Wednesday, December 26, 2012

EDI Functionality In Medical Electronic Billing

Electronic data interchange (EDI) is the structured transmission of data between organizations by electronic means. It is used to transfer electronic documents or business data from one computer system to another computer system, i.e. from a medical practice to an insurance payer.
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A Physician billing system should utilize the following three common EDI functions: submission of Electronic Claims, utilization of Real Time Eligibility (RTE) and receipt of Electronic Remittance Advices (ERA's). Lets look at each one of these further.
  • Electronic Claims replace the standard HCFA 1500 paper claim forms that are printed and mailed to the payer. The claims are batched in the medical billing software and then transmitted in an electronic format directly to the payer or to a clearinghouse. If a clearinghouse is used, they serve as the middle man for all the EDI transactions. Unlike with paper claims where you have no way to verify receipt by the payer, electronic claims can be tracked through each stage of the process, from receipt by the clearinghouse to the acknowledgement and acceptance by the payer. Additionally, electronic claims are pre-screened for certain errors with notices being sent back to the medical practice within days for quick correction and resubmittal. Due to their formatting, electronic claims are much more quickly processed by the payer, reducing the wait for reimbursement in some cases from weeks to days.

  • The Real Time Eligibility function in the medical billing software allows the medical practice to verify patient insurance coverage before services are rendered. The details provided in the RTE response also confirm or provide other valuable data such as, patient address, health insurance identification number and group number, and effective dates of coverage. All of this information eliminates denials for lack of coverage and provides great assistance in submitting clean claims that will be processed quickly.

  • Electronic Remittance Advices are the electronic equivalent of a paper Explanation of Benefits (EOB). The medical billing software imports the ERA from the payer or clearinghouse and often can adjudicate the payments automatically in the indicated patient's accounts. Amounts that are designated Contractual Obligations are written off, patient responsibilities such as co-pays and deductibles are allocated to the patient balance, and other open balances are applied to any appropriate additional payers. Even information regarding denials is attached to the designated services with complete details allowing medical office staff to research and choose the best action in order to resolve the denial with the payer.
If your medical system software is not utilizing all of these functions, it may be time to look for a better solution, Iridium Suite by Medical Business Systems.
                                         Medical Billing Software

Thursday, December 20, 2012

Five Ways to Capture More Claim Money

Often the handling of accounts receivable is considered distasteful, something that can be ignored or should be handled by somebody else.  Too often the calls don’t get made to insurance companies, the appeals don’t go out, or the resolution of denials is put off.  Even though it may be difficult to find time to perform these tasks, they are an integral part of every successful medical practice.

It is crucial to have a plan for working your accounts receivables.  Follow these suggestions below to get your cash flow going:                                          
  • time Setting aside the time and assigning the accounts receivable task to one person is the most logical option.  This assures a focused attempt to resolve problems and may reveal erroneous patterns in billing that are missed by several people handling the receivables ‘on the fly’ or ‘when they have time’.
  • computer screen Most insurance companies have made information quickly available online through their secure websites.  Often an EOB or check that has been missed may be found online and entered in the accounting software without picking up the phone.  The website can also offer more detailed information regarding claim denials.  Additionally many insurance websites offer direct email to quickly access customer service with any questions.
  • file folder Each insurance company has an appeal process that must be adhered to in order to get the attention directed to your claim. Keep an appeal file with details (also available on websites) so that the information is quickly available. When an appeal letter is written, keep a copy on the computer and use it to easily change only the patient information and date, thereby saving additional time and keeping the format needed by the insurance company.
  • phone If there is no other way around making the occasional phone call to an insurance company, they often have an IVR (Instant Voice Response) telephone number where you can retrieve all the information needed regarding claims and eligibility. To accomplish this task quickly, make sure all the details are at your fingertips prior to making the call. If you must speak to a ‘live’ person, get as much information as possible at the time of the call to avoid repeat calls.
  • employment Finally, if there is no time to squeeze these tasks into any staff schedules, check into hiring outside personnel that will concentrate on this important job. Make sure they have the communication skills and availability to give feedback when necessary so that recurrent findings or problems can easily transfer back to billers or medical staff. 
Staying involved with accounts receivables is a win-win solution for medical offices, patients and insurance companies.  
                                            
Medical practice billing software such as Iridium Suite also offers extensive practice management reporting to effectively oversee the financial health of your practice.  You will be able to stay organized and maximize claim reimbursement.

