Electronic Straight Through Billing Service and Software Methodology for Medical Practice

Medical billing complexity and massive volumes of daily claims render manual claims processes incapable of protecting both the provider and the payer from underpayments, overpayments, and billing compliance violations. Straight Through Billing addresses complexity and volume processing problems by automating the majority of the claim flow and focusing the billing follow-up specialists to exceptions only. A Straight Through Billing process flags problems, routes them for follow up, and enables online correction and resubmission. Straight Through Billing methodology implements billing service transparency and focuses management on strategic process improvement opportunities.

Straight Through Billing (STB) integrates billing process within the practice management workflow, automates vast majority of transactions, focuses manual labor on exceptions, and establishes a process for continuous improvement.

First, integrated practice management and billing workflow connects patient scheduling, medical record management, and billing into a single flow. Every participant of the practice management workflow receives a unified and coherent picture of practice workload, patient and provider location, resource availability, and cash flow.

Next, transaction automation streamlines and expedites billing process by automating claim validation, payer message reconciliation, and billing workflow management:

 

• Automated claim validation eliminates errors downstream and reduces processing time because it flags errors before submitting the claim to payer.
• Automated claim-message reconciliation eliminates costly search for the original claim and standardizes message communication, further eliminating the need to decipher the (often cryptic) payer's message.
• Billing workflow management drives the followup discipline required for resolution of claim denial and underpayment incidents and establishes high degree of process transparency for all billing process participants, resulting in full and timely payments.

 

Third, focusing manual labor to exceptions requires timely exception identification, routing to followup personnel, online error correction, and rigorous followup tracking. Again, process transparency, as implemented in vericle-like systems, enables tracking exception followup.

Finally, a process for continuous improvement requires continuous observability of every process attribute and a modification methodology for both automated claim processing and manual exception followup tracking.

STB implements billing transparency by design because billing transparency is an integral attribute of every component of STB process.

Straight Through Billing Architecture

Straight Through Billing systems architecture mirrors the architecture of general Straight Through Processing (STP) systems developed for the financial services industry. Such systems require effective workflow management, knowledge base validation system, connectivity to all process participants, including on-line data reconciliation, and tracking of problem resolution. Therefore, a typical vericle-like STB system has a three-tier architecture:

 

• Back-end processing engine designed for high-volume transaction processing environment
• Middle-tier uses Java Servlet technology
• Front-end is an HTML-JavaScript zero-footprint client

 

An STB system (e.g., Vericle) following the methodology outlined above implements rich functionality, which allows automated

 

• Computer aided preferential patient scheduling
• Integrated electronic medical records
• On-line computer aided coding
• Real-time claim validation and patient eligibility testing
• Electronic claim submission
• Payment posting, reconciliation, and verification of meeting contractual obligations
• Monitoring of audit risk and billing compliance
• Tracking of denial appeal process

 

Quantitative STB Management

STB methodology allows for quantitative management as the likelihood of failure of the entire process can be estimated as the product of such items for each individual workflow steps. A vericle-like STB system tracks the percent of clean claims (claims paid without any manual intervention in full and within the allocated timeframe) and focuses the management on those process aspects that yield the greatest potential improvement. Thus STB methodology focuses on exceptions both at tactical and strategic management levels.

Yuval Lirov, PhD, author of Practicing Profitability - Network Effect for Revenue Cycle Control in Healthcare Clinic and Chiropractic Office: Scheduling, SOAP Care Plans, Coding, Billing, Collections, and Audit Risk (Affinity Billing) and Mission Critical Systems Management (Prentice Hall), inventor of patents in Artificial Intelligence and Computer Security, and CEO of Vericle.net - Distributed Billing and Practice Management Technologies. Yuval invites you to register to the next webinar on audit risk at BillingPrecision.com

Top 10 Selection Criteria for Outsourced Electronic Medical Billing Software as a Service (SaaS)

Software as a Service (SaaS) is the new generation of ASP model designed to reduce the exorbitant costs of specialized medical practice management software. SaaS model is available for all aspects of medical practice management, including scheduling, billing, and electronic medical records (EMR), which are mission-critical for high quality clinical service, business operations, and regulatory compliance. SaaS model extends the advantages of Application Service Provider (ASP) model, which in turn evolves from the traditional Client-Server model. This article briefly defines key concepts and outlines a set of guidelines for SaaS vendor selection.

Client-Server (CS) Model

CS model involves central servers for database and application logic and multiple client modules connected to the central servers via local area network. This architecture allows allocation of significant application logic on the client computer.

Applications architects considering CS model must weigh performance and security advantages against increased maintenance costs. CS benefits stem from local control of application logic and data. CS shortcomings too stem from localizing logic and data because local arrangement requires the user to take responsibility over application maintenance, including data security, redundancy, disaster recovery, upgrades, backups, etc.

The medical practice utilizing CS model must develop in-house expertise and manage numerous services, including

1. Internet connectivity, bandwidth, and routers
2. Servers for Web server software, email, and firewalls
3. Database management
4. Data feed management
5. Capacity management
6. Redundancy management
7. Application upgrade management

 

Financially, CS models require the software user to make significant upfront investment in hardware and licensing and justify the business case using ROI-based arguments, which make little sense because of software and hardware innovation pace.

Application Service Provider (ASP) Model

ASP model shields the medical practice from high cost of specialized software and data maintenance responsibilities but not from upfront investment in hardware and in software licenses. Early ASP applications were created from traditional CS applications by moving centralized data and application servers to a third-party hosting service provider and allowing access to the application via HTML user interface as an afterthought. The third-party hosting service provider would take the responsibility for application maintenance and data protection.

The medical practice using early ASP model manages two costs:

1. Licensing and monthly support fee to software vendor
2. Software hosting fee to hosting vendor (typically a "pay-as-you-use model")

 

Software as a Service (SaaS) Model

SaaS model extends ASP benefits from outsourcing of system maintenance to simplified financial responsibilities. SaaS vendors eliminate the upfront costs to medical practice by making the upfront investment in hardware and licensing on behalf of all medical practices using the application.

To make such a financial commitment, the hosting vendor must develop thorough expertise in application maintenance and new feature development. Such a requirement became feasible with recent technology progress in terms of security (128-bit SSL encryption) and browser-based client performance along with AJAX coding methodology. The new generation technology now compensates for earlier CS model deficiencies and justifies network-native SaaS software development by design.

Because of higher specialization, SaaS vendor is able to focus on client business requirements, resulting in more responsive service and higher client satisfaction.

SaaS Vendor Selection

Medical practice in search of SaaS vendor must focus on the following topics:

1. Functionality: Does the application deliver all required functionality? Have you documented functional requirements subject to practice business goals, including financial, practice workflow and personnel objectives? Have you considered integrated practice management functionality including patient scheduling, SOAP notes, and billing?

    

    

2. Training Plan: Will the vendor provide sufficient training? What drives the training process: practice workflow changes or available software functionality?

    

    

3. Third-Party Application Interface: Does the application work with existing applications already deployed in the office? What data exchange requirements must be satisfied if you decide to purchase another application later?

    

    

4. Performance: How do you measure application and service performance? Are formal performance metrics available continuously?

    

    

5. HIPAA Compliance: What controls are in place to enable access only on a "need to see" basis? Is every access instance logged using secure mechanism?

    

    

6. Service Level Agreement: What minimum service levels does the vendor guarantee to the client? What are the penalties for violating SLA?

    

    

7. Problem Resolution: Is there a formal process to communicate problem identification and resolution? How is it tracked?

    

    

8. Data Access and Ownership: Who owns the data? Keep in mind that according to HIPAA, the patient is the ultimate owner of health data. How secure and private is the connection? Does it have Role based Access Control (RBAC)?

    

    

9. Disaster Recovery: How long would it take to recover from a disaster? Is a secondary data center available 24 x 7?

    

    

10. Disengagement Procedures: How long is data available upon severing the relationship? Who is responsible for data transfer to the new vendor?

    Yuval Lirov, PhD, author of Practicing Profitability - Network Effect for Revenue Cycle Control in Healthcare Clinic and Chiropractic Office: Scheduling, SOAP Notes, Care Plans, Coding, Billing, Collections, and Audit Risk (Affinity Billing) and Mission Critical Systems Management (Prentice Hall), inventor of patents in Artificial Intelligence and Computer Security, and CEO of Vericle.net - Distributed Billing and Practice Management Technologies. Yuval invites you to register to the next webinar on audit risk at BillingPrecision.com

     

4 Step Denial Management To Improve Performance Of Electronic Medical Billing Software And Service

Partial denials cause the average medical practice lose as much as 11% of its revenue. Denial management is difficult because of complexity of denial causes, payer variety, and claim volume. Systematic denial management requires measurement, early claim validation, comprehensive monitoring, and custom appeal process tracking.

In a high-volume clinic, the only practical way to manage denials is to use computer technology and follow a four-step procedure:

 

1. Prevent mistakes during claim submission. This can be accomplished with a built-in claim validation procedure including payer-specific tests. Such tests ("pre-submission scrubbing") compare every claim with Correct Coding Initiative (CCI) regulations, diligently review modifiers used to differentiate between procedures on the same claim, and compare charged amount with allowed amount according to previous experience or contract to avoid undercharging.

