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

Here are a few of the greatest hits, which we think youÔÇÖll 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 moneyÔÇöcollections had increased more than 30%ÔÇöand getting paid faster. ÔÇ£Those are the benefits of outsourcing billing operations that third-party billing companies like to tout: higher collection rates and fewer staff headaches,ÔÇØ the author states.

The article goes on to explain that the solution isnÔÇÖt so simple for every practice, and that ÔÇ£mom and popÔÇØ medical billing services provide mixed results. We couldnÔÇÖt agree more, and have written about that in several blog posts. ThatÔÇÖs why we argue that a nationwide, multi-branch medical billing service is the best bet for improved revenue.

Next, medical billing software resource?áSoftware Advice published a popular article?áon its blog,?áThe 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:

Eye-opening, isnÔÇÖt it? To think that you could reduce your collections costs and still collect more on an annual basisÔÇöthat 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 pointsÔÇöwe 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 ÔÇ£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.ÔÇØ

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

ÔÇ£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.ÔÇØ

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 itÔÇÖs important to evaluate whether outsourcing your medical billing is right for your practice; only you can make that decision.

If youÔÇÖd 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. ItÔÇÖs 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 theyÔÇÖll be happy to discuss your needs and how we can help bring more to your bottom line.

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. ThatÔÇÖs 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. ThereÔÇÖs 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 donÔÇÖt.

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?áBeckerÔÇÖs 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 providersÔÇÖ 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. DecedentsÔÇÖ PHI – providers may disclose only PHI that is relevant to the family member, relative or friendÔÇÖs involvement in the deceasedÔÇÖs 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?á- 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?á- a provider must comply with a patientÔÇÖs 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?á- providers complying with a patientÔÇÖs 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.?á?á?áMaintain detailed records?áof uses or disclosures of protected health information (ÔÇ£PHIÔÇØ) to be produced upon request;

B.?á?á?á?áProvide an electronic copy of PHI?áto covered entities or individuals upon request;

C.?á?á?á?áSign business associate agreements?áwith subcontractors that?ácreate or receive PHI on their behalf; and

D. ?á?áMake reasonable efforts to limit release or use of PHI?áto 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.?á For more information on your business associate agreements and what entities are covered under this definition, see this recent post on?áJD 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 practiceÔÇÖs 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 RuleÔÇÖs expansion of the definition of ÔÇ£business associate.ÔÇØ One key change to the definition of business associate is the inclusion of subcontractors of business associates that deal with PHI.?á 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 ÔÇ£business associateÔÇØ includes such partners as:

– Medical billing service

– Attorney

– Marketing group

– IT support

– Etc.

If youÔÇÖre unclear on whether a vendor is a ÔÇ£business associateÔÇØ there are several good?ádecision trees?áonline 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 ÔÇô significantly.

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

And the Office of Civil Rights, which enforces HIPAA, cautions that itÔÇÖs looking hard for violations and plans to enforce HIPAA ÔÇ£vigorously.ÔÇØ

If youÔÇÖre concerned about whether your medical billing service will be HIPAA compliant under the new rules, contact?áMedical-Billing.com?áat?á800-966-9270. Medical-Billing.com 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 ÔÇö Coming Soon to Your Practice

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 donÔÇÖt 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 canÔÇÖt possibly know enough about your work flow and staffing to choose the right software for you, and why shouldnÔÇÖt you have the freedom to choose what you prefer?

2. You deserve a medical billing service that is focused on getting you paid. IÔÇÖve 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. DonÔÇÖt 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 didnÔÇÖt include follow up on the claimsÔÇöthe company submitted the claims and that was it. You donÔÇÖt need that kind of surprise!

4. You deserve real customer service. When youÔÇÖre one of several thousand customers, itÔÇÖs hard to feel like your business has any importance to your medical billing service, isnÔÇÖt it? You want a medical billing service that makes you feel like your practice and your business is important to themÔÇöpreferably 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? DonÔÇÖt take the chance.

