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Lo, these many months now, practices have been ignoring ICD-10 and hoping it would go away.

It‘«÷s not.

CMS confirmed in March that the October 1, 2014 deadline was firm, so as of right now, you have approximately 1 year to get ready for the new code set.

Does that seem like a lot of time? It‘«÷s not.

I participated in a Tweet chat this morning with some leading experts on ICD-10, and one of them, Brad Justus, said that ‘«£Everyone should already have a budget and a detailed project plan and be well on their way to remediation.‘«ō

A Health Information Management Solutions Expert with significant expertise in ICD-10, Brad also said, ‘«£I am concerned that many are still not taking ICD-10 seriously and will have no resources available when they figure it out.‘«ō

Brad recommends that practices ‘«£have quality Project Management to make sure all tasks are completed by the right people at the right times.‘«ō

Another leading expert, Betsy Nicoletti, said in a recent blog post that ‘«£With the date for ICD-10 implementation a year away, it‘«÷s time to stop talking about ICD-10 and start learning ICD-10.‘«ō Appropriately, the title of her blog post was ‘«£A Little Less Conversation, a Little More Action,?ŠPlease,‘«ō which most experts thoroughly agree with.

Among the points Betsy makes in her blog post are that practices should:

– Send two staff members to one or two day ICD-10 training program. ?ŠA program with ICD-10 books. ?ŠLarger practices and multi-specialty groups will need to adjust this recommendation up.
– Coders without training in Anatomy and Physiology should take an on line course or community college course right now.
– Plan to train your clinicians later in 2014.
– Buy an ICD-10 book.
– Print out your ten most frequently used diagnosis codes.?Š?Š Try to code those diagnoses in ICD-10.?Š Can you?
– Select ten records that correspond to your most frequently reported diagnosis codes.?Š Based on the medical record documentation, can you select ICD-10 codes?
– Show your providers a few diagnosis conversions each week, focusing on codes that don‘«÷t have a direct crosswalk.
– Use specific ICD-9 codes. The transition will be much easier.
– Have cash on hand for the transition.

You can read the full list in her blog post, along with other useful articles on ICD-10.

Another excellent resource for preparing for ICD-10 is the website This site features useful articles every week on different aspects of ICD-10 prep. An article published last week discussed ‘«£How to improve clinical documentation,‘«ō including these useful tips:

If you’re creating a formal plan, there are five key steps to improving clinical documentation:

1. “Assess documentation for ICD-10 readiness.”
2. “Analyze the impact on claims.”
3. “Implement early clinician education.”
4. “Establish a concurrent documentation review program.”
5. “Streamline clinical documentation workflow.”

There are any number of other resources, and CMS offers multiple resources on its website, including checklists and recently posted recorded webinars on how to get started.

Don‘«÷t wait until it‘«÷s too late and your revenue will be seriously affected by the transition. As Brad Justus added in the Tweet chat this morning, ‘«£Please don’t bet your job or your facility on not being fully prepared for ICD-10; Start Now If You Have Not!‘«ō

If you have concerns about whether your medical billing team can guarantee that your revenue cycle management will be ready for ICD-10, contact today. We‘«÷ll be happy to help you with a smooth transition to ICD-10. Call us today at 800-966-9270 or email

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We write quite a bit about the benefits of outsourcing your medical billing to a highly-qualified third party medical billing service. But we‘«÷re not the only ones; if you search on Google, you‘«÷ll find quite a number of articles on the benefits of outsourcing.

Here are a few of the greatest hits, which we think you‘«÷ll find useful.

As early as 1999, the American College of Physicians-American Society of Internal Medicine wrote about comparing inhouse and outsourced medical billing, citing the example of one doctor in Pennsylvania who began outsourcing the practice’s billing. Since then, he said, he was getting more money‘«Ųcollections had increased more than 30%‘«Ųand getting paid faster. ‘«£Those are the benefits of outsourcing billing operations that third-party billing companies like to tout: higher collection rates and fewer staff headaches,‘«ō the author states.

The article goes on to explain that the solution isn‘«÷t so simple for every practice, and that ‘«£mom and pop‘«ō medical billing services provide mixed results. We couldn‘«÷t agree more, and have written about that in several blog posts. That‘«÷s why we argue that a nationwide, multi-branch medical billing service is the best bet for improved revenue.

Next, medical billing software resource?ŠSoftware Advice published a popular article?Šon its blog,?ŠThe Profitable Practice. This article actually included a study done by the site, which came up with the following results comparing annual costs for both approaches:


Billing department costs $118,000 $4,000
Software and hardware costs $7,500 $500
Direct claim processing costs $3,600 $122,500
Software and hardware costs $5,500 $2,000
% of billings collected 60% 70%
Collections $1,370,900 $1,623,000
Collections costs $129,100 $127,000
Collections, net of costs $1,241,800 $1,496,000


Eye-opening, isn‘«÷t it? To think that you could reduce your collections costs and still collect more on an annual basis‘«Ųthat additional $254,000 to the bottom line is nice to have, in our opinion. Of course, that is once again predicated on the idea that you see an increase in your collections, which requires a medical billing service with experience and trained staff.

