Improving the Patient Experience Through Technology

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There was a time when the words patient and consumer meant two different things. Practitioners were not concerned with consumers, just patients, and felt that “consumer” or “customer” cheapened their skills and importance. But more and more patients expect a consumer-centric experience regarding their medical care. Gone are the days of a supply-driven system organized around what physicians do. Instead, they have now transitioned to a patient-centered system, organized around what patients need, prefer, and value.   

Research by Accenture showed that 26% of consumers stated they would switch to a new healthcare provider for high-quality digital services, and 50% said that a bad digital experience could ruin the entire experience with a provider. Physicians are now faced with the era of technology and need to understand how it can work for them in improving the patient experience. In addition, Healthcare consumers want convenient and easy access to care and have stated that these are driving factors in their decision-making.   

Online Presence  

Your online presence, or “digital front door,” is critical to the patient experience. Your website has become your first impression to potential patients and can set the stage for what is to follow.   

Your website is what serves as a reflection of your practice’s overall brand. It is there to help patients understand what to expect from your practice, so you must offer clear and consistent information across all website pages. In addition to details on services you offer, credentials of your physicians, and the range of services you offer, utilizing professional, high-resolution images of your office and obtaining testimonials from current patients can help establish trust.  

You can also offer paperwork on your website for patients to download, complete, and bring with them when they come, instead of having a clipboard full of papers they need to fill out before the practitioner can see them. Or better yet, allow them to complete it online – no printing or writing required.   

Offer Online Scheduling  

Another opportunity your website or portal can offer is the ability to schedule an appointment. This gives patients the freedom to book their appointments when it is convenient for them. And in this digital age, more and more people prefer to book online. According to Kyruus, 43% of patients prefer to book their appointments online, and that percentage goes up yearly.  

Send Appointment Confirmation and Reminders   

In today’s busy world, any help you can offer to keep a patient on schedule, the better. Research has shown that 66% of patients want to receive a reminder for their upcoming appointment via text message. In addition, 59% have stated they would like to be reminded to book an appointment via text messaging.   

Sending out a message via email or text three days before the appointment requesting them to confirm can also help reduce the number of no-shows for appointments. Positively impacting your bottom line.  

Utilize Telemedicine  

While COVID 19 ushered in the utilization of virtual medical appointments, patients have come to expect this as an option and will continue to after the pandemic ends. In addition, patients don’t always have to come into the office for prescription refills or simple consultations, so leveraging technology can help increase patient satisfaction and enhance patient care.  

Establish a Patient Portal  

Patient portals are becoming more and more a necessity in the world of maintaining a positive patient experience. Offering patients a safe and secure way to interact with you and their health records digitally, whether it is to review test results, access medical records, request a prescription refill, pay outstanding balances, or receive and return paperwork requested before their arrival, can streamline the administrative work for them as well as for you.   

It can also give you and your team the opportunity to focus more on patient care, help optimize office workflow, and provide better patient communication. In addition, giving patients access to their medical information gives them better control and encourages participation in their healthcare journey.  

Follow Up  

Ask for feedback. Providing patients the opportunity to give feedback makes them feel valued and gives your practice important data. Sending out a post-visit survey via email, or text, shortly after their visit can help your practice compare and analyze patient experiences. The information gathered can be used to evaluate the effectiveness of initiatives and spotlight any opportunities for improvement to increase patient-centric care and patient satisfaction.    

And make sure you follow up on the feedback you receive, good or bad. This helps foster trust and shows that you care about your patient’s experience.   

Promoting Practice Growth  

In addition to providing an overall better patient experience, you are also setting the foundation for a powerful growth strategy. If a patient has a good experience with your practice, they will tell, on average, four people about their experience. If a patient has a bad experience, they will tell, on average, ten people about their experience. Making sure your patients have a good experience is worth the effort.  

Conclusion  

Healthcare is at a crossroads as it struggles with the dual demands of consumerism and traditional medical needs. However, as patients are increasingly seen as customers, medicine is still needed as an essential service. Simply put, patients are looking for good customer service but want and need quality healthcare and patient engagement.   

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Who is Billed Right?   

In 2006, two business partners envisioned creating holistic services that help improve medical billing operations. They started by listening to doctors and building a service model around what doctors need the most. As a result, Billed Right’s Revenue Cycle Management (RCM) model was born. The focus continues to be on solving the problem rather than selling a product. Hence, Billed Right’s advanced RCM model revolves around personalized service in today’s corporate world while still cutting costs and improving patient care and practice revenue. As a strategic partner, we look to streamline your revenue cycle and operational management, thus helping you to grow your healthcare practice.   

   

Contact Billed Right to learn more.    