At Medical-Billing.com, 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, Medical-billing.com 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 thatÔÇÖs why we say on our home page, ÔÇ£Every claim paid. Guaranteed.ÔÇØ

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 Medical-Billing.com today at 800-966-9270 or email Sales@Medical-Billing.com

Think you donÔÇÖt have to worry about a HIPAA breach? Think againÔÇöif a healthcare giant like Kaiser Permanente can have a HIPAA breach, your practice can too.

If you didnÔÇÖt hear about it, Kaiser was found in January to be using a ÔÇ£Mom and PopÔÇØ organization to store almost 300,000 confidential recordsÔÇöin an unsecured garage and even in the trunk of a Ford Mustang.

That was undoubtedly one of the most shocking HIPAA violations in recent memory, but it just reinforces the idea that a breach can happen to almost any organization without the proper precautions.

And if its easy in a large organization, think about the dangers a medical practice faces: files shared with medical billers, staff taking laptops home to catch up, thumb drives full of data lost either in the office or when taken home, IT people switching out hard drivesthe list is long.

Now, since the long-awaited Health Insurance Portability and Accountability Act (HIPAA) Omnibus Rule was enacted on March 23, 2013, new regulationsÔÇöand new finesÔÇöwill impact healthcare groups and medical practices.

Why worry about it now? Because practices have until September 23, 2013 to complyÔÇöand thereÔÇÖs a new ?átwist: You need to worry not only about your own business, but about your business associates.

That means that you need to worry about protecting PHI when in the possession of your business associates, such as:

– Medical billing service

– Attorney

– Marketing group

– IT support

– Etc.

If youÔÇÖre unclear on whether a vendor is a ÔÇ£business associateÔÇØ there are several good decision trees online developed by other groups that help define the term.

Is it worth the trouble?

In a word, YES. The penalties have also increased with the revision of the law, and they are significant.

The amount of civil monetary penalty as administered under the HITECH (Health Information Technology for Economic and Clinical Health) Act is broken down below with both the old and new structure. The original penalty structure was:

The new penalty structure is:

As you can see, these penalties can be quite painfulÔÇöespecially for a small medical practice already struggling to survive.

In addition, think about notifying your patients that youÔÇÖve lost their personal informationÔÇösomething very private theyÔÇÖve entrusted you with. Think that will build patient loyalty? Probably not.

ThatÔÇÖs why you need to take action now to insure youÔÇÖre in compliance by the September 23 deadline. Step 1: review your BA agreements. WeÔÇÖll take a look tomorrow at how those are impacted.

For more information, see our recent blog post outlining the HIPAA changes.

Also, if youÔÇÖre not sure that your third party medical biller will be able to provide the kind of HIPAA security your practice needs, then review your options. Medical-Billing.com is a nationwide organization with local offices that can provide the type of security you need.

Contact Medical-Billing.com today at 800-966-9270. Medical-Billing.com maintains strict HIPAA compliance at each of its 5 nationwide branches, and we will help you improve your profitabiilty while keeping you in compliance.

Recent surveys show that approximately 30% of physicians are unhappy with their EMRs.

Market research firm KLAS found in a July survey that nearly half of 300 practices who were buying EHR systems were not first-time purchasersÔÇöwhich means that they were replacing a system that wasnÔÇÖt working for them.

Some physicians even argue that EMRs are endangering patientsÔÇÖ lives.

So, should EMRs be scrapped?

No, of course not.

The computer that took the astronauts to the moon the first time was less powerful than the computer in my iPhone. Did NASA stop there? No.

Remember the first version of Microsoft Word? (For those who have been around long enough!) It was very basicÔÇödidnÔÇÖt even have the auto-correct feature that can be so annoying (especially with ÔÇ£EHRÔÇØ).

