Dr. Brian Capra, a Chiropractor and Expert in Office Automation and Billing Software - Part I

Dr. Brian Capra, a graduate of Life University, has been a practicing chiropractor and office automation expert. He routinely visits chiropractic offices around the nation while receiving raving feedback from his clients. In his blog on Chiropractic Office Billing Software Profitability, Dr. Brian offers practical solutions for building a profitable and completely paperless office. The following two-part interview with Dr. Brian provides a behind-the-scenes look at his work.

• When did you become interested in chiropractic?

  Dr. Brian : I became interested in Chiropractic just before graduating with a bachelors in biology. I have always enjoyed studying complex systems. I loved learning about how life is formed and how amazingly efficient is the human body.

  Most business systems are crude approximations of the amazingly efficient systems in the human body. Chiropractic maximizes that innate intelligence to do what it understands infinitely better than any human mind. To think that we can outsmart this intelligence with a pill, potion, or lotion is naive. Removing interference and maximizing the potential of life, relationship, or business is what has intrigued me most about Chiropractic.

• What attracted you to office automation?

   

  Dr. Brian: The human body uses automation to manage millions of processes every second. The autonomic nervous system is a good example. Imagine having to memory-manage every heart beat and breath throughout your day. That job alone would keep you so preoccupied you would forget to go get food and water for you survival.

  On the business side, the insurance companies continuously add things to manage to the practice. If these new things are memory-managed, the efficiency of the practice suffers. Ultimately, patient care, practice capacity, and profitability shrink.

  I'm concerned about where chiropractic profession is going in terms of profitability. I feel like most practice owners are indifferent and apathetic, while the ship is being steered by people who do not have our best interests at heart -- out-of-control payers and incompetent billers, to name two. We are at an absolutely crucial and unprecedented point in our history where technology enables the insurance companies to underpay us, profile us, audit, and take back the little money was paid ...

  But many billing companies do not have the processes, the technology infrastructure, or the talent required to face the challenges posed daily by the insurance companies. And the practice suffers substandard reimbursement, overworked practitioners, burnout.

  I can't tell you how many times I have heard a doctor say "how can I keep up with notes, billing, etc." The answer is simple: use your chiropractic training, use the principles that keep your own body functioning.

• Question: Why did you decide to start Billing Precision?

  Dr. Brian : The simple reason: I needed a billing solution for my own practice, I experienced second rate service first hand for too long, and I knew of no solution that would be good enough for rapid development of my practice and that I could trust to change as the insurance industry changed. I knew that lots of people feel the same way but I could not wait anymore for somebody else to do it for me.

  When I graduated, I went to learn from some of the most influential doctors, including Dr. Lerner, Dr. Loman, and Dr. Nalda. In addition to outstanding clinical training I also learned from them how to approach building and managing my own practice. I learned the importance of discipline and the potential of adequate infrastructure. I also saw how frustrated they were with the lack of integrated solutions: everything about running the office seemed to require memory-management, from scheduling the patient, to tracking care plan compliance, to managing outstanding balance.

  I feel that most practice management solutions are built backwards or incomplete (see my 4-part blog Is your Chiropractic Practice Management System Built Backwards???). They just keep reinventing the wheel. Another Scheduler, Custom notes, Automated check in. My feeling on this is SO WHAT??? Is the system checking you for compliance? Is it making sure everyone is billed? Are your notes really going to protect you against an audit? A good system must also manage patient education and community outreach. Part of our mission is to bring an industrial strength billing service and a practice management system, including a patient relationship management system, and help build the overall patient capacity of the practice.

  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 – New Features to Look for in Your In Your Next System

New features can benefit you with a more efficient practice, lower costs, and increased cash flow.

Medical Billing Software and Physician’s Practice Management Systems are the best tools you can use to improve the financial well being of your practice. Using one can help you to gain full control over your finances, and grow your business. Cutting-edge medical billing technology can significantly reduce time and costs spent processing claims. Not only will you have a better grasp of the health of your practice, you can watch your receivables increase and your payables decrease.

In the past couple of years, new features have began to emerge to increase your operational efficiency. Spurred on by the HIPAA regulations mandating electronic file transfer standards such as X12, and the growth and maturing of the internet, new features are now available to help your business.

Recent advancements include:

1. instant access from anywhere, even away from the office
2. manage multiple offices and functions from one database
3. enhanced scanning - electronically file all claims; even those needing supporting documentation attached.
4. rules engines to identify errors before submitting the claim
5. increased security to comply with new HIPAA standards
6. electronic patient statements
7. electronic remittance advice

Stay Connected

With the maturing of the internet, new technology supporting the ASP (Application Service Providers) architecture allows access to your data including data entry from anywhere with a internet connection. This flexibility is a true benefit to multi-office practices and billing services. Multiple offices can now share the same database without the need for specialized networking or wide area networks. The cost savings in communication expenses alone can be enormous. Billing services can benefit by allowing limited access to their clients. This can instill a higher level of comfort for the client. This access can allow give a billing service a competitive advantage by providing value added services such as scheduling, super bill printing, and patient lookup.

Built in Efficiencies

Leveraging newer technology such as EOB and insurance card scanning, electronic patient statements, and electronic remittance can cut time spent on billing chores by up to 30%. This can allow more time for focus on patients and collections.

Reduced paper handling

Newer systems provide insurance payer rules so that users can immediately identify and correct claim errors that would delay payment of claims. Some systems will submit all your claims on your behalf including paper claims. Carriers can respond immediately so you get faster payouts, most within 14 days. Practice Management Systems can also reduce staff workload by outsourcing the print and mail functions of processing patient claims and statements.

When supporting documentation is needed in order for a claim to be paid, some systems can attach scanned letters of medical necessity, accident reports, referral authorizations, worker’s compensation documents, and most importantly EOBs. This eliminates the need to photocopy paperwork and perform chart pulls later if there are any questions on the claims.

Increased Security:

When using the internet, many users are concerned about security. A well established vendor addresses these concerns on multiple levels. Just like banking at an ATM, all data is encrypted during transmission and is protected by a user name and password. Furthermore, with most ASP vendors, all data and servers are backed up by expert IT staff at the data center. Many ASp vendors offer redundant HIPAA-compliant servers, with backups in different locations to ensure data recovery in case of disaster.

Conclusion

What is becoming standard in ASP-based medical billing software is subscription style pricing, and low upfront cost which cover implementation and professional fees.

If your business is looking to upgrade the medical billing software, examine the new features listed to see if they will offer you cost savings and increased efficiency. If so, insist on the new features in your next system. The cost savings can easily justify the upgrade.

Lori Anderson is an independent consultant with LAtech working with AntekHealthware on their DAQbilling Medical Billing Software and LabDAQ Laboratory Information System projects.

Top 3 Electronic Medical Billing Software Methods For No-Show And Missed Appointment Risk Reduction

Most clinics lose an average of 20% of their revenue due to missed appointments. Lost revenue may not be the largest problem clinics face due to no-shows. Other problems span health damage, patient liability risks, reduced accessibility, and impeded resident education. Rigorous no-show management methods utilizing powerful vericle-like technologies, which integrate scheduling and billing data, reduce no-show rates and improve associated revenues by more than 50%.

