Accurate medical billing is a cornerstone of effective healthcare management, directly affecting the financial stability of practices and the overall patient experience.
When billing is on point, your clinic can avoid stressful financial setbacks, such as claim denials and lost revenue. Clear and correct billing results in fewer surprises for your patients, helping them better understand and manage their medical expenses.
Given the complexities of the healthcare system, getting billing right is critical to building trust and ensuring that everything runs smoothly.
With that in mind, let’s explore some practical tips and tricks for minimizing medical billing errors.
A strong foundation of accurate medical billing is the thorough collection and validation of patient data at every visit. Billing errors in healthcare can lead to claim denials and non-compliance penalties related to regulations like HIPAA, which protect patient privacy.
Here are some proven methods to make sure your patient records are always up to date:
Utilize Electronic Health Record (EHR) Systems
Electronic Health Record (EHR) systems simplify the storage and management of patient information while improving accessibility for healthcare providers. With features like automated reminders and customizable templates, these systems enable your team to enter data efficiently during patient visits.
Educate Staff About the Value of Accurate Data Entry
Teaching your staff the value of precise data is crucial for fostering a culture of accountability and excellence in your practice. When your team understands how accurate data entry impacts patient care and overall operations, they are more likely to take their responsibilities seriously.
Let’s look at some practical tips for training your staff in accurate data entry:
Explain the Impact on Patient Care
Ensure your team understands that medical billing errors in healthcare can lead to incorrect diagnoses, inappropriate treatments, and compromised patient health. Highlighting the importance of accurate data entry can reduce the risk of these errors and improve overall patient care.
Discuss Financial Implications
Data entry errors can lead to claim denials, delayed payments, and lost revenue. Educating your team about these financial repercussions emphasizes the importance of accuracy from the start.
Emphasize Compliance and Legal Considerations
Make it clear that billing errors can lead to violations, resulting in penalties and legal issues for the practice. Accurate data entry is essential for HIPAA compliance, protecting patient privacy, and properly handling sensitive information.
Encourage a Culture of Continuous Improvement
Create a space where staff feel comfortable asking questions, seeking clarification, and sharing feedback on data entry processes. Encourage them to exchange best practices and work together to improve accuracy.
2. Stay Updated with Coding Standards
Accurate coding in billing is a big deal for both healthcare providers and patients, as it translates medical diagnoses, procedures, and services into standardized alphanumeric codes.
Staying current with the latest ICD-10, CPT, and HCPCS codes is vital to avoid medical billing and coding errors. Familiarity with these codes streamlines the billing process, allowing your team to focus more on patient care and less on administrative tasks.
There are many resources available to help you stay updated on coding changes:
Follow Credible Medical Coding Resources
Stay informed by following reputable medical coding resources. 5 Star Billing and the American Medical Association are excellent examples that provide detailed updates on medical billing codes and guidelines. These resources help you access the latest information and adhere to industry best practices.
Utilize Coding Software with Automatic Updates
Invest in coding software that automatically updates with the latest codes and integrates with your EHR system. This ensures your staff always has access to current coding information, allowing them to focus on providing quality patient care without worrying about coding accuracy.
3. Conduct Regular Audits and Reviews
Regular audits are essential for identifying discrepancies and outdated information in patient records. By periodically reviewing a sample of records, you can ensure the data accurately reflects each patient’s health status.
Here are some effective steps to guide your audits:
Review Sample Claims
Select a representative sample of claims and carefully check for accuracy and completeness, including patient information, coding, and documentation. This helps identify discrepancies that need to be addressed.
Identify Common Errors
Look for recurring errors, such as incorrect coding or missing documentation. Once identified, implement corrective measures, such as updating staff training or refining billing processes, to prevent future mistakes.
External Audits
While internal audits are valuable, enlisting an external auditor can provide an unbiased perspective on your billing practices. External audits can uncover issues that may have gone unnoticed and offer insights into industry best practices.
4. Implement Comprehensive Training Programs
Regular training reduces claim denials and ensures your billing practices align with the latest regulations. Investing in continuous education enhances your staff’s skills and boosts their job satisfaction and engagement.
Here are some key topics to cover in training programs:
Accurate Data Entry
Emphasize the importance of precise data entry. Correctly inputting patient information, medical codes, and service details is fundamental to avoiding errors and ensuring smooth billing operations.
Coding Updates
Keep your team up-to-date with ICD-10, CPT, and HCPCS codes. Training should focus on new codes, changes in coding guidelines, and best practices for accurate coding to ensure compliance and effectiveness.
Compliance with Regulations
Make sure your staff is well-versed in compliance requirements, such as HIPAA. Comprehensive training helps mitigate data privacy and security risks, safeguarding you and your patients.
Common Billing Errors
Identify frequent billing mistakes, such as incorrect coding or incomplete documentation. Teach staff to recognize and avoid these errors to improve billing accuracy and reduce claim rejections.
5. Outsource Your Billing Needs
Outsourcing your medical billing to trusted companies like 5 Star Billing can result in substantial cost savings and faster claims processing. Our certified coding and billing specialists use specialized expertise and advanced technology to reduce compliance risks, boost operational efficiency, and improve cash flow.