    

    

2. Identify underpayments. Underpayment identification involves comparison of payment with allowed amount, identification of zero-paid items, and evaluation of payment timeliness. The results of this stage should be displayed in a comprehensive underpayment report sorted by payer, provider, claim identification, and the amount of underpayment.

    

    

3. Appeal denials. Appeal management includes appeal prioritization, preparation of arguments and documentation, tracking, and escalation. Note that CCI spells out bundling standards but the number of standard interpretations grows in step with number of payers. Therefore, CCI provides justification basis for an appeal and every appeal must be argued on its own merits, including medical notes. Denial appeal process is typically managed with a custom process tracking system, such as TrackLogix.

    

    

4. Measure denial rates. "You cannot manage what you do not measure." By measuring denial rates and observing payment trends, you can see if your process requires modifications.

    

    

 

Denial risk is not uniform across all claims. Certain classes of claims run significantly higher denial risk, depending on claim complexity, temporary constraints, and payer idiosyncrasies:

 

1. Claim complexity
   1. Modifiers
   2. Multiple line items

    

    

2. Temporary constraints
   1. Patient Constraint, e.g., claim submission during global periods
   2. Payer Constraint, e.g., claim submission timing proximity to fiscal year start
   3. Procedure Constraint, e.g., experimental services

    

    

3. Payer idiosyncrasies
   1. Bundled services
   2. Disputed medical necessity

    

    

 

First, for complex claims, most payers pay full amount for one line item but only a percentage of the remaining items. This payment approach creates two opportunities for underpayment:

 

1. The order of paid items
2. Payment percentage of remaining items

    

    

 

Next, temporary constraints often cause payment errors because misapplication of constraints. For instance, claims submitted during the global period for services unrelated to global period are often denied. Similar mistakes may occur at the start of the fiscal year because of misapplication of rules for deductibles or outdated fee schedules.

Finally, payers often vary in their interpretations of Correct Coding Initiative (CCI) bundling rules or coverage of certain services. Developing sensitivity to such idiosyncrasies is key for full and timely payments.

Powerful Vericle-like technology helps manage denial appeals nationwide and stay current until complete problem resolution. Every time one billing problem is solved, the newly gained knowledge is encoded for recycling. Sharing billing expertise in a central billing knowledge base expedites future problem resolution.

Yuval Lirov, PhD, author of "Practicing Profitability - Network Effect for Revenue Cycle Control in Healthcare Clinic and Chiropractic Office: Scheduling, SOAP Care Plans, Coding, Billing, Collections, and Audit Risk" (Affinity Billing) and "Mission Critical Systems Management" (Prentice Hall), inventor of patents in Artificial Intelligence and Computer Security, and CEO of Vericle.net - Distributed Billing and Practice Management Technologies. Yuval invites you to register to the next webinar on audit risk at BillingPrecision.com.

Chiropractic Office Billing Software And Patient Relationship Management - 9 Criteria For Best SaaS

Software-as-a-Service (SaaS) pushes the limits of outsourcing and reduces the exorbitant costs of specialized practice management software. SaaS model is available for all aspects of chiropractic clinic management, including scheduling, billing, and SOAP note documentation, which are mission-critical for high quality health care, practice building, and regulatory compliance.

What is Software-as-a-Service?

Software-as-a-Service (SaaS) is a logical step in the progression from build to buy to subscribe and a manifestation of a major software trend towards Service Oriented Architecture (SOA). SaaS is the software industry term for delivery of software product and services over a network (typically the Internet) under subscription business model.

The increasing reliability of the Internet coupled with availability of completely integrated practice management and billing software, create supportive conditions to pay-as-you-go business model. SaaS liberates the users in two significant ways:

 

1. SaaS requires no large upfront investment in hardware and software licenses on the part of the user
2. SaaS shifts the onus of systems management from the user to the SaaS vendor, including
   1. Internet connectivity, bandwidth, and routers
   2. Servers for Web server software, email, firewalls
   3. Capacity management
   4. Redundancy management
   5. Application upgrade management

       

       

    

    

 

In financial management terms, SaaS proposition is equivalent to turning capital expense into operating expense, which translates into

 

1. Better balance sheets
2. Lower risk, especially during the period of rapid technology innovation on one hand and practice-building stages on the other hand

    

    

 

SaaS differs from Applications Service Providers (ASP) in two ways, namely, domain expertise and software development skills. While ASP vendors developed primarily hardware and systems expertise and offered foreign business applications, SaaS vendors are experts in the specific application domain.

SaaS Vendor Selection

For the manager of chiropractic clinic, the main challenge could be the integration of newer applications with the subscribed SaaS application. SaaS Integration Platforms (SIP) is a popular way to handle the integration challenge. A SIP, such as Vericle, offers a suite of integrated applications, such as Patient Relationship Management, Patient Scheduling, SOAP notes, and Billing.

Chiropractic clinic in search of SaaS vendor must focus on the following topics:

 

1. Functionality: Does the application deliver required functionality?
2. Training: Will the vendor provide sufficient application training?
3. Third-Party Application Interface: Does the application work with existing applications already deployed in the office? What requirements must be satisfied if you decide to purchase another application later?
4. Performance: How do you measure application performance? Are formal performance metrics available continuously?
5. HIPAA Compliance: What controls are in place to enable access only on a "need to see" basis? Is every access instance logged using secure mechanism?
6. Service Level Agreement: What minimum service levels the vendor guarantees to the client? What are the penalties for violating SLA?
7. Data Ownership: Who owns the data?
8. Disaster Recovery: How long would it take to recover from a disaster? Is a secondary data center available 24 x 7?
9. Disengagement Procedures: How long is data available upon severing the relationship? Who is responsible for data transfer to the new vendor?

   Yuval Lirov, PhD, author of "Practicing Profitability - Network Effect for Revenue Cycle Control in Healthcare Clinic and Chiropractic Office: Scheduling, SOAP Notes, Care Plans, Coding, Billing, Collections, and Audit Risk" (Affinity Billing) and "Mission Critical Systems Management" (Prentice Hall), inventor of patents in Artificial Intelligence and Computer Security, and CEO of Vericle.net - Distributed Billing and Practice Management Technologies. Yuval invites you to register to the next webinar on audit risk at BillingPrecision.com

Chiropractic Office Billing Software Precision Index Improves 3.3% in June - PHCS Replaces BCBS MI

PHCS replaced Blue Cross Blue Shield Michigan on the Chiropractic Office Billing Software Precision Index (BPI). Overall, June 2007 BPI climbed 3.3%, bringing the index from 18.1 up to 14.8, almost 3% above the national average of 17.7%. Blue Cross Blue Shield Michigan dropped from its lead position down to the 8th place. June BPI replaced eight BPI participants on the list of top ten performers. BPI guides chiropractic office managers and helps the development of both chiropractic billing software and billing performance standards.

BPI = 14.8 means that the average of ten top performing payers working with Billing Precision clients have 14.8% of Accounts Receivable beyond 120 days. BPI is a key billing performance characteristic, as it is a proxy of the claims that are never paid. Obviously, the lower is the index the better is billing performance. The table below also lists the top ten performing payers and their relative index as recorded in the Billing Precision's system.

 

• Billing Precision Index 14.8
• PHCS 0.3
• Qual Care 0.9
• Atlantic Administrators 1.2
• HereIU Welfare 8.2
• Unicare 9.6
• Principal Life Insurance 10.6
• CBSA 12.4
• Blue Cross Blue Shield Michigan 13.6 (down from 3.2 in May)
• Blue Cross Blue Shield Illinois 15.9 (up from 16 in May)
• Medicare Illinois 30.4

 

May BPI dropped eight participants since May:

 

• GHI 11.5
• Humana 11.8
• Blue Cross Blue Shield Colorado 12.3
• Medicaid Pennsylvania 15.1
• Assurant Health 15.4
• United Health Care 22.6
• Medicare New Jersey 20
• Cigna 24.1

   

   

 

Although BCBS IL improved its index by 0.1%, its ranking dropped from seventh place in May down to ninth in June.

BCBS MI lowered its index from 3.2 in May and April down to 13.6 in June, dropping down to the 8th place in BPI.

June BPI added eight new participants since May:

 

• PHCS 0.3
• Qual Care 0.9
• Atlantic Administrators 1.2
• HereIU Welfare 8.2
• Unicare 9.6
• Principal Life Insurance 10.6
• CBSA 12.4
• Medicare Illinois 30.4

 

Coverage

BPI is rule-based, i.e., payer participation in the index is defined by dynamically rules at the time of computation and not by a static listing of specific payers. Therefore, any specific payer may start or discontinue participation in the index, dependent on satisfaction of rule's conditions.

Current selection of payers for participation in the BPI is based on fifty top-volume providers across all United States that have received Billing Precision services for more than six months and have more than two hundred claims in their current Accounts Receivable.

Update Cycle

BillingPrecision.com updates BPI on a monthly basis.

Volume Weighting

BPI is volume weighted, which is important to accommodate future growth of provided information, index combinations, and sensitivity across multiple indices.

Information Provided

BPI computes the percent of Accounts Receivable beyond 120 days. Note that national average across all medical specialties of percent of accounts receivable beyond 120 days is 17.7%.

