Are You Optimizing Your EDI Functionality?

When Medical Billing Software is Better Than Bacon

Bacon is pretty good.
The smell of bacon cooking can trigger such pleasant memories as weekend family breakfasts.  The smell must be so intoxicating that someone even created bacon scented deodorant. (Go ahead google it, I dare you or go to powerbacon and buy yours today.)

The taste, always salty, sometimes sweet, occasionally spicy, will make your mouth water and turn ordinarily dull toast, lettuce and tomato into a tantalizing lunch.

“As seen on TV”, the ever amazing bacon can be turned into an edible bowl you can fill with foods of your heart’s delight.

It is so popular, websites, Facebook and Google+ pages have been dedicated to it.  If you don’t believe me, see Mr. Baconpants.

But, even with all those things going for it, Iridium Suite Practice Management Software is better.

You can’t eat software, but the right one will improve your cash flow and that equals more bacon (the figurative kind and the real stuff) and/or wine, shoes, hobbies, whatever your desires might be!

So see, I am right.  Medical billing software is better than bacon.

Choose  and let us help you “Bring home the bacon!”

Contact us for your free demo today!

In the meantime, let me explain how Iridium Suite can help you to achieve maximum claim reimbursement.

The critical elements are submitting clean claims initially, receiving quick insurance payments, monitoring denials, collecting patient payments and analyzing business performance indicators through reporting.

You can fulfill all these tasks with the following functions found in Iridium Suite:

Real-time Eligibility:  This function will 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.

Claim Scrubber: To prevent denials based on the NCCI edits, you will have the ability to "scrub" claims for conflicts between the procedures being billed.  We also offer custom scrubber rules that can be designed especially for your practice/specialty.

Integrated Electronic Invoicing: You are able to submit of the majority of your payer claims electronically which provides accelerated claims processing.  Denials for untimely filing can cost your practice significant revenue.  Electronic claims submission also offers automated responses from the clearinghouse and the payer recorded in the system.  You can produce these responses as a PDF document called “Proof of Timely Filing Report” to back up your appeals for those types of denials.  Electronic invoicing also drastically reduces the number of claims lost in the mail or “not on file at the payer.”

Automated Electronic Payment Adjudication:  The software is able 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 any denied services.

Practice Management Tools:  With a full ranges of accounts receivable and revenue reports, as well as, practice statistics you can keep on top of any potential reimbursement issues and provide the accountability your providers require.

Most US Teens Missing Daily Activity Goals

Value Based Healthcare: Get Some Answers

I have an “email subscription” to the TED lecture series.  Each day I receive a notice with a link to a new video lecture that has been posted.  Some days, especially the very busy ones, I don’t even open the email.  If I do not perceive the title to be worthy of the 15-20 minutes of my time, I immediately delete it.  One title struck me as extremely worthy, I took the time to listen, and ta da here I am writing this post.

My inspiration was this lecture byphysicianStefan Larsson: What doctors can learn from each other.
Hopefully you have time to watch this lecture.  Anyone in the US healthcare industry should.  We Americans typically think we have cornered the market on being the best at everything.  Sometimes we need to be reminded we are not and even if you are the best, there is almost always room for improvement.  The improvement needed, which is pointed out so eloquently in this lecture is the idea that value based medical healthcare works!

The following 5 questions and answers will provide a brief primer on value based healthcare.

What does value based healthcare mean?  It is a relatively simple concept.  By switching the focus to the best patient care, costs are typically reduced in the long run, providing the highest “value” for the service. 

  

Think about when you buy a new TV.  You can get the “generic” brand for half the price of a “name” brand, but it lasts 2 years and the name brand lasts 5.  There is more value in the “name” brand. 

Who will be impacted by this new payment model?  The Affordable Care Act requires CMS to establish a value-based payment modifier that provides for differential payment to a physician or group of physicians under the PFS based upon the quality of care furnished to Medicare beneficiaries compared to the cost of that care during a performance period. 

For CY 2015 groups of physicians with 100 or more eligible professionals are subject to the value-based payment modifier.  The limit will be significantly reduced in CY 2016 to groups of physicians with 10 or more eligible professionals.  

It is estimated that this lowered threshold will cause approximately 17,000 groups and nearly 60 percent of physicians to be included in the value-based payment modifier program in CY 2016. (Groups of physicians with 100 or more eligible professionals could receive either upward or downward adjustments.  However, only upward adjustments will be applied to groups of physicians with between 10 and 99 eligible professionals.)

