Can we ever move towards patient friendly medical billing?

Medicine has advanced tremendously in the last 50 years. I mean we’ve come up with antibiotics and image scanning and angioplasty, so why is it we haven’t been able to come up with a bill that doesn’t royally confuse the patients?

If patients are going to be billed high prices for medical procedures, they had better well be able to understand everything they are being billed for!

After many focus groups revealed patient frustration with their medical bills, the Patient Friendly Billing project was born.

Today’s Consumers Demand More
The costs of healthcare are rising, and it’s the consumers’ savings account that’s taking the biggest hit. Today’s consumers expect to wholly participate in their medical care and demand pricing transparency and documentation that is understandable.

The Healthcare Financial Management Association (HFMA) began the Patient Friendly Billing project to promote clear, concise, and correct patient-friendly financial communications.

The project is founded on the following tenets:
• When designing administrative processes and communications, the needs of patients and their families should be the primary focus.
• It should be the responsibility of providers and insurers to coordinate the gathering of patient information in an efficient and private way, and without any unnecessary duplication.
• If at all possible, communication regarding financial matters should not happen during the medical visit.
• The language and format of communications should be understandable to the average reader.
• Better practices should be a goal of all providers and should incorporate patient feedback.
• Billing statements should be easy to understand, accurate, provide comprehensive details, and designed so the information is logical to read. Continue reading


Why Revenue Cycle Management Service is better than a simple Billing Company?

In today’s struggling economy, physicians tend to focus more on the business side of their medical practices to ensure the sustainability of their medical practice. To improve a practice’s workflow and revenue for its survival in the long run, physicians have started shifting their focus more towards medical billing and coding. Despite this shift in the healthcare industry, many practices have gone bankrupt because of the increasing claim denial rates. It is estimated that US physicians face a loss of at least $125 billion every year because of poor medical billing. There are two main reasons why physicians face such a huge loss in practice revenue; the increasing number of billing errors made by physicians or staff members in claims and the failure of staying up-to-date with the changing rules and regulations of medical billing.


To get Ready for ICD-10 many practices have started outsourcing their medical billing tasks to billing companies, so that physicians can direct more focus towards their patients and leave the ‘dirty’ work to billing experts. However, simply handing over the billing process is not going to help medical practices reach their highest potential and squeeze maximum revenue out of the submitted claims. There are some billing companies that only assist medical practices by carrying out the implied billing tasks like code reviewing, claim preparation, claim submission and insurance follow-up. These tasks can help reduce claim denial rates of medical practices to some extent, but not assist them in turning the tide against revenue loss.

Some billing companies have taken a different approach to tackle this long term revenue loss problem. These companies offer additional services to medical practices like managing claim processing, payment and revenue generation. These added services are collectively known as Revenue Cycle Management or RCM. RCM service covers tasks like claim tracking, payment collection and also addresses denied claims, which is most likely the main cause behind 60% of missed revenue opportunity for a practice. Following are some other services offered by RCM billing companies, which makes them a better choice as compared to simple medical billing companies:

  1. Pursuing denied claims

Unlike other billing companies, RCM vendors keep track of both the submitted as well as denied claims. By identifying the error behind the rejection or denial of claims, these vendors can advice physicians to make the required changes before resubmitting the claim. This increases the probability of approval of future claims as well.

  1. Reporting and analysis

A physician needs to follow up with the billing and revenue generation process of his medical practice. RCM vendors provide timely and detailed revenue reports to the physician, informing him of the number of claims accepted or denied and the shift in the practice’s revenue generated from these claims. Regular reporting and analytics also help physicians and billers to forecast the continued growth and profit of the medical practice for the next couple of years.

  1. Billing follow-up

If a patient defaults on his bill, who is supposed to follow up? RCM vendors also save physicians from the trouble of tracking all patients who have yet to pay their medical bills.

