The health care industry is always on the lookout for well-trained administrators who have attended medical billing schools. People who are formally trained to provide professional medical billing services are especially prized by hospitals, clinics and private practices; and practically anyone can learn this specialized skill.
Physicians, patients, hospital administrators, and insurance companies all rely on billing specialists to keep accurate records of medical procedures and charges. So, what does it take to learn medical billing? Of course, it can be helpful to have a background in office administration, accounting, health care, or other related field; but there are no firm prerequisites to learning to be a medical billing specialist. If you are a high school graduate, you already have one foot in the door.
You might choose to take a short course to become certified in a matter of weeks. You will learn about various medical terminology and procedures, and how to interpret the specific numeric codes assigned to everything that occurs during the patient's visit. You will develop skills in communication to help discuss claims with HMOs and insurance companies, as well as to understand patient and physician requests for your assistance.
Although billing and coding are focused on just one area of medical office administration, you can definitely expect to broaden your employment horizon with a certificate in the field. However, if you really want to open the doors to a better future, you might want to delve further into the field by seeking a degree in medical office administration. Not only will you learn about medical billing and coding, you can become a valuable part of a health care team by learning to run an efficient practice and how to take the administrative burden off busy doctors, nurses, technicians and surgeons.
With the call for extended medical care increasing each day, there is also a growing need for experts in office administration, and you can quickly get in on the trend. Learning medical billing might be the beginning of a whole new career for you! Why not find a good class and start today?
DISCLAIMER: Above is a GENERAL OVERVIEW and may or may not reflect specific practices, courses and/or services associated with ANY ONE particular school(s) that is or is not advertised on SchoolsGalore.com.
Copyright 2008 - All rights reserved by Media Positive Communications, Inc.
Notice: Publishers are free to use this article on an ezine or website, provided the article is reprinted in its entirety, including copyright and disclaimer, and ALL links remain intact and active.
We invite you to visit SchoolsGalore.com where you can find good medical billing schools in your area today.
Article Source: http://EzineArticles.com/?expert=Michael_Bustamante
Friday, November 7, 2008
Details Needed For Medical Billing
Who handles the medical billing process in any health care environment? Well, it may be handled either directly by the doctor or by his staff or by a third party professional medical billing company if it is for a bigger clinic or hospital. Medical billing is a specialized profession today and billing could be a team work process that can involve the following people.
* Office manager
* Nurse
* Receptionist
* Medical assistant
* Insurance clerk
* Medical coders
The medical claim process begins with proper identification and medical coding as all medical procedures and diagnoses have been assigned with codes. The Current Procedural Terminology (CPT) was developed in the year 1966 by (AMA) American Medical Association and it lists medical procedures and corresponding codes. Each medical procedure has a unique code that is listed in a CPT manual. What are the types of details that are required during the medical billing process? They include,
* Name, address, telephone number, and ID number of provider
* Name of insurance company / group
* ID number of insurance holder
* Patient's name, date of birth/address/phone no
* Insured person's name, date of birth/address/phone
* Relationship between patient and insured person
* Details of provider name, address, telephone number, and ID number
* Details of other health insurances
* Patient's medical history /condition
* Details whether the medical condition is related to accident etc
A document called the explanation of benefits (EOB) often may accompany the payment that is received from the insurance or managed care company. This document describes all the details of services covered and not covered. It also mentions all the bills that have been sent to the service provider and the patient. One can also know if the patient has missed out on his annual payments/deductibles to the insurance company making him ineligible for total claim.
Article Source: http://EzineArticles.com/?expert=Ricci_Mathew
* Office manager
* Nurse
* Receptionist
* Medical assistant
* Insurance clerk
* Medical coders
The medical claim process begins with proper identification and medical coding as all medical procedures and diagnoses have been assigned with codes. The Current Procedural Terminology (CPT) was developed in the year 1966 by (AMA) American Medical Association and it lists medical procedures and corresponding codes. Each medical procedure has a unique code that is listed in a CPT manual. What are the types of details that are required during the medical billing process? They include,
* Name, address, telephone number, and ID number of provider
* Name of insurance company / group
* ID number of insurance holder
* Patient's name, date of birth/address/phone no
* Insured person's name, date of birth/address/phone
* Relationship between patient and insured person
* Details of provider name, address, telephone number, and ID number
* Details of other health insurances
* Patient's medical history /condition
* Details whether the medical condition is related to accident etc
A document called the explanation of benefits (EOB) often may accompany the payment that is received from the insurance or managed care company. This document describes all the details of services covered and not covered. It also mentions all the bills that have been sent to the service provider and the patient. One can also know if the patient has missed out on his annual payments/deductibles to the insurance company making him ineligible for total claim.
Article Source: http://EzineArticles.com/?expert=Ricci_Mathew
Tuesday, November 4, 2008
Medical Billing Rules
What is the main purpose of medical billing? Well it is just to make sure that the service provider receives a fair payment for services provided and also so that the payment is received in time. The medical billing procedures are governed by certain laws. What are the main laws that govern medical billing? They include the following 3 laws;
# Fair debt Collection Act
# The Health Insurance Portability and Accountability Act
# The Privacy Rule
The Fair debt collection Act is a federal law that dictates how and when a debt is to be collected.
This act is for the protection of all the patients and other consumers from unlawful threats.
The Health Insurance Portability and Accountability Act of 1996, better known as the HIPAA, was enacted by the U.S. Congress in 1996. It has two titles.
Title I of HIPAA regulates the availability, breadth of group and individual health insurance plans. It amends both the Employee Retirement Income Security Act and the Public Health Service Act. This act also prohibits any group health plan from creating eligibility rules or deciding of insurance premiums for individuals in the plan based on health status, medical history, genetic information, or disability. Thus Title I also protects health insurance of workers and their families if they have to change jobs.
The second title of HIPAA contains a portion that increases the efficiency of data exchange for healthcare financial transactions and protects the privacy of electronic data transmission and the confidentiality of patient records. All medical providers are asked to send their claims electronically in compliance with the act to receive their payment. This includes electronic transmission of major financial and administrative dealings, including billing, electronic claims processing and reimbursement advice. Various offenses relating to health care are set and criminal penalties imposed. Besides creating several programs to control fraud and abuse within the health care system it imposes penalties when rules are violated.
The privacy rule regulates the use and disclosure of Protected Health Information (PHI). PHI is any information about health status, provision of health care, or payment for health care that can be linked to an individual. Any person who believes that the Privacy Rule is not being upheld can file a complaint with the Department of Health and Human Services Office for Civil Rights.
Article Source: http://EzineArticles.com/?expert=Ricci_Mathew
# Fair debt Collection Act
# The Health Insurance Portability and Accountability Act
# The Privacy Rule
The Fair debt collection Act is a federal law that dictates how and when a debt is to be collected.
This act is for the protection of all the patients and other consumers from unlawful threats.
The Health Insurance Portability and Accountability Act of 1996, better known as the HIPAA, was enacted by the U.S. Congress in 1996. It has two titles.
Title I of HIPAA regulates the availability, breadth of group and individual health insurance plans. It amends both the Employee Retirement Income Security Act and the Public Health Service Act. This act also prohibits any group health plan from creating eligibility rules or deciding of insurance premiums for individuals in the plan based on health status, medical history, genetic information, or disability. Thus Title I also protects health insurance of workers and their families if they have to change jobs.
The second title of HIPAA contains a portion that increases the efficiency of data exchange for healthcare financial transactions and protects the privacy of electronic data transmission and the confidentiality of patient records. All medical providers are asked to send their claims electronically in compliance with the act to receive their payment. This includes electronic transmission of major financial and administrative dealings, including billing, electronic claims processing and reimbursement advice. Various offenses relating to health care are set and criminal penalties imposed. Besides creating several programs to control fraud and abuse within the health care system it imposes penalties when rules are violated.
The privacy rule regulates the use and disclosure of Protected Health Information (PHI). PHI is any information about health status, provision of health care, or payment for health care that can be linked to an individual. Any person who believes that the Privacy Rule is not being upheld can file a complaint with the Department of Health and Human Services Office for Civil Rights.
Article Source: http://EzineArticles.com/?expert=Ricci_Mathew
Medical Billing And The PPO Plan
Medical billing is the process of collecting fees for medical services. A medical bill is also called as a claim that has to be collected from the insurance company. There are different types of insurance plans. What is the PPO plan? PPO is a term used in health insurance that stands for Preferred Provider Organizations. It is a managed care organization of medical doctors, hospitals, and other health care providers who are associated with an insurer agent/administrator's clients to provide health care at reduced rates. It is today one of the most preferred kind of health care plan in the country. A preferred provider organization is sometimes also referred to as a participating provider organization.
More than 50% of the insured population in the US have chosen to go for the PPO plan. Its popularity is mainly because of the fact that in this system, doctors / hospitals have made an agreement with the insurance companies to offer discounted fees to the company's members.
The primary advantages of going for the PPO insurance plan are,
# Its not mandatory to maintain a primary care physician
# Can directly see a specialist without referral
# Freedom to choose own doctor / hospital
The main advantage of going for a PPO plan is that one can choose a health service provider from outside the provider list Another less popular system is called an (EPO) exclusive provider organization (EPO), wherein if you seek care from a non-preferred provider there is no coverage at all. One must remember that with freedom to choose will always mean more expensive medical bills.
There are many types of PPO plans and the actual benefits depend on different factors like,
# Monthly premium amount
# The amount of coinsurance obliged to pay,
# Whether treatment from the network/ outside
# Annual deductible amount
What are the other features of a preferred provider organization? They generally include services of review of the patient records by the company representatives to ensure that there is no foul play. In the case of non-emergency admissions, an approval is taken from the insurer in advance.
Article Source: http://EzineArticles.com/?expert=Ricci_Mathew
More than 50% of the insured population in the US have chosen to go for the PPO plan. Its popularity is mainly because of the fact that in this system, doctors / hospitals have made an agreement with the insurance companies to offer discounted fees to the company's members.
The primary advantages of going for the PPO insurance plan are,
# Its not mandatory to maintain a primary care physician
# Can directly see a specialist without referral
# Freedom to choose own doctor / hospital
The main advantage of going for a PPO plan is that one can choose a health service provider from outside the provider list Another less popular system is called an (EPO) exclusive provider organization (EPO), wherein if you seek care from a non-preferred provider there is no coverage at all. One must remember that with freedom to choose will always mean more expensive medical bills.
There are many types of PPO plans and the actual benefits depend on different factors like,
# Monthly premium amount
# The amount of coinsurance obliged to pay,
# Whether treatment from the network/ outside
# Annual deductible amount
What are the other features of a preferred provider organization? They generally include services of review of the patient records by the company representatives to ensure that there is no foul play. In the case of non-emergency admissions, an approval is taken from the insurer in advance.
Article Source: http://EzineArticles.com/?expert=Ricci_Mathew
Friday, October 31, 2008
Texas Medical Billing - Use The Clean Claim Law
Texas has one of the most helpful and powerful clean claim laws in the United States. The penalties for a clean claim violation can go all the way up to the payer being required to pay billed charges; that's right billed charges. The basic idea of the law is that a payer has to respond to a clean claim within 30 days (45 days if it is not submitted electronically). In order to utilize the clean claim law effectively you must have a tracking system built into your medical billing process that flags:
1. Which payers are subject to the clean a claim law (not all are),
2. When a claim was submitted,
3. When a request fro information was received from the payer (if you receive one then it stops the 30 day clock until you respond),
4. When your office responded to the information request (this starts the 30 day clock again), and
5. When you received a payment or denial.
The design and implementation of the system and reporting can challenging, but it will pay huge dividends in terms of the penalties from payers and in the way in which you will make payers take notice of your claims next time. At ClaimCare Medical Billing Services we have used our clean claim tracking system extensively and have seen significant rewards for our clients. We have actually received calls from managers at some of our payers that have assured us they would process our claims quickly and asked if we would please stop submitting complaints.
A quick way to get started with using the clean claim law is to pick a specific payer that you believe habitually delays claims beyond 30 days. Find a handful of claims that have gone past 30 days and then test the water with those claims. This will allow you to learn the basics of using the on-line tool provided for submitting complaints and see the impact of your initial complaints.
Article Directory: http://www.articledashboard.com
1. Which payers are subject to the clean a claim law (not all are),
2. When a claim was submitted,
3. When a request fro information was received from the payer (if you receive one then it stops the 30 day clock until you respond),
4. When your office responded to the information request (this starts the 30 day clock again), and
5. When you received a payment or denial.
The design and implementation of the system and reporting can challenging, but it will pay huge dividends in terms of the penalties from payers and in the way in which you will make payers take notice of your claims next time. At ClaimCare Medical Billing Services we have used our clean claim tracking system extensively and have seen significant rewards for our clients. We have actually received calls from managers at some of our payers that have assured us they would process our claims quickly and asked if we would please stop submitting complaints.
A quick way to get started with using the clean claim law is to pick a specific payer that you believe habitually delays claims beyond 30 days. Find a handful of claims that have gone past 30 days and then test the water with those claims. This will allow you to learn the basics of using the on-line tool provided for submitting complaints and see the impact of your initial complaints.
Article Directory: http://www.articledashboard.com
3 Benefits Of Web-based Electronic Medical Billing Software
When you decide to opt for Web-based medical billing software you will find many great benefits. These include but are not limited to, reduced install and maintenance costs, security from natural disasters, anytime access.
Anytime Access
A major benefit of a Web-based medical billing solution is that you can access the information anytime. Whether you are at home, or in the office, you only need an Internet connection and you will be able to access all the information you need. Late at night or early in the morning or during the day you will be able to access the information for your practice.
Reduced Install and Maintenance costs
Another benefit of the software being Web-based is that there are much lower installation costs. You will see this benefit right up front as it will be the first step that you go through. Another benefit is the reduced maintenance cost. Many server based technologies need to be upgraded and constantly monitored. This can sometimes lead to unexpected costs to help maintain your current system. With Web-based technologies these maintenance costs are much, much, much lower.
Accidents unfortunately happen
As much as we like to think that accidents never happen to us, there is a chance that they just may. Many people use insurance to cover them incase of these major accidents. But many people do not think about what is going to happen to their information in an accident. With Web-based electronic medical billing software there is greater satisfaction in knowing that if an accident where to go through a horrific accident, you would be not lose all of your records. If there were a fire, earthquake, flood and your servers were hit, you would lose all of your client information. But if you had a Web-based software solution, even though your office may be damaged, your records wouldn’t be. You would be able to be up and running in almost no time.
So when deciding between Web-based and server side software remember these major benefits of Web-based medical billing software.
Article Directory: http://www.articledashboard.com
Anytime Access
A major benefit of a Web-based medical billing solution is that you can access the information anytime. Whether you are at home, or in the office, you only need an Internet connection and you will be able to access all the information you need. Late at night or early in the morning or during the day you will be able to access the information for your practice.
Reduced Install and Maintenance costs
Another benefit of the software being Web-based is that there are much lower installation costs. You will see this benefit right up front as it will be the first step that you go through. Another benefit is the reduced maintenance cost. Many server based technologies need to be upgraded and constantly monitored. This can sometimes lead to unexpected costs to help maintain your current system. With Web-based technologies these maintenance costs are much, much, much lower.
