7 Key Features Of Integrated Pathology Lab Workflow And Electronic Medical Billing Software

Chairing a Pathology Department at Centrastate Hospital in New Jersey and simultaneously running two laboratories in two remote states (Oklahoma and New Jersey) require Dr. Michael McGinnis to match his medical expertise with savvy business sense.

"A pathologist must track workflow of the entire laboratory from receiving a sample and requisition form, to accessioning, to patient demographics, to history, to gross, dictation, proof, distribution, and billing," says Dr. McGinnis. "I need to know precisely what unfinished work is left at each stage in every lab. I need to track every step and know exactly who has done what regardless of their location. And I need this information in real time. For instance, I need the list of signed off reports arranged by requesting doctor, date, patient, or payer, in real time."

Information Systems Challenges in a Pathology Laboratory

Pathology billing is especially complicated because it requires:

 

1. Data flowing between
   1. Hospital system,
   2. Multiple requesting doctors,
   3. Internal laboratory system,
   4. External billing service, and
   5. Multiple insurance companies

    

    

    

2. A system of checks and balances to
   1. Prevent losing a case
   2. Ensure full and timely payment

    

    

 

Continuous Measurement

Billing quality is best understood by observing the distribution of Accounts Receivable. A well-performing service will have half of the claims paid within 15 days, with over 90% of all claims being paid within 45 days. The narrower "bell-curve" of Accounts Receivable means better cash flow predictability while its lower "tail" means added revenue.

Software-as-a-Service (SaaS)

"Gone are the disk crashes and software maintenance. No more office staff moods and conflicts to resolve or benefits to pay. I now pay only for performance, which makes perfect business sense," says Dr. McGinnis. "Finally, I can replace my administrative assistants with medical specialists that can take over some of my workload and add revenue."

Mission-Critical System Features

The following seven features are critical for accomplishing the benefits listed above:

 

1. Comprehensive integrated functionality covering entire laboratory workflow
2. Internet-based access to data entry and reporting
3. An interface between hospital internal system and external billing service
4. Arbitrary aggregation and comprehensive analysis of all laboratory and billing data
5. Full and transparent access to each and every claim, from accession number to coding to payment
6. 24x7 status reports about received payments, submitted claims, rejections, follow-ups, and delays
7. HIPAA compliance. Role-based access control to clinical and billing data

   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.

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.

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.

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.

17 Electronic Medical Billing Software Red Flags for Chiropractic Office Audit

Dr. Ben Lerner, founder of Teach The World About Chiropractic and author of "One Minute Wellness," discovered a uniquely convenient way to educate thousands of chiropractors about coding compliance and audit risk reduction. "Compliance maintenance requires special skills and military discipline," says Dr. Lerner. "Webinars are ideal for audit risk management instruction because they deliver urgently needed education but require minimal investment in terms of time and cost."

According to Improper Medicare FFS Payment Report (2003), "Chiropractors have the highest provider compliance error rate in Medicare, filing claims incorrectly 30.6% of the time."

Increasing frequency of post-payment insurance audits and mounting severity of penalties, ranging from license suspension to heavy monetary fines, emphasize the need for effective and affordable education about compliant office management and audit risks.

"No insurance company offers protection against potentially enormous penalties in case of post-payment audit," says Jeff Randolph, Esq., Legal Counsel to the Association of New Jersey Chiropractors and a webinar author. "The severity of provider penalties following post-payment audit have escalated in the past two to three years from relatively non-adversarial audits and occasional return of payments to very high fines, suspension or loss of license, and imprisonment."

What is a Webinar on Billing Audit Risk?

If any chiropractic practice has a 30.6% chance of being audited and no insurance offers protection against audit risk, then the only rational way to protect the practice is to develop an in-house audit defense strategy.

Doctors and practice managers are looking for cost-effective and productive ways to learn better ways to manage their practice and revenue cycle. The key benefit of the webinar is its convenience - there is no travel required and important information is delivered in ninety-minute sessions that make it easy for even the busiest doctors to quickly gain important information on topics ranging from successfully implementing EMR systems, to understanding the real benefits and challenges of outsourced billing services, risk management of post-payment audits, and much more.

Webinars leverage Internet to bring together remote participants while viewing the same visuals or computer application. An audit risk webinar teaches chiropractors to build an effective and efficient in-house audit defense strategy and offers three-fold benefit to its participants:

 

• Lower audit risk because of SOAP note compliance and audit exposure monitoring

   

   

• Higher revenue because of more effective billing

   

   

• Improved efficiency of patient flow management

   

   

 

Expert Content

A Chiropractic Audit Webinar has three parts:

• Coding:
  • CPT (Current Procedure Terminology) Codes
  • E&M Codes
  • Modalities
  • ICD-9 Coding

     

     

• Medical Necessity Documentation:
  • SOAP Notes
  • Treatment Plan

     

     

• Audit Management:
  • Seventeen Audit Red Flags
  • Audit Exposure Monitoring
  • What to do if audited?

    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 nventor 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