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Inhouse Medical Billing Vs Outsourcing

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Inhouse Medical Billing Vs Outsourcing

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Inhouse Medical Billing Vs Outsourcing

Isn’t Medical billing one of the most time and effort consuming task, exhausting your resources, compelling you into performing frustrating tasks and diverting your attention from your main purpose i.e., patient’s wellbeing. More so because you need to focus on your practice, for smooth operations you need:

  • An accountant taking care of your financials,
  • A lawyer or team of lawyers keeping you up with the legal implications of the healthcare industry laws,
  • An industrial expert keeping you up to date with all the ever-changing medical billing procedures,
  • An IT technician keeping your infrastructure in topnotch working condition (laptops etc)
  • An assistant entering all the patient’s data/demographics as well as updating and completing required incomplete insurance information, required to submit patients billables/claims,
  • An expert who can communicate with the insurance and help you fix the denials and reduce AR days – on the same page with you regarding their requirements.

You get the idea? Think about the expenses this will incur on your practice. More so ever wondered why your denial rate doesn’t decrease or why a huge chunk of your revenue gets stuck and lost in the whole reimbursement process?

Opting for Outsourcing your Medical Billing Process enables:

AltuMED along with providing a real time, integrated and data driven solution to all your medical billing needs, works on improving your practice by helping you focus on care quality and the one thing that matters most — making patients healthier.  We are HIPPA Compliant and a certified MIPS registry. Our expert makes your practice growth their priority by working with you in building your brand score, training and coaching you regarding your service gaps and advising you on practicing quality service. We understand the current health care codes and standards and are here to assist your practice accordingly.AltuMED strives with keeping you in compliance!

Fast Revenue Recovery:

On average, a dedicated billing company will send claims more thoroughly, reliably, and quickly than an in-house billing team. This means a higher percentage will be paid at a higher amount.

Easy and Efficient Recordkeeping:

Another significant and concrete benefit to outsourcing is the ease of record keeping and filing. Many practices experience difficulties when it comes to organizing all of their files, whether it is financial records or requisition forms. Throw more complex things like file digitization in, and you can start to have more serious problems.

Reduced Office Operational and Management Costs:

Another general benefit that can expect you when you outsource is that your office management becomes much easier. With outsourced medical billing, you reap the following benefits:

  • Fewer people need to be accounted for
  • Less payroll data has to be process
  • Less space and technology has to be taken care of
  • Few individual personalities need to be accounted for during interdepartmental proceedings

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How to reduce denials

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How To Reduce Denials

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What percentage of your claims are denied yearly? How do you cater to the revenue losses? Are you too always looking for improvements that can minimize claim denials, boosting up your RCM process and reducing AR days?

In an analysis conducted in 2019 by CMS 18% of in-network claims were denied by issuers, with denial rates for specific issuers varying significantly around this average, from less than 1% to more than 40%. It was also found that appeal for denied claims is rarely made, and when it is, issuers typically uphold their original decision. MGMA states 25% of all claims not paid are never followed up on. This problematic picture results in heavy revenue plunges and thus negatively impacts the RCM process.

Patient Claims are usually denied due to number of causes:

1.     Coordination of Benefit Issues (COB)

2.     Incomplete or No Patient Insurance Validation

3.     Incomplete or incompatible diagnosis coding

4.     Upcoding or mis-coding of procedures

5.     Mis-Management of Multiple Claims

Practices are often dedicated to minimizing lost reimbursements and denials. AltuMED ensures as well as validates the insurance eligibility details of a patient from the time they request your service. Our employees verify patient insurance details as well as pre-validate whether the required treatment will be covered by their insurance or not. More so AltuMED software comes with pre-fed ICDs and CTPs assisting physicians fast and error free data entry regarding the diagnosis as well as the procedures performed.

Denials can be avoided:·        

  • Eligibility check before claims submission·        
  • Prior authorization before claim submission·        
  • Proper collection of co-pay and calculation
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Here are five steps to lower your denial rate and implement proactive strategies to ensure smooth cash flow.

1. Know your current denial rate. To calculate your current denial rate, add the total dollar amount of claims denied by payers within a given period, and divide that amount by the total dollar amount of claims submitted within the given period. For example, look at a three-month period. If your total dollar amount of claims denied within this period is $10,000—and your total dollar amount of claims submitted is $100,000—then your denial rate is 10%.Calculate your denial rate according to payer, reason for denial, provider, specialty, and location (if your practice includes more than one location).

2. Identify the major reasons for your denials. These reasons will vary by specialty and by practice. Start by compiling your claim adjustment reason codes. Though these codes may be somewhat cryptic as well as inconsistent across payers, they at least provide a foundation on which you can build a denial management strategy. Map these codes to more actionable descriptors so you can dig into your data at a more granular level and identify the root cause of the problem.

