Medical Billing - DME Software Overview

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

How to Choose the Correct Chiropractic Billing Software

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

Electronic Medical Billing Software and Service Performance Metrics

Billing performance measurement is an integral part of medical practice billing process and a prerequisite to effective practice management. Systematic measurement becomes mission-critical with growth of billing complexity or outsourcing of the billing function. 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 productive measurement and effective action by the disciplined billing office to improve claim submission and payment processes.

Using appropriate metrics helps improve policies and procedures, shorten revenue cycle, reduce patient complaints, improve financial performance and compliance, increase cash flow, reduce bad debt, identify areas of potential growth, improve employee morale, increase productivity, and reduce costs. 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. Obviously, different standards apply to different medical specialties, patient demographics, payers, and samples of CPT codes.

Medical billing metrics typically include compliance, cash balances, charges, accounts receivable, and collection ratios to help monitor cash flow. This article focuses on performance metrics. For discussion of compliance program, see companion article on Medical Billing Compliance.

Collection Ratios

Traditional metrics include gross and net collection ratios. Both metrics are subjective to individual practice because 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.) According to Medical Group Management Association (MGMA) 1998 Cost Survey, adjusted fee-for-service collections (net collections) for family practices in 1997 averaged 98.65 percent. A declining net collection ratio may be symptomatic of increased contractual write-offs or insufficient number of denial appeals. This metric is especially useful in the absence of modern computer technology, when comparison of every payment to allowed amount is impossible, or when appeal process of denials is too expensive. Otherwise, the use of charges in defining gross and net collection metrics precludes them from productive discovery of process improvement opportunities.

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

Number of days in accounts receivable = (Accounts Receivable / Average Charge) x 365

This metric too depends on medical specialty, patient demographics, payer mix, and CPT sample. Another downside is that this metric is sensitive to provider as it counts the lag time of unsubmitted claims for services already delivered. This lag time roughly averages across all payers making DAR an effective comparison metric between payers for individual provider but invalidating it across multiple providers.

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

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

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.

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.

In summary, comprehensive and charge-invariant metrics, such as PARBX, are more informative and objective than collection ratios. However, these metrics alone fall short from identifying specific areas for billing process improvement. Modern technology helps identifying billing bottlenecks as it allows interactive review of multiple metrics along different aggregation dimensions. For instance, PARBX metric is especially helpful to identify patterns of problem claims containing specific payer or CPT code. Further, modern Vericle-like technologies enable comparison of every payment to allowed amount and subsequent appeal on every denial, effectively reducing the average percent of accounts receivable to low single digits.

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