Jul 27

Traits of Medical Billing Software in Accounting Services

All health organizations such as hospitals, clinics, nursing homes and others need medical billing software for billing process. This software has become essential to cut workload of accounting, billing and documents in organizations. People create errors in billing details and calculations during the printing of bills. Thus, medical accountants are using billing software to overcome these complexities. Software automatically evaluates the data, other valuable information and arranges them according to the bill layout. Medical billing software is a functional, interactive and self-explanatory interface for accountants and other users. It is available at affordable prices, includes various features to manage accounting.

Nowadays, it is often used by accountants to manage big financial accounts of medical offices. With the help of medical Software, account management has become effortless, smooth and precise. If you are looking to buy software, you must know about its features according to your requirements. You can install more features according to your general requirements. Generally, the highly detailed software is used in large medical organizations or hospitals to handle amount of data and financial transactions. On the other hand, small medical offices and clinics can use basic software of limited features to manage accounts and billing process.

It is one of the great tools for big medical organizations. Medical practitioners can focus on other matters and cut the workload of billing processes by using this software. It has an easy-to-use interface. Today, medical billing applications are available at lower prices in the market. There are three things necessary to consider for medical billing software such as features, functions and capabilities. Accountants are offering the best, fast and precise medical accounting services with the help of Software. Many features are easy-to-use and run on all types of operating system. With this software, accountants can check the complete insurance policy data of patient.

Certain Common Features of Medical Billing Software

• Management of valuable data of patients
• Scheduling of meeting and appointments
• Filing of Electronic Claims
• Reports of system
• Make easy use of word processor
• Display the status of claims
• Filing of Paper Claims
• Record management and financial ledger

All above-mentioned features of medical billing software are commonly used by users. It provides other advantages to the medical organizations. Medical software can also be updated regularly and automatically by accountants and users through the Internet. There are several changes made by the programmers for fast processing of data and execution. Medical accountants can verify eligibility of patients and their insurance cover before performing any task on their personal computers.

At the present time, accountants are using new released medical billing software with innovative features. The new features make the process and program more effective and perfect. Some medical billing applications are well-suited with other programs and allow direct electronic claims. New software manages workflow, billing process, revenues and insurance data. Accountants can easily upgrade medical billing programs with the help of web. As well as, they can check recent versions and make the valuable changes and improvements according to the requirements.

Jul 18

Before Choosing Health Insurance, Here is Critical Information You Should Know

Understanding Health Insurance

This article is written to assist consumers sift through multiple options, plans, exclusions and summaries of benefits and understand what Critical questions you should ask when researching health coverage. Finding the most beneficial health insurance plan to meet your unique and individual needs is difficult. This guide will help consumers understand the basics of health insurance and what to look for when comparing plans.

14 Costy Mistakes You’ll Want To Avoid

1-FREE – Do You Have a “30 Day FREE Look Period?” Can you get your $ back if you are not happy?

2- DEDUCTIBLES: How many deductibles do I have per year? Some plans will have more than 1 deductible per person per year!

3- NETWORK RATES: Prior to your deductible being met, will your insurance company extend their discounted network rates to you? Example: Insurance Company A – 5 stitches to finger – Total cost $2000, patient responsibility, $800, or Insurance Company B – 5 stitches to finger – Total cost $2000, patient responsibility, $2000. (no network break).

4- NEGOTIATED RATE: What is the AVERAGE negotiated rate? (Sometimes referred to Network Rate – very very important!)

5- UNCLEAR TERMS Is your $100 “co-pay” for an Emergency Room visit REALLY $100? Some companies the $100 copay is more like a fee AFTER your deductible, and you’ll still pay the co-insurance and the $100.

6- LIMITS on benefits, for example: $500 limit or $250 limit on Emergency Room expenses. $50 limit on Dr. Visits. Once the Limit is reached, YOU pay everything else out of pocket. $500 limit on hospital expenses per day (quick way to bankruptcy!)

7- PREVENTATIVE – Will you have to meet your deductible, or do you have a 1 year waiting period for preventative? Do you want to wait 1 year before you can have your female exam, or a mammogram?

8- TRAVEL – If you are out of state, are you covered for illnesses? If you eat something that doesn’t agree with you and become very sick and need a doctor, will you be covered? (Not just life threatening emergencies.)

9- RATE INCREASES – I am buying a “fixed rate”. Ask yourself if it makes sense to pay extra over the next 2 – 3 years for a fixed rate? Make sure your rate is set for at least 12 months but does it make sense to pay in advance for a fixed rate? Sometimes plans will naturally go down in price, so does it make sense to pay extra to have a fixed rate?