In a nutshell, RCM companies have redefined the billing process of medical practices and are more suitable to handle medical billing operations as compared to simple billing companies. Moreover, not all RCM vendors charge physicians heavily for offering additional billing services, which is a plus point for small practices. In order to find a fitting RCM company for their practice, physicians must evaluate billing companies on the level of services they provide, their industry experience and use of technology.


RCM processes that a medical billing vendor must offer

The key behind a financially successful medical practice is the effective and efficient use of its Revenue Cycle Management (RCM) model. RCM involves all steps related to claim processing management and revenue generation. Looking at historical trends, revenue cycle management has always been a priority for physicians but the recent regulations imposed by CMS and HIPAA are making RCM unmanageable for many.

Due to this dilemma, many practices have considered outsourcing the entire RCM process to medical billing vendors, who are more equipped to handle the process.

The problem with outsourcing for many

The next question that arises, and one that puzzles many physicians, is that if outsourcing medical billing is the best solution for both small and medium practices, why are many practices (which have outsourced the service) still not generating more revenue?

Revenue Cycle Management-CureMD

The reason

Well research all points towards the RCM vendor selection process. It turns out that if a wrong vendor has been selected for the job, or a practice fails to maintain a proper relationship with its vendor, the results can be disastrous. Practices aiming to increase their revenue can go bankrupt if physicians fail to follow the appropriate guideline or steps while choosing their Medical Billing vendor.

The solution

The ideal medical billing vendor should not only have the relevant experience in Revenue Cycle Management, but should also offer a greater ROI than the cost required to outsource the process. Here are some RCM processes that practices must ensure their vendor is offering,:

  1. Follow-up:

Claim processing and submission is not all that is required from medical billing vendors. Billers must keep regular follow-ups on the claims that have been submitted to insurance companies for further processing. Follow up time differs for different insurance companies. Some process claims within 15 days while others take as long as 40 days. Some practices fall in bankruptcy by the time they realize that their vendors have only been submitting claims and keeping no tabs on what became of them afterwards.

  1. Regular reports to provider

Billing vendors should establish a strong relationship with the practice, and keep the latter updated of submitted claims through regular reporting. The reports must be shared at regular intervals (eg: every 90 or 120 days). These reports must include the percentage of accounts in receivables, as well as a breakdown of payers and providers with accounts in each category. The reports must also include a breakdown of claim denials and rejections, along with their causes.

  1. HIPAA considerations

The billing vendors must also keep up with the latest HIPAA regulations announced by CMS. They must also provide the practice with Risk Assessment and Measures to remain compliant with HIPAA.

There are many other RCM processes that billing vendors offer including, but not restricted to, performance guarantees, technology interfacing and address inefficiencies and shortfalls in getting fully paid on a timely basis. However, if a practice plans on outsourcing medical billing, it should be aware of billing vendors that try to trap practices by fooling them into signing misleading long term contracts. This way practices would lose a lot of revenue if they decided to end the contract early, even if the cause was poor vendor performance.

How will you gain from an integrated billing solution and outsourcing billing?

A decent Practice Management (PM) system and a competent Medical Billing Company can bring in massive gains for hospitals and clinics of all sizes. If utilized effectively, both of them will complement each other resulting in reduced patient visit duration, enhanced patient satisfaction levels, faster payments and lesser rejections; more efficient and well managed practice operations.

The integrated system works in such a way that it makes individual tasks for front desk personnel, nurses, physician assistants, physicians, billers and patients easier. Even if your practice doesn’t employ this many personnel and has a shorter chain of command, someone will still be performing all these tasks.

CureMD Billing Services from CureMD

Here’s how the system will aide:

  1. Front desk staff

With an Integrated Practice Management solution, front desk personnel can electronically transmit patient demographic information into the system; saving them the inconvenience of re-typing this information on subsequent patient visits and eliminating double entry.

Moreover, the verification of patient insurance information can be done in real-time during the appointment scheduling process; courtesy of the automatic eligibility verification feature. With a few clicks and entries, the entire patient insurance record including coverage for specific procedures, deductibles and other insurance provisions will appear in front of their screens.

