Medical Billing - DME Software Navigation

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

Dental Billing Software

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.

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.

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

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:

1. 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.
2. 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.
3. 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).
4. 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.
5. Negotiation
6. 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

Medical Billing Software – New Features to Look for in Your In Your Next System

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

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

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

Recent advancements include:

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

Stay Connected

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

Built in Efficiencies

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

Reduced paper handling

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

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

Increased Security:

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

Conclusion

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

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

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

Medical Billing - Software Capacity

 

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

An Explanation of Medical Billing Software

Medical billing is an increasingly popular office or home-based small business opportunity that involves using skills and knowledge in medical terminology, insurance claims, and customer service to ensure that physicians and clinics receive payment from patients and insurance companies.

Whether working from home based small-businesses or at large hospitals, every medical biller utilizes medical billing software. Though still referred to as medical billing software, today’s electronic medical billing software is also more accurately called medical practice management software and covers many functions. Up-to-date medical billing software will generate a variety of reports based on data, manage appointments, as well as collect, transmit, and track billing information and payments. Current medical billing software will also make sure that records are kept in compliance with the Health Insurance Portability and Accountability Act security standards. When deciding on software to buy, compliance with this act is an important consideration and will help you steer clear of some of the software scam artists out there.

When considering software for a medical billing business, here are some things to ask yourself or potential suppliers:

• Does the software include the ability to manage several different accounts?
• Can the software handle multiple doctors or multiple offices?
• Does the software recognize current procedure and diagnosis codes and it is updatable for the future (very important!)

Many vendors will allow a trial use of their program to see if it fits your needs. You will also be able to address whether the supplier answers questions in a timely fashion and if the are helpful in a trouble-shooting situation. Remember that a good medical billing software suite will cost at least $500 so don’t be fooled by people trying to sell $50 products that don’t even function.

Though electronic billing is still mainstream, there is a movement towards online billing where a subscription is setup on the web allowing a paperless entry of patient information, claims, and more. This service will cost more than $200 per month so you have to research and weigh the benefits of a one time investment for electronic medical billing software that is local or the online web-based software that can be used from any web-connected computer or device.

Medical Billing Info provides comprehensive information about medical billing software, services, jobs and companies. Medical Billing Info is the sister site of Medical Billing Software Web.