ARC Medical Billing

09/24/2021

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03/25/2021

Our new and improved web is officially LIVE! Come and check it out, we are so excited!😁 https://www.arcmedicalbilling.com

The client is the center of everything we do and every client is being valued individually Book Your Free Consultation Now  We help health care professionals make their billing processes as simple as we can, to tailor our services to accommodate the needs of every client so that they can get paid f...

02/06/2018

Developing a Revenue Cycle Game Plan

Revenue Cycle
The pace of change in healthcare is accelerating, and physician practices are facing new developments on all fronts. Every day, medical groups must deliver care, collect money, and pay the bills despite increasing costs, declining reimbursement, evolving regulations, and a steep rise in patient consumerism. At the same time, they need to learn about and plan for revolutionary shifts in how care is provided, reported, and paid for. Keeping up can be overwhelming to say the least.

To weather this storm of change-and even thrive within it-physician practice leaders must engage in strategic planning, which will allow them to make informed decisions about what to focus on now versus what to table until later-and how that fits within a larger vision. They need to set goals based on their organizations' strengths and weaknesses, define tactics for realizing those goals, and prioritize resources, as well as find a balance between maintaining a high degree of current performance and pursuing new opportunities that could elevate them to the next level.

This type of planning is especially important when it comes to the revenue cycle. Without a well-considered plan, this essential practice function may not perform to its full capacity. A lack of direction could yield a chaotic and reactive practice management environment where organization leaders constantly fight fires instead of taking deliberate steps to meet pre-determined goals. Ultimately, a haphazard approach can drive up costs, decrease efficiency, increase compliance risks, and cause the organization to leave crucial money on the table. Moreover, the practice may be hard pressed to take advantage of emerging opportunities, such as value-based payment models.

Although allocating time and resources toward strategic planning for the revenue cycle may seem like a luxury given a practice's other priorities, this kind of forecasting is necessary when weighing different courses of action. A plan permits healthcare executives to set goals and then model different methods for achieving them, assessing how various external forces may affect the practice. By engaging in this effort, organizations can create a roadmap for the department and ensure they are moving in the right direction, at the right time, and in the right way.

While there are many ways to approach the revenue cycle planning process, the following best practices can serve as a guide.

Build a team. A revenue cycle plan should not be crafted in a vacuum. Organizations can create a more realistic roadmap if they include representatives from a variety of stakeholder groups, including executive management, clinicians, front office staff, and billing team members. Top-level management should set clear expectations upfront and offer an overall vision for the work.

Note that if an organization is thinking about pursuing value-based reimbursement in some form, it can also be beneficial to bring in outside experts to help the practice understand its markets, the nuances of different payment models, and which ones might be a good match for the practice given its strengths and goals. There is a greater chance of success with these models if an organization has a deep understanding of what it takes to participate. As such, investing in some outside advice is wise.

Define objectives and work from there. The next step involves outlining the organization's revenue cycle objectives for the coming year. These will vary by practice, but may address topics including capturing patient payments, reducing payer denials, lowering bad debt, or setting up an infrastructure to respond to value-based payment. The agreed upon objectives should tie back to the practice's overarching strategy to ensure the coming year's revenue cycle supports the organization's direction and future vision. Each objective should have an owner, timelines for associated work, and definitions of success. These could be targets for key performance indicators (KPIs), such as time-of-service collections, percent of medical necessity denials, or accounts receivable (A/R) over 90 days.

Be mindful of the timing. A comprehensive plan encompasses three to five years, with the first year being highly detailed and the subsequent years being less specific and more directional. This will allow the practice to focus on manageable tasks and attainable goals while keeping the bigger picture in mind.

Organizations should commit to regularly reviewing the plan. Although it will serve as an initial guide, regulatory, competitive, and other outside forces will make it necessary to adjust it over time. Consequently, at least once a year, the team that created the plan should revisit it to see if any tweaks are warranted for the coming period.

Leverage technology to assess and communicate progress. As previously mentioned, all objectives should be tied to clear metrics that have stated performance targets. This will help practices appreciate what success looks like and figure out how close they are to achieving it. Technology can aid organizations in monitoring metrics by tracking and visually communicating performance in real time. For example, a practice can use a healthcare data analytics solution to craft dashboards that plainly show the plan's objectives and the metrics tied to them. These dashboards present measures front-and-center for everyone to see. Revenue cycle leaders can drill down into concerning values and uncover ways to tweak processes and training to respond to identified shortfalls.

