What Is a Medical Billing Assessment?

A medical billing assessment includes a comprehensive audit that focuses on:

• Analyzing your practice’s billing performance
• Auditing its policies and procedures
• Assessing the technology and tools you use
• Reviewing your patient care workflow

Often, physicians will unintentionally under code or over code for patient services performed, or simply don’t document well, which can have a negative impact on your practice’s bottom line.

Frequency of a Medical Billing Assessment

⇒  Industry experts recommend that every medical practice have a billing assessment conducted at least once a year or more often such as a semiannual audit of all providers who bill for services.

⇒  It’s also a good idea to have an ad-hoc assessment if you have any concerns about coding patterns or your practice has a history of shoddy documentation, or if you have recently added a new physician to your practice. A surprising assessment is a good idea so employees can’t try to plan ahead for the audit by falsifying or hiding documentation.

⇒  Assessments are key, providing a tool to evaluate things we are doing well and things we could do better. 

But how do you know that your practice could use an assessment, especially if it includes the state of your medical billing apparatus? 

How do you know if it is time for a medical billing assessment?

Here are some tips that it may be time to enlist the help of a financial health diagnostic specialist to evaluate the overall financial and workflow health of your practice.

Is your practice growing?

• Many practices enjoy growth and expansion; others prefer to stay small and can sometimes be forced to turn new patients away. But what if your practice is stagnant? Chances are it has nothing to do with the medical care you are providing, but more so how the patient is made to feel with regard to their interactions with your practice.
• If patients are feeling disenfranchised because they are having issues in rectifying their insurance with your revenue system, or they are experiencing inconsistent billing, the odds are likely that the patient will go elsewhere. 
• Sadly, most people don’t have time to navigate a complex system like medical billing and will opt to go where a practice understands the nuances of customer service and proper billing and collections. 
• Because it is either their own insurance or personal finances that have to work seamlessly with whatever medical practice they choose.

What is the Status of Payer Contracting?

Insurance plans are constantly changing and evolving.

Is your practice able to keep up?

Can it differentiate between extended coverage vs. federal minimum requirements?

Do you understand Tricare, VA medical, Medicare, and Medicaid?

If your practice’s understanding of contracts is not in synch with the insurance companies you accept and the services you provide, then an assessment may be in order to pinpoint areas of failure and resolve them.

Is your practice up to date with Medicare?

Does your staff know that Medicare fee schedules are updated annually? 

When they are, you can expect a lot of changes that can affect reimbursement values.  Revised fees can add hundreds even thousands of dollars to your reimbursement costs.  

Medicare is instituting a new ID card to better protect patients’ personal data. The roll-out is underway now nationwide and will cease on December 31, 2019. 

Is your practice ready to convert to the new system?

Has training occurred?

If your practice is not up to date on Medicare, then consider an assessment to bring your practice up to speed.

How do you handle denial management?

Statistics show that 20-30% of claims are rejected and 80% of those rejected claims go unprocessed. Denied claims to reduce or delay incoming revenue and that impact patients’ trust and confidence. A financial health diagnostic specialist will help you determine the gaps and flaws in your denial management system and will advise ways that can maximize revenue recoupment.

Is it time for a second opinion?

If you have any of these concerns, We can help you achieve greater profitability while at the same time freeing up your time to focus on patients. Our innovative and dynamic medical billing services will help you to achieve a high level of effectiveness that will result in the enhancement of overall practice management.

Is it time for a medical billing or comprehensive operational audit and practice evaluation? If so, Outsource your insurance medical billing duties with our professional billing staff, and your days of insurance company stress can be over for good! We will take on all tedious responsibilities that come with medical insurance billing so you can focus all your energy on what really matters: your patients.

Contact us for a complimentary practice Analysis and billing assessment consultation.

The recent changes and every additions and modification to it demand a considerable amount of training for the in-house staff. The training costs skyrocket and to make it worse, handling prior authorization for DME along with other routine billing responsibilities welcome more errors. That, in turn, forces rejections and denials.

At this juncture, providers could do well with helping a guiding star. One that could bail them out of the deep waters they are sinking into. They have found out that helping hand in the professional DME prior authorization services.

Some of the prior authorization services also go beyond the usual and offers extras like standalone services, free Telemedicine platform, and other solutions like Revenue Cycle Management and Practice Management. All these services come in affordable prices that help the providers to repair the damages done without having to spend much ultimately adding to the revenue recovery process.

Challenges of Prior Authorization

⇒DME prior authorization will be never like before. What was thought to be a great reform to check the rising prices of Durable Medical Equipment and bring an overall clarity in the DME prior authorization process turned out to create complexity and uncertainty instead.