No-Show Frequency Distribution

No-show rates average at about 20%, where 10% clinics have less than 10% no-shows, 42% clinics - 10%-20%, 34% clinics - 20-30%, and 14% clinics - more than 30% no-shows. Further, the top ten clinics range 3%-9% for no-shows, while the bottom 10 clinics reach 33%-57%.

No-Show Impact to Clinic

A missed appointment poses five kinds of problems:

 

1. Health damage: Damage to patient's health due to interrupted continuity of care or missed an opportunity to solve an acute health problem. The doctor also loses an opportunity for a timely review of patient health, treatment progress, etc.
2. Liability risk: A patient that missed an appointment and suffered an injury may have a viable cause for a lawsuit against the practice. To avoid such risk, the doctor must maintain evidence of giving clear directions and making reasonable efforts to ensure patient's compliance with care program, including keeping follow-up appointments.
3. Reduced accessibility: Other patients were postponed and did not get access to care because of a no-show or cancelled appointment.
4. Impedance to resident education: Resident doctor missed an opportunity to hone care skills.
5. Loss of revenue: Clinic is unable to make up revenue due to missed appointments.

Three-Phase No-Show Management Strategy

An effective no-show management strategy is based on tracking, rescheduling, and follow up:

1. Track
   1. Record all no-shows and reconcile with billing on a daily basis
   2. Record no-show reasons and followup notes in patient records
   3. Review End-Of-Day report daily
2. Reschedule in real time
   1. Allow patients request appointments online using Internet
   2. Overbook, use waiting lists
   3. Fill new openings with walk-ins or patients from waiting list
3. Follow up
   1. Activate a sequence of reminder calls/emails to all patients 10, 2, and 1 day prior to appointment.
   2. Follow up call to find reasons for no-show and reschedule
   3. Follow up with warning letters after one no-show
   4. Dismiss from practice after three no-shows

Reminder calls or emails prior to appointment remains the most effective method to prevent missed appointments. Additionally, sending reminders via email and allowing patients confirm online turns an office reminder into patient's action item, significantly outperforming the impact of a voice message or postcard.

Note that outsourcing reminder calls to calling services and using the Internet reduce the cost of reminders. Therefore reaching all patients prior to appointment makes good business sense.

Three technologies are especially useful in implementing the no-show management strategy outlined above:

1. End-Of-Day Report: End-Of-Day report displays New patients, Visits, Cash, Insurance, Free, Insurance (Billed, Collected), Cash Collected, Missed Appointments, Recalls, Patient Visit Average. End-Of-Day allows the manager to reconcile revenues with patient visits, eliminating no-charge visits and unbillable appointments.

    

2. Scheduler:
   1. Allow patient access to Internet-based appointment scheduler
   2. Update available appointment list due to cancellations
   3. Alert about new openings for patients on the waiting list
   4. Alert about appointments with missing authorizations
   5. Most schedulers allow monthly, weekly, and daily views. Today view should change color for no-show appointments, prompting the front-office person to follow up immediately or at the end of the day

       

3. Search: Search feature must allow finding all no-shows within specific time interval subject to specific patient name, attending physician, CPT and/or ICD-9 code combinations, or other demographic conditions. Upon finding specific appointment, drill down should be available for related appointment history or recurring appointment plan.

   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.

BCBS MI Heads Chiropractic Office Billing Software Precision Index For 2nd Month - BPI Drops 3.5%

Blue Cross Blue Shield Michigan heads Chiropractic Office Billing Software Precision Index (BPI) for the second month straight. Overall, May 2007 BPI dropped 3.5%, bringing the index from 14.6 down to 18.1, below the national average of 17.7%. May BPI replaced three 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 = 18.1 means that the average of ten top performing payers working with Billing Precision clients have 18.1% 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 18.1
• Blue Cross Blue Shield Michigan 3.2 (same)
• GHI 11.5
• Humana 11.8 (down from 7.9 in April)
• Blue Cross Blue Shield Colorado 12.3 (down from 6.8 in April)
• Medicaid Pennsylvania 15.1
• Assurant Health 15.4
• Blue Cross Blue Shield Illinois 16 (down from 11.1 in April)
• United Health Care 22.6 (down from 13.9 in April)
• Medicare New Jersey 20 (down from 16.4 in April)
• Cigna 24.1 (down from 15 in April)

May BPI dropped three participants since April:

• Blue Cross Blue Shield Texas 20
• Great West 22
• Aetna 22.1

No payer improved its index since April.

Six participants lowered their indexes with respect to April BPI:

• Humana 11.8 (down from 7.9 in April)
• Blue Cross Blue Shield Colorado 12.3 (down from 6.8 in April)
• Blue Cross Blue Shield Illinois 16 (down from 11.1 in April)
• United Health Care 22.6 (down from 13.9 in April)
• Medicare New Jersey 20 (down from 16.4 in April)
• Cigna 24.1 (down from 15 in April)

May BPI added three new participants since April:

• GHI 11.5
• Medicaid Pennsylvania 15.1
• Assurant Health 15.4

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 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 Training Video for Chiropractic Office Billing Software and Compliant SOAP Notes

Chiropractic office billing software has become mission critical component for chiropractic office profitability and post-payments audit risk management. Practice management systems automate most clinic operation activities, starting with patient check in, SOAP note editing, insurance claim creation, and medical billing.

Unfortunately, the high level of computer skill required by the prohibitively complex chiropractic office management solutions often hinders the doctor's ability to use such solutions correctly, especially for compliant visit documentation and billing. Instead of increasing office productivity and efficiency, technology becomes yet an additional obstacle and profitability impediment. Its high cost and user training problems add insult to injury and frustrate even seasoned and accomplished practice owners.

Since insufficient notes are the most frequent reason for failing a post-payment insurance audit, timely filing of compliant SOAP notes and submission of congruent insurance claims are the most mission critical parts of any practice management automation solution. But SOAP notes and insurance billing are also the most complex parts of such solutions, often confusing doctors and assisting personnel and degrading practice profitability. The ability to manage compliant notes in minimal time without delaying the patient flow is especially important in a high-volume practice environment.

Component-driven SOAP notes are both audit-proof compliant and require minimal time spent for visit documentation. Chiropractors using Vericle's SOAP notes, receive a training video, which has two parts. The first video trains chiropractors taking SOAP notes during the initial visit and the second – during subsequent visits. The training video follows a four-step outline:

1. Systems menu selection to access patient SOAP notes from Appointment Scheduler
2. Date and Doctor selection
3. Component-driven narrative creation for accelerated and compliant editing:
   1. Patient has Subjective complaints
   2. Objective tests show problems that support patient's complaints
   3. Activities and Daily Living of the patients suffer because of same complaints, which are confirmed by objective tests
   4. Show diagnosis Assessment isolating the problem for treatment
   5. Comprehensive Plan shows specific actions with measurable improvement objectives including starting time, treatment duration, and expected benefit.
4. Subsequent visit documentation - select existing SOAP note components for change:
   1. Few individual notes can be the same or even show occasional exacerbation
   2. Overall the series of notes demonstrate a trend of improvement across Subjective complaints, Objective tests, and ADLs
   3. Assessment and Plan often stay the same until re-exam

Chiropractors using Vericle system have access to the training video directly from any screen on the system using a special-purpose Wiki (shared knowledge repository on the Web). Combining Wiki with video technology solve many of the difficult training problems of chiropractic office owners and managers for compliant visit documentation and billing. Such combined training solution amplifies the advantages of individual training video materials with Wiki's ability to reach every chiropractic office, share experience of real-world experts, and help practice owners and managers stay smart at their pace and on just the content they need to know. The “on-demand” nature of an integrated solution enables doctors to learn from experts wherever and whenever it is most convenient to learn.

