The path from deciding to outsource medical billing to selecting your medical billing service requires a well planned selection strategy. A major component of this strategy is developed and executed reference checks. There are many critical components to consider when selecting a medical billing company. Reference checking is one of the most important stops along the road. There are several steps that must be taken to ensure through reference checking. This article is designed to hel... Read more...

Excellent medical billing is about the workflow and process of organizing paperwork efficiently. The recent introduction of the HITECH Act and new web-based software has become vital in increasing the number of claims that can be processed and the accuracy of claim data. The past 20 years has brought amazing advances in technology and it is likely that we are merely at the beginning stages of change. Medical billing is one of the industries that h... Read more...

The fundamental principal behind outsourcing is the focus on core competencies. The idea is that you and your practice are geared towards treating patients, not fighting insurance companies and pursuing personal balances. On the other hand, medical billing services focus on medical billing and should have the scale, focus and employees to do a better job than most medical practices or medical facilities. The primary benefits that... Read more...

In a previous entry we outlined the key benefits one should see from a strong medical billing service company. We also outlined the most frequent concerns that can stall the decision to outsource medical billing. In today's entry I will be talking about the first benefit I mentioned - Scale. By scale I mean that the medical billing company should have tens and hundreds of providers across whom large, necessary investments can be spread. If a $150,000 per year billing system admini... Read more...

 Softwareadvice.com recently had an article titled “Should You Outsource Your Medical Billing.” There is a follow up article on selecting a medical billing service which we wanted to highlight.   The first article compared outsourcing the medical billing process in-house versus outsourcing it to a medical billing company.  If you are l... Read more...

Medical billing specialists and insurance companies work hand in hand. The bill or claim begins when a patient visit his or her physician. Office staff create a chart on said patient. This chart includes the demographics of the patients. In addition to this there is also the patients physical/ medical information. All medical procedures, treatments and diagnoses are listed in this chart making it a highly private piece of information. After the patient finishes with the visit, the phys... Read more...

Congress is considering proposals that would reform the health care system.  Some, like Senator Bernie Sanders of Vermont are citing massive fraud by the health care industry and calling on “real health care reform to prevent major insurance companies, drug companies and hospital chains from perpetrating fraud and abuse on government health care programs and individuals.”  Sanders claims that this abuse is driving up health care costs in American by billions of dollars each year. ... Read more...

Modifiers are codes that are used to “ENHANCE OR ALTER THE DESCRIPTION OF A SERVICE OR SUPPLY” UNDER CERTAIN CIRCUMSTANCES. A modifier provides the means by which the reporting physician can indicate that a service or procedure that has been performed has been altered by some specific circumstance but has not changed in its definition or code. The judicious application of modifiers obviates the necessity for separate procedure listings that may describe the ... Read more...

By: Brian Lapidus, Senior Vice President of Kroll Fraud Solutions, www.krollfraudsolutions.comGuest Blogger on Healthcare Blogmatica The fact of the matter is that patients – and the law – demand that healthcare companies protect highly sensitive information from every possible thre... Read more...

Medical records services include transcribing, inputting, and managing information for patient records. This service can vary from simple dictation transcription to coding and billing insurance companies. Some medical records services include the equipment needed for dictation and others require the physician to purchase the equipment separately. Some service providers offer more comprehensive services than others. Some will contact var... Read more...

 Each state has passed a Clean Claim Law. The level of benefit these laws provide to medical practices and facilities starts on the low end with states such as South Dakota that provide little more than a slap on the insurance company's wrist to states such as Texas which levy substantial financial penalties on tardy payers. The basic idea of the law is that a payer has to respond to a clean claim within a set time (usually around 30 days for electronic claims). In order to utilize the clean... Read more...

As a physician, you want to concentrate on providing the best high-quality medical care possible to your patients while, at the same time, ensuring that your practice thrives as a business. Many tools are available to help you do just this. Medical and insurance billing companies, medical management software, medical records management services, and other medical practice management aids are available to free you to focus on the practice of medicine.... Read more...

The word "outsourcing" has become a dirty word some doctors due to experiences with some at home medical billers. Some of our doctors reported to use that before outsourcing to WorkSmart MD Billing they had reservations.Don't let a bad experience keep you from partnering with a legitimate medical billing company that can not only help you get your reimbursements faster but also realize gre... Read more...

There are many items that are confusing in the world of medical billing. One of the most confusing areas is medical billing allowables. There are not many businesses where a bill is sent out for much more than one would expect to collect. In most business if you bill $50 then you expect to collect $50. In the medical billing business a bill of $100 is often sent out with the expectation that only $50, $30 or even less will be collected.This is primarily done for four reasons: ... Read more...

So... in Texas, a Bastrop physician and an Austin doctor were among the over 60 physicians that were disciplined by the Texas Medical Board.  Why were they disciplined you ask?The Internalist that was disciplined, Dr. Rajeev Gupta, was disciplined because five patients were improperly billed and the radiology equipment was operated by a staff member that was unlicensed. Dr. Gupta was fined $1000 and required to take a course... Read more...

In today’s ModernHealthcare.com there’s an article on EMR Usablity and CCHIT Evaluation.  The main point is simple, make the user friendly aspect of an EMR part of the certification process.   I am in total agreement, most EMR may pass the “mechanical” aspects of interoperability but are hard to... Read more...

Don't  even crack your codebook unless you have done the following three things:  Number 1 - Make sure that your ICD-9 codes book is from the current billing year. New codes are issued on October 1st of every year. Make that your Medical Billing New Years and put up the previous year's code book to ensure that you don't make a mistake and code from the incorrect set of codes.Number 2 - State by reviewing the diagnostic statements and make yourself a side list choosing the conditions you need... Read more...

We are often asked - what does it take to be an excellent medical biller or coder?Medical billing and coding specialists process insurance claims to insurance companies so that physicians and practice managers can receive payment for their services. Medical Billing and coding specialists work in claims processing departments or billing departments in hospitals, clinics, doctor’s or dentist’s offices, or nursing home fa... Read more...