Summary

Chiropractic Office Billing Software Performance Index helps the development of both chiropractic office billing software and billing performance standards. Chiropractic office managers can use the index to benchmark their billing performance and guide its improvement over time. Rule-based index definition allows for automated inclusion and exclusion of payers in the index based on payer attributes, such as numbers of processed claims, accounts receivable distribution, certain mix of CPT codes, or patient demographics.

Yuval Lirov, PhD, author of "Practicing Profitability - Network Effect for Revenue Cycle Control in Healthcare Clinic and Chiropractic Office: Scheduling, SOAP  Care Plans, Coding, Billing, Collections, and Audit Risk" (Affinity Billing) and "Mission Critical Systems Management" (Prentice Hall), inventor of patents in Artificial Intelligence and Computer Security, and CEO of Vericle.net - Distributed Billing and Practice Management Technologies. Yuval invites you to register to the next webinar on audit risk at BillingPrecision.com.

Medical Billing Software - How to Choose the Right One for Your Needs

When it comes to Medical Office Billing Software, you will find there is no shortage! There are hundreds to choose from and they vary in price from $99 to several thousand dollars. It is important to pick a billing software that is right for your needs. Ask yourself the following questions before purchasing a medical office billing software:

• Are you a medical office or billing service? This makes a difference in the capabilities you will need in a software.

• Are you a specialty practice? Some softwares are for a specific specialty. For example, Lytec has a chiropractic version. RLI is a software specifically for optometry offices.

• Do you need a multi-user software or is a single user ok? Some medical office billing softwares have a limit on the number of users that can be using the software at one time. It is important that you know the limit and that you consider your needs, not only right now, but in the future. If you purchase a software with a limit on the number of users, you may want to find out if you can upgrade to more users down the road.

• What are the aging report capabilities? For billing services this is a HUGE deal. Unfortunately for many medical offices, aging reports are never run, which is an area where they lose a lot of money. Whatever your situation, you will want to know what the aging report capabilities are. (One of the offices we bill for has a very expensive program. However, in the aging reports, it doesn’t show the date of service, it shows the last date the account was adjusted. Also, the report does not separate charges by the number of days old. It only runs a report showing everything that is outstanding. There report makes it almost impossible to follow up on the oldest charges.)

• What is the cost of the software? The old saying ‘you get what you pay for’ is usually true, and applies in the case of billing software. Again, you will need to consider your specific needs when determining how much you should spend on your software. If you are a solo practitioner who sees patients part time out of your house, you will not need a terribly complex program, but if you are a 5 doctor medical office, you will need to look at an appropriate medical office billing software.

• What are the report writing capabilities? Sometimes it is necessary to create your own report. For example, you may have a form that is required but it is not a standard insurance form. If you have to fill out a number of them a month, it may be worth having a report in your billing software that does it for you. (One of our practices had to submit Medicaid claims on their preprinted forms. It was very time consuming, and they did quite a volume of them weekly. We wrote a report in Lytec to fill the forms out, and it was a HUGE time saver!)

• Is the software user friendly? Most softwares today are user friendly, but you should do a demo of the program before buying. You may also want to find out if hands on training is available. It may be beneficial to you to hire someone to train your staff. A lot of times, offices don’t use even a fraction of the billing software’s capabilities, because they were never trained properly.

• Does your software allow for more than one practice? If you are a billing service, you will need to be able to bill for multiple practices from the same software and be able to keep them separate. Or maybe you are a medical office with more than one location, and you want to keep them separate. In any case, make sure the software you are buying has the capability.

• Do you need an appointment scheduler? For billing services this feature is usually not required. Most software comes with it built in, but some are much more elaborate and easy to use. If you have a busy medical office, this feature will be important to look at.

After answering all of the above questions, make yourself a list of the features that you will need in your software. A list will make it easier when you begin your search. Compare your list to the list of features and you will be able to eliminate softwares that will not work for you and narrow your list down to ones that will. Then you can decide based on price, ease of use, and extra features that are not necessities for you.

When we started our billing service, we tested a lot of different demos of medical office billing software. At the time we started there were still programs that ran on DOS? (There’s a term you don’t hear a lot anymore!) We wanted a medical office billing software that definitely ran on windows, and was user friendly. As a billing service, we would need to train people on it as we grew.

Listing the features that were important to us was very helpful in choosing our software. It helps to eliminate options that won’t work.

Michele Redmond is co-owner of Solutions Medical Billing and has been in business since 1994. She has a bachelor’s degree in Computer Information Science and is responsible for the medical billing for over 50 providers. For more information on medical billing software and other topics visit her website at http://www.solutions-medical-billing.com

How to Export Vericle Reports to Excel for Electronic Medical Billing Software Analysis

On May 12, 2003, the president of a family practice clinic, a physician, and a nursing informatics specialist won each first-place in a Microsoft Corp.-sponsored competition to honor innovative healthcare professionals. Entrants were judged by a panel of Microsoft representatives based on the number of features in Office they were using, their productivity gains, and how applicable the featured uses would be in other healthcare settings. All three winners use Excel for financial reporting, data collection, or tracking employee payroll and taxes the number and types of office visits.

However, until recently, the use of Excel for medical billing analysis has been limited because of the difficulty to produce effective ad hoc reports and inability to export data into Excel. Vericle lifts the limitation with its integrated medical billing reporting, Excel export capability, and a standard data import capability into Microsoft Excel.

Vericle's reports include expectations management for both medical billing charges and payments, analysis of accounts receivable, medical billing compliance violations, and SOAP note tracking. To take advantage of Vericle's export of medical billing data to Excel, follow a two-step procedure:

 

 

 

1. In Vericle
   1. Create desired medical billing report in Vericle, sort it and filter according to requirements
   2. Click on Excel icon in the bottom left corner of the window
   3. Select all data in the separate window that has the data (CNTRL-A)
   4. Copy all data into the buffer (CNTRL-C)

    

    

    

2. In the target Excel page,
   1. Place the cursor at a cell where you want the upper left corner of the copied data
   2. Select Edit -> Paste Special -> Unformatted text -> OK
       

      Yuval Lirov, PhD, author of "Practicing Profitability - Network Effect for Revenue Cycle Control in Healthcare Clinic and Chiropractic Office: Scheduling, SOAP Notes, Care Plans, Coding, Billing, Collections, and Audit Risk" (Affinity Billing) and "Mission Critical Systems Management" (Prentice Hall), inventor of patents in Artificial Intelligence and Computer Security, and CEO of Vericle.net - Distributed Billing and Practice Management Technologies. Yuval invites you to register to the next webinar on audit risk at BillingPrecision.com.

Top 5 Strategies to Improve OTC Payment Performance With Electronic Medical Billing Software

For many practices, the proportion of over-the-counter (OTC) payments has recently grown from an average of 15% to as high as 75% of total payments. Systematic OTC collections, including measurable process that emphasizes upfront collections, often yield double-digit billing performance improvement. Most importantly, a disciplined and transparent collections process improves provider-patient communications, while early payment collections are also quicker and easier. Better communications and happier patients mean better health and more profitable practice.

OTC payments include copays, fees for non-covered elective services or retail products, and any outstanding balances. Successful collections of OTC payments require measurable collections process, specialized information technology infrastructure, adequate personnel training, and discipline.

OTC payment collection performance and costs greatly depend on elapsed time between service and payment. Collections performance dependence on collections timing stems from the dynamic nature of price-value relation: initially, perception of value received is high in the patient's mind. Similarly, correlation between value and price is also high. However, OTC payment collections grows more difficult in step with fading memory of service benefit.

Systematic measurement of OTC payment quality is critical for its performance improvement. Vericle's OTC payment quality metrics include the percent of accounts receivable beyond 120 days and the time spent on collecting on old account balances. While the national average of the first metric hovers around 18%, some practices have accumulated as much as 50% of their accounts receivable beyond 120 days. The second metric measures the front-office collections efficiency and it too varies widely between few hours per month to double digit hours per week spent by front office personnel chasing unpaid OTC invoices.

According to Vericle experience, the following systematic and measurable payment collections process leverages electronic medical billing software and establishes the discipline required for double-digit billing collections improvement:

 

1. Publish your payment collections policy and standard responses to typical patient's objections.

    

    

2. Clarify patient statement generated by your electronic medical billing software:
   1. Make outstanding balance easily identifiable.
   2. Add specific statement about the time period expected for balance payment (typically upon service or product delivery).
   3. Include phone number to call for patient questions.

    

    

3. Use electronic medical billing software to
   1. Test patient's eligibility and coverage. The results of such a test define patient's copay prior to her arrival to the clinic.
   2. Generate front office alerts about impending patient visit with unpaid OTC balance.

    

    

4. Train clinic physicians to direct patients to front-office staff to review financial statements.

    

    

5. Train your front office to collect OTC payments:
   1. Hold your front office staff accountable by setting up specific and personal collection goals.
   2. Use electronic medical billing software to track individual front staff collections performance.
   3. Establish personal awards for accomplishing collections goals and periodically review personal collections performance.
   4. Train your office staff to receive electronic medical billing software alerts.
   5. Develop a payment collections script and rehearse it with front office staff to improve front-office staff-patient communications.

 

Successful OTC payment collections help patient relationship management and improve practice profitability. They require measurable collections process, specialized information technology infrastructure, and adequate personnel training and discipline.