 

 

Medical Staffing Shortages Continue Into 2023

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The pandemic has been blamed for many of the problems happening in the world; however, it didn’t cause the shortage of healthcare workers. It did, however, compound it in a big way. It is estimated that nearly one in five healthcare workers has resigned since March 2020.   

Not only is there a severe shortage of nurses and medical assistants, but there is also a shortage of case managers, administrative support, and medical billing staff. As a result, providers are finding it hard to run their practices due to the lack of administrative help. In addition, the shortage of clerical and administrative staff has also resulted in longer wait times for referrals, prior authorizations, or even getting phones answered. More importantly, overall short staffing is causing treatment delays, misdiagnoses, and unintentional medical errors as the existing workforce attempts to manage the same workload with less support.    

In an MGMA poll from last September, 73% of medical group practices responded that staffing was the leading COVID-19 challenge going into 2022. Unfortunately, the shortage of healthcare workers is expected to continue to be an ongoing challenge for organizations as the strained workforce changes jobs for better pay and benefits, even going as far as to leave the healthcare industry altogether. A poll in February revealed that almost half of the respondents said that staff turnover rates worsened in the past quarter (41%) compared to 33% who noted it was about the same as previous quarters and 26% who said turnover had slowed recently.   

And in April, MGMA sent out another poll asking medical practice leaders what their best tactic was to address staffing in 2022. Again, the majority reported “raise wages” at 56%, followed by “flexible schedules” at 29%, 10% stated “other,” and 5% said “temp workers.”  

Of the respondents that stated “other,” here are some of the tactics that were included:  

  • Improve employee engagement efforts   
  • Improved benefits such as more time off and reduced schedules  
  • Adding referral bonuses for existing staff who bring in new hires  
  • Increasing automation of administrative tasks and use of bots  
  • Outsourcing for scribe work and medical coding  
  • Providing pre-emptive salary increases ahead of schedule  

Impact on Patients  

Not surprisingly, the healthcare staffing shortage is being felt by patients. Based on a CVS Health-Harris Poll National Health project, more than half of all Americans say they have directly felt the effects. From canceled appointments to delayed surgeries, shortened office hours due to lack of staff, to people stating their practitioner has stopped practicing medicine completely. By mid-2021, over 41% of adults in the United States decided to avoid or delay medical care due to COVID-19. And now, those adults are starting to reconnect with their providers and reassess their care after the pandemic lockdowns and restrictions. When providers need the income to help recover from the pandemic, a shortage of employees leaves them still losing revenue due to a lack of support staff and clinicians, lessening the number of patients they can see daily.   

Outsourcing  

One of the biggest opportunities to shore up your workforce, streamline workflows and save time and money is to contract out or outsource administrative tasks that are difficult or expensive to staff internally. These can include:  

MGMA did a poll in March 2022 asking medical practices they will be outsourcing/automating in the next six months. Of those polled, 36% stated “revenue cycle,” 33% said “patient communication,” 9% said “clinical efficiency,” and 23% said “other,” which included things like medical billing, call center, and IT services. This poll shows that the medical worker shortage is forcing medical practice leaders to think outside the box on ways to streamline workflows and ensure they have the right workers for all the key roles in their practice.   

How Billed Right Can Help   

We understand how hard it can be to decide to outsource your medical billing. But partnering with a company that understands the importance of revenue cycle management can help ensure the financial health of your practice. Billed Right handles everything from eligibility verification to claim denial management to Account Receivable collections. As a strategic partner, we look to streamline your revenue cycle and operational management, thus helping you to increase revenue and grow your healthcare practice.  

In addition to being a revenue cycle management company, we also offer front, mid and back-office services such as credentialing, fax sorting, and a virtual medical receptionist who can allow you to take even more of the administrative burden off your existing staff. By outsourcing these functions, you further streamline your workflow and allow your in-house staff the ability to focus on providing quality patient care.   

Contact us today to learn more about how we can help support your practice by becoming a strategic partner.  

 

 

Patient Access to Their Records is the Law

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We have all heard of HIPAA, and most of us associate it with the safekeeping of personal health information collected by providers, healthcare practices, and facilities. However, the HIPAA Privacy Rule also mandates that you provide adequate access to patients to information found in “a designated record set” or their medical records. The rule allows patients to request copies of their records in several formats, including electronic, via a secure web portal, or as a printed copy, and federal law requires you to comply. This means, for example, that if a patient requests an electronic copy of a paper record, the provider is required to scan the paper information into an electronic format. Patient Access to Their Records is the Law

Right of Access to Patient Records

HIPAA governs the right of access rule and, recently, has been more clearly defined by the 21st Century Cures Act. The right of access rule under HIPAA allows patients to inspect and obtain copies of their health records from their providers. This means that as their provider, you are required to allow patients to either view or obtain copies of their protected health information in the manner they choose.   