Tuesday, December 18, 2012

Choosing Medical Billing Software for Billing Companies

Claim reimbursement is increasingly challenging with insurers doing their best to minimize claim payments.  The deployment of well-designed billing tools can help level the playing field, increase income for your medical practices and generate more revenue for your physician medical billing services.

In order to achieve maximum claim reimbursement, it is critical to submit clean claims initially, receive quick insurance payments, monitor denials, and collect patient payments.  When seeking the best medical billing software it is important to have the following functions in your system:
  1. Real-time Eligibility:  This function should be built in to your medical billing system to allow staff to check patient eligibility in "real-time" before services are invoiced to the payer.  It eliminates denials for terminated policies or rejections due to incorrect identification numbers, etc.
  2. Claim Scrubber: To prevent denials based on the NCCI edits, the medical billing software should have the ability to "scrub" claims for conflicts between the procedures being billed. 
  3. Integrated Electronic Invoicing: A medical billing system should allow for submission of electronic claims providing quicker turn around for claim processing.  It also drastically reduces the possibility of claims lost in the mail,  or denied for untimely filing.  As we progress to a "paper-less" environment, this function is crucial.
  4. Automated Electronic Payment Adjudication:  The best medical billing software should have the ability to automatically adjudicate electronically received insurance explanation of benefits.  Through this process, insurance payments are posted faster allowing you to quickly collect remaining balances from secondary payers or patients and initiate any appeals for denied services.
  5. Practice Management Tools:  You need a medical billing system that can provide all the necessary information to manage your customer's practices reimbursements.  Full ranges of accounts receivable and revenue reports, as well as, practice statistics keep you on top of any potential reimbursement issues and provide the accountability your customer's require.
So remember these 5 key elements of functionality when you are doing your medical billing software comparison.



Monday, December 17, 2012

Medical Business Systems Announces the Release of Iridium Suite Version 10, Expanding Its Reach to Serve All Medical Specialties

By Susan Morrison
November 26, 2012

Reno, NV – Locally owned Medical Business Systems announced today that it has released Iridium Suite version 10 which makes its user-friendly medical billing software the best billing solution for all medical specialties.  Iridium Suite version 10 brings the technological advantages previously enjoyed primarily by radiation oncology practices to every medical practice within the United States. 
 
Iridium Suite is a leader in the billing software market.  Iridium Suite’s customers experience unparalleled billing cycle automation and error prevention measures which result in higher staff productivity and increased medical claim reimbursement and cash flow.

Iridium Suite was developed in conjunction with modern electronic billing standards and therefore its users benefit from unparalleled levels of automation throughout the medical billing cycle.  Iridium Suite is 5010 and ICD-10 compliant.  With Iridium Suite:
  • Clinics can choose between visit-based or treatment course-based billing work flow to maximize staff productivity and reduce missed charges.
  • Practices have access to fully integrated Real-Time Eligibility allowing direct online verification of patient’s insurance policy validity.
  • Users are able to import patient data directly from the practice’s EMR/EHR reducing manual keying requirements.
  • The software’s user-friendly super bill charge entry interface is easily configured to mirror each practice’s clinical documentation.
  • Iridium Suite’s automatic scrubber provides immediate feedback alerting medical billers when a charge is in violation of medical billing rules, helping practices bill claims correctly the first time.
  • Using Iridium Suite’s fully integrated and automated electronic billing features, Iridium Suite customers are able to send claims and receive ERAs without having to interact with a third party system.
  • Iridium Suite’s robust reporting module allows practices to analyze their fiscal health and clinical data through hundreds of easy-to-configure reports.
 “The other systems I’ve used to bill are far too difficult to navigate. Iridium Suite is very user friendly. It eliminated so much mundane work my staff and I had been doing for years with other systems,” says Daphne Palmer, M.D.

“The investment has been minimal compared to other alternatives and the improvement in revenue stream has been fabulous, sometimes getting the money in the bank within the same week from the date of service.  [This was] unheard of before I had Iridium Suite,” responded Dr. Jaime Lozano.