They will not have to ‘hold’ on phone calls to already swamped insurance providers; they can immediately inform the patient what all they’re covered for under their insurance, and how much they’re expected to pay.

  1. Nurses, PAs and doctors

Using document management, all the relevant information such as capturing, scanning and attaching paper charts, x-rays, medical drawings, etc can be directly transferred onto the system.

Additionally, enterprise scheduling on a single interface allows both physicians and support staff to check when patients will be coming in and which resources are expected to be there during the visits. If the system is Cloud-based, each user can access this information (if permitted) from any location with a computer and an active internet connection.

Even before the billing process starts, the E-Superbill must be made by the practice and is subsequently forwarded to the biller or outsourced billing company. ICD and CPT codes are two essentials for creating claims that are sent out to insurance providers; identifying and entering these codes is much easier using these systems.

The doctor only has to type in the name of the procedure or diagnosis and the relevant code will automatically be generated, saving the doctor a lot of time and effort.

Moreover, doctors are automatically notified about several issues such as missing fields or wrongly entered patient insurance numbers even before the Superbill is even sent out to the biller.

  1. Patients

Integrated solutions have the provision for Patient Portals which facilitate doctor-patient interaction by allowing patients to interact with doctors, and to safely access results and reports online.

  1. Billers

The billers aided by the demographic information entered by the front desk staff, which they would otherwise have had to enter manually onto their system.

Additionally, they don’t have to dive into a profusion of paper records to determine the correct codes. The automatic generation of codes as was the case during E-Superbill creation saves them a lot of time and reduces the probability of errors.

The next question is that of outsourcing medical billing and why to do so? There are three reasons for this.

  1. They possess the required expertise, skill and competence necessary to effectively mediate and transact a practice’s medical billing.
  2. They have different personnel for different segments of billing; a foundation-pillar of any efficient billing company.

Their expertise and skill will also mean that they’ll stay up-to-date with the latest industry updates in the world of medical billing via certification courses, attending important seminars, etc. This becomes impossible for most in-house billers (usually a few managing the whole practice) as they are already swamped with work all year around.

There will be dedicated personnel for identifying and checking demographic and coding errors, dedicated personnel for sending out claims, and a separate negotiation team which has a lot of experience in dealing with insurance providers.

With all of these characteristics, they will be able to identify problems sooner, correct them faster, send out claims faster, and most importantly – get you your money faster.

Now that you’re more aware of the benefits of both integrated billing systems and the benefits of outsourcing, you should carry out some research to determine which vendors out there would satisfy your practice’s needs.


If I’m creating my super bill, what does my medical billing company do?

A doctor, using Electronic Health Record (EHR) software, wanted to learn about the benefits of using the services of a medical billing company. He asked me how he’d benefit if from the company when he was creating a super bill himself. Many of you might have similar questions so let me give you an outline of what a medical billing company actually does for you.

medical billing  company

While creating the super bill is the final stage of the clinical process of a visit, it is the earliest stage of medical billing. Explained below are several important processes that your medical billing company will do for you.

After the super bill reaches the biller, the billers verify insurance, patient demographic entry and CPT and ICD codes. The billers scrub them for any errors. These could include wrongly entered codes, etc about which the doctor is informed before the claim is sent to the insurance.

After the correction is made, a charge entry is made. Next, claims are electronically submitted to the payers.

Adjudication, insurance follow-up and measures to avoid claim re-submittals are made by the billing professionals. This is the negotiation process for which the presence of seasoned veterans is a big plus. They know how to deal with the insurance carriers in order to get your money out.

Payments and adjustments need to be then entered at the soonest when payments are received so that Secondary claims can be filed in a timely manner.

Moreover, there are many instances when the insurance denies your claim. An experienced billing company will fight for these denials via appeals and try to get out as much of your money as possible.

The billing company will also administer techniques which will help reduce denials in the future and provide you with reports whenever you requires, so that you are in control of your practice.

In short, a medical billing company maximizes your insurance payments by correctly and procedurally processing your claims. This way, you can focus on the clinical aspects of your practice, and that too in a cost effective way.