physicians

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.

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.

30
Jun
2013

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

29
Jun
2013

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