responsible for any subcontractors that they work with. Business associates need to conduct a thorough risk analysis and must comply with the security and breach notification rules.

At Vitruvian MedPro we help medical practices stay out of willful neglect by providing HIPAA Compliance consulting services. As part of our HIPAA Compliance consulting services, we help medical practices perform and document a risk analysis. We provide medical practices with a thorough risk management report describing their risks and vulnerabilities with PHI.
A free consultation of 30 minutes or less will let you know whether your practice would be found under willful neglect in the case of an audit.

For more information on Vitruvian MedPro’s HIPAA Compliance kit visit: HIPAA Compliance Kit.

At Vitruvian MedPro, a Massachusetts based medical billing and practice management consulting company, we help medical practices improve cash flow and focus on patient care by providing medical billing, medical coding, and patient collection services. Visit our web site at Vitruvian MedPro

05
Nov
2013

HIPAA OMNIBUS RULES AND THE PRIVACY AND SECURITY RULES

Covered entities should have updated their privacy and security rules to comply with the final HIPAA Omnibus rules as of September 23rd, 2013. The final rules became effective on March 26, 2013 but gave covered entities 180 days to comply with the rules. Covered entities that have not updated their privacy and security rules to comply with the final omnibus rules requirements need to do so immediately. Covered entities that have not updated their privacy and security rules run the risk of being found in willful neglect by the Department of Health and Human Services (HHS) and risk the chance of having to face a full HIPAA audit and pay high fines. According to the health of the Office of Civil Rights the final Omnibus Rules bring “the most sweeping changes to the HIPAA Privacy and Security Rules since they were first implemented”.

An important aspect of updating the HIPAA compliance program to meet the final Omnibus Rules requirements is to review the privacy and security rules. Some areas that must be reviewed and updated are: breach notification procedures, disclosures of Protected Health Information (PHI), marketing, the sale of PHI, fundraising and access rights to PHI.

The way to address breach notifications has changed with the final rules. Covered entities must notify patients whenever there is a breach to PHI. Breaches to PHI must be notified unless the covered entity can demonstrate that the PHI has not been compromised or that the chances of PHI being compromised are very small. The rules for breach notifications also apply to business associates. By conducting a risk assessment, covered entities and business associates can determine what is considered a breach and how to react to a breach. To illustrate, a common recommended practice to guard PHI is to encrypt all the electronic devices that have access to and store PHI. When an encrypted device gets stolen or lost, it can be assumed that the breach is unlikely to happen and a breach notification is not necessary.

Disclosures of PHI are an important aspect of the final omnibus rules. Patients have now the right to request that medical practices do not disclose their PHI for a specific service or treatment received to their health plans if they have paid for this particular visit out of pocket. So, covered entities must address its patients request to not disclose specific treatment PHI to health plans when the patients pay cash for the treatment. Covered entities must inform patients of treatments that need to be disclosed regardless of payment in instances where it is required by law.

There are cases where the covered entities have marketing agreements with providers of medical services such as pharmaceutical companies and medical device manufacturers where they are compensated for sharing treatment information for marketing purposes. As part of the final Omnibus rules, covered entities must get patient authorization when treatment communication are shared for marketing purposes. The American Medical Association states that Physician may tell patients about a third party product without the patient’s authorization when the physician does not get compensated for the information, when the physician tell the patient in person, when the patient is already being prescribed a medication, when the communication is done to promote health and when the communication involves a government program.

Covered entities must review their policies in the cases where they receive compensation for providing PHI to an external entity. Covered entities can’t sale PHI without their patient’s written authorization. As part of the final Omnibus Rules, covered entities that are compensated for the sale of PHI, must be authorized by their patients before they can disclose their PHI. Patients must be made aware when covered entities sale their PHI to external parties.

In cases where a covered entity engages in sending fundraising communications, they must update the fundraising forms so that patients can choose to opt out of receiving fundraising communications.

