Blue Cross Blue Shield Michigan Heads April's Chiropractic Office Billing Software Precision Index

Chiropractic Office Billing Software Performance Index (BPI) in April 2007 outperformed its March value by 4.3%, bringing the index from 18.9 up to 14.6, ahead of the national average of 17.7%, while replacing four of BPI participants in March 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. This article describes a rule-based chiropractic billing index, including its coverage definition, update cycle, volume weighting, and provided information.

BPI = 14.6 means that the average of ten top performing payers working with Billing Precision clients have 14.6% 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 14.6
• Blue Cross Blue Shield Michigan 3.2
• Blue Cross Blue Shield Colorado 6.8
• Humana 7.9
• Blue Cross Blue Shield Illinois 11.1 (down from 11.2 in March)
• United Health Care 13.9 (up from 23.2 in March)
• Cigna 15 (down from 12.9 in March)
• Medicare New Jersey 16.4 (up from 20.5 in March)
• Blue Cross Blue Shield Texas 20 (down from 15.2 in March)
• Great West 22
• Aetna 22.1 (down from 20.9 in March)

April BPI dropped four participants since March:

• Blue Cross Blue Shield Pennsylvania
• Blue Cross Blue Shield Alabama
• Medicare Pennsylvania
• Blue Cross Blue Shield New Jersey

Three payers improved their index since March:

• Blue Cross Blue Shield Illinois 11.1 (down from 11.2 in March)
• United Health Care 13.9 (up from 23.2 in March)
• Medicare New Jersey 16.4 (up from 20.5 in March)

Three participants lowered their indexes with respect to March BPI:

• Cigna 15 (down from 12.9 in March)
• Blue Cross Blue Shield Texas 20 (down from 15.2 in March)
• Aetna 22.1 (down from 20.9 in March)

April BPI added four new participants since March:

• Blue Cross Blue Shield Michigan 3.2
• Blue Cross Blue Shield Colorado 6.8
• Humana 7.9
• Great West 22

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 "Mission Critical Systems Management" (Prentice Hall), inventor of patents in Artificial Intelligence and Computer Security, and CEO of Vericle.net Billing Technologies and Services. Vericle? unites hundreds of billing services across the nation. Its electronic medical billing software tracks payer performance from a single point of control and shares compliance rules globally. Yuval invites you to register to the next webinar on audit risk at BillingPrecision.com.

Medical Billing - Software ROI

One of the most heated arguments in the medical billing world, at least when it comes to the software company, is ROI or return on investment. This is something that is very difficult to calculate as far as what you want your ROI to be and everybody has their own theory and opinion on the subject. If you're a software company just starting out, or better yet, thinking of starting a medical billing software company, there are some basic things you need to consider when figuring out what you want your ROI to be. What follows is a list of the most basic of these items. For starters, you have to figure out what your cost of production is going to be before you even hire any programmers to create this software. This basically involves the cost of the lease on the building you'll be using as well as any other fixed costs such as utilities, insurance, etc. Add all this up and put the estimated total in one column.

The next thing you're going to have to calculate is the salaries of all the people who will be responsible for getting your product out. This includes programmers, QA persons, support techs and all managers. You will also need a networking department who, though they won't be directly responsible for working on your software, will be keeping your operation going. You need to calculate these salaries not just for the time that the software will be developed but also for the time after while you're supporting the product, which will hopefully be for the lifetime of the product. Will you keep the same number of programmers. QA people and support techs? What salary increases do you foresee? Figure all this out and put it in a second column.

The next thing you have to figure out is the cost of any add on items that you intend to include with the software at no extra charge. For example, in the medical billing industry there are a ton of forms that customers are going to need. Are you going to include these forms or are you going to have your customers get them from an outside source? What about peripheral equipment? Are you going to include barcode and retail sales machines? If so, you need to include the cost of these. Also, you're going to need to calculate the cost of maintaining all the equipment. If you deal in peripherals, you're also going to need a tech staff.