A plan is only effective when you follow it

Organizations can have the most thorough planning process, but if there is no follow through, then they just have an impressive document that sits in a drawer. Conversely, practices that commit to operationalizing their plans, by regularly reviewing metrics, responding to identified issues, and periodically revisiting goals to keep them current, are more likely to achieve their short-term objectives while remaining agile as the industry continues to change.

Jim Denny

02/02/2018

Easy tips for physicians to reduce billing errors
By Keith Loria
Up to 80% of all medical bills contain mistakes.
This alarming figure was deduced by the Access Project, a Boston-based health care advocacy group, and is close to what many health experts have been saying in recent years. Furthermore, Kaiser Health reported that $68 billion in lost healthcare spending can be attributed to medical billing mistakes.
Mistakes result in loss of reimbursement so the practice loses revenue. Secondly, and a potentially costlier problem, is that when it comes to Medicare billing, the federal government and Office of Inspector have “zero tolerance” for any inadvertent errors, fraud or abuse. A practice can be prevented from billing Medicare or Medicaid services for years if it is found negligent.
David Womack, president and CEO of Practice Management Institute, notes the risks are not just financial, as consequences of medical billing errors can even result in harm to a patient. A failure to bill correctly may affect a patient’s treatment due to an incorrect diagnostic code that could lead to improper patient care at another practice.
“Companies offering professional certification in medical coding, third-party billing, office management and compliance are helping set a higher standard in employment by providing up-to-date education and testing that assures each applicant’s complete understanding,” he says. “The result being that physicians can focus their attention solely to patient care, translating to a better experience for the patient, all while ensuring the practice continues to be successful.”
Jim Leonard, director of healthcare business development at GRM Document Management, a records-retention and management service, says problems with billing are less an issue of errors than attempting to file a claim with unverified information.
The smaller a practice or facility, the more likely things are overlooked, resulting in unpaid or underpaid claims and a less robust financial picture,” he says. “Many specialized companies exist to manage the revenue cycle for smaller or less sophisticated healthcare organizations.”
Joseph T. Jenkins, MD, a general surgeon with FACS of Tri-State Vein Center in Dubuque, Iowa, does all of his practice’s billing in-house and says billing errors may include under-coding or over-coding for an office visit.
“We all make mistakes transposing CPT codes wrong or ICD-10 codes wrong or putting on the wrong modifier,” he says. “Those are easy to rectify. Usually the insurance company comes back letting you know you did something wrong.”
The way he has reduced errors is by using software that helps generate the note and check items within the HPI, ROS, PFSH and physical exam, keeping track of where he stands with meeting the different levels of care provided.
“I am then only responsible for selecting the appropriate Medical Decision Making,” he says. “The system will give me a Level of Service Code.”
Elvira Kasimova, billing department supervisor for the WCH Service Bureau, says the problem of billing errors is acute at both small and independent practices.
“The combination of busy doctors and undertrained staff results in inaccurate billing, requiring superbills to be returned to doctors,” she says. “Practices often fail to ascertain the correct insurance coverage and making sure that their services are determined to be medically necessary under the patient’s insurance coverage.”
An ineffective compliance plan or one that the office doesn’t adhere to is often the culprit for mistakes resulting in billing and claims problems. Practices often fail to conduct regular training about coding and billing updates and other changes.
Kasimova says another way mistakes happen is due to improper communication, such as a physician or staff member not relaying the correct information to a provider concerning things like eligibility and coverage.
Mitigating the Problem
Every practice should have a compliance plan and policy as well as someone responsible for enforcing it, Kasimova says. Either the medical director or a staff member should function as the compliance person.
“It is important that written policies and standards assist with potential risk areas like billing, marketing and claims processing,” she says. “Failing at implementing those rules leads to miscommunication between doctor and the rest of employees—especially front desk—and as a result, it increases the risk of inaccurate coding and billing or claims being submitted to federal programs or to other insurances with mistakes that can cause red flag and pre-payment/post-payment reviews/audits.”
Jenkins says that staff should have continuing education and training to maintain compliance and get updated on new coding and billing issues. Practices can also conduct periodic internal monitoring and a billing audit, which will identify problem areas of their work and where they should pay attention in the future.
Also, it wouldn’t hurt to have an impartial, third-party billing expert retained to evaluate a portion of the claims to ensure there aren’t problems among a staff member or how bills are being submitted.

