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

Free Billing Software

Billing software is business accounting software that helps you manage your billing. It was created to help you keep track of projects, hours worked, and what your clients owe you. You can use billing software to manage your professional services business. It automatically creates a variety of reports, so you know how much you have worked, how much to bill, and who owes you what.

Billing software was designed for service industry professionals and anyone else who provides services. There are many kinds of free billing software available on the Internet, including:

Integra Office 5.2: INTEGRA OFFICE combines a powerful time and billing system with the "ultimate scheduler." Bill formats are completely customizable. The software allows any of a client's last ten bills to be re-prepared at any time.

BS/1 Professional 3.06: BS/1 Professional is an integrated time billing and accounting system, handling accounts payable, accounts receivable, general ledger, inventory, time billing, and sales analysis. Multi-currency features facilitate purchasing and international billing.

Excel Invoice Manager Platinum 2.1.1007: by integrating with Microsoft Excel, Excel Invoice Manager Platinum 2.1.1007 provides a true interface, not only for creating and editing invoices, but also for designing your own invoices with various tools provided by Microsoft Excel.

kBilling 1.2.11: kBilling - the ultimate software to use billing application runs on virtually any computer (even Windows 95) and is very simple to operate. Context-sensitive help and an intuitive user interface allows even the most novice computer user to invoice customers in seconds, not hours.

VOIP Call Shop Billing Software 5.1: using this system, you can even grant customers credit by taking payments before even they make their call. You have two options: bill your customers after the completion of a call (post-paid billing) and accept payment before they make a call (pre-paid billing).

InstantInvoice 3 3.4.8: InstantInvoice 3 3.4.8, an invoicing, billing and quotation software for small businesses, tracks customer payments and outstanding invoices. There is a powerful search-and-find option to find past invoices and quotes.

All of the above software runs on Windows 98, NT 4.0, 2000, ME and XP.

Billing Software provides detailed information on Billing Software, VoIP Billing Software, Chiropractic Billing Software, Free Billing Software and more. Billing Software is affliated with HIPAA Complaint Medical Billing Software

Invoicera: An Invoice Billing Management and Tracking Software

Are you looking for a payment tracking and invoice software which is simple and powerful? Are you spending too much time entering bills, invoices, purchase order and other data that reoccur periodically?

Invoicera (Invoice Software) has the solution.

Invoicera is professional billing & invoicing software for small to medium businesses invoicing. Invoicera is an invoice billing software which allows you to manage and track your invoicing data. With this flexible billing & invoicing software, you can create invoice, email invoice as a file and manage customer accounts and bills. It is a highly integrated Invoice Software which makes invoicing easy and automatic. The Invoice Billing software allows you to easily manage customers, invoices and payments. Invoicera is a highly integrated Invoice Software which includes a user friendly interface and several easy to use tools to track your payments and make your invoice billing better. The software is simple, easy to learn and allows you to create detailed invoices with ease. It keeps a track of your customer payments, simplifies your bookkeeping and print or email your invoice or quotes. Invoicera includes several easy to use tools to help you manage your professional business and invoicing better. It is an online invoicing software which assists you in invoice tracking and invoice management

Invoicera creates professional invoices automatically. You can print these invoices or save them to a file that you can email. Invoicera is a highly affordable and easy to learn invoice program. Instant reports, track of monthly sales, customer payments, outstanding invoices and tax reports.

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Invoicera is an Online Invoicing Software for Invoicewhich provides invoice-billing-featuresInvoicera is the perfect invoicing software, invoice tracking software, invoice management software and invoice billing software

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.

Electronic Medical Billing Software, HIPAA Compliance, and Role Based Access Control

HIPAA compliance requires special focus and effort as failure to comply carries significant risk of damage and penalties. A practice with multiple separate systems for patient scheduling, electronic medical records, and billing, requires multiple separate HIPAA management efforts. This article presents an integrated approach to HIPAA compliance and outlines key HIPAA terminology, principles, and requirements to help the practice owner to ensure HIPAA compliance by medical billing service and software vendors.

The last decade of the previous century witnessed accelerating proliferation of digital technology in health care, which, along with reduced costs and greater service quality, introduced new and greater risks for accidental disclosure of personal health information.

The Health insurance Portability and Accountability Act (HIPAA) was passed in 1996 by Congress to establish national standards for privacy and security of personal health data. The Privacy Rule, written by the US Department of Health and Human Services took effect on April 14, 2003.

