Medical Billing - DME Software Forms

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

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

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.

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.

Billing Medical Software

Billing medical software is used as a medical management system that can automate and track the process of submitting medical claims to insurance companies. It records the process from the first time a patient visits the doctor, through all the visits and diagnosis held from thereafter, till the end of the treatment. Plus it has several automatic processes and reports based on the information entered that can take much of the load experienced to run the medical process in a non-computerized environment.

Some of the features billing medical software has are:
1. appointment scheduling
2. electronic claims
3. flexible reporting
4. claim tracking
5. patient eligibility
6. ability to interact with other 3rd party software

Like other software applications, billing medical software needs to be easy to use and have the possibility to log the events that occur during the treatment. It needs to have a simple approach to the medical billing process as a whole, which normally, when done on paper, is a very time consuming process.

The advantages of billing medical software can be summarized as:
1. automatic billing computations for patients
2. auditable history of a treatment case at a glance
3. updated patient details availability
4. reduced time to process

Clients can benefit immensely from billing medical software. Some obvious benefits are:
1. confidentiality
2. eligibility verification
3. claims submission

Apart from offering the above advantages for both parties, billing medical software can automate the billing and collection process as well as offering simplified procedures for the main tasks needed as part of the medical and treatment process.

But who exactly can take advantage of billing medical software? This software is normally designed for doctors, dentists, medical billing centres and other healthcare professionals who intend to send electronic claims. A good quality billing medical software allows users to work on different modules simultaneously and have the ability to be used in a multi-user network environment. Entering patient details, diagnosis, issuing reports and scheduling appointments are all functions that can be done and are allowed to be done from different users at the same time.

Billing medical software is a must for highly geared medical centres nowadays. Many advantages can be taken from a well written and efficient software. The reduced time to process the work and paper involved, and the total organization of the medical process are just the highlights on which a billing medical software can focus and excel.

Sandro Azzopardi is a professional author who writes several articles on various subjects on his web site and local newspapers and magazines. You can visit information about this article and others on: http://www.theinfopit.com/technology/software/billingmedicalsoftware.php

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