EMS and Fire Department Billing Solutions, Help in the Midst of Chaos

Chaos is hard to control. Working in the medical industry, including EMS and fire department, may be filled with chaos everyday with patients; if not patients, then paperwork to catch up on billing. News reports show some patients don't receive ambulance billing until well after trips to the hospital. The amount of time between hospital visits and making a payment goes so far that patients potentially forget they are in debt. While ambulance billing services controls the status of patient's bills; yet, I don't see anyone is at fault or to blame. It's just chaos. EMS and fire departments have help available to them. Third parties are often being added into the chaos to keep it from spreading and get things organized.

EMS billing gathers current charges, reimbursements, and compliance resources per account. This gives a better understanding of the business that has been going on. This is pre-dispatch work. There are various departments billing companies' work through, such as data import, insurance, coding, or pre-collection. Agencies struggling to process bills and other paper work should consider ways to reduce administrative costs and optimize revenue. There are a few billing ways that help the chaos. Beyond pre-dispatch services, consultations can be utilized throughout your contract with an independent party. Aside from the paper work, an ambulance billing company focuses on full compliance, patient care and manageability. Meaning they will do more for you than organize. They want agencies to be involved in the process where you know and have access to all necessary information to manage EMS operations.

It's not often society associates the fire department with ambulances; yet alone include the fire department with medical industry as I did above. I guess I'm correlating them in the sense of that they are apart of rescuing teams. Fire service billing is an option for municipal offices experiencing budget challenges. As this happens around the country, alternative funding sources are needed to fulfill that financial void. So fire department billing collects department services like hazardous materials, specialty rescue, fire suppression, and motor vehicle accident response and extrications. For both EMS and fire department billing, third party company's services are all encompassing. They bill the correct party, collect payments and keep full track of every transaction for your viewing needs as well. When it's all said and done, it's still your agency's responsibility to know about the right accounts. Billing solutions are there for support and getting paperwork organized.

Is the Job Growth Affected by the Existence of Software That Handles Medical Billing and Coding?   General Overview of the Medical Billing and Coding Process   

The Importance of Medical Billing Codes

The process of medical billing is an interaction between a health care professional and the insurance company. By submitting and following up on insurance claims, healthcare providers receive payment for services they render. Medical billing codes play an important role in this process because they determine the amount of reimbursement the healthcare provider receives. Various codes exist for diagnosis, treatment, drugs, dental services, Medicare, and hospital treatment.

When a patient visits the doctor, a medical record is created. The doctor issues a diagnosis or cites a reason for the visit. A level of service is established, based on patient history, comprehensiveness of a physical examination, and complexity of medical decision making. This service level is subsequently converted to standardized procedure code taken from the Current Procedural Terminology (CPT) database. The diagnosis is also translated to a numerical code, taken from an ICD-9-CM database.

To arrive at these codes, medical coders translate the doctor notes from the patient visit into the proper numerical sequences. Treatment and diagnosis codes are listed on the claim form transmitted to the insurance company. Electronic transmission is the most common method, replacing paper forms used in the past. Medical claim adjusters or examiners with the insurance company process the claims. An approved claim is reimbursed at a certain percentage of billed services pre-negotiated by the insurance company and healthcare provider.

If a medical coder does not understand how to determine and assign the correct codes, the claim will be rejected by the insurance company. A rejected claim is returned to the healthcare provider, usually in the form of an electronic remittance advice or explanation of benefits, also called an EOB. The provider must then decipher the information, reconcile the details with the claim originally submitted, make any necessary corrections to the claim, and submit the revised claim to the insurance company.

Though these extra steps may not seem time or labor intensive for one claim, consider the hundreds of claims submitted by a single healthcare provider each week. In some cases, claims may be rejected and resubmitted multiple times before they are paid in full. It is not uncommon for a provider to eventually give up and accept incomplete reimbursement. To avoid loss of income for the provider, medical coders should assign the correct codes the first time the claim is submitted.

Nearly 50 percent of the time, a claim is either denied, rejected, or overpaid. This is due to the highly complex nature of some claims and errors resulting from similarities that exist with diagnoses. In some cases, the insurance company is to blame for attempting to get away without covering certain services. After the medical coder makes a small adjustment and resubmits the claim with relevant documentation, the denial may be overturned.

On October 01, 2013, the ICD-10-CM database will replace the ICD-9-CM version. Medical coders must become familiar with the medical billing codes contained in this database, so they can hit the ground running when submitting insurance claims in the future. Properly coding each claim ensures that the healthcare provider is accurately reimbursed.