For example, consider categorizing denials according to these common reasons:

  • Claim not submitted within timely filing guidelines·        
  • Demographic errors (e.g., wrong spelling of the patient’s name or wrong date of birth)·        
  • Duplicate claim·        
  • Eligibility expired·        
  • Global charges were billed when only the professional or technical component should have been billed·        
  • Incorrect insurer address·        
  • Incorrect modifier·        

  • Invalid procedure and/or diagnosis code·
  • Lack of medical necessity·
  • No referral/authorization·
  • No supporting documentation·
  • Payer requires additional information from the patient·
  • Provider not permitted to see the patient under the plan·
  • Service not covered·
  • Wrong insurer billed

3. Hire a revenue cycle manager or certified medical coder. This individual can help track denials and improve your chances of submitting error-free claims. More specifically, he or she can:·        

  • Serve as a resource to clarify code combinations, definitions of modifiers, documentation requirements, and more·        
  • Validate codes that the physician chooses in the EHR·        
  • Note discrepancies between procedures documented and supplies ordered but not billed·        
  • Find missed charges based on progress note documentation.

4. Create a multi-disciplinary denial team. Be sure to include the practice manager, a representative from registration, a coder and/or biller, and at least one physician who is willing to serve as a champion of the denial management effort. Team goals should include the following:·        

  • Collect data regarding denials. How are denials identified? Verify your ability to extract this data from your practice management system, or secure a bolt-on denial reporting product.      
  • Review data to identify trends. Can the practice use automation to route denied claims directly to specific work lists? For example, route all coding-related denials directly to the coder·        
  • Create a standardized workflow for denials. This should include a step-by-step action plan for each type of denial. Who will handle each type of denial, and how?

5. Focus on staff education. Many practices benefit from staff education on the following topics:·        

  • Accurate data entry. Collecting accurate and complete demographic and insurance information on the front-end is critical. One of the most common denials occurs when a patient’s health insurance expires and either the patient or the practice (or both) are unaware. In other cases, practices may check eligibility when an appointment is made, but coverage is dropped before the actual visit occurs. Real-time eligibility tools that provide information about coverage, deductibles, copayments, and contractual fees for specific services and procedures are helpful.      
  • Policies and procedures for insurance coverage and eligibility (e.g., payer-specific requirements regarding appropriate ICD-10 codes to use with certain CPT/HCPCS codes). Consider designating one person to receive and review all newsletters and updates from payers. This person can then disseminate important information to the rest of the team.       
  • Documentation requirements for ICD-10 specificity. Depending on your specialty, ICD-10 codes may require more specific documentation regarding laterality, anatomical location, and more.
  • Frequency/global rules for specific procedures. This should include a discussion of modifier usage.
  • Advanced Beneficiary Notices. Education should include how to fill out forms properly and what patients need to know at the time of service.  
  • Understanding your denials helps shed light on specific areas for improvement. By identifying these areas, your practice can take proactive steps to improve processes and mitigate risk going forward.

If you are looking for ways to improve you medical billing contact AltuMED – A Smart RCM Specialist.

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Stay Compliant, Stay Ahead

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Stay Compliant, Stay Ahead

Compliance is a dangerous word that can restrict your revenue inflows if not taken seriously. Healthcare compliance regulations are ever changing and therefore demands a thorough command on the requirements by being prepared and forward. AltuMED is well versed with the healthcare RCM industry and is familiar with the way the CMS operates, our team of experts know just what to keep in check, to stay relevant and well informed regarding the change in the healthcare regulations.

Serving the RCM industry from last 10 years has given us expert know-how on what a practice requires to take off in terms of business and how to stay competitive without being side tracked by such obligations.

Quality Service is The Key

AltuMED along with providing a real time, integrated and data driven solution to all your medical billing needs, works on improving your practice by helping you focus on care quality and the one thing that matters most — making patients healthier.  We are HIPPA Compliant and a certified MIPS registry. Our expert makes your practice growth their priority by working with you in building your brand score, training and coaching you regarding your service gaps and advising you on practicing quality service. We understand the current health care codes and standards and are here to assist your practice accordingly.AltuMED strives with keeping you in compliance!

AltuMED believes in evolving with the industry taking on a proactive approach towards the upcoming changes in healthcare standards. AltuMED aims to improve on your reimbursements and mitigate penalties. With AltuMED

Master the Quality Service Practice:

AltuMED’s portfolio of solutions are all formed keeping the regulatory requirements in check so that your practice can grow without any complexity

Prioritize your Patients:

AltuMED takes care of all your financial, operational and administrative tasks leaving you to focus on your Patients

Maximize on Revenue inflows:

AltuMED keeps you well informed regarding the changing CMS regulations, making sure that you stay in compliance and no cases are lost due to any such discrepancy.