Free Billing Software

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

2008-05-21T23:58:00.000-07:00

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:

Publish your payment collections policy and standard responses to typical patient's objections.
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.
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.
Train clinic physicians to direct patients to front-office staff to review financial statements.
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 "Mission Critical Systems Management" (Prentice Hall), inventor of patents in Artificial Intelligence and Computer Security, and CEO of Vericle.net Billing Technologies and Services. Vericle? unites hundreds of billing services across the nation. Its electronic medical billing software tracks payer performance from a single point of control and shares compliance rules globally. Yuval invites you to register to the next webinar on audit risk at BillingPrecision.com.

Blue Cross Blue Shield Michigan Heads April's Chiropractic Office Billing Software Precision Index

2008-05-21T02:21:00.000-07:00

Chiropractic Office Billing Software Performance Index (BPI) in April 2007 outperformed its March value by 4.3%, bringing the index from 18.9 up to 14.6, ahead of the national average of 17.7%, while replacing four of BPI participants in March 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. This article describes a rule-based chiropractic billing index, including its coverage definition, update cycle, volume weighting, and provided information.

BPI = 14.6 means that the average of ten top performing payers working with Billing Precision clients have 14.6% 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 14.6
Blue Cross Blue Shield Michigan 3.2
Blue Cross Blue Shield Colorado 6.8
Humana 7.9
Blue Cross Blue Shield Illinois 11.1 (down from 11.2 in March)
United Health Care 13.9 (up from 23.2 in March)
Cigna 15 (down from 12.9 in March)
Medicare New Jersey 16.4 (up from 20.5 in March)
Blue Cross Blue Shield Texas 20 (down from 15.2 in March)

Great West 22
Aetna 22.1 (down from 20.9 in March)

April BPI dropped four participants since March:

Blue Cross Blue Shield Pennsylvania
Blue Cross Blue Shield Alabama
Medicare Pennsylvania
Blue Cross Blue Shield New Jersey

Three payers improved their index since March:

Blue Cross Blue Shield Illinois 11.1 (down from 11.2 in March)
United Health Care 13.9 (up from 23.2 in March)
Medicare New Jersey 16.4 (up from 20.5 in March)

Three participants lowered their indexes with respect to March BPI:

Cigna 15 (down from 12.9 in March)
Blue Cross Blue Shield Texas 20 (down from 15.2 in March)
Aetna 22.1 (down from 20.9 in March)

April BPI added four new participants since March:

Blue Cross Blue Shield Michigan 3.2
Blue Cross Blue Shield Colorado 6.8
Humana 7.9
Great West 22

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.

Medical Billing Software Concept

2008-05-20T02:59:00.000-07:00

What is medical billing software More than ten years ago medical billing records were committed on paper. The advent of computers and the introduction of reliable medical billing software have largely phased out the paper system of keeping medical billing records.

Today's healthcare providers have realized medical billing software ensures their reimbursement claims are facilitated in a secure and efficient manner. It also tracks each patient's medical and insurance billing and accounting, all to the benefit of patients.

Here are three benefits inherent in the use of medical billing software as compared to the paper based systems.

1. Medical billing software improves staff productivity, as easy to use medical billing software improves efficiency.

2. Installing medical billing software in your office increases patient satisfaction. This is because a majority of medical billing software offers flexibility in scheduling and better access to personal information.

3. Fewer errors are committed in billing and insurance. When this happens, the medical billing software can easily correct these mistakes and the claims resubmitted in days rather than weeks. Medical Billing Training. With the complexity of today's health care and insurance system, medical billing has become an industry of its own. In order to manage the thousands upon thousands of patient, insurance company, and HMO accounts, doctors and hospitals rely on sophisticated medical billing systems. Far from having the time to run these systems themselves, large dedicated administrative staffs specialize in managing these systems and interacting with the account holders on a daily basis.

Medical Billing Training. With the complexity of today's health care and insurance system, medical billing has become an industry of its own. In order to manage the thousands upon thousands of patient, insurance company, and HMO accounts, doctors and hospitals rely on sophisticated medical billing systems. Far from having the time to run these systems themselves, large dedicated administrative staffs specialize in managing these systems and interacting with the account holders on a daily basis.

I maintain site http://www.popular-softwares.com having info on most popular softwares.

3 Benefits of Web-Based Electronic Medical Billing Software

2008-05-20T02:51:00.000-07:00

When you decide to opt for Web-based medical billing software you will find many great benefits. These include but are not limited to, reduced install and maintenance costs, security from natural disasters, anytime access.

Anytime Access

A major benefit of a Web-based medical billing solution is that you can access the information anytime. Whether you are at home, or in the office, you only need an Internet connection and you will be able to access all the information you need. Late at night or early in the morning or during the day you will be able to access the information for your practice.

Reduced Install and Maintenance costs

Another benefit of the software being Web-based is that there are much lower installation costs. You will see this benefit right up front as it will be the first step that you go through. Another benefit is the reduced maintenance cost. Many server based technologies need to be upgraded and constantly monitored. This can sometimes lead to unexpected costs to help maintain your current system. With Web-based technologies these maintenance costs are much, much, much lower.

Accidents unfortunately happen

As much as we like to think that accidents never happen to us, there is a chance that they just may. Many people use insurance to cover them incase of these major accidents. But many people do not think about what is going to happen to their information in an accident. With Web-based electronic medical billing software there is greater satisfaction in knowing that if an accident where to go through a horrific accident, you would be not lose all of your records. If there were a fire, earthquake, flood and your servers were hit, you would lose all of your client information. But if you had a Web-based software solution, even though your office may be damaged, your records wouldn?t be. You would be able to be up and running in almost no time.

So when deciding between Web-based and server side software remember these major benefits of Web-based medical billing software.

Alex Hachtman is a Marketing Specialist for AdvancedMD Software in Draper, Utah. For more information about medical billing software, please feel free to contact an AdvancedMD representative.

Medical Billing Software

2008-05-19T01:48:00.000-07:00

Billing software is an application that can make the billing process a breeze at any medical office. Billing software and its use guarantees the practice proficient billing practices with less manual labor involved in handling the process of billing. In fact, software can help the office keep organized and make tax time a hassle free time for the office that takes advantage of such an application.

There are numerous software applications designed for the specific needs of the community. Billing software applications are engineered for family practitioners, clinics, billing service specialists, hospitals, psychologists, physical therapy offices, chiropractic offices, dental practices, and there are even medical software applications suitable for equipment companies. The software applications that have been engineered for medical office management are diverse, providing users with a variety of functions as well. Current software allows users to bill patients, report overdue bills to collection agencies; make patient appointments; handle scheduling; easily submit claims to insurance companies and software serves as an electronic database of patients records.

Clearly, software is something no practice or office should be without. The functionality of the program alone makes the software an imperative tool in every medical office. Current medical billing software applications have been designed to meet with the standards imposed by HIPPA and the fact that any claims made to insurance companies are electronic and not paper means that the office will receive payment that much faster.

There are numerous medical billing software applications designed for the specific needs of the medical community. Billing software applications are engineered for family practitioners, medical clinics, medical billing service specialists, hospitals, psychologists, physical therapy offices, chiropractic offices, dental practices, and there are even medical billing software applications suitable for medical equipment companies. The software applications that have been engineered for office management are diverse, providing users with a variety of functions as well. Current software allows users to bill patients, report overdue bills to collection agencies; make patient appointments; handle scheduling; easily submit claims to insurance companies and billing software serves as an electronic database of patients records.

Medical billing software will undoubtedly help you in your quest to establish more organized business practices. Most doctors and medical billing professionals find that medical billing software helps them execute their billing in a more organized and efficient way. No longer will you have files and piles of information that could be better organized. Your medical billing software will help you index information in a better manner so that you can pull up bills for clients, send them out in an efficient amount of time, and simply keep good records.

Medical Billing Management is an informative Medical Billing site that looks into all aspects of Medical Billing from Software to Management. To find out more visit Medical Billing

Medical Billing - Software Capacity

2008-05-16T23:20:00.000-07:00

The one thing they haven't quite figured out yet in the world of medical billing software is how to make a package big enough in terms of capacity to handle any size company. In this article, we're going to take a look at the problem and just why it's a problem, along with some possible solutions.

Years ago, many years ago, if you had a meg of memory in your computer, you could do just about anything at all. Today, half a gig can just about get your operating system started. As systems and programs get larger, the requirements for these programs grow. But this isn't so much the issue here. Certainly today's PCs have enough memory and disk space to be able to handle starting up an operating system and a piece of software. The issue has more to do with the actual software itself and the mega businesses that use it.

Today, we have corporations involved in the medical billing business that are so massive, it isn't unusual for them to be billing hundreds of thousands of patients. Suddenly, a software package that used to run on a single PC is no longer able to do the job. So networks are built with the software running on individual workstations. The servers running this software are massive. The memory and disk space used by these servers are light years ahead of what they used to be. And yet, with all of this processing power, the software itself can only handle so much. Why?

One of the reasons is the platform on which the software is built. Unfortunately, most software companies build their products on databases that have serious limitations. For example. Some of the most popular DME software packages is built on the database known as Btrieve. While a good database, it has its limitations. One of them is the size it can grow to before you start seeing corruption problems in the database itself. When companies started getting large enough to poke holes in this database, the first solution was to break the database up into multiple companies. But this quickly lead to legal problems and other issues such as being able to get meaningful reports from multiple companies.

Another problem the software packages started running into was the actual processing of the data stored in the database once a solid platform was found. Many users began to notice that running a sales report for a company with 100,000 patients was taking a day to run and tying up all the resources of the server, thus slowing down the work of everyone else. So new network architectures had to be configured to make it so that the reports being run would not have any effect on other users of the system. This was easier said than done with a shared database. So the next solution was to duplicate the database using a RAID system and run the reports off the other drive.

And these problems are only the tip of the iceberg. The unavoidable truth is, as long as companies continue to grow and more and more data is needed, these companies will continue to outgrow the software that is being used. That's why there are constant updates for all these packages.

Michael Russell

Your Independent guide to Medical Billing

Medical Billing - Software System Reports

2008-05-16T03:40:00.000-07:00

In the land of medical billing, we get so caught up in the day-to-day operations of getting the bills out, we completely forget about checking to see if our software system is operating the way it should. Needless to say, as problems become noticeable, it is usually because of neglect in keeping an eye on things. In this review, we'll go over some basic system reports that you should be running just to make sure that your software is performing the way it should.

The first report that you should be running is an error report. All software packages track any kind of errors that occur during processing. This could be any kind of processing from submitting claims, to printing forms to running other reports. This error report should be run on a daily basis. The number of errors that occur should be minimal to say the least. If you find a gradual increase in the number of daily errors, this could be an indication that there are problems with the software. The most common of these are corrupted databases. If you suspect this, run a utility to check the integrity of your various databases.

The next report you should run is what is called a failed request report. This usually has to be run on the server unless the software package itself has this capability. Most high end DME software packages do produce a limited failed request report. But if you really want to get a full blown report with all the details that you're going to need. The usual cause of failed request is a bad network connection. If this is what you suspect, have your network administrator run diagnostics on the network. Also have him check all the wiring and network cards in all the computers. Usually the failed requests will come from one particular computer which narrows down your search for the culprit.

You're also probably going to want to run a report on network activity and system resources. For the most part, unless you have a massive billing department, the activity on the server should be minimal. Memory usage shouldn't even register a blip. However, if you find that there are spikes in memory usage, you might want to look at the times of the day that this is occurring. Find out from the billing department when their heaviest periods are as far as billing and other activities. See if there is a correlation between the two.

Finally, you're going to want to run a report to see the rate at which your databases are increasing in size. If you are a large medical billing company, your databases are going to grow at an alarming rate. While your server capacity may be in the gigabytes, it doesn't take long before you find that your medical billing software is hogging up 50% of your disk space. Once you see this happening, you're going to need to make plans to either add another drive or upgrade the one you have.

Medical billing is more than just sending out bills. If your system isn't functioning properly, you could be out of business before you even know what happened.

Michael Russell

Your Independent guide to Medical Billing

Billing Software, Free and Open this Time

2008-05-15T03:54:00.000-07:00

Billing is one important area of all small and big businesses. Billing software market is crowded that choice of one becomes so difficult for a start up business owner. The question is will billing software survives the flood of software suits or packages offered by small and big software developing companies.

It should. The problem open software community today faces is the lack of skills or interest to learn the basics of programming and working of programs.

People also seek comfort zones all the time. We all live in an age of instant gratification and we are hardly programmed to wait or try hard to get something. This is the general trend and they will go for easily available packaged solutions, instead of trying to learn what it is about the working behind the things they see.

