BCBS MI Heads Chiropractic Office Billing Software Precision Index For 2nd Month - BPI Drops 3.5%

Blue Cross Blue Shield Michigan heads Chiropractic Office Billing Software Precision Index (BPI) for the second month straight. Overall, May 2007 BPI dropped 3.5%, bringing the index from 14.6 down to 18.1, below the national average of 17.7%. May BPI replaced three BPI participants 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.

BPI = 18.1 means that the average of ten top performing payers working with Billing Precision clients have 18.1% 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 18.1
• Blue Cross Blue Shield Michigan 3.2 (same)
• GHI 11.5
• Humana 11.8 (down from 7.9 in April)
• Blue Cross Blue Shield Colorado 12.3 (down from 6.8 in April)
• Medicaid Pennsylvania 15.1
• Assurant Health 15.4
• Blue Cross Blue Shield Illinois 16 (down from 11.1 in April)
• United Health Care 22.6 (down from 13.9 in April)
• Medicare New Jersey 20 (down from 16.4 in April)
• Cigna 24.1 (down from 15 in April)

May BPI dropped three participants since April:

• Blue Cross Blue Shield Texas 20
• Great West 22
• Aetna 22.1

No payer improved its index since April.

Six participants lowered their indexes with respect to April BPI:

• Humana 11.8 (down from 7.9 in April)
• Blue Cross Blue Shield Colorado 12.3 (down from 6.8 in April)
• Blue Cross Blue Shield Illinois 16 (down from 11.1 in April)
• United Health Care 22.6 (down from 13.9 in April)
• Medicare New Jersey 20 (down from 16.4 in April)
• Cigna 24.1 (down from 15 in April)

May BPI added three new participants since April:

• GHI 11.5
• Medicaid Pennsylvania 15.1
• Assurant Health 15.4

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

Problem Tracking For Outsourced Electronic Medical Billing Software And Service

Processes involving large volumes of complex billing transactions require effective mechanisms for problem assignment and tracking. Without such mechanisms, billing personnel cannot be held accountable for problem resolution, resulting in loss of revenue and increased compliance risk. While medical billing industry has developed specialized systems and processes for resolution of content problems, little attention has been paid to billing process problem resolution methodology. This article outlines a process and a technology for integrated billing process problem resolution methodology.

Billing Content and Process Problems Require Two Different Tracking Methodologies

Medical billing exceptions can be categorized into content and process problems. Content problems have to do with claim content and patterns of processed claims, such as terminology, medical necessity, patient eligibility, denial followup, and regulatory billing compliance. Process problems have to do with claim formatting, system interfaces, entry of patient demographics, posting of charges and payments, printing and mailing or faxing of required information, provider interaction procedure, systems access, and HIPAA compliance.

While streamlining and transparency are important attributes for resolution of both kinds of problems, the required processes and systems are very different. Content problems tend to be specialized and therefore they lend themselves to a more structured, almost template-driven solution approach. Process problems, in contrast to content problems, tend to cover a wide variety of knowledge domains, precluding specialization.

The difference in solution methodology drives the difference in problem tracking. For content problem resolution methodology the reader is advised to consult companion articles on metrics, straight through billing, and billing transparency. The remainder of this article focuses on process problem tracking.

Billing Process Problem Tracking

A general-purpose tracking system allows opening problem ticket, its assignment to specific team member, its re-assignment or escalation, change of status depending on problem resolution stage, convenient reporting about sets of tickets in different states or assigned to different team members, and continuous notification of everybody involved about change of status. Therefore, such a tracking system (e.g., web-based TrackLogix) is constructed around three basic reports, notification mechanism, and a concept of ticket.

Problem Tracking Reports

The reports show

 

1. Tickets I owe to others
2. Tickets owed to me
3. Status - a summary table of the team participants with statistics of tickets in different states

 

Other reports may show and compare individual productivity and responsiveness.

Problem Notification

For transparency, the members of the team must be continuously aware of every problem resolution status. The simplest way to maintain such awareness is to send an email to every team member about every event of problem ticket status change. Other popular notification media include paging and SMS calls. More sophisticated methods involve selective notification based on nature of event or person assigned to problem resolution.

