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.


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.


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

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.


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) 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:


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.