The article also provided some recommendations on factors that would spur a provider to consider outsourcing their billing, including:

– Your billing process is inefficient.

– You have high staff turnover.

– You’re not tech savvy.

– You’re a new provider.

– You have different priorities.

All good points‘«Ųwe agree that these are good reasons to consider outsourcing your medical billing.

Most recently, we have seen two articles published by Med City News on why outsourced medical billing may be the best option for many practices. In the first article, the author points out that ‘«£More than 10% of debts for a majority of providers go over four months and are unfortunately written off as bad debts. Medical billing services, on the other hand, are much feistier in their attempt to recover debts, often turning out to be successful in cases where in-house billing teams tend to fail. Therefore, providers facing outstanding debts for longer times have much to gain by outsourcing their billing to a renowned medical billing company to experience higher revenues and much shorter billing cycles.‘«ō

In the second article, the same author points out that ‘«£Your medical billing company will be contractually bound to perform some services, such as appealing denials which will eventually result in shorter billing cycles‘«™

‘«£Outsourcing medical billing services also results in a much lower claim rejection rate such that a medical practice can expect between 5% to 15% increase in the amount they are able to collect by opting for a billing service.‘«ō

We strongly agree with these statements, as we have seen these types of improvements repeatedly with our own clients. But we also agree with the idea above that it‘«÷s important to evaluate whether outsourcing your medical billing is right for your practice; only you can make that decision.

If you‘«÷d like to learn more about choosing the right medical billing service for your practice, download our free white paper, When and to How Select the Right Medical Billing Service. It‘«÷s full of checklists you can use to determine whether outsourcing your medical billing is right for you, and how to find the medical billing service that will provide the results you want.

You can also call us today at 800-966-9270 to talk with one of our expert practice revenue consultants, and they‘«÷ll be happy to discuss your needs and how we can help bring more to your bottom line.

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As of today, the new HIPAA requirements go into effect in less than 3 weeks. Are you ready?

If not, you have 20 days to get ready. That‘«÷s DAYS.

Time to prepare, folks.

As we have noted in previous blog posts, there are several steps that you need to take in order to protect your practice. In case you missed them, here are the highlights:

There are three relatively small changes that just about all offices will encounter:

Patients can now ask for copies of their electronic medical information in electronic format. Also, with both paper and electronic record requests, the office has only 30 days to produce the information. There‘«÷s no more 30-day extension for records that are inaccessible or kept off site.

When patients pay for services personally and in full, they can require that the office not share information about the treatment with their health plans.

The office can give immunization information to a school if the school is required by law to have it and if the parent or guardian gives written permission.

A larger change that practices will encounter involves business associates, which are now required to comply with HIPAA just as providers are. They have to have safeguards and policies and procedures for keeping data secure. They are required to have business associate agreements with their own subcontractors. And they can get hit with penalties if they don‘«÷t.

What you need to do

Steps that providers need to take before the September deadline to protect their practices, provided by Holly Carnell, JD, and Meggan Bushee, JD, Attorneys at McGuireWoods on?ŠBecker‘«÷s ASC Review, include:

1. Update your internal policies.

Key changes that a practice will need to make to its internal privacy policies include (See the full list):

A. Breach standard response– the Omnibus Rule changed the standard for determining whether a breach of unsecured PHI has occurred; the new breach standard should be included in providers‘«÷ internal policies on responding to a potential breach. Who must be notified has remained unchanged.

B. Marketing and sale of PHI – marketing of third party products and services and sale of PHI is generally prohibited, unless the provider has received valid authorization from the patient.

C. Decedents‘«÷ PHI – providers may disclose only PHI that is relevant to the family member, relative or friend‘«÷s involvement in the deceased‘«÷s care, and cannot disclose PHI if the provider is aware that the deceased person expressed a prior preference for it not to be disclosed to the person in question.

D. Disclosures to schools?Š- providers may disclose proof of immunization to schools if the school is required by state, or other, law to have proof of immunization prior to admitting the individual, and the provider obtains and documents the oral agreement to the disclosure by either a parent, guardian, or other person acting in loco parentis of the individual, or from the individual if he or she is an adult or emancipated minor.

E. Patient rights to limit disclosures?Š- a provider must comply with a patient‘«÷s request that PHI regarding a specific healthcare item or service not be disclosed to a health plan for purposes of payment or healthcare operations if the patient paid out-of-pocket, in full, for that item or service.