Needless to say a billing cum accounting system will, to a great extent take the load of learning accounting from your shoulders. With Free and Open Source Software (FOSS) the modern mantra, it is quite understandable if a few companies have taken the initiative to make major inroads into the field of free open source billing software.

It is necessary for the user to have a basic coding and programming knowledge to tweak the pieces of software to a workable suite. Then again the attempts in that direction should be recognized.

When introducing an open-source billing software, it is sure to be met with much skepticism and prejudices. No open source software is an exception. The whole hearted attempts from skilful people keep the trend alive.

A recent addition to free software, specifically billing software is JBilling, located at http://www.jbilling.com/. The open source software works with all major operating systems and supports My SQL, Postgre SQL and Hypersonic. It runs on JBOSS. It is thus a 100% free open source billing system that supports recurring billing, automatic payment processing using credit cards etc. It also handles web-based interface directly with end customers.

The software thus easily becomes an alternative to proprietary billing systems.

You can find more about Jbilling at {a rel="nofollow" href=" http://jbilling.com/"} http://jbilling.com/

Medical Insurance Billing Software

2008-05-13T00:05:00.000-07:00

Working in a medical office can be hectic. However, medical insurance billing software can make your work day much more organized and easier. The days of hand writing all your patient's records are long gone. Using powerful software for organizing your patient's insurance information will make a big difference.

Having all of this information handled by a good medical insurance billing software means that you can automatically manage all insurance claims. This greatly decreases the amount of time you will need to spend sorting through past claims. Once all of this information is fed into the software, handling all this information becomes an easy task.

Medical insurance billing software can also notify you of any specific past due balances. With the click of a button you can send this notice to the proper place and have the patient notified of this balance. You can even have the system notify you of all patient's who have a bill due and take actions from there.

Privacy is a big concern with everyone and rightfully so. Medical insurance billing software gives you the option to encrypt patient's records. This greatly reduces the risk of having someone having his or her records falsely changed. No one will be able to view this information unless they have been given the proper rights to do so. Having this feature alone makes medical insurance billing software much better than a hand written file.

Another great feature offered by medical insurance billing software is that you will be instantly notified when a patient needs to make a co-payment. No longer do you need to make phone calls to the insurance company to verify this information. Everything will be automatically updated on your computer screen, and you will know exactly how much the patient is required to pay.

Streamlining your current office situation can be as easy as implementing a powerful medical insurance billing software. While they may take some time to get used to, it is definitely time worth spent. Training for these types of programs is even being offered in many medical schools around the world as this is the most effective way to manage this important information.

Lee Leong is the owner of Cheap Software which specializes in providing 100% free software information and resources for everyone

Medical Billing - Picking Your Software

2008-05-11T23:25:00.000-07:00

In the many previous installments of medical billing that we have been through, we have discussed just about everything there is to discuss about medical billing software, such as what it can do, how to find problems and how to use it. But one thing we haven't covered, which is probably the most important thing of all, is how to choose your medical billing software. There are many brands out there. So how do you know which is the best one for your needs? Hopefully, after reading this installment, you'll have a decent idea of how to pick out your medical billing software if you haven't already done so.

The first thing you have to do is look at the size of your company and your computer setup. This is important for several reasons.

For starters, not all software packages run on all platforms. So if you're running a network on Mac computers, don't buy a software package that is made for Windows platforms. If you're running a peer to peer network, don't buy a software package that specifically says that it is for star based networks or similar client server networks.

As for the size of your network, if you have a company of 100 users, don't buy a software package that is limited to 50 user licenses. Conversely, if you only have five users in your company, it is wasteful to buy a software package that is specifically designed for companies with hundreds of users. You won't need all that power.

The next thing you have to look at is what your actual billing needs are. If you are a DME billing company, you're not going to have need for software that also does dental claims. You'll be paying for functionality that you don't need. Conversely, if you plan to bill all kinds of medical claims, then you better make sure that you get a software package that is going to handle all those claims. Adding on to a package at a later date is not always an easy thing to do.

The next thing that you want to look at is what extras the software company is going to provide for you, such as forms. Forms are a very big part of medical billing and there are a ton of them. If the software company will also provide you these forms at a reduced cost, then it might be worth it to go with them even if the software is not 100% what you're looking for, as long as it is close enough. Conversely, if another company will offer you forms and the one you're looking at won't, it may be wiser to go with the other company, if the software is at least close enough to what you want.

The next thing you need to look at is price and what you can afford. If your perfect software is way above your means, especially if you're a small company, then you might want to go for something that is a step down. You don't need all the bells and whistles to do this job.

Finally, you need to look at the support record of the company. Find out if there have been any complaints against them. You can do this through the BBB.

If you do all of the above, you have a good chance of coming away with the medical billing software that is just right for you.

Michael Russell Your Independent guide to Medical Billing

Medical Billing - Software ROI

2008-05-09T23:07:00.000-07:00

One of the most heated arguments in the medical billing world, at least when it comes to the software company, is ROI or return on investment. This is something that is very difficult to calculate as far as what you want your ROI to be and everybody has their own theory and opinion on the subject. If you're a software company just starting out, or better yet, thinking of starting a medical billing software company, there are some basic things you need to consider when figuring out what you want your ROI to be. What follows is a list of the most basic of these items. For starters, you have to figure out what your cost of production is going to be before you even hire any programmers to create this software. This basically involves the cost of the lease on the building you'll be using as well as any other fixed costs such as utilities, insurance, etc. Add all this up and put the estimated total in one column.

The next thing you're going to have to calculate is the salaries of all the people who will be responsible for getting your product out. This includes programmers, QA persons, support techs and all managers. You will also need a networking department who, though they won't be directly responsible for working on your software, will be keeping your operation going. You need to calculate these salaries not just for the time that the software will be developed but also for the time after while you're supporting the product, which will hopefully be for the lifetime of the product. Will you keep the same number of programmers. QA people and support techs? What salary increases do you foresee? Figure all this out and put it in a second column.

The next thing you have to figure out is the cost of any add on items that you intend to include with the software at no extra charge. For example, in the medical billing industry there are a ton of forms that customers are going to need. Are you going to include these forms or are you going to have your customers get them from an outside source? What about peripheral equipment? Are you going to include barcode and retail sales machines? If so, you need to include the cost of these. Also, you're going to need to calculate the cost of maintaining all the equipment. If you deal in peripherals, you're also going to need a tech staff.

After you have figured out what all your yearly costs are going to be, you then have to decide what you want your return to be. In other words, let's say you plan to spend $1,000,000 a year and you want a 10% profit each year. You first have to figure out how many software packages the market will allow in a year. Let's say it's 10,000. If you want a 10% return, then you want to sell $1,100,000 worth of product. If you sell 10,000 units, doing the math, you will need to sell each unit at $110. This is actually very cheap for medical billing software as most packages go for several thousand dollars. So most likely, if you price your software correctly, you will make much more than a 10% ROI.

This is of course greatly simplified, but basically, this is what you need to do in order to figure out what your ROI is going to be for your medical billing software.

Michael Russell Your Independent guide to Medical Billing

What Is Billing Or Time Tracking Software?

2008-05-09T01:19:00.000-07:00

Any business needs to be clear about their transactions to ensure smooth functioning. But often, it is found that the off invoice has gone missing or that there is no record of it. Most of the times, it is a simple case of the record aligning itself in the wrong place. Not much you think, but identifying this itself can be quite a headache eating into precious man-hours and not to mention the anxiety it can cause.

A full-fledged billing software suite can save you from these and many other hassles. Billing software that is rich in features can often help you ensure that you do not miss out on any details in invoicing. Take taxes for instance? you did not intentionally leave out one of the tax charges for your client, but who?s going to explain that to the taxman? What it also means is that you have to fork out this money from your pocket for the time being at least! Not a nice scenario, eh?

While the above processes may be streamlined in case of a large corporations where they have full-time finance departments that are paid to ensure all billings are done correctly, in case of smaller companies and more so in the case of a start-up, this could be a troublesome area. Why burden yourself with something that is not your job? Find a good package and just enter all the right data. The rest will take care of itself.

Another advantage most time tracking software offer is the ability to configure and make repeat invoicing easier. So for your long-term jobs, you don?t need to remember to make a new invoice every time. Come the time and your invoice will be ready. What?s more is the invoice can also be a custom made one that satisfies your and your client?s needs.

But even before you reach the billing stage, there is the need to know how much to bill. Even if you are working on a project that does not need you to charge by the hour, it would be worthwhile keeping track of how much time you have spent on what just to make sure you are working optimally. Using a proper time tracking software can help you do just that. In fact, there is some software that sits in your Outlook and can help you optimize the time spent on a particular client by syncing up with your appointments. So by the end of the month, you know exactly how much time you have spent on which client and how much to charge them.

Remember that your time is valuable and also your only tool to prove to your client the effort you have put in. No matter how passionate you are about your work, there is satisfaction in knowing that you have been compensated correctly and there is peace of mind in knowing that your books are up to scratch.

Aaron Reed writes technical write-up for AECTek - Offshore Software Outsourcing Company. AECTek is based in India and also provides Billing and Time Tracking Software solutions

Medical Billing - The Internals Of Software

2008-05-08T01:50:00.000-07:00

The things that medical billing people take for granted. Open up your software, push a button, login. Push another button, get a patient menu. Push another button, pull up a patient. Click, click, click and the process goes on and on. Medical billers have no clue what is actually going on behind the scenes of their software. In the following installments and this is mainly for you tech heads, we're going to show you exactly what goes on behind the scenes with your medical billing software with the main parts of the system. To cover everything would take a lifetime.

We'll be covering how patient files get put into the system and how they are ultimately access by a biller and placed into a work order to be billed. While this seems like a very simple process, it is actually quite complex and requires a lot of indexing and cross-referencing.

Another thing we're going to cover is how a claim gets sent electronically. This is one of the mysteries of medical billing as this whole process is actually invisible. While you can see a patient being pulled to a page, you can't see a claim file being transmitted. How does it go? Where does all that data come from when you have so many record specifications? How does the software know to interact with your transmitting device, which is usually your modem? These and other questions will all be answered.

We will also discuss how forms are printed. How does the software know exactly where to place that patient name and address? How do you choose a form, as there are so many of them? Where does the data get pulled from when all you see in front of you is a patient name?

If you're curious as to how security is set and how the software knows to lock somebody out of a certain part of the system, we're going to cover that too. The many options that you have to security systems make this part of the system mind boggling to say the least. We'll do a detailed walk through of a DME security system and show how it works.

Wonder how your software knows how to read those automated posting files that come from Medicare with all your money tied up in them? No problem. We'll dig deep into the auto posting system so you can see exactly what is going on behind the scenes there.

What about those add-ons? How does the system know that you even have them or not? Remember, they are not part of the standard package and have to be added later. So what is actually done by the software maker to let your system know that an add-on is there?

Finally, we'll show you how the software manufacturer can tell if you have a valid copy of the software and when it's time to pay your maintenance fee on it. This gets into some really low level programming.

The above topics will all be covered in future installments. So get a box of lightly salted popcorn and enjoy the show.

Michael Russell

Your Independent guide to Medical Billing

Medical Billing - Getting Your Software To You

2008-05-07T04:18:00.001-07:00

Medical billing agencies take a lot of things for granted. They purchase a piece of DME software in order to do their daily billing and they expect everything to run perfectly. Well, in the real world, it isn't quite that simple. There is a lot of work that goes into putting out a piece of medical billing software. While we're not going to attempt to dive into this process in great detail, we're going to try to give you a decent idea of what goes into getting your DME software to you. In future installments, we'll cover this in more detail.

The first step in the process is actually deciding what is going to go into the software itself. This is usually determined by the owners of the company, but frequently, the programmers have a big say in the final product because they may know what is and what isn't possible. Just because management wants something doesn't mean it's going to be done.

The next step is to actually begin the design of the software itself. This involves specifications that are general as well as detailed. The software needs to be given an overall look to go along with the individual bells and whistles that it comes with.

After the software is designed, piece by piece, each section is given to a QA person to test. It is their job to make sure that the section of the software that they are testing works the way it is supposed to, whether it be billing, printing forms, updating prices or whatever. Because medical billing software is so complex, a team of QA people are usually assigned to test it.

If any bugs are found in the software through testing, the QA people send the software back to the programmers. This process continues until the software is found to be bug free.

The software is then given to the support people to learn. The reason for this is because they are the ones who are going to be taking calls from customers who have problems. So it is their responsibility to learn every inch of the software that they can.

