Categories
Medical Billing Guide

Should You Outsource Your Small Practice’s Billing?

We know that you and your practice have a lot on your plate. There’s lots to get done, and you can’t do everything! The revenue cycle is a time-consuming, complicated process, so should you outsource your billing? 

While it’s understandably tempting to want to have your part in all aspects of your practice, you’ll have to ask yourself if it’s worth sacrificing time and energy for the billing process. Will internally learning, understanding, and doing all functions of the revenue cycle contribute to a better understanding of the practice’s financial position? Here’s why you should consider letting an external company like Practisynergy take the weight of billing off of your shoulders. 

The revenue cycle is dense and complicated, and running your practice is a big task already. It would be nearly impossible for one person to be an expert on each part of the revenue cycle; verifying insurance eligibility and benefits, medical billing and coding, managing claims, denials, and accounts receivable, answering questions about medical bills, and more; taking care of each of these would be extremely difficult, especially on top of other duties. 

The cycle is also time-consuming, taking valuable time and energy from your patients. You would need to find the time to appeal claim denials, make sure your billing and patient statements are accurate, manage insurance credentialing and contracts, et cetera. With all that time dedicated, you may also need to bring on more employees to pick up the slack, especially in case of vacation or illness to keep claims going out the door.

This is a heavy burden for any one person to bear. As you’re running your practice, don’t add this weight to your load. While you stay focused on your patients, let PractiSynergy take care of your medical billing and coding. With our smooth process to transition a practice from in-house billing to us, and a model that fits your needs and increases revenue, you won’t regret switching to PractiSynergy. 

Categories
Medical Billing Guide

When to Switch Billing Companies

How do you know it’s time to start thinking about switching your billing company? When it is time, how do you know where to start? With so many questions surrounding such an important part of your practice, we’re here to lend a hand and make sure you have all the information you need to take the best steps for you, your patients, and your practice. 

How do you know it’s time to switch?

Are payments coming in slower?

Are your payments coming in at lower amounts?

Has there been an increase in patient complaints about billing?

Are claim denials and rejections increasing?

Are your Accounts Receivable creeping up?

If you’re answering yes to one or more of these questions, you may want to consider making a switch in billing companies. 

 

So you’ve decided to move forward in finding a new billing company:

Here are the key things that you’ll want to look for in a company that will be the best for your practice: 

Good references: Do other practices have good things to say about their experience?

Contact: You should be able to have a single contact person with a backup person for emergencies

Availability: Does the availability of those contact individuals match yours? Are they available during your hours of operation?

Billing options: Do they offer on-shore or off-shore billing? Your payment percent will be higher when an on-shore/local billing team is used because they are more comfortable and knowledgeable about state-specific billing guidelines

Training: You want your team to stay up to date on new developments so you don’t have to. Do they offer training opportunities to stay current?

Reports: What types of reports will you receive and how frequent will you receive them?

There are lots of different aspects that will factor into your choice of switching billing companies and which company to switch to. Whether you’re just starting this process or ready to make the change, Practisynergy is here to help with all of your medical billing and coding needs.

 

Need more advice?

Check out our “12 Questions to Ask Before Hiring a Billing Service” worksheet.

Categories
Medical Billing Guide

Am I being Scammed? – The Truth Behind Virtual Credit Cards

Did you get a piece of paper in the mail with what appears to be an outline of a credit card with numbers and a whole bit? What are these and are they legit? 

It’s no secret the internet is slowly taking over. Everything is becoming ‘optimized & automated’. After COVID, the virtual world skyrocketed as we know it. It’s no surprise credit card companies have wanted an in. These virtual credit cards advertise as a streamlined way to make purchases and keep up with payments. Much like everything else, virtuality has its pitfalls. Not everything is meant to be optimized. Have you ever been on the phone with a large company, needing assistance, but find it takes an endless amount of time to reach an actual person? Virtual robots can’t assist you the way human interaction can. 

Providers are getting buried in a sea of virtual credit cards coming from all different insurance companies – companies as large as UnitedHealthcare to small private union insurance funds. The appeal behind these virtual cards can be rooted within streamlining the process. Insurers are trying to reduce costs by outsourcing payment processing. Printing checks requires supply costs as well as people to print and handle these checks. The downfall of checks include getting lost mail. The advantage of virtual credit cards means it’s easier to track. Since the credit card isn’t tangible, the balance can’t get lost. 

Each insurer has different needs. Providers must figure out what is the best option for them – virtual credit cards, physical checks or direct deposits. All fees need to be examined as well as the time it may take if checks get lost. Some corporations find it beneficial to outsource to virtual assistance – saving them time to get back to their main job duties. The right virtual credit card can also help protect personal information and privacy. Virtual cards generate new card numbers, so that individual account numbers can stay confidential. 

Providers get dinged with fees since they have to run the cards through a merchant service provider (credit card servicer) that will deposit the funds into their bank account. If you decide a virtual credit card is not your jam. You must initial the “opt-out” of these cards and select check or direct deposit. Keep in mind some of the direct deposit options through these outsourced vendors also charge a fee.

