Protect Your Business With Your Medical Billing Service Contract

When we started our Medical Billing Service in 1994 there was very little information available on medical billing services let alone medical billing service contracts. In fact, some of the information indicated that you really didn't even need a contract if you didn't want one. That couldn't be further from the truth! Having a contract for your Medical Billing Service is very important to protect both you and the provider.

Many new billing services ask us for a sample contract or a copy of our contract. Using a sample contract or somebody else's contract is not a good idea. It would be like taking somebody else's will, whiting out their name and writing in yours. The only time it will hurt you is when you die, and then your family could be in trouble. The same can be said of a sample contract. If nothing bad ever happens, the sample contract is fine. But if a problem occurs it may not work out so well.

When starting your new business no one wants to think about things going wrong, but unfortunately in this business things do go wrong and we all need to be covered by a comprehensive contract when this happens. It may not be anything you did wrong, and it may not even be anything the provider did wrong, but sometimes things happen that are beyond our control. If you do use a sample contract and then two years later find yourself in court with a former client you are going to wish you had looked into writing the contract a little more.

Just having a contract doesn't cover it. You need to make sure the contract is very specific to your company. When we started we used a very simple contract that really didn't cover much at all. When situations arose that were problems our contract was no help. We had to re-write it once we had been in the business for a while and knew what needed to be covered.

So where does a new billing service start when they haven't been in business long? It's hard to write a contract covering all areas and what to do when you haven't experienced it yet. Most new billing services are working on limited capital and don't like to spend money on a lawyer writing a contract for them. Unfortunately many new services cut corners here to save money, but that's not a good idea.

Your contract should be at least looked over by a lawyer, if not written by one. If possible you should try to find a general practice attorney who specializes in contracts. All the better if he or she has some experience in the medical billing field. You can save money by preparing carefully before you meet with your lawyer.

Start by making a list of things you want to cover in your contract. List all of the services you will be providing and how you charge for them. In addition to how you will charge you will want to list how and when you expect to be paid. Add the provider's responsibilities to the list. List how you will receive the patient and claims information, and what information you expect from the provider. Other terms you will want to cover are what happens if you don't get paid, how either party can terminate the contract and what happens when you do term.

There are really a lot of important issues that you need to cover - many potential situations to think about. It is a good idea to try to think of everything that can go wrong in the relationship and write down your feelings about how those situations should be handled. You should be able to come up with a long list. In the circumstances of a new biller it can be difficult to know what can go wrong. It has been sixteen years since we started our medical billing business and we are still learning about new things that can go wrong.

Most providers expect to sign some form of contract when using a third party service and generally expect the billing service to produce it. They want to make sure they are covered as well as the medical billing service. Going over the contract with a provider starting out with you can set the stage for a successful relationship. You can go over the terms carefully making sure the provider understands what you need to make it a beneficial partnership. Most of us when we are starting our businesses do not realize how much a good contract can affect their business.

Contracts are kind of like insurance, you don't need them until there's a problem. But when there is a problem, it's a relief to have one. There are really a lot of areas that you need to make sure you are covered in and a contract is really the only way to do that.

Copyright 2010 - Michele Redmond - Solutions Medical Billing Inc

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Expert Billing Improves Healthcare Providers' Bottom-Line

Saving lives is a very noble act. Since humans have their expiration dates here on earth, being able to extend that period before expiration is something that everybody reveres. This is probably why medical practitioners like doctors and nurses have received high regards from society. They have been in a continuous service to people in times when lives are put in danger by diseases. But then again, it is an indubitable fact that no matter how noble curing diseases may be, a clinic is still a business - in fact, these days it is becoming more and more costly to run a successful practice.

Health practitioners charge for every kind of assistance that they give. Particularly in private hospitals, patients can always be expected to go home with a bill. That is why medical practitioners are also expected to somehow have the business management skills to be able to run a profitable practice.

The office clinic as a business office is a place where fees are charged in exchange of medical services. After the consultation and other clinical procedures, the doctor is entitled to payment. However, when payment time comes, the most tedious part comes along - the paper work. Medical billing specialists come in wide range of capacities, but they all help healthcare providers maintain a healthy revenue stream.

So how does a medical billing service reduce overhead costs for healthcare providers? Here are just a few examples:

Lower overhead expenses

Processing payments can be very tedious especially to the doctor that needs to focus his attention mostly on the patients. That is why he may decide to hire his own employees apart from the secretary who is already full of workload-on-hand. When this happens, just like in any other business, the overhead expense will inevitably increase due to the additional salary expense. But with a medical billing service that is provided by a third party vendor, additional costs can be avoided and expenses can be controlled.

