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Posted on February 3, 2014 by · Leave a Comment
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Medical billing services

?Š ?Š ?ŠAbout medical billing services

Medical billing is a special field, which requires the expertise of skilled staff. There are several companies that offer these services and this requires a team of qualified medical billing professionals, who can perform all the work related to medical billing.

The professionals employed in medical billing companies focus on different works related to medical billing even if they are not aware about the complete functioning. Thus the works are allotted to different people will help them to concentrate on the task, which is assigned to them and it can also prevent the interruption that would otherwise occur during a particular billing function. If the works is not divided among the team members, those working will have to handle the whole lot, which would decrease the quality of work.

billing function

?Š ?Š ?Š ?Šcompanies offering medical billing services

When the teammates specialize in the different task assigned to them, the efficiency of the company increases naturally. You might be aware that there would be many patients visiting the hospitals or health clinics per day. You can imagine that there would be quite a lot of claims that would have to be submitted to the insurance provider. Before submitting the claims, the billing process takes place and there are a lot of things that need to be done including printing, making reports, mailing, posting payments and analyzing the details submitted and many others. Professional medical billing and coding services ensure that the quality standards are indeed satisfied.

There would be clients for the medical billing services and the companies that could satisfy the requirements of their clients successfully would get more work and good payments. The companies that submit the work with the highest accuracy are more likely to get the best payments. You can try to get?Š?Šin to?Šcompanies offering?Šin to?Šcompanies offering?Šmedical billing services. However, you would have to attain some training for medical billing if you wish to attain a job in the medical billing service. ?ŠThere are several training schools that offer these services at an affordable cost. You need to attain training from the best training school and this will increase your possibility of getting in to a company offering medical billing and coding services.

The working in a team ensures that they save time to a great extent. Thus, they could increase their productivity and quality of work especially when the work is being handled by a qualified team.

Posted on December 30, 2013 by · Leave a Comment
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Medical billing services

?Š ?Š ?ŠMedical billing experts

Most medical institutions are hiring medical billing experts these days. In fact, there are obvious reasons for this. Appointing a medical billing expert helps reduce a lot of workload that you otherwise would have. Medical billing services include bill management, bill processing, accounts tracking, claims submission, claims clearance, pursuing rejected claims and HIPAA approval. If you are planning to hire a medical billing specialist for your institution, that would indeed be a good decision. Yet, you need to read this article to know more about the benefits of appointing a medical billing specialist.

Benefits of appointing a medical billing specialist

Are you fed up with processing bills in your house during your free time? Do you think that you are wasting your precious time to process the bills that are piling up day by day? If you answer is yes to any of the above questions, I must say it is high time you considered appointing a medical billing specialist. It can save your money and more importantly your precious time. Below are some of the reasons to hire a medical billing specialist.

  • Saves time: The best way to improve the productivity of your staff is to assign them works that they are specialised in. If your office staffs are tasked with responsibilities that they are not familiar with including medical bills processing, it does nothing but increase their workload and results in wastage of time and human resource. Hence, appoint a medical billing specialist who can do all medical billing tasks effectively within the set time frame.
  • Better performance: Most medical billing specialists are experts in their area of work. The institutions that train them give them enough exposure to various tasks such as processing denied claims, rejected claims, resubmission of claims, claim clearance and so on. Obviously, they would be much more efficient than your in-house staff.

    accounts tracking

    ?Š ?Š ?Š ?Š Medical billing specialists

  • Incentives: Medical billing experts get a good sum as incentives and other benefits when they process more bills and increase the collection. So, there will always be an enthusiasm to meet the target and go beyond it as it results in the form of monetary benefits for them.

Well, these are the main reasons for you to seek Medical billing services. Before hiring a medical billing specialist, be advised to enquire about the institution where he or she has done the course. Candidates coming out of the reputed institutions are indeed a real asset.

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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.