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 and Personal Injury Protection (PIP) in New Jersey (Interview

Barry Fredson has been practicing law for nearly four decades. His office specializes in collecting Personal Injury Protection Benefits (PIP) for medical providers in the State of New Jersey. Last week, we had a chance to speak with him.

Question: What is Personal Injury Protection?

Barry Fredson: The system as established in New Jersey requires that providers of medical benefits to those injured in automobile accidents are paid promptly and according to a fee schedule. The concept is excellent however, insurance companies tend to delay and deny payments.

Question: Is it difficult to get paid?

Barry Fredson: Insurance companies are in the actuarial business. Accordingly, the longer they keep the provider’s payment, or the more obstacles they create to avoid full payment, the better it works for the insurance company. To counter these tactics medical providers need the assistance of counsel who understands insurance company procedures and can efficiently resolve medical provider’s claims.

Question: Is it better to not treat accident victims and avoid these problems?

Barry Fredson: Definitely not. My office processes thousands of these claims for dozens of medical providers in the State of New Jersey. The claims are processed efficiently and promptly taking full advantage of shared distributed computing platform.

Question: Will using the services of your law firm increase any provider’s costs?

Barry Fredson: No. The Personal Injury Protection Law is structured so that when medical providers are not paid within 60 days of submission of their bill, the insurance carrier who has denied/delayed payment is required to pay the attorney’s fee. There is never an additional charge to the medical providers.

Question: What makes Personal Injury Protection Benefits different from other claims?

Barry Fredson: From the provider’s point of view, there is no difference. The legislature has created a formal arbitration system for PIP claims. Although this a technical area of the law, and the insurance companies have highly trained lawyers and claims adjusters who look for minor errors or non-complete submissions, we use a combination of doctor’s notes, supplemental documentation and certifications to eliminate insurance company objections and prevail in this lucrative but complex area of medical reimbursement.

Question: Do I need any particular volume of claims or any particular specialty to take advantage of this lucrative area?

Barry Fredson: No. Many providers of services to accident victims from small chiropractic offices to hospitals, diagnostic facilities, surgery centers, orthopedists, neurologist, chiropractors, physical therapist, pharmacists, and other providers, all can take advantage of this lucrative area of reimbursement.

Question: How do I take advantage of your service?

Barry Fredson: By using Vericle—Billing Precision’s unique integrated revenue cycle management platform with built in controls and accountability, you are on the way. Our staff would interface directly with Vericle and you would be kept notified in the usual efficient manner used by Billing Precision’s services.

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.

One Pocket Billiards

Billiards, like poker and darts, continues to enjoy huge popularity because of the many variations on the basic game. One Pocket billiards is just one of the many options available to billiards players. One Pocket is sometimes referred to as the "soccer" of billiards.

In One Pocket billiards, the possible pockets for players to shoot at are cut from six (in standard Eight Ball play) to two. This provides the added strategy of requiring the shooter to specialize in specific types of shots. In One Pocket billiards, you must call the pocket for your intended shot. It is not necessary, however, to call the ball that will go into the specified pocket.

The similarity of One Pocket billiards to soccer is that the specified pocket on every shot is the opponent's target goal. In other words, each player is essentially defending his or her target pocket. This requires each player to put a defensive strategy into play, in addition to the usual offensive strategies of billiards. If a player does not make a ball into the opponent's target pocket, but shoots a ball into any of the remaining pockets, the shot is then declared an "illegally pocketed" ball.

Before starting the game, the two shooters will choose which a pocket on either end of the table to use as a target pocket. The balls are set randomly in the racking triangle. The breaking shooter is required to make at least one ball into the targeted pocket, or cause at least one contacted ball hit a cushion, in order for his or her turn to continue. When the target pocket has been scored on eight or more times, the game is over.

If a shooter happens to pocket a ball in his or her own pocket, it gives the opponent a winning point total, and the shooter loses the game. The object is to successfully pocket eight balls in the target, or opponent's goal pocket. This means that the shooter will have pocketed more than half of the total game balls into the opponent's pocket. If the shooter has six pocketed balls and his or her opponent has seven, and the shooter accidentally pockets a ball in his or her own goal, the opponent wins the game.

Billiards, in it's many variations, is a fun game of skill. One Pocket billiards features an element of strategy that makes it a truly enjoyable and addictive sport. Try One Pocket billiards, and it will soon become one of your favorite ways to play.

David Wilson is an author for several online magazines, on recreation and hobbies and tips on recreation subjects.

Betting on Billiards

Billiards is one of your favorite sports and you've been playing for a while. You love betting on billiards just as much as you love playing it. The satisfaction of winning and collecting money is one of the best feelings. Unfortunately, you aren't that good at it and could use some advice. Betting on billiards is an art, and it isn't enough to just be good at the game.

Before you start betting on billiards you need to make sure you understand the game, the rules, and all its variations. Betting on billiards is easier if you not only have good technique but also remember all the rules and games, even the most obscure ones.

Once you understand all the rules, you shouldn't start betting on billiards until you are sure you have an excellent technique. Advanced understanding of the physics of the game is also an asset. If you want to be a better player, you can either take lessons or play a lot of games with someone who is better than you. You probably shouldn't start betting on billiards until you are sure you can compete with even the most advanced players.

You also need to understand that betting on billiards isn't the same as playing a pickup game with a friend. Since the stakes are higher, you will need to perform your best. If you are the type of person who can't handle the pressure, this will affect your ability to win games and win the pot.

Betting on billiards requires an advanced knowledge of the game, the rules, and all its various techniques. There are variations within the basic game, and gamblers are fond of taking advantage of them. The more you know about the game, the more successful your efforts to start betting on billiards will become.

Billiards provides detailed information on Billiards, History of Billiards, Rules of Billiards, Billiards Supplies and more. Billiards is affiliated with Pool Tables for Sale

Practice Perfect - 10 Criteria For Best Chiropractic Billing Software And Office Management Solution

Information Technology (IT) is a necessary component of a modern chiropractic office," says Dr. Greg Loman, of Trinity Chiropractic and co-founder of Teach The World About Chiropractic. "IT helps maintain patient relationships, control audit risks, and ensure full and timely billing."

Dr. Loman has established one of the most successful chiropractic offices in the world, seeing over sixty thousand patients a year. A world power boat racing champion, Dr. Loman has learned what it takes to be the very best.

Teach the World About Chiropractic, which he co-founded with Dr. Ben Lerner, the author of Body by God, Generation XL, and One-Minute Wellness, helps chiropractors and students across the world. Their clients have the largest, most successful clinics in the profession today.

"Complete practice workflow solution starts with appointment scheduling and includes SOAP notes, and billing," says Dr. Lerner. "Few vendors today offer such integrated packages as they require powerful vericle-like technologies used by trained and skilled personnel implementing rigorous and disciplined service processes."