Less paper work means time for more patients

To be able to finish all important tasks at any given time, delegation is the key. In the healthcare practitioner's case where more paper work won't fit in to his schedule, somebody else's help can be very useful. As someone who is also working for a living, a third party who provides medical billing services can afford the doctor more time for additional patients. He will be able to accommodate more people who are in need of medical attention, bringing in more income to cover his expenses.

Eliminates Wasteful Spending

Most healthcare providers shell out handsomely for inefficient and outdated Practice Management software. Even worse, software and hardware are frequently in need of costly upgrades or updates. A truly expert medical billing company can provide physicians with top of the line software as a part of their service, an instant savings for the medical practice.

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ICD 9 2011 - Relatively Few Changes For Urology This Time

Every year during the month of October, you get to see new diagnosis codes, code deletions and code revisions. And this year too it's no different. But compared to previous years, urology coders will see fewer changes this year. Here are some urology coding changes that you need to know to code right for your practice.

If we go by the proposed changes, we might see the addition of one new personal history code specific to genitourinary congenital corrections: V13.62. This is one of the most important changes for urology coders as your urologist may need to indicate this history for some patients.

For instance: Your urologist tends to chronic prostatitis in an adult patient who had a hypospadias penile repair as a child. If you add V13.62 to your claim as well as use 601.1, it'll add to the reporting accuracy of your overall clinical scenario.

Occasionally, you may also use five new fecal impaction and incontinence codes in your urological practice. This time ICD 9 deletes 787.6 and comes up with five new codes.

Your urologist may use one of the new diagnoses for a thorough ICD-9 clinical description in a patient with severe urinary incontinence as well as fecal impaction or fecal incontinence.

ICD 9 2011 has expanded the BMI codes to show higher BMIs with five new codes.

Benefit: BMI has become an important health tool and the new codes will certainly provide more data.

There are seven key signs that count for the constitutional bullet in the E/M physical exam coding, and there are those who think that BMI should be an eight option. If that eight bullet gains traction and comes into play for medical coders, the new V codes could help significantly.

To review these changes for urology coding, sign up for an audio conference. When you sign up for one, you'll stay on top of the changes in both diagnosis and procedure codes for the coming year, apart from staying tuned to all the changes taking place in the coding world. The best part of such conferences is that even if you missed out on a scheduled conference, you can always listen to the recordings in CDs and PDF transcripts. And to top it all, you also stand to acquire CEUs on attending the same.

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Obama Signs Payment "Fix"

On June 25, President Obama signed into law a 2.2% increase in the Medicare fee schedule (MPFS) retroactive from June 1 to Nov 30.

The political wrangling over this update has resulted in substantial delay in payments from Medicare providers, as claims submitted after June 1 were held pending the expected update. It is expected that claims will be processed after July 1, and will be processed normally after that time.

The politics of this issue are longstanding and complex. In order to justify blatantly optimistic budget assumptions, Congress put a yearly automatic decrease in Medicare reimbursement into the law. As the law is written, the decrease in Medicare reimbursement rates would be cumulative, totaling almost 21%. This decrease has been routinely overturned by each congress at the urging of physicians and senior groups. However, this year, because of partisan wrangling over the budget and linkage of the bill to unemployment insurance, the routine revision was not passed before the June 1 deadline.

The immediate result was a substantial drop in payments to all providers, as most claims were held pending the change. It is expected these claims will be paid relatively quickly now that the law has been signed.

The long term implications are far more daunting. The underlying issues of underfunding of Medicare, unprecedented federal deficits, and runaway medical costs are not being addressed or resolved.

Congress is hard pressed to solve this issue, and there will be substantial incentive to cut provider reimbursement as one method to address these funding problems.

Strong forces are lining up on both sides of the issue, with insurance companies, unions, and deficit hawks on one side clamoring for lower costs, with doctors, senior groups, and some care advocates claiming dire consequences if draconian cuts are instituted. It is our opinion that such cuts will greatly reduce the ability of physicians to provide quality care and result in multiple unintended consequences such as decreased access to specialists and massive increases in emergency care.

Needless to say, medical providers have much at stake in this battle. We will keep you apprised as to the progress of the issue. We strongly recommend you write your congressman, as well as get involved in your local medical organizations.

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Using a Plan to Lower Your Medical Office Insurance Accounts Receivable

When you take a look at your insurance accounts receivable are you cringing today? It may be higher than usual and that is not uncommon for this day and age. However, now is the time to take control and get it down into those single digit percentages again. Here are some tips to help you do just that:

1. Eligibility is the beginning of your service.

There are many reasons that a claim can go unpaid. The first thing you can do to stop the accounts receivable bleeding in your practice is to begin regularly checking eligibility on each and every patient you see in your medical practice that has insurance. Collecting insurance cards and verifying eligibility of coverage up front is the best indicator of:

Coverage - verifying coverage dates, limits, co-pays and deductibles Subscriber - verifying who is the covered individual Priority - verifying which insurance is primary and which one is secondary for filing claims Services - verifying if your services are covered

If you are not checking patient's insurance eligibility at the time of service then you are gambling on whether your claims will be paid or not.