Finally, after everything is completed, the manuals are written by the QA people or tech writers, depending on how the company is structured. These are the manuals that are distributed to the medical billing companies who buy the software.

When all of that is done, the software is then packaged in a nice neat and pretty box. This box is made by the graphic artists team. If you don't think presentation is important, think again. Presentation is almost everything in the business world.

After the software is packaged, it is then given to the sales people to distribute. These people usually have leads to companies looking for medical billing software. That's where they start.

It's a very long process from start to finish. So when you finally do get your DME software, try to understand that a lot of hard work went into getting it to you.

Michael Russell Your Independent guide to Medical Billing

Medical Billing - Software Manuals

2008-05-06T00:20:00.000-07:00

Medical billing is complicated enough without having to know every inch of your billing software by heart. Because of all the complexities involved, medical billing software manuals are not only critical but they're also enormous. As a matter of fact, most medical billing software manuals are shipped in parts. So you have a decent chance of finding what it is you're looking for, we're going to give you a general breakdown of how a DME software manual is put together.

The first section of the manual is usually where you will find your installation instructions. These will contain step-by-step procedures for installing the software on each type of network, with subheadings for each network. Usually, the table of contents will include the networks covered so you don't have to go hunting for yours.

In this section, you will also find installation instructions for any add ons such as retail sales and barcoding. This is in case your company purchased these extra utilities. If they didn't, then this section won't apply. It's more cost efficient to include the add ons installation instruction in the standard manual than to send out a separate one only for customers who have add ons.

In your next manual, you'll find your instructions for setting up your databases. This is where you will find out how to enter data for doctor files, inventory files, patient files and so on. This section of the manual will usually have diagrams of each data entry screen so the user will know where each field is. Also, a complete description of each field will be included as well. For fields that tie in to medical forms, the manual will also tell the user which forms the field goes to as well as where on the form, such as line number.

The next set of manuals will usually focus on how to do billing, whether it be through printing out HFCA forms or sending claims electronically. Some software manuals have these sections separated. In addition to that, most software companies provide a separate manual plus record specifications for each carrier that is being billed, such as Medicare and Medicaid. In many cases, where a company has a large customer base and bills many different carriers, they may have as many as five or six different medical billing manuals or more.

And if all that isn't enough, there is usually a whole manual dedicated to troubleshooting the system in case there are problems. The reason a software company will go through all that trouble is to cut down on the number of support calls that they get, as each call takes up man hours, which is a lot more expensive than printing out a manual.

When all is said and done, a medical billing company can literally have a bookcase filled for just one piece of software. If a company does DME billing and then has another software for dental billing, that could mean another whole bookcase full of manuals. Because there are so many, usually there is a small manual that has the master table of contents so a person knows what manual to look in for what piece of information. Yes, medical billing software companies sure do kill a lot of trees.

And to top all this off, most companies have online versions of these manuals in case the hard copies get damaged or stolen. They've got all the bases covered so that the medical billing company can spend more time concentrating on actually billing and less time looking for things.

Michael Russell Your Independent guide to Medical Billing

Medical Billing Software Troubleshooting Overview

2008-05-03T02:15:00.001-07:00

As much as billers don't want to think about it, software for medical billing is not perfect. There are going to be problems, sometimes lots of them. In the next series of articles, which will cover a number of critical areas of the DME software system, we will go over the most common problems that you will run into when operating your DME medical billing system. In this particular installment, we're going to just give a brief overview of the areas that will be covered in more detail.

The first part of the system where you are going to run into problems is the actual installation and running of the software itself. Even though manufacturers try to make software that will work on any operating system and network, this isn't always the case. Sometimes just installing the software itself can be a problem.

The second part of the system where you are going to run into problems is the entering of data, which is where you store your doctor files, patient files, inventory files and so on. These data entry problems can range from something as simple as a piece of data not saving correctly to losing whole chunks of information or even a whole database.

The third part of the system where you are going to run into problems is the actual billing of claims. This is where you run into the largest variety of problems because billing itself covers such a wide area. This installment will probably be further broken up into smaller installments in order to cover everything and not give you information overload.

The fourth part of the system where you are going to run into problems is with the printing of forms. This is another part of the medical billing system that is so complex because of the large number of forms that sometimes trying to determine the cause of the problem can be extremely difficult at best. These problems range from something simple like a form not lining up to fields not printing at all.

The fifth part of the system where you are going to run into problems is with your add ons. Because there are so many different add ons for medical billing packages, there is no one troubleshooting method that works for all of them, especially when you're dealing with something as complex as barcoding or retail sales equipment.

The sixth part of the system where you are going to run into problems is with security and administration. This is probably the last place you want to have a problem because security is so critical. These problems can run from something as simple as a person who is supposed to have access to a module not having that access to somebody literally breaking into the system.

The final part of the system where you are going to run into problems is with the communications system. This comes into play when you're doing things like electronically billing or running an online update for the system itself.

We'll be covering all of these topics in more detail in our future medical billing installments for troubleshooting your software.

Michael Russell Your Independent guide to Medical Billing

Medical Billing - DME Software Forms

2008-05-01T01:29:00.000-07:00

As is true in most of the administrative world, there are more forms than people know what to do with. Go to a doctor's office for a procedure and he'll most likely have you fill out a slew of forms that will end up taking you longer to do than the whole examination or procedure itself. Well, the world of medical billing is no different. There are more forms than you can possibly imagine. We take a look at some of the more common of these forms.

Probably the most common form in medical billing is the HCFA 1500 form. This is the main claim form to bill for services. These forms are enormous. There is more information contained on a HCFA 1500 form than probably on any other form in existence. The amount of information contained in a HCFA 1500 is beyond the scope of this article but some of the main pieces of information are patient personal information, insurance information, items billed and patient medical history. HCFA 1500 form manufacture is big business and these forms are very costly to billers. That is why many medical billers are switching over to electronic billing so that they don't have to deal with these HCFA 1500 forms.

Another billing form, though not as common but gaining popularity, is the UB-92 form for billing. The main difference between the UB-92 and the HCFA 1500 form is the format. For the most part, the same information is transmitted. It's just in different places. There are some things contained on one form and not on the other. But for the most part, they serve the same function.

Another common form is the Certificate Of Medical Necessity, or CMN. CMNs are needed for any item given to a patient where the biller has to show proof that the patient is in medical need of this item, such as a wheelchair or oxygen concentrator. This proof has to come from the doctor who fills out a CMN, which he then has to sign. CMNs are also big business and very costly forms, though not as expensive as HCFA 1500 forms.

Not quite as common are forms called Centers For Medicare And Medicaid Services, or CMS forms. These are actually very new and as of this writing, a new version will be coming out in April of 2007. These forms cater specifically to Medicare and Medicaid claims.

And there are a number of other odds and ends forms to add to the above list. Each one has its own specific purpose. Some you may use only once in a year but if you don't have it, it could lead to lost revenue. So be assured that the price you will pay for that form will be a hefty one.

And if all that isn't enough, each of these forms comes in either regular dot matrix form or specially made for laser printing. Yes, the laser forms are much more expensive.

Make no mistake about it. Medical billing forms is big business and one of the biggest costs to any medical billing agency.

Michael Russell

Your Independent guide to Medical Billing

Medical Billing - DME Software Updates

2008-05-01T01:28:00.000-07:00

In this installment of DME software for medical billing, we're going to cover one of the most important parts of the system, updates.

As much as medical billers would like the DME and medical billing industry to be stagnant, that is just not the case. Regulations are constantly changing as well as prices, diagnosis codes, procedure codes, electronic billing specifications and on and on. So what does one do when they just got the latest software and one week later Medicare pricing for wheelchairs has just changed? That's where updates are so important.

In the DME system, there are a number of updates and not all of them are done at the same time. Some are done monthly, some quarterly and some are done whenever needed. For example, diagnosis codes and procedure codes are usually updated on a quarterly basis. These updates, however, are not automatically done by the system. Each DME system is different. Some have updates that you get via the mail in the form of a CD and have to install yourself. Other systems have updates that you can get via the Internet. In most cases, these updates are not included with the software package and not free. You need to subscribe to the service in order to get them. This is particularly true with diagnosis codes and procedure codes.

In the matter of electronic billing module updates, these usually are included with the purchase of the electronic billing package for each carrier. Part of the contract that comes with these modules includes updates for life. Usually there is a small yearly fee to get them. Some companies actually provide free updates because the software itself is so expensive.

In the matter of price changes, these work a little differently. Prices for Medicare and Medicaid allowables usually don't change often. Usually, they only change once a year. Sometimes they may not change for a couple of years. These updates, because they are so seldom, usually are included with the software at no extra charge, though you can bet that the actual cost of the software has these updates factored into the price at the time of purchase.

And then there are odds and ends updates for things such forms. Medical billing forms are always changing because the carriers are always trying to find better ways to do things. One of the most nerve wracking jobs of the biller is to keep up with all the forms changes. Because these changes occur so often, the actual changes to the software are done on an as needed basis and the charges are per form. This is where the software makers usually make a good deal of their money. Some do offer contracts where the biller pays a yearly fee, usually quite high and the software maker will take care of all forms changes free of charge.

Software updates are more common than the common cold. That's why you'll see version numbers of the medical billing software going into double digits. And don't ever expect the updates to stop. As long as the medical billing industry is always changing, the updates will keep coming.

Your Independent guide to Medical Billing

Medical Billing - DME Software Navigation

2008-04-11T05:08:00.000-07:00

It would be really nice if when a medical biller opened up the software used to do their medical billing, a little voice said something like, "Press letter A for Administrative Options". Unfortunately, medical billing software doesn't speak to us. Add to that the fact that there is so much involved with medical billing that the menu systems are massive and you've got a real monster on your hands. Talk about walking through a Dungeons & Dragons maze. Fortunately, the navigation for most DME software packages is pretty standard, which makes finding your way around fairly easy.

Most systems have a main menu option where you can go to the main parts of the system. These parts include Installation Options, Administrative Functions, Billing Functions and Maintenance Operations. Some systems have extra options depending on what add ons come with the package, such as retail sales and barcoding. These are usually found under an option called ad ons.

Once you've gone past the main menu options, that's where things start to open up quite a bit. For example. When going into Administrative Functions, you'll usually be greeted with a number of menu options such as adding users, deleting users, changing security levels and a host of other security options. Also a part of administrative functions is setting up your network. There are usually a number of options for adding peripherals such as printers, scanners, barcoders, etc. Basically, administrative functions handle anything to do with controlling your software so that the inmates don't take over the asylum.

Maintenance Operations are a world unto themselves. This section usually involves updating the various sections of the software that has to do with data. Some software systems call this Database Operations. This is where you enter your inventory, doctors, facilities and patients, among a number of other things. Anywhere there is a table of data, you'll usually find it in this section.

Billing Functions include a number of things, such as patient lookup, starting a work order, submitting a work order to a print queue and electronically billing. In some systems the electronic billing subsystem, because it is so massive, is kept separate. This gets kind of confusing for the biller because they're looking for the Medicare electronic billing module and it's not under billing functions. Standardization only goes so far in this industry since every software company is trying to build the better mouse trap.

Add Ons are another world all to themselves. Because there are so many things that can be added to a billing system, there is no way to tell what a biller is going to find in this section. The submenu will have a list of all the add ons but unless the biller is familiar with the add ons themselves, they're not going to know what to do with them. Fortunately, most software companies have manuals made just for the add ons that they include optionally with their system. Just be prepared to do a lot of reading.

Software navigation in the medical billing industry may not be the easiest thing in the world, but with semi standardization, it does get at least a little easier.

Michael Russell

Your Independent guide to Medical Billing

Medical Billing - DME Software Add Ons

2008-04-11T05:07:00.000-07:00

Everybody loves the extras. Getting what you pay for is one thing, but when you get those extra items, is when you feel like you're getting more for your money. In the world of medical billing, this is no different. Unfortunately, most software systems don't give you those extras at no cost. Still, there nice to have when you want to do a little bit more than just bill for services rendered. So what are some of the more common extras that come with DME software?

One of the common items that come extra with DME software is what is called barcoding. Barcoding has actually been going on for quite some time in the retail world. Just go to the local supermarket and you'll find those Universal Product Codes, called UPC codes, all over the place. As a matter of fact, most supermarkets now have automated checkouts using these UPC codes. How UPC codes work is beyond the scope of this article, but briefly, what the manufacturer of the item does is place a special code on each package that needs a special reader to read the price associated with it. This price is then stored in the system so that when the code is read, which is the product code, the price comes up on the register and is added to the subtotal. This functionality is added to some DME software to enable billing houses to sell over the counter items to patients.