The 21st Century Cures Act, although signed into law several years ago, has only recently gone into effect. Part of this Act deals with the designation of the Office of the National Coordinator for Health Information Technology (ONC) utilizing electronic health records to improve patient care. After that, the ONC adopted a Final Rule targeting the support of seamless and secure access, exchange, and use of electronic health information.   

The rule, known as the “information blocking” rule, changes the way you respond to requests for patient records. It calls on the healthcare industry to adopt standardized application programming interfaces (APIs), helping to allow patients to securely and easily access their electronic health information from certified EHR systems via smartphones, tablets, or computers. In addition, the rule requires that healthcare providers give patients access, without charge, to all the information in their electronic medical records “without delay.”    

Understanding all the ins and outs of correctly providing adequate access to personal health records can be frustrating, but there are a few key things to remember.  

Types of clinical notes that are required to be made available:  

  • Consultation notes  
  • Discharge summary notes  
  • Procedure notes  
  • Progress notes  
  • History and physical  
  • Imaging narratives  
  • Lab reports  
  • Pathology reports  

 

Information that is not required to be made available:  

  • Any information not utilized to make decisions  
  • Psychotherapy notes such as those recorded during personal therapy sessions  
  • Any information being collected in reasonable anticipation of a civil, criminal, or administrative action or court proceeding  

Patients may not always have access to the ability to view their records electronically and can request paper copies of their medical records. If you receive a request for paper copies, you must provide them within 30 days. However, a 30-day extension is allowed for specific situations, such as needing to pull records from storage. Also, you may be able to charge a reasonable fee to cover the costs of making the copies, such as for labor or supplies. Remember that some states have specific laws related to what can be charged for supplying medical records, so be sure you verify your state law before charging anything.

The bottom line is that you cannot refuse to provide access to a patient requesting their medical records, even if they cannot afford to pay the standard fee you charge, as it can quickly lead to a HIPAA complaint, audit, violation, and big fines.

 

 

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Who is Billed Right?  

In 2006, two business partners envisioned creating holistic services that help improve medical billing operations. They started by listening to doctors and building a service model around what doctors need the most. As a result, Billed Right’s Revenue Cycle Management (RCM) model was born. The focus continues to be on solving the problem rather than selling a product. Hence, Billed Right’s advanced RCM model revolves around personalized service in today’s corporate world while still cutting costs and improving patient care and practice revenue. As a strategic partner, we look to streamline your revenue cycle and operational management, thus helping you to grow your healthcare practice.  

  

Contact Billed Right to learn more. 

Why You Shouldn’t Waive Patient Copays

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The past two years have brought financial and emotional hardship for millions of people.  It is natural, as a physician, to want to empathize with patients by providing lenient policies on payments. Especially for those struggling to get by on a limited income or those who are dealing with the financial fallout from the pandemic. Initially, it may seem like a good idea to waive the deductible or copay portion of a medical bill. But hold on – before you do that you need to consider the consequences.

Legal Ramifications of Waiving Copays

Before you go down that road, there are legalities you need to understand. The first is that most physicians have entered into legal contracts with private insurance companies, as well as the federal payers – Medicaid and Medicare. Entering into these contracts makes it an obligation to fulfill the terms and asks that providers collect copays and deductibles, Also, should a provider waive the patient portion consistently, without the payer’s permission, the payer could logically assume that the practitioner’s fees are “x” percent less than originally stated, breaching the contract.  An example of this would be, if the patient has a $10 co-pay, then insurance would pay $90 on a $100 charge. However, if the copay was waived, the patient’s bill is only $90 total, not $100.

This would give a payer grounds to file a suit for fraud. If it is Medicaid or Medicare, you could be charged under the False Claim Act and be found guilty of a felony, owing financial penalties, be permanently barred from participation in government insurance programs, and could also spend time in prison!

Other laws that could also trip you up are the Anti-Kickback Statute (AKS), which pertains specifically to government program patients.  You hear stories all the time about unethical providers or medical suppliers who trade money for referrals of new Medicare patients. But even if the practitioner’s intentions are good, you could still run into trouble with the federal government. It has been made clear in “A Roadmap for New Physicians, Fraud & Abuse Laws” from the HHS’ Office of the Inspector General that consistently failing to collect patient copays in any instance, other than a well-documented case of financial hardship, is illegal.

Also, thanks to the Affordable Cares Act, AKS violations are subject to further penalties under the False Claims Act, as mentioned above, so you can keep getting deeper and deeper in trouble.