⇒Health insurance companies normally require prior authorization for medications, durable medical equipment (DME) and medical services, and insurance authorization services are available to help handle the administrative burden associated with the process.

⇒However, the American Medical Association (AMA) notes that prior authorization policies are fraught with problems like inefficiency and lack of transparency, which undermines patient care and costs physician practices time and money.

⇒Medicare through its mandate (Final Rule) issued that it is not going to pay for certain durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) without prior authorization. It was aimed to bring transparency in the whole DME prior authorization process and it has managed to achieve its objective to a certain extent.

Here are some steps that can physicians can take to obtain preauthorization and prevent denials:

Be familiar with the coverage and preauthorization guidelines of each payer:

Surgeons must be aware of the coverage and preauthorization guidelines for payers and provide a specific diagnosis on their reports.

Follow the recommended treatment guidelines: 

Physicians should make sure they are following the recommended treatment guidelines before ordering a high-cost procedure for a patient.

Ensure preauthorization even for mundane procedures: 

Two most common procedures that insurers require preauthorization for are imaging procedures such as computerized tomography (CT) scans and magnetic resonance imaging (MRI), and brand-name pharmaceuticals.

Take steps to protect against denials: 

Providers need to have relevant information about the procedures that they routinely perform and enter into the contracting process with this information. They should have evidence to prove the medical necessity of particular procedure as well as reliable resources on coverage for certain diagnoses. Such information would also help during reimbursement negotiations.

Meet the all-payer criteria: 

Providers should make sure that they meet all of the payer’s criteria before submitting a prior authorization request.

Update contracts with insurance companies: 

Insurance companies may update their coverage policy from time to time. Providers need to track these changes and update their contracts to maintain coverage

Conduct regular audits: 

Regular preventative audits can detect issues and help identify typical denial trends for certain procedures. This will allow providers to correct minor problems that may be responsible for a large proportion of the denials. Audits should focus on diagnosis codes and final payment.

Connect at +1(302) 613-1356 or E-Mail at support@wonderws.com to discover how we can help your complex prior authorization process making it simpler and cost-effective service.

Physician practices that have recently implemented electronic health records should consider investing in supplementary medical payment software. This technology, which is part of many practice management (PM) systems, can streamline a practice’s billing processes and help increase reimbursement rates and cash flow.

Medical Billing Software (for medical billing companies)

What is it?

Medical billing software, sometimes referred to as revenue cycle management software, is a specialized application that you use to arrange for payment after providing services to your patients.

This software can help you manage appointments and schedule reminders. It can help manage billing and coding so that your practice has a much stronger cash flow and fewer claims denials.

Benefits of medical billing software:

1. In the last few years, many practices have prioritized the transition to EHR software and mitigating productivity loss from the change.
2. Once these tasks have been accomplished, small medical practices may want to consider automating some of their other time-consuming operations like claim submissions and billing.
3. Physicians Practice explained that a practice management system that streamlines medical billing is often an intimidating investment, but pays off in increased efficiency and revenue.

Find the Medical Billing Software that Fits the Needs of your Practice:

The billing and the patient workflow differs significantly among the different specialty areas, so it is important to choose the medical billing software that best fits the needs of a practice.

For example:  A surgeon or anesthesiologist that works in a variety of different hospitals and office across a region is likely to benefit from secure cloud-based medical billing software. This allows access to the program from different practice sites, which facilitates centralized billing and decreases the likelihood that procedures are missed and not charged. A small family practice might find that they can use a server based medical billing software system.

To know more about on Medical Billing Software, Click the link http://localhost/main-site-update/free-practice-analysis/ . Our billers will guide you to select the right billing software for your practice.

Make Sure that the Billing Software Integrates with Electronic Claims Submission:

One of the major advantages of medical billing software is the ability to automate eligibility verification and claims submission with insurance carriers, which greatly enhances the cash flow of the practice.

To ensure that the medical billing software chosen for the practice can communicate with the system used by the insurance company, verify that the software is H7 compliant and uses ICD-10. These features allow seamless claims submission with the insurance carriers.

Additionally, this will facilitate the integration of the medical billing software with the electronic health records of the practice, which ensures that all the services rendered are billed. By taking time when choosing medical billing software, it is possible for doctors to find the program that works the best for their practices.

It’s inevitable for practices to come across patients with insurance payment problems every now and again. These can range from patients simply being confused about why they have to co-pay or don’t understand their explanation of benefits statement; to irate patients who refuse to pay or withhold payment that was mistakenly sent to them by their insurance company.