This ties into another add on module that is called the retail sales module. This module is actually more than just software. It includes an entire retail sales checkout system, similar to what you would see in your local supermarket. These have to be specially installed by a trained technician. These retail sales modules can read the barcodes that are programmed into the barcoding module. So most people who get the barcoding add on will also get the retail sales add on as well. However, some companies only use the retail sales module and do checkout the old-fashioned way before they had barcodes. Usually small ma and pa stores will do this. These stores usually only do limited medical billing either to Medicare or Medicaid and don't handle a lot of private insurance companies.

Another common ad on, which many people believe should really be standard, is the electronic billing packages. The reason this is an add on in many cases is because standard forms billing is still pretty much the norm. Honestly, why this is the case is a mystery as electronic billing is so much faster and has a higher claim acceptance rate because of fewer errors. Eventually, electronic medical billing will be the norm and will come standard with all medical billing software packages.

There are other add ons such as special inventory control packages, auto pricing update packages and other updated packages for diagnosis codes, procedure codes and forms. Again, some packages include all this as standard but for the most part, if you want this functionality, you're going to have to pay extra for it.

Michael Russell

Your Independent guide to Medical Billing

Medical Billing - DME Software Overview

2008-03-30T22:43:00.000-07:00

In this installment, we are going to be starting a series on DME software for medical billing. This is probably the most popular software on the market because it is responsible for billing more claims than probably any other branch of the medical billing industry.

DME stands for Durable Medical Equipment. This is equipment that is either sold or rented to various Medicare, Medicaid, Blue Cross, Blue Shield and many private insurance companies including Prudential and Web MD. This equipment ranges from wheelchairs to concentrators. The amount of money involved in this industry is staggering. Because of this, there are many brands of software on the market that billers can use to bill these medical claims. Logistically, it would be impossible to review each piece of software. However, because there are so many similarities between the various brands, it is simple enough to go over the main parts that each software covers. This way you will have a decent idea of what is involved in billing DME claims.

The first part of DME software that we'll be going over in detail, in a future installment, are the setup options. These options allow the user of the software to customize it to their liking. Some of this is just cosmetic, such as screen appearance. But much of the setup also involves setting up the type of DME billing that they'll be doing, including designating what kind of provider the software will be billing for, whether it be single or multiple provider.

The next part of the DME software that we'll be going over is how patients, doctors, facilities, items and other things are setup in the system. There is a complex process involved in medical billing of claims that requires everything in the system to be pulled together when either printing out a paper claim or billing electronically. This is probably the most complex part of the whole system. This will be covered in great detail.

The third part of the DME software that we'll be going over is how billing itself is actually done, whether it be via paper or electronically. We'll cover the various ways to print or transmit a claim. We'll also cover the legalities involved with doing so, such as what needs to be signed and when.

The fourth part of the DME software that we'll be covering involves what they call add-ons. These are additional services that many billers use, such as purchase order processing and barcoding of products. This part of the system must also be integrated with the main part of the system so that it works correctly.

Finally, we'll cover some common problems that billers should be aware of with each part of the system. Medical billing, because of all the things that can be billed and all the medical regulations, is complex and confusing, even to the seasoned pro. To the beginner, it can be a total nightmare. Hopefully, after reading this series, you'll have a very clear understanding of the basics of medical billing and the DME software used to bill DME claims.

Michael Russell Your Independent guide to Medical Billing

Medical Billing - DME Software Install Options

2008-03-30T22:41:00.000-07:00

In this installment of medical billing and the DME industry, we're going to focus on the basic setup of the DME software starting with the installation options.

Installation options is the first place that the billing company goes to when first setting up the software to bill. The reason for this is because they want the software to have a certain look and feel for each biller. Plus, as is true with most software for any type of application, they're going to want to setup the software for the particular type of operating system they will be using.

Because most billing companies are fairly large, most DME software packages have the option to setup the software to run on just about any kind of network, whether it be Microsoft, Novell, or even a peer to peer network. However, there are some DME software packages that specifically say not to use on a peer to peer network. So please check with the software company before purchasing their product.

After the software is setup to run on the network, the next step is to customize the look of the software. This ranges from simple things like how the software looks when running to what options are actually shown to the billers. For example, let's say a billing company does not want billers to see patient's social security numbers. An option can be set in the installation options, usually through INI switches, that will make it so that a biller, when looking up information, cannot see a patient's social security number. Most software packages will make this option available for just about any field in the package itself. The most common fields are private information fields, such as social security numbers and credit card numbers and revenue fields, such as total costs. The biller may need to know how much the item bills for, but the company may not want that biller to know what they paid for the item so that the biller can't figure out the profit margin of the company.

Security is a big issue with DME software and this will be covered separately in another installment, but that is something else that is part of installation options. Each biller may have a different level of security.

Another part of the installation options is to designate what parts of the software will actually be used. Many DME software products are so huge that they provide options for a number of things, such as barcoding and purchase order, that many billers don't use. By going into installation options, these extra items can either be added or removed. This is also usually controlled by INI switches.

The final part of installation options usually involves the setup of printers and external devices used for billing and other things. These options are going to vary greatly depending on the capabilities of the software itself. For example. Some DME software will not allow you to use certain kinds of modems or don't support modems at all.

In our next installment of medical billing and DME software, we're cover security in more detail.

Michael Russell Your Independent guide to Medical Billing

Medical Billing - DME Software Security

2008-03-28T22:31:00.000-07:00

In this installment of medical billing and DME software, we're going to cover the topic of security, which can actually apply to any type of medical billing software since security is such a big issue these days.

The whole topic of security pretty much stems from the HIPAA privacy rules. These rules cover just about everything, including health plans, health care providers, health care clearinghouses and billing agencies. If you're associated with the medical profession in any manner shape or form, you are probably under the HIPAA privacy rule umbrella.

The main information that is protected by the HIPAA privacy rule is the patient's past, present, or future medical condition, the provision of health care to the patient, the past, present or future health care to the patient and all the patient's private information including social security number, EIN, or any other private information of the patient, including payments made by the patient or to the patient.

The above is extremely simplified, as the law is pages long. There are also some limited disclosures that are allowed. Some covered agencies are allowed access to this information but they have to show just cause why they need it, such as police, prosecutors, etc. Where this complicates things is with billers. While the billing agency itself needs to know this information in order to properly bill the patient and insurance company, there has been a lot of heated argument about who in the billing agency should have access to this information. Because of this, only people directly involved with the actual billing are granted access to this information. Therefor, non billers, of which there are plenty in a billing house, are not allowed access to this information. This is where the problem comes in.

The solution is DME software security. By restricting workers to certain parts of the system, such as inventory personnel, the administrator of the software can make it so that these people are only given access to their area and therefor gain no access to patient records. This is done in the security options section of the software under each users name.

Most software will have basic access categories so that the administrator doesn't have to go into each individual section and give and deny access one section at a time. By having categories, such as biller, inventory, supervisor, etc., the administrator can just assign a category to the worker and the programs associated with that category are then given to the worker. All other programs are blocked. If individual program access is needed under special circumstances, this is also provided by the software as well.

The job of the software administrator is not an easy one. For one thing, most administrators themselves are not billers and therefor are only allowed certain access. So while they are allowed to give access to patient records to various people, they themselves are not allowed this access. It's a tricky situation to have to deal with but not impossible if the security is set up just so. This makes medical billing just a little easier.

Michael Russell Your Independent guide to Medical Billing

Medical Billing - DME Software Biller Setup

2008-03-27T22:22:00.002-07:00

In this installment of medical billing and the DME software setup, we're going to briefly cover what is involved with the setup that is specifically designated for the people who do the actual billing of claims. This is a very complex process that involves a number of items that all have to work together.

In order to bill an insurance carrier for a claim, there are a number of items that the biller needs access to. This includes the patient personal information, the item being billed, the carrier the bill is sent to and the method by which the bill will be sent. In order for this to happen, these things have to be setup in the system for the biller.

The first order of business is that the biller needs to have patient access. When the bill comes in, the patient number is usually on the first page of the bill. This number should have then been entered into the system along with the patient information. The biller will then have access to this information through what is called a patient lookup feature. These features usually have several fields by which the biller can lookup the patient, such as by last name, ID number, etc.

After the patient is found, the next thing the biller needs to know is what the item is being billed. These items all have to be setup in inventory, which is usually done by the inventory manager. Another lookup function is then provided to the biller for looking up inventory items. This is usually done by item name or sku number. Once the item is found in inventory, the item is then added to the billing sheet.

The next thing that the biller needs is the carrier that is going to be billed and the method by which the bill will be sent. The carrier is usually attached to the patient when the patient file is setup. But in some cases, the insurance carrier is not known at the time and the biller has to add it at the time of billing. For this, another lookup table is provided with all the insurance carriers that the system supports. These are usually updated on a regular basis. The way the biller knows which carrier to pull is by looking at the billing sheet that came in. The carrier is listed there.

The method by which the bill itself will be sent is usually determined by the billing agency itself. Not all agencies have electronic billing capabilities. In the cases where such capability doesn't exist, the default billing method will be via paper claims and the biller won't have to do anything. The claim will automatically go to the print que upon submission.

Naturally, the above process is greatly simplified, but for the most part, that is all that is involved with sending a bill for a medical claim. The truth is, if medical billing was this easy, there wouldn't be so many claims that get denied each day. The problem is that billers are not properly trained and the medical billing software itself can only do so much.

Michael Russell Your Independent guide to Medical Billing

Medical Billing - DME Software Lookup Tables

2008-03-27T22:22:00.001-07:00

In this installment of medical billing and DME software, we're going to cover a brief overview of lookup tables, which is probably the heart and soul of the whole DME system. Without lookup tables, the whole operation of the system, including the medical billing itself, would be extremely difficult.

A medical biller has a hard enough job as it is. When billing a medical claim, there is an enormous amount of information that has to be sent to the insurance carrier, including patient information, item information, insurance information and so on. If you read the series on DME NSF 3.01 record specifications, then you already know that hundreds of fields of information are transmitted to the insurance carrier. If the medical biller had to enter all this information by hand, the billing of one claim would literally take hours. To speed up this process, lookup tables are used.

A lookup table is essentially a self contained database that has information pertaining to that area of billing, whether it be patient, item or carrier related. The reason that many tables are used is because of the amount of information that is contained in each table. If they were all combined into one table, the lookup process itself would be slowed to a crawl because of all the records the lookup would have to go through. As it is, with very large billing agencies, these lookup procedures can take several minutes depending on how large the network is and its capabilities to handle the load.

Each lookup table is indexed, usually in several ways. By doing this, a medical biller can lookup patient information in a number of ways. For example, if the biller doesn't know the patient's ID number, they can look it up by the patient's last name. Some lookup tables allow you to do a broad search via city and state. For item lookup tables, if the biller doesn't have the sku number, they can look up the item by description. Of course, with many of the same items in the system, this method can be time consuming.

The main point of a lookup table is that for each table, there is a large amount of information that is tied to it. So by looking up a patient, the biller is pulling all the information associated with that patient, such as name, address, phone, date of birth and a number of other things. In the process, all these items are automatically pulled to the various forms that need to be filled out. So what would normally take maybe 5 to 10 minutes to fill out, can literally be done in seconds. Obviously, this is a real time saver for medical billing agencies and greatly reduces costs, which are high enough as it is.

Quite simply, without lookup tables, DME software would be pretty much worthless, as the bulk of the operation would be the manual input of hundreds of pieces of information, which would totally defeat the purpose of having the software, to speed up operations.

Michael Russell Your Independent guide to Medical Billing

Medical Billing - DME Software Item Inventory

2008-03-26T23:26:00.000-07:00

In this installment of medical billing and DME software, we're going to cover the topic of item inventory. We're going to explain how the inventory functions work, what information inventory tables contain and how this all ties in with the medical billing of a claim.

Item inventory is a very large part of the DME system. Because DME billing is for durable medical equipment, thus the name DME, a lot of items get dispensed to the patient. These items range from small things like test strips for diabetics, to large items like wheelchairs, beds and oxygen concentrators. Some of these items are sold and some are rented. There alone lies a big distinction and the reason why the inventory tables have to be broken up into what are called purchased items and serialized items. Purchase items are pretty well self explanatory, but some explanation is needed for why rental items are referred to as serialized items.

Rental items are referred to as serialized items because each item that is rented has a unique serial number attached to it. This serial number is tracked for the purposes of billing monthly rentals, which is usually how either the patient or insurance company pays for these items. If a rental item has to be replaced because it is defective or broken, then a new item has to be issued and its serial number noted for future billing. The old item is then put back in inventory and either fixed or thrown away and deleted from inventory.