Chiropractic IT must meet five functional criteria and five technology criteria:

 

1. Clinical Relevance

    

   Technology can only help the healing process if it helps making treatment decisions at the point of care. Therefore, it must be available next to treatment table and it must have intuitive user interface to facilitate simple data entry and helpful online reporting.

    

2. Patient Relationship Management

    

   Successful practice development requires perfectly managed patient relationships, starting with establishing and tracking financial care plans, appointment reminders, balance follow-ups, and avoidance of unbillable appointments.

    

3. Compliant SOAP Notes

    

   SOAP is short for Subjective, Objective, Assessment, and Plan:

   Subjective describes the patient's current condition, including all pertinent and negative symptoms. Document how symptoms impact activities of daily living; Use the Standard SOAP format modified to SOAAP by adding an extra "A" for Activities of Daily Living.

   Objective includes vital signs, findings from physical examinations, and results from laboratory tests. Document functional measurements (e.g., Range of Motion), comparison data, test results, co-morbidities, etc. to paint a picture of what is going on with the patient.

   Assessment is a quick summary of the patient with main symptoms/diagnosis including a differential diagnosis, a list of other possible diagnoses usually in order of most likely to least likely.

   Plan is what the health care provider will do to treat the patient's concerns. This should address each item of the differential diagnosis. Document goals for the patient and establish a reasonable timeline to reach those goals. Update your treatment plan every 30 days or 12 visits or any time there is a significant change in the patient's condition, i.e., exacerbation, new injury, discharge exam. Document the patient's progress toward those goals in the daily SOAAP notes.

    

4. Full and Timely Payments

    

   Revenue cycle management software must help the practice manager to make sure that every service encounter gets paid in full and on time. It must provide full and detailed 24x7 account of all actions on every claim, systematic discovery of denials, patient invoicing, electronic claims submissions to payers, payment posting and reconciliation with charges, HIPAA compliance, built-in tests for medical necessity, and comprehensive online reporting.

    

5. Audit Risk Management

    

   Audit risk management consists of continuous monitoring for potential compliance violations and meticulous management of patient encounter notes.

    

6. Reporting and Transparency

    

   Without transparency billing may not be reliable. 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.

   Vendors that manage their own billing technology typically have better control of reporting capabilities in terms of scope, analysis, frequency, and transparency. 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, 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.

   Reports must allow arbitrary data aggregation and drill-in. Export to Excel spreadsheets for further analysis is a very useful feature.

    

7. Billing Quality Metric

    

   Make a list of metrics available online. Focus on collections completeness and payment delay. Can the system report the differences between payers and between various CPT codes in real time? What is the denial followup success rate?

    

8. Data Entry Protocols

    

   Modern technologies allow the doctor to take over coding and reduce the billing role down to claims processing and followup. Technology-competent vendor will supply your superbill online, along with a separate form for patient and charge entry, EOB posting, and on-line claim editing. Similarly, much of data entry validity, including some of claim scrubbing will be done online at the point of data entry.

    

9. ASP or SaaS Delivery Model

    

   Rapid technology progress results in low return on investment in software licenses, typical of client-server technology. Therefore, monthly leasing arrangements with zero upfront investment, typical of ASP (application service provider) or SaaS (software as a service) delivery models are preferable to license purchase.

    

10. Data Security and Protection

     

    Review data center facilities. Ask for evidence on HIPAA compliance: claims must be viewed only on the "need to know" basis, access to claims and modifications must be thoroughly documented. Data must be protected with redundant disaster recovery measures. Review backup process, backup intervals, and data restore capabilities.

     

 

Summary

Increasing regulatory scrutiny, poor in-house billing performance, and rapid technology progress are key growth drivers in chiropractic information technology. On one hand, thousands of outsourced billing solutions and software vendors ensure continued competitiveness in terms of both service quality and pricing. On the other hand, the lack of standards and uniform metrics among the vendors, combined with their large numbers, frustrates the selection process. Ten effective guidelines streamline outsourced solution selection process and reduce vendor switching costs.

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

6 Worst Payer Trends That Impede Electronic Medical Billing Software and Service Performance

Healthcare insurance business continued to boom in 2006, mostly at the expense of both providers and patients. A review of recent healthcare insurance industry trends help identification of six payer activities that will impact medical billing and healthcare providers revenue in 2007.

Two key aspects dominated business background for insurers in 2006. They

 

1. Must meet tougher profit margin benchmarks. For instance, United Healthcare saw its earnings rise 38% in the 3rd quarter of 2006 alone. To keep its share value growing, United Healthcare will have to demonstrate still better performance in the 3rd quarter of 2007.

    

    

2. Approach the limit of their ability to grow premiums. Premiums increased significantly beyond inflation and workers' earnings growth in 2001-2006. For instance, health insurance premiums increased 65.8% between 2001 and 2006 while inflation grew 16.4% and workers' earnings increased 18.2% during the same period.

    

    

Therefore, in 2007, insurance companies will continue to pay less using the following six key strategies:

 

 

1. Add new denial reasons and increase costs of medical billing service and software because of growing complexity. In January 2007, thousands of physicians discovered they were having trouble getting Medicare to pay for services billed under the codes 99303 and 99333. The reason for denial was simple: Medicare deleted codes 99301-99303 from CPT in 2007, forcing the physicians to review the new 99304-99306 codes in an up-to-date CPT code book. The 99331-99333 codes also were deleted in 2007. Review the new codes, 99324-99328.

    

   The payer-related component of the medical billing process costs an average 8% to 10% of providers collections. It includes claim generation, scrubbing, electronic submission to payers, payment posting, denial identification, follow up, and appeal. By complicating the process, payers increase the likelihood of failing the payment and winning the subsequent appeal process. Providers face the lose-lose choice of expensive medical billing process upgrades or forfeiting denied payments.

    

2. Reduce allowed fees. Average physician reimbursement from billing Medicare and commercial payers dropped 17% in 2002-2006. From 2005 to 2006, allowed amounts for E&M visits alone dropped 10% nationally, 27% in the Northeast, and 20% in Northwest.

    

    

3. Underpay. 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. 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: the order of paid items and payment percentage of remaining items. Additionally, temporary constraints often cause payment errors because of 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. Payers also vary in their interpretations of CCI bundling rules or coverage of certain services.

    

    

4. Increase leverage over providers through consolidation. It is harder to drop a contract with low allowed amounts when there are fewer remaining payers. Consolidation in the insurance industry reduces competition among payers for physician's services, allowing payers pay less to providers. Today, 73% of insured population are covered by 3 plans alone: the top ten health plans cover 106 million lives, while three plans, namely, United, WellPoint, and Aetna together cover 77.7 million lives. In 2006, consolidation rate accelerated. For instance, United Healthcare Group purchased 11 plans in 2006, including MetLife, PacifiCare, and Oxford. Turning down a contract offered by a payer that controls such a large portion of population results in giving up significant revenue from medical billing. Providers face the lose-lose choice of seeing fewer patients or accepting lower rates.

