Medical Billing - DME Software Biller Setup

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

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

Billing Software Peripherals

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.

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.

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

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.

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

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

Question: What is Personal Injury Protection?

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

Question: Is it difficult to get paid?

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

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

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

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

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

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

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

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

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

Question: How do I take advantage of your service?

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

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

A Review of Billing Software

Recent recurring themes, like cutbacks and downsizing, are in the news every day when it comes to businesseses of all sizes. Due to those problems there are now less people in the companies left to complete essential company work and that’s typical for every company. Fortunately there are products that can help companies cope with the results of that trend. Billing software is one of those products. As there always are bills to be processed no matter the size and the type of the business itself, there are a number of programs to choose from that can help doing that, and that include so many additional useful features that they can actually match the needs of any company.

Such software can be used for example both in a medical clinic and in a law firm. It will equally well serve for medical billing that includes direct billing of patients, processing claims to insurance companies and many others depending on the situation and for the law firm to track time that’s billed to a certain customer. This professional billing software is capable of tracking incurred expenses by the attorney’s work also and many other things.

Application of such software seems to be unlimited as it can also be used by merchandise selling companies. Such program can be so set up that it will send and track invoices and include them for the specific time periods required. What is more, the billing software can fit perfectly a company with routine expenditures as it can produce time based bills electronically for all the automatic and recurring purchases.

Billing software can manage claims made by both suppliers and customers, and in addition it can process employee time slips for example. Not only will it process them but it can also calculate automatically and process payroll deductions based on that too. In some companies they have it even easier. Employees enter their timesheets electronically and the billing software generates a calculation of their exact pay. So if you set the daily or hourly wage for an employee, the software itself keeps track of time-slips, payments, accounts and all necessary details. Of course there are online billing programs too. Such programs don’t even require software for the companies with mostly routine expenses that don’t fluctuate significantly. They do offer quick and easy to follow billing procedure though.

Billing software has just as many variations as the different factors that make up a business as it is. Having different sizes, numbers of employees, etc. or the function of the company being manufacturing, distribution or dealing with different professionals to generate business leads to a great variety in the requirements each company has for its billing software. In order to help with that situation there are free directories that match billing software with company requirements. The billing software will be a great help for you but you have to make sure that you choose the right program for your type of business and your needs exactly. That’s why it is always better to use the help of those directories, search them through and find the perfect match.

Morgan Hamilton offers expert advice and great tips regarding all aspects concerning business. Get the information you are seeking now by visiting Billing Software