Your All-In-One Medical Billing Software

Do you have trouble keeping all your files, data, and reports sorted, yet easy to find? The latest medical billing software will do that for you as well as save the amount of time you spend searching and accessing that information; the costs it takes to manage all the different databases, and the headaches you get from worrying about all the various aspects of your business.

Consolidate Offices?Medical billing software allows you to consolidate all your offices together. You will not have to log-in and log-out of a bunch of different databases; that?s all taken care of with this system. All you need to do is log-in through this billing system, and manage each separate account without the hassle of going into multiple databases.

Work From Home?Do you have a computer and broadband connection? That means you are ready to go. Once logged into the system, you can work from your home, office, or on the road. If you?re not in the office, you don?t have to worry whether or not your business information is staying up-to-date. With medical billing software, you?re able to manage and stay on top of your business functions at all times and places.

Easy-to-Use?The #1 web-based software is simple to use. Your clients will reap the benefits from you using this system. Without the hassle of going through multiple databases, you will be able to close out all your business day dealings in a timely manner. The data always stays separate and doesn?t require duplication or extras hassle. Quick, easy, and efficiently, the job will get done right and on time for the convenience of your customers.

Security?Your data is safe and backed up at all times. Medical billing software is protected through HIPPA-compliant servers that only you and other authorized staff members can access. If you ever have a problem, a team is ready and willing to help at all times. The support team will answer as quickly as possible to solve any needs or concerns about your system.

Payment?Medical billing software won?t take much money out of your business either. You can pay monthly as you go and don?t have to worry about or deal with large, up-front software fees. Best of all, no long-term commitment is required. You?ll see and experience the benefits right away as you use the software to maximize your business.

If you?re looking to upgrade, or just want to save time and money, give medical billing software a try. With less headaches and stress, you will be able to concentrate on the really important matters of your business. Medical billing software is definitely your solution to smarter billing and efficient client service.

Jordan Bartlett is a client account specialist with an Internet marketing company (http://www.10xmarketing.com). For more information about medical billing software please visit AdvancedMD (http://www.advancedmd.com)

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

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. The following two-part interview with Dr. Brian provides a behind-the-scenes look at his work.

• When did you become interested in chiropractic?

  Dr. Brian : I became interested in Chiropractic just before graduating with a bachelors in biology. I have always enjoyed studying complex systems. I loved learning about how life is formed and how amazingly efficient is the human body.

  Most business systems are crude approximations of the amazingly efficient systems in the human body. Chiropractic maximizes that innate intelligence to do what it understands infinitely better than any human mind. To think that we can outsmart this intelligence with a pill, potion, or lotion is naive. Removing interference and maximizing the potential of life, relationship, or business is what has intrigued me most about Chiropractic.

• What attracted you to office automation?

   

  Dr. Brian: The human body uses automation to manage millions of processes every second. The autonomic nervous system is a good example. Imagine having to memory-manage every heart beat and breath throughout your day. That job alone would keep you so preoccupied you would forget to go get food and water for you survival.

  On the business side, the insurance companies continuously add things to manage to the practice. If these new things are memory-managed, the efficiency of the practice suffers. Ultimately, patient care, practice capacity, and profitability shrink.

  I'm concerned about where chiropractic profession is going in terms of profitability. I feel like most practice owners are indifferent and apathetic, while the ship is being steered by people who do not have our best interests at heart -- out-of-control payers and incompetent billers, to name two. We are at an absolutely crucial and unprecedented point in our history where technology enables the insurance companies to underpay us, profile us, audit, and take back the little money was paid ...

  But many billing companies do not have the processes, the technology infrastructure, or the talent required to face the challenges posed daily by the insurance companies. And the practice suffers substandard reimbursement, overworked practitioners, burnout.

  I can't tell you how many times I have heard a doctor say "how can I keep up with notes, billing, etc." The answer is simple: use your chiropractic training, use the principles that keep your own body functioning.

• Question: Why did you decide to start Billing Precision?

  Dr. Brian : The simple reason: I needed a billing solution for my own practice, I experienced second rate service first hand for too long, and I knew of no solution that would be good enough for rapid development of my practice and that I could trust to change as the insurance industry changed. I knew that lots of people feel the same way but I could not wait anymore for somebody else to do it for me.