All in all, there’s a give and take between payment options. Each individual requires different needs. And it’s important to seek counsel when choosing the best option. At PractiSynergy, we work closely with clients to give them the best option for their unique needs. To get informed about our medical coding and billing services, reach out to Katie Fergus. Call 515.412.2800 or email  katie@practisynergy.com.

Categories
Medical Claim Adjustments Medical Coding Guide

Deductible Season For All Medical Insurances

Doctor with health insurance healthcare graphic.

It’s here. Deductible Season. The time of year when most insurance plans re-set deductibles back to $0.

So, what exactly does that mean to your practice? Its not all doom and gloom, its not too late to make a few changes to help you maintain your cash flow.

1. Eligibility Check

Always check insurance eligibility. This includes MEDICARE! Medicare beneficiaries had open enrollment late fall allowing them to choose Medicare advantage plans as well as supplemental
plans. What do you want to look for when checking eligibility and verifying benefits?

a. Does the patient have an active policy? What is the effective date of that policy?

b. Does the patient have a co-pay, deductible, coinsurance, or an out-of-pocket maximum?

c. Does the service you provide require a prior authorization or a referral?

d. Does the patient have any secondary insurance?

2. Payment Collection

Collect payments from patients at the time of service. Unless an insurer bars you from billing a patient (such as Medicaid), it is wise to collect money up front. Always collect a co-pay at the time of service. If a patient has a deductible or co-insurance that applies to your service, collect a set amount of money at the time of service. Depending on your patient population and service provided anywhere between $50-$150 might be appropriate for your practice.

3. Don’t Make It Difficult To Pay For Patients

Always take a payment if a patient offers, and do not make it difficult for your patients to pay.

Technology is spanning all the generations. Patients regardless of age expect the ability to pay their bills online. Identity theft has increase and few patients want to send a check or credit card through the mail for fear it will be stolen. Secure email and text is a great way to remind your patients they still have a bill outstanding.

Finally, remind patients (verbally, in writing, or both) of their financial responsibility. Whether it is keeping insurance updated, patient contact information updated, and a friendly reminder that most insurers require the patient to pay the provider some portion of their bill – even Medicare (Medicare’s deductible for 2022 is $233).

These strategies will help medical practices keep a better cash flow during this deductible season. PractiSynergy can help providers set up these processes. Please contact Katie Fergus, call 515.412.2800 or email  katie@practisynergy.com.

Categories
Medical Billing Guide Medical Claim Adjustments

Claim Adjustments In Medical Billing

Claim Adjustments In Medical Billing - PractiSynergy

What are the adjustments codes do on the payers’ explanations of benefits and what do they mean? These codes tell the provider why all the money charged was not paid.

I have three categories for these adjustments: Contract Related, Process Related, and Patient Liability. From these categories, you should examine whether there is a payer error (not abiding by contracted rates or agreements), a billing error (something on the claim was not correct), or if the amount is owed by the patient

Payer Error and Contractual Adjustments:

  • The maximum amount was paid by the insurance company based on the contract the provider holds with the insurance company – This means what the amount charged by the clinic was more than the allowed reimbursement in the provider’s contract.
  • No prior Authorization – Provider contracts spell out the responsibility of the provider to acquire any prior authorization required by a policy or their payment may be reduced or denied
  • Billing Guidelines – claims may be denied due to the provider not following the proper rules to bill a particular medical procedure. For instance, providers may not be paid for cosmetic procedures. The definition of “cosmetic” is usually determined by a patient’s diagnosis coded and is spelled out in coverage documents for the plan. Providers are expected to review these and submit claims appropriately.

Medical Billing And Claim Adjustments

Billing Error and Process Related Adjustments:

  • Non-covered benefit – Providers are expected to check benefits for patients before they perform a procedure on a patient. Even a simple sick visit may be denied, or the payment may be reduced if an out of network provider give these services and the patient does not have out of network benefits. Another example may be when the insurance company expects a certain type of provider to perform a service (a physical therapist should not submit a claim for a throat culture for strep)
  • Patient does not have active coverage – Providers must verify a patient is eligible for their insurance as of the date the service will be provided. If the service happens before, after, or during a gap in coverage, the provider is not eligible for reimbursement from the insurance company. The beginning of the year is most common for these adjustments.
  • Incorrect coding – medical codes on a claim are critical to payment. Providers are ultimately responsible for which codes go on a claim. They may delegate this duty to certified coders to do a thorough job. Providers should always use current codes and not rely on Google to find the right code since there are many codes which are expired that swirl around cyberspace. For reliable codes please visit PractiSynergy.

Patient Responsibility:

  • Insurance companies may not pay a claim or only partially pay a claim if the patient has some cost-share responsibility. This may be in the form of co-pays, deductibles, or co-insurance. These amounts are deducted from the amount owed by insurance companies. Providers collecting these amounts up front would be best practice.
  • An insurance company may designate a patient owes the full amount charged if a provider is out of network or if the patient is not eligible for coverage on a particular date of service.