F. Provision of electronic copies of medical records?Š- providers complying with a patient‘«÷s request for an electronic copy of his or her PHI are required to provide access to such records in the electronic format requested by the patient if the records are maintained by the provider in an electronic designated record set and are readily producible in the requested format.

2. Provide staff training.

Make sure that your policies are both updated and implemented. Once your practice has updated your privacy policies, staff members should receive training on any new and revised policies.

3. Offer notice of privacy practices.

After you have updated your NPP, your practice must make the NPP readily available to existing patients who request a copy on or after the effective date of the revisions; must post the revised notice on its website, if applicable; and must post the notice in a prominent location on its premises.

4. Revise your business associate agreements.

Providers should revise their business associate agreement forms to reflect the new requirements under the Omnibus Rule. The deadline for this is September 23, 2013. However, existing BAAs that were entered into on or before January 25, 2013 and have not been modified after March 26, 2013 do not have to be updated until September 23, 2014.

You should note that the Final Rule broadened the definition of a business associate to include subcontractors, health information organizations, entities that offer a personal health record to individuals on behalf of a covered entity, and other entities that provide data transmission services for covered entities and that require access on a routine basis.

The Final Rule also provides a list of HIPAA Privacy and Security Rule requirements that apply directly to business associates, including requirements to:

A.?Š?Š?ŠMaintain detailed records?Šof uses or disclosures of protected health information (‘«£PHI‘«ō) to be produced upon request;

B.?Š?Š?ŠProvide an electronic copy of PHI?Što covered entities or individuals upon request;

C.?Š?Š?Š?ŠSign business associate agreements?Šwith subcontractors that?Šcreate or receive PHI on their behalf; and

D. ?Š?ŠMake reasonable efforts to limit release or use of PHI?Što the minimum necessary to accomplish the intended purpose of the use or disclosure.

Many of these new requirements were not previously believed to apply to business associates, so business associate agreements will need to be amended to comply with the new provisions.?Š For more information on your business associate agreements and what entities are covered under this definition, see this recent post on?ŠJD Supra Law News, which provided the BAA items above.

Once your practice has updated its BAA form, attorneys recommend conducting an inventory of all current BAAs (including BAAs in which the provider is the covered entity and BAAs in which the provider is a business associate or subcontractor). Each of these BAAs will need to be modified by an amendment or replaced with the practice‘«÷s revised BAA form. This may also be a good opportunity to consider whether the protections and restrictions in the form agreement go far enough in protecting patients and the practice.

You should review all your business relationships to ensure you have a BAA in place where one is required under HIPAA. Providers may have relationships that did not previously require a BAA, but which do now under the Omnibus Rule‘«÷s expansion of the definition of ‘«£business associate.‘«ō One key change to the definition of business associate is the inclusion of subcontractors of business associates that deal with PHI.?Š However, covered entities are not required to enter into BAAs with downstream subcontractors. Rather, the business associate who contracts with the subcontractor must enter into a BAA with the subcontractor.

Remember that ‘«£business associate‘«ō includes such partners as:

– Medical billing service

– Attorney

– Marketing group

– IT support

– Etc.

If you‘«÷re unclear on whether a vendor is a ‘«£business associate‘«ō there are several good?Šdecision trees?Šonline developed by other groups that help define the term.

The penalties get higher

Finally, lest you think you can ignore these changes, remember that the penalties for noncompliance have gone up ‘«Ű significantly.

The amount depends on the level of negligence. Previously, the limit was $25,000 per violation; now it‘«÷s $50,000, with an annual limit of $1.5 million.

And the Office of Civil Rights, which enforces HIPAA, cautions that it‘«÷s looking hard for violations and plans to enforce HIPAA ‘«£vigorously.‘«ō

If you‘«÷re concerned about whether your medical billing service will be HIPAA compliant under the new rules, contact?ŠŠat?Š800-966-9270. maintains strict HIPAA compliance at each of its 5 nationwide branches, and we will help you bring more to the bottom line while keeping you in compliance.


Additional Resources

HIPAA: What Your Medical Practice Needs to Do for the September 23, 2013 Deadline

HIPAA: Why Your Practice Needs to Worry About the September 23, 2013 Deadline

Be Prepared for the New HIPAA Rules ‘«Ų Coming Soon to Your Practice

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Many medical billing software/EMR companies are offering medical billing services as an add-on to their technology offerings these days, but is that really the best way to handle your revenue cycle management, the lifeblood of your practice? We don‘«÷t think so, and here are 5 reasons why.

1. You deserve freedom of choice when it comes to technology. If a technology company is handling your medical billing, guess who chooses the software you will use? They do! They can‘«÷t possibly know enough about your work flow and staffing to choose the right software for you, and why shouldn‘«÷t you have the freedom to choose what you prefer?