Is the Job Growth Affected by the Existence of Software That Handles Medical Billing and Coding?   General Overview of the Medical Billing and Coding Process   

Billing and Collections During Hard Economic Times Part I

Insurance companies are more and more shrinking reimbursement to physicians. Unfortunately this is out of the physicians control but there's hope. Physicians and medical insurance billers need to be more aggressive and in turn they will be more successful in collecting payment from insurance companies and patients that is owed to them. There are two aspects of revenue being decreased. First, claims are being denied by insurers and some claims are not resubmitted after a denial, or if they are resubmitted, they are past the allowable date. Generally, about 7% to 15% of claims are denied by insurers.

Second, because of these hard economic times, patients are simply not paying their bills. A study showed that 40% to 50% of patient balances are not being paid. This is sometimes due to high deductible health plans and the rise in people losing their jobs.

Most physicians have mastered their specialty but didn't realize that they would have to become business owners and also would need to learn the billing part of their business.

Physicians should compile a spreadsheet that shows each month's accounts receivable compared to the prior months. It should also list the date of submission of all claims and the number of denials each month. The number of denied claims resubmitted and the time that it took to resubmit the denied claims.

Offices that employ an onsite biller can delegate this responsibility to this person; or even better using an outside billing service they should be able to provide this type of report for you.

Start with denied claims

Some of the most common reasons a claim is denied is problems with eligibility and benefits verification. This should be verified EVERY time a patient comes in the office, even if it was the day before. Anything can change and it could mean losing out on revenue. Some other reasons are miscoding, duplicate submissions, transposed or missing numbers and billing the secondary insurance plan instead of the primary plan.

Improve the way patients are checked in during the registration process. It may take a little more time but the form that patients fill out when they are new or returning should be thoroughly gone over with the patient to verify everything is correct. On the patient registration form at the top should be an expiration date of the form that should be re-filled out after at least a year. Changes happen in people's lives everyday; divorce, new insurance, new job, change of address, change of phone number and all these things can affect your claim and could lead to a denial.

In the following article we will continue to discuss ways to collect and how to avoid denials from insurance companies. Collecting from patients will be the next subject we discuss in detail.

Is the Job Growth Affected by the Existence of Software That Handles Medical Billing and Coding?   General Overview of the Medical Billing and Coding Process   

A Brief on Medical Billing And Coding Schools

Medical billing and coding schools will help a person to obtain employment in medical billing. In order to obtain employment, a person needs to go to the right school. There are many schools that offer medical billing and coding, but they all may not prepare the person to be successful. In order to start the process of working in the medical field, a person will need to research the top three schools. Most doctors will prefer a person who has received not only book training, but hands-on-experience.

Self-Paced and Vocational Schools Online

Career Step is a self-paced online course that takes 640 hours to complete. The course prepares students to sit to become certified. There is no hands-on-training, but a student will not have a hard time finding employment after graduation. Career Step is one the medical billing and coding schools that provides a quality education to their students. At Career Step, the financial aid department will help a student to finance their education. They offer private loans, scholarships, and payment plans.

A person who doesn't have the funds to a self-paced school can look for vocational schools. Vocational schools that offer medical billing and coding can be found by entering in "medical billing and coding" and "vocational schools" in the search engine box. Vocational schools may offer financial assistance to students. Most of the medical billing and coding schools offer training online. A person may want to contact as many schools as possible to find out what their curriculum is and if the school offers job placement. It may be a good idea to find a vocational school in the same state that you live since a lot of the schools tend to have connections in the state where the school is located.

Community Colleges

Medical billing and coding schools online are good for someone who doesn't want to commute to school. On the other hand, a student may need to see their instructor face-to-face. Community colleges are another place where a person can receive training in medical billing and coding. When a person goes to a community college, they can apply for financial aid. The student may have to take entrance tests such as Reading, Writing, and Math. Once the student graduates from the course, they will be able to find work if they get into contact with the Career Services department. At a community college, the Career Services department has a list of hospitals and clinics that hire their graduates.

Is the Job Growth Affected by the Existence of Software That Handles Medical Billing and Coding?   General Overview of the Medical Billing and Coding Process   

Medical Billing Outsourcing: Choosing An Appropriate Vendor

The medical billing industry is experiencing some changes and medical billing outsourcing is playing a significant role. The job outlook for medical billers and coders looks promising; however, outsourcing to reduce costs is becoming commonplace. There are several benefits to outsourcing medical billing tasks.

What Do Medical Billing Personnel Do?

Medical billing professionals use a number of skills to complete the claims process on behalf of doctors, hospitals, outpatient facilities and other medical operations. They are responsible for organizing and understanding a health facilities medical data to ensure the information is accurate.

