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Brookline, MA 02445
Tel: 781.454.7406

Friday, June 21, 2013

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Medical Financial Services helping medical practices increase cash flow!!!

Friday, May 17, 2013


Outsourcing Medical Billing is the solution for doctors that want to increase the profitability of their practice.

With all the changes that are taking place with Health care reimbursements, doctors are seeing a decrease in the money that they receive from insurance companies. By outsourcing their medical billing, doctors save money and get paid for the services they provide faster.  Outsourcing the medical billing functions of a practice to a reputable company that focuses solely on processing medical claims will make a medical practice more money. Vitruvian MedPro Consulting, a Massachusetts based medical billing company, helps doctors increase cash flow. Doctors should focus on providing patient care and not on dealing with the insurance companies or patients.

Vitruvian MedPro sole focus is to help doctors get reimbursed for the medical services they provide faster. Vitruvian MedPro helps doctors focus on providing care and not on dealing with insurance companies. The medical billing process is complex and requires skills. It makes sense to outsource this task to a company that focuses on making sure that claims are processed in an efficient and timely manner. With all the current changes with medical reimbursement, doctors who do not have an efficient medical billing process in place run the risk of going out of business.

By outsourcing the medical billing functions, doctors save money since they do not have to hire additional staff to do the billing for them. Doing the billing in house causes additional expenses that can lower significantly the revenue a doctor receives. Most medical billing companies have a business model that involves charging a rate based on the money that gets collected for the doctors. Moreover, doctors do not have to deal with the headaches and the costs associated with purchasing and maintaining their own practice management systems. Vitruvian MedPro business model consists on charging doctors after they get paid.

Some doctors have a hard time with outsourcing their billing because they fear a loss of control of the financial aspects of their practice. Doing the billing in house does not guarantee complete control of the billing. The dynamics of a practice make it difficult for doctors to be in complete control of their revenue cycle management. This is the main reason why outsourcing to a company that can process the claims and fight with the insurance companies on behalf of the doctor makes the most sense.  Doctors are trained to provide patient care and should focus on providing patient care.

With today's technology advancements, doctors are able be in control of the financial aspects of their practice even when they outsource. Vitruvian MedPro offers a cloud based, HIPAA Compliant practice management system with the most advanced reporting capabilities that allows doctors real-time access to their billing records.

Vitruvian MedPro helps doctors that are frustrated because they see a decrease in cash flow and are struggling with their claim submission process. Outsourcing the billing to Vitruvian MedPro is the solution for doctors that need to increase the profitability of their practice. For more information visit Vitruvian MedPro at


Friday, April 26, 2013

National Unifom Claim Committe - NUCC Approves a Revised 1500

The NUCC will be releasing the new CMS 1500 form soon. There will be an update to accommodate the changes in 5010, 837P and 5010A1 and also to prepare for the implementation of ICD-10. We are currently using the 08/05 version of the CMS 1500 form. Beginning June 1, 2013, you can begin using the 02/12 version. The 02/12 version will replace the current form October 1, 2013 and will no longer be accepted by insurance carriers. The new form is awaiting approval, so it isn’t available just yet. You can learn more about the 02/12 claim form on the NUCC’s website at


CMS Today issued a proposed rule that would increase rewards paid to Medicare beneficiaries and others whose tips about suspected fraud lead to the recovery of funds. In addition, the rule would allow the agency to deny Medicare enrollment to providers affiliated with any entity that has unpaid Medicare debt; deny enrollment or revoke billing privileges of a provider or supplier if a managing employee has been convicted of certain felony offenses; and revoke billing privileges for providers and suppliers who “have a pattern or practice of billing for services that do not meet Medicare requirements” CMS said.