We at 5 Star Billing pride ourselves on lowering errors and increasing efficiency through our vast industry experience and innovative tech solutions. Here’s how we deliver proven results:
Expertise in Complex Billing and Coding
Navigating the complexities of medical billing and coding can be overwhelming for healthcare providers. That’s why we have assembled a team of certified professionals well-versed in the latest coding guidelines and payer requirements. Their in-depth knowledge helps reduce claim denials and delays, ensuring faster reimbursements for your practice.
Access to Advanced Billing Technology and Compliance Updates
Our cutting-edge billing technology enhances data management and enables real-time claims tracking, making it easy to monitor reimbursement statuses. We remain vigilant about the latest compliance regulations and coding changes to ensure your practice meets industry standards.
Overcome Billing Challenges with 5 Star Billing’s Precision
Accurate billing is crucial for timely payments, healthy cash flow, and smooth operations. When mistakes happen, it can lead to claim denials and delays, which only adds stress to your team. Clear billing reduces unexpected costs, helping patients manage expenses while fostering trust and control over their healthcare finances.
By implementing these strategies to boost billing accuracy, you can optimize your processes, improve cash flow, and make your patients happier.
Tap Into Our Expertise
Ready to cut down on errors and improve your revenue cycle management? With 5 Star Billing Services, you can take advantage of our certified coding and billing specialists, who are always up to date with the latest billing regulations.
Leave the billing and coding complexities to us so you can focus more on your patients. Book a consultation today and learn how we can elevate your practice!
The healthcare industry is preparing to switch from ICD-10 to ICD-11, and medical billing departments must adapt quickly and efficiently. If your billing department is not well-equipped, it can result in severe consequences, such as coding errors and delayed reimbursements.
In this blog, we’ll delve into the practical implications of ICD-11 for billing professionals. We’re here to provide you with the knowledge and tools necessary to navigate the shift to ICD-11 with confidence and competence.
Understanding ICD-11
The transition from ICD-10 to ICD-11 marks a significant advancement in healthcare coding systems. Unlike previous updates, which primarily focused on refining existing codes and expanding the classification system, the shift to ICD-11 represents a fundamental reimagining of how we categorize and document diseases and medical conditions.
ICD-11 coding introduces many vital improvements over its predecessor, including:
Enhanced specificity
Better alignment with current medical practices
Improved usability
More streamlined structure
Expanded code options for diseases and conditions
Integration of electronic health records
Increased emphasis on data interoperability
Additionally, ICD-11 introduces new chapters, such as “Traditional Medicine Disorders” and “Extension Codes,” to capture additional information. The development process also features greater collaboration among international stakeholders, ensuring a more globally relevant medical billing and coding system.
Timeline for Implementation and Adoption
As for the timeline in the US healthcare system, the implementation and adoption of ICD-11 will follow a carefully planned trajectory. While there isn’t a fixed timeline due to the complexity of transitioning large-scale coding systems, adoption typically involves phases of testing, training, and integration.
Healthcare organizations and providers may undergo training programs to familiarize themselves with the new coding system, followed by pilot implementations to assess efficacy and identify potential challenges. Once these stages are completed satisfactorily, broader adoption across the healthcare landscape can occur.
Impact on Medical Billing Processes
The transition from ICD-10 to ICD-11 will significantly impact medical billing processes, influencing various aspects of diagnosis coding and reimbursement procedures. These aspects include:
1. Changes in structure and classification. The structure and classification of diagnosis codes undergo refinement, with ICD-11 offering a more logical and intuitive organization. This allows for easier navigation and accurate code selection, potentially reducing coding errors and claim denials.
2. Expanded code set and specificity. This increased granularity enables healthcare providers to capture a broader range of conditions and manifestations, leading to more precise diagnoses. While this enhances clinical accuracy, ICD-11 codes also demand greater attention to detail in documentation and coding practices.
3. Effects on reimbursement and claims processing. The transition to ICD-11 requires adjustments in billing systems and payer policies. Providers must ensure alignment between diagnosis codes and reimbursement criteria to avoid payment delays or denials.
4. Increased documentation requirements. The adoption of ICD-11 also entails heightened documentation requirements to support the specificity of diagnosis coding. Healthcare professionals must capture detailed clinical information to reflect patient conditions, treatment plans, and outcomes accurately. While this change promotes more complete medical records, it may initially pose time and resource challenges.
Preparation and Transition Strategies
Successful implementation of ICD-11 adoption hinges on effective training, complete infrastructure, and collaborative efforts among clinicians, medical coders, billers, and staff.
Education and Training
Provide comprehensive training to familiarize medical billing/coding staff with the new ICD-11 system. Such learning sessions ensure they understand the ICD-11 code structure, classification changes, and increased specificity requirements.
Review of Coding Policies
Existing coding policies and procedures must be thoroughly reviewed and revised to align with ICD-11 requirements, ensuring consistency in the coding process.
