Speed and accuracy. What all medical practices and billing companies strive for, which seems to be the opposite of healthcare reform with the introduction of time-consuming value-based compensation models. On top of that, failure to stay up to date with billing rules and regulations result in major billing errors, which means less revenue and unhappy patients. So, how do you avoid these billing errors and accelerate your collections performance? Here are 4 medical billing tips that will boost reimbursement immediately, and yes, they actually work!

1. Capture the patient-responsible revenue you resolved to write off.
2. Use business intelligence to identify areas for improvement.
3. Create hands-free claims generation and submission.
4. Streamline your collections process with artificial intelligence.

 

What is Medical billing reimbursement?

Healthcare reimbursement is the means by which healthcare providers are compensated by either a private insurance company or through government payers for services or procedures rendered. Unlike most service industries, healthcare providers are often compensated months after a services is performed. The amount reimbursed for said procedure is determined by it's ascribed CPT code, the patient's co-pay, and the agreed upon amount in a payer's contract.

Capture the Patient-responsible Revenue you Resolved to Write Off.

Unfortunately, the vast majority of patients don’t have a clear understanding of how their health insurance coverage works. In a recent survey taken by over 2,000 Americans, only 4% of respondents could define all four common health insurance terms: deductible, coinsurance, co-pay, and out-of-pocket maximum. With such limited understanding of health insurance, the chances of collecting on patients is drastically reduced. However, arming yourself with the right tools will allow you to identify the correct insurance coverage which can be applied to a patient visit for payment. ImagineDiscovery™ checks for patient coverage that can be applied to their previous claim, then identifies incremental revenue from insurance for patients who may not have had (or didn’t understand if they had) coverage at time of service and from A/R that is going to be written off.

Use Business Intelligence (BI) to Identify Areas to Improve Medical Billing Reimbursement.

The best way to make informed data-driven decisions about medical billing management is through a business analytics tool. BI allows the user to run custom reports to assess financial performance from every angle of the business, from collection rates to staff productivity. Through business intelligence, billing companies can also give their clients insight into how their practices are performing and where there is area for improvement. By reviewing data, you can set realistic expectations and develop ways to meet goals. Data is solid and reliable, so you know you can make accurate decisions.

Create Hands-free Claims Generation and Submission.

How many hours could you save in staff time if your claims processing was completely automated? Especially for billing companies who bill multi-specialty, it’s impossible to be time or cost-efficient in manual claim submission. With an automated claims processing workflow each step is hands-free including charge coding, checks against payer rules, and submission for payment. Staff members are given much more functionality and can shift gears to focus their efforts on other responsibilities.

Streamline Your Collections Process with Artificial Intelligence.

Think about how much time and money you spend attempting to collect on patients compared to how many actually pay their bills. If you’re not segmenting your patients according to their propensity to pay and customizing the collections process around that information, you should be. There are medical billing AI applications that customize a patient’s statement cycle depending on whether the patient is eligible for the primary insurance listed on the visit before you send a claim to insurance. Based on that information, the application customizes the collections process and even provides alternative payment methods for financial aid. This helps reduce denials and the number of statements sent to patients. With a little luck, these medical billing tips will give you the edge you need to avoid unnecessary billing errors and accelerate your collections.

Medical billing reimbursement is much more than patients paying their bills. It is a critical component of your company’s cash flows. A good system for medical billing is also essential for avoiding costly errors. Applying any of the medical billing tips discussed here can help you improve your medical billing process.

I recently read an article over my morning coffee that said doctors leave approximately $125 billion on the table each year due to poor billing practices. Believe it or not, that's only a small piece of the pie. Groups like the Medical Billing Advocates of America estimate 80-90 percent of medical bills contain errors that result in doctors not being paid correctly. The Center for Medicare and Medicaid Services (CMS) released data in 2018 stating billing errors resulted in a $31.5 billion dollar loss to Medicare, accounting separately for cases of fraud.

When a billing system is outdated, the organization will suffer from billing mistakes like mismatched procedures, lengthy claims processes, failure to collect co-pays, and forgetting to stay current on coding. At the end of the day, efficiency of your medical billing automation operations majorly affects the success of your business.