Yuval Lirov, PhD, author of "Practicing Profitability - Network Effect for Revenue Cycle Control in Healthcare Clinic and Chiropractic Office: Scheduling, SOAP Notes, Care Plans, Coding, Billing, Collections, and Audit Risk" (Affinity Billing) and "Mission Critical Systems Management" (Prentice Hall), inventor of patents in Artificial Intelligence and Computer Security, and CEO of Vericle.net - Distributed Billing and Practice Management Technologies. Yuval invites you to register to the next webinar on audit risk at BillingPrecision.com.

Medical Billing Software Provides Easy Access to 2005 CPT Code Book

Multiple data bases, multiple servers, superbills, synchronization, multiple logins, reports, backups, workstations. Honestly, there is enough to worry about already in managing medical offices. On top of all of that there are multiple codes to remember and refer to?

Medical billing software services have been developed to streamline the medical billing process, not simply by allowing practices to connect to multiple locations and databases in one place (which is quite a feat in and of itself), but also by creating simplified access to important codes to which medical billing must comply. The 2005 CPT code book, updated CPT codes, ICD.9 codes, and all other codes are accessible in the same location as the rest of the billing information, and they are updated automatically from year to year.

When President George W. Bush visited the Midwest during his reelection campaign, he spoke to medical practitioners in several locations and referred to “preventative medicine.” Effective management of records and compliance to codes has become a type of preventative medicine, protecting both the client or patient and the practice. Accessing codes on a simple medical billing software helps to ensure not only an efficiently run medical office but also a secure billing process.

Developments in medical billing software have come to benefit the medical field immensely. Databases allowed business to electronically manage billing and medical history information. Technology also created an IT infrastructure to manage the information.

More recent developments include HIPAA-compliant servers and removal of expensive IT infrastructure. Medical billing software has also developed color-coded appointment making, automatic reminders, and billing generation.

The developments continued to include SOAP note management and transcriptions. Medical billing software can now manage everything in one location, even information from multiple offices and servers. There has also been increased security on the servers and on backups.

Topping off the developments in medical billing software has been access to real-time updated codes, including CPT, HIPAA, HCFA 1500, and ICD.9. As medical companies continue to develop, adoption of a compatible medical billing software should be a prime consideration. Preventative medicine begins with accurate and effective record management and code compliance. As your practice searches through the medical billing software, it is important to take into consideration the recent developments available in medical billing software.

Joe Miller is an author of informational articles and online advertisements on business, technology, and health. Information on 2005 cpt code book or medical billing software is available at AdvancedMD.com.

Electronic Medical Billing Dashboard Software - 9 Performance Indicators For Service Outsourcing

Arcane terminology and complex rules for payer- and time-dependent claim validity and pricing interpretation plague medical billing industry, resulting in massive payments of invalid or ineligible claims and denials of error-free claims. The amount and complexity of billing information make it very difficult for the doctor to maintain compliance and identify and resolve errors and underpayments.

"With integrated Billing Transparency, I see for myself how Vericle leverages every opportunity to expedite payments of healthcare insurance claims in a continuous 24 x 7 effort. It has enabled 27% revenue gain over past billing process," says Doug Cassel, M.D., Director of Interventional Radiology at Hoag Memorial Hospital in Newport Beach, California.

Greater visibility of internal process activities promotes teamwork, increases client satisfaction, and assists in process streamlining. Billing service transparency allows participants of the billing process to expedite error identification and resolution, resulting in reduced over- and under-payments and improved regulatory compliance.

1. Billing Dashboard as Main Transparency Mechanism

Selection of meaningful and intuitive indicators for billing process performance is a mission-critical stage in the process of creating a useful transparency mechanism. A dashboard presenting such most meaningful data must be easy to find and simple for interpretation. Cumulative experience of hundreds of doctors using Vericle-like billing technologies, has shown that a dashboard containing nine specific indicators expedite the development of intuitive and powerful transparency mechanisms:

 

1. Month-to-date collections

    

    

2. Total failed or denied claims

    

    

3. Aggregate failed or denied claims in follow-up queue

    

    

4. Dollar Accounts Receivable (AR) below 30 days,

    

    

5. $ AR in ( 30, 120] days

    

    

6. $ AR > 120 days

    

    

7. Percent Accounts Receivable (AR) below 30 days,

    

    

8. % AR in ( 30, 120] days,

    

    

9. % AR > 120 days

    

    

 

Note that national average of percent accounts receivable above 120 days hovers around 18%. Therefore, a well-performing outsourced billing service must deliver % AR > 120 days significantly below 18%. Specifically, to justify its fees, an outsourced billing service must measure its AR > 120 days anywhere around 5%.

2. Drill-down Functionality, Reporting, and Transparency

Advanced dashboard allows drill-down for more detail directly by pointing and clicking the cursor at the dashboard. At the minimum, the following features must be available:

 

 

 

• Operational Report shows total claims and $ amounts submitted, paid, adjusted, written off, and failed. It allows breakdown by CPT code, payer, referral, or a combination of such dimensions.

   

   

   

• Denials Report shows the list of denied claims and a log of followup actions. By sorting it by amount paid, you can tell the smallest payment the billing service will fight for.

   

   

   

• Compliance Report shows the potential for post-payment audit and itemizes compliance violations.

   

   

 

These reports allow multiple dimensions for data presentation, by single parameter, such as, payer, CPT code, provider, or referring physician, or by more complex parameter combinations, such as pairs of payer-CPT code, provider-CPT code, or referring physician-CPT code.

3. Complexity Considerations

Note that even a small single-provider practice working with 20 CPT codes and 20 payers, has 400 (20x20) payer-CPT code pairs. Therefore, an on-line report comparing month-to-date collections between current and previous years requires powerful database query capability. Moreover, automation of such queries like "find the worst performing payer for the best performing CPT code" requires OLAP technology.

4. Summary

Billing Transparency is a necessary feature of a modern and accountable billing service. Billing Transparency allows the practice owner to know both the big picture and minute detail of billing process. To be able to observe every step of the billing process on a continuous 24 x 7 basis, reporting must be available using a secure HIPAA compliant connection over the Internet. While traditional services delivered monthly paper reports, modern technology allows the delivery of continuously updated and meaningful billing performance data.

Yuval Lirov, PhD, author of "Practicing Profitability - Network Effect for Revenue Cycle Control in Healthcare Clinic and Chiropractic Office: Scheduling, SOAP Notes, Care Plans, Coding, Billing, Collections, and Audit Risk" (Affinity Billing) and "Mission Critical Systems Management" (Prentice Hall), inventor of patents in Artificial Intelligence and Computer Security, and CEO of Vericle.net - Distributed Billing and Practice Management Technologies. Yuval invites you to register to the next webinar on audit risk at BillingPrecision.com.

17 Electronic Medical Billing Software Red Flags for Chiropractic Office Audit

Dr. Ben Lerner, founder of Teach The World About Chiropractic and author of "One Minute Wellness," discovered a uniquely convenient way to educate thousands of chiropractors about coding compliance and audit risk reduction. "Compliance maintenance requires special skills and military discipline," says Dr. Lerner. "Webinars are ideal for audit risk management instruction because they deliver urgently needed education but require minimal investment in terms of time and cost."

According to Improper Medicare FFS Payment Report (2003), "Chiropractors have the highest provider compliance error rate in Medicare, filing claims incorrectly 30.6% of the time."

Increasing frequency of post-payment insurance audits and mounting severity of penalties, ranging from license suspension to heavy monetary fines, emphasize the need for effective and affordable education about compliant office management and audit risks.

"No insurance company offers protection against potentially enormous penalties in case of post-payment audit," says Jeff Randolph, Esq., Legal Counsel to the Association of New Jersey Chiropractors and a webinar author. "The severity of provider penalties following post-payment audit have escalated in the past two to three years from relatively non-adversarial audits and occasional return of payments to very high fines, suspension or loss of license, and imprisonment."

What is a Webinar on Billing Audit Risk?

If any chiropractic practice has a 30.6% chance of being audited and no insurance offers protection against audit risk, then the only rational way to protect the practice is to develop an in-house audit defense strategy.

Doctors and practice managers are looking for cost-effective and productive ways to learn better ways to manage their practice and revenue cycle. The key benefit of the webinar is its convenience - there is no travel required and important information is delivered in ninety-minute sessions that make it easy for even the busiest doctors to quickly gain important information on topics ranging from successfully implementing EMR systems, to understanding the real benefits and challenges of outsourced billing services, risk management of post-payment audits, and much more.

Webinars leverage Internet to bring together remote participants while viewing the same visuals or computer application. An audit risk webinar teaches chiropractors to build an effective and efficient in-house audit defense strategy and offers three-fold benefit to its participants:

 

• Lower audit risk because of SOAP note compliance and audit exposure monitoring

   

   

• Higher revenue because of more effective billing

   

   

• Improved efficiency of patient flow management

   

   

 

Expert Content

A Chiropractic Audit Webinar has three parts:

• Coding:
  • CPT (Current Procedure Terminology) Codes
  • E&M Codes
  • Modalities
  • ICD-9 Coding

     

     

• Medical Necessity Documentation:
  • SOAP Notes
  • Treatment Plan

     

     

• Audit Management:
  • Seventeen Audit Red Flags
  • Audit Exposure Monitoring
  • What to do if audited?