Accidents unfortunately happen
As much as we like to think that accidents never happen to us, there is a chance that they just may. Many people use insurance to cover them incase of these major accidents. But many people do not think about what is going to happen to their information in an accident. With Web-based electronic medical billing software there is greater satisfaction in knowing that if an accident where to go through a horrific accident, you would be not lose all of your records. If there were a fire, earthquake, flood and your servers were hit, you would lose all of your client information. But if you had a Web-based software solution, even though your office may be damaged, your records wouldn’t be. You would be able to be up and running in almost no time.
So when deciding between Web-based and server side software remember these major benefits of Web-based medical billing software.
Article Directory: http://www.articledashboard.com
Medical Billing And Coding Online Schools
Online Medical Billing and Coding Specialist Schools teach courses that focus on the administration of Medical Billing and Coding for purposes of proper categorization of medical procedures and accurate billing processes. Students of Medical Billing and Coding will be prepared with those skills essential for Medical Billing and Coding processes and for Certified Medical Coding and Billing Specialist examinations for certification.
Online Medical Billing and Coding Specialist Schools train students specifically in the universal language that was developed for the purpose of streamlining medical insurance claims that ensure correct reimbursement from insurance companies for services rendered. Every symptom, diagnosis, procedure, and treatment has been assigned a numeric code that informs the insurance company which services were administered in a hospital, a doctor's office, a clinic, or other medical facility. This numeric language is used by Medical Billing and Coding Specialists to establish the exact services provided. The Medical Billing and Coding Specialist determines these codes and makes a selection based on information provided by the care provider, then processes the claim.
Online Medical Billing and Coding students can expect to study medical terminology, anatomy and physiology, reimbursement methods, law and ethics that apply to medicine, information management, and practices of various office environments.
Additionally, courses in Medical Billing and Coding will prepare students with professional skills that will allow for management of records, preparation of insurance forms, correct filing of claims, and for billing insurance companies for services rendered.
Responsibilities of a Medical Billing and Coding Specialist involve the accurate completion of billing and medical claim forms, appropriate billing, and good understanding of individual insurance company policies and procedures. Medical Billing and Coding Specialists can expect to work for hospitals, medical practitioners, medical clinics, and physical therapists, where efficient and well-prepared Medical Billing and Coding Specialists will manage billing and coding processes.
If you are interested in learning more about Online Medical Billing and Coding Schools please search our site for more in-depth information and resources.
DISCLAIMER: Above is a GENERAL OVERVIEW and may or may not reflect specific practices, courses and/or services associated with ANY ONE particular school(s) that is or is not advertised on our website.
Copyright 2007 - All Rights Reserved in association with Media Positive Communications, Inc.
Article Directory: http://www.articledashboard.com
Online Medical Billing and Coding Specialist Schools train students specifically in the universal language that was developed for the purpose of streamlining medical insurance claims that ensure correct reimbursement from insurance companies for services rendered. Every symptom, diagnosis, procedure, and treatment has been assigned a numeric code that informs the insurance company which services were administered in a hospital, a doctor's office, a clinic, or other medical facility. This numeric language is used by Medical Billing and Coding Specialists to establish the exact services provided. The Medical Billing and Coding Specialist determines these codes and makes a selection based on information provided by the care provider, then processes the claim.
Online Medical Billing and Coding students can expect to study medical terminology, anatomy and physiology, reimbursement methods, law and ethics that apply to medicine, information management, and practices of various office environments.
Additionally, courses in Medical Billing and Coding will prepare students with professional skills that will allow for management of records, preparation of insurance forms, correct filing of claims, and for billing insurance companies for services rendered.
Responsibilities of a Medical Billing and Coding Specialist involve the accurate completion of billing and medical claim forms, appropriate billing, and good understanding of individual insurance company policies and procedures. Medical Billing and Coding Specialists can expect to work for hospitals, medical practitioners, medical clinics, and physical therapists, where efficient and well-prepared Medical Billing and Coding Specialists will manage billing and coding processes.
If you are interested in learning more about Online Medical Billing and Coding Schools please search our site for more in-depth information and resources.
DISCLAIMER: Above is a GENERAL OVERVIEW and may or may not reflect specific practices, courses and/or services associated with ANY ONE particular school(s) that is or is not advertised on our website.
Copyright 2007 - All Rights Reserved in association with Media Positive Communications, Inc.
Article Directory: http://www.articledashboard.com
Tuesday, October 21, 2008
Got Stomach Flab? Quickly Remove Stomach Flab With This Powerful Dieting Solution
Alright guys, today in this article, we're going to talk about how you can quickly remove stomach flab with the following powerful dieting solution. I hope you're ready....because this is going to knock your socks off!
Okay, first things first. Let's talk about the basic core principles. Let me tell you, if you don't comprehend, implement, and practice the basic core principles of a healthy lifestyle, ladies and gentleman....results will be minimal to none....it's just as simple as that.
What are those principles? Proper nutrition (complex carbs, healthy fats, fiber, protein, and foods rich in vitamins and minerals), drink plenty of water daily ( I recommend for you to drink 1/2 to 1 gallon of water daily for optimal results), get plenty of sleep every night (7-8 hours of sleep every night is ideal), cardio exercise (if you want to remove stomach flab fast, do yourself a favor and do high intensity cardio exercise guys), and weight training exercise (building lean muscle is absolutely essential for fat loss and weight loss).
Now let's get down to business! Are you ready? Are you prepared to receive this breakthrough dieting solution to quickly remove stomach flab? Ladies and gentleman....drum roll please.....the 2008 dieting solution of the year to remove stomach flab is... consistency.
"What the"?! "I thought it was going to be some super secret!" Was that one of your responses? If so, don't feel bad, that's usually the response everyone gives.
Why is consistency so shocking to people as being the best dieting solution? It's because people are so brain washed into thinking that there are miracles, potions, and secrets to fat loss.....and it just isn't. Guys, it comes down to the basics of a healthy lifestyles, and STAYING CONSISTENT with it all to quickly remove stubborn stomach flab. The more consistent you are with a diet, the faster the results....it's just that simple!
Looking for a way to "remove stomach flab" fast? I highly recommend for you to check out the brand new breakthrough diet of the decade....The Everloss Diet. With The Everloss Diet, you'll get a complete diet plan that covers every aspect of healthy living and weight loss from food and diet, to activities, to supplements, recipes, fat burning techniques, and an inside view of how your body type works at your age.
Find out more extensive information about how to lose weight and get faster fat loss now at http://Ever-Loss-Diet.info
Article Source: http://EzineArticles.com/?expert=Avy_Barnes
Okay, first things first. Let's talk about the basic core principles. Let me tell you, if you don't comprehend, implement, and practice the basic core principles of a healthy lifestyle, ladies and gentleman....results will be minimal to none....it's just as simple as that.
What are those principles? Proper nutrition (complex carbs, healthy fats, fiber, protein, and foods rich in vitamins and minerals), drink plenty of water daily ( I recommend for you to drink 1/2 to 1 gallon of water daily for optimal results), get plenty of sleep every night (7-8 hours of sleep every night is ideal), cardio exercise (if you want to remove stomach flab fast, do yourself a favor and do high intensity cardio exercise guys), and weight training exercise (building lean muscle is absolutely essential for fat loss and weight loss).
Now let's get down to business! Are you ready? Are you prepared to receive this breakthrough dieting solution to quickly remove stomach flab? Ladies and gentleman....drum roll please.....the 2008 dieting solution of the year to remove stomach flab is... consistency.
"What the"?! "I thought it was going to be some super secret!" Was that one of your responses? If so, don't feel bad, that's usually the response everyone gives.
Why is consistency so shocking to people as being the best dieting solution? It's because people are so brain washed into thinking that there are miracles, potions, and secrets to fat loss.....and it just isn't. Guys, it comes down to the basics of a healthy lifestyles, and STAYING CONSISTENT with it all to quickly remove stubborn stomach flab. The more consistent you are with a diet, the faster the results....it's just that simple!
Looking for a way to "remove stomach flab" fast? I highly recommend for you to check out the brand new breakthrough diet of the decade....The Everloss Diet. With The Everloss Diet, you'll get a complete diet plan that covers every aspect of healthy living and weight loss from food and diet, to activities, to supplements, recipes, fat burning techniques, and an inside view of how your body type works at your age.
Find out more extensive information about how to lose weight and get faster fat loss now at http://Ever-Loss-Diet.info
Article Source: http://EzineArticles.com/?expert=Avy_Barnes
Find Out How to Blast Your Metabolism to the Moon and Lose 5 Pounds in 1 Week!
Just 1 week....safely! Ready for lift off Captain in 5, 4, 3, 2..,
*Attention mission control*.... We have brief problem we need to address first: Do you know and understand the basic core principles of a healthy lifestyle? Without understanding, and implementing these principles, results will be minimal to none.
The basic core principles of a healthy lifestyle are proper nutrition (protein, complex carbs, fiber, healthy fats, and foods rich in vitamins and minerals), drink plenty of water daily (I recommend 1/2 to 1 gallon of water daily for optimal results), get plenty of sleep every night (7-8 hours is ideal), cardio exercise (high intensity cardio works best), and weight training exercise.
*Attention mission control*....Commence with lift off!
Metabolism Booster #1 - Eat more! That's right! One of the easiest ways to boost your metabolism fast is by eating more frequently through out the day. Start with breakfast and have a small healthy meal every 2-3 hours after. Eating more frequently will keep your digestive system active, which will cause a significant boost in your metabolism.
Metabolism Booster #2 - Intense workouts! Getting more intense with your workouts will boost your metabolism and the rate at which you'll burn off fat. Some of my favorite high intensity workouts would be incline treadmill and sprinting!
Metabolism Booster #3 - Ice Cold Water! Don't just drink regular water....get your water ICE COLD! If you drink ice cold water, you will send your body into thermogenesis (the act of your body warming up fluids to body temperature). That whole process burns off calories!
*Attention mission*.....We have landed our metabolism on the moon! Mission complete and 5 pounds lost in 1 week....woohoo!!
Looking for a way to "lose belly fat" fast? I highly recommend for you to check out the brand new breakthrough diet of the decade....The Everloss Diet. With The Everloss Diet, you'll get a complete diet plan that covers every aspect of healthy living and weight loss from food and diet, to activities, to supplements, recipes, fat burning techniques, and an inside view of how your body type works at your age.
Find out more extensive information about how to lose weight and get faster fat loss now at http://Ever-Loss-Diet.info
Article Source: http://EzineArticles.com/?expert=Avy_Barnes
*Attention mission control*.... We have brief problem we need to address first: Do you know and understand the basic core principles of a healthy lifestyle? Without understanding, and implementing these principles, results will be minimal to none.
The basic core principles of a healthy lifestyle are proper nutrition (protein, complex carbs, fiber, healthy fats, and foods rich in vitamins and minerals), drink plenty of water daily (I recommend 1/2 to 1 gallon of water daily for optimal results), get plenty of sleep every night (7-8 hours is ideal), cardio exercise (high intensity cardio works best), and weight training exercise.
*Attention mission control*....Commence with lift off!
Metabolism Booster #1 - Eat more! That's right! One of the easiest ways to boost your metabolism fast is by eating more frequently through out the day. Start with breakfast and have a small healthy meal every 2-3 hours after. Eating more frequently will keep your digestive system active, which will cause a significant boost in your metabolism.
Metabolism Booster #2 - Intense workouts! Getting more intense with your workouts will boost your metabolism and the rate at which you'll burn off fat. Some of my favorite high intensity workouts would be incline treadmill and sprinting!
Metabolism Booster #3 - Ice Cold Water! Don't just drink regular water....get your water ICE COLD! If you drink ice cold water, you will send your body into thermogenesis (the act of your body warming up fluids to body temperature). That whole process burns off calories!
*Attention mission*.....We have landed our metabolism on the moon! Mission complete and 5 pounds lost in 1 week....woohoo!!
Looking for a way to "lose belly fat" fast? I highly recommend for you to check out the brand new breakthrough diet of the decade....The Everloss Diet. With The Everloss Diet, you'll get a complete diet plan that covers every aspect of healthy living and weight loss from food and diet, to activities, to supplements, recipes, fat burning techniques, and an inside view of how your body type works at your age.
Find out more extensive information about how to lose weight and get faster fat loss now at http://Ever-Loss-Diet.info
Article Source: http://EzineArticles.com/?expert=Avy_Barnes
Friday, October 17, 2008
Spend Less Time on Your Medical Billing
A busy medical practice can be challenging because of much-needed organization. The schedule can be difficult to work with and the patients must be seen and cared for. Because of all of the details, sometimes billing will be put on hold for tomorrow. The billing portion of the busy office is the portion of running a busy office, which cannot be allowed to slide. The office needs to collect the money for the office to be able to pay their obligations.
You will need to organize your office in order to save time, which will also help cut down your costs of running the office. In a physician's office information is extremely important. You cannot afford to lose any information. By organizing your office you will have a better chance of know where everything is. Then you will want to make sure all the other employees in the office know where everything is suppose to be to eliminate the chance of any information being misplaced.
A good time saver is the implementation of a web based medical billing software. The web based medical billing software is intended to eliminate or reduce paperwork in your office. It will assist with the billing and keep information organized. The recovery of records, information and past due billing information is simple and easy. Processing claims with the insurance companies will reduce delays and non-payments. The web based medical billing software has been incorporated with the diagnosis and procedure codes to reduce or eliminate errors, which can be the cause of delays, or denied claims. The information, which is stored by the server of the software, is backed up in a secure online server and not your computer's hard drive. Most of these companies with the software will provide training for the use of the software. If the software is created to work with Windows or Microsoft Office, you might receive a video and materials for your and all of your staff on the operating procedure of the software.
The Electronic Medical Records are included in many of the web based medical billing software. This feature will allow you to file medical histories of your patients into the software. You can also scan the information and in some cases you will be able to dictate information, which a transcriber will access from another computer and input into the software. This feature of your web based medical billing software will make it simple to contract someone to transcribe dictation for you or even do the medical billing for you.
If it is easier and less expensive for you, you may want to relinquish your medical billing to a medical billing service. The companies doing this type of work will have training and software in order to get the job done, which can relieve your office to do what it does best. That is taking care of patients. The service will keep all of your information organized, so you will be able to get any information from the service quickly.
Article Source: http://EzineArticles.com/?expert=Evan_Lagasse
You will need to organize your office in order to save time, which will also help cut down your costs of running the office. In a physician's office information is extremely important. You cannot afford to lose any information. By organizing your office you will have a better chance of know where everything is. Then you will want to make sure all the other employees in the office know where everything is suppose to be to eliminate the chance of any information being misplaced.
A good time saver is the implementation of a web based medical billing software. The web based medical billing software is intended to eliminate or reduce paperwork in your office. It will assist with the billing and keep information organized. The recovery of records, information and past due billing information is simple and easy. Processing claims with the insurance companies will reduce delays and non-payments. The web based medical billing software has been incorporated with the diagnosis and procedure codes to reduce or eliminate errors, which can be the cause of delays, or denied claims. The information, which is stored by the server of the software, is backed up in a secure online server and not your computer's hard drive. Most of these companies with the software will provide training for the use of the software. If the software is created to work with Windows or Microsoft Office, you might receive a video and materials for your and all of your staff on the operating procedure of the software.
The Electronic Medical Records are included in many of the web based medical billing software. This feature will allow you to file medical histories of your patients into the software. You can also scan the information and in some cases you will be able to dictate information, which a transcriber will access from another computer and input into the software. This feature of your web based medical billing software will make it simple to contract someone to transcribe dictation for you or even do the medical billing for you.