  When I graduated, I went to learn from some of the most influential doctors, including Dr. Lerner, Dr. Loman, and Dr. Nalda. In addition to outstanding clinical training I also learned from them how to approach building and managing my own practice. I learned the importance of discipline and the potential of adequate infrastructure. I also saw how frustrated they were with the lack of integrated solutions: everything about running the office seemed to require memory-management, from scheduling the patient, to tracking care plan compliance, to managing outstanding balance.

  I feel that most practice management solutions are built backwards or incomplete (see my 4-part blog Is your Chiropractic Practice Management System Built Backwards???). They just keep reinventing the wheel. Another Scheduler, Custom notes, Automated check in. My feeling on this is SO WHAT??? Is the system checking you for compliance? Is it making sure everyone is billed? Are your notes really going to protect you against an audit? A good system must also manage patient education and community outreach. Part of our mission is to bring an industrial strength billing service and a practice management system, including a patient relationship management system, and help build the overall patient capacity of the practice.

  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.

Centralized Workflow Management for Outsourced Electronic Medical Billing Service and Software

The reduction of accounts receivable is key responsibility of billing function in a medical practice. This article compares traditional (distributed) billing function with centralized workflow management. It shows that centralized workflow management yields significant advantages over the distributed approach in terms of the ability to manage accounts receivable. However, it also requires significant investment in process, technology, and personnel training.

Benefits of Centralized Workflow Management for Medical Billing

Centralized workflow management is superior to traditional billing operations management because it enables continuous billing process improvement and avoidance repetition of errors, while reducing dependency on specific individual billing knowledge. The billing process improves systematically along the key performance dimensions, including payment amount and its timeliness.

Centralized workflow management accomplishes such important benefits using a two-pronged approach based on formal encoding of billing and compliance knowledge and a computer program to apply the knowledge and manage claim followup lists.

As encoded billing knowledge base grows, the accuracy of the claims and the speed of the process increases. Additionally, the staff can spend more time focusing on exceptions, while an increasing majority of claims is processed automatically.

Moreover, centralized workflow shares its billing rules across all providers and billers. Therefore, errors discovered and corrected for one provider will be avoided in the future for all of the providers using the system.

What is Workflow?

Workflow is defined as a sequence of actions performed on a claim until it is paid. Centralized workflow management must quickly separate “clean” claims from potential failures, submit clean claims to payers, and flag potential failures for correction. Workflow must also track the correction process, ensuring its integration with other sources of failures and successful completion. Finally, workflow must facilitate meticulous documentation of every step to enable continuous improvement and learning from experience.

Failed Claim

A failed claim is a claim that is flagged by the workflow system upfront as an invalid claim, is rejected by the payer after submission, or is not properly adjudicated within 30 days -- in other words, a claim that requires followup.

Workbench

Centralized workflow manages such followup lists of failed claims using workbenches. A workbench is a list of failed claims assigned to individual biller or operator. Such individual assignment of work enables continuous and individual performance tracking and improvement.

Activity Triggers

In medical billing operation, the followup lists and “to-do” lists of individual actions for each failed claim constantly change. To manage multiple to-do lists, the centralized workflow system has activity triggers. Activity triggers are the heart of task automation; they help determine what's important. Activity triggers match up promises with events and manage individual work queues in the process.

Remembering to call a payer or a provider weeks after a phone conversation when payment or claim clarification was promised requires a billing clerk to sort through their call-on-receipt folder several times a day. Activity triggers eliminate the reliance on personal memory and enable communication between individual workbenches. They are the strings that tie billing activities together. When Mary from the provider’s office updates the claim with correct ICD-9, the system needs to be aware that the claim is ready for validation, and John in billing office needs to know so he can review it again, if the validation failed or schedule its transmission to the payer.

Task Automation

Centralized workflow eliminates paper-based steps. Like a relay team passing the baton, the billing staff members electronically pass along their work without delays. Instead of printing, faxing, and following up with an e-mail or a phone call, all tasks arrive complete with supporting documentation. Rather than thumbing through reams of paper reading scribbled notes, billers receive onscreen reminders when tasks are due.