Providers should review these adjustment reasons on a regular basis to evaluate a payers’ performance (or the billing company performance). A quick check monthly on your most utilized procedure codes is also an easy way to make sure you are capturing all the revenue owed to you. PractiSynergy helps its clients with this analysis. Please contact Katie Fergus Call or Email to assist your practice review your payments and adjustments to make sure you are not missing any cash.

Categories
Medical Billing Guide

Payer Credentialing and Contracts In Medical Billing

Payer Credentialing And Contracts

Payer credentialing and contracting process – Yawn! The most boring topic – Yet one of the most important for medical providers. The process is laborious and tedious.

Gathering paperwork, filling out forms, and negotiating is not how most professionals want to spend their time, unless of course they are attorneys or accountants 😉

The process is meant for the payers to “vet” medical providers and make sure they are legit. (Wiki: Credentialing)

The process also allows the provider, to align themselves with different employer groups or accountable health organizations for exposure and marketing of their practice.

Why are some networks so narrow? These networks are aiming for a truly patient centered experience. The primary care provider and the patient would make decisions together for the best course of treatment. Specialists need to decide what groups might have the biggest impact on your bottom line.

That is where the negotiating comes in. In a narrow network, the specialists need to prove their worth and may have to jump through extra hoops or make certain concessions in contract negotiations to become an in-network provider.

Is it so bad to be out of network? If you are out of network, most commercial insurance plans have an entirely separate set of benefits. Patients typically have separate (and large) deductibles and out-of-pocket maximums for out of network providers.

While the insurance company may “allow” the full fee of your service instead of a negotiated discount that an in-network provider might receive – this balance typically falls on the patient.

The patient becomes responsible for the entire balance. Large medical bills are extremely scary for patients.

payer credentialing and contracting

Scary may not even be the correct term – if they don’t know it is coming, they can be outright mad. Collecting money from patients is typically much more difficult than collecting from an insurance company.

Why aren’t there set fee schedules which all insurance companies just pay the same [Pay transparency]? That is a discussion we all need to continuously be asking our legislators. Until the “system” changes this is the game – if you don’t play, other will. PractiSynergy understands and knows how to play this game. We guide providers in revenue cycle management to maximize their profits. This all starts with contracts and credentialing.

Want to get in the game and learn more about credentialing and contract negotiations?

Call Katie at PractiSynergy or reach out via Email to receive a FREE CONSULTATION on how PractiSynergy might help your practice maximize revenues through payer contracting and credentialing strategies.

Categories
Medical Coding Guide

Medical Coding Commodity : Why Medical Coding Is Essential?

Medical Code Commodity

The Merriam-Webster dictionary defines commodity as “something useful or valued.” In healthcare, coding is the most important yet silent commodity in the revenue cycle. So, what is Medical Coding Commodity and why is it essential? Let’s understand it…

With over 68,000 ICD-10-CM medical diagnosis codes and over 87,000 ICD-10-PCS procedure codes for providers to comb through, selecting the right combination of diagnosis and procedure codes can be a daunting task.

Medicare and other major insurance companies have their own “billing guidelines” which must be followed to get paid. Certified coders know where to look for the information to find what diagnoses may be used to determine medical necessity for various procedures.

For instance, Botox®, this drug is covered by Medicare and most insurance companies for Migraines, but they will not pay for it if you want to smooth out your facial wrinkles.

Most providers do not have the time to look up if a specific diagnosis is payable for each appointment, certified coders are essential to getting providers paid.

Electronic Medical Records (EMR) and Practice Management systems are supposed to assist with coding however, the EMR does not have the experience working with insurance companies who may have different policies on how to code a single procedure. Some insurers may require a modifier – while some may not.

Some may only pay when a procedure is paired with a certain diagnosis – while some may be flexible. Each insurer is different, and each state may also have different guidelines.

Certified professional coders added into a revenue cycle allows a critical view on a patient encounter prior to being sent to payers.

Coders can focus on certain specialties such as orthopedics, podiatry, optometry, etc. garnering experience from the different insurance companies and maximize payment for the providers on the first pass of a claim.

When a provider is searching for the right code that is time they are not spending with their patient. Any process improvement program would tell you wasted time/wasted resources is inefficient. Inefficiency can cause a debilitating effect on a medical practice. 

Investing in an experienced coder will more than pay for itself by maximizing reimbursement and decreasing claim denials.

PractiSynergy has Certified Professional Coders (CPC) on our team reviewing procedure notes and providing education on documentation to providers to ensure compliance.

The combination of a CPC and experienced biller will improve compliance and increase cash flow, maximizing a clinic’s profits.

To tap into this “Coding Commodity”:

Call Katie at PractiSynergy 515.635.5531 or email katie@practisynergy.com

Receive a Free Consultation on how PractiSynergy might help your practice maximize revenues and boost your cash flow.