10- SUPPORT – After I buy this plan, MAY I CALL MY AGENT’S DIRECT LINE with billing issues, or plan questions, or technical problems, or claims questions or concerns of any kind?

11- EXCLUSIONS – Read the “Exclusions” in your plan. Are the exclusions available for you to read? Is there an exclusion that you cannot live with? For example: exclude well baby visits. Is this an exclusion that you didn’t catch in the plan details?

12- MAJOR MEDICAL plans are designed to pay for MOST of your medical expenses when you become ill or injured. You’ll want a Major Medical plan from a reputable company that has “Credible Coverage.” Discount plans or Limited Medical Plans are NOT designed to protect your losses like Major Medical plans are. They are marketed as “Insurance,” but you MUST ask, is it a Credible Coverage Major Medical plan?

13 – MATERNITY – Maternity plans. Do your homework. Does your plan have an outrageous deductible for maternity? Do you have a waiting period of 12 months, 24 months, or more? How many doctors do you get to choose from “In Network” that can deliver your baby? Are you happy with the choices of Doctors in the network that will deliver your baby? What if your doctor is not on-call the night you go in for delivery?

14- MEDICATIONS – Is there a limit on how much the insurance company will pay for medications. If you become very ill, this could be a very big problem. Do your research, ask questions. Do you have a deductible on medications?

*Did you know that key information about how coverage works is not always disclosed? *When comparing plans, is the language confusing? Why is the language confusing? *Did you know that many consumers compare prices of health insurance plans, but cannot always tell if they are comparing “apples to apples.”

How to avoid Medical Bankruptcy!

According to a Harvard Law and Harvard Medical School study, they found that ½ of all bankruptcies are caused by illnesses and medical expenses. If you are a breadwinner for yourself, or breadwinner for a family or spouse, and the breadwinner gets sick, you may loose your medical coverage, and a way to pay for your day to day expenses.

When you are shopping for a health plan to protect yourself financially from medical bills and bankruptcy, there are many things to consider. Probably the most important thing is to consider is what “Type” of plan you are getting. There are several types of health plans that are available. If you buy a plan that is not “Underwritten” and is “Guaranteed Issue” you are not buying a Major Medical Plan. Major Medical plans will go through a process called “underwriting.”

Some plans will pay a certain dollar amount for a procedure, or a certain dollar amount per day while in the hospital. IT IS CRITICAL you understand the implications financially if choosing a non Major Medical plan. Your chance for greater personal losses including Bankruptcy exist with non-Major Medical plans. If you are shopping price with health insurance, and you decide on a discount or limited liability plan, YOU HAD BETTER UNDERSTAND WHAT YOUR RISKS ARE if you end up needing to use that “insurance.”

Major medical plans are designed to cover most of your hospital expenses if you become hospitalized.

Do you have a disability plan? This type of plan will pay your day to day expenses if you loose your job due to an injury or illness. This should be a very important consideration when getting health insurance. If the breadwinner loses his/her income while injured or ill, how will the day to day expenses be paid for?

The 6 costly misconceptions about Health Insurance

1 – I don’t need medical insurance, I’m a healthy person, I eat right, exercise and take care of myself. This is risk-taking. You are gambling your financial future.

2- I’m not getting insurance because There is no benefit before my deductible. Some Major Medical Plans will A) extend their network rates to you before the deductible is met, but not all. Another benefit before your deductible is met is B) the copays for Dr. Visits and C) Copays for Prescription coverage. Again, check the individual plan.

3- If I get sick, or now that I’m pregnant I’ll get insurance. Once you are ill or pregnant, depending on the illness, you may or may not be eligible for health insurance. Certainly once pregnant, you will not be eligible for an individual plan. The insurance company will always reserve the right to underwrite your medical condition and elect to take you on as a risk, or not. You wouldn’t expect to run out and get auto insurance after you’ve banged up your car and have them pay for it. For this reason, it is important to not let your Major Medical insurance lapse for more than 63 days.

4 – I will get stuck with a bill that I thought should have been paid for, or the insurance company should have paid. Here again, you must do your homework on the plan you intend to purchase. Look for Limits, deductibles, exclusions, co-pays, and understand these details. Also, if you come into a plan with pre-existing conditions and did not have continuous “credible coverage,’ you can expect to pay for your pre-existing conditions for 1 full year.

5- I want excellent care at a cheap price. If you want Major Medical, shop between the competitors, and get the most for your money, but don’t expect the same benefits in a discount plan as in a Major Medical Plan.