Ensuring Compliance with Guidelines
Compliance with regulatory standards and guidelines for medical coding and billing should also be monitored and enforced throughout the transition to ICD-11. Besides consistency, this approach helps reduce the risk of penalties for non-compliance.
Engaging with the Medical Billing Partner
Close collaboration with your medical billing outsourcing partner must be maintained throughout the transition to ICD-11. This ensures the alignment of processes, systems, and expectations, which mitigates disruptions and optimizes billing operations’ efficiency.
Establishing Cross-Functional Teams
Consider forming cross-functional teams with representatives from IT, clinical, billing, and compliance departments to facilitate the smooth implementation of ICD-11 and foster collaboration through problem-solving.
Tracking Success in ICD-11 Adoption
Determining the success of ICD-11 adoption in a medical billing department involves assessing several key metrics and indicators. Here are some factors to consider:
Check for a decrease in coding errors and inaccuracies.
Track any increase in timely reimbursements and a reduction in claim denials.
Evaluate whether there are improvements in revenue capture, billing efficiency, and overall financial performance.
Assess whether there are improvements in workflow processes, resource utilization, and staff productivity.
Monitor adherence to coding standards, documentation requirements, and privacy regulations.
Measure billing staff proficiency in ICD-11 codes and assess their confidence in navigating the new coding system.
By closely monitoring these indicators, medical billing departments can evaluate the success of their ICD-11 adoption efforts and make informed decisions to optimize billing processes.
Takeaway
The transition to ICD-11 will represent a significant leap forward in healthcare and medical billing departments. This shift is anticipated to impact medical billing processes, necessitate adjustments in coding policies, and align reimbursement criteria. Transition strategies and expert medical billing services are vital to a billing department’s successful adoption of ICD-11.
Tap Into Our Expertise
When the time comes, and you are facing the challenges of transitioning, choose 5 Star Billing Services for reliable coding and billing support.
Discover revenue cycle management solutions designed to improve your practice’s financial health while enabling you to focus on patient care:
ICD Coding Support: Our team of seasoned experts ensures a seamless transition to ICD-11, providing guidance every step of the way.
Medical Billing Solutions: From patient input to collections, we handle all aspects of medical billing, optimizing efficiency and accuracy.
Expert Consultation: Whether you need help developing an ICD transition plan or facilitating coding training, our consultants provide expert assistance.
With 5 Star Billing Services, you can trust that your billing processes are in capable hands, allowing you to navigate the complexities of ICD-11 adoption with confidence.
There is much complexity in medical billing and coding. No matter how well-organized a billing department is, dealing with the discord of codes can be challenging. Moreover, untrained staff who file claims can make inadvertent errors that result in substantial financial and time losses.
Medical billing and coding errors account for most claims denials and payment delays. Another issue is that frequent errors can have a negative impact on the relationship between you and your patient.
The issue of medical coding and billing is pervasive. Why is this so? Is there a way to avoid medical billing and coding errors?
As we move into 2023, we’ll discuss some common challenges and the best medical coding and billing solutions.
Three Common Challenges In Medical Billing and Coding
According to BMC Health Services Research, medical coding errors could lead to revenue loss. Simple mistakes can occur; human error must be allowed for, but lost fees drain the finances of a healthcare facility, which is why medical billing departments must minimize them.
Below are three common challenges that medical billers and coders face:
1. Usage of Outdated Coding Guides
To accurately bill for services and assign diagnosis codes, it’s crucial to have the latest coding materials. Each year, medical billing companies and practices should update or purchase the latest coding publications to ensure accuracy in billing and coding.
AMA, CMS, and WHO are the organizations that maintain and update the three principal medical coding codes every year. Coders are responsible for learning any new codes or reorganizations as they become available and using them correctly. This is partly because professional organizations like the AAPC and AHIMA require members to complete a certain number of education credits every two years.
However, failing to append the correct codes illegally inflates your practice’s revenue.
2. Improper Coding
The following reasons contribute to claims being coded incorrectly:
The unbundling of charges that need to be handled under the same procedure code
The practice of upbilling and underbilling
Inconsistencies in codes
Missing codes
Billing CPT codes that are not on your insurance provider’s list
In the same regard, erroneous coding leads to poor patient care and trouble with reimbursements, but how does the responsible party address these issues? Those medical practices with a history of coding mistakes may be subject to fines and/or federal penalties.
The False Claims Act (FCA) enters at this part. It provides enforcement for false claims, and the consequences may include monetary penalties or legal issues.
3. Missing Documentation
To pay claims, all insurance providers require documentation. If you don’t provide it, they may deny your claim and send it back to you, in which case you will have to resubmit it with the necessary documentation. The American Medical Association (AMA) estimates costs between $21 billion to $210 billion in claims processing inefficiencies each year.
At the same time, medical billing specialists need help assigning the right codes and billing patients correctly when physicians or other healthcare providers turn in sloppy paperwork.
Best Medical Coding and Billing Solutions for 2023
There is a great deal of interest among healthcare firms and organizations in finding the best coding and billing solutions for 2023. With these features, they know that their practice will be able to advance faster than their competitors.