    Yuval Lirov, PhD, author of Practicing Profitability - Network Effect for Revenue Cycle Control in Healthcare Clinic and Chiropractic Office: Scheduling, SOAP Notes, Care Plans, Coding, Billing, Collections, and Audit Risk (Affinity Billing) and Mission Critical Systems Management (Prentice Hall), inventor of patents in Artificial Intelligence and Computer Security, and CEO of Vericle.net - Distributed Billing and Practice Management Technologies. Yuval invites you to register to the next webinar on audit risk at BillingPrecision.com

Problem Tracking For Outsourced Electronic Medical Billing Software And Service

Processes involving large volumes of complex billing transactions require effective mechanisms for problem assignment and tracking. Without such mechanisms, billing personnel cannot be held accountable for problem resolution, resulting in loss of revenue and increased compliance risk. While medical billing industry has developed specialized systems and processes for resolution of content problems, little attention has been paid to billing process problem resolution methodology. This article outlines a process and a technology for integrated billing process problem resolution methodology.

Billing Content and Process Problems Require Two Different Tracking Methodologies

Medical billing exceptions can be categorized into content and process problems. Content problems have to do with claim content and patterns of processed claims, such as terminology, medical necessity, patient eligibility, denial followup, and regulatory billing compliance. Process problems have to do with claim formatting, system interfaces, entry of patient demographics, posting of charges and payments, printing and mailing or faxing of required information, provider interaction procedure, systems access, and HIPAA compliance.

While streamlining and transparency are important attributes for resolution of both kinds of problems, the required processes and systems are very different. Content problems tend to be specialized and therefore they lend themselves to a more structured, almost template-driven solution approach. Process problems, in contrast to content problems, tend to cover a wide variety of knowledge domains, precluding specialization.

The difference in solution methodology drives the difference in problem tracking. For content problem resolution methodology the reader is advised to consult companion articles on metrics, straight through billing, and billing transparency. The remainder of this article focuses on process problem tracking.

Billing Process Problem Tracking

A general-purpose tracking system allows opening problem ticket, its assignment to specific team member, its re-assignment or escalation, change of status depending on problem resolution stage, convenient reporting about sets of tickets in different states or assigned to different team members, and continuous notification of everybody involved about change of status. Therefore, such a tracking system (e.g., web-based TrackLogix) is constructed around three basic reports, notification mechanism, and a concept of ticket.

Problem Tracking Reports

The reports show

 

1. Tickets I owe to others
2. Tickets owed to me
3. Status - a summary table of the team participants with statistics of tickets in different states

 

Other reports may show and compare individual productivity and responsiveness.

Problem Notification

For transparency, the members of the team must be continuously aware of every problem resolution status. The simplest way to maintain such awareness is to send an email to every team member about every event of problem ticket status change. Other popular notification media include paging and SMS calls. More sophisticated methods involve selective notification based on nature of event or person assigned to problem resolution.

Problem Ticket

The ticket has the following data elements:

 

1. Subject - short description of problem
2. Owner - name of the employee responsible for issue resolution
3. Requestor - name of the manager that assigned the issue to the employee
4. Date - date the issue was identified and documented
5. Scheduled - date (time) this issue must be resolved
6. Body - a detailed issue description
7. Log - time-and owner-stamped history of all documentation, including
   1. Escalation. Issues may be escalated to upper management via TrackLogix by simply changing the Owner
   2. Priority change
   3. Status change
   4. Date change
   5. Owner change
   6. Specific action taken to resolve the issue
8. Priority - relative issue importance order among other issues on the same workbench.
9. Status
   1. Open for new issue
   2. Pending for resolved and waiting for approval
   3. Closed for resolved and approved

    

    

 

Vericle-like Straight Through Billing (STB) systems automate majority of billing transactions and focus manual followup on exceptions. A formal web-based process problem tracking system, such as TrackLogix, provides accountability, which is based on a precise account of all process problems and their resolution status. With such a tracking system, every process participant has visibility to other problems. An increased level of personal accountability promotes teamwork, increases client satisfaction, and assists in streamlining the process.

For more information about problem resolution transparency and its four attributes, including universality, continuity, ubiquity, and scalability, read our companion article about medical billing transparency.

Yuval Lirov, PhD, author of Practicing Profitability - Network Effect for Revenue Cycle Control in Healthcare Clinic and Chiropractic Office: Scheduling, SOAP Notes, Care Plans, Coding, Billing, Collections, and Audit Risk (Affinity Billing) and Mission Critical Systems Management (Prentice Hall), inventor of patents in Artificial Intelligence and Computer Security, and CEO of Vericle.net - Distributed Billing and Practice Management Technologies. Yuval invites you to register to the next webinar on audit risk at BillingPrecision.com

Top 5 Metrics For Chiropractic Office Billing Software and Service Performance

Effective practice management depends on solid billing performance. Its measurement is an integral part of practice management process and its importance grows in step with growth of patient volume. Traditional billing metrics are limited in scope and focus on claim submission process, ignoring process imperfections on the insurance (payer) side. Modern computer technologies allow both measurement and action to improve revenue cycle efficacy and efficiency.

Useful metrics must be comprehensive and simple. They must combine both complete end-to-end processes and their individual components. Metrics must be used consistently over time and compared to standards.

 

1. Days in Accounts Receivable (DAR)

    

   A growing number of days in accounts receivable are symptomatic of a faulty billing process. One way to determine DAR is to count days from the date of service to the date of payment for every claim and then average across all claims. A simpler way to compute average number of days in accounts receivable by taking a ratio of accounts receivable to average daily charges, or

   DAR = (Accounts Receivable / Average Charge) x 365

   The main downside is this metric is its sensitivity to provider as it counts the lag time of unsubmitted claims for services already delivered.

   One obvious advantage of DAR metric is its independence of charges. The averaging feature of this metric eliminates sensitivity to specific day or CPT code but also hides the behavior shape of the accounts receivable curve.

   Note that national average of DAR hovers around 73 days. Advanced billing service providers leveraging powerful Vericle technologies often drive average DAR as low as 15 days.

    

2. Percent of Accounts Receivable Beyond 60, 90, and 120 Days (PARB60, PARB90, and PARB120)

    

   PARBX resolves the sensitivity issue of DAR metric and offers simple and charge-invariant metric of billing process. Its graphic representation has a skewed bell shape. Its steepness represents billing process quality: a steep curve and thin tail means healthy billing process, while a flat bell and a fat tail means billing problems.

   According to the MGMA survey, 25.35 percent of the average family practice's accounts receivables were more than 120 days old in 1997. This number has improved down to 17.7% in 2004.

   PARBX metric is especially helpful to identify patterns of problem claims containing specific payer or CPT code. Advanced billing service providers leveraging powerful Vericle technologies often drive average PARB120 as low as 5%, significantly below the national average of 17.7%.

   Further, PARB120 has been used to develop rule-based Billing Performance Index, which helps the development of billing industry standards. Chiropractors can use the index to benchmark their billing performance and to guide its improvement over time. Rule-based index definition allows for automated inclusion and exclusion of payers in the index based on payer attributes, such as numbers of processed claims, accounts receivable distribution, certain mix of CPT codes, or patient demographics.

    

3. First-Pass Pay (FPP Rate) and Denial Rate

    

   FPP is the percentage of claims paid in full the first time upon submission (subject to federal or state timely payment regulations: 15 days for electronic submission and 30 days - for paper).

   Denial rate is the complementary metric to FPP rate. It counts the percent of claims that require followup and therefore cost more to process. Followup may take the form of a phone call to payer to discover a lost claim or to receive interpretation of denial message, correction of earlier submitted data, resubmission of the original claim, consultation with the provider and medical notes, or denial appeal.

   Both FPP and Denial rates are very important metrics often used for billing process improvement. The upside of FPP/Denial metric is that it is charge-invariant but its downside is that it hides the differences between process imperfections on the claim submission and claim payment sides. To identify patterns of problem CPT codes or payers, FPP/Denial metric needs to be computed and compared across all pairs of payer-CPT code, which is a standard feature for modern billing technologies.

    

4. Patient Liability Rate

    

   Percent of Patient Liability is the ratio of patient responsibility to total billed charges and it roughly reflects patient deductibles. This measure is important in measuring front office function as it has little to do with clean claim submission or effective followup.

    

5. Collection Ratios

    

   Gross and net collection ratios metrics used to be popular metrics in the early day of digital computing. They compare (often arbitrary) charges to (allowed) payments. Net collection rate is defined as a ratio of Total Collections and Total Charges less Adjustments. Gross collection rate is defined as a ratio of Total Collections to Total Charges only. The main drawback of Collection Ratios metrics is the use of charges in defining gross and net collections, which precludes productive discovery of process improvement opportunities.

    

 

In summary, comprehensive and charge-invariant billing metrics, such as PARBX, are more informative and objective than collection ratios. Modern Vericle-like technology using such metrics helps identifying billing bottlenecks as it allows interactive review of multiple metrics along different aggregation dimensions.

Yuval Lirov, PhD, author of "Practicing Profitability - Network Effect for Revenue Cycle Control in Healthcare Clinic and Chiropractic Office: Scheduling, SOAP Notes, Care Plans, Coding, Billing, Collections, and Audit Risk" (Affinity Billing) and "Mission Critical Systems Management" (Prentice Hall), inventor of patents in Artificial Intelligence and Computer Security, and CEO of Vericle.net - Distributed Billing and Practice Management Technologies. Yuval invites you to register to the next webinar on audit risk at BillingPrecision.com.