01/31/2018

4 Medical Billing Issues Affecting Healthcare Revenue Cycle
Addressing these four common medical billing challenges can have a positive impact on the healthcare revenue cycle.


By Jacqueline Belliveau
Medical billing is the backbone of healthcare revenue cycle management, but many providers experience significant challenges with efficiently and accurately billing patients and payers for services they perform.

The medical billing process can be a pain point for some providers because it involves an array of healthcare stakeholders and each step to getting paid relies on the previous interaction. Healthcare organizations must communicate across departments and payers as well as ensure that crucial information is properly captured in each step of the process.
Despite the long and winding journey, effective medical billing is essential for optimizing healthcare revenue cycle management and reducing days in accounts receivable.
Here are the four most common medical billing challenges and some tips for providers about how to streamline and improve the process.
Failure to capture patient information leads to claims reimbursement delays
The medical billing process usually starts at the initial point of contact between a patient and a healthcare organization. During this interaction, front-end staff must collect patient information that will lay the foundation for billing and collecting.
“From a revenue cycle perspective, getting the most accurate information up front starts with patient scheduling and patient registration,” explained Gary Marlow, Vice President of Finance for Beverly Hospital and Addison and Gilbert Hospital in 2015. “That provides the groundwork by which claims can be billed and collected in the most efficient and effective manner possible.”
“The last thing you want is getting a claim submission kicking back to them then having to work their way through the institution. If you get the information up front in as pleasant a manner as possible, it saves heartache for the patient and family if the claim is processed and cleared in a judicious manner.”
While ensuring a patient’s demographic information is correctly put into the provider’s billing system is essential, it is also key that front-end staff also verify health insurance status and coverage.
However, a ClaimRemedi survey found that eligibility issues are the top reasons for claim rejections, and about 80 percent of claims submitted are rejected because of eligibility problems.
The survey stated that providers were not asking patients and insurance companies the right questions regarding eligibility, causing an increase in denials and rejections.
Healthcare organizations should regularly retrain front-end employees regarding patient registration and remind workers to check a patient’s eligibility for each appointment, not just the first one.
Neglecting to inform patients about financial responsibility spells collection issues
The main goal of medical billing is to collect the full amount for services rendered, but many healthcare organizations have recently experienced more issues with collecting payments from patients because of an increase in patient financial responsibility.
About 90 percent of the 12.7 million individuals participating in the 2016 open enrollment period selected a high-deductible insurance plan, according to CMS. The increase in high-deductible plans shifted healthcare payment responsibility to the consumer rather than the payer.
An Instamed report from June stated that nearly three-quarters of providers have witnessed an increase in patient financial responsibility in 2015, but a report from McKinsey & Company also found that providers only expect to collect 50 to 70 percent of a patient’s balance after a visit. Seventy percent of providers anticipate a month or longer to receive payments from patients.
To help boost patient revenue, healthcare organizations should implement financial policies that include estimating costs of services, informing patients about financial responsibility, and collecting some of the balance during a visit.
“Now with high deductibles, because many more people are forced into a situation where they owe far more money than they used to for the same services, their share has grown so significantly that a lot of providers have decided we need to try to collect this money at or near the time of service,” Mark Owen, Director of the Division of Emergency Medicine for Payor Logic, said in a 2015 interview.
“But we need to know what that amount is in order to do that. With the insured patient, we didn't really used to need to know this information about what they owed because it wasn't a significant amount and a very high proportion of the patients paid when they received their bill.”
Healthcare organizations must also take steps to simplify patient bills. The Department of Health and Human Services responded to reports that medical bills were too confusing because of medical jargon and multiple requests for payments. The federal agency developed a contest that will award several innovators for developing an easy-to-understand medical bill for patients and a simplified medical billing system for providers.
Manual claims management processes create administrative burden, more A/R days
As most healthcare organizations know, submitting a claim involves more than just pushing a button. Providers must engage robust data collection tools, develop effective communication channels between front-end and clinical staff, and streamline denials management procedures.
Claims management is complex process for the entire healthcare organization, especially as more providers transition to data-driven value-based care models.
However, one-third of providers still use a manual process for denials management, reportedHIMSS Analytics in July.
“Given the complexities around submitting claims and the labor associated with managing denials, it came as a surprise that more organizations have not automated the denial management process through a vendor-provided solution,” stated Brendan FitzGerald, HIMSS Analytics Director of Research.
Automating the medical billing and claims management process could help providers retrieve reimbursements from rejections and denials in a timelier manner. The HIMSS Analytics report stated that organizations with a vendor solution were able to better identify root causes of denials, manage resolutions, and reduce write-offs.
“There is a tremendous amount of opportunity with automation,” John Dugan, CPA, Partner at PricewaterhouseCoopers, explained in an interview. “From a claims processing perspective, there are still a number of manual processes as you go through the entire revenue cycle, which in and of itself contributes to inaccuracies. That is why there is a huge need for claims scrubbers, follow-up work, etc.”
Dugan added that automated solutions can help organizations monitor and improve on key performance indicators, such as days in accounts receivable, discharged but not final billed, and case mix performance.
Inaccurate coding remains a top medical billing error
While ICD-10 implementation went smoother than expected for most healthcare organizations, coding inaccuracies are still a significant challenge for many providers.
In July, the American Health Information Management Association (AHIMA) identified the top coding challenges, including incorrectly applying the seventh characters for trauma and fracture codes, improperly using procedure codes that drive a diagnostic related group, misidentifying respiratory failure, mistaking the use of guidance tools, and insufficiently documenting devices, components, and grafting materials.
Incorrectly or mistakenly coding a medical service will likely lead to an uptick in claims denials, so healthcare organizations should regularly train clinical staff on ICD-10 coding updates and encourage front-end staff to communicate with clinicians if there are documentation issues.
“We continue to recommend that hospitals and providers utilize more of an ongoing training program where perhaps the education occurs over two or four weeks,” Michelle Leavitt, Director of Courseware and Product Strategy at HealthcareSource told EHRIntelligence.com in 2014.
“The coders should be spending two, three, four hours a week on the education when it makes sense for them, so that they have the flexibility in their schedule to do it when it makes sense.”