Posted on July 15, 2013 by · Leave a Comment
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New 1500 Claim Form Approved to Accommodate ICD-9 or ICD-10 Diagnosis Codes
Version 02/12 1500 Health Insurance Claim Form (1500 Claim Form), which accommodates reporting needs for ICD-10, was approved, the National Uniform Claim Committee (NUCC ) announced on June 17, 2013. The Office of Management and Budget (OMB) has approved the 1500 Claim Form under OMB Number 0938-1197.

During its work, the NUCC was made aware by the healthcare industry of two priorities that were included in the revisions to the 1500 Claim Form. The first was the addition of an indicator in Item Number 21 to identify the version of the diagnosis code set being reported; i.e., ICD-9 or ICD-10.

The need to identify which version of the code set is being reported will be important during the implementation period of ICD-10.

The second priority was to expand the number of diagnosis codes that can be reported in Item Number 21, which was increased from 4 to 12. Additional revisions will improve the accuracy of the data reported, such as being able to identify the role of the provider reported in Item Number 17 and the specific dates reported in Item Number 14.

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For Billing Purposes, When Should a New Provider Start Seeing Patients? Review 3 FAQs to Avoid Giving Away Free Services
The Coding Institute
When a new physician joins your practice, if you don’t think about getting the new provider’s credentialing info to your payers before he starts seeing patients, you will actually lose money, upset patients, and possible face fraud charges before you see any benefits.

Review these three frequently asked questions to make sure you are equipped to face the challenge of how to bill for the provider’s services to both new and established patients who visit him at your practice.

1. ?ŠCan We Bill Retroactively?
When you can bill for a new physician’s services depends on when you’re able to get him/her credentialed. You’ll also need to know the differences between the payers you bill, because they do not all follow the same policies.

For Medicare, you’re allowed to bill 30 days retroactively. Regardless of when the provider starts with your practice, you’ll only be able to retroactively bill Medicare for services your physician rendered up to 30 days prior to the date he received his Medicare credentialing status.

Note: In the past you had a full 27-month window during which you could retroactively bill. That changed in 2009.

2. ?ŠCan We Just Use Another Provider’s NPI?
In a word, “No.” While it may be tempting, you should not use another credentialed doctor’s national provider identifier (NPI) on the new doctor’s claims to get paid for services the new physician performs before being credentialed. Doing this is considered fraud.

Either avoid having the new physician see patients until the Medicare credentials come through, or have the physician see only patients who are self-pay or who have insurance that allows you to bill before credentialing.

Question: You can just report the new doctor’s service under an existing physician’s ID number and append the locum tenens modifier to it, right?

Answer: No. Locum tenens is designed to represent services performed “in the absence of the regular physician,”?ō according to chapter 1 of the Medicare Claims Processing Manual. Practices that simply report the new physician’s service as if it was performed by a locum tenens doctor, are violating the original intent of the locum tenens rules.

3. ?ŠWhat is the Best Way to Ensure We Get Paid?
Allow your office more time when trying to credential a new physician.

The process can take 90 days or even longer, according to Medicare. Experts recommend that you initiate this process as far in advance of your new physician’s starting date as you can (once you have all the necessary information such as the state license and DEA number); two months ahead of time, if not more. Experts advise that with the advent of PECOS, things should move quicker, but say that some of the commercial payers could take as much as six months.

If you act early, you’ll have the necessary credentials in place when the physician starts seeing patients and you won’t have to hassle with delayed payments.


Medicare to Boost Physician Payments for Complex Care Management

CMS issued a proposed rule on July 8 that would update payment policies and payment rates for services furnished under the Medicare Physician Fee Schedule (PFS) at the start of 2014. Currently, Medicare only pays for primary care management services as part of a face-to-face visit; under the proposed rule, CMS would make a separate payment to physicians for managing select Medicare patients’ care needs beginning in 2015. CMS will accept comments on the new rule until Sept. 6, then will generate the final rule by Nov. 1.