2. Utilize your aging reports to work oldest balances first.

It makes perfect sense to attack oldest balances first when working your accounts receivable. However, it is most important to look at the insurance aging report and define which balances are the highest. You want to begin following up on the oldest and the highest balances first. If you see that one insurance in particular has the highest outstanding claims, then work that insurance first. Then work the next plan with the highest balances.

Ultimately, you want to be able to track insurance payments that are being filed electronically within 30 days by following up on rejections and denials immediately after filing. However, many medical offices have not been able to track insurance and it has now aged over 120 days. The sooner you can work a claim the more success you will have, but it does not mean you want to ignore the aged accounts beyond 120 days. For timely filing purposes these are the accounts you want to attack first when working an accounts receivable plan.

3. Refiling and Sending Appeals.

Phone calls could quite frankly slow you down with insurance company claim denials and/or rejections. It is not uncommon to be on hold with an insurance company for the better part of an hour before you have a chance to discuss a claim. If you have access to your clearinghouse rejection reports you can usually tell immediately why a claim has rejected or been denied. Correct and refile claims as soon as possible to get them back to the insurance for review and payment.

Appeal letters for denials will need to be written and sent via certified mail with return receipt if possible to follow the process. If additional operative notes are being requested, those will need to be sent via mail also. For procedures that continually require notes to be sent, begin sending the notes with the original claim to reduce the waiting time for payments.

4. Develop a working tickler system.

You must have a working tickler system to know which claims you have worked, called on or refiled so that you can systematically follow up at the appropriate time. Some practice management systems have built-in collection modules with tickler systems for tracking accounts for review. If you have one, begin using it immediately to keep a record of your communication with the insurance company and also to remind you of which contacts to make next.

It is recommended to utilize your software system to track comments and communication with insurance companies. If you do not have a practice management system to do that then an expandable tickler file will always work to keep you on track of who to follow up with next.

5. Document your processes.

By documenting your process you develop not only a process, but also a collecting procedure to be utilized by anyone who joins your practice in this capacity. Anyone who inquires about your policy on accounts receivable and collecting procedures can readily see you have a process and it is documented. It also makes it very easy for new employees to adapt to your processes if they are clearly written.

6. Recoupment and billing agencies.

If you find that you cannot work your own accounts receivable or do not have the staff to do so, you can always look into recoupment agencies, billing, or collection agencies who will work your outstanding insurance balances for a fee. The fees will vary so you need to investigate these companies to determine which type would best suit your practice needs.

Your accounts receivable does not have to be intimidating anymore. You can achieve the percentage goal that you desire once you put a plan in place. Just remember that it will not correct itself and you must make a practice manager decision to take charge of it now.

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Medical Billing Mistakes That You Need to Avoid

Medical billing is an absolute joke. That is exactly what it is, a big hilariously funny joke. The only problem with that is that it's not a joke...it's a problem. A really big problem. If you have medical problems or medical problems in your family you know what I am talking about. Your insurance didn't pay the bills like they were supposed to or the doctor didn't file it correctly with the insurance company.

There is a huge misconception that it's the doctor to hospital's fault that your insurance isn't taking care of your bill. This is wrong - it is in legal terms your fault. Let me explain. When you sign up for insurance with any insurance company the contract that you sign is between you and them. This means that the insurance that you have is only by law an agreement between you and your insurance company. This in turn means that by law a medical facility doesn't even have to file your insurance. This is technically a courtesy. Of course they will try and file your insurance for you because it helps them get paid easier.

The problem is that when the insurance doesn't go through correctly the responsibility to make sure it gets done correctly falls solely on you. What you have to do is actually put some effort in. You need to do a little research find out exactly what your bill is for. Call up your insurance company and find out why they didn't pay the bill. You will want to continue to bug your insurance company and not bug your creditor. Your insurance company works for you so call them up over and over until they have all the information that they need to process your claim. The earlier you get proactive on this the better because sometimes there is a time limit on whether your insurance company will pay your bill or not.

Another big problem that you have to realize is the complications of multiple bills. Some medical facilities, especially hospitals, will give you tons of different bills all for the same date of service. This happens a lot in hospitals. You go to the emergency room and the next thing you know you have a bill for the doctor that saw you, a machine they used, for the ambulance that took you, for the anesthesiologist, for the EKG, and pretty much anything you can dream up. This is terribly hard to keep track of because you don't always get billed correctly. What you need to do is call the hospital up and give them as much information that you can and call all of the different billing departments. Give them your name, social, address, date of birth or pretty much anything you can think of that would help them look up all of those accounts. After you have done that get copies of all those bills and get them to your insurance company to make sure they all get filed on your claim.

-Don-

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