Meeting Medicaid Billing Needs with Sensitive Medical Billing Software

Medicaid Billing

Medicaid billing (similar to http://www.advancedmd.com/features/medicare-billing.asp medicare billing)requires medical billing software that is versatile and sensitive enough to work with Medicaid. Medicaid is state subsidization of medical expenses paid on behalf of qualified low-income individuals or families. Though requirements differ in each state, the payment is made directly to the medical practice or service provider.

In establishing medical billing solutions within a medical office, software is generally purchased to manage, track, and control billing information. Medicaid billing is handled differently than most medical billing. Since most medical billing is paid directly by the client or by the clients insurance company, most medical billing software is set up for traditional billing to the client or the clients insurance company. But Medicaid billing is paid through state government operations and requires software that is sensitive to Medicaid billing.

Medicaid Billing Need

In 1985, over 30 million Americans were enrolled in Medicaid. In 2003, less than 20 years later, the American population enrolled in Medicaid climbed to over 40 million. Clearly, with technological advances since 1985, medical billing software should be sensitive to the growing need for Medicaid billing allowances.

In understanding the nature of the need for Medicaid billing allowances in medical billing software, it is helpful to understand the Medicaid enrollment trends. Though low-income families may apply for enrollment in Medicaid, these young to middle-aged families do not make up much, if any, of the Medicaid population.

In 1999, over 38 million Americans were enrolled in Medicaid. About 33 million of those enrolled in Medicaid were the elderly, while the other 5 million consisted of disabled individuals. In 2003, the trend remains similar. Of the over 40 million individuals enrolled, over 34 million consisted of the elderly, while slightly fewer than 6 million individuals were disabled.

The point is that, in general, those enrolled in Medicaid (statistically the elderly and disabled) also require more medical care than other low-income families or individuals. That means that if a medical service provider is unable to react to Medicaid billing needs, then that medical service provider will be unable to assist not only the large demographic of Medicaid-enrolled individuals but also many elderly and disabled-two of the most medically-needy demographics.

Benefits of Medicaid Billing Sensitive Software

Millions of Medicaid-enrolled individuals are seeking medical service providers who are able to meet with the Medicaid billing needs of the state government and of Medicaid individuals.

Fortunately, with advances in technology, Medicaid billing sensitive software is available to answer the needs of the increasing Medicaid-enrolled population, many of whom are in regular need of medical attention.



About the author:
Joe Miller is an author of informational articles and online advertisements on business, technology, and health. Information on Medicaid billing is available at AdvancedMD.com.

Chiropractic Office Workflow In 2025 - Scheduling, Clinical Service, Notes, And Billing Software

Pattie Stechschulte's vision of a chiropractic office in 2025 ("A Glance into the Future," Today's Chiropractic, May, 2003) includes simplified check-in, complete patient checkup using non-invasive techniques, self-configurating adjustment table that sets itself up for next patient, a touch-screen computer system in each room loaded with intelligent software for SOAP notes, consultation modules to tap into more experienced doctor's knowledge, and a patient-friendly portal for online patient education and appointment scheduling.

While non-invasive checkups and self-configurating adjustment tables still belong to the future, the information technology aspects of Pattie's vision has already become a reality for chiropractors armed with advanced Vericle-like solutions.

First, their patients check themselves in by swiping a key tag in a scanner located in the front office. The key tag contains basic information about the patient (encrypted for HIPAA compliance) as well as practice logo and phone number for a handy patient reminder. The system immediately finds patient's SOAP notes and informs the front office person about outstanding patient balance or waiting messages.

Next, as the patient proceeds to the adjustment room, her SOAP notes are already displayed on a touchscreen computer system, the doctors have installed in each room. The system is loaded with intelligent software for care plans, SOAP notes, and retail sales products. Touchscreen technology helps doctors avoid costly mistakes of handwritten notes. Because the note generation process is standardized, notes are complete and compliant under the insurance audit scrutiny. Unlike computer mouse and drop-down menus of traditional systems or the prohibitive numbers of screens in a typical PDA, touchscreen technology requires minimal eye-hand coordination; the doctor can enter information and still maintain eye contact with the patient.

Finally, as the patient leaves the office, the system automatically generates an insurance payment claim, presents it for doctor's review, and immediately forwards it to the insurance company. With front-to-back office integration, advanced Vericle-like solutions deliver the claims to their destination in real time, as soon as the patient leaves the office.

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

Most Popular Electronic Medical Billing Software

In the last few years there has been an increase in pressure in the medical profession. Many people do not have medical insurance to pay their medical bills and this has resulted in medical offices having less money for hiring employees. Because of this, many doctor’s offices have started using third-party electronic medical billers to help improve their cash flow.

Other offices are purchasing electronic medical billing software so they can upgrade their own billing system. Being fully automated helps to cut down on office personnel and is more efficient than the former billing practices. The medical billing software comes with options such as printing the bill with late charges or just showing the number of days the bill is late. There are several software companies which provide billing software; you just need to know what features you need to fulfill your office requirements.

Sage Software: This company offers a billing software package which can be customized to suit the needs of the company. There is a section provided for address changes or to announce an upcoming event. It also has a feature to provide collection letters or letters reminding someone of their appointment time.

Collaborate MD: This software offers medical billing which uses the Internet for its day to day operations. The small monthly fee is affordable and the company always performs back-ups each day. This insures that you will not lose all of the valuable data which is stored in the system. With the click of the mouse you can view the reports needed to tell you what is going on with your business. This frees up time for the office staff since they do not have to spend hours running reports.

Medical ProClaim: This is a powerful program which is windows based and provides top notch medical claims processing. There is more than one version to choose from including medical practice, anesthesia, and dental. The low price for this software with its extensive features can help the medical practice office save a lot of time and money.

Choice Medical Billing Service: This is an outside medical billing firm that charges a percentage of the paid medical claims. Their goal is to provide a dependable billing service that has a high rate of success. They are not paid unless their clients get paid which can help reduce the costs of repeat billing. They offer a 100% guarantee that you will be satisfied with their service.

No matter what route you choose to take, electronic billing can help speed up the process of billing claims. You can choose software which is installed on your office computer which requires very little input from the staff. This software also compiles the reports needed for accounting so your staff has more time to perform other duties. This software is usually fairly inexpensive and provides updated versions for a nominal fee.

By choosing an outside firm or individual to do your billing you will be able to employee less staff and cut the costs of everyday operations. By having fewer employees you will not have to pay the salary or the benefits which are associated with each employee.

Kelly Hunter writes for http://www.electronic-medical-billing-guide.com for Electronic Medical Billing and has several years experience in research and writing.