After you have figured out what all your yearly costs are going to be, you then have to decide what you want your return to be. In other words, let's say you plan to spend $1,000,000 a year and you want a 10% profit each year. You first have to figure out how many software packages the market will allow in a year. Let's say it's 10,000. If you want a 10% return, then you want to sell $1,100,000 worth of product. If you sell 10,000 units, doing the math, you will need to sell each unit at $110. This is actually very cheap for medical billing software as most packages go for several thousand dollars. So most likely, if you price your software correctly, you will make much more than a 10% ROI.

This is of course greatly simplified, but basically, this is what you need to do in order to figure out what your ROI is going to be for your medical billing software.

Michael Russell Your Independent guide to Medical Billing

Billing Software

Every business or company needs efficient, fast and quick results from their employees; they are more dependent on the manual work than machines for a few accurate and quick processes. The major places where there are problems, faced by either small businessmen or tycoons, are accounts or cash procedures. Even in an age where machine power is the norm, many businesses yet depend on manpower. This gives rise to inefficient and delayed results. Billing software, also known as invoice software, is software that helps us to maintain bills or accounts accurately.

It simplifies the process of manual billing and provides features like automatic invoicing, integration with other systems, time management, self service, payment processes and more. Added to this, it can be used to maintain a complete client and staff history with billing adjustments and time-slip production. This software can be also used in creating invoices, quotes, proposals and customer statements, and also to keep track of outstanding invoices and customer payments. This is a very important component that can be used in any type of business.

If the billing isn?t on time and accurate, or if the billing processes are inefficient, then there are chances of losing customers and revenue. Billing software can be the perfect solution to your problem. It can not only help get your billing done fast, but manages to save your customer contacts and provide sales reports. This software meets the requirements of not only a one-person office, but also a large network-based organization getting fast and immediate results.

If you are looking for software that will get your billing done with minimum time and maximum flexibility, get billing software in your office. Spend less time billing your customers and more time filling their needs.

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

Five Key Benefits of Using Medical Billing Software for Your Medical Practice

If handling your practice's medical billing seems like pulling teeth, you probably need a solution that will simplify things around the office. Many medical professionals are turning to the automated way of processing medical invoices and claims. They are discovering the amazing advantages of using advanced medical billing software to do the work. Here are five key benefits of using medical billing software.

1. Automation for Medical Billing

Every business owner understands the necessity to automate some things around the office. For an MD or other health professional, running the office is no different. Automating the invoicing and claims process in your office through medical billing software is what differentiates yesterday's doctors and today's advanced MD!

You can use the medical billing software to pull up patient or insurance company information any time you need it. A click of the mouse tells who, when, where and how much is due.

2. Reduce Paperwork

In any medical practice, paperwork builds in a hurry. Whether you use medical billing services or your own software, you will reduce paperwork dramatically. Even medical billing services provide and use software to keep up with all patient records, bills, claims, etc. So, filing and organizing paperwork is reduced, thus, saving much space in your office.

3. Reduce Office Expenses

Doing everything by hand takes time and plenty of employees to handle the paperwork during busy times. The medical billing software prices may seem high, but not when compared with the cost of hiring additional employees, paying a portion of their social security and insurance costs, space and time used in the office, etc. You can even save money on your software by comparing medical billing software prices and discounts. Sometimes, you can find the software at very affordable prices. It's considered a tax deduction as well.

Even if you choose to use medical billing services, you can sometimes find very affordable rates. The key is to compare apples with apples. Consider every aspect of the service or software as compared with your current operational costs before making a commitment.

4. Easy Access to Patient Information

Another advantage of medical billing software is you can access your patients' information from anywhere. Most software can be integrated with a program as simple and common as Microsoft Office and with the Internet. This makes it possible to open several practices and have all information in one central location on the Web. You and your employees will be able to update billing information from either office location.

5. Reduce Error Margin

There will always be some human error when entering a lot of information into a computer system. Medical billing software helps to reduce this error by "catching" common mistakes. You can personalize the software for your billing needs and reduce entry errors by pre-programming the software. This will save time and money for the long haul.