If it is easier and less expensive for you, you may want to relinquish your medical billing to a medical billing service. The companies doing this type of work will have training and software in order to get the job done, which can relieve your office to do what it does best. That is taking care of patients. The service will keep all of your information organized, so you will be able to get any information from the service quickly.
Article Source: http://EzineArticles.com/?expert=Evan_Lagasse
Take Your Medical Billing Business to the Next Level
Do you have your own Medical Billing Business? Is it doing as well as you would like it to be? Do you want to grow but not sure how to get started? Maybe you've been cruising along now at the same place for a while and you're ready for a change. Whatever your situation is, if you are ready to Take Your Medical Billing Business to the Next Level then you will need a plan.
Many people want to grow their business but they just sit and wait for it to happen on its own. If you want your business to grow then you need to act first. Don't sit around waiting and wondering when. If you do that you will have no control over how fast you grow and what direction you grow in. You need a plan.
First, sit down and figure out exactly what it is you want. How much do you want to grow? Do you want to just pick up a few more clients? Do you want to double? Are you ready to hire an employee or two? Maybe you are ready to quit your full time job and work at your medical billing business full time. After you figure out how much you want to grow you need to figure out what it will take to get you there.
Your plan for getting there will involve many things. You will need to plan a marketing strategy. You will need to consider many new things if you need to hire and train an employee. Your work space must be taken into consideration. You will need to consider the costs of expansion. And you will need to learn to put many systems in place.
After you decide how much you want to grow you need to give yourself a time frame and a set of steps to reach your goal. A goal without a deadline is just a dream. Set specific dates that you want to reach certain parts of your goal. They can be flexible. If you don't reach a goal by the set date, you can move it a little. It doesn't mean you have to give up. A time frame makes sure you are keeping on track to reach your goal. If you don't meet a deadline maybe you need to rethink how you are trying to get there and make some changes.
The important thing is that you take control of your business. If you want growth, prepare for it, decide what you want, and when you want to be there. Then go for it! Good luck.
Article Source: http://EzineArticles.com/?expert=Michele_Redmond
Many people want to grow their business but they just sit and wait for it to happen on its own. If you want your business to grow then you need to act first. Don't sit around waiting and wondering when. If you do that you will have no control over how fast you grow and what direction you grow in. You need a plan.
First, sit down and figure out exactly what it is you want. How much do you want to grow? Do you want to just pick up a few more clients? Do you want to double? Are you ready to hire an employee or two? Maybe you are ready to quit your full time job and work at your medical billing business full time. After you figure out how much you want to grow you need to figure out what it will take to get you there.
Your plan for getting there will involve many things. You will need to plan a marketing strategy. You will need to consider many new things if you need to hire and train an employee. Your work space must be taken into consideration. You will need to consider the costs of expansion. And you will need to learn to put many systems in place.
After you decide how much you want to grow you need to give yourself a time frame and a set of steps to reach your goal. A goal without a deadline is just a dream. Set specific dates that you want to reach certain parts of your goal. They can be flexible. If you don't reach a goal by the set date, you can move it a little. It doesn't mean you have to give up. A time frame makes sure you are keeping on track to reach your goal. If you don't meet a deadline maybe you need to rethink how you are trying to get there and make some changes.
The important thing is that you take control of your business. If you want growth, prepare for it, decide what you want, and when you want to be there. Then go for it! Good luck.
Article Source: http://EzineArticles.com/?expert=Michele_Redmond
Basics of Medical Billing
Whether you are planning on starting a medical billing business, already own a medical billing business, work for a billing service or in a medical office, it is crucial that you completely understand the entire billing process. From the time a patient schedules an appointment to the time that full payment is received, everyone who interacts with either the patient or the billing process can affect the payment.
Billing is such an important part of a medical office. The money brought in from the billing is what keeps the office running. It pays everyone's salary, including the doctor. It always amazes me that so many providers do not make sure that their billing is being done properly and that their office staff isn't all working together to make sure all is being done that needs to be.
When a patient calls to schedule an appointment it is important that the person doing the scheduling not only gets all of the necessary information from the patient but also that they understand how insurance works so they can tell if anything needs to be done prior to the patient's appointment. Having someone who understands medical billing can reduce visits that end up not being covered by insurance.
The person responsible for actually submitting the insurance claims needs to know the different requirements by each carrier and understand how to handle all aspects of billing. Following up on unpaid insurance claims is an area that most offices lose a ton of money. If you don't have a very good follow up system then you are definitely losing money.
Many medical providers think that only the billing person needs to understand medical billing. Actually it is important that all staff have some knowledge of insurance billing in order for things to run smoothly. The more that the staff understands, the less money you throw out the door. Providers deserve to be paid for all the patients they treat.
Article Source: http://EzineArticles.com/?expert=Michele_Redmond
Billing is such an important part of a medical office. The money brought in from the billing is what keeps the office running. It pays everyone's salary, including the doctor. It always amazes me that so many providers do not make sure that their billing is being done properly and that their office staff isn't all working together to make sure all is being done that needs to be.
When a patient calls to schedule an appointment it is important that the person doing the scheduling not only gets all of the necessary information from the patient but also that they understand how insurance works so they can tell if anything needs to be done prior to the patient's appointment. Having someone who understands medical billing can reduce visits that end up not being covered by insurance.
The person responsible for actually submitting the insurance claims needs to know the different requirements by each carrier and understand how to handle all aspects of billing. Following up on unpaid insurance claims is an area that most offices lose a ton of money. If you don't have a very good follow up system then you are definitely losing money.
Many medical providers think that only the billing person needs to understand medical billing. Actually it is important that all staff have some knowledge of insurance billing in order for things to run smoothly. The more that the staff understands, the less money you throw out the door. Providers deserve to be paid for all the patients they treat.
Article Source: http://EzineArticles.com/?expert=Michele_Redmond
Tuesday, October 14, 2008
Cheaper Medical Insurance - Ideas To Help You Cut Down Costs
Cheaper medical Contrary to what you might have thought, it's quite easy to get a lower rate. The only things that stand between you and attracting a more affordable rate now are relevant information and a motivation to make use of the recommendations you get. Let's look at a few sure-fire ways to get better rates...
1. Ensure a healthy life style and you will get lower rates with time. If you can stop eating junk food you'll pay less over time. Removing fats, cholesterol and high carb from your diet will make it easier for you to retain the right weight, live a healthier life and, as a result, attract cheaper rates.
You will also help your health and rate by going on regular exercise.
2. For folks who have a longtime ailment that makes it hard or too expensive for them to enjoy private personal health insurance, the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) insurance could offer a more affordable option.
3. Some persons are not poor enough to qualify for plans for low-income earner and also have financial challenges that make regular health insurance hard to pay for. In case this defines you, then you can reduce your budget for health care by going for a discount medical card. So what are they?
With these cards you are given medical attention from a network of health care professionals who have agreed to render services to card carriers at reduced rates. Such cards are not issued by insurance companies.
You can fall back to this option if you have a medical history that has made health insurance providers either reject you or give you a rate that is too high. One advantage of a discount medical card is that everybody can use it. Just make your monthly payments and you'll have access to a network of health care providers who will bill you lower for their services.
4. Your premiums may be tax-deductible if you're self employed. You may also be entitled to a tax break if your employer offers a flexible spending account. You can get details on this from your tax professional. This will help you know for sure what will entitle you to a tax break and what won't.
5. Don't become carried away by the lowest quote as you shop for low cost health insurance. You want a cheap rate that also offers you much value. If the cheapest price has all that is important to you, then go for it. But in situations where you don't find the right value in the cheapest rate, you'll be making the right choice if you pay more to ensure you truly have the quality of coverage that you really need.
Take note of this because a number of low quotes are that low because they don't offer much. A health insurance plan that compromises you does not make sense even if it's 500% less than the quote that offers you sufficient coverage.
6. You will save much if you only have between 25-30 minutes. Visit, obtain and compare health insurance quotes from selected quotes sites. The cheapest offer should be your choice easily. However, you have to look beyond just the lowest quote to the best price to value ratio. The cheapest may not be the best price/value for you as an individual.
Here are great pages for health insurance quotes...
Article Source: http://EzineArticles.com/?expert=Chimezirim_Chinecherem_Odimba
1. Ensure a healthy life style and you will get lower rates with time. If you can stop eating junk food you'll pay less over time. Removing fats, cholesterol and high carb from your diet will make it easier for you to retain the right weight, live a healthier life and, as a result, attract cheaper rates.
You will also help your health and rate by going on regular exercise.
2. For folks who have a longtime ailment that makes it hard or too expensive for them to enjoy private personal health insurance, the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) insurance could offer a more affordable option.
3. Some persons are not poor enough to qualify for plans for low-income earner and also have financial challenges that make regular health insurance hard to pay for. In case this defines you, then you can reduce your budget for health care by going for a discount medical card. So what are they?
With these cards you are given medical attention from a network of health care professionals who have agreed to render services to card carriers at reduced rates. Such cards are not issued by insurance companies.
You can fall back to this option if you have a medical history that has made health insurance providers either reject you or give you a rate that is too high. One advantage of a discount medical card is that everybody can use it. Just make your monthly payments and you'll have access to a network of health care providers who will bill you lower for their services.
4. Your premiums may be tax-deductible if you're self employed. You may also be entitled to a tax break if your employer offers a flexible spending account. You can get details on this from your tax professional. This will help you know for sure what will entitle you to a tax break and what won't.
5. Don't become carried away by the lowest quote as you shop for low cost health insurance. You want a cheap rate that also offers you much value. If the cheapest price has all that is important to you, then go for it. But in situations where you don't find the right value in the cheapest rate, you'll be making the right choice if you pay more to ensure you truly have the quality of coverage that you really need.
Take note of this because a number of low quotes are that low because they don't offer much. A health insurance plan that compromises you does not make sense even if it's 500% less than the quote that offers you sufficient coverage.
6. You will save much if you only have between 25-30 minutes. Visit, obtain and compare health insurance quotes from selected quotes sites. The cheapest offer should be your choice easily. However, you have to look beyond just the lowest quote to the best price to value ratio. The cheapest may not be the best price/value for you as an individual.
Here are great pages for health insurance quotes...
Article Source: http://EzineArticles.com/?expert=Chimezirim_Chinecherem_Odimba
Medical Insurance Savings - These Tips Will Help You A Lot
With the right advice you'll get more affordable rates for sufficient coverage. It is also necessary that I point out that there are recommendations that might put you at risk even if they help you make savings at the moment. I will, nevertheless, only make suggestions that will save you much while you still keep enjoying adequate coverage...
1. Even though most individuals know that smoking adds to their rates, they may not know that this also applies if they use other tobacco products. Those who snuff or chew tobacco will also get higher rates than those who don't. Staying away from all tobacco products will attract less expense in health insurance.
2. A group plan is less expensive than an individual plan. Don't miss it if you're in a position that gives you the opportunity of using a group plan as it generally implies that you'll pay lower rates. This statement becomes even more so if you're overweight, a smoker or an older person.
A group plan will help you make considerable savings if you have a pre-existing condition that makes individual health insurance either too costly or almost impossible to come by. A group plan is an easy way to lower your cost without reducing the quality of coverage you will enjoy.
3. You will spend less in health insurance if you if you get the right tips. Individuals who know more about health care and insurance get better deals. Moreover, you will find it easier to get every benefit that you are eligible for if you always have the right information.
There are toll-free numbers you can call if you need help on health matters. One of such numbers is that of the National Health Information Center: 1-800-336-4797
4. Buying your prescriptions on the internet is a proven way to bring down your health care spend. Buying by telephone might as well give you affordable prices. The internet reduces the cost of doing business and pharmaceutical companies or groups who sell their drugs online do so at cheaper rates. But if you've chosen to buy online try to find out a little about whom you are buying from because there are wolves online. Just go to BBB online and you will know if you should buy from an exact company.
Always remember that while we want to reduce costs we also want to avoid risks.
5. Electronic Funds Transfer, known as EFT is an easy way to reduce your premium. By doing this you authorize your insurance provider to automatically withdraw your payments from your account when due. This eliminates administrative overheads like those involved in sending payment notices. Your premium is therefore lowered in line with the cheaper cost of giving you insurance.
6. Visit a minimum of five quotes sites. Using a minimum of five quotes sites raise the chances that you'd receive cheaper health insurance quotes. This is because insurance companies not covered by one site will be represented by the other. Moreover, you know that because your chances of getting lower health insurance quotes has to do with the number of quotes you obtain, the more companies you obtain quotes from, the higher your chances will be. Requesting for your health insurance quotes online will help you save a bundle if you take out around 25 minutes to obtain quotes from at least five sites.
Article Source: http://EzineArticles.com/?expert=Chimezirim_Chinecherem_Odimba
1. Even though most individuals know that smoking adds to their rates, they may not know that this also applies if they use other tobacco products. Those who snuff or chew tobacco will also get higher rates than those who don't. Staying away from all tobacco products will attract less expense in health insurance.
2. A group plan is less expensive than an individual plan. Don't miss it if you're in a position that gives you the opportunity of using a group plan as it generally implies that you'll pay lower rates. This statement becomes even more so if you're overweight, a smoker or an older person.
A group plan will help you make considerable savings if you have a pre-existing condition that makes individual health insurance either too costly or almost impossible to come by. A group plan is an easy way to lower your cost without reducing the quality of coverage you will enjoy.
3. You will spend less in health insurance if you if you get the right tips. Individuals who know more about health care and insurance get better deals. Moreover, you will find it easier to get every benefit that you are eligible for if you always have the right information.
There are toll-free numbers you can call if you need help on health matters. One of such numbers is that of the National Health Information Center: 1-800-336-4797
4. Buying your prescriptions on the internet is a proven way to bring down your health care spend. Buying by telephone might as well give you affordable prices. The internet reduces the cost of doing business and pharmaceutical companies or groups who sell their drugs online do so at cheaper rates. But if you've chosen to buy online try to find out a little about whom you are buying from because there are wolves online. Just go to BBB online and you will know if you should buy from an exact company.
Always remember that while we want to reduce costs we also want to avoid risks.
5. Electronic Funds Transfer, known as EFT is an easy way to reduce your premium. By doing this you authorize your insurance provider to automatically withdraw your payments from your account when due. This eliminates administrative overheads like those involved in sending payment notices. Your premium is therefore lowered in line with the cheaper cost of giving you insurance.
6. Visit a minimum of five quotes sites. Using a minimum of five quotes sites raise the chances that you'd receive cheaper health insurance quotes. This is because insurance companies not covered by one site will be represented by the other. Moreover, you know that because your chances of getting lower health insurance quotes has to do with the number of quotes you obtain, the more companies you obtain quotes from, the higher your chances will be. Requesting for your health insurance quotes online will help you save a bundle if you take out around 25 minutes to obtain quotes from at least five sites.
Article Source: http://EzineArticles.com/?expert=Chimezirim_Chinecherem_Odimba
Sunday, October 12, 2008
CMS 1500 Form - Completing it Correctly
CMS 1500 forms are the universal claim forms used by medical providers to submit claims for their services to the insurance carriers. They are pre-printed red and white forms designed by the Centers for Medicare and Medicaid Services. They were formally known as HCFA 1500 forms but they were redesigned to allow for the reporting of the NPI, or National Provider Identifier.
It is very important that the CMS 1500 forms are completed properly to ensure that correct payment is made. If the form is not completed properly, the claim may be denied by the insurance carrier. Many providers have practice management software that completes the forms for them, but the information must still be loaded into the practice management software program properly in order for it to be printed out in the right format.