    

    

5. Drive providers into networks (which offer lower allowed amounts). United Healthcare has announced a new national policy to discontinue direct payment of medical billing to out of network providers. Effective July 1, 2007, under the "pay the enrollee program," United Healthcare will direct out-of-network benefit checks to the insured member rather then non-participating providers. This policy forces the providers to choose between chasing the patients for payments or joining the payer's network. In any case, provider loses some of earned revenue. Oxford Health Plans, a United Healthcare Company, implemented the Pay the Enrollee policy on April 1, 2006. According to the Oxford web site announcement, Oxford may refuse to honor the assignment of benefits for claims from non participating providers pursuant to language in the Certificate of Coverage. If enrollees choose to receive treatment out-of-network, the claim reimbursement may be sent directly to the enrollee. In such cases, the non-participating provider will be instructed to bill the covered patient for services rendered.

    

    

6. Return for refunds and penalties. Justice Department recovered a record of $3.1 billion in refunds and penalties in 2006. It is the largest amount ever recovered in a single year. Invariably, providers are in denial about their exposure, and insurers are quick to comfort them. They will tell you that medical billing audits are an unfortunate but necessary tactic for keeping fraud in check, implying that honest providers have nothing to worry about. But insurers are not crusaders for truth and justice. Providers need to understand that payer's motive is money, the means is a gargantuan statistical database, and that every provider is an opportunity. Healthcare finance insiders call this a Big Brother system and, setting aside the melodramatic implications of such a name, it is easy to see why. While executives have a soft spot for pretty charts, the true power of such a system is its ability to drill into the data and find outliers (when they talk about this type of tool, Information Systems specialists use jargon like data mining and On Line Analytical Processing, or OLAP for short). The system automatically pinpoints providers that are “easy audit targets: because they are:

    

    

   • Doing something differently from the pack,
   • Lacking infrastructure for systematic denial follow up,
   • Lacking compliant medical notes.

    

    

Having acquired the means to cost-effectively target providers, insurers have begun the hunt. It behooves providers to arm with powerful electronic medical billing software and fight back for improved revenue.

References

 

1. Neil Weinberg, “Envy Engines,” Forbes, March 14, 2005
2. “Fraud Statistics – October 1, 1986 – September 30, 2004”, Civil Division, U.S. Department of Justice, March 4, 2005
3. Capra, Lirov, and Randolph, “The “Business” of Healthcare Provider Audits - How Payers Are Getting Away with Practice Murder,” Today's Chiropractic, January 2007, pp. 60-62.
4. P. Moore, "Power to the Payers - Consolidation Puts Insurers in Charge," Physicians Practice, January 2007, pp. 23-30.

   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.

5 Facts About NPI For HIPAA Compliant Electronic Medical Billing Software And Service

The 1996 Health Insurance Portability and Accountability Act (HIPAA) established national privacy and security standards for electronic health care transactions, including a national identifier for providers, health plans and employers. Accordingly, by May 23, 2007, healthcare providers and all health plans and clearinghouses must change both their processes and information systems to implement HIPAA’s National Provider Identifier (NPI) regulations.

Background on the NPI regulation

• HIPAA mandated regulation
• Effective nationwide on May 23, 2007
• The compliance date for health care payers with less than $5 million in annual revenue is May 23, 2008

 

What is the NPI?

• A unique 10-digit identification number
• Assigned for life to a provider and de-activated only upon death, retirement, or identity theft
• Replaces multiple legacy provider identification numbers, including Medicare UPINs, commercial payer IDs and state Medicaid IDs
• Contains no identifying information related to the provider - randomly generated
• Independent of key provider information changes, such as practice location or specialty
• Providers have 30 days to update their NPI record

 

Who is affected by the NPI mandate?

• Payers
  • Health plans
• Clearinghouses
• Providers
  • Organizational providers
  • Individual providers

 

Why is the NPI necessary?

• NPI delivers two-fold benefits for payers and providers:
  • Simplifies communication and administration
  • Facilitates efficient electronic transmission of certain health information
• Streamlines detection of billing fraud and abuse
• Improves debt collection efforts

 

What are the challenges of NPI implementation for payers and providers?

• Providers and payers must exchange information
• Technological implementation cost within organizations

 

What should payers and providers do now to prepare for the NPI?

• Organize project teams to ensure a smooth transition
• Identify and address processes and information system changes
• Evaluate outsourcing solutions offered by technology vendors

  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.

Improve Patient Loyalty With Integrated Electronic Medical Billing, Notes, And Scheduling Software

Patient Loyalty

Patient loyalty is key to continued practice success in terms of both recurring and new revenue. As patients keep returning to your practice, it maintains revenue stability and as patients refer their friends and family, your practice billing collections grow. In terms of profitability, new patient acquisition is by an order of magnitude more expensive than loyalty maintenance for an existing patient.

Time delay is a major problem of eroding patient loyalty. By the time you discover that you have a patient loyalty problem, it is typically too late to do anything about the patients who already left. Patients typical desert without saying “good bye,” and your only way to discover patient attrition is by observing lower collections and more free time on your appointment scheduler.

Frequent patient communication is the only effective way to reduce such time delay and increase the likelihood of timely loyalty problem identification and resolution. Such patient communications can revolve around any of the practice management components, starting with patient scheduling, to SOAP notes, to special health care literature, to medical billing, insurance payments, copays, and deductibles.

Patient Identification for Targeted Communications

It's convenient to view targeted communications from the patient visit perspective:

 

• Patients due for scheduled appointment or owe you payments need a reminder.
• Patients that recently had an appointment need results, interpretation, prescriptions, and follow up.
• Patients with prescriptions that are about to expire may need to schedule a visit
• Patients that have not had an appointment for long time need a reminder to schedule a checkup. A screening procedure schedule should be generated using specific combinations of procedures (CPT) and diagnoses (ICD) codes.
• Patients with chronic conditions or permanent injuries need literature about recent progress in treating their conditions
• Patients that have had a long series of appointments need progress reports
• Patients that receive good progress reports need to be solicited for referrals
• Patients with bad progress reports need special literature and special appointments
• Patients waiting in reception area need access to custom information about their specific condition.

 

To generate such lists of patients, your systems must combine scheduling, medical notes, and billing data in a single database.

Patient Communications Venue

While traditional phone and conventional mail systems are still in use, Internet is the most obvious choice for communicating with patients. A custom, HIPAA-compliant patient portal is the least expensive way to allow your patients interact with their doctor outside the clinic at their convenience and privacy. Patients can

• Review reminders and schedule appointments.
• Review visit results.
• Ask you clarifying questions.
• Request prescriptions.
• Read special literature and progress reports you sent them.
• Send you referrals.
• Review medical bills and pay invoices
• Track their medical costs

 

Active patient loyalty management based on selective patient identification for targeted communications at the patient's convenience is one of the most effective way to improve practice profitability.

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.

7 Key Features Of Integrated Pathology Lab Workflow And Electronic Medical Billing Software

Chairing a Pathology Department at Centrastate Hospital in New Jersey and simultaneously running two laboratories in two remote states (Oklahoma and New Jersey) require Dr. Michael McGinnis to match his medical expertise with savvy business sense.