Obviously, technology evolves; and this is as true in healthcare IT as in other industries. There will be a shake out of those EMRs that donÔÇÖt serve practices well or donÔÇÖt have a sustainable business model. MitochonÔÇÖs decision to shut down their EMR is just the first of these that we will see over the next few years. And as Dr. Gregg Alexander ?ásaid on Twitter recently, ÔÇ£Too bad, too, cuz Mitochon had some good pieces.ÔÇØ But this is the way of software, as in most thingsÔÇöonly the strong survive.

Meaningful Use incentives drove development of many EMRs that will not survive this shakeout, and for good reasonÔÇöthey donÔÇÖt serve their physician users as they should.

Where does this leave practices?

Well, in some senses it puts practices in the best possible position: The software will have to improve in order to keep users happy and survive the shakeout. Healthcare IT should only improve from here.

But of course, the flip side is that some practices will be left in the lurch, like MitochonÔÇÖs users. And I donÔÇÖt mean to minimize thatÔÇöitÔÇÖs incredibly frustrating to go through all of the hard work of selecting, implementing and training on a new system, only to see it yanked out from under you. ThatÔÇÖs not something anyone wants to happen, least of all EMR companies.

But it will happen, unfortunately.

So what do you do? Protect yourself.

Utilize the resources at hand for selecting the best EMR for your practice:

1. Define what you want going inÔÇöidentify your wants/needs and make a list. Otherwise, itÔÇÖs easy to be swayed by a sales pitch.
2. Review KLAS and other leading directories for objective data on systems.
3. Talk to your colleagues about what systems theyÔÇÖve tried, what workedÔÇöand most importantly, what didnÔÇÖt.
4. Insist on a 30-day trial of any system youÔÇÖre consideringÔÇöthis is very common now, and any system that wonÔÇÖt allow it is suspect in my book.
5. Talk to your medical billing service.

Most medical billing services of any size work with a variety of systems, and they get feedback and insights from a number of different practices. They can share their overview of the systems that practices are successful with and those that are not working out.

Bottom line: You need to make sure youÔÇÖre getting what you really need and not just what a software company can wrap in a pretty package and sell you.

I firmly believe that we will reach a point where doctors have user-friendly, truly useful EMRs that will make patient care easier and better. But weÔÇÖre not there yet.

Until we are, be careful out there.

Specialists, take note of these valuable tips for improving your coding, for cardiologists, neurologists, OB/GYNs, ophthalmologists and others.

Cardiology

Coding for Acute Coronary Syndrome

Acute coronary syndrome (ACS) is classified to ICD-9-CM code 411.1, which is the same code assigned for unstable angina. It is vital to review the entire medical record to make sure the information presented supports the final code assignment. Therefore, if the record contains evidence that the patient may have experienced an AMI but only ACS is documented, then it may be appropriate to query the physician for clarification of the final diagnosis. Final code assignment always is based on physician documentation…?áRead More

Gastroenterology
The Coding Corner: Coding for an Incomplete Colonoscopy

Medicare rules for coding colonoscopy differ from American Medical Association (AMA) rules, particularly with regard to “incomplete”?Ø colonoscopies. For a Medicare patient undergoing a screening colonoscopy, if the surgeon is able to advance the scope past the splenic flexure, consider the colonoscopy “complete”?Ø and report the appropriate code…?áRead More

Neurology
Modifier Indicators: Keys to Success for 64615 Edit Pairs

The Coding Institute

The latest Correct Coding Initiative (CCI) edits–version19.1, effective April 1, 2013–introduced a number of edits for new chemodenervation code 64615 (Chemodenervation of muscle[s]; muscle[s] innervated by facial, trigeminal, cervical spinal and accessory nerves, bilateral [e.g., for chronic?ámigraine]). Read on for the rundown of how the changes could affect your pain management coding.

Check Whether a Bypass Is Possible
Some of the edits involving 64615 can be “bypassed”?Ø by appending a modifier in order to report both procedure codes. You can’t slip past the edit for other pairs, however, so pay attention to the assigned modifier indicators.