Many of the insurance carriers have different requirements for what information goes in each box on the CMS 1500 form. For example, if you are billing an insurance carrier that requires authorization for the services being billed and they assign an authorization number, they may require that the authorization number be in box 23. Other carriers do not require that anything be in box 23. It is important to know the different requirements for each of the insurance carriers that you bill to.
If you do not have all of the necessary boxes completed, or if they are not completed properly, the claim may be denied. For example, if you do not put the patient's date of birth on the CMS 1500 form, then the claim will most likely be denied out. Most insurance carriers scan the CMS forms and if all the required fields are not completed the claim is automatically denied without a human even touching it. Another thing that could cause an immediate denial is if the date of birth on the claim doesn't match what's on file with the insurance carrier. When the claim is scanned, it will deny out stating they can't identify the patient.
Many claims do not get paid on the first submission and in many cases it is due to the CMS form not being completed properly. In order to cut down on denials, make sure you are completing the forms completely and correctly. This will make a big difference in your bottom line.
Article Source: http://EzineArticles.com/?expert=Michele_Redmond
It is very important that the CMS 1500 forms are completed properly to ensure that correct payment is made. If the form is not completed properly, the claim may be denied by the insurance carrier. Many providers have practice management software that completes the forms for them, but the information must still be loaded into the practice management software program properly in order for it to be printed out in the right format.
Many of the insurance carriers have different requirements for what information goes in each box on the CMS 1500 form. For example, if you are billing an insurance carrier that requires authorization for the services being billed and they assign an authorization number, they may require that the authorization number be in box 23. Other carriers do not require that anything be in box 23. It is important to know the different requirements for each of the insurance carriers that you bill to.
If you do not have all of the necessary boxes completed, or if they are not completed properly, the claim may be denied. For example, if you do not put the patient's date of birth on the CMS 1500 form, then the claim will most likely be denied out. Most insurance carriers scan the CMS forms and if all the required fields are not completed the claim is automatically denied without a human even touching it. Another thing that could cause an immediate denial is if the date of birth on the claim doesn't match what's on file with the insurance carrier. When the claim is scanned, it will deny out stating they can't identify the patient.
Many claims do not get paid on the first submission and in many cases it is due to the CMS form not being completed properly. In order to cut down on denials, make sure you are completing the forms completely and correctly. This will make a big difference in your bottom line.
Article Source: http://EzineArticles.com/?expert=Michele_Redmond
Securing An Adequate Cheap Insurance Medical Policy
No matter how healthy your lifestyle, how wisely you plan your diet or how much you exercise in an effort to take care of your body, unexpected situations may arise. You may land in the hospital with bills that could potentially wipe out everything you own. Thus it is extremely important to acquire an adequate insurance medical policy that will take care of your expenses in case of just such an emergency.
Everyone needs at least some form of health insurance. Some people are concerned about qualifying for an insurance plan especially if they have health issues. There are so many options available and although some are not easy to find, they can be quite simple to qualify for.
Before signing up for a plan, consider your family's medical needs and budget requirements. There are basically two types of plans to consider, a private plan and a government plan.
Types of Coverage
The private plan is commonly obtained through employment. Most employers will offer some form of insurance for their full time employees. In some states employers are required to provide insurance if the employee exceeds a certain level of hours worked during the course of a week. Often times the employer will offer some sort of group health plan for their employees which decreases the monthly premium costs. Normally this type of plan will cover your spouse and family. Many people may not be able to participate in group plans. There are many individual plans are offered although they may be a bit more expensive in relation to group plans.
If you are going to sign on with a private plan learn all you can about the coverage in the contract. Read all the inclusions and exclusions and avoid signing up with a plan that has a long list of exclusions. Also make sure you obtain a copy of all the paperwork you sign.
Health insurance offered by the government is generally on a state or national level. One example would be Medicare which is a national plan. Medicare is available for those people over 65 years of age and also is available to disabled people. Some other types of government assisted health care plans include Medicaid which is based on income level, health and care for veterans and children's health programs.
Article Source: http://EzineArticles.com/?expert=Peter_Kingston
Everyone needs at least some form of health insurance. Some people are concerned about qualifying for an insurance plan especially if they have health issues. There are so many options available and although some are not easy to find, they can be quite simple to qualify for.
Before signing up for a plan, consider your family's medical needs and budget requirements. There are basically two types of plans to consider, a private plan and a government plan.
Types of Coverage
The private plan is commonly obtained through employment. Most employers will offer some form of insurance for their full time employees. In some states employers are required to provide insurance if the employee exceeds a certain level of hours worked during the course of a week. Often times the employer will offer some sort of group health plan for their employees which decreases the monthly premium costs. Normally this type of plan will cover your spouse and family. Many people may not be able to participate in group plans. There are many individual plans are offered although they may be a bit more expensive in relation to group plans.
If you are going to sign on with a private plan learn all you can about the coverage in the contract. Read all the inclusions and exclusions and avoid signing up with a plan that has a long list of exclusions. Also make sure you obtain a copy of all the paperwork you sign.
Health insurance offered by the government is generally on a state or national level. One example would be Medicare which is a national plan. Medicare is available for those people over 65 years of age and also is available to disabled people. Some other types of government assisted health care plans include Medicaid which is based on income level, health and care for veterans and children's health programs.
Article Source: http://EzineArticles.com/?expert=Peter_Kingston
Medical Billing Audit, Clean Claims Metrics, And the Payer-Provider Conflict
Dr. Noah Payne shook his head in disbelief: the practice reimbursements shrank instead of climbing in response to the recent hiring of Dr. Inna Ternist. The new doctor clearly added to the total number of patients seen yet overall payments did not reflect the added charges. Perhaps the new claims were not created, submitted, or paid? Dr. Noah remembered noticing the growing pile of rejected and denied claims accumulating dust on his desk - he never had the time to review them...How many of these claims are clean? How many of them require manual review and correction?
Dr. Noah looked at his Vericle screen and began analyzing the numbers. The system showed 58 percent clean claims (PCC). In other words, almost every second claim required manual correction. Who could be causing such a high level of problems: the practice, the billing service, or the payer? Dr. Noah's instinctively felt that perhaps the billing service was negligent about data entry process and kept introducing massive data errors. But the service manager was quick to explain a rigorous quality assurance process for data entry. What else could be causing such a high level of manual work in a seemingly streamlined process?
A quick review shows that PCC varies along several dimensions:
1. 19 and 70 percent for financial class
2. 37 and 66 percent for month of service
3. 55 and 59 percent for physician
4. 29 and 70 percent for various CPT codes
Trying to discover a pattern, Dr. Noah looked for a root cause dimension. He drilled into 99213 - the single largest frequency CPT code for his practice. Vericle showed 3,135 claims and the above average 62 PCC carrying charges and payments for 99213 code.
Having isolated the single most frequent CPT code, Dr. Noah was thinking about other dimensions that influence PCC. He hypothesized that if all doctors in his practice had the same coding skills, and assuming uniform distribution of errors, he should observe no PCC variance across the doctors. Yet, a quick click on a Vericle screen yielded a spread, confirming his suspicion that different doctors maintained slightly different coding skills:
1. Dr. Ted 1,554 claims and PCC = 63%
2. Dr. Lori 865 claims and PCC = 62%
3. Dr. Inna 194 claims and PCC = 61%
4. Dr. Noah 516 claims and PCC = 60%
Next, Dr. Noah switched his attention to distribution of PCC across the financial classes. Again, he hypothesized that if all payers used the same rules to deny claims then there should be no difference in the average PCC for different payers, subject to a uniform distribution of errors over a large sample of submitted and paid claims. Yet the numbers showed a significant (30 percent) variation of PCC for the same CPT code: UHC - 82, Blue Cross Blue Shield - 73, Oxford - 64, Aetna - 59, Medicare - 59, and Cigna - 51, confirming his conclusion that various payers used various rules to deny and underpay claims.
Dr. Noah recalled reading an article about PacifiCare, a Californian insurance company being fined upon an audit. The joint Department of Managed Health Care and Insurance Department recently analyzed 1.1 million paid claims from June 2005 to May 2007 that covered about 190,000 members in PacifiCare's HMO plans and PPO coverage [Gilbert Chan , "PacifiCare fined record $3.5 million," www.sacbee.com , January 30, 2008]. They discovered 30 percent of the HMO claims wrongly denied and 29 percent of the disputes with doctors were handled incorrectly. PacifiCare paid out over $1 million and was fined additional $3.5 million. Dr. Noah's findings roughly matched PacifiCare audit - the insurance companies were failing anywhere between twenty to fifty percent of his claims and each insurance company showed a different failure rate, depending on a system used to fail submitted claims.
Finally, Dr. Noah thought of the billing service operation. Is his billing service systematically working to discover failed claims and improve its response to such discoveries? Is there a pattern of an occasional drop of PCC reflecting its deterioration in response to various payer's initiatives? Conversely, is there any evidence for a systematic improvement effort? A chart of the distribution of a single CPT-code clean claim percentage over the entire year must answer his question. In his mind, PCC should iterate between drops and climbs, hopefully each time at a higher level. Vericle confirmed his expectations, showing an overall improvement of PCC over the year (46% 1-07, 39% 2-07, 52% 3-07, 55% 4-07, 63% 5-07, 67% 6-07, 72% 7-07, 69% 8-07, 72% 9-07, 68% 10-07, 74% 11-07, 73% 12-07)
Article Source: http://EzineArticles.com/?expert=Yuval_Lirov
Dr. Noah looked at his Vericle screen and began analyzing the numbers. The system showed 58 percent clean claims (PCC). In other words, almost every second claim required manual correction. Who could be causing such a high level of problems: the practice, the billing service, or the payer? Dr. Noah's instinctively felt that perhaps the billing service was negligent about data entry process and kept introducing massive data errors. But the service manager was quick to explain a rigorous quality assurance process for data entry. What else could be causing such a high level of manual work in a seemingly streamlined process?
A quick review shows that PCC varies along several dimensions:
1. 19 and 70 percent for financial class
2. 37 and 66 percent for month of service
3. 55 and 59 percent for physician
4. 29 and 70 percent for various CPT codes
Trying to discover a pattern, Dr. Noah looked for a root cause dimension. He drilled into 99213 - the single largest frequency CPT code for his practice. Vericle showed 3,135 claims and the above average 62 PCC carrying charges and payments for 99213 code.
Having isolated the single most frequent CPT code, Dr. Noah was thinking about other dimensions that influence PCC. He hypothesized that if all doctors in his practice had the same coding skills, and assuming uniform distribution of errors, he should observe no PCC variance across the doctors. Yet, a quick click on a Vericle screen yielded a spread, confirming his suspicion that different doctors maintained slightly different coding skills:
1. Dr. Ted 1,554 claims and PCC = 63%
2. Dr. Lori 865 claims and PCC = 62%
3. Dr. Inna 194 claims and PCC = 61%
4. Dr. Noah 516 claims and PCC = 60%
Next, Dr. Noah switched his attention to distribution of PCC across the financial classes. Again, he hypothesized that if all payers used the same rules to deny claims then there should be no difference in the average PCC for different payers, subject to a uniform distribution of errors over a large sample of submitted and paid claims. Yet the numbers showed a significant (30 percent) variation of PCC for the same CPT code: UHC - 82, Blue Cross Blue Shield - 73, Oxford - 64, Aetna - 59, Medicare - 59, and Cigna - 51, confirming his conclusion that various payers used various rules to deny and underpay claims.
Dr. Noah recalled reading an article about PacifiCare, a Californian insurance company being fined upon an audit. The joint Department of Managed Health Care and Insurance Department recently analyzed 1.1 million paid claims from June 2005 to May 2007 that covered about 190,000 members in PacifiCare's HMO plans and PPO coverage [Gilbert Chan , "PacifiCare fined record $3.5 million," www.sacbee.com , January 30, 2008]. They discovered 30 percent of the HMO claims wrongly denied and 29 percent of the disputes with doctors were handled incorrectly. PacifiCare paid out over $1 million and was fined additional $3.5 million. Dr. Noah's findings roughly matched PacifiCare audit - the insurance companies were failing anywhere between twenty to fifty percent of his claims and each insurance company showed a different failure rate, depending on a system used to fail submitted claims.
Finally, Dr. Noah thought of the billing service operation. Is his billing service systematically working to discover failed claims and improve its response to such discoveries? Is there a pattern of an occasional drop of PCC reflecting its deterioration in response to various payer's initiatives? Conversely, is there any evidence for a systematic improvement effort? A chart of the distribution of a single CPT-code clean claim percentage over the entire year must answer his question. In his mind, PCC should iterate between drops and climbs, hopefully each time at a higher level. Vericle confirmed his expectations, showing an overall improvement of PCC over the year (46% 1-07, 39% 2-07, 52% 3-07, 55% 4-07, 63% 5-07, 67% 6-07, 72% 7-07, 69% 8-07, 72% 9-07, 68% 10-07, 74% 11-07, 73% 12-07)
Article Source: http://EzineArticles.com/?expert=Yuval_Lirov
Tuesday, October 7, 2008
Medical Billing and the Discrepancy Paradox of the Rising Healthcare Costs
Health care spending continues to rise at the fastest rate in our history. In 2005, total national health costs rose 6.9 percent -- twice the rate of inflation - reaching $2 trillion, or $6,700 per person [Catlin, Cowan, Heffler, et al, 2006]. Currently, total health care spending represents 16 percent of the gross domestic product (GDP). In the next decade, U.S. health care spending is expected to increase at similar levels, reaching $4 trillion in 2015 [Borger et al, 2006].
While some experts maintain that our health care system is costly because it is riddled with inefficiencies, excessive administrative expenses, inflated prices, poor management, waste, inappropriate care, and fraud [Health Insurance Cost, National Coalition on Health Care, 2008], at least three remaining key factors, namely, aging population, expensive medical innovation, and defensive care, contribute substantially, to the overall cost picture.
1. Aging population
In the United States, the proportion of the population aged >65 years is projected to increase from 12.4% in 2000 to 19.6% in 2030. The number of persons aged >65 years is expected to increase from approximately 35 million in 2000 to an estimated 71 million in 2030, and the number of persons aged >80 years is expected to increase from 9.3 million in 2000 to 19.5 million in 2030 [Public Health and Aging: Trends in Aging --- United States and Worldwide, 2008; Kaiser Family Foundation, 2006].
"The growing number of older adults increases demands on the public health system and on medical and social services. Chronic diseases, which affect older adults disproportionately, contribute to disability, diminish quality of life, and increased health- and long-term--care costs." [UN, 2002] 125 million Americans have one or more chronic conditions (e.g. congestive heart failure, diabetes.) Chronic diseases account for 75% of all health care expenditures. Source: Burrill & Company, 2006
2. Expensive innovation
* The American biotechnology industry has surpassed pharmaceutical companies for the third straight year as the primary source of new medicines, and biotech revenue jumped nearly 16 percent to a record $50.7 billion in 2005. Source: Ernst & Young LLP, 2006
* The USA is the world's largest and wealthiest pharmaceutical market, accounting for around 48% of the world total. Per capita expenditure on drugs is US $1,069 in 2006, nearly double the level found in the rest of the world. Source: Espicom Business Intelligence, 2006
* ...an estimated 30% of new products under development are "combo products" - involving medical devices embedded with pharmaceutical or biologics components. [Combination Products- Navigating Two FDA Quality Systems, Microtest White Paper, 2007]. The combination products market is estimated at $5.9B in 2004, and will continue to grow at a compound annual rate of 10% through 2009. By 2009, the market is expected to reach approximately $9.5B worldwide with a majority of these revenues from drug-eluting stents and steroid-eluting electrodes. Source: Navigant Consulting, Inc. In 2004, the US held approximately 65% of the drug-device combination product market. By 2010, the US is projected to hold 57%. Source: Business Communications Inc.