The proposed rule will be published in the April 29 Federal Register with comments accepted for 60 days. In addition, the Department of Health and Human Services’ Administration for Community Living this month announced up to $7.3 million in funding to expand Senior Medicare Patrol activities. Each of the current 54 SMP projects is eligible for varying funding levels, up to a total of $7.3 million across the program, CMS said. See the proposed rule at

Monday, April 1, 2013

CMS to host calls on ICD-10 preparation

From our friends at AMBA

The Centers for Medicare & Medicaid Services on Thursday, April 18, at 1:30 p.m. Eastern Time, will host a national provider call on transitioning to the ICD-10 coding system. The call will provide a basic overview as well as strategies for planning and preparing for ICD-10 implementation. To register, see the call notice. Hospitals and other entities covered by the Health Insurance Portability and Accountability Act must convert to the ICD-10 coding system by Oct. 1, 2014. In addition, CMS contractor National Government Services will host a series of listening sessions to gather feedback from providers on end-to-end testing of ICD-10 and other HIPAA administrative simplification requirements. For more information, see the CMS website.  

2% Medicare cuts begin today as a result of sequestration

Starting today April, 1st, 2013, reimbursements for medical services that are provided and procedure that are performed to Medicare patients will be cut by 2% due to the sequester federal budget cuts.

Patients responsibilities will not change as they still have to pay their co-insurance, deductibles or copays. they still have to pay their full patient responsibility.  So, Medicare patients are not getting ta 2% discount on what they owe.  Medicare is reducing their share of the payment by 2%.  To illustrate with an example, if a doctor bills $150.00 for a procedure and the patient is responsible for a $50.00 co-insurance and Medicare is responsible for the remaining $100.00.  The patient is still responsible for the entire co-insurance amount while Medicare will deduct 2% out of its $100.00 responsibility and pay $98.00.

See below the CMS Provider enews that came out on March 8th, 2013 (brought by the Medicare Learning Network)

To All Health Care Professionals, Providers, and Suppliers

Mandatory Payment Reductions in the Medicare Fee for Service (FFS) Program -“Sequestration”

The Budget Control Act of 2011 requires, among other things, mandatory across - the - board reductions in Federal spending, also known as sequestration. The American Taxpayer Relief Act of 2012 postponed sequestration for 2 months. As required by law, President Obama issued a sequestration order on March 1, 2013. The Administration continues to urge Congress to take prompt action to address the current budget uncertainty and the economic hardships imposed by sequestration.

This listserv message is directed at the Medicare FFS program (i.e., Part A and Part B). In general, Medicare FFS claims with dates - of - service or dates - of - discharge on or after April 1, 2013, will incur a 2 percent reduction in Medicare payment. Claims for durable medical equipment (DME), prosthetics, orthotics, and supplies, including claims under the DME Competitive Bidding Program, will be reduced by 2 percent based upon whether the date - of - service, or the start date for rental equipment or multi - day supplies, is on or after April 1, 2013.

The claims payment adjustment shall be applied to all claims after determining coinsurance, any applicable deductible, and any applicable Medicare Secondary Payment adjustments.

Though beneficiary payments for deductibles and coinsurance are not subject to the 2 percent payment reduction, Medicare’s payment to beneficiaries for unassigned claims is subject to the 2 percent reduction. The Centers for Medicare & Medicaid Services encourages Medicare physicians, practitioners, and suppliers who bill claims on an unassigned basis to discuss with beneficiaries the impact of sequestration on Medicare’s reimbursement.

Questions about reimbursement should be directed to your Medicare claims administration contractor. As indicated above, we are hopeful that Congress will take action to eliminate the mandatory payment reductions.


Thursday, March 21, 2013

Outsource Medical Billing or Do it in House?

Should Health Care Providers Outsource Medical Billing or do it in House?

Health Care Providers face the dilemma of outsourcing medical billing rather than keep it in house.  The trend points out to outsourcing being a better option.