Failure to comply with HIPAA risks accreditation and reputation damage, lawsuits by federal government, financial penalties, ranging from $100 to $250,000, and imprisonment, ranging from one year to ten years.

Protected Health Information (PHI)

The key term of HIPAA is Protected Health Information (PHI), which includes anything that can be used to identify an individual and any information shared with other health care providers or clearinghouses in any media (digital, verbal, recorded voice, faxed, printed, or written). Information that can be used to identify an individual includes:

1. Name
2. Dates (except year)
3. Zip code of more than 3 digits, telephone and fax numbers, email
4. Social security numbers
5. Medical record numbers
6. Health plan numbers
7. License numbers
8. Photographs

    

    

 

Information shared with other healthcare providers or clearinghouses

1. Nursing and physician notes
2. Billing and other treatment records

    

    

 

Principles of HIPAA

HIPAA intends to allow smooth flow of PHI for healthcare operations subject to patient's consent but prohibit any flow of unauthorized PHI for any other purposes. Healthcare operations include treatment, payment, care quality assessment, competence review training, accreditation, insurance rating, auditing, and legal procedures.

HIPAA promotes fair information practices and requires those with access to PHI to safeguard it. Fair information practices means that a subject must be allowed

1. Access to PHI,
2. Correction for errors and completeness, and
3. Knowledge of others who use PHI

    

    

 

Safeguarding of PHI means that the persons that hold PHI must

1. Be accountable for own use and disclosure
2. Have a legal recourse to combat violations

    

    

 

HIPAA Implementation Process

HIPAA implementation begins upon making assumptions about PHI disclosure threat model. The implementation includes both pre-emptive and retroactive controls and involves process, technology, and personnel aspects.

A threat model helps understanding the purpose of HIPAA implementation process. It includes assumptions about

1. Threat nature (Accidental disclosure by insiders? Access for profit? ),
2. Source of threat (outsider or insider?),
3. Means of potential threat (break in, physical intrusion, computer hack, virus?),
4. Specific kind of data at risk (patient identification, financials, medical?), and
5. Scale (how many patient records threatened?).

    

    

 

HIPAA process must include clearly stated policy, educational materials and events, clear enforcement means, a schedule for testing of HIPAA compliance, and means for continued transparency about HIPAA compliance. Stated policy typically includes a statement of least privilege data access to complete the job, definition of PHI and incident monitoring and reporting procedures. Educational materials may include case studies, control questions, and a schedule of review seminars for personnel.

Technology Requirements for HIPAA Compliance

Technology implementation of HIPAA proceeds in stages from logical data definition to physical data center to network.

 

 

 

1. To assure physical data center security, the manager must
   1. Lock data center
   2. Manage access list
   3. Track data center access with closed circuit TV cameras to monitor both internal and external building activities
   4. Protect access to data center with 24 x 7 onsite security
   5. Protect backup data
   6. Test recovery procedure

    

    

2. For network security, the data center must have special facilities for
   1. Secure networking - firewall protection, encrypted data transfer only
   2. Network access monitoring and report auditing

    

    

3. For data security, the manager must have
   1. Individual authentication - individual logins and passwords
   2. Role Based Access Control (see below)
   3. Audit trails - all access to all data fields tracked and recorded
   4. Data discipline - Limited ability to download data

    

    

 

Role Based Access Control (RBAC)

RBAC improves convenience and flexibility of systems management. Greater convenience helps reducing the errors of commission and omission in granting access privileges to users. Greater flexibility helps implement the policy of least privilege, where the users are granted only as much privileges as required for completing their job.

RBAC promotes economies of scale, because the frequency of changes of role definition for a single user is higher than the frequency of changes of role definitions across entire organization. Thus, to make a massive change of privileges for a large number of users with same set of privileges, the administrator only makes changes to the role definition.

Hierarchical RBAC further promotes economies of scale and reduces the likelihood of errors. It allows redefining roles by inheriting privileges assigned to roles in the higher hierarchical level.

RBAC is based on establishing a set of user profiles or roles according to responsibilities. Each role has a predefined set of privileges. The user acquires privileges by receiving membership in the role or assignment of a profile by the administrator.

Every time when the definition of the role changes along with the set of privileges that is required to complete the job associated with the role, the administrator needs only to redefine the privileges of the role. The privileges of all of the users that have this role get redefined automatically.

Similarly, if the role of a single user is changed, the only operation that needs to be performed is the reassignment of the user profile, which will redefine user's access privileges automatically according to the new profile.