01/23/2018

MEDICAL BILLING
http://blogs.law.widener.edu/healthlaw/academic-programs/Medical billing is an extremely important component of the health care industry. This article highlights some common medical billing mistakes and the types of services available to ensure the best record of care for patients and the best physician reimbursements for the services rendered.

After years and years of studying, practicing, and preparing for a future in health care, physicians and other medical care providers mark their place in the industry by providing the best cutting-edge care for their patients. These professionals face major challenges every day – from providing life-saving emergency treatment to researching complex diseases – but there is another critical component of a successful medical practice that is not the focus of the skills learned in med school: medical billing.

In today’s complex world and struggling economy, business issues in the medical industry can take precedence (sometimes even over the treatment of medical conditions) in determining the sustainability of a medical practice. One of the biggest challenges facing physicians today is not solely concerned with patient care; instead, many of today’s care providers are concerned with the business side of health care, especially concerning medical billing and coding.

Medical Billing Mistakes
It is estimated that doctors in the U.S. leave approximately $125 billion on the table each year due to poor billing practices. This is a stark reminder for physicians that providing optimal patient care is only one of the big factors in becoming a successful in the industry.

2 of the most common factors contributing to a loss in profits:

Billing errors.
It is estimated that up to 80% of medical bills contain errors. Insurance companies are very strict on correct medical billing and coding practices, and even the smallest mistake can cause an insurance company to reject a medical billing claim. This starts a long process requiring the doctor to fix the error, submit the claim a second time, and then wait (and hope) for the new claim to be accepted and processed. Medical billing errors can cause a doctor to have to wait several months or more before receiving payment for their services.
Failure to stay up-to-date on medical billing rules and regulations.
These rules are constantly changing, requiring physicians and administrators to spend time and money on continuing education, software, or staff training to stay current, having a direct effect on the cash flow and profits of a practice.
Not only are the rules and regulations concerning medical billing changing, but they are also changing for health care as a whole. Updates and major changes administered with the Health Care Reform bill have increased the number of insured Americans by more than 30 million, so proper medical billing procedures are more important than ever.

Sourcing Medical Billing
With the economy in such a delicate state, medical practitioner’s patients affected as well as their own private practices. Unemployment, along with higher co-pays and deductibles, results in patients that are unable to afford medical services. In turn, practices end up losing tons of money.

Medical practices now have to worry about insurance companies’ unique rules along with new and changing coding standards. With the burden of knowledge being so heavy, they’re losing money due to lost or ignored claims, denials, and underpayments.

Hiring a third party hold responsibility for billing services can sometimes be an effective way to increase revenue and gain control of the situation, but others feel that keeping operations in-house is the safest and most cost-effective bet.