The information that is contained in inventory is more than what most people realize. It is more than just the description of the item. For purchase items, it includes how many of the items are in stock, how many sales of the item were made, so that companies can track how well an item performs, reorder points so that they don't run out and a number of other things. For rental items, the information includes when the item was rented, how many months of billing have occurred, when the item is scheduled for maintenance and a host of other items. Most normal inventory records contain anywhere from 30 to 100 fields depending on how much information the company wants to track and the capability of the software itself.

How does this all tie in with medical billing? Well, the biller has to know how each item needs to be billed. So for starters, they have to know if it is a rental or purchase item. They have to know the price of the item. They have to know when maintenance is due on a rental item so they can send a bill for that maintenance. They have to know when an item is low so that they can notify inventory, just in case they're not aware of it, which they should be. If a biller has to replace an item, they have to know what replacement items are available. The list of things that a medical biller needs in relation to inventory is endless.

Without item inventory tables, the medical billing process would be a total nightmare because billers wouldn't know where anything was, what it cost and if it was even in stock.

Michael Russell Your Independent guide to Medical Billing

A Guide to Billing Software

2008-03-24T23:16:00.000-07:00

One of the most recent developments in the use of billing software is its use in the medical profession, which has allowed physicians and hospitals have access to an effective and efficient billing system. To have access to such a system, most physicians and hospitals outsource their medical billing services, which means that they have to pay companies to provide them with an effective system. However, as the developers of medical billing software have made their product more user-friendly, physicians and doctors now have access to medical billing software that they can use themselves.

User-friendly medical billing software

Before, medical billing software packages were complicated to use because almost all of them were text-based interfaces filled with awkward textual fragments. As a result, only companies with trained personnel could provide medical billing services using the software. However, the medical billing software of today has been designed to be simpler and more convenient to use, which can mean that there is no need to outsource medical billing services. The medical billing software of today is designed to make learning how to use it easier, allowing any member of a doctor?s staff or the hospital staff to do it. Evidence to this is the step-by-step process that users can follow in using the software. In addition to this, they have also been designed to generate correct and easy to understand documents that doctors could present to their patients.

Apart from these, some of the newest medical billing software has also been designed to allow doctors to configure it based on the requirements of his practice. In relation to this, medical billing software has also been designed to contain more information, which can eliminate the need to file documents with information that can easily be stored in their computers. All of these factors can make a doctor?s practice more efficient, especially with regard to billing.

Billing Software provides detailed information on Billing Software, VoIP Billing Software, Chiropractic Billing Software, Free Billing Software and more. Billing Software is affiliated with HIPAA Complaint Medical Billing Software

Automotive Shop Billing Software

2008-03-24T23:15:00.001-07:00

You have a busy automotive shop and not enough time in the day to take care of all your accounting yourself. Sure, you have an accountant, but you don?t even have the time to put together the materials to take to him so that they can do your bookkeeping. Automotive shop billing software is a great way for you to keep your business organized and functioning properly. The more organized the business is, the easier it will be to make a profit.

To find the best automotive shop billing software, you will first need to do your research. Ask other shops which software they like. Look online to find companies that have the software you are looking for. Find product review sites and magazines to see which program has the best reputation. You can also ask questions in forums to see what other people have to say.

In general you will want your automotive billing software to be easy to use yet still get the job done. Your software will need to keep track of your customer information. It will also need to keep track of work orders and be able to print invoices. You will also need to have their auto insurance on file. This is especially handy if you repair their car after an accident.

Once you find the automotive shop billing software that seems the best, you can then begin to comparison shop. Different companies often have completely different prices on their products. You can also consider buying the software used. Used software is much cheaper. However, you run the risk of getting it damaged, and the warranty may either be expired or it won?t transfer when the ownership switches.

Automotive shop billing software can help you manage your business better. Just do your research to make sure you find the program that best meets the needs of your business. Also research to find the best prices. Once you learn and use the program, you will feel much more organized.

Billing Software Advancements

2008-03-23T22:45:00.001-07:00

In recent times, companies have been able to use billing software to help them have an efficient system by which they can charge and collect payments from their clients for the products and services that they provide. However, as with any software, the people who develop billing software are in a constant process of finding more applications for the software, allowing them to have access to a wider market. One recent development in billing software is that it can now be used to cater to very specific requirements of companies and individuals. One of these is the use of billing software for medical billing purposes, allowing doctors and hospitals to take advantage of the benefits that billing software provides.

How billing software is used in the medical profession

The use of billing software in the medical profession can be considered unique because, unlike most companies, some physicians and most hospitals outsource medical billing services. This is mainly because of the complexity of the process in medical billing, which includes giving treatment descriptions and filing the necessary claims with insurance companies that medical billing companies take care of for their clients. In addition to this, having a company to do the medical billing can help physicians and hospitals ensure that they are paid on time and with the proper amount because of the efficiency and accuracy that medical billing companies provide.

To be able to provide efficient and accurate medical billing services, medical billing companies use the most up-to-date software. This software allows them to input the billing information provided to them by their clients, which they can process and send to either the people who received the medical services or the insurance companies that pay for medical services. In addition to this, the medical billing software also allows the company to produce a number of reports that could help their clients analyze their cash flow and profitability. Moreover, medical billing companies also answer any billing questions that patients or insurance companies may have, and they are also responsible for following up on overdue payments.

One of the most recent developments in the use of billing software is that they are now being used in the medical profession. However, the ones who use the software are usually not the doctors or the hospitals themselves because they usually outsource their medical billing services from companies who use the software. However, given the newest developments in medical billing software technology, physicians and hospitals may no longer need to outsource their medical billing services. This is because the newest medial billing software has been designed to me more user-friendly, making it easier to use, more convenient, and more practical.

Billing Software Guides

2008-03-20T23:17:00.000-07:00

You have your own business and it?s doing well. However, you feel a little disorganized. Your accounting and billing system could use some organization. You need to find some billing software guides that will help you find the perfect software program for your business. Billing software is designed to help you keep track of customers and generate statements, invoices, and other business documents.

Billing software guides are designed to help you choose the billing software that is right for your business. When it comes to billing software, you can get as general or specialized as you need to. For example, medical billing software has special features designed to accommodate the needs of a thriving medical practice including a place to enter patient insurance information. Automotive billing software is designed to meet the needs of an auto body shop. What kind of business do you own? Is there specialized billing software designed for your type of business? If not, then you will need to choose a more generalized program.

Once you choose the billing software program that is right for you, you will need to learn how to use it. The best software program is one that is easy to learn and easy to use. If a system is too complex and confusing, it won?t have the desired effect because you may not use it. That?s not to say a learning curve will not exist or is not normal. But it shouldn?t take you too long to figure out how to use it.

Billing software guides help you choose the billing software that is right for your business. If your industry doesn?t have specialized software, as is the case with medical billing, then you will need to purchase a more generalized system. When you do find the software that is perfect for you, it will make your job so much easier.

Billing Software Peripherals

2008-03-20T23:16:00.000-07:00

Among the different computer peripherals that are available on the market, one of the most important is the memory of the computer. The memory of computers can determine how well a computer will perform different tasks because there are certain computer tasks that have very specific memory requirements that may require a computer user to get more memory. Usually, there are five scenarios in which a person may need to get more memory. These scenarios include operating systems upgrades, installation of new applications, installation of multimedia cards, installation of computer peripherals, and hard disk ?chugging.? With regard to installing billing software, which is a new application, there is a need to get more memory to enable the computer to effectively perform the tasks of the software.

Memory for billing software

Given the various tasks that billing software performs that sometimes need to be done simultaneously, there is a need to get the adequate amount of memory so that the system can effectively carry out the tasks of the software. To determine how much memory is needed, check the user?s manual of the software because it usually contains the system requirements of the software, including its memory requirements. However, if the user?s manual does not specify the memory requirements of the software, you can try to do a little research on similar software and their requirements and buy the average amount of memory that they require. As a rule of thumb, applications like billing software, which falls under the executive/professional category of software, usually require about 512 MB to 1 GB of memory.

One of the most important computer peripherals is computer memory because it can determine the performance of the system in carrying out a number of tasks. With regard to billing software, this is also very true because an adequate amount of memory allows a person using the software to maximize the benefits he can get from the software. An adequate amount of memory can allow the system to perform the numerous tasks that billing software needs to carry out to serve its important functions.

Dental Billing Software

2008-03-19T23:44:00.000-07:00

Dental billing software is an essential part of the medical billing industry. Dental offices either take care of their own dental billing or hire a medical billing specialist to take care of it. Either way, the need for dental billing software that is fast, effective, and inexpensive, is a prevalent one. Do you need to purchase dental billing software? Here is some advice that will help you.

Your first step in purchasing dental billing software is to do your research. Which dental billing software programs are considered the best? Which ones have the best prices? Find reviews of the software in magazines and on websites. Ask other dental billing specialists which software they use. The more information you can find, the easier it will be to make a wise purchase decision.

After you do your research, you will need to purchase the dental billing software. Once you have a particular software package in mind, you can start comparison shopping on the price. Check online, in stores, and in catalogs. Make sure you understand the warranty information and the return policy. When all the factors meet your approval, you can make the purchase with confidence.

Good dental billing software has a few functions. It helps manage patient accounting. It issues bills and invoices. It also manages patients? insurance and helps make the process of submitting a claim much easier. It is also important for the software to be easy to learn and easy to use.

When it comes time to purchase dental billing software, there are a few things to keep in mind. First, do research to find the best product. Search for information online, in magazines, and ask other billing specialists. Once you are confident you found a good product, you can start to compare prices. Keep in mind that you want the software to be easy to use.

Downloadable Billing Software

2008-03-19T23:34:00.000-07:00

You run your own business. Do you have a system when it comes to billing? If not, then you could be losing money. Downloadable billing software is a great option when you are looking for something that will make your billing tasks easier. Are you not sure you need to buy downloadable billing software?

There are a lot of benefits for using downloadable billing software for your business. The first is that it will help your business run smoother. When you need to type and print every invoice by hand, this wastes time, especially if you have a lot of work to do.

Downloadable billing software can also help eliminate paper waste by making your business more electronic. Printing extra copies of your business transactions is not necessary, as long as you constantly back up all your customer files. If you only have your files in one location, if something happens, it can spell disaster. Possible ways to back up your files include having an extra hard drive, putting all on a DVD or CD, and putting the information on more than one computer.

Another benefit is that downloadable billing software can do more than just take care of accounting tasks. The extra features are nice, especially if they save you money. Some let you print out labels and create reports and other business documents. You can also have the software automatically generate statements on a specified time period, which is nice if the service you perform for the customer is ongoing, such as a long-term contract project.

Downloadable billing software makes running your business a lot easier. It helps automate your business, keep track of billing and accounting, and generate automated statements. Once you find the software that is best for your business, it will make your business run a lot smoother.

Used Billing Software

2008-03-19T01:20:00.000-07:00

One of the best ways to save money on our purchases is to tap the 'used' market, which means buying second-hand items. This is because doing so can provide access to some of the best deals and the lowest prices for quality goods. However, people who tap the second-hand market are not only given access to lower prices on products like appliances and clothes. Nowadays, people looking for a good price on software can also tap the used market. This is especially true for billing software because as companies expand, the billing software that they use needs to be replaced to accommodate the expansion, meaning that they have to replace their existing software. However, getting used software requires that you take the necessary steps to ensure that you are getting good quality software for your money.

Tips on buying used software

To get good quality used billing software, there are a number of steps that you can take to help you. They usually involve employing the same amount of meticulousness, if not a little more compared to when you buy brand new software. One of these steps is to read the customer reviews of the software you are considering because knowing what people think of the software can give you an idea on whether the software fits your requirements. Another step includes making sure that the software you are buying is compatible with your computer, which is very important for billing software because of the specific system requirements that it has.

More importantly, you should also make sure that you are buying from a reputable seller, by making sure you are getting the original version of the software and not copies. Other steps you can take include making sure that you are able to get the manuals that come with the software and asking for a warranty and return guarantee from the seller.

Nowadays, people looking for a good price for billing software can access the second-hand market. Individuals and companies that have replaced their old software sometimes opt to sell their old software to those who may find a use for them. However, buying used software also requires the same amount of meticulousness that people employ when they buy brand new services to ensure that they get good quality software and a good value for their money.