1. Medical Practice Management Solution
A practice management software serves as a lifeline for medical practices. It enhances the efficiency of your practice by satisfying customers. Among the core capabilities of practice management software are:
Adding patient information to the database
Recording patients’ demographics
Managing billing operations
Streamlining billing processes
Processing and submitting claims for payment
Hiring a third-party service provider’s medical coding and billing services, streamlining all these tasks so healthcare practices can focus more on patients.
Furthermore, you should choose a practice management system with coding automation that meets current coding requirements. With software that allows you to list only the codes specific to each medical insurance carrier, you can easily reduce billing time and prevent errors. It is much less likely that your staff will make mistakes when they can quickly look up diagnosis and procedure codes.
2. Medical Coding and Billing Training/Education
Medical billing and coding are becoming increasingly complex for clinics dealing with different insurance companies. As complexity rises, coding certification becomes increasingly valuable.
Your clinic will reap several benefits from medical coding training from a certified professional. For example, ensure your staff is properly trained to recognize medical documentation needs. Your billing software should allow you to attach documents to your claims simultaneously. In this way, you’ll experience an increase in the efficiency of the workflow in your office.
Similarly, well-trained employees will code more accurately, easing the process of filing claims and receiving reimbursements. You will increase revenue and reduce refilling and appealing costs by minimizing claims rejections and denials.
3. Medical Outsourcing
Medical coding outsourcing refers to contracting the work to a third-party company instead of completing it in-house. Depending on your agreement, many medical billing and coding companies may handle all or most of your medical coding needs. They must also ensure that their staff is up-to-date on the latest coding requirements and skills. Medical coders often work remotely, but you can hire them in your practice.
Outsourcing medical coding has some major advantages, including:
Keeping Up-To-Date With Certifications.
It takes much time to keep up with certifications and updates. Medical coding can undergo substantial changes when a major update occurs. For example, ICD-10 led to a significant increase in codes. If you hire a third-party medical coding company, they will handle these issues for you. Having the right coders working on your charts ensures that their skills, certifications, and knowledge are up-to-date.
Cost-Effectiveness
It can be more cost-effective to outsource your medical coding than hire and maintain an in-house team. The price will be higher if you hire medical coders with specialization and superior skills. By outsourcing, you can employ top-level coders at a lower cost.
Flexibility
The flexibility of contract medical billing and coding companies can be superior to hiring an in-house team. Outsourcing provides you access to an extensive network of coding experts. Moreover, the coding company can assign more employees to do your work on a busy day so you can submit claims and receive payments quickly.
Transparency
Your coding company is the one to provide you with detailed performance reports about your medical billing. They may send you these reports automatically or upon request. This way, you can get a clear view of your practice’s coding and billing, which helps you gain a more comprehensive understanding of your practice’s operations.
Security and Compliance
Regulatory compliance and security are major concerns for healthcare organizations. To protect against data loss and other cyber incidents, you need robust disaster recovery plans for medical coding and billing. Additionally, you need to ensure that you comply with HIPAA regulations.
Medical coding firms specializing in security and compliance will understand your coding concerns. You can always trust your coding company to take the appropriate precautions.
Furthermore, medical coding outsourcing companies can also conduct coding audits, provide research support, and improve clinical documentation.
You should consider outsourcing if you’re looking for an easy, hassle-free way to improve medical coding and billing. Many healthcare organizations can benefit from this approach in a variety of ways.
Tap Into Our Expertise
Indeed; many healthcare establishments struggle with common coding and billing issues. To ensure your practice’s prosperity in 2023, we offer the most effective solutions mentioned above.
These medical coding and billing solutions will help your medical practice compete in an increasingly competitive market.
At 5 Star Billing Services Inc, we offer the highest level of performance for high-quality medical billing and coding. Save your money by outsourcing to a professional billing service.
The American Academy of Family Physicians (AAFP) encourages safe, secure online interactions between physicians and patients, such as electronic visits or “virtual e-visits.” In non-emergency situations, e-visits can substitute for office visits with primary care providers. It is a fast and easy online procedure for patients to receive a diagnosis and treatment plan.
This article will give you the best guide to e-visit documentation, coding, and billing.
What Should Providers Know About E-visits?
An encounter must meet the following criteria to be considered an e-visit:
The practice must have a well-established relationship with its patients.
E-visits require patient consent and a communication request.
The patient must initiate non-face-to-face electronic communication. For example, patient portal systems.
Patients must not have seen an office visit to a physician or therapist for the same clinical concern in the past seven days.
It is only possible to report e-visits every seven days.
An e-visit is not the same as typical therapy sessions.
For e-visits, the following documentation requirements are needed:
The main complaint with all evaluation and management services (E/M).
The specifics of treatments, assessment of diagnoses or symptoms, evaluation, and conversation.
An official patient consent record is backed up by a signature and captured in the clinical note. Moreover, e-visit software platforms accept scanned copies of signed consents. Some systems allow electronic signatures.
The total time recorded over the seven days supporting the billable service.