If that wasn’t enough, you could also be seen as breaking the Civil Monetary Penalties Law (CMPL), with a Medicare patient, if the arrangement is seen as influencing a patient to order specific services or medical items from your practice or another provider your office has a relationship with. Understanding that multiple laws, both federal and state, govern a practitioner’s engagement with government healthcare programs, as well as private payers, is critical to the health of your practice.

Financial Ramifications of Waiving Copays

In addition to the legal ramifications, there are financial ones. First of all, when you waive copays and deductibles you are undervaluing your services.  With payers paying less and less, not collecting patient copays and deductibles can also have negative consequences on your practice’s cash flow.  With the increase in high deductible healthcare plans, sometimes the payer is paying less than the copay or deductible for a service as the majority of the cost of the visit is the patient’s responsibility.

To compound the loss of revenue, legal fees can run into the thousands or even hundreds of thousands of dollars. And should you lose, the financial penalties can be substantial.

Doing It the Right Way

In order to ensure your revenue stream, make sure you comply with all contractual obligations. Also, make it easier on your staff by establishing a financial policy that clearly spells out provisions for collecting patient copays and deductibles as well as clearly stating your policy on patient discounts and charity policies. Establishing these rules and guidelines with all staff will help protect your practice.

Some other ways to help ensure that your revenue stream stays positive and that you are following all legal rules and contractual guidelines are:

  • Set up a system for establishing and documenting financial hardship in a patient’s chart – It is hard to talk about money but giving your staff the tools and guidance will help ensure this is done correctly. Just having a patient sign a form isn’t enough. You need to have someone on your staff perform due diligence and thoroughly document, in the patient’s file, proof of financial hardship.
  • Ensure you have set a policy for professional courtesy – This used to be a common situation, extending discounts to colleagues as a professional courtesy. But with payer contracts, laws, and guidelines you need to be clear about how to handle these situations so as not to put your practice at risk.
  • Set up payment plans – Work out agreeable terms for patients to pay off their balance in installments.
  • Establish a consistent, fair system for collecting outstanding balances – The industry standard is to send out three statements and if you don’t hear back from the patient, follow up with a phone call or collection letter. If after all of that, you still haven’t received payment, ensure it is documented well in their patient record. If done correctly your practice can then choose what to do including turning it over to collections.

You can certainly help patients struggling with financial hardships, just do it sparingly and make sure you document, in their patient record, that they qualify as a hardship case per your established policy. That is because there are exceptions built into the AKS and CMPL that allow you to forgive copayments providing you can prove the patient’s financial need. But these should be an exception and the rule should be to always collect copays and deductibles.

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Who is Billed Right?

In 2006, two business partners had a vision of creating holistic services that help improve medical billing operations. They started by listening to doctors and building a service model around what doctors need the most. As a result, Billed Right’s Revenue Cycle Management (RCM) model was born. The focus continues to be on solving the problem, rather than selling a product, and hence, Billed Right’s advanced RCM model revolves around personalized service in today’s corporate world, while still cutting costs and improving both patient care and practice revenue.  As a strategic partner, we look to streamline your revenue cycle and operational management thus helping you to grow your healthcare practice.

 

Contact Billed Right to learn more about how we can become your strategic partner.

Orlando-based Revenue Cycle Management Company Billed Right Acquires Miami-based Medical Billing Company Ruffe Systems, Inc. (RSI).

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Orlando, Florida, April 26, 2022 – Billed Right, a nationwide Revenue Cycle Management company founded in 2006, headquartered in Longwood, Florida, announced today the acquisition of Miami-based medical billing company RSI.

“We are thrilled to add RSI to our Billed Right family as we are both driven by the same values of building long-term partnerships, focusing on people, and promoting honesty and trustworthy practices in the services we offer to healthcare organizations. We are driven by our core values and always strive to find and maintain alignment between us, our team, clients, and partnerships; this acquisition is no exception. For over 30 years, RSI. has demonstrated success in providing significant value for practices across several specialties with their expertise and innovation and we are thrilled to have them join forces with Billed Right.” said Saurin Patel, CEO of Billed Right.

This acquisition will complement the experience Billed Right gained over the last 16 years in the medical billing industry for a multitude of medical specialties such as Cardiology, Primary Care, Internal Medicine, Psychiatry, Urgent Care, Pain Management, and many more. It also allows Billed Right to expand its presence to South Florida.

Established in 1982, RSI has consistently delivered services beyond medical billing. RSI specializes in medical billing services for hospital-based physician groups such as pathology and radiology. Ruffe Systems, Inc. was originally created through the collaborative vision of radiologists and a specialized medical software developer. RSI has innovative, best-in-class technology for the specialized needs of physicians’ billing and revenue collection. With Integrity as a core RSI value, it allowed them to deliver revenue success to providers for over 30 years.