So, do you think your medical claims billing software has what it takes to keep you running at peak efficiency? Perhaps you do. But as the saying goes, knowledge is power, and if you don't know exactly how billing software should improve your workflow processes and bottom line, you’ll never realize your full potential to improve and earn.

What Should Your Medical Billing Software Programs Improve?

There are certain features of medical claims billing software you should consider whether you’re opening a new medical office and need a software that can be used efficiently out of the box, or you’re an established medical practice looking to scale your current operations. Below is a list of features common in medical billing software programs that will help your practice through its growth phase and into maturation:

1. Workflow Automation. Billing automation is essential in a high-volume, complex medical billing workflow. From the moment a patient steps into the front office to actually receiving payment. Automated billing identifies billing errors before a claim is even submitted, leading to cleaner claims and faster turnaround. Not only that, payments can be posted automatically to expedite the billing cycle.
2. Turnaround Time. The speed and efficiency at which you turn claims into cash is a big determinate of whether or not a practice will thrive. The more optimized your submissions, the better your chances at a successful first pass rate will be. On the other hand, patient self-pay (including co-pays, deductibles, etc.) provide a large portion of patient services revenue. Your ability to collect on those balances in a timely manner drastically influences your bottom line.
3. Data Analysis Tools. Even if you're profitable, there are probably cashflow kinks and untouched revenue streams that you’re unintentionally missing. With the right analytics in place, you can identify your practice’s strengths and weaknesses, while identifying areas for improvement and new revenue streams.
4. Built-In Security. Medical billing software programs should provide patient information security that is HIPAA compliant. You can access clinical data, financial transactions and insurance information instantly and securely while staying up-to-date with the latest federal regulations.
5. Cost/Time Reduction. Your medical billing software should do all the heavy lifting for you. Your staff shouldn't spend long hours on data entry or claim submissions. It should also prevent the need to hire extra hands in the future.

What is Automated Medical Billing Software?

Automated medical billing is a process when charge entry, claim scrubbing, and remittance are all performed automatically through timers and natural language processing every day, week or month depending on how often your business submits claims. As a result, the medical billing system improves cash flow, simplifies processes and streamlines medical billing workflow. Essentially, your organization is paid faster and more often.

Another important but often overlooked component of medical billing software programs is your health insurance billing software. Every healthcare insurance company has its own set of complicated guidelines. Health insurance billing software improves your quality of care by giving more time back to your staff to help patients. Health insurance billing software lets you file claims electronically, check the status of a claim, fix errors in your insurance claims, and receive payment in fewer days than what is allowed with a manual process. Best of all, healthcare insurance billing software integrated with your overall medical billing software allows you to automate the process, helping move claims seamlessly through the revenue cycle from submission to reimbursement.

Now that you really know what automated medical billing looks like, are you experiencing that "Where have you been all my life" moment? Yeah, that's the difference between life with versus without the best medical claims billing software.

Denials can be a huge pain for any healthcare practice - costing time, money, and unavoidable frustration. However, there are some things you can do to help minimize the number of denials, maximizing your practice’s efficiency and revenue. In this blog post, we'll share 5 tips for managing denials so you can keep your practice running smoothly.

Develop relationships with payers

Developing relationships with insurance payers is a great way to give healthcare providers the edge they need in healthcare denial management. Working together, healthcare providers and payers can optimize reimbursement and payment strategies while ensuring that healthcare services are appropriately delivered. A strong relationship with the payer could help healthcare providers reduce denials due to incorrect coding or lack of prior authorization. Additionally, knowing the expectations of payers can help healthcare providers minimize their administrative tasks related to denying or appealing denials. All in all, forming productive relationships with payers can be a beneficial way to create a mutually beneficial relationship between both parties. Learn more about payer contract management during our on-demand webinar, “ImagineInsights - Contract Management to Combat NSA.”

Identify frequent denials and resolutions

Denials can take a serious toll on healthcare organizations. They cause huge delays in payments, disrupt cash flow, and pull focus away from more important billing operations. To prevent these costly occurrences, adopting automated denial management is paramount. Automated denial management keeps errors and inaccuracies to a minimum while automated claim submission ensures that everything gets delivered properly and quickly. An automated approach also gives providers more time to identify the causes of denials and take proactive steps to resolve them, preventing future recurrences. It is essential for medical practices to invest in automated denial management to increase revenue, save time and remain compliant with regulations.