How To Choose The Right Billing Software For Your Small Business

If you own or manage a small business, you know how much time can be spent chasing down paper invoices, purchase orders and sales reports. It can be a real nightmare! That is where billing software comes in. It allows you to record all your customers, sales, invoices, inventory, suppliers (and more) in a PC-based system that is easy to use.

Deciding that you need to invest in good quality billing software is not hard. The tricky part can be choosing the right software package for your requirements. There are dozens of systems on the market claiming to be the holy grail of all your business problems, but choosing the wrong one can cost you valuable time and money.

Here's a simple checklist of 11 things to look for when purchasing billing software for your small business:

1) Customer records

This is the core element of any billing system. What sort of information do you need to record about your customers? There's the obvious things like address, phone, fax, mobile, email and web address. But what about marketing-related information like "how did the customer find out about your business?", and "standard discounts" for key clients.

2) Multiple contacts & Communication history

If many of your clients are businesses with multiple contacts, can you record individual contact details for each person? Word of mouth is the most powerful form of advertising, and statistics show that one of the most important factors in customer satisfaction is good customer service. Have you thought about keeping a log of all communication with your customers? It can be extremely helpful for improving internal communication within your business, and results in a more personalised service for your clients.

3) Multiple shipments

Obviously your billing software will need to create sales orders - that's a gimme. But do you need to record employee-related information, like who the "salesperson" was? What about flexible dispatch options, like multiple shipments per sales order?

4) Search facility

There's no point recording all this really useful information if there's no easy way to get to it. Check that the search facility is flexible and easy to use. What criteria can you search by? Here are a couple useful fields you may want to use: customer phone number, customer address, order date, dispatch date and dispatch consignment number.

5) Tax & regional support

Are you able to change the tax rates on an order line basis? What about currency formatting? If you and your clients are in Europe, then there's no point using billing software that can only handle US dollars.

6) Reporting

Producing accurate reports in seconds is something you no longer have to dream about. In fact it is a necessity in today's competitive market. Ensure your billing software can calculate information on sales based on date, salesperson and customer type. If you operate a B2B business, another key performance indicator may be dispatch totals, based on date, and employee. But one important thing to remember about software... you can only get out what you put in. So if you are looking for a specific report, make sure that information is being recorded by your billing software package.

7) Backup

I've seen first-hand how devastating a hardware failure can be. Hundreds of thousands of dollars worth of data can be destroyed in seconds... if you do not have a backup procedure in place. Ensure you select a billing software package that has a built-in backup utility or works with your current backup system.

8) Online help & support

If you're a new computer user, then you'll definitely need a software package that has a comprehensive online and easy-to-use help system. Also check out what direct technical support is available through the vendor. Some software companies charge very high fees for personal support, so ensure you include this in your budget.

9) Budget

How much are you going to spend? That really depends on the complexity of the software package you are looking for. Smaller software packages can be found under US$100, and larger more complex packages can cost well over US$3000. Take a look at the number of customers you have, the number of sales orders you process, and choose a solution that fits your business.

10) Customisations

If you purchase an off-the-shelf billing software package, you may require minor customisations to suit your unique business processes and industry. Some software vendors offer customisations at quite reasonable prices. But ensure you include this cost in your budget.

11) Other features

What else do you want from you billing software? If you deal with fixed price products, you may need a comprehensive inventory management system allowing you to purchase stock, manage inventory levels and supplier relations. Some quality software packages also include a useful follow-up diary, allowing you to keep track of tasks and assign them to other staff members.

When choosing a billing software package for your business, make sure you check that it offers everything your business needs. And then the only thing you'll have to worry about is what to do with all your newly found spare time!

Josh Bender is an experienced database developer and qualified software engineer. He helps small-to-medium businesses streamline processes and improve efficiency using reliable and proven software solutions. Take a free test drive of 'InstantSalesTracker', easy-to-use billing software: http://www.InstantSalesTracker.com

Count the Ways Medical Billing Software Helps You Save

Wouldn’t you want the newest billing software that meets all the needs of your business? Your clients will be more satisfied with the service you give them. Your staff will stay on top of details and be more efficient. You will be able to manage your practices with less worries and stress. Medical billing software is the easy, simple solution that will help you treat your patients right, make life on your staff less complicated, and help you stay in control of your business.

Now let’s count the ways medical billing software can help save you time and money.

1. Easy-to-use and maintain

2. Efficient and accurate in data entry process

3. Customizable to your office

4. Can work efficiently and effectively with multiple clinics

5. Doctors can schedule and manage patients from their office

6. Entry screens are easy to handle

7. Save on data entry time

8. Costs less than old software

9. User friendly

10. New employees will learn how to use it quickly

11. Tracking reports are ever changing to fit practices needs

12. Stay connected and updated with all your offices

13. Work anywhere with an Internet connection

14. It’s secure—HIPPA-compliant servers back it up 24x7

15. Technical Remote Service always available for your needs

16. Tier 1 data center facility ensures system upkeep

17. Reduce IT costs across the board—no extra servers, log-ins, or installations needed

18. Synchronize data

19. Pay-as-you-go—upgrade or keep it simple depending on your practice needs

20. Updates installed often (usually weekly) and major upgrades as you go along

21. Guided setup makes it easy on staff and you for use

22. Professionals train staff and offer continuous help

23. Organize and retrieve client folders without hassle

24. Multiple locations can work on the same real-time data all day

25. Reports are always up-to-date no matter where you are

26. Can archive, download and run reports day or night

27. System speed is quick

28. Pre-configured defaults

29. Have option for patient and appointment data imports

30. It’s web-based and easier to handle for your office than the old software

What do all of these mean for you? They mean better accuracy, more efficiency, and greater benefits for all involved. Not only will you save in time and money, but you will also reduce the amount of stress dealing with outdated software that doesn’t meet your needs. Medical billing software meets and takes care of your clients’ needs, your staff needs, and your needs. It will change the way you manage and keep up on all your office affairs for the greater good.

Jordan Bartlett is a client account specialist with 10x Marketing – More Visitors. More Buyers. More Revenue. For more information about medical billing software please visit AdvancedMD.

Electronic Medical Billing Software Products in Press (June - July 2006)

Medical Billing technology has witnessed continued expansion during the first two months of this summer, as evidenced by press releases about some ninety products accumulated in BillingWiki. A practice manager may find it difficult to select the best product from such a large product variety. This article roughly tabulates some eighty-five press releases about medical billing technology products and/or vendors across two-dozen service categories.

Asset Life Cycle Management: Products that help healthcare organizations optimize the performance of their capital assets, uncover hidden expenses, gain more visibility and control over their asset and facility operations, and improve safety. Such systems also serve as repositories for hazards, alerts and recalls facilitating a closed-loop process that documents the hospital's course of notifications and corrective action. See St. Croix and LYNX.

Audit and Compliance: Products that help providers and payers to manage compliance by facilitating internal audits and planning external audits respectively. Such systems assist an auditor to spot errors, omissions, fraud, and abuse. Solutions span spectrum from basic audit reporting to complete automation of the audit process by using data mining, natural language processing, and statistical methods to produce a random sample of medical records, data scoring, and potential revenue loss estimate.

• Claim Audit: A-Life, CodeRyte
• EFT Audit: GlobalSCAPE
• HIPAA Privacy and Security Compliance: MedicalSuite

   

   

 

Certification and Awards:

• Best in KLAS: KLAS is a leading source of information on Healthcare Information Technology vendor performance, with information gathered from users at more than 4,500 healthcare facilities nationwide. Performance data collected from 300 Healthcare Information Technology vendors and 500 of their products is evaluated and made available to subscribers through the KLAS website as well as through periodic reports and custom research. See press releases about VantageMed and athenahealth.
• CCHIT Certification: The CCHIT Certified mark - a "seal of approval" for EHR products - provides the first consensus-based, consistent benchmark for ambulatory products. See LSS Data Systems and Misys.
• DOQ-IT Testing: CMS, an agency of the U.S. Department of Health and Human Services, established the DOQ-IT initiative program to encourage physicians to adopt EHRs and, in turn, improve the quality, safety and efficiency of health care. In order to gain official DOQ-IT recognition, vendors must meet all 35 DOQ-IT reporting requirements. See Misys

   

   

 

Deals: This category shows business development activity based on leveraging reciprocal client relationships and complementary product capabilities. See A-Life, Affinity Billing, athenahealth, eClinicalWorks, Eclipsys, GE Centricity, H-Quotient, Healthnostics, IngeniousMed, JPI Data Resource, LEAPpm, Massachusetts Medical Society, MedLink, Misys, medFORCE, medHost, MediSys, Nexplicit, Nicka & Associates, Nightingale On-Board Communications, PatientKeeper, Quantum Group, RXHub, Scandent, Streamline Health.

Electronic Charge Capture: MedAptus

Electronic Data Interchange (EDI): The ability to access one single source of continuously updated claims tracking data to perform real-time status checks directly from local PCs instead of spending hours on the phone calling one insurer after another to track down the status of submitted claims. See MicroSys.