6- I’m waiting for the President to take care of this mess. It is not a good idea to wait to purchase medical insurance ever!

Important to Know:

Many People Feel That Health Insurance Companies are Greedy and Corrupt According to the Wellpoint Institute of Health Care Knowledge:

“Popular theories suggest that health insurance premiums are driven by an aging population, excessive insurer profits or medical malpractice. Objective research, however, clearly indicates that these factors have a minimal impact on the high price of health insurance premiums.

If meaningful health care reform, including health care cost containment, is to occur, emphasis must be placed on the real drivers of increased health care costs and concomitantly, health care premiums. These include the following key factors: such as

* Advances in medical technology and subsequent increases in utilization

* Price inflation for medical services that exceeds inflation in other sectors of the economy

* Cost-shifting from people who are uninsured and those receiving Medicaid to the private sector

* High cost of regulatory compliance

* Patient lifestyles, such as physical inactivity and increases in obesity.”

Other Important Facts

Will they check my credit score. NO

Will they require a physical or blood work? In most cases, NO.

All insurance companies are the same. No they are not.

My Premiums keep going up. You can do very little about increases in health care costs. You may want to change plans or increase your deductible to try and save money. Try and find a company that will guarantee their rates for at least 1 year. No need to pre-pay for future rate increases.

Definitions:

DEDUCTIBLES (Phase 1)- Money that you pay out of your pocket before traditional insurance begins. Ranging traditionally from $0 to $10,000. Usually if you choose a lower deductible, your premiums will cost more, if you have a higher deductible, your premiums will be lower (you are assuming a higher risk in exchange for lower premiums).

CO-INSURANCE – (Phase 2) – After you meet your deductible, you’ll pay a “co-insurance.” “Co” meaning 2, two entities will share the burden of the bill; usually you’ll see “co-insurance” as a 70/30, 80/20, 50/50, 60/40, 90/10. The larger portion of the co-insurance the insurance company will pay, the lesser portion you will pay.

MAXIMUM OUT OF POCKET – (Phase 3) – After you’ve paid your deductible, and then your portion of the co-insurance, you finally reach your maximum out of pocket. From this point on, the insurance company will pay the rest of the bill. (Major Medical Plan.)

CO-PAY – A flat dollar amount to be paid at the Doctors office. Sometimes referred to as a “first dollar benefit” (before deductible). Meaning, you pay a flat $30 or $20 or $40 dollar copay, or whatever the copay is, and the visit is paid in full. WATCH FOR LIMITS! Make certain the copay is a flat dollar amount paid BEFORE your deductible.

HMO is Health Maintenance Organization, usually a limited regional/geographical area, with a certain number of providers in the HMO. You will select 1 Dr to manage your care, and your Dr. will “help you decide” if you need a referral or not. HMO’s usually have very low deductibles and copays.

PPO Insurance is Preferred Provider Organization. You may visit anyone you wish in the network, still you must know the geographical area of your Network, even with a PPO plan. If you are on vacation and become ill, will your plan out of state cover you (in network)?

CREDIBLE COVERAGE In order to cover your pre-existing conditions when moving from one plan to another, you must have a Credible Coverage Major Medical plan. It is a document given to you from your insurance company as proof that you had a Major Medical plan protecting you from a start date to an end date. You must not go further than 63 days from one Major Medical Insurance coverage to the next, if you do go beyond the 63 days, you will have a pre-existing condition clause in your new policy that states you will not be covered for any of your pre-existing conditions for 1 full year (at a minimum.)

If you go beyond 63 days without “Credible Coverage,” the new insurer will look to your previous 6 months (average) health history and condition, and not cover you for any ailment you have (pre-existing.)

Now don’t be mistaken, that when you want to go from one insurer to the next, if you were covered with “credible coverage” that you are automatically guaranteed a plan. This is not true. You will still need to be underwritten, and the new company is not obligated to take you on as an insured if you don’t fit their underwriting guidelines.

Please Note: This Free Consumers Guide is meant to be used as informational only. The author herein will not accept liability for any circumstances in which an outside company may define their features and benefits differently than in this document. Consumers will accept this document as informational only, and not a legal document. Consumers will be held responsible for their own purchases, and not hold the authors in this document liable for any actions taken by any consumer. Consumers must verify the plan in which they purchase, and will not hold the information in this document as a specific reason to take or not to take a certain action. This document is produced by a licensed health agent. The 14 Costly mistakes you should avoid when selecting your health plan.

Jul 02

Options to Get Your Diabetes Medical Supply

If you have diabetes, you may be wondering what is the best way to get your medical supplies. Your options depend on your type or lack of insurance and personal preferences.