List of Current Procedural Terminology (CPT) Codes That Require Providers to Follow Policies Set by Payers
The codes for online digital evaluation services (e-visits) used by doctors are complex. Below are the codes used:
Medicare uses the following HCPCS codes and descriptors for qualified non-physician professionals for its online digital evaluation service (e-visit):
Private payers and workers’ compensation are using the following online digital evaluation service (e-visit) CPT codes and descriptors:
Do’s and Don’ts in Billing E-Visits
When the following conditions are met, you can bill an e-visit:
The provider establishes a relationship with the patient.
Response time by the provider is longer than five minutes.
A provider responds through the patient portal to a message initiated by the patient.
A visit meets the 2021 E/M guidelines.
It has been seven days since the clinician last saw the patient.
There is no global period for the same or similar condition for the patient.
In this case, the provider is making a clinical decision that would normally be performed in the office (e.g., medication dose adjustment, ordering a test, or prescribing a new medication).
A patient has consented to the e-visit and understands that he may be billed.
For online digital E/M services, the service period includes all related work done within seven days by the reporting individual and other registered healthcare providers (RHPs) in the same group practice.
The 7-day period begins when the reporting provider reviews the patient’s inquiry personally for the first time.
A new/unrelated problem from the patient arises within seven days of the previous E/M visit for a different issue.
Do not bill an E-visit in the following situations:
During the 7-day period, the provider may bill for other separately reported services (such as care management, INR monitoring, remote monitoring, etc.)
The same or similar condition was billed to the patient for an e-visit within the past 7 days.
The patient inquires about a surgical procedure that happens during the surgery’s postoperative period (global).
Providers are simply disseminating results, processing medication requests, or scheduling appointments (for billing, E/M services must be performed).
A separate face-to-face E/M service (either in person or via telehealth) happens (included in the E/M) during the 7-day period of the e-visit.
Besides clinical staff time, only provider time can be included.
The AAFP published an algorithm in response to the growing number of virtual visits. It was developed by James Dom Dera, MD, FAAFP, to determine which code should be used for virtual services.
Tap Into Our Expertise
At 5 Star Billing Billing Services Inc, we offer the highest level of performance for high-quality medical billing and coding. Save your money by outsourcing to a professional billing service.
Change is inevitable in healthcare. Providers are seeking ways to streamline medical billing and coding. Therefore, advanced technology is vital to achieving optimum efficiency in coding and billing processes.
Pain Management Crisis
Chronic pain is a colossal public health issue. It costs billions of dollars in lost productivity and creates major health problems. According to the Centers for Disease Control (CDC), more than 50 million U.S adults suffer from chronic pain or one in five adults. As incidents of long-term arthritis and age-related conditions go up, this number will continue to rise. There will be more demand for pain medicine in the future. Additionally, payer demands are becoming a hassle. Prior authorization requirements put pain management at risk, affect fee schedules, and require patients to shoulder financial responsibility.
How to Optimize Coding and Billing in Pain Management Practices
Utilizing the latest technology in revenue cycle management allows your practice to get paid for work in a timely and efficient manner. In pain management, coding and billing solutions are readily available to help your practice. We will explore the latest solutions that help optimize pain management medical billing and coding:
Outsourcing
Medical practices know that medical billing is a vital but demanding task. Revenue cycle tasks such as patient scheduling, insurance verification, claims management, AR follow-ups, and payment collection can be challenging. When revenue is at stake, the quality of patient care goes down. That’s why many healthcare providers in pain management consider medical billing outsourcing.
Outsourcing billing and coding allows practices to:
Achieve a flexible schedule for staff.
Maintain continuity and manage risks.
Boost growth.
Manage the basic tasks efficiently.
Ensure operational control.
Make sure reimbursements are prompt.
Reduce expenditures.
Increase productivity.
Cut revenue leaks.
Balance AR (account receivables)
Outsourcing is an effective way for medical practices to grow and expand while minimizing costs. Indeed, the best pain management billing company will help you ensure profitable revenue.
Automation of coding and billing
Automation is the future of medical billing and coding. Software automation can assist healthcare providers in cutting down unnecessary expenditures. Furthermore, it eliminates time-consuming tasks.. Billing automation can also bring considerable benefits to insurance pre-authorization. Moreover, the process of verifying eligibility and payment limits is simplified.. Thus, patients can get immediate care as soon as they need it.
Accurate pain management coding
Pain management coding always must be accurate. It’s the first step towards optimizing your healthcare revenue cycle management. A correct coding initiative is essential from a compliance standpoint. It is also helpful for reducing rejections, claim denials and ensures optimum reimbursements. Claims must be error-free and precise before they are sent out.
Here are coding initiatives that will increase collection and reduce denials:
Hire coding specialists for accuracy and efficiency. Partnering with a certified medical coder that focuses on pain management practices can quickly improve your cash flow.
Avoid non-specific diagnoses codes. In comparison with ICD 9, ICD 10 documentation requirements are much more detailed.
Avoid incorrect modifier usage.Make sure your coding follows payer-specific guidelines so that you don’t face denials or underpayments.
Avoid using a higher-paying code on a claim to receive big reimbursements. This refers to upcoding. This issue can cause more claim denials.