Process Monitoring

Centralized workflow also simplifies process monitoring. Providers and managers use dashboards to review key indicators. Like activity triggers, dashboards help focus personnel on what is important from high-level perspective. They show key business information that tells us if we are paid more or less over time, if our charges are going up or down, and if our followup policies are too lenient. They tell us whether we are heading in the right direction and act like lighthouses to keep us off the shoals. When we see that warning light, we can drill into the details and take corrective action.

Summary

The key difference between vericle-like centralized workflow management and traditional approaches is that a centralized workflow guides the operator in terms of claims that need followup. There is no need to manually look up reports to analyze data and select claims for followup. Vericle-like approach ensures followup consistency and timeliness.
 

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

Electronic Medical Billing Software and Service Compliance in Chiropractic Office

Over the course of the past two decades, federal and state enforcement agencies have investigated medical billing incidents and brought multiple enforcement actions against healthcare practices. The list of agencies tasked with billing compliance enforcement includes federal Department of Justice, the Office of Inspector General (OIG) at the Department of Health and Human Service, state Medicaid fraud control units, and others.

The number of medical billing fraud investigations and enforcement actions has been steadily growing. For instance, according to BillingWiki, thirteen articles and news items were published on the topic of medical billing fraud during May of 2006. In addition to growing frequency of incidents, the severity of penalties has also escalated from relatively non-adversarial audits and occasional return of payments to fines, suspension or loss of license, and imprisonment.

Six out of thirteen news items and articles about medical billing fraud published in May 2006 involve chiropractors (BillingWiki/Compliance). The remaining items are distributed more or less evenly across such specialties as psychiatry, gynecology, neurology, orthopedics, and aged care. The growing frequency of audits and increasing severity of penalties are symptomatic of inadequate attention to billing compliance at the chiropractic office.

An insurance company typically performs post-payment audit by soliciting medical notes for a random sample of paid claims during the previous year. Next, the proportion of inadequate medical notes defines the overpayment percentage. The total amount of overpayment is then calculated by applying the overpayment percentage to all payments over the past six years.

Billing compliance is doctor's responsibility and ignoring it often results in practice ruin. To avoid billing audit risks, some doctors have elected to work on cash-only basis, collecting cash payments directly from the patients instead of submitting medical claims to insurance agencies. However, such tactics does not help avoid the potential audit because patients submit requests to pay the claim to the healthcare insurance company on their own.

Since the top two reasons for post-payment audits are over utilization of certain CPT codes and hot line calls by patients and staff, the best strategy to manage post-payment audit risk has three prongs:

1. Formal compliance program,
2. Competent management of medical notes, and
3. Continuous monitoring of potential audit triggers.

First, the existence of a compliance program may determine whether the payer can routinely handle the matter as an innocent overpayment mistake or it must be investigated by the OIG as a potentially fraudulent act.

Next, careful management of medical notes is a basis for a successful audit defense, which often reduces the damages significantly and helps avoiding a repeat audit a few years later.

Finally, audit trigger monitoring ensures compliance of both cumulative service patterns across multiple patients and individual treatments. Real-time juxtaposition of histograms of CPT code frequencies between practice and national averages compares service patterns and alerts of potential compliance infringements.

Individual treatment compliance is ensured when no specific CPT code exceeds its monthly limits, such as billing a 9894X on each visit, or billing a 97140 manual therapy in place of a manipulation code because it pays more, or charging for 97149 together with 9894X, while both procedures linked to the same diagnosis. In the latter example, performing both an adjustment and a soft tissue manipulation in the same part of the body for the same complaint is illegal and a repeat submission of such a claim may trigger an audit.

An environment of high volume of patient encounters creates thousands of possibilities to deviate from normal distribution of services and trigger an audit. Therefore, real time analysis requires powerful technology infrastructure and competent legal coverage. Such infrastructure must handle all compliance aspects together, which necessitates modern Vericle-type integrative approach, combining billing, monitoring, and medical record management components in a single and comprehensive system

Yuval Lirov, PhD, author of Practicing Profitability - Network Effect for Revenue Cycle Control in Healthcare Clinic and Chiropractic Office: Scheduling, SOAP  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