Patients have the right to request a copy of their PHI. Covered entities that use an EMR system to store patient information are now required to provide patients with their PHI EMR stored data upon request. Covered entities must provide the patients with their requested PHI within 30 days after the patient has made the request. Covered entities can request a 30-day extension. Covered entities must provide access to their EMR in the electronic format that the patient requests. The costs of obtaining the PHI information may be charged to the individual who is requesting the records.
Finally, covered entities must ensure that their staff is trained on all the new policies and procedures. The training must be completed on a yearly basis and it must be documented.

The new rules must be taken seriously as they have the potential for $1.5 million in fines and can put a covered entity out of business

At Vitruvian MedPro we help medical practices stay out of willful neglect by providing HIPAA Compliance consulting services. As part of our HIPAA Compliance consulting services, we help medical practices perform and document a risk analysis. We provide medical practices with a thorough risk management report describing their risks and vulnerabilities with PHI.
A free consultation of 30 minutes or less will let you know whether your practice would be found under willful neglect in the case of an audit.

For more information on Vitruvian MedPro’s HIPAA Compliance kit visit: HIPAA Compliance Kit.

At Vitruvian MedPro, a Massachusetts based medical billing and practice management consulting company, we help medical practices improve cash flow and focus on patient care by providing medical billing, medical coding, and patient collection services. Visit our web site at Vitruvian MedPro

01
Nov
2013

BEST PRACTICES FOR REDUCING PATIENT NO SHOWS

In today’s health care environment patients have more responsibility for paying their medical bills. In the new environment, patients are responsible for paying higher copays and have high deductibles. With the decrease in reimbursements from the insurance companies, medical practices must run a tight schedule in order to maximize the revenue that they generate. An important aspect of practice management is to ensure that patients show up for their scheduled visits. It is not uncommon for patients to not show up for their visits without providing notice to the medical practice. A no show from a patient means a loss of revenue that can be important to the financial well-being of the practice. Moreover, a patient no show prevents the medical practice from collecting copays from patients and sending a claim to the insurance company.

In order to reduce patient no-show, medical practice must put in place a process to discourage patient from missing scheduled appointments. This process can be broken down into four simple steps.

The first step in the process is for the medical practice to develop a patient no show policy and make patients aware of it. The practice must make an effort to stick to the rules in the no show policy at all times to ensure that patient no shows are minimized. The patient no show policy should be as simple as having rules for cancellations, missed appointments.

The second step in the process is for the practice to communicate the no show policy with its patients. The no show policy should documented the practice’s policy regarding no shows along with consequences of missed appointment. Some practices charge a certain amount for missed appointments. The policy is to be reviewed and signed by the patient. Patients must provide enough notice to the practice if they need to cancel an appointment.

The third step in the process is for the practice to make calls to patients scheduled to be seen 24 hours before their scheduled appointment. Calls can help catch cancellations giving the medical practice enough time to schedule the cancelled slot with another patient.

The fourth and final step in the process is to communicate with patients that failed to show for their appointment. Communicating with patient that have missed appointments helps build rapport and trust. At the same time, it allows the practice to check any unusual situations behind the appointment have been missed.

It is important that practices communicate with their patient the importance of showing up or making arrangements in the case that an appointment needs to be missed. Opening a dialog with patients regarding the importance of showing up will improve a practice’s bottom line.

To recap, some best practices for preventing no shows are:

1. Develop a no show policy and make patients aware of it.
2. Communicate the no show policy to all patients.
3. Make appointment reminder calls to all patients 24 hours before their appointment.
4. Communicate with patients that fail to show up for their scheduled appointments.

At Vitruvian MedPro Consulting, we are more than medical billers. We are certified medical reimbursement specialists by the American Medical Billing Association. We can help medical practices at any stage of the revenue cycle management process. Our goal is to help medical practices improve cash flow and focus on patient care.

Please visit our medical billing page to learn more about our services at: Medical Billing Services

We are currently offering a free practice analysis to help medical practitioners determine whether it makes sense to outsource their billing. Gives us a call at 781-454-7406 and schedule your free demo.

