Medical Billing - DME Software Lookup Tables

In this installment of medical billing and DME software, we're going to cover a brief overview of lookup tables, which is probably the heart and soul of the whole DME system. Without lookup tables, the whole operation of the system, including the medical billing itself, would be extremely difficult.

A medical biller has a hard enough job as it is. When billing a medical claim, there is an enormous amount of information that has to be sent to the insurance carrier, including patient information, item information, insurance information and so on. If you read the series on DME NSF 3.01 record specifications, then you already know that hundreds of fields of information are transmitted to the insurance carrier. If the medical biller had to enter all this information by hand, the billing of one claim would literally take hours. To speed up this process, lookup tables are used.

A lookup table is essentially a self contained database that has information pertaining to that area of billing, whether it be patient, item or carrier related. The reason that many tables are used is because of the amount of information that is contained in each table. If they were all combined into one table, the lookup process itself would be slowed to a crawl because of all the records the lookup would have to go through. As it is, with very large billing agencies, these lookup procedures can take several minutes depending on how large the network is and its capabilities to handle the load.

Each lookup table is indexed, usually in several ways. By doing this, a medical biller can lookup patient information in a number of ways. For example, if the biller doesn't know the patient's ID number, they can look it up by the patient's last name. Some lookup tables allow you to do a broad search via city and state. For item lookup tables, if the biller doesn't have the sku number, they can look up the item by description. Of course, with many of the same items in the system, this method can be time consuming.

The main point of a lookup table is that for each table, there is a large amount of information that is tied to it. So by looking up a patient, the biller is pulling all the information associated with that patient, such as name, address, phone, date of birth and a number of other things. In the process, all these items are automatically pulled to the various forms that need to be filled out. So what would normally take maybe 5 to 10 minutes to fill out, can literally be done in seconds. Obviously, this is a real time saver for medical billing agencies and greatly reduces costs, which are high enough as it is.

Quite simply, without lookup tables, DME software would be pretty much worthless, as the bulk of the operation would be the manual input of hundreds of pieces of information, which would totally defeat the purpose of having the software, to speed up operations.

Michael Russell Your Independent guide to Medical Billing

VoIP Billing Software

VoIP is an acronym for Voice over IP (Internet Protocol), or in more common terms, phone service over the Internet. Basically, it's a set of common Internet standards that allows a user's voice to be converted into small packs of digital data which can then be sent over computer networks. At the receiving end, VoIP computers reassemble the data packets back into a conventional audio signal that can be heard just as if on a regular telephone line. This is an online scheme that has been bubbling around the Internet community for the past few years. A major advantage of VoIP is that it avoids the tolls charged by ordinary telephone services.

There is VoIP billing software also that handles billing and other processes. This software can be used by all kinds of businesses. It helps in keeping track of customers, the bills to be sent to them and other such details through a protocol. This software has features like broadband phone, PC to phone, wholesale (termination), traffic exchange, international callback and prepaid calling cards that meet your VOIP business needs.

VoIP billing is tightly integrated with popular gateways, gatekeepers, proxies and soft switches from vendors like Quintum, Cisco, Sylantro, Veraz, Nextone, IPtel, Mera, and other compliant devices. Most telephony billing systems currently used today are based on non-IP standards, making them not equipped to handle or accurately bill for IP services; hence, VoIP billing rose to prominence. The reasons why most of the service providers and enterprises chose the VoIP billing software to expand their business is that it integrates the core functions like authentication, authorization, and accounting with vital functions that facilitate the effective management of all billing-related processes, like customers, services, finance, service distribution, reporting, traffic partners, and user rights.

VoIP billing software allows service providers and enterprises to expand their business by including cost-effective VoIP services in their offerings. It also enables the pre-paid or post-paid billing options for call usage and provides the ability to offer flexible call plans.

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

Chiropractic Office Billing Software Precision Index Improves 3.3% in June - PHCS Replaces BCBS MI

PHCS replaced Blue Cross Blue Shield Michigan on the Chiropractic Office Billing Software Precision Index (BPI). Overall, June 2007 BPI climbed 3.3%, bringing the index from 18.1 up to 14.8, almost 3% above the national average of 17.7%. Blue Cross Blue Shield Michigan dropped from its lead position down to the 8th place. June BPI replaced eight 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 = 14.8 means that the average of ten top performing payers working with Billing Precision clients have 14.8% 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 14.8
• PHCS 0.3
• Qual Care 0.9
• Atlantic Administrators 1.2
• HereIU Welfare 8.2
• Unicare 9.6
• Principal Life Insurance 10.6
• CBSA 12.4
• Blue Cross Blue Shield Michigan 13.6 (down from 3.2 in May)
• Blue Cross Blue Shield Illinois 15.9 (up from 16 in May)
• Medicare Illinois 30.4

 

May BPI dropped eight participants since May:

 

• GHI 11.5
• Humana 11.8
• Blue Cross Blue Shield Colorado 12.3
• Medicaid Pennsylvania 15.1
• Assurant Health 15.4
• United Health Care 22.6
• Medicare New Jersey 20
• Cigna 24.1

   

   

 

Although BCBS IL improved its index by 0.1%, its ranking dropped from seventh place in May down to ninth in June.

BCBS MI lowered its index from 3.2 in May and April down to 13.6 in June, dropping down to the 8th place in BPI.

June BPI added eight new participants since May:

 

• PHCS 0.3
• Qual Care 0.9
• Atlantic Administrators 1.2
• HereIU Welfare 8.2
• Unicare 9.6
• Principal Life Insurance 10.6
• CBSA 12.4
• Medicare Illinois 30.4

 

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  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