"A pathologist must track workflow of the entire laboratory from receiving a sample and requisition form, to accessioning, to patient demographics, to history, to gross, dictation, proof, distribution, and billing," says Dr. McGinnis. "I need to know precisely what unfinished work is left at each stage in every lab. I need to track every step and know exactly who has done what regardless of their location. And I need this information in real time. For instance, I need the list of signed off reports arranged by requesting doctor, date, patient, or payer, in real time."

Information Systems Challenges in a Pathology Laboratory

Pathology billing is especially complicated because it requires:

 

1. Data flowing between
   1. Hospital system,
   2. Multiple requesting doctors,
   3. Internal laboratory system,
   4. External billing service, and
   5. Multiple insurance companies

    

    

    

2. A system of checks and balances to
   1. Prevent losing a case
   2. Ensure full and timely payment

    

    

 

Continuous Measurement

Billing quality is best understood by observing the distribution of Accounts Receivable. A well-performing service will have half of the claims paid within 15 days, with over 90% of all claims being paid within 45 days. The narrower "bell-curve" of Accounts Receivable means better cash flow predictability while its lower "tail" means added revenue.

Software-as-a-Service (SaaS)

"Gone are the disk crashes and software maintenance. No more office staff moods and conflicts to resolve or benefits to pay. I now pay only for performance, which makes perfect business sense," says Dr. McGinnis. "Finally, I can replace my administrative assistants with medical specialists that can take over some of my workload and add revenue."

Mission-Critical System Features

The following seven features are critical for accomplishing the benefits listed above:

 

1. Comprehensive integrated functionality covering entire laboratory workflow
2. Internet-based access to data entry and reporting
3. An interface between hospital internal system and external billing service
4. Arbitrary aggregation and comprehensive analysis of all laboratory and billing data
5. Full and transparent access to each and every claim, from accession number to coding to payment
6. 24x7 status reports about received payments, submitted claims, rejections, follow-ups, and delays
7. HIPAA compliance. Role-based access control to clinical and billing 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.

Electronic Medical Billing Software - Client-Server Versus Application Service Provider (ASP)

Electronic Medical Record (EMR) and digital billing systems offer substantial clinical care, financial, practice workflow, and compliance benefits to doctors, insurance companies, and patients. But half of medical practices that purchase EMR software fail to successfully implement it.

Rapid development is a salient feature of this technology market: eighteen news items published by technology vendors of electronic medical record and billing systems were listed in May 2006 alone on BillingWiki/Technology. The eighteen news items split seven-to-eleven between web-based Application Service Provider (ASP) solutions and Client Server (CS)-based technologies. Upon briefly reviewing key factors defining each technology, we compare them along two criteria, namely implementation success likelihood and costs.

Client Server Architecture

CS model has been around since the early eighties of the twentieth century. Its architecture includes a central server deployed at the doctor’s office and multiple client stations to allow the users to interact with the application. The central server typically runs the database and some of the application logic, while the client stations perform much of the processing locally.

Such distributed processing architecture facilitates relatively high application performance, minimizing waiting time. The downside of CS architecture is that it requires the practice owner to establish necessary infrastructure upfront and to continuously manage it down the road. The infrastructure includes a central server, client terminals, and local network connecting the computers. The management tasks include installation, configuration, backups, restores, and periodic upgrades.

Therefore, a typical CS charge model involves upfront investment in infrastructure and application license and subsequent monthly support costs as well as significant time spent on completing the required tasks and maintaining the knowledge level required for successful operation of hardware and software.

To justify an investment, CS solution vendors offer traditional five-year return on investment (ROI) analysis. Such analysis compares EMR benefits derived from reduced office workload, clerical and clinical errors, improved coding, and faster cash flow, to infrastructure ownership costs.

The pitfall of this approach is that it ignores both technical and financial aspects of technology aging. Technically, Moore's law of digital technology development tells us that chip density doubles every 18 months. Therefore, computer hardware and technology developed on it becomes obsolete every 36 months. Can you justify an investment using five-year horizon in a technology, which might become outdated in three years?

Financially, investments make sense in goods that appreciate in value. Otherwise, renting business-necessary equipment or software often offers the double-pronged advantage of both freeing up cash flow and tax deductible business expense.

Application Service Provider Architecture

ASP model was introduced just before the turn of the new century. It is based on leveraging Internet. ASP architecture places the database server at the vendor’s site instead of the doctor’s office and allocates the majority of application logic to the server, reducing the amount of code needed to run the client. Such an approach allows the users to interact with the application directly via Internet browser, entirely eliminating the need for local office infrastructure and its management. The vendor manages all of the technology centrally and for all offices, including compliance, disaster recovery, installation, upgrades, backups, and restores.

The ability to configure systems and train and support personnel without ever visiting the practice sites, provides one of the most cost-effective EMR solutions. Deployed remotely over the Internet, ASP methodology avoids time-intensive, on-site disruptions. Online training allows physicians and staff to schedule for convenience, further minimizing practice disruption.

Obviously, ASP model creates major economies of scale eliminating the need for local IT staff. Typical charge model of modern Vericle-like solutions consists of monthly access fees and avoids investment in and ownership of associated infrastructure.

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

7 Steps To NPI For HIPAA-Compliant Electronic Medical Billing Software And Service

The Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) mandated the adoption of standard unique identifiers for health care providers, as well as the adoption of standard unique identifiers for health plans. They become mandatory on May 23, 2007.

The purpose of these provisions is to improve the efficiency and effectiveness of the electronic transmission of health information. The Centers for Medicare & Medicaid Services (CMS) has developed the National Plan and Provider Enumeration System (NPPES) to assign these unique identifiers.

CMS has contracted with Fox Systems, Inc. to serve as the NPI Enumerator. The NPI Enumerator is responsible for dealing with health plans and providers on issues relating to unique identification.

HCFA Timetable

Changes in the HCFA 1500 form to accommodate the NPI number took place January 1, 2007. Until March 30, 2007, using NPI number on the HCFA form is optional but as of April 2, 2007, using NPI becomes mandatory.

Getting an NPI is free - Not Having One Can Be Costly: If you delay applying for your NPI, you risk your cash flow.

 

1. Enumerate: Enumeration is mandatory for both individual providers and organizations and subparts. When applying for your NPI, CMS urges you to include your legacy identifiers, not only for Medicare but for all payors. If reporting a Medicaid number, include the associated State name. This information is critical for payors in the development of crosswalks to aid in the transition to the NPI.
2. Update: Make sure to upgrade your software, HIPAA Transactions, CMS1500, UB04, and/or Dental claim form changes.
3. Communicate: Notify your payers once you have obtained your NPI number. As outlined in the Federal Regulation (The Health Insurance Portability and Accountability Act of 1996 (HIPAA)) you must also share your NPI with other providers, health plans, clearinghouses, and any entity that may need it for billing purposes -- including designation of ordering or referring physician.
4. Collaborate: Check the readiness of your payment partners (such as health plans, TPAs, clearinghouses, etc...)? Not all payers are ready to accept the NPI number at this time. Use both your existing (legacy) number and the NPI number when submitting electronic claims.
5. Test: Test transactions well before the deadline. Make sure to test HIPAA Transactions, e.g., 837 Claims, 835 Remittance Advice, and, if you submit paper claims, verify that the data is printed in the correct fields. The new HCFA form has new fields for identifier numbers on lines 17b, 32a and 33a.
6. Educate: Focus on staff working on insurance verification of eligibility and claim denial or underpayment follow up.
7. Implement: Once you obtain your NPI, it might take about 120 days to do the remaining work to use it. This includes working on your internal billing systems, coordinating with billing services, vendors, and clearinghouses, testing with payers.