Bypass option: Approximately 20 other edits involving 64615 are classified with modifier indicator “1”which means you can sometimes append a modifier to break the edit and report both services. The most appropriate modifier will depend on the situation, but coders often turn to modifier 59 (Distinct procedural service).

Some of the edits in these pairs that you might be able to unbundle and report with 64615 include:

– 92585 -?áAuditory evoked potentials for evoked response audiometry and/or testing of the central nervous system; comprehensive
– 95822 -?áElectroencephalogram (EEG); recording in coma or sleep only
– 95907-95913 -?áNerve conduction studies
– 95925 -?áShort-latency somatosensory evoked potential study, stimulation of any/all peripheral nerves or skin sites, recording from the central nervous system; in upper limbs
– 95928 -?áCentral motor evoked potential study (transcranial motor stimulation); upper limbs
– 95938 … –?áin upper and lower limbs.

OB/GYN
How to Avoid Making Modifier 22 Mistakes

The Coding Institute

Appending modifier 22 (Increased procedural services) may be something you think you’ve got down pat, but that doesn’t mean your coding will always be error-proof.

The following three modifier 22 tips will clarify how much longer a procedure should take to append modifier 22, if you can use an unlisted procedure code instead, and whether you have regular CPT?« code alternatives.

1. Some experts suggest that you shouldn’t use modifier 22 unless the procedure takes at least twice as long as usual. Several memorandums from Medicare carriers indicate that time is an important factor when deciding to use this modifier. The additional time and work must be significant. Rule: A procedure should take at least 25 percent more time and effort than usual.

2. Using an unlisted-procedure code instead of modifier 22 is a big mistake. Some coders go this route because they think the payer will manually review such claims and the carrier’s computer cannot automatically deny them. But you could be setting your practice up for missed reimbursement, because quite a few insurers will deny the service on first submission–which will lead to appeals. Conversely, all claims that go in with a modifier 22 will be reviewed.

3. Instead of attaching modifier 22 when a procedure is above and beyond its normal scope, you should consider reporting a CPT?« code that more specifically explains why the procedure was prolonged or unusual. In other words, before you use modifier 22, you should always look to see if there’s another CPT?« code that more accurately reflect the work the OB/GYN did.

Ophthalmology
Include Lens Fitting In These Cornea Codes

The Coding Institute

If your ophthalmologist is using a relatively new code for the fitting of a therapeutic contact lens, you will need to know the new CCI rules.

According to the new set of CCI edits, CPT?« code 92071 (Fitting of contact lens for treatment of ocular surface disease), introduced in 2012, is now bundled into:

– 65220-65222 -?áRemoval of foreign body, external eye …
– 65275-65286 -?áRepair of laceration …
– 65400 -?áExcision of lesion, cornea (keratectomy, lamellar, partial), except?ápterygium
– 65410 -?áBiopsy of cornea
– 65420 -?áExcision or transposition of pterygium; without graft
– 65426 -?áExcision or transposition of pterygium; with graft
– 65430-65600 -?áRemoval or destruction procedures on the cornea
– 65710-65757 -?áKeratoplasty procedures on the cornea
– 65760-65782 -?áOther procedures on the cornea.

These edits all carry a modifier indicator of “1”,?Ø meaning that you can use a modifier to break the bundle under the appropriate clinical circumstances, and report the two bundled codes separately.

For more information on the Correct Coding Initiative, visit http://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/index.html?redirect=/nationalcorrectcodinited/.

Orthopedic
3 Steps to Sharpen Your Skills for Strapping Codes

The Coding Institute

A simple treatment like strapping could really tie you in knots–if you’re not clear on some coding fundamentals. Take these three steps to strapping coding success.

1: Understand Unna Boot, Buddy Tape Definitions

Before you go ahead and assign a code for strapping, you’ll need to understand how your payer defines strapping. Strapping may be done to support and/or restrict movement of ligament structures by exerting pressure upon the extremity or other area of the body.