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Monitor Revenue to Strengthen Bottom Line

In a competitive healthcare marketplace like Dallas-Ft. Worth, a physician practice must tightly manage its revenue cycle. Texas Health Physicians Group (THPG) is doing that by tracking five key financial metrics.Sam Civello, vice president at THPG, told attendees at the 2013 HFMA ANI conference that THPG follows five metrics it considers critical to physician revenue performance. They are:

–?Š?ŠClaim entry dates?Š– Two days or less from the date of service.
–?Š?ŠUn-reconciled visits?Š– Maintain at 0.5 percent or less.
–?Š?ŠPre-bill rejection rates?Š– Maintain at 4 percent or less.
–?Š?ŠFirst-pass denial rates?Š– Keep them at less than 10 percent.
–?Š?ŠPass-through rates?Š– Keep them below 3 percent.

Read more:

Posted on July 11, 2013 by · 1 Comment
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As we mentioned yesterday, now is the time for medical practices to bring their processes and documents into compliance with the new Health Insurance Portability and Accountability Act (HIPAA) Omnibus Final Rule, released in January of this year and effective on September 23, 2013. Read the first blog post now.

Our post yesterday discussed why you need to be concerned about the new rule and outlined the possible fines. Today we‘«÷ll look a little closer at what you need to do.

There are several 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 Becker‘«÷s ASC Review:

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. 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. The 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. The definition of ‘«£protected health information‘«ō now expressly excludes the health information of a person who has been deceased for more than 50 years. 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. 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. 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. 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. In particular, management and higher-level employees should be fully trained on the new breach standard, so that, if necessary, they can correctly perform the required analysis.

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. Your new patients who receive services for the first time after modification of an NPP should be provided with a copy of the revised NPP. Consistent with the existing rules, your practice should retain copies of previous versions of your NPPs and of any written acknowledgements by patients of receipt of NPPs.

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.

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 of uses or disclosures of protected health information (“PHI”) to be produced upo request;

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

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

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

Many of these new requirements were not traditionally thought 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 JD 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.

Your practice should review all 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 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.

And remember, ‘«£business associates‘«ō include medical billing, as we noted in our blog post yesterday. If you have any questions about how your medical billing service is handling PHI on your behalf, please contact and we‘«÷ll be happy to advise you on how to improve the situation.

Posted on May 2, 2013 by · 1 Comment
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Just when you thought you didn‘«÷t have enough to worry about, stronger controls have been put in place for HIPAA. They are in the final regulations for the Omnibus Health Insurance Portability and Accountability Act, or the HIPAA rule and took effect March 26. Fortunately, medical offices and business associates have until September 23 to comply.

The final rule is comprised of four final rules, as HHS explains in the document (PDF), ‘«£which have been combined to reduce the impact and number of times certain compliance activities need to be undertaken by the regulated entities.‘«ō

The four rules include:

1. Final modifications to the HIPAA Privacy, Security, and Enforcement Rules mandated by the Health Information Technology for Economic and Clinical Health (HITECH) Act, and certain other modifications to improve the Rules, which were issued as a proposed rule on July 14, 2010. These modifications:

– Make business associates of covered entities directly liable for compliance with certain of the HIPAA Privacy and Security Rules‘«÷ requirements.

– Strengthen the limitations on the use and disclosure of protected health information for marketing and fundraising purposes, and prohibit the sale of protected health information without individual authorization.

– Expand individuals‘«÷ rights to receive electronic copies of their health information and to restrict disclosures to a health plan concerning treatment for which the individual has paid out of pocket in full.

– Require modifications to, and redistribution of, a covered entity‘«÷s notice of privacy practices.

– Modify the individual authorization and other requirements to facilitate research and disclosure of child immunization proof to schools, and to enable access to decedent information by family members or others.

– Adopt the additional HITECH Act enhancements to the Enforcement Rule not previously adopted in the October 30, 2009, interim final rule (referenced immediately below), such as the provisions addressing enforcement of noncompliance with the HIPAA Rules due to willful neglect.

2. Final rule adopting changes to the HIPAA Enforcement Rule to incorporate the increased and tiered civil money penalty structure provided by the HITECH Act, originally published as an interim final rule on October 30, 2009.