Stop upcoding and unbundling, as both are illegal. Unbundling involves submitting bills piecemeal to maximize the reimbursement for tests and procedures that require billing together.
Stay away from under-coding – omitting or exchanging codes for a lower level of codes or less expensive code is leaving money on the table.
The medical necessity needs more documentation.
Switching to Telehealth
The concept of a virtual visit is an interaction between patient and provider that doesn’t take place in the same room. It is also becoming more common in health care. For medical practitioners, virtual visits affect medical billing. The new CPT codes reflected the billing and procedures changes, so insurers had to update their policies right away. COVID-19 prompted many new treatments and protocols, which resulted in modifications to coding and billing. Health care providers lost a lot of money in the transition period due to denied claims. That’s why pain management billing software for your practice helps incorporate these changes. In addition, it prevents revenue leaks and ensures maximum future compatibility.
New Software for Revenue Cycle Management (RCM)
What is Revenue Cycle Management software? It helps physicians and healthcare providers track and manage revenue from a patient’s lifecycle. Revenue cycle management solutions augment medical billing software functionality. It includes:
Seamless integration with EHR/EMR software – an easier way for exchanging data with the billing system.
Insurance eligibility and pre-authorization toolsensure the revenue collection process starts on the right path.
Advanced A/R management enables you to assist your facility’s staff and patients with the payment process.
Clearinghouse – an in-house intermediary service reduces the time spent on the remittance process.
More important than ever, these features support financial operations throughout the life cycle of a medical facility.
Tap Into Our Expertise
It’s crucial to rely on current medical coding and billing solutions in light of these changes. These processes can further enhance your— billing processes, revenue cycle, and pain management practice.
At 5 Star Billing Billing Services Inc, we offer the highest level of performance for high-quality medical billing and coding. Save your money by outsourcing to a professional billing service.
Medical billing and coding are a great challenge for healthcare providers. Veteran surgeons and seasoned healthcare professionals see it as a struggle. Regardless of the resources and assets, hindrances still occur. It’s a parade of medical codes, insufficient time, and failure to follow-up for collections. How do you make more time for your patients?
Medical practices are now finding ways to find the appropriate solution. In particular, pain management practices continue to deal with complex billing and coding. If your pain management practice seems to face many issues, you can always ask for our assistance. At 5 Star Billing Services, we offer comprehensive pain management billing services and collections. We can help your pain management practice grow. So what are the signs that you need to outsource your billing and coding?
Late Payments
Following up on payments causes frustration. The increased reliance on patient payments requires an increased collection budget. Hiring a pain management billing service makes billing collections and claims easier. Our pain management billing experts track late payments quicker, so the in-house staff can focus on other tasks. About 54% of insured patients have trouble understanding their medical bills. We can also help patients clarify their confusion with their claims and other processes.
The Decline of Patient Care
Spending more time on billing and coding than patient care is a big problem. Medical exams may get delayed when your nurses are busy with billing processes. In the end, your patients may end up walking out and never return to your practice. Your staff is probably finding it hard juggling multiple tasks. That’s why outsourcing your billing and coding is the best option. Our pain management billing experts are always available to handle all the complex billing tasks on your behalf.
Pressure on staff
The administrative staff also faces difficulties with in-house medical billing. It’s time-consuming and frustrating. Training is necessary for up-to-date changes in rules and codes. However, it also takes significant time away from dealing with other admin tasks. In that case, you may need to assign tasks to other departments. Many practices are still hesitant to outsource their billing and coding. They fear that the cost will be prohibitive, but you can save a lot of money by outsourcing medical billing. It will help your practice become more efficient and help your staff maintain a work-life balance.
Loss of Workforce
High staff turnover is always a problem. When a staff member leaves, the remaining work might get divided among your team members. Often, these members lack medical billing and coding expertise, and new hires may leave before they complete their training. These issues reduce revenues, increase billing and coding errors, and erodes the quality of care. That’s why healthcare providers want the best for their pain management practices. Your patients can benefit from the services, and your pain management practice will be stable. In contrast, if staff resignations are piling up, it may be time to look for pain management billing services. Let the experts handle the tough job.
Struggle to find Staff Replacement
Finding qualified staff for your pain management practice can be hard. Both urban and rural areas are experiencing a shortage of skilled workers. Coding experts, medical billers, and administrative staff are especially hard to find. Other physician offices have high turnover rates due to problems with managers or office politics. According to the Medical Group Management Association (MGMA), practice costs have risen by 50%.
Increase in Insurance Denials
To maintain compliance with insurance coverage requirements, AR and billing staff must continually handle insurance denials. A high rate of insurance denials could indicate a poor denial resolution process. Experts can help you expedite your transactions. Our AR management and electronic claims in pain management reduce delays. Also, we provide an initial evaluation of your practice before we move forward.