With the Global Medical Billing, Outsourcing Market Size projected to register a CAGR increase of 12.6% during the 2021 – 2027 time period, it only makes sense that Billed Right position itself to increase its ability to service more healthcare organizations in different geographical areas. This acquisition will add a second Florida location to Billed Right’s portfolio and will allow them to continue growing their reach in the Florida medical billing market and beyond.

About Billed Right:

Billed Right is a Florida-based company providing leading and innovative expertise in revenue cycle management solutions while building meaningful partnerships with our clients. Guided by our mission, we empower doctors to focus on delivering the best patient care. Driven by our vision, we focus on leading in revenue cycle and operational management for healthcare organizations of all specialties. As a company, we take pride in delivering experience and unsurpassed business solutions to meet and enhance the needs of our healthcare providers.  Website: www.billedright.com

About Ruffe Systems, Inc.

Ruffe Systems Inc. is a medical billing company based out of Miami, Florida. They provide complete billing services for hospital-based physician groups throughout Florida. They specialize in Pathology, Radiology, Cardiology, Emergency, and Urgent Care billing. RSI was founded in 1982.

10 Questions to Ask When Hiring a Medical Billing Company

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The healthcare landscape has changed considerably over the last couple of years thanks to COVID-19. Whether your practice lost revenue due to a reduction of in-person visits, you are struggling with the Great Resignation situation or both. Your goal at this point is to figure out how to lessen expenses, increase staff, and maintain a positive cash flow.

But how do you decrease your expenses and add important staff to your team, all while increasing your revenue? Hiring an experienced medical billing company could be the answer you are looking for. But you don’t want to just hire anyone. You need to be sure that the medical billing company you hire has the knowledge and expertise that can not only help you manage your medical billing but also help grow your practice.

To ensure you are hiring the right medical billing company there are several questions that you should ask when making this critical decision:

  1. How long has the company been in business? You need to understand how long the company has been handling medical billing. As part of this line of inquiry, also ask what their customer retention rate is and the average length of time they have had their clients?
  2. What will it cost? This of course is top of everyone’s mind when looking to outsource. Standard in the industry is a percentage of net revenue collected, normally under 8%. Also ask about any start-up fees, data conversion fees, termination fees, and any other surprise or hidden additional costs.
  3. Have they worked with practices of similar size, scope, and/or specialty as yours? Verifying that the company understands your specific needs is important. You could even ask if they have testimonials or references you could speak to.
  4. What exactly are the services they offer? Do they only do medical billing or are they a true revenue cycle management company that does everything from eligibility verification through collecting on account receivables? Are there services they don’t provide in their rate? Some companies charge extra for patient collection follow-up and other services. Also, do they work in your EHR or will you have to change software?
  5. Will you have access to all the billing information? Your billing information is just that, yours, and you should be able to access it at any time, for any reason.
  6. Are they HIPAA compliant? Protecting patient data is a top priority. Do they ensure compliance with stringent software and encryption practices that minimize the risk of patient data loss?
  7. Do they provide transparency into their performance? Do they provide reports? If so, what are they and how often will you receive them? Can they customize reports based on your needs? How will they communicate with you through the process? What will your responsibilities in the medical billing process be?
  8. What kind of training do their employees receive? Are their coders certified? What kind of training do they get to continually keep up with rules and guidelines? Are they utilizing the most recent guidebooks and resources, for example, CPT, ICD-10, HCPCS?
  9. How are denied claims handled? Although hiring a medical billing company should lessen the number of denied claims due to their expertise, denials will happen. How do they handle them?
  10. What happens when the people on my account get sick or go on vacation? You need to make sure that you will receive the same level of service every day, even if the people who usually work on your account are out. Do they have a team that is cross-trained and can ensure a consistent service level?

 

With the answers to these questions in hand, you will be more prepared to choose the best medical billing company for your healthcare practice.

Who is Billed Right and How Can They Help with Your Medical Billing?

Founded in 2006, Billed Right is a Florida-based company providing leading and innovative expertise in revenue cycle management solutions while building meaningful partnerships with our clients. Guided by our mission, we empower doctors to focus on delivering the best patient care. Driven by our vision, we focus on leading in revenue cycle and operational management for healthcare organizations of all specialties. As a company, we take pride in delivering experience and unsurpassed business solutions to meet and enhance the needs of our healthcare providers.

Contact Billed Right to schedule a consultation and learn more about how becoming a strategic partner with us can benefit your practice.

 

Correctly Handling Medical Balance Write-offs

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You and your staff work hard taking care of patients and deserve to be compensated for your efforts. With third-party payers, uninsured patients, or ones with high deductible insurance, there are unfortunately times when you have to write off some, or all of the charges, for a visit. Medical billing is complicated enough without adding this to the mix, but it is a fact of doing business. It takes well-trained revenue cycle management staff and clear, consistent billing policies and procedures to handle all your billing challenges.

