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 info@vitruvianmedpro.com to schedule a free practice analysis so that we can help you determine whether outsource medical billing makes sense for your practice.

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. http://www.cms.gov/Medicare/Coding/ICD10/ICD-10ImplementationTimelines.html 

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 www.cms.gov.

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 >> http://www.amednews.com/article/20130225/profession/130229986/5/

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.

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.

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.