2. You deserve a medical billing service that is focused on getting you paid. I‘«÷ve worked in a software company, and I can tell you that the focus tends to be on the software and engineering new features in the software. Don‘«÷t you want a medical billing service that is focused on your revenue cycle management? Of course you do.

3. You deserve thorough follow-up on your claims. One technology company that provided medical billing services for a low rate neglected to tell its provider customers that the low rate didn‘«÷t include follow up on the claims‘«Ųthe company submitted the claims and that was it. You don‘«÷t need that kind of surprise!

4. You deserve real customer service. When you‘«÷re one of several thousand customers, it‘«÷s hard to feel like your business has any importance to your medical billing service, isn‘«÷t it? You want a medical billing service that makes you feel like your practice and your business is important to them‘«Ųpreferably one that provides you with a dedicated Account Manager just for your practice.

5. You deserve a medical billing service that will make sure your practice is ready for the changes coming at you: HIPAA changes as of September 23, 2013, ICD-10 as of October 1, 2014, and others as they arise. A medical billing service that focuses on revenue cycle management (and has for years) is up to speed on the regulatory changes and what it means to medical billing; will a software company be prepared? Don‘«÷t take the chance.

At, we offer all of these benefits and more. With five locations nationwide that offer more than five decades of collective top management experience in medical billing services, we have the depth and breadth of experience to get your claims paid.

Plus, allocates over 50% of its billing costs to the successful collection of the last 20-30% of charges that typically do not get paid on first submission. We want to make sure you receive payment for every claim, and that‘«÷s why we say on our home page, ‘«£Every claim paid. Guaranteed.‘«ō

And to make you comfortable with the whole process, we provide you with a dedicated Account Manager who works closely with your practice and understands your unique concerns and challenges.

Why not find out how we can help you bring more to the bottom line? Contact today at 800-966-9270 or email

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ICD-10 is just over 400 days away, yet many practices have not yet begun to plan for it. Here‘«÷s a review of the latest news and tips on preparing for this change that‘«÷s being called ‘«£the Y2K of healthcare.‘«ō

ICD-10 Could Cause Healthcare Reimbursements to Take a Hit
Becker‘«÷s ASC Review

Providers who are not prepared for the ICD-10 transition may see their bottom lines suffer, according to aMediGainreport. The?ŠHealthcare Billing and Management Association?Šrecently stressed the importance of being prepared for the change to ICD-10’s more granular code set. Holly Louie, chair of the organization’s ICD-10/5010 committee, testified before Congress that the economic stability of the country’s healthcare reimbursement system is hinging upon this successful switch‘«™ Read More

ICD-10 Budgeting: Do You Know How Much the Transition Will Cost?
ICD-10 Watch

The true cost of the ICD-10 transition may not be as easy to calculate as you think. Sure you can call healthcare vendors to get quotes on modifications to software and hardware, upgrades and purchases of new software, systems and equipment.

But that’s not the whole price. You need to get your best estimates of the following elements‘«™ Read More

61% of Providers Say ICD-10 Testing Will Take 9 to 12 Months
Becker‘«÷s ASC Review

A new?Šreport?Šfrom Qualitest Group shows that around 75 percent of healthcare organizations have not begun testing for ICD-10 despite the looming deadline for a full transition next year‘«™ Read More

ICD-10 Transition: Maybe It’s Time to Panic a Little
ICD-10 Watch

We are about 14 months away from the ICD-10 implementation deadline. Surveys report that healthcare providers are in various states of readiness. QualiTest Group?Šsurveyed more than 300 professionals?Šabout their ICD-10 testing plans. The two major findings are:

– Most respondents have either completed ICD-10 assessments or are in the process of assessments.

– 75 percent of respondents have not yet begun ICD-10 testing.

While starting sooner than later is important, this survey doesn’t raise too many alarm bells. It does report a great deal of planning and progress in the ICD-10 transition. Other surveys released in the past few months have found less preparation.

Perhaps a more troubling indicator is the amount of newly released literature that suggests there is an audience that hasn’t heard of ICD-10 implementation. If the healthcare industry is on its way to a smooth ICD-10 transition, we wouldn’t need so many guides to planning ICD-10 implementation. Read More

Physician Practice Costs for ICD-10: Clinical Documentation
ICD-10 Monitor

Physician offices are inching slowly toward ICD-10 ‘«Ų very slowly. A recent survey of 1,200 practices conducted by MGMA reveals that loss of physician productivity, staff efficiency, and changes to clinical documentation are still major concerns.

While MGMA and the physician community at large are reluctant to implement ICD-10 (and have raised many roadblocks to its progress), the organization‘«÷s May 16, 2012, letter to CMS provides valuable guidance regarding the six key areas of cost impact to watch.