Whether you choose to buy medical billing software for your office or use a medical billing service, you can work like the pros. You can become an advanced MD or other health professional that stays ahead of the competitors.

Chris Robertson is an author of Majon International, one of the worlds MOST popular internet marketing companies on the web. Learn more about Benefits Medical Billing Software or Majon's Business and Entrepreneurs directory.

Electronic Straight Through Billing Service and Software Methodology for Medical Practice

Medical billing complexity and massive volumes of daily claims render manual claims processes incapable of protecting both the provider and the payer from underpayments, overpayments, and billing compliance violations. Straight Through Billing addresses complexity and volume processing problems by automating the majority of the claim flow and focusing the billing follow-up specialists to exceptions only. A Straight Through Billing process flags problems, routes them for follow up, and enables online correction and resubmission. Straight Through Billing methodology implements billing service transparency and focuses management on strategic process improvement opportunities.

Straight Through Billing (STB) integrates billing process within the practice management workflow, automates vast majority of transactions, focuses manual labor on exceptions, and establishes a process for continuous improvement.

First, integrated practice management and billing workflow connects patient scheduling, medical record management, and billing into a single flow. Every participant of the practice management workflow receives a unified and coherent picture of practice workload, patient and provider location, resource availability, and cash flow.

Next, transaction automation streamlines and expedites billing process by automating claim validation, payer message reconciliation, and billing workflow management:

 

• Automated claim validation eliminates errors downstream and reduces processing time because it flags errors before submitting the claim to payer.
• Automated claim-message reconciliation eliminates costly search for the original claim and standardizes message communication, further eliminating the need to decipher the (often cryptic) payer's message.
• Billing workflow management drives the followup discipline required for resolution of claim denial and underpayment incidents and establishes high degree of process transparency for all billing process participants, resulting in full and timely payments.

 

Third, focusing manual labor to exceptions requires timely exception identification, routing to followup personnel, online error correction, and rigorous followup tracking. Again, process transparency, as implemented in vericle-like systems, enables tracking exception followup.

Finally, a process for continuous improvement requires continuous observability of every process attribute and a modification methodology for both automated claim processing and manual exception followup tracking.

STB implements billing transparency by design because billing transparency is an integral attribute of every component of STB process.

Straight Through Billing Architecture

Straight Through Billing systems architecture mirrors the architecture of general Straight Through Processing (STP) systems developed for the financial services industry. Such systems require effective workflow management, knowledge base validation system, connectivity to all process participants, including on-line data reconciliation, and tracking of problem resolution. Therefore, a typical vericle-like STB system has a three-tier architecture:

 

• Back-end processing engine designed for high-volume transaction processing environment
• Middle-tier uses Java Servlet technology
• Front-end is an HTML-JavaScript zero-footprint client

 

An STB system (e.g., Vericle) following the methodology outlined above implements rich functionality, which allows automated

 

• Computer aided preferential patient scheduling
• Integrated electronic medical records
• On-line computer aided coding
• Real-time claim validation and patient eligibility testing
• Electronic claim submission
• Payment posting, reconciliation, and verification of meeting contractual obligations
• Monitoring of audit risk and billing compliance
• Tracking of denial appeal process

 

Quantitative STB Management

STB methodology allows for quantitative management as the likelihood of failure of the entire process can be estimated as the product of such items for each individual workflow steps. A vericle-like STB system tracks the percent of clean claims (claims paid without any manual intervention in full and within the allocated timeframe) and focuses the management on those process aspects that yield the greatest potential improvement. Thus STB methodology focuses on exceptions both at tactical and strategic management levels.

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

4 Step Denial Management To Improve Performance Of Electronic Medical Billing Software And Service

Partial denials cause the average medical practice lose as much as 11% of its revenue. Denial management is difficult because of complexity of denial causes, payer variety, and claim volume. Systematic denial management requires measurement, early claim validation, comprehensive monitoring, and custom appeal process tracking.