At Vitruvian MedPro, a Brookline, Massachusetts medical billing and practice management company, we work with independently owned medical practices on any aspect of their revenue cycle management. Besides medical billing, we help medical practices with their coding, account receivables and HIPAA compliance. We make sure that practices receive the highest reimbursements from the insurance companies.

26
Sep
2013

THE MEDICAL BILLING PROCESS NEEDS A GOOD PATIENT COLLECTION SYSTEM

Medical Billing is one of the most important functions of a medical practice. Medical Billing is part of the revenue cycle management process of a practice. So, medical billing is much more than submitting claims to insurance companies and waiting to be paid for those claims. The revenue cycle management of a medical practice is a complex process that involves: insurance verification, patient demographic entry, medical coding, charge entry, claims submission, payment posting, patient collections, denial management and reporting. In order to ensure financial success, medical practices must put in place a solid revenue cycle process. Putting in place the steps that the practice staff needs to ensure that every step of the revenue cycle management process is worked will save the medical practice money and will increase revenue in the long run.

At the center of the revenue cycle management process, is patient collections. Current trends in medical insurance are putting more responsibility on patients due to higher co-pays and higher deductibles which patients are responsible for. Also, patients that have no health insurance are responsible for paying the medical services they receive. A good patient collections process will make the revenue cycle management process runs smoothly. Moreover, having a good patient collections process will ensure that the medical practice gets the money patients are responsible to pay.

One of the best practices that medical practices should implement is to set patient collection expectations up front before the patient gets seen or during the patient’s visit. Not discussing patient collection responsibilities up front can damage the relationship between the medical practice and the patient when a bill is sent to the patient after the visit. It is not uncommon for patients to dispute and fight a medical bill when they are not made aware of their responsibilities up front. Sharing patient payment responsibilities up front will set ground rules and will make patients be aware of their responsibilities after they receive care.

Medical practices must make sure that they obtain patient insurance coverage and eligibility before the patient shows up for a visit. Providing patients with the copay and deductible responsibilities will set payment expectations up front and will prepare the patient to receive statements from the practice. A good practice management system can provide eligibility and coverage information to the practice on the spot saving the practice staff time from calling the patient’s insurance company. Ass an added benefit to the practice processes, a printed copy of the insurance coverage and eligibility information can be provided to patients from the get go as a way to engage them in the collection process.

Medical practices must also make sure that once patients are aware of their coverage and eligibility benefits, they collect patient co-payments at the time the patient walks in for a visit. It is good practice to let patients know in advance how much they will be expected to pay when they come in for a visit and how much they will be expected to pay after the insurance processes the claim.

To conclude, in order to improve their patient collections, medical practices should:

1. Educate and guide patients on their insurance coverage and eligibility.
2. Inform patients of their financial responsibilities at the time of check-in, prior to coming to a visit or when booking the next visit.
3. Make sure that your practice has an up to date practice management system that will allow you to check benefits and track patient balances.

At Vitruvian MedPro Consulting, we are more than medical billers. We are certified medical reimbursement specialists by the American Medical Billing Association. We can help medical practices at any stage of the revenue cycle management process. Our goal is to help medical practices improve cash flow and focus on patient care.

Please visit our medical billing page to learn more about our services at: Medical Billing Services

We are currently offering a free practice analysis to help medical practitioners determine whether it makes sense to outsource their billing. Gives us a call at 781-454-7406 and schedule your free demo.

At Vitruvian MedPro, a Brookline, Massachusetts medical billing and practice management company, we work with independently owned medical practices on any aspect of their revenue cycle management. Besides medical billing, we help medical practices with their coding, account receivables and HIPAA compliance. We make sure that practices receive the highest reimbursements from the insurance companies.

30
Aug
2013

UNDER HIPAA Willful Neglect Now Has Minimum Mandatory Fines

Under the final Omnibus Rule that will start being enforced on September 23, 2013 things have changed. The department of Health and Human Services (HHS) Office of Civil Rights (OCR) is going to start enforcing the final Omnibus Rules. The fines have increased for those practices that are not following the new regulations. The OCR will determine whether a medical practice is complying with the new HIPAA rules and regulations. The days of informal resolutions are gone. Minimum mandatory fines for “willful Neglect” start at $10,000.