Commercial payers are also creating processes and protocols to follow suit with implementing value based healthcare. 

Where will the data come from?  CMS collects and analyzes data via the PQRS program.  

A recent survey published by Availity™, shows that commercial payers as well as providers have growing concerns over the ability to exchange the necessary health information in an automated fashion. 

How will the value of the care be measured? Current plans include utilizing data collected via PQRS performance.  The Medicare Spending per Beneficiary (MSPB) measure may be included as an additional measure in the cost composite of the value-based payment modifier beginning with CY 2016.

When should I expect this to occur?  Part of theACA statute requires that CMS begins applying the value-based payment modifier on January 1, 2015, with respect to items and services furnished by specific physicians and groups of physicians (as determined by the Secretary) and to apply it to all physicians and groups of physicians beginning not later than Jan. 1, 2017.  

The CMS website provides more extensive information on the Physician Value-based Payment Modifier.

Hot Off the Press: Cancer Rates Dropping

Get More Patients for Your Medical Practice

When medical students are concentrating on preparing for anatomy tests and attempting to remember endless lists of diseases and conditions, I doubt the thought of “How will I get patients in my door?” ever crosses their minds.
I read a blog the other day with a few suggestions on how hospitals should utilize their website to bring patients in to their facility.  There are usually not hospitals on every corner whereas, it can seem like you can’t throw something and miss a physician’s office.  This increases the competition for patient business exponentially over that of hospitals.  So if a “business machine” like a hospital needs help with their “web presence” to entice patients, private practice physicians must be in dire straits in that department.
The suggestions posted for hospitals were: provide a toll-free customer support number, add trust indicators, and include testimonials.
I think with some minor adaptations we can follow their reasoning and come up with some good suggestions to increase the flow of customers to your medical practice.
  I do not see any advantage to a toll-free number, but a prominently displayed contact number and address with available directions is very important content for your website.

 I also suggest avoiding the “press a number for your party and leave a message” as the only option with your automated telephone answering system.  People like to speak to humans, always have this as an option.                                                                                                                                                         
 Your credentials are another highly valuable addition to your website. At the bare minimum, provide details of your professional degrees as well as internship, fellowship and residency completions.  Patients are interested in their physicians’ training and will have increased confidence when able to easily see this information.
  You can really impress patients by also including any medical publications you have authored, lectures or teaching participations, etc.  It’s perfectly okay to boast a little, be proud of the knowledge and expertise that you can provide for your patients.
 When patients love their doctor, they love to tell other people.  If you have some particularly enthusiast patients, go ahead, ask for a testimonial.  Just be sure to keep to a first name basis for privacy sake, like: Sally says, “I am so happy I found Dr. Smith.  I have never felt better.”
 Physician referrals and “industry” word of mouth are significant factors patients consider when selecting a provider.  Always try to cultivate good professional relationships with local hospitals and other physicians and don’t forget to “return the favor” for those who regard highly as well.

 See the Medical Business Systems website for more insight on creating a successful medical practice with Iridium Suite Practice Management Software.

Do Medical Billers Make New Year's Resolutions?

As made fact by the all-knowing Google search, these are the typical top 10 New Year’s Resolutions in no particular order:
Eat Healthy/Exercise Regularly    Drink Less     Learn Something New
Better Work/Life Balance Quit SmokingSave Money                 Volunteer
Get Organized    Read More Finish To-do List

So if you are sitting in your billing office, looking ahead to 2014, your list of resolutions might look similar to those below.  Iridium Suite Practice Management Software wants to help you keep your medical billing resolutions.  We offer free access to informative blog articles, user forums, healthcare infographics, white papers and ebooks.
 Learn how to use ICD-10… I have until October 1!

Increase revenue by analyzing fee schedules and negotiate better reimbursements. 

Read newsletters and healthcare articles to keep up with billing changes like new CPT codes, additional PQRS measures, claims filing rules (like the new HCFA 1500 format and quarterly CCI edits)

 Organize my EDI transactions to maximize new payer ERA and EFT mandates.

Keep up with those dreaded tasks like patient accounts receivables follow-up.

Medical Business Systems wishes you a Happy and Very Prosperous New Year!!