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.

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

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.

                                                                                                                                     

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.

Optimize Claim Reimbursement for 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 Code	Description
90654	Influenza virus vaccine, split virus, preservative free, for intradermal use
90655	Influenza virus vaccine, split virus, preservative free, for children 6-25 months of age, for intramuscular use
90656	Influenza virus vaccine, split virus, preservative free, for use in individuals 3 years and above, for intramuscular use
90657	Influenza virus vaccine, split virus, for children 6-25 months of age, for intramuscular use
90660	Influenza vaccine, live, for intranasal use
90662	Influenza virus vaccine, split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use. (High Dose)
Q2034	Influenza 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)
Q2036	Influenza virus vaccine, split virus, when administered to individuals 3 years of age and above, for intramuscular use (Fluluval)
Q2037	Influenza virus vaccine, split virus, when administered to individuals 3 years of age and above, for intramuscular use (Fluvirin)
Q2038	Influenza virus vaccine, split virus, when administered to individuals 3 years of age and above, for intramuscular use (Fluzone)
G0008	Administration of influenza virus vaccine

Diagnosis Code	Description
V04.81	Influenza vaccination with dates of service 10/1/2003 and later
V06.6	Influenza 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 Code	Description
90669	Pneumococcal conjugate vaccine, polyvalent, for children under 5 years, for intramuscular use
90670	Pneumococcal conjugate vaccine, 13-valent, for intramuscular use
90732	Pneumococcal polysaccharide vaccine, 23-valent, adult or immunosuppressed patient dosage, for use in individuals 2 years or older, for subcutaneous or intramuscular use
G0009	Administration of the pneumococcal vaccine when no physician fee schedule service on the same day

Diagnosis Code	Description
V03.82	Pneumococcal vaccination
V06.6	Pneumococcal 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/

The 2012- 2013 Immunizers’ Question & Answer Guide : http://www.cms.gov/Medicare/Prevention/Immunizations/Downloads/2012-2013_Flu_Guide.pdf

Current pricing information: http://www.cms.gov/McrPartBDrugAvgSalesPrice/10_VaccinesPricing.asp#TopOfPage

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.

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:

http://medicare.fcso.com/EM/165590.asp

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.

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.

Iridium Suite is Dedicated to Customer Service

The Miriam-Webster Dictionary defines Service as:

1

    a: the occupation or function of serving <in active service>

2

    a: the work performed by one that serves <good service>

             b: help, training, use, benefit <glad to be of service>

At Medical Business Systems, we are dedicated to serving the needs of our Iridium Suite Medical Billing Software customers during all phases from the initial system set up and continuing on through to the daily operations of your practice.

Once you have decided to purchase Iridium Suite, a Support Representative will instruct you on the details of the system configuration and electronic payer enrollment processes for claims, electronic remittance advices, and real time eligibility transactions. 

Our Support team utilizes payer data provided from your practice to obtain the enrollment requirements from the claims clearinghouse, completes all necessary forms, and submits forms for approval while constantly tracking each step of this process to ensure a smooth and timely transition from your current system to Iridium Suite.  

With the assistance of a Support Representative, our in house IT Department creates your practice specific database that will include all of your service locations, practice providers, system users, payers, and referring physicians.

All billing staff members are provided with approximately 20 hours of comprehensive, live online training with your Support Representative before going “live” with Iridium Suite.  Once the system is “live”, additional support is provided to assist your staff in the “real life” application of the software.  Based on individual preference and the situation, this assistance can be done by telephone, email or online meeting. 

Iridium Suite Customer Service and Support are available from 8 AM ET through 8 PM ET, Monday through Friday.  You are able to contact them toll free by telephone or via email that can be directly accessed in the Iridium Suite Software.