Here are the arguments for both sides of the sourcing issue.

Outsourcing Medical Billing
Outsourcing medical billing sounds expensive upfront. However, when everything is added up, it may end up being more beneficial over time. Here’s why:

Most billing services charge on a percent-basis, meaning they will only charge a percentage of the revenue they are bringing in for your company. With this in mind, they are going to be a lot more diligent about faster collections and resubmitting claims. Your current employees don’t have time to run through denied claims. A third-party professional is dedicated to this.
Employing a staff for billing purposes can get expensive. Even to hire just one new person, a practice has to think about the costs of training, the employee’s salary, benefits, and taxes, as well as compensation for turnover. Using an outside billing service eliminates the headache of training and familiarizing a staff with your billing software, procedures, coding, etc. A billing service has already trained professionals, who only make money when you do.
The amount of time doctors and nurses spend on billing and staffing concerns can be eliminated. This freed-up time can be used to care for patients – which is what you’re goal is in the first place.
Odds are, outsourced billing companies have more billing and coding expertise, and necessary resources. Even if you are still concerned with internally handling billing, an outside service can assist in providing proper software, such as EMR (Electronic Medical Records), packaged billing, and practice management. Sometimes for an added fee, there are companies that provide appointment reminders, electronic eligibility verification, patient follow-up, coding, consulting, and data reporting. For one lump sum, you can outsource services that might have been costly to handle within your practice.
Certified billing companies are compliant with the latest health care laws, like HIPAA and the Health Care Reform bill, so your staff can rest assured that the law is being followed.

01/23/2018

https://www.billing-coding.com/detail_article.cfm?articleID=5802

Improving billing and collections department efficiency, Billing

01/10/2018

http://www.billing-coding.com/detail_article.cfm?articleID=5755

What’s the difference between a Claim Denial and Claim Rejection?, Billing

01/09/2018

With current insurance companies offering insurance with much higher deductibles, this is a "must read!"

https://revcycleintelligence.com/news/68-of-consumers-did-not-pay-patient-financial-responsibility

About two in three individuals failed to fully pay their patient financial responsibility to hospitals in 2016, a study uncovered.

01/08/2018

https://revcycleintelligence.com/news/healthcare-rcm-medicare-reimbursement-dominate-2017-stories

The most clicked stories from 2017 covered a range of topics on healthcare revenue cycle management and Medicare reimbursement basics and strategies.

12/18/2017

Things to look for in a Medical Billing Company

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Medical billing is a very important part of a practice. We are not here to tell you that anyone can do it. All ASC’s, surgeons, and physicians must choose this person or company carefully because your practice depends on it.
FACT: A Medical Billing company can make or break an offices income.
Before you can choose a billing person you need to decide what your needs are. Do you prefer to outsource or have an in office Medical Biller? If you have never outsourced your medical billing then consider speaking to other physicians and ask about their experiences.
7 Things to look for in a Medical Billing Company
1. Ask about how they work to streamline the billing process with other physicians and how the coding works. --While coding ultimately should be the responsibility of the physician, a good medical billing company should be knowledgeable about coding issues and be able to spot possible errors, and advise on the best practices.
2. Ask questions like, How will you follow up on claims? What type of appeal system do you have in place? --The medical billing company should know that the follow up is a very important task and that appeals must be done. Keep in mind that not all medical billing companies do appeals or the follow up on appeals.
3. If they are going to put all of your information into the software they are using, ask what type of reports you will receive for your practice? How frequently (Monthly, quarterly, annually, etc.)? Are they flexible on how often you need your reports? --Some medical billing companies post accounts receivable/payable by department, some have account representatives.

4. Find out if they are they up-to-date on their coding books for the current year or what kind of coding software do they use? --If your Medical Biller is using out of date books or software, they may not be able to best advise Doctors on recent code changes which may be more discriptive.
5. What are their collection practices and procedures? --For example; Ask do they provide soft collections? Do they alert you and take action on accounts needing extra attention? Finally, ask how they will inform you of problems with claims or requested information by the carrier.
6. What are their hours of operation and can they return your call within 24 hours. --Not all companies have set office hours and are available to return your call within a timely manner.
7. What are their fees? --If it is based on a percent, will it be on total charges billed or what you are actually paid? Do they have a startup fee and is this a one time fee? Is their agreement with you based on a month to month or long term?