In a high-volume clinic, the only practical way to manage denials is to use computer technology and follow a four-step procedure:

 

1. Prevent mistakes during claim submission. This can be accomplished with a built-in claim validation procedure including payer-specific tests. Such tests ("pre-submission scrubbing") compare every claim with Correct Coding Initiative (CCI) regulations, diligently review modifiers used to differentiate between procedures on the same claim, and compare charged amount with allowed amount according to previous experience or contract to avoid undercharging.

    

    

2. Identify underpayments. Underpayment identification involves comparison of payment with allowed amount, identification of zero-paid items, and evaluation of payment timeliness. The results of this stage should be displayed in a comprehensive underpayment report sorted by payer, provider, claim identification, and the amount of underpayment.

    

    

3. Appeal denials. Appeal management includes appeal prioritization, preparation of arguments and documentation, tracking, and escalation. Note that CCI spells out bundling standards but the number of standard interpretations grows in step with number of payers. Therefore, CCI provides justification basis for an appeal and every appeal must be argued on its own merits, including medical notes. Denial appeal process is typically managed with a custom process tracking system, such as TrackLogix.

    

    

4. Measure denial rates. "You cannot manage what you do not measure." By measuring denial rates and observing payment trends, you can see if your process requires modifications.

    

    

 

Denial risk is not uniform across all claims. Certain classes of claims run significantly higher denial risk, depending on claim complexity, temporary constraints, and payer idiosyncrasies:

 

1. Claim complexity
   1. Modifiers
   2. Multiple line items

    

    

2. Temporary constraints
   1. Patient Constraint, e.g., claim submission during global periods
   2. Payer Constraint, e.g., claim submission timing proximity to fiscal year start
   3. Procedure Constraint, e.g., experimental services

    

    

3. Payer idiosyncrasies
   1. Bundled services
   2. Disputed medical necessity

    

    

 

First, for complex claims, most payers pay full amount for one line item but only a percentage of the remaining items. This payment approach creates two opportunities for underpayment:

 

1. The order of paid items
2. Payment percentage of remaining items

    

    

 

Next, temporary constraints often cause payment errors because misapplication of constraints. For instance, claims submitted during the global period for services unrelated to global period are often denied. Similar mistakes may occur at the start of the fiscal year because of misapplication of rules for deductibles or outdated fee schedules.

Finally, payers often vary in their interpretations of Correct Coding Initiative (CCI) bundling rules or coverage of certain services. Developing sensitivity to such idiosyncrasies is key for full and timely payments.

Powerful Vericle-like technology helps manage denial appeals nationwide and stay current until complete problem resolution. Every time one billing problem is solved, the newly gained knowledge is encoded for recycling. Sharing billing expertise in a central billing knowledge base expedites future problem resolution.

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.

How to Export Vericle Reports to Excel for Electronic Medical Billing Software Analysis

On May 12, 2003, the president of a family practice clinic, a physician, and a nursing informatics specialist won each first-place in a Microsoft Corp.-sponsored competition to honor innovative healthcare professionals. Entrants were judged by a panel of Microsoft representatives based on the number of features in Office they were using, their productivity gains, and how applicable the featured uses would be in other healthcare settings. All three winners use Excel for financial reporting, data collection, or tracking employee payroll and taxes the number and types of office visits.

However, until recently, the use of Excel for medical billing analysis has been limited because of the difficulty to produce effective ad hoc reports and inability to export data into Excel. Vericle lifts the limitation with its integrated medical billing reporting, Excel export capability, and a standard data import capability into Microsoft Excel.