The Billing professional understands human anatomy and medical terminology. He uses this knowledge to ensure claims filed with insurance companies include the appropriate coding for specific conditions, diseases and procedures.

One of the most important components of the job, and one that plays a role in outsourcing, is the understanding of the Health Insurance Portability and Accountability Act. In addition, changes in the American health system will likely require additional knowledge of the Patient Protection and Affordable Care Act.

Billing specialists are also able to identify loopholes and apply their technical skills to identifying billing concerns before they arise.

What Are the Benefits of Outsourcing?

There are multiple benefits involved with outsourcing billing services. Reducing your expenses and gaining the knowledge that someone skilled at billing are two examples. Following are more examples of how outsourcing benefits doctors and other medical vendors:

* Less money spent on employees. Outsourcing medical billing to an experienced and reputable contractor will cost less in health insurance, vacation pay and other costs associated with hiring a full- or part-time employee.

* You gain access to modern technologies. The billing and coding process requires advanced technologies to ensure information complies with government regulations. Contractors have access to the appropriate technologies.

* You may experience increased turnaround time. Doctors may attempt to complete their own medical billing, but in a busy office, this can lead to delays in payment, which affect cash flow. Selecting a contractor for this type of work can increase turnaround times substantially.

What You Should Look For in a Contractor?

Selecting the appropriate business partner is essential to continued success. Not every medical billing contractor is the same. Following are a few key things to consider when searching for a provider:

* Does the company have the level of staff required to support your business? Some companies are small and may have few employees. If you are running an operation that needs to submit multiple claims daily, you may consider finding out how many people the company employs.

* Is the company compliant with HIPAA regulations? Supplying patient information to a company that lacks the appropriate security measures could result in a disaster. Consequently, asking questions about HIPAA compliance and inquiring about training programs offered to employees could make the difference between a happy relationship and a sour one.

* Does the vendor offer relevant reporting tools and generated reports? The purpose of outsourcing is to save money and increase revenue. Understand where the budget is going requires sound information delivered in a timely fashion. Ask the potential vendor if they provide reports. If so, find out if you can customize the reports to fit your needs.

The medical billing and coding industry offers a substantial service that affects the revenue, and overall health, of medical services facilities. Outsourcing certain aspects of the medical office workload can have a positive impact on revenue and expenses. There are multiple contractors available, but asking the right questions will help you decide the best medical billing outsourcing contractor for your needs.

Is the Job Growth Affected by the Existence of Software That Handles Medical Billing and Coding?   General Overview of the Medical Billing and Coding Process   

Billing Practices That Can Be Costly - Part I

Obviously, to receive proper reimbursement it is very important to have accurate coding practices for all health care practitioners however; here are several reasons. A group that is often involved in the billing process is nurse practitioners. Generally they are billing for their own services or they may be using a billing form (superbill) provided by their employer by marking procedural codes and diagnostic codes in order to bill for their services. The responsibility for the accuracy of the coding and billing, as well as for maintaining medical records that support the diagnosis code and procedural code that is being used to bill for specific services, is the professional provider or the nurse practitioner.

Keeping up to date with accurate coding procedures is very important when billing to receive maximum reimbursement. However, due to new codes being added, modified or deleted, this may cause an impact on reimbursement. Sometimes the definition of a code may not be so clear. That's why it is vital to utilize sources that are available to the medical community. Such as workshops, online information and online telephone consultation services for health care providers to get better clarification on a code before billing.

It's also important to remember that even if billing by the physician or nurse practitioner is outsourced to an outside billing service or a trained billing clerk that is onsite, it is the person on whose professional licensure the care and billing are based is the person that is responsible for accurate billing. A nurse practitioner or a physician still has to learn something about reimbursement and coding.

Any health care professional who knowingly cheats on coding to enhance their reimbursement, can be guilty of both civil wrongs which is considered a "breach" of the insurance contract, and it's considered a crime, which can lead to costly legal fees. Billing fraud can also result in having to return part or all of the wrongly paid money, fines, loss of their professional license and possibly serving time in prison.

How do fraudulent claims get noticed? There are several ways. Some insurance carriers have fraud detection software which they use to analyze data. When unusual billing patterns are discovered, they initiate an investigation. Sometimes it is the patient that is complaining about the amount of the bill or services that were billed. Employees have revealed on their good conscience of fraudulent practices and don't want to be part of the scheme or it violates their own ethics. Bottom line is physicians or other health care providers who engage in this type of behavior have been costly and have led to them no longer being able to practice in the medical field.

Is the Job Growth Affected by the Existence of Software That Handles Medical Billing and Coding?   General Overview of the Medical Billing and Coding Process