Standard or Expected Write-offs

There can be a number of reasons for write-offs, some of them are approved and even expected, such as the following:

  • Contractual write-offs are the difference between the set fee from the practice fee schedule and the allowable fee schedule the practice has agreed to accept. An example of such an agreement is the one made between a practitioner and an insurance company.
  • Hardship or Charity write-offs happen when a patient is having a hard time financially and is incapable of paying. These write-offs can be due to policy adherence in a faith-based health care system, as part of a community indigent care effort, or a financial assistance program. Documentation of the patient financial hardship and a qualification process must be in place before considering this write-off.
  • Self-pay (no insurance) discounts happen when the patient receives a discount off the set fee schedule for paying their balance in full at the time of service because they are uninsured.

Unexpected or Unnecessary Write-offs

All of the reasons above are standard write-off reasons, however, some situations can happen that are not expected and can get you into trouble either financially, legally, or both, if not handled correctly.

  • Errors in medical claims such as coding issues, documentation issues, or erroneous patient information lead to denials. Once this occurs your staff needs to be able to immediately make corrections and appeal the medical claim denial. If it isn’t appealed promptly the revenue is lost.
  • Missing medical claim filing deadlines for a payer. Each payer has a contracted deadline for filing medical claims and if this is missed you don’t get paid. Each payer is different so ensure you know each payer’s deadline.
  • Un-credentialed provider write-offs happen when you file a claim for a practitioner who has not finalized their credentialing and contracting with payers prior to the filing.
  • Waiving or writing off copays or deductibles by writing these balances off you could be violating regulations including the Anti-kickback Statute, the False Claims Act, the Civil Monetary Penalties Law, and/or some state laws and regulations.
  • Payer Changes happen when a payer makes changes without notifying a practice.
  • Bad debt write-off is debt that, after exhausting all avenues to collect, you decide to write off the debt for good.

Suggestions for Managing Write-offs

To ensure you are managing your write-offs it is suggested that you start with basic write-off categories and add more as needed. Also, decide which write-offs need manager approval. Although not all write-offs should require approval, as this can complicate the process more, there are times when it is prudent to get an approval.

It is also advised that you do write-offs monthly and track them to see if you spot any trends.  But remember, if you raise your fees but don’t renegotiate your contracts with payers, your contractual write-offs will start trending higher. Also, keep in mind that sending a balance to collections is not the same as writing off a debt. The monies owed are not forgiven but transferred to a third party to collect for you.

And it is a good idea to audit your write-offs periodically to ensure they are being handled correctly. Knowing they are being checked can keep your staff vigilant and you will know you are making business decisions on accurate information.  Overall, try to keep your write-offs to a minimum.

Ensuring the financial health of your practice is a priority and being in control of the unnecessary write-offs can help to support a healthy financial situation.

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Who is Billed Right?

In 2006, two business partners had a vision of creating holistic services that help improve medical billing operations. They started by listening to doctors and building a service model around what doctors need the most. As a result, Billed Right’s Revenue Cycle Management (RCM) model was born. The focus continues to be on solving the problem, rather than selling a product, and hence, Billed Right’s advanced RCM model revolves around personalized service in today’s corporate world, while still cutting costs and improving both patient care and practice revenue.  As a strategic partner, we look to streamline your revenue cycle and operational management thus helping you to grow your healthcare practice.

 

Contact Billed Right to learn more about how we can become your strategic partner.

MGMA Poll Shows Need for Prior Authorizations Continues to Increase

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A recent poll by MGMA showed that 79% of those polled indicated that prior authorizations (PA) requirements had increased when asked “How did payer prior authorization requirements change in the past 12 months?”. Only 19% said they stayed the same and 2% stated they had decreased.

They also noted significant challenges associated with the increase in PA requirements:

  • Slow or lack of response from payers on approvals
  • An increase in time spent by staff to obtain PAs, which has been compounded by the shortage in staff amid the tightened labor market
  • Patient care delays due to lack of PAs

A study, by the AMA, showed that 88% of physicians responded that handling PA requests are either a “high” or an “extremely high” burden on them and their staff. Over 90% of respondents stated that PA requests “often”, “always”, or “sometimes” hold up patient care. The survey also found that an average of 13 hours a week are spent by medical staff completing PA requirements for medications, medical services, and procedures that are needed. That is the equivalent of almost two days per week spent obtaining prior authorizations.