Following is a comparison between outsource medical billing or do it in house:

Doing Medical Billing in house:
  • The office staff may not be able to devote all the necessary time to meet the demands that the medical billing processes require.  The revnue cycle management process involves a number of steps that go beyond the submission of claims.  The office staff may not be able to keep up with the insurance verification, medical coding, charge entry, claim submission, payment posting, A/R follow up, denial management and reporting on a consistent basis.
  • Medical billing and medical coding norms are consistently being changed.  The office staff may not be able to stay on top of all the changes resulting in loss of revenue for the practice.
  • Office staff turnover can be a factor where the medical billing process can be interrupted or halted requiring hiring and training new staff.
  • Health Care providers need to continuosly invest new capital on new technology in order to keep up with all the changes that take place in the health care information technology field.  
Outsource Medical Billing:
  • Outsource Medical Billing to a company with superior expertise and resources will help health care providers improve their reimbursement rates while they focus on providing care.
  • Health care providers will have more control of their operating costs. Medical Billing companies can provide savings to their clients because of the volume of claims that they process. 
  • Health care providers will experience faster reimbursement of claims as claims get submitted on a daily basis.  Moreover, claims are followed concistently from the moment that they are submitted until the moment they get paid.
  • Health care providers can improve the quality of care that they provide to their patients.  The office staff can focus on providing better care and increasing the patient base of the practice.
Vitruvian MedPro consulting, a Massachusetts based medical billing company, helps health care providers focus on patient care while improving cash flow.  Contact us at to schedule a free practice analysis so that we can help you determine whether outsource medical billing makes sense for your practice.

Wednesday, March 20, 2013

Medical Practice changes needed to recoup costs of EHR adoption

A recent article in Medical Economics discusses a new study that shows that just getting the Meaningful Use incentive money ($44K) for implementing a new EHR system is not enough for most smaller practices to be successful.  The implementation of an EHR alone will not improve the profitability of a practice.

The article states: “Offices that experienced a positive return saw more patients or improved billing to achieve fewer rejected claims and higher reimbursement from insurance companies.”

Partnering with a reputable medical billing company can help a practice improve its medical billing reimbursements.  By outsourcing the billing, a practice can focus on providing patient care, not to mention increase its patient base.

Click here to read the full article

Vitruvian MedPro, a Massachusetts medical billing company, we can help medical practices improve cash flow and focus on patient care.  We offer at free practice analysis of the revenue cycle managament of the practice where we can determine whether it makes senses for a practice to outsource their medical billing.

Transitioning to ICD-10

The Centers for Medicare & Medicaid Services recently posted checklists and timelines to help small hospitals, physician practices and payers transition to ICD-10 for reporting patient diagnoses and inpatient procedures. 

Under a final rule issued in August, hospitals and other entities covered by the Health Insurance Portability and Accountability Act must transition to the ICD-10 coding system by Oct. 1, 2014. For more information, visit

Friday, March 15, 2013

Five Things Doctors are Concerned with in 2013

The medical industry is currently going through a lot of changes. In most cases, it’s not a great time to be an independent medical practitioner.  But, medical practitioners can improve the fficiency of their practice by outsourcing their billing.

Following are five things doctors are worrying about in 2013:

1.  Medical professionals losing their autonomy – Doctors are losing theier autonomy because of the increasing regulatory environment that is affecting physicians’ ability to exercise independent medical judgment.

2.  Administrative burdens are increasing – Doctors are spending more time doing paperwork. There’s no way around it, increased regulations means increased paperwork, diminishing quality of care.

3.  Consolidation of Hospitals and Medical Practices – Hospitals have been buying up smaller groups and practices. This increases cost of care and other problems for the remaining solo practices. Solo practices can reduce expenses by outsourcing their billing.

4.  Volume of new patients increasing – About 30 million Americans will have insurance with Obamacare in place. Add the fact that there is a shortage of new physicians entering medicine, and you are going to have a lot of stressed out physicians, struggling even more than before to manage quality of patient care while balancing administrative functions within the office. In this case, outsourcing some burdens like medical billing just makes sense.

5. Affordable Care Act (ACA) – A recent survey stated that 77% of physicians are concerned about the future of medicine once the ACA is fully implemented.