What is considered “willful neglect”? Medical practices that do not perform a yearly risk assessment or that do not have an updated policies and procedures manual for the HIPAA privacy and security rules are considered in “willful neglect”. Practices that are not aware of, and have not documented their adherence to the HIPAA definition of minimum necessarty could face penalties of up to $125,000. Medical practices must start paying attention to the ins and outs of HIPAA regulations. Not being up to date with the new regulations can ruin all the hard work that has been invested in building a practice. The government sees HIPAA as a set of rules that medical practices must put in place in order to guarantee their patients access to their medical records and provide good security measures to protect patient information.

At Vitruvian MedPro, working with HITECH asscociates HIPAA — compliance simplified — is our mission and is accomplished using our 8 step, full turnkey HIPAA Compliance Kit. Starting with a Security Risk Assessment the HIPAA Compliance Kit also gives you the tools and documents you need for Business Associates, a set of customizable policies and procedures, staff and HIPAA Compliance Officer Training, a Breach Response Plan, Contingency Plan that meets the requirements of the HIPAA Privacy Rule, complete set of HIPAA documents including the required updated Notice of Privacy Practices, and a Risk Management Plan.

At Vitruvian MedPro we help medical practices stay out of willful neglect by providing HIPAA Compliance consulting services. As part of our HIPAA Compliance consulting services, we help medical practices perform and document a risk analysis. We provide medical practices with a thorough risk management report describing their risks and vulnerabilities with PHI.
A free consultation of 30 minutes or less will let you know whether your practice would be found under willful neglect in the case of an audit.

For more information on Vitruvian MedPro’s HIPAA Compliance kit visit: HIPAA Compliance Kit.

At Vitruvian MedPro, a Massachusetts based medical billing and practice management consulting company, we help medical practices improve cash flow and focus on patient care by providing medical billing, medical coding, and patient collection services. Visit our web site at Vitruvian MedPro

29
Aug
2013

SHOULD A MASSACHUSETTS MEDICAL PRACTICE OUTSOURCE ITS BILLING

Many practice managers and medical providers do not like to hear the work “outsource” when it comes to their medical billing. One of the main concerns with outsourcing is about losing control and having to let practice staff go. However, many medical practices find themselves overwhelmed with their day to day operations and experience issues with their billing and patient collections. In cases where the medical practices is not receiving the reimbursements they should be receiving from the insurance companies and are falling behind with their collections, outsourcing their medical billing may be the way to go.

With today’s advances in technology, outsourcing does not mean losing any control over the practice billing. Medical billing companies can offer medical practices real time access to their practice management systems providing a practice managers and medical providers instant access to their data. Medical billing companies can also use the medical practice’s EMR billing module to do the billing for the practice.

At Vitruvian MedPro, a Massachusetts medical billing company and practice management consulting company, we offer a cloud based solution that allows medical practices real time access to their data from any computer with internet access. At the same time, we partner with our clients and maintain constant communication with the daily activities related to medical claim submission and patient collection.

Medical practices that outsource their billing can focus their time on providing top notch patient care and on growing the practice. Also, by outsourcing practices do not have to worry about costs associated with maintain a practice management system and dealing with the technology issues associated with running a billing department.

A recent Medical Group Management Association survey showed that medical practices that outsource their billing to medical billing companies typically see improved performance across multiple dimensions. The survey focused on practices that outsource their medical billing functions. The survey reported the following results for practices that switched from doing their medical billing in-house billing to outsourcing to a medical billing company:

– 73% saw a reduction in their A/R
– 73% realized higher collections
– 59% decreased the volume of lost/denied claims
– 59% enjoyed significantly better reporting and practice performance insights
– 46% achieved higher staff productivity

The breadth of the performance improvements uncovered by the MGMA survey (with three-quarters of all practices seeing sizable performance improvements) adds fact-based credibility to the notion that a well-selected and highly-qualified medical billing company provides substantial performance improvement for medical practices. Our average clients enjoy a 15 to 25 percent increase in collections while noticing that their A/R time drops below 35 days.

