medical billing


AMA Releases Update CPT Errata and Technical Corrections

Errata listing Corrections in CPT 2013 (dated July 9, 2013) has been posted to the AMA Web Site. To view the updated corrections, go to:


Outsource Medical Billing

Medical practices and medical professionals often debate whether they should do their billing in-house or whether they should outsource their billing to a medical billing service.

At Vitruvian MedPro, a Massachusetts Medical Billing company, we believe that by outsourcing their medical billing, medical practitioners will benefit by having more time to provide patient care. By eliminating the worry of having to process their medical claims, medical practitioners can devote all their time to provide patient care. Moreover, medical practitioners can grow and expend their book of patients. Outsourcing to a company with a high level of expertise in medical billing and medical coding will increase collections and provide stability to the financial workflow of the practice.

Medical Billing Companies provide another advantage to medical practitioners as they are on top of all the new regulations related to the medical billing process. Following all the new changes and regulations can distract a medical practice from concentrating in providing care. A medical billing services can integrate the new changes and regulations to the practice’s billing workflow without disrupting the day to day operations of the practice.

Practices that do their billing in-house have to hire staff which becomes an additional expense to the practice. Furthermore, doing billing in-house will add costs related to software implementations, employee training and employee turnover. It has been proven that medical practices save money by outsourcing their medical billing as it the overhead costs to run the practice.

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.

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

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


Below is what Brad Lund, HBMA Executive director had to say about why practices outsourcing medical billing.

Physician practice always asks itself is should it do its billing internally with its own internal staff, or should it consider outsourcing its billing? If you look at the anatomy of a practice, the physician’s focus is patient care. That’s really all they care about. There are support staff in the nursing area, in the lab area, in the radiology area, that everybody is doing the coordination of patient care.

Billing, oftentimes, is an afterthought. Although there might be people within the practice that are responsible for the billing, billing is very complex. Billing changes, the rules and regulations of billing changes all the time, and it’s a real talent and skill to do the billing.

So, if one would consider, if I’m a practice manager or a physician, consider outsourcing the billing to a professional organization, you’ll find that not only do you receive the reimbursement that’s due you, but you’re going to get it in a more efficient manner, in a faster manner. In other words, whatever the cost of the billing professional relationship is
really gets compensated for in the additional income that the practice is going to receive. So the relationship really is very inexpensive, and you’re going to get all the money that you’re entitled to.

At Vitruvian MedPro we provide medical billing services to medical practices that want to focus on providing patient care. To find out more visit the


Medicare is recommending through one of its influential advisory boards that payment rates to providers be lowered.

The current issue is the different rates that are paid to doctors that work as part of a hospital owned clinic versus doctors that work on their own. Doctors that bill Medicare working as part of a hospital owned practice are reimbursed more than doctors that bill Medicare as part of their own independent practices. The reason behind this discrepancy is in the fee schedule that currently exist between Medicare’s Part A (inpatient) and Medicare’s Part B (outpatient).

In recent years hospitals have focused on purchasing independent physician practices. The main goal behind purchasing these independent practices has been to bring physician reimbursements under the Medicare Part A fee schedule. Under Medicare’s Part A fee schedule, physicians can bill at higher rates for the same services that they were providing when they were running their practices independently. It is not surprising that hospitals outpatient services provide higher profits.

Physicians have welcomed the idea of being bought out by hospitals as they see it as a way to offset declining incomes by billing using the Medicare Part A reimbursement schedule while obtaining long term employment agreements with the hospital. Being acquired is a good way to fight the rising costs of running an outpatient medical practice.

Medicare’s Payment Advisory Commission (MedPAC) wants reimbursements to be made site neutral immediately. The difference in charges between Medicare Part A (inpatients) and Mediare Part B (outpatients) patients should end. MedPAC states that Medicare pays under Part A scheme should match pays under the Part B scheme. The MedPAC report states “[i]f the same service can be safely provided in different settings, a prudent purchaser should not pay more for that service in one setting than in another”. According to MedPAC, “Medicare should base payment rates on the resources needed to treat patients in the most efficient setting, adjusting for differences in patient severity, to the extent that severity differences affect costs.”

The current disparities in payments have given an incentive to hospitals to buy independent physician practices increasing costs for Medicare and for beneficiaries. In order to accommodate Obamacare, physician reimbursements will need to go down.

As a way to meet the costly mandates under Obamacare and still maintain health plans cheap, insurers will need to control what providers do and limit what they are paid. In order to help the math work, Medicare billing rates are a target. Much of the private market is priced off the Medicare schedules.

Last year MedPAC proposed to cut Medicare’s fees to specialists and then freeze these lower rates for years. Under the proposal, specialists would see payments be decreased by 5.9% per year for three years totaling a 16.7% cut in reimbursements followed by a seven year freeze at the lower levels. Even these are just proposals, they need to be taken seriously.

You can read the Scott Gottlieb’s article here


The American Medical Association has released its sixth annual report on the claims processing performance of the nation’s largest health insurers. This year’s report looks at the timeliness, transparency and accuracy of claims processing by Medicare and seven commercial insurers: Aetna, Anthem Blue Cross and Blue Shield, Cigna Corp., Health Care Services Corp., Humana Inc., Regence, and United Healthcare. While error rates for commercial insurers on paid medical claims dropped from nearly 20% in 2010 to 7.1% in 2013, AMA estimates that more than $43 billion could have been saved if commercial insurers consistently paid claims correctly. Claim denials by the commercial insurers declined from 3.5% in 2012 to 1.8% in 2013, while Medicare had the highest denial rate at 4.9%. This year’s report includes a new index ranking the commercial insurers according to the level of unnecessary cost they contribute to the billing and payment of claims.


In order to maximize reimbursement the documentation of each patient encounter should include the following:

1. Reason for the encounter and relevant history, physical examination findings and prior diagnostic test results;
2. Assessment, clinical impression or diagnosis;
3. Plan for care; and
4. Date and legible identity of the observer.

For paper charts, the patient’s name plus one additional identifier should be on every single page within a patient chart.

For small practices, chart auditing is an often overlooked compliance effort – one that should be performed at least annually or semi-annually.

At Vitruvian MedPro we help medical practice increase cash flow by providing medical billing services. Our Medical Financial Services help doctors focus on patient care while we take care of the paper work.


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Welcome and thanks for checking out the first blog post in our brand new site! We plan on posting information on a regular basis regarding revenue cycle management and practice management topics. We are currently helping medical practices improve cash flow by providing Medical Billing, Medical Coding, and Patient Collection services. We are also actively working on helping medical practices with the HIPAA compliance programs.