The future is not clear, but there are some clearly identifiable steps that doctors can take to help ease some of the issues above.  At Vitruvian MedPro, a Massachusetts Medical Billing Company, we help medical practices focus on patient care rather than paperwork.  Medical practices can focus on providing better care and grow their patient base by outsorcing their medical billing.

Taking Shortchanging Payers to Court

From our friend at AMBA
According to a recent story in the AMA News - taking shortchanging payers to court — rather than battling internal administrators — may be more beneficial than some doctors think. That is precisely what Florida dermatologist Steven Rosenberg, MD, chose to do in 2009 after attempting to recoup unpaid bills from Humana for more than a year. Humana eventually settled, agreeing to pay the first set of claims and the doctor’s filing fees, totaling $5,340. Shortly after filing a second suit in 2010, Dr. Rosenberg’s practice began receiving checks in the mail from Humana. Since then, the insurer has paid nearly all of the $130,000 Palm Beach Dermatology was owed – Read the entire story here >>

Thursday, March 14, 2013

No more delays to ICD-10 Implementation

From our friends at AMBA

In a Feb. 6, 2013 letter to the AMA, acting CMS Administrator Marilyn Tavenner made the case for moving forward with ICD-10 with no further delays. She said that many in the healthcare industry are under with the necessary changes and that halting this progress would be costly and burdensome. MGMA estimates adopting ICD-10 would cost a small practice about $83,000.

Wednesday, March 13, 2013

The Importance of Denial Management

A big part of an efficient medical billing process is what is called “denial management”. This is where most offices falter and lose money. Denial management is an important step that is often overlooked by doctors and staff because of lack of follow through by the office.  We find that claims will be rejected by insurance companies and end up “stacking up” over time if someone isn’t on top of them daily, reviewing and correcting issues, and resubmitting them.

There several main reasons a claim is rejected. Two of the most important reasons are:
  • the office is using outdated medical codes.
  • the patients contact info doesn’t match what the insurance company has on file. With the traditional set up, there are staff members in the office that are tasked with trying to keep this information up to date, as well as trying to stay educated on all the new medical codes that get released by the government. In fact, the number of codes will be almost double what they are now by Oct 1, 2014!

Our iClaim practice management system makes these patient demographich issues are a thing of the past. Patient demographichs such as contact info andinsurance status is updated real time as our system can automatically pulls data directly from the insurance company and creates a patient chart with one click! This means that medical practices not only get up-to-date name, address, etc. but can also see immediately if the person’s insurance is current, co-pay amounts, etc.

Our iClaim system comes with the entire database of medical codes. All updates/additions/deletions are being done by our technology partners (not you) automatically! So you are always up to date and will usually know more about updated codes than the doctor and his/her staff will know!

“Why would a doctor even need to outsource if iClaim is so awesome?” Doctors and their staff have many things they must do throughout the day, removing the billing aspect allows them to focus on quality of care for patients, which is what they would rather be doing anyway.

To understand more about what is involved in denial management, visit this article. (You must sign up for free to read it)

At Vitruvian MedPro, Denial Management represents an importact aspect that is embedded within the medical billing cycle.  Denials are worked consistently to make sure that medical practices get their claims paid consistently.

Tuesday, March 12, 2013

CMS describes how sequester will be applied to Medicare payments

From our friends at AMBA:

Unless Congress acts to change the sequester, the Centers for Medicare & Medicaid Services will reduce Medicare fee-for-service payments by 2% for service/discharge dates and durable medical equipment/supply dates starting April 1, the agency announced Friday. CMS said it will apply the 2% reduction to all claims after determining coinsurance and any applicable deductible and Medicare secondary payment adjustments. Medicare payments to beneficiaries for unassigned claims also are subject to the 2% reduction, CMS said. The agency encouraged physicians, practitioners and suppliers who bill claims on an unassigned basis to inform beneficiaries of the impact of sequestration on Medicare’s reimbursement.