Unna boot?áapplication is one method of strapping. An Unna boot is a type of paste bandage.

The Unna boot bandage restricts the volume of the distal lower extremity, controls edema, and promotes venous blood return. You report Unna boot application with (29580, Strapping; Unna boot).

A common mistake is to overlook the removal of an Unna boot. Check if the removal was done by same or another provider. Removal of an Unna boot applied by another provider outside the practice may be reported using CPT?« code 29700 (Removal or bivalving; gauntlet, boot or body cast).

Remember: Confirm with your payer specific reporting guidelines for Unna boot removal.

Another example of strapping is buddy tape or “buddy splint.” Buddy straps are prefabricated straps made of canvas or foam and Velcro and are reported with codes 29280 (Strapping; hand or finger) or 29550 (Strapping; toes).

Step 2: Look to Body Area for Code Selection
CPT?« arranges strapping codes by body area. Begin with code family 29000-29799 (Application of casts and strapping), then narrow your code choices by anatomic area (body, upper extremity, or lower extremity). Each anatomic section has options for splints, casts, and strapping. In particular, the strapping codes are in ranges 29200-29280 (body and upper extremity) and 29520- 29590 (lower extremity).

Step 3: Keep Up With Payers’ Supplies Guidelines

Payers support strapping when the physician has stabilized a joint with non-rigid materials allowing the patient to retain some range of motion, such as tape, web rolls and possibly an elastic (e.g., ACE) bandage. But the sole use of elastic bandages as strapping may be controversial among certain payers. Check with your payer to see if specific codes are applicable.

Radiology
Avoid Separate Imaging with Thoracentesis

Thoracentesis is a puncture made between the ribs into the pleural cavity to aspirate or remove accumulated fluid (pleural effusion) from the chest cavity. A needle attached to a syringe is introduced through the skin and chest wall until it penetrates the pleura.

For 2013, CPT?« deleted 32421 and 32422, previously used to describe thoracentesis, and replaced them with two new codes…?áRead More

Two very interesting pieces of news caught my eye this week, and the implications for medical practices from each of these pieces of news is rather staggering, in my opinion.

1. A survey on physician profitability just released by social learning and collaboration platform ?áQuantiaMD and EHR/PMS company CareCloud found that only 9% of physicians are ÔÇ£very confidentÔÇØ in their current staff, tech and processes for getting paid.

2. A recent blog post on Healthcare IT News discussed the fact that payers are changing their systems from a ÔÇ£pay-and-chaseÔÇØ post-payment recovery model to efforts to prevent overpayments. ÔÇ£Some are implementing analytical technologies to identify possible claim discrepancies at the time a claim is adjudicated. These tools combine predictive, data-driven, integrated code edits and clinical aberrancy rules to identify claim outliers. Unlike rules-based systems, data-driven analytical solutions examine hundreds of variables, and can detect previously unknown and emerging patterns that rules-based analytics may not recognize,ÔÇØ the article says.

The article goes on to say that ÔÇ£An additional layer that can deliver savings to a multi-faceted payment integrity program is to reduce billing overpayments that result from improper coding. This can be achieved by supplementing analytics with clinical code edit technologies backed by nationally recognized coding guidelines as they are designed to find coding errors, unbundled treatments, unusual and inconsistent treatment patterns, and inappropriate diagnoses.ÔÇØ

What these two pieces of news mean to me is that while 91% of physicians are less than ÔÇ£very confidentÔÇØ about their billing processes, they are about to face increased scrutiny from payers with finely tuned analytics software, which means that every coding error, unbundled treatment, unusual and inconsistent treatment pattern and inappropriate diagnosis could cause their claim reimbursements to, at best, be delayed, and at worst, to be denied.

This is a recipe for disaster for many practices.