3. Final rule on Breach Notification for Unsecured Protected Health Information under the HITECH Act, which replaces the breach notification rule‘«÷s ‘«£harm‘«ō threshold with a more objective standard and supplants an interim final rule published on August 24, 2009.

4. Final rule modifying the HIPAA Privacy Rule as required by the Genetic Information Nondiscrimination Act (GINA) to prohibit most health plans from using or disclosing genetic information for underwriting purposes, which was published as a proposed rule on October 7, 2009.

You can read more about the rules at

What do the new rules mean to you?

There are a several key points that medical practices need to note:

According to Susan Crawford in a blog post on KevinMD, the changes mostly affect patient requests and approvals, breach reporting, and business associates. Along with that, the penalties for noncompliance have gone up. And accompanying the penalty increases is a promise from the government to search out violators with a vengeance.

Crawford, editor of Medical Office Manager, writes that 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.

Guilty till proved otherwise

Next, Crawford notes, there‘«÷s also a change in how to determine when a breach has to be reported to the government. Until now, offices have followed the harm standard, which said a breach was reportable only if it posed a significant risk of harm to the patient‘«÷s finances or reputation.

The new regulations change that pretty much 360 degrees. They say that any loss or inappropriate disclosure of data is presumed to be a breach unless the office (or hospital or business associate) can show there is a low probability the information will be used improperly.

To determine that, the office has to do a documented risk assessment that covers four elements:

1. The type of information. ?ŠInformation about sexually transmitted diseases, for example, could harm a patient‘«÷s reputation. Credit card numbers and Social Security numbers could be used for identity theft. Risk is high. Yes, there‘«÷s been a reportable breach.

2. The recipient of the information. If the office doesn‘«÷t know who has accessed the information, assume there has been a breach. However, if the other person is a HIPAA-covered entity, misuse probability is low and so is the risk.

3. Whether the data was actually seen or used. Suppose a stolen computer is recovered and forensic analysis shows the data was never accessed. Risk is low. No breach. Another example: suppose a patient‘«÷s record is mailed to the wrong person. If the envelope is returned unopened, risk is low. But if it‘«÷s returned opened or not returned at all, risk is high, and the office has to assume there has been a breach.

4. How well the risk has been mitigated. ?ŠThe mitigating factor might be that the office gets assurance the information won‘«÷t be used or disclosed or will be destroyed. That makes the risk low and probably not reportable. However, who that other party is makes a difference. Assurance from a business associate is probably worth relying on; assurance from an unrelated person or company with no obligation to comply with HIPAA is another story.

You need to think about HIPAA for business associates too

Additionally, business associates are now required to comply with HIPAA just as offices are. They have to have safeguards and policies and procedures for keeping data secure. They have to have business associate agreements with their own subcontractors. And they can get hit with penalties if they don‘«÷t.

That‘«÷s a logical move, Crawford says, because some of the greatest breaches to date have involved business associates.

The penalties get higher

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

You can read the full article at

If you‘«÷re concerned about whether your medical billing service will be HIPAA compliant under the new rules, contact?ŠŠat 800-966-9270. 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.

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When you decide to consider an external medical billing service, there are several criteria you should consider:

  • Performance
  • Customer Service
  • Compliance
  • Reporting/Transparency
  • Technology
  • Capability/Scalability
  • Pricing

Today, let‘«÷s look at Performance. In future posts, we‘«÷ll discuss each of these areas and key points you need to evaluate for each.


One of the first areas to consider, of course, is performance. If a medical billing company can‘«÷t keep your denials, DRO, net collection rate and other key performance indicators (KPI) within industry standards (or better), then other issues such as customer service are moot.

Key Performance Indicators

To get a feel for how well the medical billing service candidate performs within common KPIs, ask:

  1. What is your clients‘«÷ average Days in Receivables Outstanding (DRO)?
  2. What is your clients‘«÷ average A/R over 120 days percentage?
  3. What is your clients‘«÷ net collection rate?
  4. Has your clients‘«÷ cash flow improved or declined over the last 90 days? If it has declined, why?