 

Automate the RCM process

Implementing automated RCM systems can be crucial for improving the efficiency of the revenue cycle process. ImagineBilling’s automation helps improve accuracy and optimize compliance while speeding up traditionally slow manual tasks. It also enables organizations to strengthen operational control, optimize cash flow, reduce overhead costs, prevent denials and grievances, and streamline processes. Automating the revenue cycle can create a 360-degree view of patient visit data that is key to accurate billing and coding -- all while empowering stakeholders with actionable insights. All these benefits make automated RCM systems essential investments for any organization looking to streamline their revenue cycle process.

Train your team 

Training your team is an essential step to achieving success when understanding insurance denials. With a knowledgeable team in place, understanding processes and understanding how to address payer issues quickly and efficiently are tasks that can easily be accomplished. In order to make sure everyone is working towards the same goal, developing rapport with payers is key. It’s not just about understanding their processes, but also the people behind them. That understanding helps to ensure overall success because it helps open the lines of communication, which reinforces teamwork in order to clear any roadblocks that arise along the way.

Learn more about...

A Radiology Practice’s training process, transitioning to more innovative and automated billing solutions.

Client Testimonial - Innovation, Training

 

A Medical Billing Company’s ability to get a new employee up-to-speed in one day.

Client Testimonial - Training

 

A Radiology Practice’s first year using ImagineSoftware.

Client Testimonial – Training & Product Customizations

 

Negotiate with Payers as needed

Negotiating with payers doesn't have to be the overwhelming, daunting process that it once was. Today, the art of negotiation is a key piece of the healthcare denial management puzzle and can make the difference between the success or failure of a practice or facility. With the right tactics and the necessary skills, negotiating with payers can become a positive experience in the bigger picture of healthcare reimbursement. Want to learn more? Watch on on-demand webinar, “Navigating Negotiations - A Payer Contract Workshop,” showcasing proven payer negotiation strategies and best practices, setting your practice up for success. Managing and decreasing denials is a vital component of a healthy revenue cycle.  By following these five tips, you can increase your practice’s productivity, accuracy, and ultimately, revenue!

Learn more about ImagineSoftware’s complete revenue cycle management platform here. Feel free to reach out to us for a one-on-one conversation, where we’re happy to provide comprehensive information about our services and how we can benefit your unique organization.

Including anesthesiology, radiology, palliative care, and audiology

CompMed works with a wide variety of specialties, filling claims across 35 sates. Each specialty has a unique coding and billing need, calling for a configurable software solution equipped with automation and reporting that can keep up with a multitude of demands. With ImagineBilling^TM and ImaginePay^TM ComMed has been able to:

• Pull customized data for each client's unique set of requests and needs
• A real person answer patient questions and process payments through an online portal
• Accommodate anesthesia billing through a configurable billing solution

In this article, we will explore some of the challenges associated with medical billing in practice management, as well as the benefits of automating your current practice management system software.

Everyone in healthcare knows receiving payments is hard. They know it’s not just one thing that makes it hard. It’s all the small, routine tasks that are never reported, all the conversations, and all the files moving between systems that are never mentioned in your monthly report, determine your budget, and help to make smarter business decisions.

Industry experts have been saying for the past five years how a surge of automation is leading to the next big change in healthcare. One example we meticulously follow is the day to day operations and financial impact of automation on medical billing and practice management.

What is a Practice Management System?

A medical practice management system is software used by large hospitals, medical offices, and group practices to manage the front end and back end of their daily operations. Some of the medical practice management features include eligibility checks, pre-authorization, payment estimation, billing and coding, payment posting, and reporting. An integrated medical practice management system like ImagineSoftware allow you to enter and track patient demographics and billing information, translate procedure codes to claims, process those claims, and receive payment from a single system. For high-volume and complex billing, automation removes some of the labor-intensive tasks, where 95% of your payment posting can be performed with no human intervention.

What is a Practice Management System Used for in a Medical Office?

Practice management systems are used to run the business side of a medical office, including scheduling, insurance claims, billing and accounting. Practice management systems typically do not include a patient’s medical records, but they can integrate with EMRs for a more robust view of a patient’s experience.