In addition, when asked in the survey how much of their time was spent on ÔÇ£coding, documentation and administration,ÔÇØ rather than patient care, the majority of physicians?á(59%)?ásaid they sacrificed more than?á(20%)?áof their time this way. This is the equivalent of one day per week for a full-time physician spent at a desk rather than in an exam room. About?á(30%)?áof physicians spend one-third of their time ÔÇô or more ÔÇô on administrative tasks.

So what this picture reveals is that physicians are spending way more time than they want toÔÇöor shouldÔÇötrying to oversee billing processes they were never trained to manage, with staff who have varying levels of training and experience.

No wonder 91% of them are less than ÔÇ£very confidentÔÇØ about their billingÔÇöIÔÇÖm sure an even higher percentage are less than ÔÇ£very happyÔÇØ about this situation!

Plus, a key finding of the PPI survey was that the 5,012 physician participants were two-thirds more likely to foresee a downward trend in profitability for the year ahead than a positive one (36% negative vs. 22% positive). That means itÔÇÖs even more hazardous to have billing processes that theyÔÇÖre not confident inÔÇöthey need every dollar they can get on the bottom line.

Add all of this together, and it becomes more clear than ever that now is the time for medical practices to change their approach to billing and entrust it to trained professionals who have the technology, processes and experience to handle the current requirements and challenges that lie ahead.

Medical billing is an exceptionally complicated and convoluted process, and only becoming more so. Why would you want less than expert help to manage the lifeblood of your practice?

Find out today how you can have full confidence in your billing processes and bring more to your bottom line. Contact Medical-Billing.com at 800-966-9270 for a complimentary review of your billing.

“Medical Billing made all the difference for my practice. They eliminated all the frustrations associated with insurance reimbursements and increased my revenues by 100%.” ?á–Janice

Last week we looked at how to write an effective appeals letter, but obviously thereÔÇÖs much more to the process. To review how to effectively manage your appeals process, weÔÇÖll turn to two experts in the field: Elizabeth W. Woodcock, MBA, FACMPE, CPC, and Nancy Clark, CPC, CPC-I.

Practice management expert Elizabeth W. Woodcock, MBA, FACMPE, CPC, offered ÔÇ£A Dozen Steps to Successfully Appeal Denied ClaimsÔÇØ in this article, including these tips:

– Recognize denials. The key is to identify it as separate and distinct from a contractual adjustment, which is ÔÇô and should be ÔÇô a write off.

– DonÔÇÖt procrastinate. There is often a timeframe in which you can resubmit a claim after itÔÇÖs been denied.

– Make a compelling case. Among the tips Woodcock provides here are: Develop a professional letter that begins by referencing the claim number, date of service and patient; then, briefly describe the particulars of the service in question; use the insurerÔÇÖs own language if possible; look to see if Medicare or Medicaid pays for the service; if they do, you can argue that even the government has determined that payment is appropriate; Copy and attach sections that support your case from coding manuals, including past issues of the American Medical Association (AMA) CPT Coding Assistant.

– Confirm receipt. DonÔÇÖt just send the appeal and hope for the best, Woodcock advises. Review your submission online, or call the insurance company to confirm that they received your appeal, noting the name of the operator, extension number, date and time. Follow up in 30 days.

– Set boundaries and donÔÇÖt go overboard. Establish protocols for dollar thresholds that youÔÇÖll appeal only once, twice, etc. Avoid fighting for a claim that should have never been submitted in the first place, such as an undocumented service.

– Carbon copy stakeholders. Your appeal to reverse a denial is a matter between you and the insurance company, but sometimes pulling in other key stakeholders helps. Your first, and most important, advocate is the patient.

– Maintain a hassle folder for each insurance company and develop supportive language in your contract. It pays to maintain a record of reimbursements and denials in order to effectively review your contract for its strategic contribution to the practiceÔÇÖs bottom line. Proactively negotiate the inclusion of language that supports your efforts to appeal claims.

– Compile appeals. Appealing claims one-by-one may get the results you need, but it is laborious. If youÔÇÖve seen the same service denied for the same reason multiple times, compile your appeals and present them together for reconsideration.