When these situations arise, it’s important for your staff to know how to handle them properly as their actions or inaction can affect how the entire practice will be viewed. They also directly affect how efficiently your practice will get paid and consequently, your bottom line.

The way your office staff handles payment problems with patients reflects on your entire practice, and the outcome can have a significant effect on your staff’s satisfaction and your bottom line.

Here are a few tips for helping your staff manage difficult situations.

How should you deal with patients in these types of situations?

1. In these instances patients are not only sick, they may feel insecure, frustrated and fearful which shows outwardly as anger directed towards staff. Make sure your staff are well aware of this and that they should not take these kinds of reactions personally. They must remain calm, cordial and professional; assuring the patient that they will do everything they can to resolve the matter.
2. When patients become irate, chances are they just need to blow off some steam before they can discuss things reasonably. Train your staff to listen to patients first and never interject while the patient is talking, as this can only make the patient more aggravated. Only after the patient has calmed down should staff start assuring the patient of a resolution, and providing the information that the patient needs.
3. If the patient is out-of-network and may therefore have to shoulder most of the bill, make sure your staff are able to clearly explain to the patient your policies regarding out-of-network patient payments.
4. Insurance payment problems can be resolved easily as long as you know the right way of handling them. You can also make it easier on yourself and your staff by partnering with a reliable billing company like WWS Medical Billing.

When patients don’t want to make their co-pays

Many patients do not understand that their insurance company’s reimbursement does not cover the full cost of care. Next time a patient says he doesn’t think he should have to pay you (“My insurance company pays you. Why do I have to pay too?”), it might help for you or your staff member to explain.

For example: The insurance company allows $42 for the service (despite the fact that your full fee is $50) and pays you $32 because the patient’s health insurance contract says he owes$10 co-pay at each visit.

Your staff must make it clear to patients who refuse to make their co-payments that they are actually in violation of their contract with their insurance company. Pointing this out may help patients better understand your role in the process.

At Wonder Worth Solutions, we employ the latest technology and proven methodologies to provide our clients with an impeccable medical billing service.

When patients say they can’t pay

Now that your staff has made it clear why the patient is responsible for paying, how can you help them collect from patients who say they can’t pay?

Your staff may want to ask patients who chronically resist paying at the time of service for their co-pay before you treat them. If they have left their means of payment in their car, this will give them time to get it.

Another good idea is to make sure your practice accepts credit cards. Credit cards have proven to be an important tool for collecting patient payments. Most patients have them, and they don’t have to be present to use them.

For example:  When a patient forgets to bring his wallet, checkbook and credit card to the visit, he can simply call you from home with a credit card number. It’s convenient for the patient, and it benefits the practice.

With our help, your practice can achieve greater levels of efficiency and maximize your revenue. Know more about our services. Give us a call today at +1(302) 613-1356.

“Patient intake process offers a valuable opportunity to engage patients early on,before they see a provider”

As technology develops it infiltrates every aspect of medical billing, patient care, and practice management, one piece of day-to-day medical office operations has been largely spared: check-in. Even small practices with single healthcare providers can find themselves buried under hefty files for each patient.And as the healthcare system shifts from a fee-for-service model to one that emphasises value and accountability, providers are focusing more and more attention and resources on helping patients gain the skills they need to effectively manage their health.

Click the link and Check out on Medical Practices: http://localhost/main-site-update/new-medical-practice-setup-usa/

A patient may be tired, a foolproofrushed, worried, insecure, or ill. They are rarely in the right state of mind to answer medical questions.

First:

It’s an inefficient process since there’s obviously more involved in intake, from an administrative perspective, than just patient sign-in.

Second:

Many people are rightfully suspicious about downloading files off websites. Even if they don’t think their healthcare provider would intentionally infect their computer, you never know what malicious files are floating around.

Third:

Most of the people don’t have printers at home these days. With the ease of transferring files and storing information on cloud services, printers are falling out of style. Plus, the cost of ink has risen. If your forms require five or six pages, your patients won’t spend their ink.

The healthcare IT community has recognised the above issues and pounced on the perceived business opportunity. Automated intake solutions, including patient check-in kiosks, are now widely available to healthcare providers of all sizes. For some practices, they certainly do. The increased efficiency of an automated check-in process can be a revenue driver for large practices, especially those with long intake times.

“As a healthcare provider’s look for feasible ways to improve patient engagement and experience, the patient intake process presents an exciting opportunity and automating the intake process aligns with those preferences and expectations and can offer an effective path to increased patient engagement and improved outcomes from the start.”