MGMA advises ICD-10 will add significant costs for physician practices and clinical laboratories in these six areas:

  • – Staff education and training
  • – Business-process analysis
  • – Changes to ‘«£superbills‘«ō
  • – IT system changes
  • – Increased documentation costs
  • – Cash flow disruption

Read More

ICD-10 Transition: What It Takes to Work with Healthcare Payers
ICD-10 Watch

You could put off communicating with your healthcare payers until you submit your first ICD-10 coded claim Oct. 1, 2014. What could go wrong?

Early communication will help healthcare providers test the ICD-10 claims process and gain insight into how reimbursements will be affected after Oct. 1, 2014. That second part will help prepare for DRG shifts. This puts a price tag on procrastination. Read More

Fast Tracking ICD-10: Building the Action Plan
ICD-10 Monitor

It‘«÷s time to get geared up for ICD-10 by building an action plan. We just finished developing a budget for a large hospital system and found that the bulk of the budget will go to software applications, hardware upgrades, and education and training. These also happen to be three high-risk areas as it pertains to compliance.

Now we have to turn the impact assessment and gap analysis into the action plan. I am finding that working with hospital systems that have large steering committees with several sub-committees helps distribute the action items evenly. For example, every department will need education, whether in the form of simple awareness, fundamental instruction, documentation courses or in-depth training. By assigning this task to the education subcommittee, an organization can map out an education plan listed front and center in the action plan. I find that, for large health systems and hospitals, it is helpful to map out action items and milestones in an Intranet portal so every steering committee member and subcommittee chair can track progress along the way‘«™ Read More

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Big changes are occurring in health care, and to help you stay abreast of them, we‘«÷ve gathered the latest news that can affect your practice revenue. Below you‘«÷ll find articles on health insurance exchanges, collaborating with other practices to save money, getting tax breaks for your practice, online patient payments, and much more.

5 Ways Health Insurance Exchanges Could Impact Physician Income
Becker‘«÷s ASC Review

The Patient Protection and Affordable Care Act’s health insurance exchanges will open on Jan. 1, 2014, and likely have an impact on physician income, according to a?ŠMedscape News?Šreport.

The exchanges will be open online Oct. 1, 2013, designed to allow uninsured people to choose coverage for the next year. According to the report, primary care physicians and specialists could see:

‘«ů?Š?Š ?ŠLower reimbursement rates from insurance companies participating in the exchange
‘«ů?Š?Š ?ŠLess control over the number of patients from exchanges they see
‘«ů?Š?Š ?ŠProblems collecting out-of-pocket from exchange patients
‘«ů?Š?Š ?ŠPatients who aren’t familiar with following treatment regimens
‘«ů?Š?Š ?ŠFormation of narrow networks for insurers, which begin with hospitals and then decide how physicians are included with the potential for “cost profiling”

Read More

Collaboration Can Save Medical Practices Time, Money and Effort

Physicians can share front office staff and an electronic health record system. However, they need to prove integration efforts are legal to avoid antitrust violations‘«™
Read More

Patients More Willing to Pay Healthcare Bills Online
Becker‘«÷s ASC Review

In 2012, around 13 percent of the gross dollar volume of all patient payments was made online, according to “Trends in Healthcare Payments Annual Report: 2012,” a recent report by vendor Instamed. The figure is up from around 8 percent in 2010‘«™ Read More

How to Get Tax Breaks for Your Medical Practice

Federal, state and local governments offer doctors incentives because practices are recognized as economic engines. But physicians must know how and where to find them‘«™ Read More

Waste Not, Want Not: Billing Unused Drug Supplies

Physicians sometimes must discard an unused portion of a drug. If the physician (rather than the patient and/or facility) supplies the drug, Medicare may allow compensation for this ‘«£wasted‘«ō portion.

As instructed by the National Medicare guidelines for reporting drug waste found in the?ŠClaims Processing Manual, chapter 17, ?ļ 40.0, drug waste is reported?Šin addition to?Šthe drug administered‘«™ Read More

A Quick Guide to ‘«£Separate Procedures‘«ō

CPT?ę codes designated as ‘«£separate procedures‘«ō are considered to be incidental and bundled with any related comprehensive/major procedure when performed during the same session, through the same incision, and/or at same anatomic site. A separate procedure may be reported only if:

1. It is the only procedure performed,?Šor

2. It is unrelated to or distinct from other procedures performed during the same operative session (e.g., separate incision or site, performed on the ipsilateral/contralateral side, etc.).

Read More

For Some Post-Op Care, a Phone Call May Be All That’s Needed

Scheduling a call instead of an in-person visit could reduce patient no-shows, which would help physicians better manage patient loads and follow-up care‘«™ Read More

The Top Five Essential Tips for Successful Appeals
California Medical Association

How you present appeals to your carrier can make the difference between success and failure. AAPC‘«÷s Managing Editor?ŠG. John Verhovshek, MA, CPC,?Šrecently offered five tips for successful appeals in an article published by?ŠCalifornia Medical Association.