Patient Care Suffers

A concerning downside to the increase of prior authorizations has to do with actual patient care. When asked, 29% of physicians said they waited at least three business days to receive a response from the payer, and 64% said they waited one business day. A number of physicians have reported that prior authorizations have led to adverse patient events due to not receiving a PA promptly. Or patients have abandoned treatment completely due to the time-consuming nature of prior authorizations and not being able to move ahead with treatment immediately.

Insurance Companies Keeping Costs In Line

It is understood that insurance companies want to keep costs in line. Prior authorizations are their way to control costs by determining if a procedure or medication is medically necessary, being duplicated, if there is a less expensive option, or if it is even covered under the patient’s insurance plan. However, prior authorizations take a lot of administrative time to procure. There are forms to complete and sometimes follow-up calls or faxes that need to happen. All to ensure that the PA is received promptly to minimize any delay in medical care and avoid a medical claim denial.

How to Reduce the Stress

In an effort to streamline the process for your practice, without taking on the burden of another employee, which includes salary, benefits, training, and unfortunately, turnover, outsourcing this function can be the answer. Hiring a company that specializes in obtaining prior authorizations can save you time and increase revenue. Easing the stress on you and your office staff and allowing the focus to return to providing your patients the quality care they deserve.

How Billed Right Can Help with Prior Authorizations

At Billed Right, we specialize in revenue cycle and operational management, including offering a prior authorization service as an add-on solution. We can provide you with peace of mind that your PAs are being requested, followed up on, and filed appropriately in your EHR software. This helps avoid medical claim denials, patient frustration, and loss of staff time.

Our team of experts understands all the ins and outs of obtaining prior authorizations and submit authorization requests within 12 – 24 hours, follow-up with payers ensuring that they are received quickly, and work within your EHR so that your staff has access to them when they are needed.

We are more than a vendor, we are a strategic partner, working hard to support your practice’s growth.

Contact us today to learn more about how we can help by handling your prior authorizations!

Research Shows the Outsourcing Medical Billing Market Will Increase

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According to the Global Medical Billing Outsourcing Market Size study, the global medical billing outsourcing market was worth US$10.2 billion in 2020 and is projected to register a compound annual growth rate (CAGR) of 12.6% during 2021-2027.

Some of the driving forces behind this projected growth come from the pandemic and private physicians needing to trim their budgets and generate more income.  The industry was struck hard when the ability to see patients in person was derailed by COVID 19 and fear of being exposed to the virus kept patients home. The drop in some physicians’ revenue, according to research, was as much as 50%, but on average was about 30-35%. Physicians will be looking to save on overhead costs and make up some of their lost revenue by outsourcing their medical billing.

Another reason is the shortage of healthcare workers. The pandemic has seen an unprecedented reduction in workers while seeing an increase in the need for medical care, both due to COVID infections and in the specialty area of mental health.  For example, the two states most impacted by the pandemic are New York and California. These states may see their labor forces drop by as much as 500,000 by 2026. However, patient visits are estimated to increase by another 10% by 2026. Outsourcing will be a way to eliminate the void left by the staffing shortage and keep cash flowing into practices.

Medical billing is an important part of the health of a medical practice and ensuring that it is executed successfully is critical. Although it may seem counter-intuitive, outsourcing medical billing can be the answer. Looking at the overall cost of salaries, benefits, and continually training staff to keep up with this complex job, having an outside company that focuses solely on medical billing can actually save you money. It can also give your office staff back critical time, allowing them the ability to provide a good patient experience. Not having to be divided between following up with payers on medical claims and handling patients can increase the happiness of not only your patients but your workers as well.

Here is a list of benefits that can come from outsourcing your medical billing.

  1. Reduces Billing Errors. A medical billing company’s sole responsibility is to ensure they provide exceptional medical billing services. Which means staying compliant and up to date on the most current medical codes and payer guidelines. This helps to reduce the number of denials and rejected claims due to billing errors. They can also provide feedback to help maximize income from future claims.
  2. Improves Cash Flow. Most practices have only a few people that handle their medical billing, some only have one. What happens when your biller goes on vacation, gets sick, or worse leaves? Medical claims have to wait and cash flow slows down. By outsourcing to a medical billing services company you never have to worry about that as they have teams dedicated to ensuring your claims go out promptly.
  3. Ensures Billing Compliance. We all know that healthcare is an ever-changing industry. Keeping up with Medicaid, Medicare and private payers is what makes billing complex and hard to stay on top of. Since all medical billing service companies do is focus on the billing cycle they have to stay up-to-date on the latest in government regulations and private payer guidelines in order to maintain compliance and the submission of clean claims.
  4. Increases Revenue. Understanding that by outsourcing your billing you can save money on overhead expenses such as salaries, benefits, training, office space, and supplies, you can see how there would be an increase in revenue. Also, outsourced medical billing service companies can help you clarify your medical claims to ensure you are obtaining the most reimbursement for your patient care. This is done by reviewing documentation and pointing out modifiers that should be listed based on the notes. And by getting clean claims out on time, you will also see an increase in revenue due to fewer claim denials.
  5. Improves Patient Satisfaction. Having to handle both billing paperwork and face–to–face patient interaction can be challenging at the best of times. Reducing the stress on your staff by removing the burden of medical billing frees them up to provide exceptional customer service and focus on what is important – the patient’s experience.