VoIP Billing Software

2008-03-17T23:48:00.000-07:00

VoIP is an acronym for Voice over IP (Internet Protocol), or in more common terms, phone service over the Internet. Basically, it's a set of common Internet standards that allows a user's voice to be converted into small packs of digital data which can then be sent over computer networks. At the receiving end, VoIP computers reassemble the data packets back into a conventional audio signal that can be heard just as if on a regular telephone line. This is an online scheme that has been bubbling around the Internet community for the past few years. A major advantage of VoIP is that it avoids the tolls charged by ordinary telephone services.

There is VoIP billing software also that handles billing and other processes. This software can be used by all kinds of businesses. It helps in keeping track of customers, the bills to be sent to them and other such details through a protocol. This software has features like broadband phone, PC to phone, wholesale (termination), traffic exchange, international callback and prepaid calling cards that meet your VOIP business needs.

VoIP billing is tightly integrated with popular gateways, gatekeepers, proxies and soft switches from vendors like Quintum, Cisco, Sylantro, Veraz, Nextone, IPtel, Mera, and other compliant devices. Most telephony billing systems currently used today are based on non-IP standards, making them not equipped to handle or accurately bill for IP services; hence, VoIP billing rose to prominence. The reasons why most of the service providers and enterprises chose the VoIP billing software to expand their business is that it integrates the core functions like authentication, authorization, and accounting with vital functions that facilitate the effective management of all billing-related processes, like customers, services, finance, service distribution, reporting, traffic partners, and user rights.

VoIP billing software allows service providers and enterprises to expand their business by including cost-effective VoIP services in their offerings. It also enables the pre-paid or post-paid billing options for call usage and provides the ability to offer flexible call plans.

VoIP Billing Software provides detailed information on Billing Software, VoIP Billing Software, Chiropractic Billing Software, Free Billing Software and more. VoIP Billing Software is affiliated with HIPAA Complaint Medical Billing Software

Free Billing Software

2008-03-17T00:20:00.001-07:00

Billing software is business accounting software that helps you manage your billing. It was created to help you keep track of projects, hours worked, and what your clients owe you. You can use billing software to manage your professional services business. It automatically creates a variety of reports, so you know how much you have worked, how much to bill, and who owes you what.

Billing software was designed for service industry professionals and anyone else who provides services. There are many kinds of free billing software available on the Internet, including:

Integra Office 5.2: INTEGRA OFFICE combines a powerful time and billing system with the "ultimate scheduler." Bill formats are completely customizable. The software allows any of a client's last ten bills to be re-prepared at any time.

BS/1 Professional 3.06: BS/1 Professional is an integrated time billing and accounting system, handling accounts payable, accounts receivable, general ledger, inventory, time billing, and sales analysis. Multi-currency features facilitate purchasing and international billing.

Excel Invoice Manager Platinum 2.1.1007: by integrating with Microsoft Excel, Excel Invoice Manager Platinum 2.1.1007 provides a true interface, not only for creating and editing invoices, but also for designing your own invoices with various tools provided by Microsoft Excel.

kBilling 1.2.11: kBilling - the ultimate software to use billing application runs on virtually any computer (even Windows 95) and is very simple to operate. Context-sensitive help and an intuitive user interface allows even the most novice computer user to invoice customers in seconds, not hours.

VOIP Call Shop Billing Software 5.1: using this system, you can even grant customers credit by taking payments before even they make their call. You have two options: bill your customers after the completion of a call (post-paid billing) and accept payment before they make a call (pre-paid billing).

InstantInvoice 3 3.4.8: InstantInvoice 3 3.4.8, an invoicing, billing and quotation software for small businesses, tracks customer payments and outstanding invoices. There is a powerful search-and-find option to find past invoices and quotes.

All of the above software runs on Windows 98, NT 4.0, 2000, ME and XP.

Billing Software provides detailed information on Billing Software, VoIP Billing Software, Chiropractic Billing Software, Free Billing Software and more. Billing Software is affliated with HIPAA Complaint Medical Billing Software

Billing Software

2008-03-17T00:19:00.000-07:00

Every business or company needs efficient, fast and quick results from their employees; they are more dependent on the manual work than machines for a few accurate and quick processes. The major places where there are problems, faced by either small businessmen or tycoons, are accounts or cash procedures. Even in an age where machine power is the norm, many businesses yet depend on manpower. This gives rise to inefficient and delayed results. Billing software, also known as invoice software, is software that helps us to maintain bills or accounts accurately.

It simplifies the process of manual billing and provides features like automatic invoicing, integration with other systems, time management, self service, payment processes and more. Added to this, it can be used to maintain a complete client and staff history with billing adjustments and time-slip production. This software can be also used in creating invoices, quotes, proposals and customer statements, and also to keep track of outstanding invoices and customer payments. This is a very important component that can be used in any type of business.

If the billing isn?t on time and accurate, or if the billing processes are inefficient, then there are chances of losing customers and revenue. Billing software can be the perfect solution to your problem. It can not only help get your billing done fast, but manages to save your customer contacts and provide sales reports. This software meets the requirements of not only a one-person office, but also a large network-based organization getting fast and immediate results.

If you are looking for software that will get your billing done with minimum time and maximum flexibility, get billing software in your office. Spend less time billing your customers and more time filling their needs.

Billing Software provides detailed information on Billing Software, VoIP Billing Software, Chiropractic Billing Software, Free Billing Software and more. Billing Software is affliated with HIPAA Complaint Medical Billing Software

Invoicera: An Invoice Billing Management and Tracking Software

2008-03-14T03:54:00.000-07:00

Are you looking for a payment tracking and invoice software which is simple and powerful? Are you spending too much time entering bills, invoices, purchase order and other data that reoccur periodically?

Invoicera (Invoice Software) has the solution.

Invoicera is professional billing & invoicing software for small to medium businesses invoicing. Invoicera is an invoice billing software which allows you to manage and track your invoicing data. With this flexible billing & invoicing software, you can create invoice, email invoice as a file and manage customer accounts and bills. It is a highly integrated Invoice Software which makes invoicing easy and automatic. The Invoice Billing software allows you to easily manage customers, invoices and payments. Invoicera is a highly integrated Invoice Software which includes a user friendly interface and several easy to use tools to track your payments and make your invoice billing better. The software is simple, easy to learn and allows you to create detailed invoices with ease. It keeps a track of your customer payments, simplifies your bookkeeping and print or email your invoice or quotes. Invoicera includes several easy to use tools to help you manage your professional business and invoicing better. It is an online invoicing software which assists you in invoice tracking and invoice management

Invoicera creates professional invoices automatically. You can print these invoices or save them to a file that you can email. Invoicera is a highly affordable and easy to learn invoice program. Instant reports, track of monthly sales, customer payments, outstanding invoices and tax reports.

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Invoicera is an Online Invoicing Software for Invoicewhich provides invoice-billing-featuresInvoicera is the perfect invoicing software, invoice tracking software, invoice management software and invoice billing software

Your All-In-One Medical Billing Software

2008-03-12T23:22:00.001-07:00

Do you have trouble keeping all your files, data, and reports sorted, yet easy to find? The latest medical billing software will do that for you as well as save the amount of time you spend searching and accessing that information; the costs it takes to manage all the different databases, and the headaches you get from worrying about all the various aspects of your business.

Consolidate Offices?Medical billing software allows you to consolidate all your offices together. You will not have to log-in and log-out of a bunch of different databases; that?s all taken care of with this system. All you need to do is log-in through this billing system, and manage each separate account without the hassle of going into multiple databases.

Work From Home?Do you have a computer and broadband connection? That means you are ready to go. Once logged into the system, you can work from your home, office, or on the road. If you?re not in the office, you don?t have to worry whether or not your business information is staying up-to-date. With medical billing software, you?re able to manage and stay on top of your business functions at all times and places.

Easy-to-Use?The #1 web-based software is simple to use. Your clients will reap the benefits from you using this system. Without the hassle of going through multiple databases, you will be able to close out all your business day dealings in a timely manner. The data always stays separate and doesn?t require duplication or extras hassle. Quick, easy, and efficiently, the job will get done right and on time for the convenience of your customers.

Security?Your data is safe and backed up at all times. Medical billing software is protected through HIPPA-compliant servers that only you and other authorized staff members can access. If you ever have a problem, a team is ready and willing to help at all times. The support team will answer as quickly as possible to solve any needs or concerns about your system.

Payment?Medical billing software won?t take much money out of your business either. You can pay monthly as you go and don?t have to worry about or deal with large, up-front software fees. Best of all, no long-term commitment is required. You?ll see and experience the benefits right away as you use the software to maximize your business.

If you?re looking to upgrade, or just want to save time and money, give medical billing software a try. With less headaches and stress, you will be able to concentrate on the really important matters of your business. Medical billing software is definitely your solution to smarter billing and efficient client service.

Jordan Bartlett is a client account specialist with an Internet marketing company (http://www.10xmarketing.com). For more information about medical billing software please visit AdvancedMD (http://www.advancedmd.com)

Count the Ways Medical Billing Software Helps You Save

2008-03-12T23:20:00.000-07:00

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 http://www.advancedmd.com

Count the Ways Medical Billing Software Helps You Save

2008-03-11T22:34:00.000-07:00

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

How To Choose The Right Small Business Billing Software

2008-03-10T22:51:00.000-07:00

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

How to Choose the Correct Chiropractic Billing Software

2008-03-10T22:49:00.000-07:00

One important step in finding the perfect chiropractic billing software program to fit your needs is to take a look at your existing computer equipment. With system needs changing on a virtually daily basis, it is necessary that the software program you choose be compatible with your hardware.

You also have the option of upgrading your system if it is not currently compatible with the software option you choose.

Giving a rough estimate, there are approximately 30 different vendors that deal in chiropractic billing software. Prices can range from a couple hundred dollars to several thousand dollars. While cost is certainly a consideration, assuring that you get the best quality software to meet your needs should be the primary consideration. Many new chiropractors, fresh out-of-school may decide to go with a discount software solution in order to save costs. Experts in the field suggest that skimping on costs in the beginning can cause a huge headache in the future. It is often a lot of trouble and work to change over systems; not to mention that your files will temporarily be on hold while the change occurs. A good word of advice is to thoroughly examine your needs and then choose the appropriate chiropractic billing software program for your practice base your decision on need, not cost.

Chiropractic billing software can be a godsend for many practices. Not only will you save valuable space from limiting your need for paper files, your office staff will also be able to retrieve important medical information in a virtual instant. Most offices claim that the best aspect of the electronic billing software is the ability to instantly file insurance claims. This is an excellent way to reduce the cost of office staff and postage. Many of these billing software programs also have a built-in clearinghouse feature to enable the business manager to track and locate any outstanding claims.

Those using some of the more advanced chiropractic billing software programs are able to perform a wide variety of tasks that, in the past, could have taken hours or even days. Some programs allow the administrator to submit claims on a patient to multiple insurance companies. Other programs make billing less complicated when dealing with HCFA, Workers Compensation and Medicare: these programs have the necessary forms built into the program and are easily accessed. It is obvious that there is a plethora of variances in software; the key is to know what you need in a program and search for one that closely resembles your needs.

Chiropractic Software provides detailed information on chiropractic billing and office management software, as well as detailed chiropractic software product comparisons. For more information go to http://www.e-chiropracticsoftware.com and/or visit our affiliate site at http://www.original-content.net

Meeting Medicaid Billing Needs with Sensitive Medical Billing Software

2008-03-10T00:08:00.000-07:00

Medicaid Billing

Medicaid billing (similar to http://www.advancedmd.com/features/medicare-billing.asp medicare billing)requires medical billing software that is versatile and sensitive enough to work with Medicaid. Medicaid is state subsidization of medical expenses paid on behalf of qualified low-income individuals or families. Though requirements differ in each state, the payment is made directly to the medical practice or service provider.

In establishing medical billing solutions within a medical office, software is generally purchased to manage, track, and control billing information. Medicaid billing is handled differently than most medical billing. Since most medical billing is paid directly by the client or by the clients insurance company, most medical billing software is set up for traditional billing to the client or the clients insurance company. But Medicaid billing is paid through state government operations and requires software that is sensitive to Medicaid billing.

Medicaid Billing Need

In 1985, over 30 million Americans were enrolled in Medicaid. In 2003, less than 20 years later, the American population enrolled in Medicaid climbed to over 40 million. Clearly, with technological advances since 1985, medical billing software should be sensitive to the growing need for Medicaid billing allowances.

In understanding the nature of the need for Medicaid billing allowances in medical billing software, it is helpful to understand the Medicaid enrollment trends. Though low-income families may apply for enrollment in Medicaid, these young to middle-aged families do not make up much, if any, of the Medicaid population.