  1. – Be prepared
  2. – Write a proper appeal letter
  3. – Correct the claim before you appeal
  4. – Code only what documentation supports
  5. – Avoid obvious mistakes

Read More

Prompt Proper Assistant-at-surgery Payment

Successful coding and billing for surgical assistants depends on three principal factors:

  1. – Does the payer allow additional reimbursement for surgical assistance for the reported procedure?
  2. – Has the surgeon sufficiently documented the need for and role of the surgical assistant?
  3. – Has the proper modifier been appended to the claim?

Here are some tips and techniques for ensuring your assistant-at-surgery claims prompt proper payment‘«™ Read More

Advance: Appending Modifiers 50, 51, and 59
AAPC News/Advance

Modifiers are crucial to telling the story of a claim by identifying procedures that have been altered, without changing the core meaning of the code(s) submitted. AAPC‘«÷s National Advisory Board Member Relations Officer Nancy Clark, CPC, CPB, CPMA, CPC-I,?Š recently published an article in?ŠAdvance for Health Information Professionals, in which she expounded on the proper application of modifiers 50, 51, and 59. Ms. Clark provided examples, tables, and even comparisons between modifiers.

1. Modifier 50?ŠBilateral procedure?Šdescribes procedures or services that take place on identical, opposing structures (e.g., shoulder joints, breasts, eyes).

2. Use modifier 51?ŠMultiple procedures?Što show that the same provider performed multiple procedures (other than E/M services) during the same session.

3. Modifier 59?ŠDistinct procedural service?Šindicates a:

– Different encounter or session;

– Different procedure;

– Different site; or

– Separate incision, excision, injury, lesion, or body part.

Read More

15 Statistics on Surgery Center Accounts Receivable Days
Becker‘«÷s ASC Review

In all ASCs:
1. 0 to 30 days: 53.4 percent
2. 31 to 60 days: 17.2 percent
3. 61 to 90 days: 8.2 percent
4. 91 to 120 days: 5.4 percent
5. Over 120 days: 15.9 percent

The article also provides data on AR days In ASCs with fewer than 3,000 cases and ASCs with at least 6,000 cases. Read More

Posted on August 8, 2013 by · Leave a Comment
Filed under: Medical Billing, Physician billing, Resources, Tips and Tricks  

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Earlier this week, we shared a post entitled, ‘«£Physicians‘«÷ Top Concerns Include Financial Management: 5 Ways to Relieve Those Concerns,‘«ō which discussed several ways your practice can improve profitability, including expanding your schedule. We recommended adding hours before and after ‘«£normal‘«ō practice hours, as well as adding Saturday hours, in order to increase availability for patients and add revenue.

By coincidence, Physicians Practice published a related article just yesterday entitled, ‘«£How to Code, Negotiate After-Hours Reimbursement at Your Practice‘«ō which you will find extremely useful if you are considering expanding your schedule.

Among the useful tips the article provides:

– When negotiating with payers which are reluctant to pay additional reimbursement for after-hours services, you may succeed if you use savings potential as leverage. The author suggests that you ‘«£make it clear that you‘«÷ll willingly send patients to the emergency department instead of offering in-office after-hours services, but that ED services can cost as much as 10 times more than‘«ō comparable services you would provide. That‘«÷s a pretty powerful argument!

-To further demonstrate cost savings, the author advises that you could also start billing all applicable after-hours codes for your practice. Over time, he says, you will have compiled an archive of claimed charges, which you can use to show the insurer how often you provide these services. In this report to the insurer, consider adding data on the much higher price of ED visits for the same services.

Coding Correctly is Key

Another consideration, of course, is how to code and bill services in these added hours. We found useful information on this subject in an article on Supercoder Bolt (formerly Coding News), where the author detailed the differences between coding for services provided during your regularly scheduled expanded office hours and what is considered ‘«£after hours‘«ō (after your posted office hours).

The article advises that when your physician provides E/M service in your practice during regularly scheduled ‘«£evening, weekend, or holiday office hours,‘«ō you should bill 99051 (Service[s] provided in the office during regularly scheduled evening, weekend, or holiday office hours, in addition to basic service), according to AMA guidelines outlined in the?ŠCPT Assistant?Š(Vol. 13, Issue 6, June 2003).

However, if you should decide not to expand your office hours, keep in mind that you can still receive additional reimbursement for patients seen after your normally posted office hours. If your physician sees a patient in the office during hours when the practice would normally be closed, such as on weekends or after 6 p.m., CPT guidelines allow you to bill 99050 (Services provided in the office at times other than regularly scheduled office hours, or days when the office is normally closed [e.g., holidays, Saturday or Sunday], in addition to basic service) as long as the documentation supports the after hours service, according to?ŠJetton Torix, CCS-P, CPC-H,?Šcourse director of Knowledge Source Seminars in Star, Idaho, in the article.