Account Receivables are Too High
In a short time, account receivables (AR) can mount up. That might be because of faulty software or an inexperienced biller. You may need to restructure your entire patient-to-pay revenue cycle. Likewise, you may not have enough staff to handle claims errors and denials right away. AR levels can rapidly rise due to any of these reasons or a combination of them. The American Medical Association (AMA) stated that the average is now 24%, with half of that percentage collected at the point-of-service—thereby adding to the overall A/R increase. Further, an unclear collections success rate results in administrative waste, unnecessary write-offs, and a loss of bottom-line profit.
Tap Into Our Expertise
Pain management coding and billing are indeed strenuous. That is why we provide you with several reasons to consider medical outsourcing. With the help of an outsourcing billing company, your pain management practice will grow.
At 5 Star Billing Billing Services Inc, we offer the highest level of performance for high-quality medical billing and coding. Save your money by outsourcing to a professional billing service.
There are still doctors who think outsourcing their medical billing process would deprive them of a healthy cash flow. However, most doctors swear by their outsourced billing services and wouldn’t consider bringing it in-house ever again. No matter where you fall on the spectrum, there might still be leaks in your revenue cycle. Here are five signs that you need to tap into the expertise of an experienced medical billing specialist.
1. Revenue Stream Slowing
You might not notice your revenue stream reducing when you’re focused on the day-to-day duties of patient care. First and foremost, assess how well your in-house billing department is operating, how much it costs, and if you’re paid on time. Then, start adding up what you spend on phone bills, internet, information systems, physical space, support staff salary, and billing supplies to get a handle on your billing expenses. When comparing the cost of a third-party medical billing specialist, this figure will come in handy.
2. Recruiting and staffing challenges
Because the process of filing claims and following up on them can be time-consuming, independent practices often find it difficult to maintain staff while being cost-effective. Any practice will suffer from high personnel turnover, leaving the billing department particularly vulnerable. The revenue cycle, on the other hand, will not run properly without up-to-date and constant staffing. If you’re having trouble finding and keeping the right billing employees, outsourcing might be the way to go.
3. Services rendered without payment and late payments
Payment problems can cause the revenue cycle to wind down quickly. Medical billing has evolved into a complex science, and most practices deal with multiple payers regularly, making it easier for unpaid bills to slip through the cracks. An outsourced billing system can help by taking care of the time-consuming and inconvenient task of following up on outstanding claims and notifying patients about their costs.
4. A high number of rejected claims
A rejected claim must be reviewed, altered, and sent again immediately by your billing or office staff. The procedure can take up a considerable amount of their time and decrease the insurer’s productivity, not to mention making a new claim submission a second time. As a result, your billing process is not as efficient as possible if you notice an increase in rejected claims. With the help of a medical billing specialist, you will get fewer rejections and better service.
5. The billing and coding process is not up-to-date.
You may be overlooking inefficiencies in your practice if your billing staff cannot keep up with changing rules and trends. Errors in medical billing are costly and all-too-common. A third-party medical billing specialist will retain a high level of competence while also providing you with efficiency reports, which will give you vital, real-time feedback.
Benefits of Outsourcing your Billing Process
Working with experienced medical billing specialists has many benefits. Here the top 3 benefits of outsourcing your medical billing process:
Healthy Revenue Cycle
Medical billing companies are experts in the field. Entrusting your revenue cycle management to renowned specialists will be the best choice you can make for your practice.
Committed and licensed professionals
You’ll need the assistance of a devoted and licensed staff, and you won’t necessarily need to go through the training and hiring process. The experts will advise you to keep track of all of your claims. Their primary focus will most likely be on maintaining and improving the status of one’s practice.
Maintaining regulatory compliance
Medical billing companies are always up-to-date in changes in regulatory compliance and coding procedures.
Save money
You can save a ton by outsourcing because you won’t have to spend as much money on overhead costs, hardware, and software. Management software can cost up to $200 per month per physician, and it isn’t inexpensive. Those concerns do not present once you have decided to outsource maintenance, and the cost of the equipment appears to be around $500.
More time with patients
Who doesn’t want more time and energy to devote to their patients? When you outsource medical billing services, you free up time and resources to focus on your key strengths, such as healthcare. Once your medical billing professionals take care of your billing and insurance processing, you’ll have hours on your hands.
You can use the following methods in measuring the quality of the accounts receivables of your Pain Management Practice:
1. Day’s Sales Outstanding (DSO)
The day’s sales outstanding (DSO) ratio is a simple way to assess the quality of accounts receivables. It’s determined by dividing average accounts receivables by revenue and multiplying by 365. The DSO ratio indicates how long it takes practice to turn its receivables into cash on average. It is often easier to use than the accounts receivable-to-sales ratio and the accounts receivable turnover ratio because it is in an intuitive unit of calculation (days).
2. Accounts Receivable Turnover Ratio
Analyzing a practice’s accounts receivables turnover ratio is another way to assess the quality of its receivables. It’s calculated by dividing a period’s sales by the average accounts receivables balance during that period.
The accounts receivable turnover ratio is a metric that measures how quickly a company can convert its receivables into cash. A high ratio usually indicates that a practice’s accounts receivables are of higher quality, as it reveals that receivables are being converted to cash more quickly.