If you have Medicare and a supplemental insurance policy, you can get your insulin at any regular or insurance mail order pharmacy. You can order your supplies for a diabetes supply company or get them at your local pharmacy. It is actually easier and often FREE to get them through the supply companies though. These companies know how to give you the best advantage of your Medicare benefits.

They will check your Medicare, Medicaid and/or insurance eligibility for you. If you need a prescription, they will get physician authorization and keep them current. They deliver the supplies to your home, usually via UPS or Priority Mail. The companies also track all shipments to make sure that what you need arrives on time and on a regular schedule if you choose. There are usually options for “subscription” type deliveries or the company will contact you to remind you of renewals. These companies also do all the paperwork and bill Medicare and/or your insurance company. It will usually cost you nothing if you have Medicare and supplemental insurance.

If you have no insurance your options are not quite as easy as deciding which company or where to get your supplies. You can try contacting your local board of health to see if they have any programs. Some doctors have samples in their offices to give away and they often have coupons for discounted or free supplies. It certainly cannot hurt to ask. Some hospitals run support groups for diabetics and offer coupons etc. for discounts on supplies. These groups are also a good place to network.

Some other things associated with your diagnosis of diabetes are also available and covered by Medicare. You can get orthotic shoes, podiatry visits, special eye exams for glaucoma and retinal problems, along with insulin pumps, inhaled insulin devices certain specialized blood tests. Do some through research no matter which way you decide to get your diabetic supplies.

Jun 23

Going Electronic – 5 HIPAA Tools for your Medical Practice

Much like the major financial institutions closely following the lead of the Federal Reserve, health insurance carriers follow the lead of Medicare. Medicare is getting serious about filing medical claims electronically. Yes, avoiding hassles from Medicare is only one piece of the puzzle. What about the commercial carriers? If you are not fully utilizing all of the electronic options at your disposal, you are losing money. In this article, I will discuss five key electronic business processes that all major payers must support and how you can use them to dramatically improve your bottom line. We’ll also explore options available for going electronic.

Medicare recently began putting some pressure on providers to start filing electronically. Physicians who continue to submit a high volume of paper claims will receive a Medicare “request for documentation,” which must be completed within 45 days to confirm their eligibility to submit paper claims. Denials are not subject to appeal. The bottom line is that if you are not filing claims electronically, it will cost you extra time, money and hassles.

HIPAA is Your Friend

While there has been much groaning and distress over new rules and regulations heaved upon us by HIPAA (the Health Insurance Portability and Accountability Act of 1996), there is a silver lining. With HIPAA, Congress mandated the first electronic data standards for routine business processes between insurance carriers and providers. These new standards usher in a new era for providers by providing five ways to optimize the claims process.

Electronic Tool 1: Eligibility

Practitioners frequently accept insurance cards that are invalid, expired, or even faked. The Health Insurance Association of America (HIAA) found in a 2003 study that 14 percent of all claims were denied. Out of that percentage, a full 25 percent resulted from eligibility issues. More specifically, 22 percent resulted from coverage termination and/or coverage lapses. Eligibility denials not only create more work in the form of research and rebilling, but they also increase the risk of nonpayment. Poor eligibility verification increases the likelihood of failing to precertify with the correct carrier, which may then result in a clinical denial. Furthermore, time wasted because of incorrect eligibility verification can cause you to miss the carrier’s timely filing requirements.

Use of the HIPPA eligibility transaction allows practitioners to automate this process, increasing the number of patients and procedures that are correctly verified. This standard allows you to query eligibility multiple times during the patient’s care, from initial scheduling to billing. This kind of real-time feedback can greatly reduce billing problems. Taking this process even further, there is at least one vendor of practice management software that integrates automatic electronic eligibility into the practice management workflow.

Electronic Tool 2: Referral Request & Authorization

A common problem for many providers is unknowingly providing services that are not “authorized” by the payer. Even when authorization is given, it may be lost by the payer and denied as unauthorized until proof is given. Researching the issue and giving proof to the carrier costs you money. The situation is even more acute with HMOs. Without proper referral authorization, you risk providing free services by performing work that is outside the network.

The HIPAA referral request and authorization process allows providers to automate the requests and logging of authorization for many services. With this electronic record of authorization, you have the documentation you need in case there are questions about the timeliness of requests or actual approval of services. An additional benefit of this automated precertification is a reduction in time and labor typically spent getting authorization via telephone or fax. With electronic authorization, your staff will have more time to get more procedures authorized and will never have trouble getting to a payer representative. Additionally, your staff will more effectively identify out-of-network patients in the beginning and have a chance to request an exception. While extremely useful, electronic referral requests and authorizations are not yet fully implemented by all payers. It is a good idea to seek the assistance of a medical management vendor for support with this labor-intensive process.