3. "Defensive" Medicine
"One of the major cost drivers in the delivery of health care are these junk and frivolous lawsuits. The risk of frivolous litigation drives doctors -- and hear me out on this -- they drive doctors to prescribe drugs and procedures that may not be necessary, just to avoid lawsuits. That's called the defensive practice of medicine.. . . . See, lawsuits not only drive up premiums, which drives up the cost to the patient or the employer of the patient, but lawsuits cause docs to practice medicine in an expensive way in order to protect themselves in the courthouse. The defensive practice of medicine affects the federal budget. The direct cost of liability insurance and the indirect cost from unnecessary medical procedures raise the federal government's health care costs by at least $28 billion a year." [US President George Bush, Arkansas, January 26, 2004]
Now let us observe the paradox:
1. On one hand, the participants of every ancillary industry to health care, including insurance companies, hi-tech and pharmaceutical engineers and scientists, as well as lawyers, have increased their profits in step with the rising costs of health care at ever accelerating pace.
2. On the other hand, the medical and chiropractic office owners - the actual health care providers - have not only failed to keep up with raising costs but have lost a significant part of their income. In fact, between 1995 and 1999, at a time when most wages and salaries in the United States rose 3.5 percent after adjusting for inflation, average physician net income from the practice of medicine, adjusted for inflation, dropped 5 percent [Reed and Ginsburg, 2003]. In 2006, the median compensation for specialty and primary physicians grew only 1.7 ($322,259) and 2 ($171,519) percent respectively, slower than consumer price index of 3.2 percent [MGMA Physician Compensation and Production Survey: 2007 Report]. In comparison, health care costs beat the inflation by 3.5% reaching the annual growth rate of 6.7 [Health Care Spending, 2008]
Diverting our focus away from trying to find solutions to the problem of rising health care costs, we ask a different question: How such a paradoxical situation is possible without a deliberate and systematic strategy against health care providers?
References:
1. Catlin, A, C. Cowan, S. Heffler, et al, "National Health Spending in 2005." Health Affairs 26:1 (2006): 142-153.
2. Borger, C., et al., "Health Spending Projections Through 2015: Changes on the Horizon," Health Affairs Web Exclusive W61: 22 February 2006.
3. Health Insurance Cost, National Coalition on Health Care as of January 4, 2008
4. Public Health and Aging: Trends in Aging --- United States and Worldwide, as of January 4, 2008
5. United Nations. Report of the Second World Assembly on Aging. Madrid, Spain: United Nations, April 8--12, 2002.
6. Kinsella K, Velkoff V. U.S. Census Bureau. An Aging World: 2001. Washington, DC: U.S. Government Printing Office, 2001; series P95/01-1.
7. U.S. Census Bureau. International database. Table 094. Midyear population, by age and sex. 2008
8. The Henry J. Kaiser Family Foundation. Employee Health Benefits: 2006 Annual Survey. 26 September 2006.
9. President Bush Calls for Medical Liability Reform, Baptist Health Medical Center, Little Rock, Arkansas, January 26, 2004 http://www.whitehouse.gov/news/releases/2004/01/20040126-3.html as of January 4, 2008
10. Marie C. Reed, Paul B. Ginsburg, Behind the Times: Physician Income, 1995-99, Data Bulletin No. 24, March 2003
11. Medical Group Management Association (MGMA) Physician Compensation and Production Survey: 2007 Report
12. MEDICARE SPENDING - United States Government Accountability Office (GAO), Testimony Before the Subcommittee on Health, Committee on Energy and Commerce, House of Representatives, March 6, 2007, Healthcare Costs 101
13. Health Care Spending http://www.cms.hhs.gov/NationalHealthExpendData/01_Overview.asp as downloaded on January 15, 2008
Article Source: http://EzineArticles.com/?expert=Yuval_Lirov
While some experts maintain that our health care system is costly because it is riddled with inefficiencies, excessive administrative expenses, inflated prices, poor management, waste, inappropriate care, and fraud [Health Insurance Cost, National Coalition on Health Care, 2008], at least three remaining key factors, namely, aging population, expensive medical innovation, and defensive care, contribute substantially, to the overall cost picture.
1. Aging population
In the United States, the proportion of the population aged >65 years is projected to increase from 12.4% in 2000 to 19.6% in 2030. The number of persons aged >65 years is expected to increase from approximately 35 million in 2000 to an estimated 71 million in 2030, and the number of persons aged >80 years is expected to increase from 9.3 million in 2000 to 19.5 million in 2030 [Public Health and Aging: Trends in Aging --- United States and Worldwide, 2008; Kaiser Family Foundation, 2006].
"The growing number of older adults increases demands on the public health system and on medical and social services. Chronic diseases, which affect older adults disproportionately, contribute to disability, diminish quality of life, and increased health- and long-term--care costs." [UN, 2002] 125 million Americans have one or more chronic conditions (e.g. congestive heart failure, diabetes.) Chronic diseases account for 75% of all health care expenditures. Source: Burrill & Company, 2006
2. Expensive innovation
* The American biotechnology industry has surpassed pharmaceutical companies for the third straight year as the primary source of new medicines, and biotech revenue jumped nearly 16 percent to a record $50.7 billion in 2005. Source: Ernst & Young LLP, 2006
* The USA is the world's largest and wealthiest pharmaceutical market, accounting for around 48% of the world total. Per capita expenditure on drugs is US $1,069 in 2006, nearly double the level found in the rest of the world. Source: Espicom Business Intelligence, 2006
* ...an estimated 30% of new products under development are "combo products" - involving medical devices embedded with pharmaceutical or biologics components. [Combination Products- Navigating Two FDA Quality Systems, Microtest White Paper, 2007]. The combination products market is estimated at $5.9B in 2004, and will continue to grow at a compound annual rate of 10% through 2009. By 2009, the market is expected to reach approximately $9.5B worldwide with a majority of these revenues from drug-eluting stents and steroid-eluting electrodes. Source: Navigant Consulting, Inc. In 2004, the US held approximately 65% of the drug-device combination product market. By 2010, the US is projected to hold 57%. Source: Business Communications Inc.
3. "Defensive" Medicine
"One of the major cost drivers in the delivery of health care are these junk and frivolous lawsuits. The risk of frivolous litigation drives doctors -- and hear me out on this -- they drive doctors to prescribe drugs and procedures that may not be necessary, just to avoid lawsuits. That's called the defensive practice of medicine.. . . . See, lawsuits not only drive up premiums, which drives up the cost to the patient or the employer of the patient, but lawsuits cause docs to practice medicine in an expensive way in order to protect themselves in the courthouse. The defensive practice of medicine affects the federal budget. The direct cost of liability insurance and the indirect cost from unnecessary medical procedures raise the federal government's health care costs by at least $28 billion a year." [US President George Bush, Arkansas, January 26, 2004]
Now let us observe the paradox:
1. On one hand, the participants of every ancillary industry to health care, including insurance companies, hi-tech and pharmaceutical engineers and scientists, as well as lawyers, have increased their profits in step with the rising costs of health care at ever accelerating pace.
2. On the other hand, the medical and chiropractic office owners - the actual health care providers - have not only failed to keep up with raising costs but have lost a significant part of their income. In fact, between 1995 and 1999, at a time when most wages and salaries in the United States rose 3.5 percent after adjusting for inflation, average physician net income from the practice of medicine, adjusted for inflation, dropped 5 percent [Reed and Ginsburg, 2003]. In 2006, the median compensation for specialty and primary physicians grew only 1.7 ($322,259) and 2 ($171,519) percent respectively, slower than consumer price index of 3.2 percent [MGMA Physician Compensation and Production Survey: 2007 Report]. In comparison, health care costs beat the inflation by 3.5% reaching the annual growth rate of 6.7 [Health Care Spending, 2008]
Diverting our focus away from trying to find solutions to the problem of rising health care costs, we ask a different question: How such a paradoxical situation is possible without a deliberate and systematic strategy against health care providers?
References:
1. Catlin, A, C. Cowan, S. Heffler, et al, "National Health Spending in 2005." Health Affairs 26:1 (2006): 142-153.
2. Borger, C., et al., "Health Spending Projections Through 2015: Changes on the Horizon," Health Affairs Web Exclusive W61: 22 February 2006.
3. Health Insurance Cost, National Coalition on Health Care as of January 4, 2008
4. Public Health and Aging: Trends in Aging --- United States and Worldwide, as of January 4, 2008
5. United Nations. Report of the Second World Assembly on Aging. Madrid, Spain: United Nations, April 8--12, 2002.
6. Kinsella K, Velkoff V. U.S. Census Bureau. An Aging World: 2001. Washington, DC: U.S. Government Printing Office, 2001; series P95/01-1.
7. U.S. Census Bureau. International database. Table 094. Midyear population, by age and sex. 2008
8. The Henry J. Kaiser Family Foundation. Employee Health Benefits: 2006 Annual Survey. 26 September 2006.
9. President Bush Calls for Medical Liability Reform, Baptist Health Medical Center, Little Rock, Arkansas, January 26, 2004 http://www.whitehouse.gov/news/releases/2004/01/20040126-3.html as of January 4, 2008
10. Marie C. Reed, Paul B. Ginsburg, Behind the Times: Physician Income, 1995-99, Data Bulletin No. 24, March 2003
11. Medical Group Management Association (MGMA) Physician Compensation and Production Survey: 2007 Report
12. MEDICARE SPENDING - United States Government Accountability Office (GAO), Testimony Before the Subcommittee on Health, Committee on Energy and Commerce, House of Representatives, March 6, 2007, Healthcare Costs 101
13. Health Care Spending http://www.cms.hhs.gov/NationalHealthExpendData/01_Overview.asp as downloaded on January 15, 2008
Article Source: http://EzineArticles.com/?expert=Yuval_Lirov
Medical Billing Audit - Why Should Providers Audit Payers?
A Sacramento-area surgeon couldn't schedule surgeries for more than six months because his contract was not loaded in the insurer's computer system. More than 200 of Dr. Watson's patients received letters indicating incorrectly that he was no longer participating in the network. Watson lost about 25 percent of these patients and was not paid for about eight months. Another insured spent eleven months trying to get claims paid for his family, including an autistic child. The insurer never specified what information was needed to make the denied claims eligible for payment.
Are these three isolated incidents or are they three symptoms of a growing problem with the entire provider's reimbursement system? The owners of health care practices easily recognize these painfully familiar symptoms. The better questions are: how are they related to the rising healthcare costs and what can a provider do to help?
In 2005, national healthcare costs rose 6.9 percent - twice the rate of inflation, reaching $2 trillion. National healthcare costs are predicted to double to $4 trillion by 2015. While key health care cost factors include aging US population, the arrival of new and expensive drugs and bio-tech devices, and the defensive medicine, the insurance costs alone stand out as a key contributor to rising healthcare costs. Exorbitant executive compensation became a hallmark of healthcare insurance industry, where William McGuire, CEO of UnitedHealth Group, has reportedly received over $500 million since 1992, more than $1 billion worth of options, a lump sum payout of $6.4 million upon leaving the company, and an annual pension of $5.1 million. But such compensation can be easily justified on Wall Street, when comparing it to outstanding insurance industry profits, such as 38 percent growth in earnings in the 3rd quarter of 2006.
The problem for any successful insurance company is how to make such growth sustainable? This question is difficult because the premium growth (68.4 percent) has disproportionally outpaced both inflation (16.4 percent) and workers earnings (18.2 percent) during the same period (2001-2006), making it impossible to continue to rise the premiums without losing major segments of insured population.
Without the ability to attract new clients or to further raise insurance premiums, cost reduction becomes the next most important approach to enhance profitability. Such cost reduction can be done in a variety of ways, which we conveniently divide into strategic and tactical or opportunistic approaches.
Strategic insurer's arsenal
The creation of an oligopsony through consolidation is the main weapon in the strategic arsenal of insurance companies. Oligopsony exists when providers significantly outnumber buyers, enabling them to dictate prices. Take for example, the PacifiCare's $9.2 billion merger with United Health Group Inc. in late 2005, which created a vast network of HMO and PPO plans covering more than 3 million Californians. Today, three plans alone (UnitedHealthcare, WellPoint and Aetna) cover 77.7 million insured lives. Oligopsony allows the systematic and continuous cost reduction without extra investment, e.g., annual cut of allowed rates (such as the average reimbursement for E&M allowable dropped 10 percent in 2006 and another 6.5 percent in 2007), payment suspension for specific procedures (such as EKG tests for routine physicals), offering "all or none" participation alternatives, or the creation of "tiered networks" that profile providers and incentivize patients to see lower cost providers.
Tactical insurer's weapons
Increasing billing process complexity and inventing new denial reasons through arcane terminology, disparate data formats, and modifications of CPT/ICD codes and medical necessity rules - these are all examples of tactical methods designed to increase providers costs for both billing and follow up and reduce the payments at the expense of practice owners. These methods need continuous investment in personnel training, better process management, and improved technology to keep them effective as the providers begin building more sophisticated systems to scrub and analyze claims and discover payment discrepancies and irregularities.
Provider's Response
Returning to the three incidents mentioned at the outset of this article, the joint Department of Managed Health Care and Insurance Department determined that these are not isolated cases. It analyzed 1.1 million paid claims from June 2005 to May 2007 that covered about 190,000 members in PacifiCare's HMO plans and PPO coverage [Gilbert Chan , "PacifiCare fined record $3.5 million," www.sacbee.com , January 30, 2008] and discovered 30 percent of the HMO claims wrongly denied and 29 percent of the disputes with doctors were handled incorrectly. PacifiCare paid out over $1 million and was fined additional $3.5 million.
In summary, providers need new and effective approaches to mobilize both legal and organizational talent to reverse their revenue decline. Legal methods battle market conditions like oligopsony while large-scale medical billing networks aggregate claim volumes and create resulting economies of scale to enable analytical discovery of under-payments.
Article Source: http://EzineArticles.com/?expert=Yuval_Lirov
Are these three isolated incidents or are they three symptoms of a growing problem with the entire provider's reimbursement system? The owners of health care practices easily recognize these painfully familiar symptoms. The better questions are: how are they related to the rising healthcare costs and what can a provider do to help?
In 2005, national healthcare costs rose 6.9 percent - twice the rate of inflation, reaching $2 trillion. National healthcare costs are predicted to double to $4 trillion by 2015. While key health care cost factors include aging US population, the arrival of new and expensive drugs and bio-tech devices, and the defensive medicine, the insurance costs alone stand out as a key contributor to rising healthcare costs. Exorbitant executive compensation became a hallmark of healthcare insurance industry, where William McGuire, CEO of UnitedHealth Group, has reportedly received over $500 million since 1992, more than $1 billion worth of options, a lump sum payout of $6.4 million upon leaving the company, and an annual pension of $5.1 million. But such compensation can be easily justified on Wall Street, when comparing it to outstanding insurance industry profits, such as 38 percent growth in earnings in the 3rd quarter of 2006.