Summary

HIPAA compliance requires special practice management attention. A practice with multiple separate systems for scheduling, electronic medical records, and billing, requires multiple separate HIPAA management efforts. An integrated system reduces the complexity of HIPAA implementation. By outsourcing technology to a HIPAA-compliant vendor of vericle-like technology solution on an ASP or SaaS basis, HIPAA management overhead can be eliminated (see companion papers on ASP and SaaS for medical billing).

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

Top 5 Metrics For Chiropractic Office Billing Software and Service Performance

Effective practice management depends on solid billing performance. Its measurement is an integral part of practice management process and its importance grows in step with growth of patient volume. Traditional billing metrics are limited in scope and focus on claim submission process, ignoring process imperfections on the insurance (payer) side. Modern computer technologies allow both measurement and action to improve revenue cycle efficacy and efficiency.

Useful metrics must be comprehensive and simple. They must combine both complete end-to-end processes and their individual components. Metrics must be used consistently over time and compared to standards.

 

1. Days in Accounts Receivable (DAR)

    

   A growing number of days in accounts receivable are symptomatic of a faulty billing process. One way to determine DAR is to count days from the date of service to the date of payment for every claim and then average across all claims. A simpler way to compute average number of days in accounts receivable by taking a ratio of accounts receivable to average daily charges, or

   DAR = (Accounts Receivable / Average Charge) x 365

   The main downside is this metric is its sensitivity to provider as it counts the lag time of unsubmitted claims for services already delivered.

   One obvious advantage of DAR metric is its independence of charges. The averaging feature of this metric eliminates sensitivity to specific day or CPT code but also hides the behavior shape of the accounts receivable curve.

   Note that national average of DAR hovers around 73 days. Advanced billing service providers leveraging powerful Vericle technologies often drive average DAR as low as 15 days.

    

2. Percent of Accounts Receivable Beyond 60, 90, and 120 Days (PARB60, PARB90, and PARB120)

    

   PARBX resolves the sensitivity issue of DAR metric and offers simple and charge-invariant metric of billing process. Its graphic representation has a skewed bell shape. Its steepness represents billing process quality: a steep curve and thin tail means healthy billing process, while a flat bell and a fat tail means billing problems.

   According to the MGMA survey, 25.35 percent of the average family practice's accounts receivables were more than 120 days old in 1997. This number has improved down to 17.7% in 2004.

   PARBX metric is especially helpful to identify patterns of problem claims containing specific payer or CPT code. Advanced billing service providers leveraging powerful Vericle technologies often drive average PARB120 as low as 5%, significantly below the national average of 17.7%.

   Further, PARB120 has been used to develop rule-based Billing Performance Index, which helps the development of billing industry standards. Chiropractors can use the index to benchmark their billing performance and to 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.

    

3. First-Pass Pay (FPP Rate) and Denial Rate

    

   FPP is the percentage of claims paid in full the first time upon submission (subject to federal or state timely payment regulations: 15 days for electronic submission and 30 days - for paper).

   Denial rate is the complementary metric to FPP rate. It counts the percent of claims that require followup and therefore cost more to process. Followup may take the form of a phone call to payer to discover a lost claim or to receive interpretation of denial message, correction of earlier submitted data, resubmission of the original claim, consultation with the provider and medical notes, or denial appeal.

   Both FPP and Denial rates are very important metrics often used for billing process improvement. The upside of FPP/Denial metric is that it is charge-invariant but its downside is that it hides the differences between process imperfections on the claim submission and claim payment sides. To identify patterns of problem CPT codes or payers, FPP/Denial metric needs to be computed and compared across all pairs of payer-CPT code, which is a standard feature for modern billing technologies.

    

4. Patient Liability Rate

    

   Percent of Patient Liability is the ratio of patient responsibility to total billed charges and it roughly reflects patient deductibles. This measure is important in measuring front office function as it has little to do with clean claim submission or effective followup.

    

5. Collection Ratios

    

   Gross and net collection ratios metrics used to be popular metrics in the early day of digital computing. They compare (often arbitrary) charges to (allowed) payments. Net collection rate is defined as a ratio of Total Collections and Total Charges less Adjustments. Gross collection rate is defined as a ratio of Total Collections to Total Charges only. The main drawback of Collection Ratios metrics is the use of charges in defining gross and net collections, which precludes productive discovery of process improvement opportunities.

    

 

In summary, comprehensive and charge-invariant billing metrics, such as PARBX, are more informative and objective than collection ratios. Modern Vericle-like technology using such metrics helps identifying billing bottlenecks as it allows interactive review of multiple metrics along different aggregation dimensions.

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.

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.