Read the full article at http://www.kareo.com/gettingpaid/2010/08/a-dozen-steps-to-successfully-appeal-denied-claims/

In a separate article, The Real Deal About Appeals, Part 1, expert Nancy Clark, CPC, CPC-I, offers additional useful advice, including:

– Clarify the reason for the denial. For example, is the service not covered because it is deemed medically unnecessary? Is this procedure specifically excluded from the patientÔÇÖs benefits contract? Did the insurance carrier not recognize a modifier or modifiers on the claim?

– When the cause of denial has been clearly identified, ask what documentation you need to appeal the claim. For example, they may request operative notes and pathology reports.

– Confirm the insurance carrierÔÇÖs formal appeal process. This may require using a form provided by the company or it may require a written appeal on the practiceÔÇÖs letterhead. Some commercial carriers and Medicare Administrative Contractors (MACs) have a standardized form available on their websites, while some carriers may prefer the use of a form from the stateÔÇÖs department of banking and insurance.

– Obtain the specific address to which the claim should be mailed. Include the name of the department or person to whose attention it should be addressed. If possible, get a fax number. This may yield faster results.

– Document the phone call, the representativeÔÇÖs name, and the date of the conversation. Keep this information in the appeal file.

Read the full article at http://news.aapc.com/index.php/2012/04/the-real-deal-about-appeals-part-1/

Be sure to prepare for battle when youÔÇÖre appealing claims by having a plan, doing your homework, and writing an effective appeals letter.

When you need assistance with your appeals, contact Medical-Billing.com at 800-966-9270. Medical-Billing.com 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 can help you get paid for the tough claims your staff doesnÔÇÖt have time to pursue.

Related Articles

Medical Billing Update: Appeals That Work, Part I
Medical Billing Appeals: Make Sure TheyÔÇÖre Working for You

Are the results from your appeals as good as youÔÇÖd like them to be? If not, you should check out the advice from leading experts in the industry. They have practical recommendations on process, how to write a strong appeal letter, knowing when to appeal, and more.

Our first resource is an excellent article in For the Record magazine, The Art of the Appeal Letter
by Lindsey Getz. The author interviewed several experts, who provided these tips on writing a successful appeal letter:

1. Before putting pen to paper, review the claim for hints about why it was rejected.

2. Include documentation of exactly what took place, including the clinical outcome. The goal is to show that you followed procedure.

3. Gather all documentation prior to starting the writing process.

4. Be sure to include the necessary info: Any good appeal letter requires a few basic necessities, including the background information/scenario, the issue at hand, the request to return to the initial Medicare-severity diagnosis-related group (MS-DRG), and a detailed explanation regarding the request.

5. Remember that there are three basic types of appeals: medical necessity, administrative, and coding, each of which requires a unique approach.

Medical Necessity Appeal
In this situation, denials typically are focused on short stays. When writing the appeal, focus on engaging the reader. Jacqueline E. Poliseno, RN, BSN, CPHM, a case management manager at Craneware, says this can be accomplished by ÔÇ£telling the storyÔÇØ behind the appeal. DonÔÇÖt scrimp on the details, she says, and be sure to include the following points when pertinent:

– What did the patient look like at the time of presentation?

– What treatment did the patient receive in the emergency department?

– What symptoms remained after treatment?

– What treatment was intended for the admission?

– What happened each day of the stay? (Talk specifically about what the patient looked like clinically and the treatments/services provided.)

ÔÇ£Then end your story with discharge information,ÔÇØ she advises.

Administrative Appeal
In the event of a weak clinical argument, it may be wise to write an administrative appeal focused on the physicianÔÇÖs intent to admit the patient as an inpatient. Highlight the principles articulated in the Medicare Benefit Policy Manual that provide MedicareÔÇÖs definition of an inpatient.