The problem for any successful insurance company is how to make such growth sustainable? This question is difficult because the premium growth (68.4 percent) has disproportionally outpaced both inflation (16.4 percent) and workers earnings (18.2 percent) during the same period (2001-2006), making it impossible to continue to rise the premiums without losing major segments of insured population.
Without the ability to attract new clients or to further raise insurance premiums, cost reduction becomes the next most important approach to enhance profitability. Such cost reduction can be done in a variety of ways, which we conveniently divide into strategic and tactical or opportunistic approaches.
Strategic insurer's arsenal
The creation of an oligopsony through consolidation is the main weapon in the strategic arsenal of insurance companies. Oligopsony exists when providers significantly outnumber buyers, enabling them to dictate prices. Take for example, the PacifiCare's $9.2 billion merger with United Health Group Inc. in late 2005, which created a vast network of HMO and PPO plans covering more than 3 million Californians. Today, three plans alone (UnitedHealthcare, WellPoint and Aetna) cover 77.7 million insured lives. Oligopsony allows the systematic and continuous cost reduction without extra investment, e.g., annual cut of allowed rates (such as the average reimbursement for E&M allowable dropped 10 percent in 2006 and another 6.5 percent in 2007), payment suspension for specific procedures (such as EKG tests for routine physicals), offering "all or none" participation alternatives, or the creation of "tiered networks" that profile providers and incentivize patients to see lower cost providers.
Tactical insurer's weapons
Increasing billing process complexity and inventing new denial reasons through arcane terminology, disparate data formats, and modifications of CPT/ICD codes and medical necessity rules - these are all examples of tactical methods designed to increase providers costs for both billing and follow up and reduce the payments at the expense of practice owners. These methods need continuous investment in personnel training, better process management, and improved technology to keep them effective as the providers begin building more sophisticated systems to scrub and analyze claims and discover payment discrepancies and irregularities.
Provider's Response
Returning to the three incidents mentioned at the outset of this article, the joint Department of Managed Health Care and Insurance Department determined that these are not isolated cases. It analyzed 1.1 million paid claims from June 2005 to May 2007 that covered about 190,000 members in PacifiCare's HMO plans and PPO coverage [Gilbert Chan , "PacifiCare fined record $3.5 million," www.sacbee.com , January 30, 2008] and discovered 30 percent of the HMO claims wrongly denied and 29 percent of the disputes with doctors were handled incorrectly. PacifiCare paid out over $1 million and was fined additional $3.5 million.
In summary, providers need new and effective approaches to mobilize both legal and organizational talent to reverse their revenue decline. Legal methods battle market conditions like oligopsony while large-scale medical billing networks aggregate claim volumes and create resulting economies of scale to enable analytical discovery of under-payments.
Article Source: http://EzineArticles.com/?expert=Yuval_Lirov
Saturday, October 4, 2008
Selecting Medical Billing Services Using Smart Reference Checks
The path from deciding to outsource medical billing to selecting your medical billing company requires a well planned selection strategy. A cornerstone of this strategy is well thought out and executed reference checks.
Reference checking is certainly not the only element that must be properly executed in your medical billing company selection. It is, however, one of the more critical and it has several sub-steps that must be properly considered.
Although today's write-up is geared towards creating an effective interview guide, this is far from the only ingredient of a successful medical billing services company selection. Other critical ingredients include outlining the minimum requirements of an acceptable reference (e.g., does it need to be in your state, what specialties are acceptable, etc), deciding if you want to speak with a former client, outlining the roles of the people with whom your wish to speak (e.g., lead partner, practice administrator, day-to-day billing contact, etc), creating the interview guide, call the references, and making the final go/no-go decision.
Your interview guide will allow you and not the references to determine what topics are addressed in the reference calls. If you do not drive the calls, you may well end the process still unsure about your final decision. To kick-off the interview guide creation think about the worst things and the best things that could happen as a result of medical billing outsourcing. Keeping your mind on these best and worst cases develop questions that will help you determine where between these two extremes your potential medical billing company operates.
It is critical to ensure that your questions are specific enough that you can come away with real facts from the reference calls. You do not want to ask broad questions like "Are you happy with this company's performance?" Such questions are open to much interpretation and are driven by the individual's previous experiences.
Given this issue, your next task is to make the question more geared towards gathering objective facts. For instance, you might change the question above to say, ?How many hours per week did you spend before outsourcing on reviewing billing performance reports, reviewing EOBs, and reconciling your bank deposits with your billing system reports? How many hours per week do you spend on this now??
Once you complete the list of questions and make them specific enough to gather objective data type them out in a logical manner and leave the space required to jot down the answer right on the interview guide. Before the first call sit down and look at the questions one final time. Make sure that the answers to these questions will give you the comfort you need to make a final decision. Start making the reference calls once you are confident your interview guide is ready.
It is your job to make sure you get specific answers to all of all your questions. Think of yourself as a reporter and do not let the call end until you have all of your questions specifically answered. You will need to practice good time management to make sure this happens in the period the person is allowing for the reference call. If you do not get all of your questions answered, then ask to schedule a second call.
You may find that one of your references brings up a point you had not considered. If they do, add the relevant question to the end of your interview guide and call back any individuals with whom you have already spoken to get this additional information.
With your well planned and structured reference checks complete you will be in a position to make an informed medical billing service decision.
Article Directory: http://www.articledashboard.com
Reference checking is certainly not the only element that must be properly executed in your medical billing company selection. It is, however, one of the more critical and it has several sub-steps that must be properly considered.
Although today's write-up is geared towards creating an effective interview guide, this is far from the only ingredient of a successful medical billing services company selection. Other critical ingredients include outlining the minimum requirements of an acceptable reference (e.g., does it need to be in your state, what specialties are acceptable, etc), deciding if you want to speak with a former client, outlining the roles of the people with whom your wish to speak (e.g., lead partner, practice administrator, day-to-day billing contact, etc), creating the interview guide, call the references, and making the final go/no-go decision.
Your interview guide will allow you and not the references to determine what topics are addressed in the reference calls. If you do not drive the calls, you may well end the process still unsure about your final decision. To kick-off the interview guide creation think about the worst things and the best things that could happen as a result of medical billing outsourcing. Keeping your mind on these best and worst cases develop questions that will help you determine where between these two extremes your potential medical billing company operates.
It is critical to ensure that your questions are specific enough that you can come away with real facts from the reference calls. You do not want to ask broad questions like "Are you happy with this company's performance?" Such questions are open to much interpretation and are driven by the individual's previous experiences.
Given this issue, your next task is to make the question more geared towards gathering objective facts. For instance, you might change the question above to say, ?How many hours per week did you spend before outsourcing on reviewing billing performance reports, reviewing EOBs, and reconciling your bank deposits with your billing system reports? How many hours per week do you spend on this now??
Once you complete the list of questions and make them specific enough to gather objective data type them out in a logical manner and leave the space required to jot down the answer right on the interview guide. Before the first call sit down and look at the questions one final time. Make sure that the answers to these questions will give you the comfort you need to make a final decision. Start making the reference calls once you are confident your interview guide is ready.
It is your job to make sure you get specific answers to all of all your questions. Think of yourself as a reporter and do not let the call end until you have all of your questions specifically answered. You will need to practice good time management to make sure this happens in the period the person is allowing for the reference call. If you do not get all of your questions answered, then ask to schedule a second call.
You may find that one of your references brings up a point you had not considered. If they do, add the relevant question to the end of your interview guide and call back any individuals with whom you have already spoken to get this additional information.
With your well planned and structured reference checks complete you will be in a position to make an informed medical billing service decision.
Article Directory: http://www.articledashboard.com
Texas Medical Billing Services
Medical billing is a rapidly expanding field in the healthcare sector, and the demand for skilled medical billing specialists is on the rise. There are many companies now offering medical billing services in Texas in an effective and prompt manner. These companies assist with the tedious tasks of billing and follow-up functions, thus allowing you to concentrate more on your core business.
The process of medical billing involves preparing, submitting as well as following up on insurance claims. The procedures involved in medical billing applications and insurance claims are highly complex. Since most medical office personnel do not have much time to process claims with the insurance companies, they outsource their medical billing assignments to other locations.
Most of the medical billing companies in Texas provide medical billing services to all types of practices and organizations, including physicians’ groups, clinics, hospitals, large healthcare facilities and insurance companies. The companies appoint well trained and highly qualified billing specialists to carry out all the medical billing procedures in an efficient way. They also take care of your insurance details and medical coding processes as part of their services.
Mentioned below are some of the medical billing services provided by medical billing companies:
o Demographic and insurance information
o Insurance verification procedures
o Authorization
o Cash posting
o Charge entry
o Accounts receivable follow up and collections
o Insurance collection
You can enjoy a number of benefits by using the services of a well established medical billing company:
o Electronic processing
o HIPAA compliance
o Complete medical billing management
o Improve your cash flow and collections
o Reduce billing costs
o Reduce payer denials
o Eliminate billing headaches
Before relying on a medical billing firm in Texas, it is better to perform considerable research in terms of rates, services, and other associated factors. As many of the medical billing companies offer free trial version for service quality evaluation, it is an excellent idea to take advantage of those free trial packages.
Article Directory: http://www.articledashboard.com
The process of medical billing involves preparing, submitting as well as following up on insurance claims. The procedures involved in medical billing applications and insurance claims are highly complex. Since most medical office personnel do not have much time to process claims with the insurance companies, they outsource their medical billing assignments to other locations.
Most of the medical billing companies in Texas provide medical billing services to all types of practices and organizations, including physicians’ groups, clinics, hospitals, large healthcare facilities and insurance companies. The companies appoint well trained and highly qualified billing specialists to carry out all the medical billing procedures in an efficient way. They also take care of your insurance details and medical coding processes as part of their services.
Mentioned below are some of the medical billing services provided by medical billing companies:
o Demographic and insurance information
o Insurance verification procedures
o Authorization
o Cash posting
o Charge entry
o Accounts receivable follow up and collections
o Insurance collection
You can enjoy a number of benefits by using the services of a well established medical billing company:
o Electronic processing
o HIPAA compliance
o Complete medical billing management
o Improve your cash flow and collections
o Reduce billing costs
o Reduce payer denials
o Eliminate billing headaches
Before relying on a medical billing firm in Texas, it is better to perform considerable research in terms of rates, services, and other associated factors. As many of the medical billing companies offer free trial version for service quality evaluation, it is an excellent idea to take advantage of those free trial packages.
Article Directory: http://www.articledashboard.com
Outsource Medical Billing - Deciding If It Is Right For You
Over the next several articles I plan to discuss a framework for thinking through whether outsourced medical billing is the right decision for you. The decision is a critical one, so it is imperative that it be based in facts and not in urban legends and myths. Although I am focusing on medical insurance billing services, the basic concepts apply to any outsourcing decision. Today I will outline the main benefits to consider when making the decision about medical insurance billing outsourcing and the most typical concerns and risks associated with the decision to outsource medical billing. Over the following days I will discuss each element in more detail.
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 insurance billing services focus on 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 a medical practice should see from the right medical billing service are:
1. They have more scale to purchase and deploy the technologies required to properly submit claims, battle with insurance companies and collect personal balances.
2. They are able to attract a higher caliber of billing specialists and retain these individuals.
3. They have a deeper bench of employees and this provides a layer of protection for your practice by decoupling you from the risk associated with losing a key (if not the key) billing employee.
4. They are better positioned to properly utilize the technology they have.
5. They have a broader scope than any single medical practice or facility. This allows them to see patterns across practices, specialties, states and payers that can add money to your medical practice's bottom line.
The typical concerns that physicians and practice managers have when deciding whether they want to outsource medical billing are:
1. Will billing services fight as hard for me with insurance companies as my own employees?
2. Can outsourced billing companies handle the unique elements of my practice?
3. Will I lose control and visibility into how my accounts are being worked?
4. Will an outsourced billing company alienate my patients through heavy handed collection practices?
5. Will medical insurance billing services only go after the low hanging fruit, and leave the more difficult money uncollected?
Over the upcoming articles I will go into more depth on each of the benefits and concerns outlined above. I will go ahead and give you a peek at the final chapter. The trick is finding the right insurance billing company. Once you have a company with a proven track record you will be able to see substantial improvements in your practice's revenues have a more attractive bottom line and have more time and energy for your patients, growing your practice and - heaven forbid - a life outside the office.
Article Directory: http://www.articledashboard.com
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 insurance billing services focus on 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 a medical practice should see from the right medical billing service are:
1. They have more scale to purchase and deploy the technologies required to properly submit claims, battle with insurance companies and collect personal balances.
2. They are able to attract a higher caliber of billing specialists and retain these individuals.
3. They have a deeper bench of employees and this provides a layer of protection for your practice by decoupling you from the risk associated with losing a key (if not the key) billing employee.
4. They are better positioned to properly utilize the technology they have.
5. They have a broader scope than any single medical practice or facility. This allows them to see patterns across practices, specialties, states and payers that can add money to your medical practice's bottom line.
The typical concerns that physicians and practice managers have when deciding whether they want to outsource medical billing are:
1. Will billing services fight as hard for me with insurance companies as my own employees?
2. Can outsourced billing companies handle the unique elements of my practice?
3. Will I lose control and visibility into how my accounts are being worked?
4. Will an outsourced billing company alienate my patients through heavy handed collection practices?
5. Will medical insurance billing services only go after the low hanging fruit, and leave the more difficult money uncollected?
Over the upcoming articles I will go into more depth on each of the benefits and concerns outlined above. I will go ahead and give you a peek at the final chapter. The trick is finding the right insurance billing company. Once you have a company with a proven track record you will be able to see substantial improvements in your practice's revenues have a more attractive bottom line and have more time and energy for your patients, growing your practice and - heaven forbid - a life outside the office.
Article Directory: http://www.articledashboard.com
Tuesday, September 30, 2008
Medical Claims Processing - Billing Software, Home Business
Health care facilities around the country see numerous patients every day. An important part of their operation is the health care providers that they choose to employ. Some hire better doctors, nurses, and technicians. Therefore, they are frequented by more patients. Many people do not realize that an important part of a health care facility's operation is it's medical claims processing abilities.
To ensure timely payments by insurance companies, medical claims must be processed in a timely manner and submitted to the appropriate insurance companies for consideration.
Some facilities employ medical billers and coders. Other facilities employ individuals who handle both aspects of the claim process simultaneously. A medical biller and coder will generally earn more than a medical biller or coder does. That is because he or she is performing double duties and eliminating the need for the health care facility to hire two different people.
Medical coders provide the diagnostic codes and procedure codes that apply to the patient's visit. If the codes do not match, a claim may be denied. The insurance company will more than likely say that the treatment was not medically necessary. That is why it is so important for a medical coder to be precise.
A medical biller obtains the correct codes from the medical coder. He or she uses the codes to fill out a claim form. The claim is submitted to the insurance company, generally in the form of an electronic claim. It is important that the medical biller comply with the requirements of each insurance company. Many have specific guidelines that must be followed. The claim could be delayed or denied, if the claim form is not filled out properly and according to the insurance company's regulations.
Medical billing software is often used in medical claims processing. The software saves time and eliminates common mistakes. Medical billing software allows medical coders to look up diagnostic codes and procedure codes via the software rather than in a manual. The software also checks databases to ensure that the diagnostic codes and procedure codes match up, eliminating the denial of claims based on discrepancies.