Because a company can receive cash from its accounts receivables faster, a shorter DSO indicates that the accounts receivables quality is higher. While a high DSO ratio (more than 90 days) can indicate that receivables will become “stale” and may not be collected, it also indicates the poor quality of practice earnings.
3. Accounts Receivable-to-Sales Ratio
The accounts receivable-to-sales ratio is a simple way to assess the quality of your receivables. The ratio is calculated by dividing accounts receivable at a given point in time by sales over time. It shows what percentage of a practice’s sales are still owed to them. With a few tweaks, it’s the inverse of the accounts receivable turnover ratio. It’s the exact opposite of the accounts receivable turnover ratio, but with a few tweaks.
Since it is not guaranteed that all accounts receivable can be collected, a high accounts receivable-to-sales ratio may indicate a riskier practice with a poor quality of accounts receivable.
What Period Should be Analyzed for the Formulas?
While opinions differ on this, we think it is prudent to use a period that is appropriate for your specialty and practice and then study this measure over time to determine its pattern for your work. We suggest a time limit of the last 90 days. Divide your Current A/R Balance with the quotient of Total Billed Charges over the past 90 days.
How to Determine if the Result is Good or Bad?
The lower the A/R Days, the better it is. This means you’ll have fewer billed payments awaiting billing and adjudication. The A/R Days benchmark varies by specialty and can be influenced by practice-specific factors like treatment mix, payer mix, and internal policies. Consider the following scenarios:
Insurance providers can take longer to assess and pay claims for a specialty practice that conducts complex procedures with high average payout rates, such as Interventional Pain, resulting in a longer average period to adjudicate and pay the practice’s claims and a higher A/R Days measure.
Since pain practices are subject to denials due to inadequate prior authorization, medical necessity, or other obstacles, these factors cause claims adjudication delays, resulting in higher average A/R Days. Pain practices need to be aggressive about collecting time-of-service payments from patients at the front desk because these balances can take time to collect which can cause A/R Days to rise.
What other Factors Need to be Considered in Evaluating A/R Days?
The A/R balance of practice often includes both debit and credit balances, which means that although the majority of the balances are debited to be paid to the practice, others are credits showing possible overpayments that may be refunded. Significant credit balances in the total A/R balance will outweigh large debit balances, resulting in a deceptive A/R Days metric. Specialty practices that have higher than average credit balances can take this into account when calculating A/R Days. The argument is that when determining whether your A/R day’s number is positive or bad, you must understand the content and essence of the statements that make up your A/R Balances.
Tap Into Our Expertise
At 5 Star Billing Billing Services Inc, we offer the highest level of performance for high-quality medical billing. Let us help you during these dire times.
Effective medical billing is the backbone of a successful practice. Thus, maintaining a healthy cash flow is every provider’s daily challenge. Any mistake, error, or delay will not only disrupt your flow but will also negatively affect your patient experience and patient retention. Therefore, it is essential to determine blockages that are hurting your finances. It will make it easier for you to streamline your processes, minimize errors, and improve the overall patient experience. We’ve gathered the top five medical billing errors and how to solve them:
1. Limited Payment Options
Delay in your payment collection clogs up your cashflow. Consumers, including patients, prefer to settle their bills online through bank transfers, Amazon pay, PayPal, or credit cards. If you don’t offer at least some of these, that’s a problem. Patients will pay more promptly if you give them a variety of payment options.
Equip your patient portal with online payment options that comply with HIPAA and HITRUST standards. It will make it easier for your patients to pay you, increasing your patient collection in the process.
2. Incorrect Patient Data
Patient details are the foundation of your medical billing process. One typo on a patient ID number or name can get your claims rejected immediately. Always remind your staff to not just double-check, but to triple the effort using claim scrubbing software that can automatically detect typos, errors, or missing information.
3. Inaccurate Coding
Always get the updated version of your coding books. Coding guidelines, procedural, and diagnosis codes are updated annually. Coding errors are inevitable no matter how seasoned or experienced your staff may be. Make it a habit to conduct training or refresher courses for your staff for ICD-10 coding updates.
4. Manually Managing Your Claims
There are still providers who are using a manual process for their denials management. If you are one of them, then it’s time for you to embrace medical billing innovations. You can get more
insights through better analytics and improve your medical practice using automated EHR/EMR solutions integrated into your medical billing software. Some software has a checklist and alerts to ensure proper coding and billing practices.
5. Sending Claims to the Wrong Insurer
Sending the claim to the incorrect insurance provider is one of the simplest medical billing errors you can avoid. Usually, it happens because you do not have a copy of the patient’s insurance card. In order for you to send it to the right insurance company, always secure a copy of the front and back of the insurance card. Always ask the patients if there are any changes to their insurance, too.
By eliminating the top billing mistakes in your medical practice, you can shorten billing cycles, maintain healthy cash flow, prevent regulatory violations, and deliver a better patient experience that will help you retain more patients and become more profitable.
Tap Into Our Expertise
By being aware of your medical billing errors, you can easily remove your blockages and improve your cashflow. At 5 Star Medical Billing, we offer the highest level of performance for high-quality medical billing. Let us help you during these dire times.