   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 Workflow In 2025 - Scheduling, Clinical Service, Notes, And Billing Software

Pattie Stechschulte's vision of a chiropractic office in 2025 ("A Glance into the Future," Today's Chiropractic, May, 2003) includes simplified check-in, complete patient checkup using non-invasive techniques, self-configurating adjustment table that sets itself up for next patient, a touch-screen computer system in each room loaded with intelligent software for SOAP notes, consultation modules to tap into more experienced doctor's knowledge, and a patient-friendly portal for online patient education and appointment scheduling.

While non-invasive checkups and self-configurating adjustment tables still belong to the future, the information technology aspects of Pattie's vision has already become a reality for chiropractors armed with advanced Vericle-like solutions.

First, their patients check themselves in by swiping a key tag in a scanner located in the front office. The key tag contains basic information about the patient (encrypted for HIPAA compliance) as well as practice logo and phone number for a handy patient reminder. The system immediately finds patient's SOAP notes and informs the front office person about outstanding patient balance or waiting messages.

Next, as the patient proceeds to the adjustment room, her SOAP notes are already displayed on a touchscreen computer system, the doctors have installed in each room. The system is loaded with intelligent software for care plans, SOAP notes, and retail sales products. Touchscreen technology helps doctors avoid costly mistakes of handwritten notes. Because the note generation process is standardized, notes are complete and compliant under the insurance audit scrutiny. Unlike computer mouse and drop-down menus of traditional systems or the prohibitive numbers of screens in a typical PDA, touchscreen technology requires minimal eye-hand coordination; the doctor can enter information and still maintain eye contact with the patient.

Finally, as the patient leaves the office, the system automatically generates an insurance payment claim, presents it for doctor's review, and immediately forwards it to the insurance company. With front-to-back office integration, advanced Vericle-like solutions deliver the claims to their destination in real time, as soon as the patient leaves the office.

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.

5-Step Lockbox Selection for Outsourced Electronic Medical Billing Software and Service

Lockbox helps medical practices streamline HIPAA-compliant mail processing and same-day check deposits. Electronic access to scanned documents, including EOBs, simplifies key office and billing processes and achieves multiple benefits:

• Reliability Better revenue cycle reliability via elimination of dependency on staff or on billing service for handling checks
• Transparency Lockbox allows bi-directional verification of check deposit between the bank and billing service. Doctor can personally verify deposit 24 x7 via secure Internet connection. No lost checks.
• Billing Efficiency Faster and better controlled submission of secondary claims
• Patient Service Efficiency Simpler and faster resolution of patient account inquiries and disputes
• Added Interest Revenue Automated or semi-automated posting of insurance and patient payments. Check deposit upon arrival. Automated investment of deposit in a Money Market account earning interest (Automatic Sweep). The doctor's money is never idle.

Operation

1. Practice mail arrives directly to the lockbox service
2. Lockbox service
   1. Opens all mail and archives it in a document management system including scanning and indexing for future retrieval,
   2. Makes images available to practice or Billing Service via a secure, encrypted Web site;
   3. Deposits all checks received that day
3. Practice administrative staff has direct access to web-driven interfaces for mail and check queries and reports

Implementation

Lockbox service is typically offered by two kinds of providers:

• Large-scale Vericle-like billing service vendor as part of service
• Specialized financial institution, e.g., bank

Lockbox Selection

1. HIPAA Compliance - Can the service guarantee access only on the "need to know basis" and only to qualified staff? Are all required privacy and security measures in place? Is there a solid disaster recovery capability and process?
2. Quality Assurance Process - What measures are taken to ensure timely error identification, correction, and tracking? Is there sufficient QA process transparency to allow the practice owner complete control of mail and checks?
3. Intuitive User Interface - How many steps are required to find a letter, EOB, or a check? What are mail and check indexing parameters?
4. Batch Interfaces - Is there a convenient way to download all or partial content of the document management system for upload in other systems, such as a billing system, or in alternative lockbox provider facility?
5. Timeframes - How long does it take to open mail, scan it into a document management system, and deposit a check? What is the time horizon for archived image storage? What is the time period for storage of original paper before shredding?

Complexities

Lockbox

• Must be fully implemented - a partial implementation only increases management complexity.
• Adds headache with payers - all payers need to change mailing address, adding error likelihood during transition period.

Lockbox services lower administrative costs, increase staff productivity, and close collection cycles faster. A more efficiently run practice and happier staff mean more satisfied patients.

Yuval Lirov, PhD, author of "Practicing Profitability - Network Effect for Revenue Cycle Control in Healthcare Clinic and Chiropractic Office: Scheduling, SOAPCare 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

Centralized Workflow Management for Outsourced Electronic Medical Billing Service and Software

The reduction of accounts receivable is key responsibility of billing function in a medical practice. This article compares traditional (distributed) billing function with centralized workflow management. It shows that centralized workflow management yields significant advantages over the distributed approach in terms of the ability to manage accounts receivable. However, it also requires significant investment in process, technology, and personnel training.

Benefits of Centralized Workflow Management for Medical Billing

Centralized workflow management is superior to traditional billing operations management because it enables continuous billing process improvement and avoidance repetition of errors, while reducing dependency on specific individual billing knowledge. The billing process improves systematically along the key performance dimensions, including payment amount and its timeliness.

Centralized workflow management accomplishes such important benefits using a two-pronged approach based on formal encoding of billing and compliance knowledge and a computer program to apply the knowledge and manage claim followup lists.

As encoded billing knowledge base grows, the accuracy of the claims and the speed of the process increases. Additionally, the staff can spend more time focusing on exceptions, while an increasing majority of claims is processed automatically.

Moreover, centralized workflow shares its billing rules across all providers and billers. Therefore, errors discovered and corrected for one provider will be avoided in the future for all of the providers using the system.

What is Workflow?

Workflow is defined as a sequence of actions performed on a claim until it is paid. Centralized workflow management must quickly separate “clean” claims from potential failures, submit clean claims to payers, and flag potential failures for correction. Workflow must also track the correction process, ensuring its integration with other sources of failures and successful completion. Finally, workflow must facilitate meticulous documentation of every step to enable continuous improvement and learning from experience.

Failed Claim

A failed claim is a claim that is flagged by the workflow system upfront as an invalid claim, is rejected by the payer after submission, or is not properly adjudicated within 30 days -- in other words, a claim that requires followup.

Workbench

Centralized workflow manages such followup lists of failed claims using workbenches. A workbench is a list of failed claims assigned to individual biller or operator. Such individual assignment of work enables continuous and individual performance tracking and improvement.

Activity Triggers

In medical billing operation, the followup lists and “to-do” lists of individual actions for each failed claim constantly change. To manage multiple to-do lists, the centralized workflow system has activity triggers. Activity triggers are the heart of task automation; they help determine what's important. Activity triggers match up promises with events and manage individual work queues in the process.