How Outsourcing Your Medical Billing Can Impact Your Bottom line?

We understand that the decision of hiring a medical billing company requires a great deal of thought. We also know that outsourcing can positively impact your bottom line if you partner with the right company. You can lower your overhead expenses and increase your cash flow. With an entire medical billing team focused on your revenue cycle management, your internal staff can focus on providing quality patient care.

Let Billed Right become your strategic partner. With over 15 years of experience handling a variety of medical specialties, we understand all the pain points and how to eliminate them from your daily workflow.  From understanding claim profitability, navigating complex payor rules, keeping up-to-date on everchanging reimbursement methodologies, and analyzing denial trends impacting your practice, we partner with you to navigate all the facets of the revenue cycle.

Contact Billed Right today to learn how we can be your strategic partner and not only increase your revenue but grow your practice.

 

 Six Tips to Avoid Telehealth Claim Denials

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The pandemic brought with it a shift in how medical care is carried out. Due to the fear associated with catching COVID 19, the rules surrounding telehealth were relaxed. As a result, it brought telehealth to the forefront, and providers were able to care for their patients even through the stay-at-home orders and social distancing mandates.

With telehealth becoming a growing topic for providers, payers, patients, and the overseeing governmental agencies, attention needs to be paid to ensuring that providers are getting reimbursed correctly.  Research shows that by 2020 there will have been an estimated 158.4 million telehealth video sessions compared to just 19.7 million in 2014.  Even with the relaxation of rules and regulations around telehealth services the billing process can be complex as the guidelines are constantly changing and will more than likely change again once the public health emergency has been lifted.

There are several things providers should do to ensure they are filing telehealth medical claims correctly:

  1. Verify exact coverage – Medicare has listed the services covered under the Medicare Physician Fee Schedule however, not all commercial payers follow this list. Your best option is to call and verify each payer’s telehealth policy to ensure it is covered. Questions to ask could include:
    • What telemedicine health care services can be done?
    • Is live video telemedicine specifically covered?
    • Are there limits on the total number of telemedicine visits the patient may have each year?
    • Are there conditions that must be met, or restrictions, before patients qualify to be covered for telemedicine services? (Ex: established patient vs new patient, patient consent in writing, specific distance from provider)
    • What are the specific CPT codes that are considered payable when services are provided via telehealth?
  1. Documentation requirements – Although most payers are required to cover telehealth visits at the same or similar rate as in-person visits, they may have different requirements on how to document the visit so it is important to research each payer’s guidelines.
  2. Accuracy in coding – Unfortunately, not all payers follow the same rules, so like with your standard in-office billing, you must be diligent and understand what code is appropriate when billing for telehealth.
  3. Make a list – Compile a list of all payers along with any specific requirements for POS codes or additional documentation. Having this at hand can help to ensure you are coding claims correctly thus lessening the opportunity for a claim denial.
  4. Monitor denials – Like with all denials, monitoring telehealth claim denials will allow you to avoid continuing to make the same mistake or give you a heads up that a payer has changed their policy. Denials may be the only way that you know if something has changed. Also, should a claim be denied, make sure you file a timely appeal to ensure you don’t lose revenue.
  5. Keep up – Things are changing rapidly and therefore require you to stay informed on any new rules, regulations, or laws pertaining to telehealth services.

 

As telehealth becomes more utilized we can hope that a set of clear guidelines and rules will get adopted across payers. Until then being vigilant through the entire telehealth billing process is what it will take to ensure correct and timely reimbursement.

Technology advances are happening daily and the demand for flexibility and convenience is growing. The benefits of telehealth and telemedicine will continue to increase and remain an integral part of healthcare, which is good news for patient outcomes, care continuity, and chronic care management.

How Billed Right Can Help

With the ever-changing landscape, it is important to have someone who is keeping up with the new rules and guidelines. That is where Billed Right comes in. As a strategic partner, focused on ensuring that your medical billing is done correctly and on time, utilizing our revenue cycle management services can take the burden off your staff.  We employ AAPC certified coders and experienced medical billers to ensure we maximize your revenue potential and keep you educated and updated along the way.

Contact us today to learn more about how outsourcing your medical billing with Billed Right gets you a strategic partner focused on growing your business and optimizing your operational management.