Electronic Tool 3: Claim Submission

Submitting claims electronically is the most fundamental process out of the five HIPPA tools. By processing your claims electronically you receive priority processing. Your electronically submitted claims go directly to the payer’s processing unit, ensuring faster turnaround. By contrast, paper claims are processed only after manual sorting and batching.

Processing insurance claims electronically improves cash flow, reduces the expense of claims processing and streamlines internal processes allowing you to focus on patient care. A paper insurance claim typically takes about 45 days for reimbursement, where the average payment time for electronic claims is 14 days. The reduction in insurance reimbursement time results in a significant increase in cash available for the needs of a growing practice. Reduced labor, office supplies and postage all contribute to the bottom line of your practice when submitting claims electronically.

Electronic Tool 4: Claim Status

Continuous rebilling of unpaid claims creates denials for duplicate claims with each rebill processed by the payer – causing more work for you and the carrier. Using the HIPAA electronic claim status standard offers an alternative to paying your staff to spend hours on the phone checking claim status. In addition to confirming claim receipt, you can also get details on the payment processing status. The reduction in denials lets your staff focus on more productive revenue recovery activities. You can use claim status information to your advantage by optimizing the timing of your claim inquiries. For example, if you know that electronic remittance advice and payment are received within 21 days from a specific payer, you can set up a new claim inquiry process on day 22 for all claims in that batch that are still not posted.

Electronic Tool 5: Remittance Advice

HIPAA’s electronic remittance advice process can provide extremely valuable information to your practice. It does much more than just save your staff time and effort. It increases the timeliness and accuracy of postings. Reducing the time between payment and posting greatly reduces the occurrence of rebilling of open accounts – a major cause of denials.

Another major benefit from electronic remittance advice is that all adjustments are posted. Without this timely information, you data entry personnel may fail to post the “zero dollar payments,” resulting in an overly inflated A/R. This distortion also makes it more difficult for you to identify denial patterns with the carriers. You can also take a proactive approach with the remittance advice data and start a denial database to zero in on problem codes and problem carriers.

Free Resources

Thanks to HIPAA, nearly all major commercial carriers now provide free access to these electronic processes via their websites. With a simple Internet connection, you can register at these websites and have real-time access to patient insurance information that used to be available only by phone. Even the smallest practice should consider registering to verify eligibility, request referral authorizations, submit claims, check status, receive remittance advice, download forms and update your provider profile. Registration time and the learning curve are minimal.

Software & Clearinghouses

Registering for free access to individual carrier websites can be a significant improvement over paper for your practice. The drawback to this approach is that your staff must continually log in and out of multiple websites. A more unified approach is to use a good practice management application that includes full support for electronic data exchange with the carriers. Depending on the type of software you use, your choices and costs may vary as to how you submit claims. Medicare provides the option to submit claims at no cost directly via dial-up connection.

Alternately, you may have the option to use a clearinghouse that receives your claims for Medicare and other carriers and submits them for you. Many software vendors dictate the clearinghouse you must use to submit claims. The cost is usually determined on a per-claim basis and can usually be negotiated, with prices starting around twenty-four cents per claim. While using billing software and a clearinghouse is an effective way to streamline procedures and maximize collections, it is important to closely monitor the performance of your clearinghouse. Providers should instruct their staff to file claims at least three times per week and verify receipt of those claims by reviewing the various reports provided by the clearinghouses.

How About a Good Scrub?

A powerful tool that you can use to maximize the percentage of “clean claims” that go out is called a claim scrubber

These systems automatically review electronic claims before they are sent out. They check for missing fields, misused modifiers, mismatched CPT and ICD-9 codes and generate a report of errors and omissions. The best systems will also check your RVU sequencing to ensure maximum reimbursement.

This process gives the staff time to correct the claim before it is submitted, making it far less likely that the claim will be denied and then need to be resubmitted. Remember, the carriers make money the longer they can hold on to your payments. A good claim scrubber can help even the playing field. All carriers use their own version of a claim scrubber when they receive claims from you.

The Bottom Line

With the mandates from Medicare and with all other carriers following suit, you simply cannot afford to not go electronic. All aspects of your practice can be enhanced by the use of the HIPAA standards of electronic data exchange. While the initial investment in hardware, software and training could cost tens of thousands of dollars, the proper use of the technology virtually guarantees a rapid return on your investment.