Vericle's reports include expectations management for both medical billing charges and payments, analysis of accounts receivable, medical billing compliance violations, and SOAP note tracking. To take advantage of Vericle's export of medical billing data to Excel, follow a two-step procedure:

 

 

 

1. In Vericle
   1. Create desired medical billing report in Vericle, sort it and filter according to requirements
   2. Click on Excel icon in the bottom left corner of the window
   3. Select all data in the separate window that has the data (CNTRL-A)
   4. Copy all data into the buffer (CNTRL-C)

    

    

    

2. In the target Excel page,
   1. Place the cursor at a cell where you want the upper left corner of the copied data
   2. Select Edit -> Paste Special -> Unformatted text -> OK
       

      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 OLAP Software for Lost Revenue Discovery

Average medical practice may lose as much as 11% of its revenue due to underpayments. But underpayment recovery potential averages only 5% of revenue and involves costly appeal process. To avoid unrecoverable losses, some providers discontinue servicing patients insured by the worst performing payers. Unfortunately, such a drastic loss reduction measure may boomerang and increase losses depending on complexity of referral relationships. This article outlines limitations of traditional database queries used to identify payer candidates for contract termination and demonstrates alternative decision choices with superior performance in terms of revenue and risk management, facilitated with On Line Analytical Processing (OLAP) technology.

First Order SQL Queries for Accounts Receivable Analysis

Traditional accounts receivable analysis includes identification of payers that systematically underpay and refuse denial appeals. Such analysis is based on simple queries, designed to identify the best CPT code or the worst payer in absolute terms:

• Comparison of revenue for various CPT codes for a given time-period
• Comparison of underpayments for various payers for a given time-period
• Comparison of denials for various payers for a given time-period

 

A single key database indexing is a standard measure to improve time performance of such queries. It builds an ordered relationship within the data elements based on the value of the selected metric. But single key indexing precludes implementation of more complex queries like "who is the payer that underpays the most for the best CPT code," or "who is the worst referring physician for my worst payer?" and require complex SQL programming skills because of the need to store and process intermediate results. Therefore, ranking the data elements along a single attribute, forces a limited choice for management decision:

• Ignore the problem,
• Renegotiate the contract with the payer, or
• Stop serving patients insured by the worst payer.

 

But to find more subtle solutions the office manager requires the ability to aggregate and drill into data and formulate queries in real time, in response to observed results to the previous queries. Specifically, a low frequency under performing payer with a high degree of underpayment may not be as detrimental to the office as a high frequency under performing payer with a low degree of underpayment. Contract termination with a wrong payer may accomplish the opposite result to practice goals in terms of revenue maximization and workload reduction. Additionally, a decision to stop serving patients insured by any one payer may cause reduction of referral volume of other patients across all payers for a particular referring physician.

Combinatorial (Second Order SQL) Queries for Accounts Receivable Analysis

Fortunately, modern database query technology can address both limitations by enabling "second order SQL" queries, which allow data manipulation based on multiple criteria and using functions of combinations of such criteria.

In our case, second-degree SQL queries allow finding the worst payer for best revenue generating code. Such a discriminating approach allows focusing on higher priority items first, resulting in more effective management. In general, the manager performs a custom comparison of payers according to the following four-step sequence:

 

• Select metrics (e.g., % paid, % accounts receivable beyond 120 days, % denials)
• Select dimensions (providers, payers, CPT codes, ICD-9 codes, referring physicians)
• Partition
• Aggregate, drill-down, pivot

 

Worst Payer Query

To find a payer with highest amount of underpayments for the most-frequent CPT code, a second order SQL query can be written along the following lines:

For a given time-interval,

Select payers

Where sum of underpayments over

(all CPT codes Where Revenue > Revenue Threshold) > Underpayment Threshold

Worst Referring Physician Query

To avoid the risk of losing referrals from better-performing payers, the manager may consider severing referral relationship with some referring physicians instead of payers. In such a case, distribution of patients across various payers plays an important role for each referring physician. A single combinatorial query may fetch the Worst Referring Physician as follows:

For a given time-interval,

Select referring physicians Where Revenue for the Worst Payer > Threshold

Summary

Underpayment management involves all phases of claims processing and requires powerful Vericle-like computing platforms for exhaustive comparisons of payments versus allowed amounts and subsequent appeal management. OLAP allows better analysis of accounts receivable and more effective management because of the ability to handle queries with functions of multiple attributes and dimensions. Note that in the absence of native OLAP mechanism, effective Vericle-like billing platforms allow similarly powerful analysis by introducing intermediary steps. Such steps may add insight to analysis and improve decision quality.

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