Also ask:

What resources does the group dedicate to the last 20-30% of claims that are harder to collect and often never paid?

What is the service‘«÷s process for continuous improvement? Do they evaluate their performance every month and assess where improvement is needed? You want to find a group that is striving to be better and will help to make your practice better.

Try Our Practice Revenue Assessment Tool to Gauge Your Practice‘«÷s Financial Health

You can analyze how your practice is currently performing compared to industry standards with this quick assessment tool.

Other key components of performance are Timeliness and References, so that you know the service can actually deliver what they are promising.


Ask if adequate checks and balances are provided between the practices and the medical billing service to assure that all charges or superbills are being entered in a timely fashion. A typical benchmark for this would be a guaranteed entry rate of 48 hours or better. Does the service have a good audit system to confirm charge entry against a service/procedure log to avoid missed charges?


Can the medical billing service provide you with references in your specialty? If you talk to the key contact, be sure to ask the performance questions above to validate the information you are receiving from the service. Ask if they are offered any compensation for acting as a reference, and if so, what is it? A small gift is normal, but anything extravagant raises questions about the validity and enthusiasm of the reference.

As you‘«÷re considering medical billing services, be sure to consider Our nationwide network of experienced, highly qualified billing experts insures that you will receive the best management of your practice revenue possible.

And, we dedicate over 50% of our 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 doesn‘«÷t have either the time or expertise to collect on‘«Ųbut we do, and we do it every day.

Don‘«÷t let that money slip through your fingers‘«Ųlet the experts handle it. Call today at 800-966-9270, or email

Related Blog Posts
Medical Billing Services: What Do You Get for Your Percentage?
When It Comes to Medical Billing, Don‘«÷t Settle for Less Than You Deserve
Shortage of Qualified Staff Predicted: Will You Have the Right Medical Coding and Billing Staff for ICD-10?

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A great deal has been written and said about ICD-10, so you may be feeling like you know what to expect. Want to be sure? Take our quick 10-question quiz below and score yourself using the answers at the end.

ICD-10 Assessment Quiz

      1. What is the implementation date set by CMS for the implementation of ICD-10?
        a) October 1, 2013
        b) October 1, 2014
        c) October 1, 2011
        d) Hopefully never
      1. Even though the deadline has been set, the healthcare industry is certain that another extension will be given.
        a) True
        b) False
      1. ICD-10-CM is the official name of ICD-10. What does that stand for?
        a) International Safety Classification of Diseases, Class Medical
        b) Immediate Statistical Confusion, Clinical Madness
        c) International Statistical Classification of Diseases and Health Related problems, Clinical Modification
        d) None of the above
      1. Why the change to ICD-10? What makes it worth the headache?
        a) Bureaucrats needed another way to drive physicians crazy
        b) New EMRs require more sophisticated coding
        c) ICD-9 is outdated with no room for expansion and doesn‘«÷t provide enough detail
      1. What should medical practices do now to insure that they are ready for ICD-10?
        a) Medical practices can and must plan for the transition in order to prevent claims denials, lost productivity and cash flow disruption
        b) Medical practices don‘«÷t need to worry about it, since software vendors will handle the entire transition
        c) CMS has issued ‘«£Crosswalks‘«ō that show how ICD-9 coding converts to ICD-10, so coders just need to memorize those
      1. Since the codes will continue being updated between now and October 2014, there‘«÷s no point in learning ICD-10 too early.
        a) True
        b) False
      1. ICD-10 codes require both numbers and letters, unlike ICD-9.
        a) True
        b) False
      1. The complexity of ICD-10 and the difficulty in implementation comes from which of these areas:
        a) Dramatically increased specificity required for code selection.
        b) Expansion from about 14,000 diagnosis codes to almost 70,000 diagnosis codes. There are 21 Chapters in ICD-10.
        c) Variation based on specialty.
        d) Expansion from codes that are 3, 4, or 5 characters to complete codes that are 3,4, 5, 6, or 7 characters long.
        e) A placeholder character for use in the fourth, fifth orsixth position for some codes.
        f) A seventh character extender that has different meanings in different chapters.
        g) The possibility for five diagnosis codes for the initial visit for an injury
        h) Complex sequencing guidelines.
        i) There are two types of Excludes notations:?Š Excludes1 and Excludes2.
        j) Need for increased documentation in the medical record to select a code.
        k) Date of service will determine which code set to use: ICD-9 or ICD-10.
        l) A through J
        m) All of the above, and more
      1. In the months following implementation of ICD-10, practices should expect:
        a) Software vendors will have smoothly made the transition to ICD-10 without any need for testing on the part of practices
        b) GEMS Crosswalks issued by CMS will be sufficient to insure that coding and reimbursement continues smoothly.
        c) ICD-10 Look Up Tools available on various sites will be enough to insure a smooth transition
        d) Decreased productivity, increased queries to physicians while staff members adjust
      1. Experts predict a large number of coders and billers familiar with ICD-10 will be available after the transition, so hiring staff familiar with the new code set won‘«÷t be a problem
        a) True
        b) False