A copy of this survey is available from the MGMA’s website at www.mgma.com

At Vitruvian MedPro Consulting, we are more than medical billers. We are certified medical reimbursement specialists by the American Medical Billing Association. We can help medical practices at any stage of the revenue cycle management process. Our goal is to help medical practices improve cash flow and focus on patient care.

Please visit our medical billing page to learn more about our services at: Medical Billing Services

We are currently offering a free practice analysis to help medical practitioners determine whether it makes sense to outsource their billing. Gives us a call at 781-454-7406 and schedule your free demo.

At Vitruvian MedPro, a Brookline, Massachusetts medical billing and practice management company, we work with independently owned medical practices on any aspect of their revenue cycle management. Besides medical billing, we help medical practices with their coding, account receivables and HIPAA compliance. We make sure that practices receive the highest reimbursements from the insurance companies.

01
Aug
2013

MAKING SENSE OF OUTSOURCING MEDICAL BILLING

All the changes that are happening in the healthcare industry in the next few years will challenge the way medical practices operate. Physicians are going to be pressed to see more patients with the new influx of patients that will come into the health care system with Obamacare (this is if Obamacare was to be fully implemented).

Doctors main focus is patient care and not running the business side of their practice. If Obamacare was to be fully implemented, doctors and their staff will be facing the challenge of having to provide care to more patients and keep up with all the changes that are taking place on the business side. All the changes in coding and billing represent a challenge for medical practices. It is now more important than ever for medical practices to focus more on patient care and not on how to collect their money. At Vitruvian MedPro, we help doctors focus on helping their patients and leave the billing side of the business to us. We work with insurance companies and government agencies on a daily basis and strive to make sure that our clients receive their due reimbursements. Trying to keep up with the business of providing care is hard enough. Keeping up with all the revenue cycle management side of the business should be left to the experts.

Health Care Providers that are striving to stay independent and not become part of a hospital or become a part of a larger practice are facing the need to cut costs while building and maintaining the patients that they see. Independent providers that have given into selling their practices realize that they lose control of their independence and don’t enjoy being told what to do. For those physicians that want to stay independent and succeed, outsourcing their medical billing makes sense. But outsourcing, doctors are able to focus on providing care and growing their practice. Outsourcing billing companies like Vitruvian MedPro, charge the doctor a percentage of the money that is actually collected. If the doctor does not get paid for claim, the doctor will not receive a bill for that claim. At Vitruvian MedPro, we get paid only after the doctor gets paid.

With the looming shortage of doctors across all specialties, doctors will be facing an influx of new patients into their practice. If doctors and their staff will need to spend all their time taking care of patients, outsourcing makes sense. With additional influx of patients, medical practices will have less time to spend on the revenue cycle management side of the business. Outsourcing the business side of the practice to a company that keeps up with all the changes in coding and billing interacts with insurance companies and Medicare and Medicaid on a daily basis.

At Vitruvian MedPro Consulting, we are more than medical billers. We are certified medical reimbursement specialists by the American Medical Billing Association. We can help medical practices at any stage of the revenue cycle management process. Our goal is to help medical practices improve cash flow and focus on patient care.

Please visit our medical billing page to learn more about our iClaim services at: Medical Billing Services

We are currently offering a free practice analysis to help medical practitioners determine whether it makes sense to outsource their billing. Gives us a call at 781-454-7406 and schedule your free demo.

At Vitruvian MedPro, a Brookline, Massachusetts revenue cycle management company, we work with medical practices of all sizes with any aspect of their revenue cycle management. Besides billing, we can help practices with their coding, account receivables and make sure that practices receive the highest reimbursements from the insurance companies.

30
Jul
2013

Medical Billing Optimizing Revenue Generation

On a day to day basis a medical practice is busy with taking care of patients and running the back end operations. The staff is busy scheduling patients, seeing the daily inflow of patients, calling insurance companies to request authorizations or follow up on claims, etc. In such a dynamic and hectic environment it is not uncommon to see mistakes being made that result in the reducing revenue and increasing expenses.