Remembering to call a payer or a provider weeks after a phone conversation when payment or claim clarification was promised requires a billing clerk to sort through their call-on-receipt folder several times a day. Activity triggers eliminate the reliance on personal memory and enable communication between individual workbenches. They are the strings that tie billing activities together. When Mary from the provider’s office updates the claim with correct ICD-9, the system needs to be aware that the claim is ready for validation, and John in billing office needs to know so he can review it again, if the validation failed or schedule its transmission to the payer.

Task Automation

Centralized workflow eliminates paper-based steps. Like a relay team passing the baton, the billing staff members electronically pass along their work without delays. Instead of printing, faxing, and following up with an e-mail or a phone call, all tasks arrive complete with supporting documentation. Rather than thumbing through reams of paper reading scribbled notes, billers receive onscreen reminders when tasks are due.

Process Monitoring

Centralized workflow also simplifies process monitoring. Providers and managers use dashboards to review key indicators. Like activity triggers, dashboards help focus personnel on what is important from high-level perspective. They show key business information that tells us if we are paid more or less over time, if our charges are going up or down, and if our followup policies are too lenient. They tell us whether we are heading in the right direction and act like lighthouses to keep us off the shoals. When we see that warning light, we can drill into the details and take corrective action.

Summary

The key difference between vericle-like centralized workflow management and traditional approaches is that a centralized workflow guides the operator in terms of claims that need followup. There is no need to manually look up reports to analyze data and select claims for followup. Vericle-like approach ensures followup consistency and timeliness.
 

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

Electronic Medical Billing Software, HIPAA Compliance, and Role Based Access Control

HIPAA compliance requires special focus and effort as failure to comply carries significant risk of damage and penalties. A practice with multiple separate systems for patient scheduling, electronic medical records, and billing, requires multiple separate HIPAA management efforts. This article presents an integrated approach to HIPAA compliance and outlines key HIPAA terminology, principles, and requirements to help the practice owner to ensure HIPAA compliance by medical billing service and software vendors.

The last decade of the previous century witnessed accelerating proliferation of digital technology in health care, which, along with reduced costs and greater service quality, introduced new and greater risks for accidental disclosure of personal health information.

The Health insurance Portability and Accountability Act (HIPAA) was passed in 1996 by Congress to establish national standards for privacy and security of personal health data. The Privacy Rule, written by the US Department of Health and Human Services took effect on April 14, 2003.

Failure to comply with HIPAA risks accreditation and reputation damage, lawsuits by federal government, financial penalties, ranging from $100 to $250,000, and imprisonment, ranging from one year to ten years.

Protected Health Information (PHI)

The key term of HIPAA is Protected Health Information (PHI), which includes anything that can be used to identify an individual and any information shared with other health care providers or clearinghouses in any media (digital, verbal, recorded voice, faxed, printed, or written). Information that can be used to identify an individual includes:

1. Name
2. Dates (except year)
3. Zip code of more than 3 digits, telephone and fax numbers, email
4. Social security numbers
5. Medical record numbers
6. Health plan numbers
7. License numbers
8. Photographs

    

    

 

Information shared with other healthcare providers or clearinghouses

1. Nursing and physician notes
2. Billing and other treatment records

    

    

 

Principles of HIPAA

HIPAA intends to allow smooth flow of PHI for healthcare operations subject to patient's consent but prohibit any flow of unauthorized PHI for any other purposes. Healthcare operations include treatment, payment, care quality assessment, competence review training, accreditation, insurance rating, auditing, and legal procedures.

HIPAA promotes fair information practices and requires those with access to PHI to safeguard it. Fair information practices means that a subject must be allowed

1. Access to PHI,
2. Correction for errors and completeness, and
3. Knowledge of others who use PHI

    

    

 

Safeguarding of PHI means that the persons that hold PHI must

1. Be accountable for own use and disclosure
2. Have a legal recourse to combat violations

    

    

 

HIPAA Implementation Process

HIPAA implementation begins upon making assumptions about PHI disclosure threat model. The implementation includes both pre-emptive and retroactive controls and involves process, technology, and personnel aspects.

A threat model helps understanding the purpose of HIPAA implementation process. It includes assumptions about

1. Threat nature (Accidental disclosure by insiders? Access for profit? ),
2. Source of threat (outsider or insider?),
3. Means of potential threat (break in, physical intrusion, computer hack, virus?),
4. Specific kind of data at risk (patient identification, financials, medical?), and
5. Scale (how many patient records threatened?).

    

    

 

HIPAA process must include clearly stated policy, educational materials and events, clear enforcement means, a schedule for testing of HIPAA compliance, and means for continued transparency about HIPAA compliance. Stated policy typically includes a statement of least privilege data access to complete the job, definition of PHI and incident monitoring and reporting procedures. Educational materials may include case studies, control questions, and a schedule of review seminars for personnel.

Technology Requirements for HIPAA Compliance

Technology implementation of HIPAA proceeds in stages from logical data definition to physical data center to network.

 

 

 

1. To assure physical data center security, the manager must
   1. Lock data center
   2. Manage access list
   3. Track data center access with closed circuit TV cameras to monitor both internal and external building activities
   4. Protect access to data center with 24 x 7 onsite security
   5. Protect backup data
   6. Test recovery procedure

    

    

2. For network security, the data center must have special facilities for
   1. Secure networking - firewall protection, encrypted data transfer only
   2. Network access monitoring and report auditing

    

    

3. For data security, the manager must have
   1. Individual authentication - individual logins and passwords
   2. Role Based Access Control (see below)
   3. Audit trails - all access to all data fields tracked and recorded
   4. Data discipline - Limited ability to download data

    

    

 

Role Based Access Control (RBAC)

RBAC improves convenience and flexibility of systems management. Greater convenience helps reducing the errors of commission and omission in granting access privileges to users. Greater flexibility helps implement the policy of least privilege, where the users are granted only as much privileges as required for completing their job.

RBAC promotes economies of scale, because the frequency of changes of role definition for a single user is higher than the frequency of changes of role definitions across entire organization. Thus, to make a massive change of privileges for a large number of users with same set of privileges, the administrator only makes changes to the role definition.

Hierarchical RBAC further promotes economies of scale and reduces the likelihood of errors. It allows redefining roles by inheriting privileges assigned to roles in the higher hierarchical level.

RBAC is based on establishing a set of user profiles or roles according to responsibilities. Each role has a predefined set of privileges. The user acquires privileges by receiving membership in the role or assignment of a profile by the administrator.

Every time when the definition of the role changes along with the set of privileges that is required to complete the job associated with the role, the administrator needs only to redefine the privileges of the role. The privileges of all of the users that have this role get redefined automatically.

Similarly, if the role of a single user is changed, the only operation that needs to be performed is the reassignment of the user profile, which will redefine user's access privileges automatically according to the new profile.

Summary

HIPAA compliance requires special practice management attention. A practice with multiple separate systems for scheduling, electronic medical records, and billing, requires multiple separate HIPAA management efforts. An integrated system reduces the complexity of HIPAA implementation. By outsourcing technology to a HIPAA-compliant vendor of vericle-like technology solution on an ASP or SaaS basis, HIPAA management overhead can be eliminated (see companion papers on ASP and SaaS for medical billing).

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