1. b) CMS has set an updated implementation date of October 1, 2014 for the adoption of ICD-10-CM, after delaying it from the original start date of October 1, 2013 when it became clear that the industry wasn‘«÷t going to be ready. The Federal Register on January 16, 2009 put into law the change to ICD-10.?Š Initially, the effective date was 2011, later moved to 2013, now 2014.

2. b) False. Experts advise that practices should not count on another reprieve.

3. c) ICD means the International Statistical Classification of Diseases and Health Related Problems.?Š CM stands for Clinical Modification

4. c) The ICD-9-CM system is outdated without room for expansion and does not provide the level of detail that policy experts and payers say is needed in reporting on morbidity. Policy experts state that the codes are not sufficiently specific and the coding scheme does not have room for needed updates.

5. a) Medical practices can and must plan for the transition in order to prevent claims denials, lost productivity and cash flow disruption.

6. b) False. Updates to each coding system will be limited between now and the implementation date of ICD-10.?Š The last regular updates to both systems were made October 1, 2011.?Š?Š The October 1, 2012 update will be limited for both code sets.?Š For October 1, 2013 there will again be limited code updates to ICD-10, reflecting only new technology and new diseases.?Š Regular updates to ICD-10 will begin October 1, 2014.

7. a) True. ICD-10 codes are alphanumeric.?Š Each starts with a letter, and subsequent characters are alphabetical or numeric.

8. M) The complexity of ICD-10 and the difficulty in implementation comes from a number of areas:

a)?Š?Š?Š?Š?Š Dramatically increased specificity required for code selection.

b)?Š?Š?Š?Š?Š Expansion from about 14,000 diagnosis codes to almost 70,000 diagnosis codes. There are 21 Chapters in ICD-10.

c)?Š?Š?Š?Š?Š Variation based on specialty.

d)?Š?Š?Š?Š?Š Complications of surgery greatly expanded.

e)?Š?Š?Š?Š?Š Location for neoplasms greatly more specific.

f)?Š?Š?Š?Š?Š?Š?Š New concept of underdosing in table of drugs and chemicals.

g)?Š?Š?Š?Š?Š Expansion from codes that are 3, 4, or 5 characters to complete codes that are 3,4, 5, 6, or 7 characters long.

h)?Š?Š?Š?Š?Š A placeholder character for use in the fourth, fifth orsixth position for some codes.

i)?Š?Š?Š?Š?Š?Š?Š A seventh character extender that has different meanings in different chapters.

j)?Š?Š?Š?Š?Š?Š?Š The possibility for five diagnosis codes for the initial visit for an injury

k)?Š?Š?Š?Š?Š Complex sequencing guidelines.

l)?Š?Š?Š?Š?Š?Š?Š There are two types of Excludes notations:?Š Excludes1 and Excludes2.

m)?Š?Š?Š Need for increased documentation in the medical record to select a code.

n)?Š?Š?Š?Š?Š Date of service will determine which code set to use: ICD-9 or ICD-10.