Practice Management System vs. EMR. There is some overlap between features included in an EMR versus a practice management system. EMRs focus primarily on the clinical side of a medical practice management systems focus primarily on the administrative side. Common features of an EMR include document scanning, charting, medication tracking, and appointment scheduling. Common features of a practice management system include the following:

 

• Patient Scheduling and Registration - setting an appointment via an online portal or with the front desk; providing demographic data, updated contact details, and payer information
• Eligibility Check and Demographic Verification - including pre-authorization, instantly highlights issues with payer compatibility. Resolving these issues prior to a patient visit can reduce your denial rate later
• Coding and Review - translating medical practice diagnostics, equipment and procedures as billable records while reducing instances of denials due to incorrect or missing information
• Collection of Co-pay/Balance - the fixed amount received from a patient for a service immediately after the appointment or soon after
• Claim Management - creating, validating and submitting a claim to a clearinghouse or payer, either electronically as an e-claim or manually as a paper claim
• Correcting Errors/Denials - systematically addressing the causes of why a claim was rejected or denied before resubmitting it for consideration
• Payment Posting - posting payments into the respective patient accounts against a particular claim to reconcile them
• Patient Statement and Communication - sending patient invoices and reminders via their preferred method of contact, either over the phone, through email, or as a printed statement
• Analytics/Data Analysis - comprehensive financial dashboards can help you and your team analyze the performance of your practice at a single glance

Is it Possible for Any Existing Practice Management Systems to be Integrated with the EHR or EMR?

The short answer is, Yes. Any practice management system can theoretically be integrated with any EHR, so long as they can share data seamlessly. You’ll know if your practice management system and EHR are integrated if a patient’s medical records and insurance information are available in the same place and change one another at the same time.

For more detail, it’s important to distinguish between an integration and an interface. An interface is a feature that connects two or more independent systems, so they can communicate with data in a standard file format that’s stored in multiple locations. As such, there will often be restrictions on what information can be transmitted between the EHR and the practice management system. Data maintained in one location is usually indicative of a full integration. Instead of a patchwork of applications desperately trying to talk, the systems share a common code and database.

Integrating complex systems comes with its own social and technical challenges. Social challenges include regulatory restrictions, political constraints, and navigating operational requires of backend billing staff with front end administrative requirements. Technical challenges include building around legacy, premise systems, and cloud-based applications.

Challenges Associated with Medical Billing in Practice Management

Obstacles in implementing a medical practice management software include a lack of time to set up the infrastructure, lack of expertise, and system privacy/security:

• Security and privacy of web-based or cloud-based practice management software is a concern when hosted on another company’s server. Since this software is available from anywhere with a web connection, it’s also vulnerable to attacks by cybercriminals. Consider the financial and reputational risks related to use of third parties for core services. If security is a priority, check out ImagineMedFM^TM VPN, encryption, and user authentication.
• Billing and collections, charge capture and coding was rated as one of the top risk areas for healthcare organizations in 2019. While outsourcing medical billing is a common method for offloading organizational tasks, lack of visibility into controls of third-party systems can result in lost revenue and lower claim resolve rates. Furthermore, outsourcing occasionally requires careful supervision to ensure business and patient experience standards are upheld.
• Value-based care holds a healthcare organization accountable for both the clinical and financial outcomes of a patient’s care. 36% of hospital system executives are exploring medical practice management systems that will allow them to streamline financial and clinical systems. This challenge increases exponentially for multi-specialty practices whose claims are spread out across multiple billing systems.
• Staff turnover and retaining talent affects provider workloads, patient outcomes and costs when managed using manual billing systems. Some doctors will choose employment with a healthcare system as a way to avoid the clerical responsibilities associated with running their own practice. For practice owners who remain independent, they are faced with the challenge of providing the necessary training and resources their staff needs to manage their day to day.

Benefits of Automated Practice Management System Software

Products like ImagineBilling^TM built for high-volume, complex medical billing can be configured to your current practice management software workflow while automating it in the following ways:

• Real-time validation of demographic information, insurance eligibility checking, and pre-authorization makes quick work of top sources of claim denials.
• Claim generation, scrubbing and submission automatically looks for issues in your claims before they are sent to your clearinghouse or payer.
• Electronic Remittance to automatically post insurance payments and reconcile balances much faster than can be done manually.
• Real-time analytics and business intelligence gives you centralized access to business information and status reports for making smarter business decisions.

End-to-end medical billing software