E-learning: AlphaQuest, Care2Learn

Enhanced website: CAP-MPT, Companion Technologies, Patientrak

Factoring: Factoring provides healthcare professionals with automated electronic insurance claims management solutions and advance funding on medical claims, as submitted, through a revolving line of credit. See MDWerks

Integration: Products that expedite revenue cycle by integrating office management functions, which in the past used to be performed separately. Integration eliminates data entry repetition, reduces errors and costs, and streamlines revenue cycle. See press releases about four integration aspects outlined below.

• Billing and Coding: ChartLogic
• Billing and EMR: Affinity Billing, MediEMR, Siemens, NextGen, athenahealth.
• Billing and Compliance: Billing Precision.
• Billing and Imaging: IMPAC, AMICAS, Fujitsu, MedLink.

   

   

 

New clients: Ingenious Med For, Lumetra, Misys, Per-Se, MediSys, Craneware, PaperFree, athenahealth, Picis, MicroMD, intraNexus, Visionary Medical Systems, AllScripts, LUMEDX, Streamline Health, LYNX, Sullivan Group, PHNS, Streamline Health, ECDS, McKesson

New billing products and services: Automed, HealthWare, JP Morgan, Physmark-Transplant, LabDAQ

Online Supply Store: Antek HealthWare

Patient Payment Ability Verification: Offers predictive reporting functionality to determine a patient's ability to pay for services and verify a patient's billing address in real time. See Per-Se.

Payer-side automation: See Guidewire ClaimCenter, XPERT Connect.

Personal Health Record Smart Card: Patients and health care providers can access medical health records, and send and save their most vital personal medical information instantly using the Internet or multiple devices, such as smart cards, USB keys, mobile phones, PDA's and Tablet PC's. See Patientrak.

Telemedicine: eNotes.

Yuval Lirov, PhD, author of Practicing Profitability - Network Effect for Revenue Cycle Control in Healthcare Clinic and Chiropractic Office: Scheduling, SOAP Notes, Care Plans, Coding, Billing, Collections, and Audit Risk (Affinity Billing) and Mission Critical Systems Management (Prentice Hall), inventor of patents in Artificial Intelligence and Computer Security, and CEO of Vericle.net - Distributed Billing and Practice Management Technologies. Yuval invites you to register to the next webinar on audit risk at BillingPrecision.com

Intelligent Electronic Medical Billing and SOAP Notes Software Requirements

Doctors and therapists must produce clinical documentation in ever increasing volumes and detail to ensure best healthcare, get medical claims paid in full and on time, and protect the practice from post-payment audits and unfair litigation.

But visit documentation speed conflicts with documentation accuracy and thoroughness. For insurance companies, patient visit documentation must be precise and comprehensive. If the quality of documentation is high, the medical billing appeals on unpaid claims are paid faster and at a higher rate. Otherwise, appeals are denied and the practice becomes vulnerable to post-payment audits, refunds, and penalties.

Insurance companies do not care how long does it take to produce good documentation. But for provider, slow documentation impedes practice profitability and wastes valuable time. The doctor must be done with visit documentation by the time the patient leaves the office.

To ensure comprehensive note coverage, healthcare industry adopted a two-pronged structured approach. First, the doctor uses SOAP notes format, which reflects four key stages of patient care, starting from Subjective observations, to Objective symptoms, to diagnostic Assessment, and culminating with treatment Plan:

 

1. SUBJECTIVE: The initial portion of the SOAP note format consists of subjective observations. These are symptoms typically expressed verbally by the patient. They include the patient's descriptions of pain or discomfort, the presence of nausea or dizziness or other descriptions of dysfunction.

    

    

2. OBJECTIVE: The next part of the format include symptoms actually be measured, seen, heard, touched, felt, or smelled. Included in objective observations are vital signs such as temperature, pulse, respiration, skin color, swelling and the results of diagnostic tests.

    

    

3. ASSESSMENT: Assessment is the diagnosis of the patient's condition based on Subjective observations and Objective symptoms. In some cases the diagnosis may be a simple determination while in other cases it may include multiple diagnosis possibilities.

    

    

4. PLAN: The last part of the SOAP note is the treatment plan, which may include laboratory and/or radiological tests ordered for the patient, medications ordered, treatments performed (e.g., minor surgery procedure), patient referrals (sending patient to a specialist), patient disposition (e.g., home care, bed rest, short-term, long-term disability, days excused from work, admission to hospital), patient directions and follow-up directions for the patient.

    

    

 

Next, each one of the four key SOAP stages consists of templates reflecting multiple possibilities for each stage. Templates, organized according to SOAP order, ensure comprehensive coverage and allow the doctor simply check multiple selection boxes on the screen driven by a computer program.

Templates have attracted two-fold criticism both from the provider and the payer sides. The providers dislike the lack of built-in intelligence to reflect individual doctor's preferences to treat patients. The payers often suspect template-generated notes of low quality and poor reflection of true patient state and treatment progress because template susceptibility to mechanical clicking and difficulty of interpretation.

The challenge is to combine the advantages of template and verbose formats without their shortcomings to describe precise patient condition, ensure productive medical billing, prepare for regulatory scrutiny, and improve practice productivity. To overcome the perception of mechanically generated notes while saving the doctor the time to type, some vendors have created specialized products that use randomized wording for each template. Such automatically generated notes include sentence structures, which closely resemble natural speech patterns.

Flexibility and integration must be key design features of SOAP notes. In the opening section, for example, you create new patient files that grow organically with each visit or treatment. Built-in intelligence allows you to customize a document to your own preferences and observe the entire patient progress history in a single screen. Native system integration with medical billing systems, enable automated claim generation, validation, and submission to payers for payment.

SOAP notes must not merely emulate the paper folder that every doctor has for every patient. They must use computer technology to help automate routine tasks and create a faster, easier, and error free process to increase practice profitability and reduce its audit risks.

Yuval Lirov, PhD, author of "Practicing Profitability - Network Effect for Revenue Cycle Control in Healthcare Clinic and Chiropractic Office: Scheduling, SOAP  Care Plans, Coding, Billing, Collections, and Audit Risk" (Affinity Billing) and "Mission Critical Systems Management" (Prentice Hall), inventor of patents in Artificial Intelligence and Computer Security, and CEO of Vericle.net - Distributed Billing and Practice Management Technologies. Yuval invites you to register to the next webinar on audit risk at BillingPrecision.com.

Electronic Medical Billing OLAP Software for Lost Revenue Discovery

Average medical practice may lose as much as 11% of its revenue due to underpayments. But underpayment recovery potential averages only 5% of revenue and involves costly appeal process. To avoid unrecoverable losses, some providers discontinue servicing patients insured by the worst performing payers. Unfortunately, such a drastic loss reduction measure may boomerang and increase losses depending on complexity of referral relationships. This article outlines limitations of traditional database queries used to identify payer candidates for contract termination and demonstrates alternative decision choices with superior performance in terms of revenue and risk management, facilitated with On Line Analytical Processing (OLAP) technology.

First Order SQL Queries for Accounts Receivable Analysis

Traditional accounts receivable analysis includes identification of payers that systematically underpay and refuse denial appeals. Such analysis is based on simple queries, designed to identify the best CPT code or the worst payer in absolute terms:

• Comparison of revenue for various CPT codes for a given time-period
• Comparison of underpayments for various payers for a given time-period
• Comparison of denials for various payers for a given time-period

 

A single key database indexing is a standard measure to improve time performance of such queries. It builds an ordered relationship within the data elements based on the value of the selected metric. But single key indexing precludes implementation of more complex queries like "who is the payer that underpays the most for the best CPT code," or "who is the worst referring physician for my worst payer?" and require complex SQL programming skills because of the need to store and process intermediate results. Therefore, ranking the data elements along a single attribute, forces a limited choice for management decision:

• Ignore the problem,
• Renegotiate the contract with the payer, or
• Stop serving patients insured by the worst payer.

 

But to find more subtle solutions the office manager requires the ability to aggregate and drill into data and formulate queries in real time, in response to observed results to the previous queries. Specifically, a low frequency under performing payer with a high degree of underpayment may not be as detrimental to the office as a high frequency under performing payer with a low degree of underpayment. Contract termination with a wrong payer may accomplish the opposite result to practice goals in terms of revenue maximization and workload reduction. Additionally, a decision to stop serving patients insured by any one payer may cause reduction of referral volume of other patients across all payers for a particular referring physician.

Combinatorial (Second Order SQL) Queries for Accounts Receivable Analysis

Fortunately, modern database query technology can address both limitations by enabling "second order SQL" queries, which allow data manipulation based on multiple criteria and using functions of combinations of such criteria.