9. D) Be prepared for decreased productivity, increased queries to physicians

The first months using a new coding system are bound to be difficult, with many questions and slower coding. Be sure to plan for reduced income in the first 90 days following the implementation of ICD-10.

10. B) False. Experts predict a shortage of trained ICD-10 coders at the time of implementation. Many professional organizations are concerned about the shortage of proficient, trained ICD-10 coders.


8-10 correct: You are an ICD-10 wiz and should start your own blog.

5-7 correct: You are doing fairly well, but read up to insure you don‘«÷t miss key points.

1-4 correct: Be worried‘«Ųit‘«÷s time to get up to speed on this subject!

0 correct: Time to change fields? At a minimum, start gathering info!

The point of this quiz is not to provide a Halloween scare regarding ICD-10; it‘«÷s to make sure that you understand what‘«÷s involved to prepare your practice. For some practices, the challenge of preparing for ICD-10 in the face of the daily workload will be too much. In these cases, it makes sense to turn to trained professionals.

That‘«÷s why now is the time to consider moving your medical billing to a nationwide medical billing company with the resources to handle the transition‘«Ųand yet still provide local service.

Plus, on average, our physician clients get paid faster than 75% of multi-specialty group practices nationwide as surveyed by the Medical Group Management Association and Healthcare Billing Management Association for Days Revenue in AR.

For more information on how you can protect your practice from loss of revenue due to ICD-10, and to insure that you are getting paid as fast as you should be, contact today at 800-966-9270. We‘«÷re ready to help you.

Posted on October 18, 2012 by · 1 Comment
Filed under: Medical Billing, Physician billing, Physician medical billing  

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Do you know the average A/R Days for your specialty, and how your practice compares?

Do you know the denial rates for your specialty and whether your practice is higher or lower?

Do you know the average days to submit charges for your specialty, and how your submission times compare?

If not, you should‘«Ųbecause these are all useful measures of how well your practice is performing financially compared to other practices.

Certainly, you can argue that your practice is unique or that you didn‘«÷t go into medicine just to worry about the financial aspects of running a practice.

Both can be true, but they don‘«÷t change the fact that if you don‘«÷t manage your practice finances, you could soon be closing the doors. And that benefits no one: not you, your staff, your vendors and most importantly, your patients.

Fortunately, you can see some of these numbers by key specialties, courtesy of PhysBizTech:


Average A/R Days By Specialty
Category A/R Days
Durable Medical Equipment








Surgeons/Ambulatory Surgical Centers


Physical Therapy


Primary Care



2011 Denial Rates by Specialty
Category Denial Rate
Primary Care




Surgeons/Ambulatory Surgical Centers




Physical Therapy




Durable Medical Equipment



Average Time to Submit Charges by Specialty

Category Average days to submit
Durable Medical Equipment


Surgeons/Ambulatory Surgical Centers


Primary Care






Physical Therapy




But even more important than knowing these statistics is knowing the stats for your own practice and how they compare. Do you have that information at your fingertips?

If you don‘«÷t, then it‘«÷s time to reevaluate your medical billing team. You shouldn‘«÷t be kept in the dark about your practice‘«÷s performance‘«Ųyou need to have this type of information at your fingertips.

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‘«ů A proven, systematic approach to accounts receivable management that ensures all necessary billing, payment and follow-up activities are performed in a timely manner throughout each claim’s life cycle.

‘«ů The best customer service in the industry, with Client Managers and Billing Supervisors specifically assigned to each client who are responsible for daily client communications and issues resolution.

‘«ů Faster payment – on average, our physician clients get paid faster than 75% of multi-specialty group practices nationwide as surveyed by the Medical Group Management Association and Healthcare Billing Management Association for Days Revenue in AR.

That‘«÷s why we invite you to get a free quick assessment of your practice revenue and learn whether your medical billing team is managing your revenue correctly, or whether you could be bringing more to the bottom line.

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