About Medical Business Systems

Medical Business Systems is an innovator in the field of medical billing software.  Medical Business Systems was founded by a practicing physician.  Its flagship product, Iridium Suite medical billing software, was developed in clinical setting.  Iridium Suite features leading edge technology which benefits its users throughout the United States.  For more information, please visit http://www.iridiumsuite.com

ContactTo learn more about Iridium Suite medical billing software, please contact:
Susan Morrison
Medical Business Systems
Office:  (775)453-3193
susan@iridiumsuite.com

Thursday, December 13, 2012

Benefits of Electronic Health Records (EHR)

All practices have felt the push to Electronic Health Records(EHR). Whether you have already complied or are holding off, there are definite benefits to making the change.
                                                                                                                                      EHR
The first and maybe the most important is legibility. We have all heard the jokes about “doctor's handwriting”, but handwriting in general is typically far less readable than a typed record. Illegible records can definitely be the cause of patient mistreatment. It is commonly known to cause inaccurately filled prescriptions. Legibility and how it can prevent medical errors is one of the main “pros” for the implementation of EHR.

As the health and safety of the patient is always first and foremost, it is important to also consider how easily read medical records can assist your practice in maximizing your claim reimbursement in several ways. 

All Commercial payers as well as CMS, reserve the right to deny any service they deem not reasonable and necessary. 

By utilizing an EHR system, you can avoid claim payment denials by having decipherable clinical notes and supporting documentation. The EHR system will automatically assign the date, time and appropriate service provider to the medical record. It will also update this information as necessary when changes are made to the record insuring complete and accurate tracking of the patient's treatment process. 

In many instances, an EHR can walk you through a process, such as an Evaluation and Management service, prompting the provider to fully complete one part of the evaluation before moving on to the next.

As an EHR many times is completed “real time” with the patient face to face, it will record all procedures and services performed. When this record is reviewed by the medical coder all appropriate procedure codes can be collected and billed, eliminating any forgotten check marks on those old super bills. 

So, when you have decided it's time to select your EHR, keep something else in mind. The ability of your EHR to communicate electronically with your medical billing software. At Medical Business Systems we have developed the “Connectivity Clearinghouse” allowing our billing software, Iridium Suite, to import patient data directly from the EHR eliminating the need for double data entry.

Tuesday, December 11, 2012

Optimize Claim Reimbursement for Vaccinations



                                                                                         vaccinations

If your office is administering Influenza Virus and Pneumococcal vaccinations, you should review the following information to insure you are submitting the correct diagnosis and procedure codes to receive the proper claim reimbursement. The vaccine procedure code should be chosen based on the description of the drug and the age of the patient. Each vaccine code should be billed with the appropriate administration code as well.

The following procedure and dianosis codes are used for influenza virus vaccinations:

CPT/HCPCS CodeDescription
90654Influenza virus vaccine, split virus, preservative free, for intradermal use
90655Influenza virus vaccine, split virus, preservative free, for children 6-25 months of age, for intramuscular use
90656Influenza virus vaccine, split virus, preservative free, for use in individuals 3 years and above, for intramuscular use
90657Influenza virus vaccine, split virus, for children 6-25 months of age, for intramuscular use
90660Influenza vaccine, live, for intranasal use
90662Influenza virus vaccine, split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use. (High Dose)
Q2034Influenza virus vaccine, split virus, for intramuscular use (Agriflu)
Q2035 Influenza virus vaccine, split virus, when administered to individuals 3 years of age and above, for intramuscular use (Afluria)
Q2036Influenza virus vaccine, split virus, when administered to individuals 3 years of age and above, for intramuscular use (Fluluval)
Q2037Influenza virus vaccine, split virus, when administered to individuals 3 years of age and above, for intramuscular use (Fluvirin)
Q2038Influenza virus vaccine, split virus, when administered to individuals 3 years of age and above, for intramuscular use (Fluzone)
G0008Administration of influenza virus vaccine

Diagnosis CodeDescription
V04.81Influenza vaccination with dates of service 10/1/2003 and later
V06.6Influenza and pneumococcal vaccination (Report this code when the purpose of the visit was to receive both vaccinations during the same visit)

The following procedure and diagnosis codes are used for pneumococcal vaccinations:

CPT/HCPCS CodeDescription
90669Pneumococcal conjugate vaccine, polyvalent, for children under 5 years, for intramuscular use
90670Pneumococcal conjugate vaccine, 13-valent, for intramuscular use
90732Pneumococcal polysaccharide vaccine, 23-valent, adult or immunosuppressed patient dosage, for use in individuals 2 years or older, for subcutaneous or intramuscular use
G0009Administration of the pneumococcal vaccine when no physician fee schedule service on the same day