In our case, second-degree SQL queries allow finding the worst payer for best revenue generating code. Such a discriminating approach allows focusing on higher priority items first, resulting in more effective management. In general, the manager performs a custom comparison of payers according to the following four-step sequence:

 

• Select metrics (e.g., % paid, % accounts receivable beyond 120 days, % denials)
• Select dimensions (providers, payers, CPT codes, ICD-9 codes, referring physicians)
• Partition
• Aggregate, drill-down, pivot

 

Worst Payer Query

To find a payer with highest amount of underpayments for the most-frequent CPT code, a second order SQL query can be written along the following lines:

For a given time-interval,

Select payers

Where sum of underpayments over

(all CPT codes Where Revenue > Revenue Threshold) > Underpayment Threshold

Worst Referring Physician Query

To avoid the risk of losing referrals from better-performing payers, the manager may consider severing referral relationship with some referring physicians instead of payers. In such a case, distribution of patients across various payers plays an important role for each referring physician. A single combinatorial query may fetch the Worst Referring Physician as follows:

For a given time-interval,

Select referring physicians Where Revenue for the Worst Payer > Threshold

Summary

Underpayment management involves all phases of claims processing and requires powerful Vericle-like computing platforms for exhaustive comparisons of payments versus allowed amounts and subsequent appeal management. OLAP allows better analysis of accounts receivable and more effective management because of the ability to handle queries with functions of multiple attributes and dimensions. Note that in the absence of native OLAP mechanism, effective Vericle-like billing platforms allow similarly powerful analysis by introducing intermediary steps. Such steps may add insight to analysis and improve decision quality.

Yuval Lirov, PhD, author of "Practicing Profitability - Network Effect for Revenue Cycle Control in Healthcare Clinic and Chiropractic Office: Scheduling, SOAP Care Plans, Coding, Billing, Collections, and Audit Risk" (Affinity Billing) and "Mission Critical Systems Management" (Prentice Hall), inventor of patents in Artificial Intelligence and Computer Security, and CEO of Vericle.net - Distributed Billing and Practice Management Technologies. Yuval invites you to register to the next webinar on audit risk at BillingPrecision.com

Electronic Medical Billing OLAP Software for Lost Revenue Discovery

Average medical practice may lose as much as 11% of its revenue due to underpayments. But underpayment recovery potential averages only 5% of revenue and involves costly appeal process. To avoid unrecoverable losses, some providers discontinue servicing patients insured by the worst performing payers. Unfortunately, such a drastic loss reduction measure may boomerang and increase losses depending on complexity of referral relationships. This article outlines limitations of traditional database queries used to identify payer candidates for contract termination and demonstrates alternative decision choices with superior performance in terms of revenue and risk management, facilitated with On Line Analytical Processing (OLAP) technology.

First Order SQL Queries for Accounts Receivable Analysis

Traditional accounts receivable analysis includes identification of payers that systematically underpay and refuse denial appeals. Such analysis is based on simple queries, designed to identify the best CPT code or the worst payer in absolute terms:

• Comparison of revenue for various CPT codes for a given time-period
• Comparison of underpayments for various payers for a given time-period
• Comparison of denials for various payers for a given time-period

 

A single key database indexing is a standard measure to improve time performance of such queries. It builds an ordered relationship within the data elements based on the value of the selected metric. But single key indexing precludes implementation of more complex queries like "who is the payer that underpays the most for the best CPT code," or "who is the worst referring physician for my worst payer?" and require complex SQL programming skills because of the need to store and process intermediate results. Therefore, ranking the data elements along a single attribute, forces a limited choice for management decision:

• Ignore the problem,
• Renegotiate the contract with the payer, or
• Stop serving patients insured by the worst payer.

 

But to find more subtle solutions the office manager requires the ability to aggregate and drill into data and formulate queries in real time, in response to observed results to the previous queries. Specifically, a low frequency under performing payer with a high degree of underpayment may not be as detrimental to the office as a high frequency under performing payer with a low degree of underpayment. Contract termination with a wrong payer may accomplish the opposite result to practice goals in terms of revenue maximization and workload reduction. Additionally, a decision to stop serving patients insured by any one payer may cause reduction of referral volume of other patients across all payers for a particular referring physician.

Combinatorial (Second Order SQL) Queries for Accounts Receivable Analysis

Fortunately, modern database query technology can address both limitations by enabling "second order SQL" queries, which allow data manipulation based on multiple criteria and using functions of combinations of such criteria.

In our case, second-degree SQL queries allow finding the worst payer for best revenue generating code. Such a discriminating approach allows focusing on higher priority items first, resulting in more effective management. In general, the manager performs a custom comparison of payers according to the following four-step sequence:

 

• Select metrics (e.g., % paid, % accounts receivable beyond 120 days, % denials)
• Select dimensions (providers, payers, CPT codes, ICD-9 codes, referring physicians)
• Partition
• Aggregate, drill-down, pivot

 

Worst Payer Query

To find a payer with highest amount of underpayments for the most-frequent CPT code, a second order SQL query can be written along the following lines:

For a given time-interval,

Select payers

Where sum of underpayments over

(all CPT codes Where Revenue > Revenue Threshold) > Underpayment Threshold

Worst Referring Physician Query

To avoid the risk of losing referrals from better-performing payers, the manager may consider severing referral relationship with some referring physicians instead of payers. In such a case, distribution of patients across various payers plays an important role for each referring physician. A single combinatorial query may fetch the Worst Referring Physician as follows:

For a given time-interval,

Select referring physicians Where Revenue for the Worst Payer > Threshold

Summary

Underpayment management involves all phases of claims processing and requires powerful Vericle-like computing platforms for exhaustive comparisons of payments versus allowed amounts and subsequent appeal management. OLAP allows better analysis of accounts receivable and more effective management because of the ability to handle queries with functions of multiple attributes and dimensions. Note that in the absence of native OLAP mechanism, effective Vericle-like billing platforms allow similarly powerful analysis by introducing intermediary steps. Such steps may add insight to analysis and improve decision quality.

Yuval Lirov, PhD, author of "Practicing Profitability - Network Effect for Revenue Cycle Control in Healthcare Clinic and Chiropractic Office: Scheduling, SOAP nventor of patents in Artificial Intelligence and Computer Security, and CEO of Vericle.net - Distributed Billing and Practice Management Technologies. Yuval invites you to register to the next webinar on audit risk at BillingPrecision.com

Electronic Medical Billing Software and Service Compliance in Chiropractic Office

Over the course of the past two decades, federal and state enforcement agencies have investigated medical billing incidents and brought multiple enforcement actions against healthcare practices. The list of agencies tasked with billing compliance enforcement includes federal Department of Justice, the Office of Inspector General (OIG) at the Department of Health and Human Service, state Medicaid fraud control units, and others.

The number of medical billing fraud investigations and enforcement actions has been steadily growing. For instance, according to BillingWiki, thirteen articles and news items were published on the topic of medical billing fraud during May of 2006. In addition to growing frequency of incidents, the severity of penalties has also escalated from relatively non-adversarial audits and occasional return of payments to fines, suspension or loss of license, and imprisonment.

Six out of thirteen news items and articles about medical billing fraud published in May 2006 involve chiropractors (BillingWiki/Compliance). The remaining items are distributed more or less evenly across such specialties as psychiatry, gynecology, neurology, orthopedics, and aged care. The growing frequency of audits and increasing severity of penalties are symptomatic of inadequate attention to billing compliance at the chiropractic office.

An insurance company typically performs post-payment audit by soliciting medical notes for a random sample of paid claims during the previous year. Next, the proportion of inadequate medical notes defines the overpayment percentage. The total amount of overpayment is then calculated by applying the overpayment percentage to all payments over the past six years.

Billing compliance is doctor's responsibility and ignoring it often results in practice ruin. To avoid billing audit risks, some doctors have elected to work on cash-only basis, collecting cash payments directly from the patients instead of submitting medical claims to insurance agencies. However, such tactics does not help avoid the potential audit because patients submit requests to pay the claim to the healthcare insurance company on their own.

Since the top two reasons for post-payment audits are over utilization of certain CPT codes and hot line calls by patients and staff, the best strategy to manage post-payment audit risk has three prongs:

1. Formal compliance program,
2. Competent management of medical notes, and
3. Continuous monitoring of potential audit triggers.

First, the existence of a compliance program may determine whether the payer can routinely handle the matter as an innocent overpayment mistake or it must be investigated by the OIG as a potentially fraudulent act.

Next, careful management of medical notes is a basis for a successful audit defense, which often reduces the damages significantly and helps avoiding a repeat audit a few years later.

Finally, audit trigger monitoring ensures compliance of both cumulative service patterns across multiple patients and individual treatments. Real-time juxtaposition of histograms of CPT code frequencies between practice and national averages compares service patterns and alerts of potential compliance infringements.

Individual treatment compliance is ensured when no specific CPT code exceeds its monthly limits, such as billing a 9894X on each visit, or billing a 97140 manual therapy in place of a manipulation code because it pays more, or charging for 97149 together with 9894X, while both procedures linked to the same diagnosis. In the latter example, performing both an adjustment and a soft tissue manipulation in the same part of the body for the same complaint is illegal and a repeat submission of such a claim may trigger an audit.

An environment of high volume of patient encounters creates thousands of possibilities to deviate from normal distribution of services and trigger an audit. Therefore, real time analysis requires powerful technology infrastructure and competent legal coverage. Such infrastructure must handle all compliance aspects together, which necessitates modern Vericle-type integrative approach, combining billing, monitoring, and medical record management components in a single and comprehensive system

Yuval Lirov, PhD, author of Practicing Profitability - Network Effect for Revenue Cycle Control in Healthcare Clinic and Chiropractic Office: Scheduling, SOAP  inventor of patents in Artificial Intelligence and Computer Security, and CEO of Vericle.net - Distributed Billing and Practice Management Technologies. Yuval invites you to register to the next webinar on audit risk at BillingPrecision.com