An important note in the article:?ŠA patient is considered an after-hours patient only if they come to your office after your normal office hours end ‘«Ų not when they visit during normal office hours and the appointment runs past closing time.

Remember:?ŠThe article also cautions that whether you select 99050 or 99051, you would report the after-hours code in addition to the appropriate E/M service code for the visit.

We hope you will consider some of these methods for improving your practice profitability. And remember, you don‘«÷t have to expand your hours necessarily; by hiring a part-time physician or non-physician, you can provide additional access to medical care for your patients when they need it.

If you are interested in improving your practice bottom line, a great way to start is to review your medical billing and insure that you are being reimbursed for all of your care, and getting paid in a timely fashion. will be happy to review your current levels of reimbursement and speed of payment and advise if there are ways they can be improved. Just contact us today at 800-966-9270 or at

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Survey reveals top challenges for medical practices include financial management, increasing practice efficiencyYet another recently released survey shows that physicians in the U.S. are struggling with financial management‘«Ų90% report this as a concern, and it‘«÷s second in the list of top challenges second only to shifting reimbursement models (91%). The survey, conducted by Wolters Kluwer Health, revealed that the financial management challenges are coming from increased costs, healthcare IT adoption and the Affordable Care Act/increasing legislation.

When asked about their top focus areas for the next three to five years, physicians cite increasing their practice‘«÷s efficiency (48 percent), exploring different business models such as mergers, becoming part of a hospital system or patient-centered medical homes (34 percent) and adopting technology to improve clinical decision making or support evidence-based decision making (31 percent).

For those of us in the revenue cycle management field, the first item is key: increasing a practice‘«÷s efficiency.

This is something we have always encouraged, and continue to do so. Here are some things you should consider in terms of making your practice more efficient:

1. Make sure you‘«÷re getting paid for all of your care. I recently heard of a practice that hadn‘«÷t looked at their missed encounter reports for a year. When the reports were reviewed, the practice discovered that they had 15 missed encounter reports for just one code. That meant thousands of dollars of revenue lost! Don‘«÷t let this happen to your practice‘«Ųmissed encounter and other reports should be reviewed on a regular basis‘«Ųweekly reviews are recommended.

2. Are you maximizing your schedule? Look at your no-show rate, and if you have a no-show rate of 25%, you should be double-booking 1 of 4 appointments. If you don‘«÷t, you could be losing up to $1.2 million per year, according to practice management consultant Rochelle Glassman. You should also keep a waiting list as many dentists do, says Glassman. That way when your schedule opens up, your staff can fill it quickly with patients who want to be seen‘«Ųand will rarely be no-shows.

3. Are you expanding your schedule? As we mentioned in a recent blog post entitled Physicians: Are You Prepared to Compete with Retail Clinics?, ?Šyou need to be aware that your competition now includes the Minute Clinics and Urgent Care Centers opening on nearly every corner. These centers are popular because many patients are no longer comfortable taking time off work, or they want to get help for their screaming baby first thing with a walk-in or same-day appointment. In order to compete, you need to take two steps according to Glassman:

A. Offer expanded hours before and after your current normal office hours, on Saturdays and during the lunch hours. You don‘«÷t have to cover these hours yourself; consider bringing on a part-time physician or non-physician provider to see these patients.

B. Review your schedule and arrange it to offer walk-in and same-day appointments. How can you do this while double-booking? Set specific times, and use your wait list to fill the appointments if needed. Don‘«÷t lose your long-time and new patients to the retail clinics.

4. Consider how you‘«÷re using your office space. Are you using valuable office footage for administrative functions when you could be using it to see patients? Functions like medical record storage and medical billing do not need to‘«Ųand shouldn‘«÷t be‘«Ųhoused in your office when that office space could be generating revenue.

5. Is your medical billing team the right one for your practice today? The medical field is changing rapidly, and methods that once worked are no longer optimal for today‘«÷s medical practices. Hiring a front office person and teaching her to handle your medical billing is no longer sufficient with today‘«÷s more stringent‘«Ųand complicated‘«Ųrequirements. Similarly, a one-person medical billing company is no longer the best choice to insure you are receiving maximum reimbursement.

In these challenging times, you need to choose the best, most cost-efficient means for insuring your practice profitability. That means the right medical billing team, and with the challenging reimbursement environment today, you need a top-notch team.

That‘«÷s why you should talk to a nationwide medical billing company with offices across the country. is proud to say that we have experienced teams in cities across the country, providing a depth of experience and resources unmatched by most internal billing teams or medical billing companies.

To find out how we can help you improve your practice profitability, contact us today at 800-966-9270 or by email at

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That‘«÷s right‘«Ųmy medical billing service beats your inhouse billing staff. Well, not literally‘«Ųbut in the things that matter, yes, our third party billing service can beat inhouse staff hands down on most points.