Diagnosis CodeDescription
V03.82Pneumococcal vaccination
V06.6Pneumococcal and influenza vaccination (Report this code when the purpose of the visit was to receive both vaccinations during the same visit)

CMS has available on it's website numerous resources to assist providers:

Facts on Influenza, Pneumococcal, and Hepatitis B Immunizations: http://www.cms.gov/Medicare/Prevention/Immunizations/index.html?redirect=/Immunizations/



Coding Hint: Based on CCI edits, when performing an unrelated E/M service on the same date as the vaccination, append a “25” modifier to your E/M service procedure code to prevent denials of your immunization service.

Thursday, December 6, 2012

How Do You Score Your Evaluation and Management Services?




Subscribers of eNews from First Coast Service Options Inc. (FCSO) the Medicare Fiscal Intermediary for Florida, Puerto Rico and the U.S. Virgin Islands were asked this question:

Do you find the E/M interactive tool useful?

The choice of answers listed was:
Yes
No
Don't have a need for it
Unaware of its existence

This made me start thinking about those answers, especially “Don't have a need for it” and how E/M services are “scored” and then coded to be submitted for payment. 

Almost everyone familiar with medical billing and coding has read through a CPT manual's section on E/M codes. To determine the level of the code, you are supposed to consider either the level of complexity or the extent of detail of the top 6 of the listed components. The seven components are:

History
Examination
Medical decision making
Counseling
Coordination of care
Nature of presenting problem
Time

For the person responsible for selecting the correct level of E/M service, it is easy to see with all of the elements to consider when choosing, this is a much more daunting task than it seems.

That is why an E/M score sheet is a great tool to enable the physician, a physician extender, or medical coder to quantitatively evaluate the service provided and assign the accurate E/M code representation. By using a scoring  system, it also helps to insure proper documentation in the medical record.

Some EHR software contain a scoring system, that keeps track of the components as they are entered in the medical record, providing the user with the recommended code once all documentation has been completed. This would obviously be the most convenient solution, but for those without this capability, FCSO offers this tool on their website for use by anyone, no website enrollment is required. The link is:


By using E/M scoring in your practice you will have the benefit of coding to the highest applicable service level to generate the highest reimbursement and insuring proper documentation safeguarding against any chart audit recoupments.

Tuesday, December 4, 2012

Review Your Fee Schedules for Maximum Reimbursement

As the new year quickly approaches, we all await the “final” Medicare fee schedule. We are familiar with the routine. Each November a fee schedule is published, but it is pending based upon Congress and the supposed required budget reductions. The large cuts seem to eventually get overturned, producing a much different “final” schedule than seen in November.

So while you are waiting to see how your Medicare will reimburse in 2013, take time to review your Commercial payer contracts and fee schedules. 

Some contracts are base on Medicare rates, but are typically renewed every few years, not annually. Depending on the wording of your contract, if the reimbursement is based on a particular year's Medicare fees, then you may be due for an increase adjustment. 

For contracts that have their own payer determined fee schedule, you should review those to see when the rates were last adjusted by the payer. It may be time to contact your Provider Relations Representative and discuss the potential for any upcoming changes in reimbursement.

If your specialty in is high demand, you may also use this as a factor in negotiating higher fees from the payer.

Besides just being familiar with your payer fee schedules, it is integral to the health of your practice to confirm that you are being paid accordingly.

To do this you could be “old school” and compile a sampling of EOB's from your contracted payers, comparing the allowed amounts to the fee schedules to check for discrepancies. This of course will be a laborious and time consuming project.

If you have medical billing software such as Iridium Suite, you could let the system do it for you with the Reimbursement Analyzer Report. The report data indicates the expected reimbursement versus the actual payments, indicating those that are lower than the contracted rate and poor faith contracting on the part of the payer. The results can demonstrate a consistent and possibly an intentionally inappropriate reimbursement pattern. This report can also reveal problems where an opportunity to improve billing can occur. 

Iridium Suite also allows the report to be scheduled to run automatically, emailing the results to any indicated party. This type of automation is one of the many features that makes this one of the best medical billing softwares available today.