Problem Ticket

The ticket has the following data elements:

 

1. Subject - short description of problem
2. Owner - name of the employee responsible for issue resolution
3. Requestor - name of the manager that assigned the issue to the employee
4. Date - date the issue was identified and documented
5. Scheduled - date (time) this issue must be resolved
6. Body - a detailed issue description
7. Log - time-and owner-stamped history of all documentation, including
   1. Escalation. Issues may be escalated to upper management via TrackLogix by simply changing the Owner
   2. Priority change
   3. Status change
   4. Date change
   5. Owner change
   6. Specific action taken to resolve the issue
8. Priority - relative issue importance order among other issues on the same workbench.
9. Status
   1. Open for new issue
   2. Pending for resolved and waiting for approval
   3. Closed for resolved and approved

    

    

 

Vericle-like Straight Through Billing (STB) systems automate majority of billing transactions and focus manual followup on exceptions. A formal web-based process problem tracking system, such as TrackLogix, provides accountability, which is based on a precise account of all process problems and their resolution status. With such a tracking system, every process participant has visibility to other problems. An increased level of personal accountability promotes teamwork, increases client satisfaction, and assists in streamlining the process.

For more information about problem resolution transparency and its four attributes, including universality, continuity, ubiquity, and scalability, read our companion article about medical billing transparency.

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

How To Choose The Right Billing Software For Your Small Business

If you own or manage a small business, you know how much time can be spent chasing down paper invoices, purchase orders and sales reports. It can be a real nightmare! That is where billing software comes in. It allows you to record all your customers, sales, invoices, inventory, suppliers (and more) in a PC-based system that is easy to use.

Deciding that you need to invest in good quality billing software is not hard. The tricky part can be choosing the right software package for your requirements. There are dozens of systems on the market claiming to be the holy grail of all your business problems, but choosing the wrong one can cost you valuable time and money.

Here's a simple checklist of 11 things to look for when purchasing billing software for your small business:

1) Customer records

This is the core element of any billing system. What sort of information do you need to record about your customers? There's the obvious things like address, phone, fax, mobile, email and web address. But what about marketing-related information like "how did the customer find out about your business?", and "standard discounts" for key clients.

2) Multiple contacts & Communication history

If many of your clients are businesses with multiple contacts, can you record individual contact details for each person? Word of mouth is the most powerful form of advertising, and statistics show that one of the most important factors in customer satisfaction is good customer service. Have you thought about keeping a log of all communication with your customers? It can be extremely helpful for improving internal communication within your business, and results in a more personalised service for your clients.

3) Multiple shipments

Obviously your billing software will need to create sales orders - that's a gimme. But do you need to record employee-related information, like who the "salesperson" was? What about flexible dispatch options, like multiple shipments per sales order?

4) Search facility

There's no point recording all this really useful information if there's no easy way to get to it. Check that the search facility is flexible and easy to use. What criteria can you search by? Here are a couple useful fields you may want to use: customer phone number, customer address, order date, dispatch date and dispatch consignment number.

5) Tax & regional support

Are you able to change the tax rates on an order line basis? What about currency formatting? If you and your clients are in Europe, then there's no point using billing software that can only handle US dollars.

6) Reporting

Producing accurate reports in seconds is something you no longer have to dream about. In fact it is a necessity in today's competitive market. Ensure your billing software can calculate information on sales based on date, salesperson and customer type. If you operate a B2B business, another key performance indicator may be dispatch totals, based on date, and employee. But one important thing to remember about software... you can only get out what you put in. So if you are looking for a specific report, make sure that information is being recorded by your billing software package.

7) Backup

I've seen first-hand how devastating a hardware failure can be. Hundreds of thousands of dollars worth of data can be destroyed in seconds... if you do not have a backup procedure in place. Ensure you select a billing software package that has a built-in backup utility or works with your current backup system.

8) Online help & support

If you're a new computer user, then you'll definitely need a software package that has a comprehensive online and easy-to-use help system. Also check out what direct technical support is available through the vendor. Some software companies charge very high fees for personal support, so ensure you include this in your budget.

9) Budget

How much are you going to spend? That really depends on the complexity of the software package you are looking for. Smaller software packages can be found under US$100, and larger more complex packages can cost well over US$3000. Take a look at the number of customers you have, the number of sales orders you process, and choose a solution that fits your business.

10) Customisations

If you purchase an off-the-shelf billing software package, you may require minor customisations to suit your unique business processes and industry. Some software vendors offer customisations at quite reasonable prices. But ensure you include this cost in your budget.

11) Other features

What else do you want from you billing software? If you deal with fixed price products, you may need a comprehensive inventory management system allowing you to purchase stock, manage inventory levels and supplier relations. Some quality software packages also include a useful follow-up diary, allowing you to keep track of tasks and assign them to other staff members.

When choosing a billing software package for your business, make sure you check that it offers everything your business needs. And then the only thing you'll have to worry about is what to do with all your newly found spare time!

Josh Bender is an experienced database developer and qualified software engineer. He helps small-to-medium businesses streamline processes and improve efficiency using reliable and proven software solutions. Take a free test drive of 'InstantSalesTracker', easy-to-use billing software: http://www.InstantSalesTracker.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