Medical claims processing is a job that can be done from home. Many people have started their own home businesses in medical claims processing. It is a great way for stay at home mothers to earn an extra income and remain at home with their children. Source: Accrmedicalbillingtraining dot
Article Source: http://EzineArticles.com/?expert=Louis_Zhang
Investigating Health Care Fraud
Investigations relating to health care fraud activity are reportedly at an all time high, and will continue to flourish with the advent of new working groups, task forces and other fraud-fighting activity that existence depends on the development and investigation of health care fraud cases. Simply put, the investigation of health care fraud consists of proving that the provider engaged in an intentional deception or misrepresentation (of material fact) that resulted, or could have resulted, in an unauthorized payment. Some key facts related to health care fraud investigations:
Complaint Driven: Private, local, state and/or federal agencies are actively involved in the identification and investigation of health care fraud and abuse, which, for the most part, are initiated by complaints received from patients, insurers and others on a health care provider or entity.
Complaint Evaluation: The investigative process starts by the investigator evaluating the information in the complaint to determine if it represents actual misconduct, and then to identify what specific laws, rules, and/or regulations may have been violated. Critical areas to be addressed may include:
oDOCUMENTATION-was the services documented as medically necessary, and completely and accurately documented in the patient's health care record?
oREGULATORY LAWS & RULES-were the services rendered consistent with the administrative law for the State, including scope of practice, training, supervision and delegation? Additionally, were the services, or the manner in which they were rendered, in violation of prohibited conduct?
oTHIRD PARTY PAYER RULES-were the services rendered consistent with the rules set by the involved third party payer, including those relevant to limitation of services rendered, and those limiting the service provider?
oCODING-were the proper ICD-9 and CPT-4 codes used to identify the condition (s) being treated and the services rendered when seeking reimbursement?
Investigative Plan: The investigator will identify potential witnesses to interview, other needed information, such as patient and insurance claim files that may possess evidence of the misconduct. The successful investigation will result in the collection identify and collect all relevant evidence that would indicate the laws, rules and/or regulations governing health care have been violated, and to identify storytellers who will be able to testify on matters relevant to the identified misconduct. The patient file is the crime scene when investigating health care fraud & abuse.
MAJOR TRENDS IN HEALTH CARE FRAUD
Problem (Multidiscipline Practices): Some multidiscipline practices of medical doctors, chiropractors, and other providers working together in one practice entity are formed by some chiropractors as a means to circumvent managed care and other third party payer limitations on reimbursement of chiropractic services. At times, when necessary, multiple corporations are created to allow the chiropractor to employ medical doctors and to maintain control over all revenues of the multidiscipline practice. The services rendered by the chiropractor in cases where there is little or no chiropractic coverage are billed to the third party payer under the license and name of the medical doctor, purportedly following "Incident-to" billing principles after the medical doctor evaluated the patient and referred them for care with the chiropractor. Is the chiropractor billing for their services rendered under the license of a medical doctor?
Problem (Mobile Labs): Some external companies, or mobile labs, market their electro-diagnostic testing services extensively to health care providers as a means to increase patient retention and increase revenues. The mobile lab provides on-site electro-diagnostic testing on the provider's patients with their equipment and by their technician. The provider pays the lab a rental fee for the equipment and technician, and agrees to provide a minimum number of patients for testing during one day. The lab bills the third party payer for only the reading of the tests, or the professional component, and the provider bills for administering the tests, or the technical component, because they rented the equipment/technician and supervised its administration. Further, the lab will provide the provider with the CPT codes and amounts that should be reported and billed for the technical portion of the test. The provider, claiming to have supervised the administration of the diagnostic test, may not have the requisite training and skill on the test. Often, the total amount billed (both professional and technical) for the tests will far exceed the RVU (Relative Value Unit) set for these tests. The client provider usually will have no actual knowledge on what the labs will bill to the third party payer. What service did the provider perform to bill for the technical portion?
Problem (Rehab): Some providers implement (active) rehabilitation care into their health care practices by having their unlicensed staff administer therapeutic procedures to patients that are defined as one-on-one with the patient by a licensed provider, and are reported in 15-minute increments. Documentation of medical necessity of therapeutic procedures may not be properly established in the patient's clinical record as part of a treatment plan. Documentation of procedures in file, even when directly provided by licensed provider, may not be properly documented to account for the time component of the service, i.e., Start & End time, which includes pre-intra-post service time. Is the provider's unlicensed staff rendering the rehab services to the patients of the practice? What does the patient's health care record show? Do they support the need and accuracy of the billings?
Problem (Billing): Various insurance companies have limitations on what health care conditions and services they will reimburse providers for. Some providers provide their patients with health care services that are not reimbursable by the involved managed care organization or third party payer, but report and bill for these services via use of ICD-9 and CPT-4 codes that are reimbursable. Some providers provide their patients with various health care services based solely on the premise that the involved managed care organization or third party payer will reimburse for those services.
Problem (Solicitation): A number of providers market "free" services, such as consults, exams and x-rays to attract new patients that may not be established as medically necessary, or will later be billed to a third party payer. A number of providers' market "free" services, such as therapeutic massage, as a means to attract new patients to the health care practice, which later may become a part of the patient's billed care. A number of providers inform marketed individuals when converting them to patients that they will not be responsible for what the insurance company does not pay. For the health care provider what is a consult? Isn't it a history? Was the promised free service, or a portion of it, later billed? Is it possible to give away a therapeutic massage without first examining the patient to establish need?
Article Source: http://EzineArticles.com/?expert=Daniel_J_Osborne
Therapeutic Procedures - Explode Your Practice
One of the more potentially volatile risk areas for health care practitioners today is the delegation of therapeutic procedures to unlicensed assistants, and billing for those procedures as though the practitioner personally provided the procedures. This practice activity is particularly prevalent and ever-growing in chiropractic!
Some practice consultants - with promises of increased income, coach chiropractors to integrate low-tech rehab and protocols into their practices. Chiropractors are advised that it is legally permissible for unlicensed assistants (e.g., chiropractic assistants) to perform the therapeutic procedures on patients that are billed (per "incident-to") as if personally performed by the chiropractor, who at the same time, is providing services to other patients who are billed for the chiropractor's services during the same time frames as the therapeutic procedures.
Does the regulatory board allow for delegation of therapeutic procedures to unlicensed staff?
Individual state health care regulatory boards establish their own state's administrative practice standards for licensees for the purpose of protecting the public from conduct that does not conform to their state's accepted standards of conduct. Such administrative regulations almost always include standards relating to the delegation of services to persons other than the licensed provider. In many states, chiropractic boards do not allow their licensees to delegate therapeutic procedures to unlicensed staff, and, as such it would be inappropriate in any and all circumstances for the licensees to engage in this conduct!
However, some boards opine that licensees (e.g., chiropractors) can delegate therapeutic procedures to qualified and properly trained unlicensed staff (e.g., chiropractic assistants) acting under a licensee's supervision consistent with the health and welfare of a patient so as to encourage the more effective use of the skills of licensees. It would appear prudent for chiropractors to gain clarification from respective regulatory agencies regarding the following:
What are the standards that must be met by chiropractors to ensure their unlicensed staff are "qualified and properly trained"?
What level of supervision (general, direct or personnel) is required of the chiropractor relative to unlicensed staff directing therapeutic procedures?
What is meant by "consistent with the health and welfare of a patient so as to encourage the more effective use of the skills of licensees"?
How should the therapeutic procedures (supervised) by unlicensed staff be documented in the patient's clinical record?
How should the therapeutic procedures be reported to payers - especially those following Medicare standards, to avoid potential allegations of misconduct?
Is reporting therapeutic procedure codes for supervised procedures consistent with CPT?
Therapeutic procedure codes (97110-97546) identify the application of clinical skills and/or services that attempt to improve function that requires the physician or therapist to have direct (one-on-one) contact with the patient. These procedure codes do not indicate "supervised" services and to report them to payers in such a manner could result in allegations of misconduct. Consequently, it is imperative for the practitioner (e.g., chiropractor) to obtain prior approval for this billing practice from ALL involved payers notwithstanding the fact that this type of practice activity has previously been found to be consistent with state regulatory standards on delegation. The purpose of seeking the payer's approval is not to enable the payer to make determinations on what practices are legal and what practices are not; rather, it is to protect the individual provider from a payer's unilateral referral of the provider billing practices to law enforcement authorities who may have a differing interpretation of the acceptable standards of delegation that the provider's state regulatory board.
Current Procedural Terminology (CPT) is a listing of (a) descriptive terms and (b) identifying codes. The foregoing is used to report medical services and procedures, as well as to provide a uniform language that accurately describes medical, surgical, and diagnostic services. The use of CPT provides an effective means of reliable nationwide communication among providers, patients, and payers.
The listing of a service or procedure and its code number in a specific section is not restricted to any specific specialty group. Any procedure or service in any section may be used to designate services rendered by any qualified physician or other qualified health care professional. CPT indicates that the terms -"Physician or Therapist" and "Provider" as identified in CPT are interchangeable to refer to someone licensed to perform health care services.
Select the name of the procedure or service that accurately identifies the service performed that is adequately documented in the medical record. Do not select a CPT code that merely approximates the service provided, and that if no such procedure or service exists then report the service using the appropriate unlisted procedure or service.
Suggestions concerning introduction of new procedures, or the coding, deleting, or revising of procedures contained in CPT should be made by contacting the CPT Editorial Research & Development.
The Final Rule for transactions and code sets as part of the Health Insurance Portability and Accountability Act (HIPAA) identifies CPT codes and modifiers as the national standard for health care plans and providers to electronically transmit: Physician services; physical and occupational therapy services; radiological procedures; clinical laboratory tests; other medical diagnostic procedures; hearing and vision services; and transportation services including ambulance.
Does the involved payer reimburse for supervised therapeutic procedures?
Payers often set their own standards for reimbursement of health care services and determine what will be paid, who will be paid, and how much will be paid. Standards may vary from payer to payer, and may differ from those standards established by the provider's own regulatory licensing board. Accordingly, it is the responsibility of all practitioners (e.g., chiropractors) to be familiar with both the payer's billing/coding and their state board's standards and seek to abide by those standards that impose the stricter requirements when seeking reimbursement! By adopting a policy of compliance with the stricter standard the provider will always ensure that he/she is protected from claims of improper billing practices.
Medicare, and other payers following Medicare standards, indicates that therapeutic procedures supervised by (unqualified) unlicensed staff are not reimbursable! Payers with such standards do not pay for provider services, at provider rates, when such services are administered by non-providers. Further, these payers do not maintain that practitioners can not delegate therapeutic procedures to unlicensed assistants but are asserting that such services are not covered and, therefore, they are not reimbursable - BILL THE PATIENT! Medicare Benefits Policy Manual, Chapter 15, Sections 220 and 230 specifies:
Therapeutic procedures are medically necessary only when they require the professional skills of a qualified practitioner, are designed to address specific needs of the patient, and are part of an active treatment plan intended to achieve a specific goal.
Medicare pays only for skilled, medically necessary services delivered by qualified individuals, including therapists or appropriately supervised therapy assistants. Supervising patients who are exercising independently is not a skilled service.
Providers can not bill and seek payment for one-on-one codes (e.g., therapeutic procedures) administered at the same time as other procedures were rendered to the patient, or to other patients.
A physician may not delegate physical therapy services (e.g., therapeutic procedures) to unlicensed persons and report them as "incident-to" services unless that person has the education and clinical experience equivalent to a physical therapist.
Incident-to a physician's professional services are defined (Benefits Policy Manual, Chapter 15, Section 60) as services or supplies furnished by auxiliary personnel as an integral, although incidental, part of the physician's personal professional services in the course of diagnosis or treatment of an injury or illness that are billed to Part B by the physician as if they personally provided them.
Some within chiropractic have differing opinions as to the appropriateness of the delegation and billing of therapeutic procedures. Illustrative of this is the following written opinion of a chiropractor to whom a colleague was referred subsequent to requesting assistance from a State Chiropractic Association regarding the issue discussed herein:
The auditor is confused, to say the least. As a doctor, you can delegate to whomever you wish to perform those [therapeutic procedure] services. You simply must be in the building at the time services are rendered to supervise [sic]. You do not have to perform the treatment yourself, nor do you have to stand over them and watch. This auditor may be confused with what some insurance companies are pushing for and have proposed, i.e., they require the doctor to do it. However, as far as I know, no insurance company has any policy in place to prohibit you from delegating to staff. As far as statute goes in Xx, if an insurance company did write that into their policy, we would have to go to the Xx with complaint. The P.T.'s would love to have those rules in place as well. Short answer is the auditor is wrong. Maybe some other state he/she is familiar with has that as a rule. Not here though.
The bottom-line is that due-care and good judgment must be exercised by chiropractors in this risk area, as missteps could result in administrative, civil and/or criminal exposure. A few years ago chiropractors, similarly instructed on use of "incident-to" to increase income, billed for their rendered services under the license of an associated medical doctor in MD/DC practices so as to avoid limited chiropractic (insurance) coverage. Several of these doctors, including a highly prominent chiropractic consultant who advised them on the use of "incident to" billing, are now serving federal prison sentences. Many chiropractors have learned the hard way that "incident-to" does not allow for the misrepresentation of the actual service provider to facilitate reimbursement for services that would otherwise be non-covered.
Article Source: http://EzineArticles.com/?expert=Daniel_J_Osborne
Sunday, September 28, 2008
Hatch is pushing medication bill
WASHINGTON -- Dietary supplement and over-the-counter medications would have a new mandatory reporting system for any illnesses, death or other problems associated with their products, based on a bill introduced Wednesday by Sen. Orrin Hatch, R-Utah, and Sen. Dick Durbin, D-Ill.
The new bill builds on the Dietary Supplement Health and Education Act that Hatch sponsored and Congress supported in 1994. Right now, the Food and Drug Administration regulates these two types of products, but there is only a voluntary system for companies to report any problems.
Under the bill, manufacturers, packers or distributors of over- the-counter drugs or dietary supplements would need to file a report to the FDA within 15 days of any reported incident of an adverse health effect specified in the bill such as death, inpatient hospitalization, birth defects and several others. They would also have to keep records for six years of any reported health problem, even if it is not under a "serious" one listed in the legislation.
"This is an important public health initiative, which at the same time safeguards access to dietary supplements and over-the-counter drugs," Hatch said.
The Utah Natural Products Association, National Nutritional Foods Association, the Center for Science in the Public Interest and the Council for Responsible Nutrition all support the bill.
Durbin said the "strange bedfellows" coming together to support the legislation -- he and Hatch do not always see eye to eye -- demonstrates the quality of the bill.
"Those who are selling dangerous products will have to face the music," Durbin said.
Sen. Tom Harkin, D-Iowa, also a co-sponsor of the bill, said that filing a report is not evidence of anything and does not automatically mean a product is unsafe but it could lead the government to discover where there might be a problem. Harkin said if this was in place problems associated with ephedra would not have happened.
"This is another example of how good legislation can come out of a serious situation," Harkin said.
The Senate Health, Education, Labor and Pensions Committee will take up the bill next week, and Hatch hopes it will be passed this year. There is no identical bill in the House yet.
Hatch did not know an exact cost of the reporting procedures and other protocol laid out in the bill but estimates say about $2 million for over-the-counter-drugs and $2 million for supplements.
The new bill builds on the Dietary Supplement Health and Education Act that Hatch sponsored and Congress supported in 1994. Right now, the Food and Drug Administration regulates these two types of products, but there is only a voluntary system for companies to report any problems.