In 1999, over 38 million Americans were enrolled in Medicaid. About 33 million of those enrolled in Medicaid were the elderly, while the other 5 million consisted of disabled individuals. In 2003, the trend remains similar. Of the over 40 million individuals enrolled, over 34 million consisted of the elderly, while slightly fewer than 6 million individuals were disabled.

The point is that, in general, those enrolled in Medicaid (statistically the elderly and disabled) also require more medical care than other low-income families or individuals. That means that if a medical service provider is unable to react to Medicaid billing needs, then that medical service provider will be unable to assist not only the large demographic of Medicaid-enrolled individuals but also many elderly and disabled-two of the most medically-needy demographics.

Benefits of Medicaid Billing Sensitive Software

Millions of Medicaid-enrolled individuals are seeking medical service providers who are able to meet with the Medicaid billing needs of the state government and of Medicaid individuals.

Fortunately, with advances in technology, Medicaid billing sensitive software is available to answer the needs of the increasing Medicaid-enrolled population, many of whom are in regular need of medical attention.

About the author:
Joe Miller is an author of informational articles and online advertisements on business, technology, and health. Information on Medicaid billing is available at AdvancedMD.com.

Medical Billing Software takes the Stage

2008-03-07T21:42:00.000-08:00

Medical Billing Software

The practice is running smoothly, with patients coming in and out with smiles on their faces because of the great service your practice is providing. At the end of the day, you review the office secretarys billing records and realize you are behind, again.

Running a successful practice depends upon the efficiency of the billing. Unfortunately many practices still must deal with a variety of different databases containing different sets of information. The patient contact information and the patient histories may be in totally separate databases, both of which have to be accessed in order to put information into a third database containing billing history. Though the database information in this example may be different from information in your practices databases, the database confusion is the same.

In addition to the database difficulties, running on multiple servers, installing billing technology with IT, and backing up all of your data is overwhelming if not impossible to always be on top of.

Simplify

Medical billing software has simplified the practices office structure to open up more time to continue giving quality service to patients. Medical billing software is a solution employed by countless medical practices to ensure effective and accurate billing.

One of the biggest ways medical billing software saves practices extra work is by enabling information on various servers or databases to be synchronized onto one account. By logging into your account you can access all of the information you need on any patient.

In addition to streamlining the billing process, medical billing software simplifies the financial obligation to billing and database technology by cutting most of it out. Using medical billing software enables tracking, billing, and security of all accounts online, eliminating the need for a costly IT infrastructure. The cost is usually a monthly fee payable as you use it.

Feel free to access your account from anywhere, including your PDA.

Secure

No practice should read an article like this and be convinced to find medical billing software without asking itself if an online medical billing software system is a secure system to change to.

Some of the examples of security precautions medical billing software takes includes electronic back ups, automatic posting, HIPAA and HCFA compliance, and secured accounts only accessible to authorized viewers.

In selecting a system for medical billing to suit your medical practice needs, consider a solution recognized by countless medical practices already. A secure a simple way to streamline medical billing is with medical billing software.

Joe Miller is specialist in online advertising. For more information on medical billing software, please visit AdvancedMD.com

Electronic Medical Billing Software and Service Compliance With Pre-Payment And Post-Payment Audits

2008-03-05T22:41:00.000-08:00

Mistaken payments add up to an estimated $200 billion, exceeding 10% of national healthcare costs. Other Party Liability (OPL) alone, i.e., claims that should be paid by somebody else, make up $68 billion or 3.6% of national healthcare cost. The enormous size of potential savings due to improved claims processing continues to attract attention and resource focus. Insurance profitability experts believe that a payment scrutiny program can be as successful a profit-building strategy for insurance companies as raising premiums or adding members. A growing industry of outsourced technology and services to avoid mistaken payments is also symptomatic of a growing demand for such services. Some vendors cite cumulative payment savings as high as $3 billion.

However, avoiding mistaken payments is hard because of four-pronged constraints, namely, the volume of claims, the disparate and disconnected sources of relevant information, the resource-intensive manual processes needed to identify and investigate recovery opportunities, and regulatory requirements for timely payments.

To manage these difficulties, many payers adopted a two-phase-based “pay-and-refund” approach for payment minimization. The second phase of this approach is designed to correct any mistakes made during the first phase. Each of the phases can be further divided into two stages. Specifically, the initial phase splits into prepayment review and timely payment of valid items, while the final phase includes post-payment audits and refunds of items proven invalid during the audit.

Prepayment Review

Prepayment review typically proceeds in two stages, identification and confirmation. Potential overpayment identification requires cross-referencing multiple systems that manage provider enrollment, authorizations, recovery case management, and call centers for both insured and providers.

Overpayment confirmation uses Correct Coding Initiative (CCI), Local Medical Review Policies (LMRP), and other rules to categorize the potential overpayments into Contractual/Clinical, Eligibility, Coordination of Benefits, or Duplicate Payments. Overpayment confirmation typically includes tests for inter-claim, intra-claim, or cross claim inconsistencies, lifetime duplicates, date range duplicates, re-bundling, inappropriate modifier codes, wrong E&M crosswalk, upcoded or undercoded visit level, etc.

Prepayment review requires powerful database technology. Most of prepayment claim review process can be automated along with subsequent denial notice or explanation of benefits (EOB).

Post-Payment Audit

In contrast, post-payment audits tend to consume more resources during each one of the audit stages:

Target identification Audit identification report shows total annual revenue and the degree of variance between the audit target and peers in the same specialty and geography. The product of the two numbers is proportional to the expected gain from the audit, essentially providing a natural audit ranking.
Audit preparation A higher return to the payer is the key advantage of a carefully designed and executed post-payment audit. Audit preparation starts with a review of audit target selection, which is the result of provider profiling and variance reporting. This stage includes a list of claims paid in the past that are most likely to fall outside of standard distribution of the peer group.
Audit execution The auditor requests and analyzes medical notes supporting the data reflected in the sample of paid claims produced at the audit preparation stage. The auditor’s objective is to establish the proportion of claims found unsupported by reviewed medical notes within the set of audited sample (percent of overpayment).
Refund (and penalty) extrapolation The auditor extrapolates refund as the product of percent of overpayment and the total payments by the auditing insurance carrier for the past six years.
Negotiation
Settlement

Some stages, such as audit execution, negotiation, and settlement must be entirely manual, and may require highly skilled and experienced personnel. Other stages, such as verification of overpayment amount and currency, identification of overpayment reason, and audit prioritization, may be partially automated, using rule-based technology to identify procedure repetition, high payments per day, surge analysis, unusual modifiers, unusual procedure rates, geographic improbabilities, or 5/50 patterns. External resources might be added at this stage to consult provider watch lists, OIG sanctions databases, or high-risk address databases.

Summary

A full-scale implementation of payment scrutiny requires sophisticated processes to handle prepayment claim review and post-payment audits and uses advanced fraud detection technology. Prepayment claim reviews are less expensive than post-payment audits and therefore can be applied to every claim, while post-payment audits must be carefully targeted. A system to manage overpayment recovery process must include claim identification, its history, provider and insured information, medical notes, insured services call center notes, authorizations, etc. Without the ability to efficiently manage a large volume of recovery cases, the risk for errors or missed payment deadlines is high, resulting in missed recovery opportunities.

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

Blue Cross Blue Shield Michigan Heads April's Chiropractic Office Billing Software Precision Index

2008-03-05T22:40:00.000-08:00

Billing Precision Index 14.6
Blue Cross Blue Shield Michigan 3.2
Blue Cross Blue Shield Colorado 6.8
Humana 7.9
Blue Cross Blue Shield Illinois 11.1 (down from 11.2 in March)
United Health Care 13.9 (up from 23.2 in March)
Cigna 15 (down from 12.9 in March)
Medicare New Jersey 16.4 (up from 20.5 in March)
Blue Cross Blue Shield Texas 20 (down from 15.2 in March)
Great West 22
Aetna 22.1 (down from 20.9 in March)

April BPI dropped four participants since March:

Blue Cross Blue Shield Pennsylvania
Blue Cross Blue Shield Alabama
Medicare Pennsylvania
Blue Cross Blue Shield New Jersey

Three payers improved their index since March:

Blue Cross Blue Shield Illinois 11.1 (down from 11.2 in March)
United Health Care 13.9 (up from 23.2 in March)
Medicare New Jersey 16.4 (up from 20.5 in March)

Three participants lowered their indexes with respect to March BPI:

Cigna 15 (down from 12.9 in March)
Blue Cross Blue Shield Texas 20 (down from 15.2 in March)
Aetna 22.1 (down from 20.9 in March)

April BPI added four new participants since March:

Blue Cross Blue Shield Michigan 3.2
Blue Cross Blue Shield Colorado 6.8
Humana 7.9
Great West 22

Coverage

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

Top 4 Transparency and Accountability Attributes for Electronic Medical Billing Software and Service

2008-03-04T22:25:00.000-08:00

Medical billing industry has volumes of arcane terminology and payer- and time-dependent claim validity and pricing interpretation rules, facilitating massive payments of invalid or ineligible claims and denials of error-free claims. Process transparency provides its participants greater visibility of internal process activities. An increased level of access promotes teamwork, increases client satisfaction, and assists in process streamlining.

Billing process is the interaction between the participants (i.e., insurance company (payer), healthcare service provider (provider or doctor), patient, and billing service provider (biller)) designed to pay or deny a payment request (claim) submitted by the biller to the payer and to the patient on behalf of the provider. The amount and complexity of billing information make it very difficult for the doctor to maintain compliance and identify and resolve errors and underpayments.

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.

Attributes of Billing Transparency

Billing transparency has four key attributes, including universality, continuity, ubiquity, and scalability.

Universality: every participant in the billing process, including patient, provider, payer, and biller, has access to every aspect of the billing process.
Continuity: process detail is available continuously on a 24 x 7 basis.
Ubiquity: access to billing process is provided over secure standard Internet browser that requires no special hardware or software and is available everywhere.
Scalability: both the big picture and minute detail are available for scrutiny universally and continuously. The big picture consists of total cash flow in a given time period, current submitted and failed claims, and billing quality metric. It must contain comprehensive summary of patient visits and unpaid balances. The minute detail pertains to individual claims making up the big picture, including complete history from the moment of creating the claim, testing its validity and eligibility, making corrections, performing submissions, reconciling payer messages and explanations of benefits (EOB) with original claims, until payment. Both perspectives must allow arbitrary aggregation of claims and drill in for detail to enable effective followup.

How to Build Transparency Into Your Billing Service?

A transparent billing service leverages technology to enable competent personnel to execute disciplined billing process. Therefore, to implement a transparent billing process, you must

[ ] Get access to adequate technology to support universality, continuity, ubiquity, and scalability.

[ ] Develop and thoroughly document claim processing procedures, including compliance and integration with practice workflow.

[ ] Train personnel in following the procedures and using the technology

[ ] Review personally and continuously billing quality, technology capabilities, adequacy of procedures, discipline, and training.

Note that Vericle-like technologies based on Straight Through Billing (STB) methodology implement billing transparency by design because billing transparency is an integral attribute of every component of STB process.

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 - The Partner of Medical Practitioners

2008-03-03T22:01:00.002-08:00

To keep track of hospital or clinic finances, payments, and patient records, a lot of doctors and hospital administrators already make use of the various medical billing software products available. Should you use one in your clinic or hospital, too? Read on so you can make an informed decision.

What can a medical billing software do?

A medical billing software is a program that helps medical professionals like yourself keep track of payments, patient records, dues, insurance information and revenues in their hospitals and clinics. Some more advanced versions also enable users to send out billing notices to patients.

Types of billing software

A desktop based medical billing software stores patient and billing information in a computer database. Hospitals and clinics use these types of programs to follow-up on their patients' payments, as well as for sending out billing notices.

Meanwhile, a web-based medical billing software is hosted online by a third-party web provider. It provides much larger databases for managing billing statements and patient records. It also allows patients to access their records online.

Tips when purchasing a medical billing software

Before buying, you should sample the program's trial version first. Software trial versions are available for free on the Internet and can easily be downloaded at websites dealing with computer software. They usually last for 15 to 30 days, depending on the product's specifications. You should also choose a software that supports medical practice management functions. This added bonus will greatly help your establishment become a more efficient and organized -- not to mention accurate --workplace.

Important consumer information on medical billing software

A complete Guide to MEDICAL BILLING SOFTWARE is available in Picky Guide, one of the fastest growing online magazines giving free consumer advice and product information

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

2008-03-03T22:01:00.001-08:00

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. In the second part of his interview, Dr. Brian gives advice to chiropractors who are at the start of their professional career.