Whether the practice does its billing in house or it outsources this function, mistakes can be avoided by putting processes in place that will help the practice staff be more efficient while optimizing revenue generation for the practice. Following are five recommendations that medical practices can implement in order to improve their day to day processes:

1. Make a copy of patients insurance cards

An office policy must, is to always make photocopies of patients insurance id cards. Insurance cards can be scanned directly into the practices EMR or can be copied and scanned into the EMR system. Insurance ID cards should be copied or scanned on both sides as they provide important information that is required to submit a claim. The practice must educate its patients on bringing in their newest insurance card every time they come for an appointment even if they claim that the information has not changed. There are instances when the patient is not the primary policy holder of the insurance and is not aware of any changes to the insurance policy. Also, employers may change insurance companies or change plans requiring the practice to update the insurance information in its system.

2. Putting in place a system to submit claims on time

Filing medical claims in a timely manner is vital to a medical practice financial success. The sooner a medical claim is filed, the sooner the practice will get paid. Most insurance companies have time frame limits for a practice to submit a claim from the date of service. Claims that are submitted even a day late from the insurance time frame limit requirements will be denied and the practice will not get paid. Claims that are filed outside of the time limit set forth by the insurance companies will not get paid. Insurance companies time filing limits vary from company to company, the medical practice must be aware of the time filing limits of every insurance company the practice files claims with.

3. Reviewing the practices coding practices

Medical coding translates what took place during a patient visit and determine the level of payment that a medical practice will receive. It is important for medical practices to review their coding practices on a regular basis to make sure that the practice is not under-coding or over-coding. The person doing the coding should be the provider diagnosing the patient or a certified professional coder that can translate what was documented during the patient’s visit into the proper diagnosis and procedure codes. When hiring a certified professional coder, medical practitioners should provide detailed encounter documentation so that the coder can assign the correct diagnosis and procedure codes to the visit.

4. Reviewing clearinghouse reports

Most medical practices today submit their medical claims electronically through a clearing house. Clearinghouses provide a report after a claim has been submitted with information regarding the submission. Some claims will pass through the clearinghouse and get submitted directly to the payer while some claims get rejected and are sent back to the sender for review. Reviewing clearing house reports on a daily basis will ensure that those claims that get rejected at the clearinghouse level get reviewed, fixed and re-submitted on a timely manner. Not reviewing clearinghouse rejected claims on time can result in late time filing submissions which result in the practice not getting paid. Some claims that are rejected at the clearinghouse level can be easily fixed and re-submitted.

5. Follow up on claims and obtaining aging reports

Practices must make it a standard operating procedure to run aging reports on a regular basis. Aging reports will help the practice follow up and take action on the outstanding claims that have not been paid. Not following up on aging reports can cost the practice a lot of money. The hectic day to day operations of a medical practice may prevent the staff from regularly checking the status of the practice claims until someone notices that cash flow levels are down. Regularly running aging reports and follow up of the reports will help reduce insurance denials and rejections.

Please visit our medical billing page to learn more about our iClaim services at: Medical Billing Services

We are currently offering a free practice analysis to help medical practitioners determine whether it makes sense to outsource their billing. Gives us a call at 781-454-7406 and schedule your free demo.

At Vitruvian MedPro we work with medical practices of all sizes with any aspect of their revenue cycle management. Besides billing, we can help practices with their coding, account receivables and make sure that practices receive the highest reimbursements from the insurance companies.

17
Jul
2013

outsource to Massachusetts medical billing company

The medical billing and revenue cycle management aspects of a medical practice are keys to its success. Medical billing is among the most important processes within a medical practice. At the end of the day, the cash flow levels of a medical practice depend on how the billing is done. Medical practitioners have to decide whether they want to do the billing themselves or whether they want to outsource the billing functions to a medical billing company. In order to determine what makes the most sense medical practitioners need to take into account the size of the practice, its costs and the volume of patients that flow through the practice on a daily basis.

