Medical Billing - DME Software Security

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 Software takes the Stage

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

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 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.