Under the bill, manufacturers, packers or distributors of over- the-counter drugs or dietary supplements would need to file a report to the FDA within 15 days of any reported incident of an adverse health effect specified in the bill such as death, inpatient hospitalization, birth defects and several others. They would also have to keep records for six years of any reported health problem, even if it is not under a "serious" one listed in the legislation.
"This is an important public health initiative, which at the same time safeguards access to dietary supplements and over-the-counter drugs," Hatch said.
The Utah Natural Products Association, National Nutritional Foods Association, the Center for Science in the Public Interest and the Council for Responsible Nutrition all support the bill.
Durbin said the "strange bedfellows" coming together to support the legislation -- he and Hatch do not always see eye to eye -- demonstrates the quality of the bill.
"Those who are selling dangerous products will have to face the music," Durbin said.
Sen. Tom Harkin, D-Iowa, also a co-sponsor of the bill, said that filing a report is not evidence of anything and does not automatically mean a product is unsafe but it could lead the government to discover where there might be a problem. Harkin said if this was in place problems associated with ephedra would not have happened.
"This is another example of how good legislation can come out of a serious situation," Harkin said.
The Senate Health, Education, Labor and Pensions Committee will take up the bill next week, and Hatch hopes it will be passed this year. There is no identical bill in the House yet.
Hatch did not know an exact cost of the reporting procedures and other protocol laid out in the bill but estimates say about $2 million for over-the-counter-drugs and $2 million for supplements.
Medical practice bill not voted on
A bill excluding Kansas physicians and other health professionals from the state's consumer protection law may become a legislative fatality.
The Senate Judiciary Committee passed Thursday on an opportunity to vote on a House bill drafted after the Kansas Supreme Court ruled deceptive acts and practices of medical professionals fell under the Kansas Consumer Protection Act.
Physicians, nurses, veterinarians, anesthesiologists, pharmacists and radiologists had reacted to the Supreme Court's decision by insisting the Legislature approve a statute nullifying it .
Opposition for the House bill had surfaced from the Kansas Trial Lawyers Association, Attorney General Paul Morrison and AARP of Kansas.
"We ran out of time," said Sen. John Vratil, R-Leawood, and chairman of the Judiciary Committee.
His committee met Thursday for the final time in the 2007 session, but the health industry exemption could be amended to other legislation before adjournment in April.
Another option, Vratil said, would be to refer the issue to an interim legislative committee. That panel's report would be due before the start of the 2008 session in January.
Jerry Slaughter, executive director of the Kansas Medical Society, said legislators need to declare the exemption clearly in state law.
Otherwise, he said, plaintiffs will file consumer protection claims in addition to medical malpractice lawsuits.
"It will raise the cost of defense and interject a new element into an already difficult situation," he said.
The Supreme Court ruling stems from the case of a Parker woman who sued an orthopedic surgeon in 1999. Two surgeries on Tracy Williamson by Dr. Jacob Amrani, formerly of Wichita, were supposed to relieve her back pain. Amrani told her the procedure was highly likely to succeed when it actually hadn't worked in a majority of cases in which he had performed the procedure. Her medical condition deteriorated after the operations.
The Supreme Court found Williamson could bring a claim under the Kansas Consumer Protection Act related to Amrani's conduct in providing treatment.
Callie Hartle, spokeswoman for the Kansas Trial Lawyers Association, said the House bill was flawed because it "would create the broadest exemption to a consumer protection act of any state in the nation with regard to the health care industry."
Passage of the bill will trigger a landslide of pleas from other professions or industries for an exemption, she said.
"We'll have a consumer protection act that is Swiss cheese," she said.
The Senate Judiciary Committee passed Thursday on an opportunity to vote on a House bill drafted after the Kansas Supreme Court ruled deceptive acts and practices of medical professionals fell under the Kansas Consumer Protection Act.
Physicians, nurses, veterinarians, anesthesiologists, pharmacists and radiologists had reacted to the Supreme Court's decision by insisting the Legislature approve a statute nullifying it .
Opposition for the House bill had surfaced from the Kansas Trial Lawyers Association, Attorney General Paul Morrison and AARP of Kansas.
"We ran out of time," said Sen. John Vratil, R-Leawood, and chairman of the Judiciary Committee.
His committee met Thursday for the final time in the 2007 session, but the health industry exemption could be amended to other legislation before adjournment in April.
Another option, Vratil said, would be to refer the issue to an interim legislative committee. That panel's report would be due before the start of the 2008 session in January.
Jerry Slaughter, executive director of the Kansas Medical Society, said legislators need to declare the exemption clearly in state law.
Otherwise, he said, plaintiffs will file consumer protection claims in addition to medical malpractice lawsuits.
"It will raise the cost of defense and interject a new element into an already difficult situation," he said.
The Supreme Court ruling stems from the case of a Parker woman who sued an orthopedic surgeon in 1999. Two surgeries on Tracy Williamson by Dr. Jacob Amrani, formerly of Wichita, were supposed to relieve her back pain. Amrani told her the procedure was highly likely to succeed when it actually hadn't worked in a majority of cases in which he had performed the procedure. Her medical condition deteriorated after the operations.
The Supreme Court found Williamson could bring a claim under the Kansas Consumer Protection Act related to Amrani's conduct in providing treatment.
Callie Hartle, spokeswoman for the Kansas Trial Lawyers Association, said the House bill was flawed because it "would create the broadest exemption to a consumer protection act of any state in the nation with regard to the health care industry."
Passage of the bill will trigger a landslide of pleas from other professions or industries for an exemption, she said.
"We'll have a consumer protection act that is Swiss cheese," she said.
MPMsoft chosen by Empower as patient scheduling and medical billing software
Empower Technologies Inc, a provider of speciality specific electronic medical record software systems, has chosen MPMsoft, a provider of electronic billing software solutions for the healthcare industry, as its front-office patient scheduling and back-office electronic medical billing software solution.
Empower's SonoSoft is an EMR (electronic medical record), designed for phlebology and venous surgery. SonoSoft's Vein Specialist module produces reports of every procedure, including a complete initial workup, endovenous ablation procedures (laser or radiofrequency) and follow-up visits for sclerotherapy, and can automatically generate a CEAP classification.
The company said it believes the partnership with MPMsoft will give it a combined product that meets the specialised needs of vein surgery practices, providing a seamless operation between the two programs.
No financial details were disclosed.
Empower's SonoSoft is an EMR (electronic medical record), designed for phlebology and venous surgery. SonoSoft's Vein Specialist module produces reports of every procedure, including a complete initial workup, endovenous ablation procedures (laser or radiofrequency) and follow-up visits for sclerotherapy, and can automatically generate a CEAP classification.
The company said it believes the partnership with MPMsoft will give it a combined product that meets the specialised needs of vein surgery practices, providing a seamless operation between the two programs.
No financial details were disclosed.
Friday, September 26, 2008
Medical Billing and the Discrepancy Paradox of the Rising Healthcare Costs
Health care spending continues to rise at the fastest rate in our history. In 2005, total national health costs rose 6.9 percent -- twice the rate of inflation - reaching $2 trillion, or $6,700 per person [Catlin, Cowan, Heffler, et al, 2006]. Currently, total health care spending represents 16 percent of the gross domestic product (GDP). In the next decade, U.S. health care spending is expected to increase at similar levels, reaching $4 trillion in 2015 [Borger et al, 2006].
While some experts maintain that our health care system is costly because it is riddled with inefficiencies, excessive administrative expenses, inflated prices, poor management, waste, inappropriate care, and fraud [Health Insurance Cost, National Coalition on Health Care, 2008], at least three remaining key factors, namely, aging population, expensive medical innovation, and defensive care, contribute substantially, to the overall cost picture.
1. Aging population
In the United States, the proportion of the population aged >65 years is projected to increase from 12.4% in 2000 to 19.6% in 2030. The number of persons aged >65 years is expected to increase from approximately 35 million in 2000 to an estimated 71 million in 2030, and the number of persons aged >80 years is expected to increase from 9.3 million in 2000 to 19.5 million in 2030 [Public Health and Aging: Trends in Aging --- United States and Worldwide, 2008; Kaiser Family Foundation, 2006].
"The growing number of older adults increases demands on the public health system and on medical and social services. Chronic diseases, which affect older adults disproportionately, contribute to disability, diminish quality of life, and increased health- and long-term--care costs." [UN, 2002] 125 million Americans have one or more chronic conditions (e.g. congestive heart failure, diabetes.) Chronic diseases account for 75% of all health care expenditures. Source: Burrill & Company, 2006
2. Expensive innovation
* The American biotechnology industry has surpassed pharmaceutical companies for the third straight year as the primary source of new medicines, and biotech revenue jumped nearly 16 percent to a record $50.7 billion in 2005. Source: Ernst & Young LLP, 2006
* The USA is the world's largest and wealthiest pharmaceutical market, accounting for around 48% of the world total. Per capita expenditure on drugs is US $1,069 in 2006, nearly double the level found in the rest of the world. Source: Espicom Business Intelligence, 2006
* ...an estimated 30% of new products under development are "combo products" - involving medical devices embedded with pharmaceutical or biologics components. [Combination Products- Navigating Two FDA Quality Systems, Microtest White Paper, 2007]. The combination products market is estimated at $5.9B in 2004, and will continue to grow at a compound annual rate of 10% through 2009. By 2009, the market is expected to reach approximately $9.5B worldwide with a majority of these revenues from drug-eluting stents and steroid-eluting electrodes. Source: Navigant Consulting, Inc. In 2004, the US held approximately 65% of the drug-device combination product market. By 2010, the US is projected to hold 57%. Source: Business Communications Inc.
3. "Defensive" Medicine
"One of the major cost drivers in the delivery of health care are these junk and frivolous lawsuits. The risk of frivolous litigation drives doctors -- and hear me out on this -- they drive doctors to prescribe drugs and procedures that may not be necessary, just to avoid lawsuits. That's called the defensive practice of medicine.. . . . See, lawsuits not only drive up premiums, which drives up the cost to the patient or the employer of the patient, but lawsuits cause docs to practice medicine in an expensive way in order to protect themselves in the courthouse. The defensive practice of medicine affects the federal budget. The direct cost of liability insurance and the indirect cost from unnecessary medical procedures raise the federal government's health care costs by at least $28 billion a year." [US President George Bush, Arkansas, January 26, 2004]
Now let us observe the paradox:
1. On one hand, the participants of every ancillary industry to health care, including insurance companies, hi-tech and pharmaceutical engineers and scientists, as well as lawyers, have increased their profits in step with the rising costs of health care at ever accelerating pace.
2. On the other hand, the medical and chiropractic office owners - the actual health care providers - have not only failed to keep up with raising costs but have lost a significant part of their income. In fact, between 1995 and 1999, at a time when most wages and salaries in the United States rose 3.5 percent after adjusting for inflation, average physician net income from the practice of medicine, adjusted for inflation, dropped 5 percent [Reed and Ginsburg, 2003]. In 2006, the median compensation for specialty and primary physicians grew only 1.7 ($322,259) and 2 ($171,519) percent respectively, slower than consumer price index of 3.2 percent [MGMA Physician Compensation and Production Survey: 2007 Report]. In comparison, health care costs beat the inflation by 3.5% reaching the annual growth rate of 6.7 [Health Care Spending, 2008]
Diverting our focus away from trying to find solutions to the problem of rising health care costs, we ask a different question: How such a paradoxical situation is possible without a deliberate and systematic strategy against health care providers?
While some experts maintain that our health care system is costly because it is riddled with inefficiencies, excessive administrative expenses, inflated prices, poor management, waste, inappropriate care, and fraud [Health Insurance Cost, National Coalition on Health Care, 2008], at least three remaining key factors, namely, aging population, expensive medical innovation, and defensive care, contribute substantially, to the overall cost picture.
1. Aging population
In the United States, the proportion of the population aged >65 years is projected to increase from 12.4% in 2000 to 19.6% in 2030. The number of persons aged >65 years is expected to increase from approximately 35 million in 2000 to an estimated 71 million in 2030, and the number of persons aged >80 years is expected to increase from 9.3 million in 2000 to 19.5 million in 2030 [Public Health and Aging: Trends in Aging --- United States and Worldwide, 2008; Kaiser Family Foundation, 2006].
"The growing number of older adults increases demands on the public health system and on medical and social services. Chronic diseases, which affect older adults disproportionately, contribute to disability, diminish quality of life, and increased health- and long-term--care costs." [UN, 2002] 125 million Americans have one or more chronic conditions (e.g. congestive heart failure, diabetes.) Chronic diseases account for 75% of all health care expenditures. Source: Burrill & Company, 2006
2. Expensive innovation
* The American biotechnology industry has surpassed pharmaceutical companies for the third straight year as the primary source of new medicines, and biotech revenue jumped nearly 16 percent to a record $50.7 billion in 2005. Source: Ernst & Young LLP, 2006
* The USA is the world's largest and wealthiest pharmaceutical market, accounting for around 48% of the world total. Per capita expenditure on drugs is US $1,069 in 2006, nearly double the level found in the rest of the world. Source: Espicom Business Intelligence, 2006
* ...an estimated 30% of new products under development are "combo products" - involving medical devices embedded with pharmaceutical or biologics components. [Combination Products- Navigating Two FDA Quality Systems, Microtest White Paper, 2007]. The combination products market is estimated at $5.9B in 2004, and will continue to grow at a compound annual rate of 10% through 2009. By 2009, the market is expected to reach approximately $9.5B worldwide with a majority of these revenues from drug-eluting stents and steroid-eluting electrodes. Source: Navigant Consulting, Inc. In 2004, the US held approximately 65% of the drug-device combination product market. By 2010, the US is projected to hold 57%. Source: Business Communications Inc.
3. "Defensive" Medicine
"One of the major cost drivers in the delivery of health care are these junk and frivolous lawsuits. The risk of frivolous litigation drives doctors -- and hear me out on this -- they drive doctors to prescribe drugs and procedures that may not be necessary, just to avoid lawsuits. That's called the defensive practice of medicine.. . . . See, lawsuits not only drive up premiums, which drives up the cost to the patient or the employer of the patient, but lawsuits cause docs to practice medicine in an expensive way in order to protect themselves in the courthouse. The defensive practice of medicine affects the federal budget. The direct cost of liability insurance and the indirect cost from unnecessary medical procedures raise the federal government's health care costs by at least $28 billion a year." [US President George Bush, Arkansas, January 26, 2004]
Now let us observe the paradox:
1. On one hand, the participants of every ancillary industry to health care, including insurance companies, hi-tech and pharmaceutical engineers and scientists, as well as lawyers, have increased their profits in step with the rising costs of health care at ever accelerating pace.
2. On the other hand, the medical and chiropractic office owners - the actual health care providers - have not only failed to keep up with raising costs but have lost a significant part of their income. In fact, between 1995 and 1999, at a time when most wages and salaries in the United States rose 3.5 percent after adjusting for inflation, average physician net income from the practice of medicine, adjusted for inflation, dropped 5 percent [Reed and Ginsburg, 2003]. In 2006, the median compensation for specialty and primary physicians grew only 1.7 ($322,259) and 2 ($171,519) percent respectively, slower than consumer price index of 3.2 percent [MGMA Physician Compensation and Production Survey: 2007 Report]. In comparison, health care costs beat the inflation by 3.5% reaching the annual growth rate of 6.7 [Health Care Spending, 2008]
Diverting our focus away from trying to find solutions to the problem of rising health care costs, we ask a different question: How such a paradoxical situation is possible without a deliberate and systematic strategy against health care providers?
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