Coding Appeal
These denials typically are related to documentation, Poliseno says, adding that the arrival of ICD-10 will have no effect on the process. No matter if itÔÇÖs ICD-9 or ICD-10, writing an effective coding appeal letter requires the author to have extensive coding knowledge. Like the other appeal processes, gathering the appropriate support materials is essential.

Managing Appeals
Poliseno says organizations must have a system in place that allows them to track and monitor denials and appeals. This will help ensure that appeal letters go out in a timely manner to meet payer deadlines.

ÔÇ£You have to assess what you already have in queue, asking ÔÇÿHow old is it?ÔÇÖ and ÔÇÿHow small is it?ÔÇÖÔÇØ Nesbitt says. ÔÇ£These are the questions that will help you determine if itÔÇÖs truly worth pursuing.

Read the complete article at http://www.fortherecordmag.com/archives/0413p14.shtml

Next week, weÔÇÖll share tips from practice management expert Elizabeth W. Woodcock, MBA, FACMPE, CPC.

And if you need assistance with your appeals, contact Medical-Billing.com at 800-966-9270. Medical-Billing.com 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. These are the claims your staff probably doesnÔÇÖt have either the time or expertise to collect onÔÇöbut we do, and we do it every day.

Physicians Practice, a site I admire and read frequently, recently posted an article entitled ÔÇ£The Case for Outsourcing RCM at Your Medical Practice.ÔÇØ The post made some excellent points, which I have also made on this blog, about the fact that with so many regulatory and coding changes affecting medical practices, billing and collections is getting more challenging for physician practices.

We couldnÔÇÖt agree more.

What we disagree with, however, is the concept behind the case study presented in the article. The article profiles a practice that made the wise decision to outsource their medical billingÔÇöbut they did so with a company that essentially provides medical billing as a sideline to their normal business.

Why would a practice do that, you ask?

ItÔÇÖs because many companies that produce medical billing software are now offering medical billing services. Practices see these companies as safe options since they have used the software successfully.

This is like asking GoToMeeting to run your next all-staff meeting. Or having Microsoft write your next practice brochure.

Medical billing is not what these companies do; itÔÇÖs what they facilitate with software.

We spoke recently with a practice owner who told us that they had done this, and found that while they were only paying 4% for their medical billing, the company neglected to tell them that they were not following up on claims! As a result, the practice has found that theyÔÇÖre collecting approximately 42% of whatÔÇÖs owed to them.

Are you willing to accept only 42% of what youÔÇÖre owed? I hope not!

ThatÔÇÖs why, when itÔÇÖs time for you to outsource your medical billing, itÔÇÖs vital to carefully evaluate your medical billing partner and make sure you get the right one for your practice.

Here are some key questions to ask:

1. Does the company have enough experience in medical billing to know how to get your claims paidÔÇöhow to follow up, file effective appeals, etc.?

2. How well trained is their staff? Do they have practical experience with medical billing?

3. Is medical billing going to be the primary focus of your partner? If theyÔÇÖre worried about getting their next software release out and pull some of their medical billers to test, what will be the effect on your revenue?

4. Make sure you know what youÔÇÖre getting: Will the claims be followed up on? Will the follow up be effective?

5. What kind of customer service will your practice receive? With a larger company focused primarily on software development, will your practice (particularly if itÔÇÖs smaller) receive the attention you need and deserve?

6. What is the companyÔÇÖs overall success rate with medical billing? What type of service level agreement are they willing to give you on your claims (not your software!)?

There are many more points to consider when you evaluate a medical billing partner, and thatÔÇÖs why we recommend that you get our free white paper, When and How to Select the Right Medical Billing Service.

Just a few of the key items youÔÇÖll get are:

– A 30+ point checklist for evaluating a medical billing service

– The different types of medical billing services and the advantages/disadvantages of each

– Medical billing service pricing–how it works and what you get for your percentage/fees

– And more

Make sure you get what you need for your practice to protect your revenue. A Johnny-Come-Lately medical billing software company may not be it.