Here‘«÷s why I say that:

1. You only pay for our billing services when you‘«÷re actually using them. You don‘«÷t have to pay us whether or not you have claims to bill, whether or not we are sick or on vacation. And you only pay us when you get paid. That‘«÷s a pretty efficient way to run your medical billing.

2. Our medical billers are highly trained and expert in medical billing. Medical billing is what our billers do, every day, all day. We hire only highly trained billers, and we make sure they stay up to date on their training. Plus, they learn from each other‘«Ųtheir colleagues in our offices across the country who are handling just about every specialty.

3. Our medical billers are up to speed on all the latest requirements and software. We make sure they‘«÷re up to date on HIPAA, CPT coding changes and other important legal issues. And they are trained on multiple software platforms. Because if we don‘«÷t, we are out of business.

4. Our medical billing staff will provide you with reports you can trust, and that have been proven to work for hundreds of other practices. We follow best practices across our multiple locations, and learn from what our experience managers throughout the company are doing. Reports are developed and refined to insure they are providing you with the information you need to manage your practice. And if you need different reports, tell us‘«Ųwe‘«÷ll work with you to get you what you need.

5. We save you all the hidden costs of hiring and maintaining a billing staff inhouse. ?ŠHiring and maintaining a billing staff has multiple hidden costs you probably don‘«÷t think about:

A. Medical Billing Specialist’s Employee salary

B. Medical Billing Specialist’s Employee benefits

C. Worker’s compensation


E. Healthcare insurance

F. Vacation, sick leave, etc.

G. Performance bonus

H. Computer hardware purchase & maintenance

I. Software purchase & renewal

Do what you do best. Let us handle the rest.

You didn‘«÷t go to medical school to learn how to manage medical billing staff; you wanted to treat patients. Why waste your valuable time on administrative details better outsourced and left to the experts?

Here‘«÷s what one of our customers said about making the change:

‘«£ made all the difference for my practice. They eliminated all the frustrations associated with insurance reimbursements and increased my revenues by 100%.‘«ō

Why not find out how you can reduce your headaches and increase your bottom line? Contact today at 800-966-9270 and talk to one of our practice revenue consultants about how we can improve your practice profitability.

We‘«÷d love to show you how we can beat the results your inhouse medical billing staff is getting.

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Medical billing service adsWhen you search for ‘«£medical billing services‘«ō on Google, it may seem like you‘«÷re being deluged with information‘«Ųand you may feel like you have no way to sort through what you‘«÷re seeing.

There are quite a few medical billing companies listed for any search‘«Ųso how do you find the right one for your practice? Here are a couple of tips for looking at Google ads:

1. Look for reviews. As you can see from our listing, we have more than 30 reviews from customers linked to our Google listing. These reviews give you a good idea of how well we‘«÷ve performed for practices like yours.

2. Notice what the ad says.?ŠOur ad plainly states, ‘«£Every Claim Paid. Guaranteed.‘«ō We put our guarantee in print, right at the top of our ad, because we mean it. And we stand by it.

3. Placement matters. Being one of the top ads on the left side of the page says that the company is large enough to commit some significant dollars to advertising‘«Ųand that‘«÷s a good thing if you want a medical billing service that will be around for a while (and you do). Having a medical billing service with resources and a commitment to the field will serve you in the long run.

Once you‘«÷ve called the number in the Google ad, notice a couple of things:

A. Does the representative on the phone seem to understand medical billing? If not, how can they match you with the service you need? If it‘«÷s a call center or the person just wants to close a sale without understanding your needs, beware. You want to deal with a medical billing service that understands and works to meet your requirements, and that starts with the first contact.

B. Does the representative give you a proposal in writing? Percentages and service level promises mean nothing unless they‘«÷re written down. Make sure you get all of your specified needs in writing in the proposal, so you know what the pricing includes.

C. Will the representative quote you real prices? In the beginning, of course, the rep needs to understand exactly what your needs are and how the medical billing service can meet them. But at some point the rep needs to be willing to quote you a price that includes what you‘«÷re looking for. And once you have a written proposal, you can compare that with what the services and price you are currently receiving. Otherwise, you don‘«÷t know what you‘«÷re comparing.

D. Can the representative answer your questions about denial rates, appeal success and other key performance indicators? Make sure you‘«÷ll be receiving the level of service that you need‘«Ųa high denial rate and low appeals success rate will slow down your revenue stream significantly. And how soon after claims are received by the medical billing service are they submitted? Data will help you choose the best revenue cycle management partner for your practice.

When you‘«÷re looking for the best medical billing service for your practice, be sure to consider these questions.

And for more tips on when and how to select the right medical billing service for your practice, download our white paper with checklists and useful advice now.

Or, call now at 800-966-9270 and we‘«÷ll be happy to answer your questions on improving your practice profitability.

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