How did your own viewpoints evolve from the time you started Billing Precision?

Dr. Brian : My viewpoints evolved in step with the growing scope of our service. As the number and size of the practices we support grew, I realized that my initial conjecture about the importance of integrated office workflow is paramount to success. For instance, besides a solid billing process, perfect SOAP notes are critical for better care, for lower audit risk, and for full reimbursement.
Two other critical points are practice owner's business focus and teamwork. An unfocused practice owner will always confuse profit, revenue, and costs. And insurance companies will always exploit the lack of teamwork between billing and front office personnel.
Today I realize that focus and teamwork can be turned around from being points of vulnerability to the strongest weapon for improving practice profitability and making the insurance companies pay everything they owe you. You can lock them down. You can research your options, fight back, and help others to fight back too.
When talking to practice owners who invite you to their office, what are the comments that stick out most in your mind?

Dr. Brian: In many ways, working with practice owners reminds me of working with the patient: a practice is a very complex system, where the flow of information must be uninhibited in order to have the practice growing at a healthy pace. Patients must make progress and vital functions of the office too must perform optimally to grow and to avoid risks.
Patients are notorious for saying "well, I just get these headaches about once a day." When they realize that a headache is a problem with blood to the brain and most chiropractic do not have headaches, they see a whole new reality they never knew is possible. When patients begin to understand the principles of how things happen, they understand that chiropractic is not just a treatment for headaches. They begin to appreciate their true potential.
A systemic "subluxation" may not be immediately observable to a naked and untrained eye, yet it may cause major setbacks for the practice owner. Just like patients who lack education about their own body and their nervous system, practice owners are often ignorant about the reasons for their underpayment or for the lack of practice growth. Many are complacent, they think where they are is as good as it gets.
Doctors and practice managers are no different with realizing the potential for the health and wellness of their own office. Their own resistance to change and education, not the payers or the lack of adequate technology, is their biggest enemy. Few practice owners are open immediately to the changes in attitude and self-discipline required for measurable improvement in collections and reduction of audit exposure. Some seem stuck on "I don't need this," "we have it under control," "we tried it and it did not work," "we can do it better" or "if it is so great how come nobody else is doing it?" Others have tasted previously awful experiences with outsourcing to billing services that neglected denials and underpayments and collected commission fees only on claims that were paid anyway.
What would you advise to the chiropractor who is about to start a new practice?

Dr. Brian: Keep the principles in mind. An office is in a lot of ways a living thing. Just as it is impossible to for the liver to do the job of the kidneys it is impossible for the chiropractor to do the job of the biller of front desk. Luckily, God made a centralized system to control and coordinate the intercommunication and function of every cell in the body. Obviously the system is the CNS and all organs and systems are accountable to it. A new doctor should see that he/she should leverage a technology and use it as the CNS of his/her practice. In that way they can act at times like the brain, sending messages and giving orders to the rest of the body through the technology, and at other times allow that system to sustain the life of the practice. The doctor can then pick and choose where his/her time is most effectively spent: IE, Marketer, Adjuster, or Manager.
Steps to success:
1. Get a system of practice
2. Get a technology that will help measure that system and one that will help manage it
3. Run the system
4. Find inefficiencies
5. Build in automation, leveraging technology and other people’s time, to prevent the inefficiency from reoccurring
6. Measure the changes and adjust accordingly
  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.

Five Key Benefits of Using Medical Billing Software for Your Medical Practice

2008-03-02T22:19:00.001-08:00

If handling your practice's medical billing seems like pulling teeth, you probably need a solution that will simplify things around the office. Many medical professionals are turning to the automated way of processing medical invoices and claims. They are discovering the amazing advantages of using advanced medical billing software to do the work. Here are five key benefits of using medical billing software.

1. Automation for Medical Billing

Every business owner understands the necessity to automate some things around the office. For an MD or other health professional, running the office is no different. Automating the invoicing and claims process in your office through medical billing software is what differentiates yesterday's doctors and today's advanced MD!

You can use the medical billing software to pull up patient or insurance company information any time you need it. A click of the mouse tells who, when, where and how much is due.

2. Reduce Paperwork

In any medical practice, paperwork builds in a hurry. Whether you use medical billing services or your own software, you will reduce paperwork dramatically. Even medical billing services provide and use software to keep up with all patient records, bills, claims, etc. So, filing and organizing paperwork is reduced, thus, saving much space in your office.

3. Reduce Office Expenses

Doing everything by hand takes time and plenty of employees to handle the paperwork during busy times. The medical billing software prices may seem high, but not when compared with the cost of hiring additional employees, paying a portion of their social security and insurance costs, space and time used in the office, etc. You can even save money on your software by comparing medical billing software prices and discounts. Sometimes, you can find the software at very affordable prices. It's considered a tax deduction as well.

Even if you choose to use medical billing services, you can sometimes find very affordable rates. The key is to compare apples with apples. Consider every aspect of the service or software as compared with your current operational costs before making a commitment.

4. Easy Access to Patient Information

Another advantage of medical billing software is you can access your patients' information from anywhere. Most software can be integrated with a program as simple and common as Microsoft Office and with the Internet. This makes it possible to open several practices and have all information in one central location on the Web. You and your employees will be able to update billing information from either office location.

5. Reduce Error Margin

There will always be some human error when entering a lot of information into a computer system. Medical billing software helps to reduce this error by "catching" common mistakes. You can personalize the software for your billing needs and reduce entry errors by pre-programming the software. This will save time and money for the long haul.

Whether you choose to buy medical billing software for your office or use a medical billing service, you can work like the pros. You can become an advanced MD or other health professional that stays ahead of the competitors.

Chris Robertson is an author of Majon International, one of the worlds MOST popular internet marketing companies on the web. Learn more about Benefits Medical Billing Software or Majon's Business and Entrepreneurs directory.

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

2008-02-29T22:09:00.000-08:00

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

2008-02-29T22:08:00.000-08:00

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:

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

2008-02-27T22:34:00.000-08:00

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:

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.
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.
Reduced accessibility: Other patients were postponed and did not get access to care because of a no-show or cancelled appointment.
Impedance to resident education: Resident doctor missed an opportunity to hone care skills.
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:

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
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
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:

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.
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
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%

2008-02-26T21:58:00.000-08:00

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

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

4-Step Training Video for Chiropractic Office Billing Software and Compliant SOAP Notes

2008-02-26T21:56:00.000-08:00

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:

Systems menu selection to access patient SOAP notes from Appointment Scheduler
Date and Doctor selection
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.
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.

Chiropractic Office Billing Software and Personal Injury Protection (PIP) in New Jersey (Interview

2008-02-25T23:00:00.000-08:00

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.

One Pocket Billiards

2008-02-14T01:16:00.000-08:00

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

2008-02-14T01:15:00.000-08:00

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

2008-02-13T00:48:00.000-08:00

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:

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.
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.
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.
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.
Audit Risk Management

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

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

2008-02-13T00:47:00.000-08:00

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

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.
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:

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.
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.
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.
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.
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.
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

Neil Weinberg, “Envy Engines,” Forbes, March 14, 2005
“Fraud Statistics – October 1, 1986 – September 30, 2004”, Civil Division, U.S. Department of Justice, March 4, 2005
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.
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

2008-02-11T02:10:00.000-08:00

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

2008-02-11T02:09:00.000-08:00

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.

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

2008-02-09T01:19:00.001-08:00

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:

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

Comprehensive integrated functionality covering entire laboratory workflow
Internet-based access to data entry and reporting
An interface between hospital internal system and external billing service
Arbitrary aggregation and comprehensive analysis of all laboratory and billing data
Full and transparent access to each and every claim, from accession number to coding to payment
24x7 status reports about received payments, submitted claims, rejections, follow-ups, and delays
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)

2008-02-07T22:43:00.001-08:00

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.

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

2008-02-06T22:13:00.001-08:00

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.

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.
Update: Make sure to upgrade your software, HIPAA Transactions, CMS1500, UB04, and/or Dental claim form changes.
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.
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.
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.
Educate: Focus on staff working on insurance verification of eligibility and claim denial or underpayment follow up.
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

2008-02-05T22:26:00.001-08:00

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.

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

2008-02-04T22:46:00.001-08:00

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

Practice mail arrives directly to the lockbox service
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
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

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?
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?
Intuitive User Interface - How many steps are required to find a letter, EOB, or a check? What are mail and check indexing parameters?
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?
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

2008-02-03T22:35:00.001-08:00

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.

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

2008-02-01T22:43:00.000-08:00

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:

Name
Dates (except year)
Zip code of more than 3 digits, telephone and fax numbers, email
Social security numbers
Medical record numbers
Health plan numbers
License numbers
Photographs

Information shared with other healthcare providers or clearinghouses

Nursing and physician notes
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

Access to PHI,
Correction for errors and completeness, and
Knowledge of others who use PHI

Safeguarding of PHI means that the persons that hold PHI must

Be accountable for own use and disclosure
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

Threat nature (Accidental disclosure by insiders? Access for profit? ),
Source of threat (outsider or insider?),
Means of potential threat (break in, physical intrusion, computer hack, virus?),
Specific kind of data at risk (patient identification, financials, medical?), and
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.

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
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
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).

Electronic Straight Through Billing Service and Software Methodology for Medical Practice

2008-01-30T22:43:00.001-08:00

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)

2008-01-30T22:42:00.001-08:00

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

Internet connectivity, bandwidth, and routers
Servers for Web server software, email, and firewalls
Database management
Data feed management
Capacity management
Redundancy management
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:

Licensing and monthly support fee to software vendor
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:

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?
Training Plan: Will the vendor provide sufficient training? What drives the training process: practice workflow changes or available software functionality?
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?
Performance: How do you measure application and service performance? Are formal performance metrics available continuously?
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?
Service Level Agreement: What minimum service levels does the vendor guarantee to the client? What are the penalties for violating SLA?
Problem Resolution: Is there a formal process to communicate problem identification and resolution? How is it tracked?
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)?
Disaster Recovery: How long would it take to recover from a disaster? Is a secondary data center available 24 x 7?
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

2008-01-28T22:46:00.001-08:00

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:

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.
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.
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.
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:

Claim complexity
1. Modifiers
2. Multiple line items
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
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:

The order of paid items
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

2008-01-28T22:45:00.001-08:00

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:

SaaS requires no large upfront investment in hardware and software licenses on the part of the user
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

Better balance sheets
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:

Functionality: Does the application deliver required functionality?
Training: Will the vendor provide sufficient application training?
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?
Performance: How do you measure application performance? Are formal performance metrics available continuously?
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?
Service Level Agreement: What minimum service levels the vendor guarantees to the client? What are the penalties for violating SLA?
Data Ownership: Who owns the data?
Disaster Recovery: How long would it take to recover from a disaster? Is a secondary data center available 24 x 7?
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

2008-01-28T00:18:00.001-08:00

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

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

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

2008-01-28T00:17:00.001-08:00

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

2008-01-23T23:29:00.001-08:00

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:

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)
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

2008-01-22T23:29:00.000-08:00

Publish your payment collections policy and standard responses to typical patient's objections.
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.
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.
Train clinic physicians to direct patients to front-office staff to review financial statements.
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.

Medical Billing Software Provides Easy Access to 2005 CPT Code Book

2008-01-20T22:59:00.001-08:00

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

2008-01-18T22:43:00.001-08:00

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:

Month-to-date collections
Total failed or denied claims
Aggregate failed or denied claims in follow-up queue
Dollar Accounts Receivable (AR) below 30 days,
$ AR in ( 30, 120] days
$ AR > 120 days
Percent Accounts Receivable (AR) below 30 days,
% AR in ( 30, 120] days,
% 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.

17 Electronic Medical Billing Software Red Flags for Chiropractic Office Audit

2008-01-18T22:42:00.001-08:00

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

2008-01-17T22:56:00.001-08:00

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

Tickets I owe to others
Tickets owed to me
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:

Subject - short description of problem
Owner - name of the employee responsible for issue resolution
Requestor - name of the manager that assigned the issue to the employee
Date - date the issue was identified and documented
Scheduled - date (time) this issue must be resolved
Body - a detailed issue description
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
Priority - relative issue importance order among other issues on the same workbench.
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.

Top 5 Metrics For Chiropractic Office Billing Software and Service Performance

2008-01-17T22:55:00.000-08:00

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.

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.
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.
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.
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.
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.

How To Choose The Right Billing Software For Your Small Business

2008-01-17T00:48:00.000-08:00

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.

Count the Ways Medical Billing Software Helps You Save

2008-01-11T22:18:00.000-08:00

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.