Some medical practices are reluctant to outsource their medical billing because they fear that they will lose control over the financial aspect of their practices. It is easy and convenient for some physicians to have direct access to their medical billing team in order to address any issues that arise. At the same time, some doctors that have developed an in house team to do the billing have invested a lot of time and money on their practice management software and team of medical billers. However, medical practitioners have to realize that running an in house billing team will cost a significant amount of money. Other than the costs of the costs to install and maintain a practice management system, practices will have to pay additional salaries and benefits to their employees. Not to mention, employee retention is an issue that can cost the practice a significant amount when considering the delay in submitting and following up on claims if the practice’s biller quits, is out sick, or takes time off.

At Vitruvian MedPro, we help medical practices increase cash flow by providing medical billing and revenue cycle management services. By outsourcing to our Massachusetts based medical billing company, medical practitioners can focus on providing care and do not have to worry about the set up and daily operations of a billing department. We provide the transparency our clients need so that they can stay in control of the revenue cycle management of their organization. Our software solutions are web based and can be accessed 24/7 from any computer with internet access. At the same time, our vast number of reports provide medical practices with a real time snapshot of their finances. At Vitruvian MedPro we focus on doing medical billing and stay on top of all aspect of the medical claim process such as constant follow ups on submitted claims and appealing denials.

Please visit our medical billing page to learn more about our iClaim services at: Medical Billing Services

We are currently offering a free practice analysis to help medical practitioners determine whether it makes sense to outsource their billing.

At Vitruvian MedPro we work with medical practices of all sizes with any aspect of their revenue cycle management. Besides billing, we can help practices with their coding, account receivables and make sure that practices receive the highest reimbursements from the insurance companies.

Outsource Medical Billing
15
Jul
2013

Medical Billing Fighting Timely Denials

Know your state’s law on timely filing limitations. Also, you should know the time limits for all carriers in which your doctor/client participates with. The contract for participation will define timely limitations.

Example from BCBS of Arizona: BCBSAZ asks providers to submit complete and accurate claims, preferably within 30 days of service, and require submission within one year of the date of service. BCBSAZ will deny any claims received more than one year after the date of service. Members are not liable to a BCBSAZ contracted provider for payment of a claim on which BCBSAZ denied payment for lack of timely filing. For the Federal Employee Program (FEP), the claim submission deadline is December 31 of the year immediately following the year in which service was rendered.

For paper claims – always send certified/return receipt so you have proof the claims were received. You can use the return receipt for proof that the claim was received timely.

For faxed claims
– always ensure that your machine prints out a “faxed received” message you can use as proof that the intended party in fact did receive your fax.

For electronic claims – use your clearinghouse submission report as proof a claim was submitted timely. Some carriers will accept a “print screen” printout of the filed date from your billing software program.

Non-participating Payer Denial

The Benefit Argument – this argument is one you can use to appeal to the carrier by framing it as 1) we are not obligated to file claims on behalf of your insured. 2) Your insured purchased health insurance in good faith and this is a covered benefit they are entitled to receive benefits for. In the above example (BCBS AZ) the patient would have had up to a year, so you could throw that date out since the provider isn’t obligated to file a claim for non-participating (excluding Medicare) carriers.

ERISA

And finally, ERISA can be your best defense. Under ERISA, state law has no jurisdiction, and neither do plan limitations. See 29 USC 18, 1003(a) and 1144(a) http://codes.lp.findlaw.com/uscode/29/18/I/B/5/1144 and US Supreme Court Decision in Davilla vs. Aetna and Calad vs. Cigna for references. Note that you must have the patient’s written permission to pursue an ERISA violation/denial unless the patient is willing to pursue denial him/herself.

At Vitruvian MedPro, we help medical practices increase cash flow by making sure that all claims are submitted on time. Claims submission status is followed up on a regular basis to make sure that the providers gets reimbursed for the services provided. Our state of the art practice management system helps us stay on top of the revenue cycle of every practice. For more information visit our web site at: