Physician Billing


# 1. Medical Billing Services by PracticeSuite

What Distinguishes PracticeSuite From Other Billing Companies?

Their front-office Revenue Cycle Management technology and billing expertise put you back in control of your practice’s finances. Their unique RCM software detects revenue-loss as it occurs and triggers notifications to management. You’ll notice an immediate improvement in revenue and a corresponding correction to aging A/R.

With PracticeSuite, you’ll begin every morning with a current operating balance, and end each day with a summary of that day’s progress. Any deviation from the daily plan registers a real time alert to staff so that revenue leaks are plugged before precious income is lost!

Their Proprietary Technology Alerts You When:

  • Patients are checked-in but eligibility is unchecked expertise 294x300
  • Co-pays or patient pay go uncollected
  • Appointments are deleted, canceled, moved, missed, etc.
  • An unauthorized visit or procedure is about to happen
  • Patients have been seen but remain unbilled
  • Balances above your preset threshold are written off
  • Timely filing presets are ignored
  • Claims or denials are not followed up
  • Collections performance is below preset threshold
  • Monitoring of User productivity, and much more.

Interventional Radiology

Best Practice Management

Radiology and Imaging have always been at the cutting edge of science and medicine, but changes are taking place at a breathtaking pace. This requires a billing partner that stays ahead of technology and coding.

Neurosurgical Billing

Neurosurgery is state-of-the-art medicine, and coding it is a science that requires expertise in coding complex procedures. PracticeSuite’s coding staff is experienced and skilled at coding complicated neurosurgeries at maximum reimbursement.

Billing Service Highlights

  • Inter-Office Communication makes it easy to exchange documents, discuss coding decisions, and interact with our management and staff at every level.
  • Credentialing into new health plans to obtain in-network rates
  • Free, integrated Stage III Certified EHR (+61 specialties, including radiology and neurosurgical) puts you in immediate compliance with HIPAA, HITECH, and OMNIBUS.
  • Software training for you and your staff
  • Audit-proofing your practice with our CMS Bell Curve Software Module

PracticeSuite Billing Service Guarantees

  1. We work on your existing insurance A/R. If it is collectible, we collect it. We aggressively pursue all outstanding unpaid claims and rapidly turn around EDI rejections. Going forward, our 94% first-pass claim success insures that A/R is kept at a manageable level.
  2. We create a daily financial plan: Before you arrive to work we verify insurance eligibility and benefits on every patient, perform a patient balance reconciliation, and each morning before you begin work we provide you with an updated operating balance.
  3. As work flows in through the day, our proprietary Money Monitor software sends out text messages/emails to office administrators, billing managers, and doctors on any deviation from the plan.
  4. Then, at the end of the day we reconcile and compare the outcome to the original plan –What was supposed to happen (PLAN), to what actually occurred (OUTCOME).

A Teamwork Approach

Our billing staff operate as an extension of your business. We treat your claims as our own. We treat your patients like family.

RCM Technology Features

  • Text, chat and cell phone access to your dedicated account manager, as well as coding and billing staff
  • Work assignment queues that show work waiting to be action-ed
  • Inter-office Communication Portal keeps you connected to your team and they to you
  • Real-time claim status dashboard & Real-time financial reporting
  • Complete visibility, accountability, and transparency into all billing activities
  • Run reports. Start each day with a plan, end each day with measurable results

# 2. Elation Health Billing Service

Elation HealthOur 2019 review of ElationHealth outsourced medical billing services earns Elation 5 Stars (See full review).

The bottom line of any business is top line revenue verses bottom line net-income (EBITA). Simply put, we increase collections and reduce cost.

Engaging Elation is like having a fractional CEO that ensures your practice is run like a business. This means executing a daily plan with experience, technology, best practices, skill, and hands-on back office management.

The challenge of running a finely tuned billing office is that success rises and falls on the skills of your billing staff: Top notch Billing Managers are hard to come by and costly.

By partnering with Elation, you get the instant horsepower you need to regain control of your insurance billing and finances; along with a dedicated, professional team that feels like an extension of your office––working in unison with you and your staff.

By partnering with Elation Health, you conveniently bypass:

  • Employee search and hire
  • Employee retention
  • Payroll, with holdings, taxes, benefits
  • Employee training, supervision, oversight
  • Employee liability: Absenteeism, turnover, theft, work-ethic, drama, etc.

RCM Calculator

Calculate the Advantage of Third-Party Billing

Partnering with Elation is the clear alternative to in-house medical billing. Stay on top of the endless changes in billing and coding rules. Efficiently handle claims processing, payment reconciliation, resolving of payment disputes, and achieving successful appeals.

MEDICAL BILLING SERVICES

You Focus on Patients, We’ll Get You Paid

# 3. Practice Fusion Billing Services

Practice FusionWith Practice Fusion Medical Billing Service, you’ll earn more money, have greater peace of mind, and have more time to spend with patients, staff, and family.

The average in-house biller has 2-3 years of experience at one or two practices and experience with only a handful of payers. When they leave at night, your finances are your problem.

PracticeFusion RCM services operate 24 hours a day. They never sleep. “When you leave at night, your finances are our problem“. All medical billing staff are credentialed and have +5 years experience dealing with hundreds of Payers in all States, and they have specific expertise in your medical specialty. At the end of each day they make sure that:

  • The majority of claims are billed same day, and all are filed within 72 hours.
  • All errors and denials are rigorously worked, daily.
  • Supportive documentation and legal letters are generated to all payers.
  • Your business is tended to by a name you can trust and rely on

Medical office staff’s pay is rarely tied directly to what they recover from insurance. In contrast, PracticeFusion is paid only on what they collect. And they pursue every last penny of every patient encounter. Let them quickly help you reduce overhead, eliminate claim errors, relieve payer stress, and reduce days in A/R.

# 4. Quest Quantum Revenue Cycle Management

Quest DiagnosticsWith Quest RCM Managed Services, you’ll earn more money, have greater peace of mind, and have more time to spend with patients, staff, and family. Call today for a free revenue consultation.

In a one hour meeting, learn how to:

  • Quickly stabilize your practice revenue and cashflow
  • Immediately cut costs and increase revenue
  • Let experts relentlessly pursue every dollar you’ve earned
  • Take control of your practice’s finances through cloud based technology
  • Quickly plug financial leaks with proactive monitor controls
  • Better determine patient responsibility before the patient arrives
  • Increase successful patient payment collection
  • Maximize revenue capture through proper coding, fee schedule analysis, and contract negotiation
  • Immediately increase cash flow by cleaning up and retiring insurance A/R
  • Increase first-pass claim rates and decrease / eliminate claim denials
  • Receive personal service and custom tailored billing solutions
  • Ask the tough questions when interviewing a billing service

Call today and learn how hiring the right billing service can be like bringing a fractional CFO into your practice

# 5. Ramsoft Billing Services

RamSoftWhen it comes to imaging and radiology billing, The Ramsoft Billing Service Program will earn you more money, streamline your payments, and give you greater peace of mind than you’ve ever had. Ramsoft software users can now scale their business quickly, by practically turning their backs to the many hassles of insurance billing. As a radiologist or radiology business, by outsourcing your insurance billing, you can not only increase collections, but the introduction of revenue cycle management best practices in the front end can help ensure that eligibility, precertification, and prior authorization is obtained, thus reducing denials and avoiding costly and inefficient patient collections. Learn more about radiology billing services for Ramsoft software users today.

Visibility – Accountability – Performance

Ramsoft certified billing services offer you real-time access to all of your business metrics and daily billing activity:

  • Know the status of any claim in real time
  • Know your operating balance in real time
  • Start each day off with a daily plan of action
  • Receive real time alerts upon any deviation from that plan
  • Maintain complete control of your A/R with real time financial reporting

They understand that the value of any business is not what they promise, but what they deliver.

Review More Billing Service Vendors

What other billing companies provide medical billing services?

What Is Physician Billing?

The US healthcare system is a third-party payer system in which care providers submit claims to insurance companies or government agencies (Medicare and Medicaid) for services rendered to patients. Physicians notate diagnoses derived from the visit and treatments performed during the encounter in the patient’s medical record, and medical coding experts use standard codes known as ICD-10 to create a bill or insurance claim for those services to be sent to the insurer for reimbursement.[1]

Until about 20 years ago, physician billing was done almost exclusively on paper. Today, standalone billing applications or billing modules built into practice management software are used by virtually all care providers. Some providers hire medical billing experts to create claims and follow up with insurers regarding denied or rejected claims; others outsource the medical billing function to a third-party service or company that specializes in medical coding and billing.

Billing Process

Healthcare practitioners contract with insurance companies to provide patient care services, and the rates for those services are pre-negotiated. Following each patient visit, the provider charts the diagnoses and treatments that should be billed, and a coding expert assigns the appropriate diagnosis and procedure codes to create a claim. The claim is sent electronically to the insurer, either to a private insurance carrier, or government entity such as Medicare, Medicaid, Tr-Care (Veterans), or Railroad (retired federal workers). Often, the claim goes first to a clearinghouse, which scrubs the claim to make sure there are no errors or omissions, and that the codes are valid to the patient type, and that the procedure codes are appropriate for the diagnosis code submitted with it.[2]

PHYSICIAN BILLING SERVICES

PracticeSuite helped a Jacksonville Practice clear up a $900,000 AR backlog

Once a clean claim makes it to the health benefit payer, approved claims are reimbursed based on the pre-arranged agreement. Claims will be rejected (not processed) if the patient’s personal information is inaccurate (e.g., name, date of birth, and identification number do not match) or the claim contains errors such as invalid or truncated diagnosis or procedure codes. Rejected claims must be corrected and resubmitted. Claims will be denied if the insurer processes a claim and finds it to be not eligible or otherwise payable. The insurer must inform the provider about the reason for the denial, and the provider can appeal the decision.[3]

Denials

A claim can be denied for a variety of reasons.[4] The most common mistakes leading to denial are:

  1. The coding was not specific enough. For example, simply diagnosing a patient with diabetes is insufficient. Instead, the code for a specific type of diabetes must be entered.
  2. The claim was missing information such as the date of accident/medical emergency or the date of onset.
  3. The claim was not filed on time. The Affordable Care Act reduced the claims-submittal period for Medicare from 15 to 27 months to 12 months. A claim must be received by the appropriate Medicare claims processing contractor prior to the end date, which is exactly one calendar year after the start date (the “From” date on the claim form).
  4. There were coding issues resulting from using an outdated code book or a biller incorrectly interpreting a provider’s handwriting.
  5. The claim lacked proper documentation. Each payer has its own definition of the medical records it requires before it will adjudicate a claim. It’s the medical biller’s specific responsibility to keep track of and understand payer requirements and submit the documentation needed to support the level of service performed.
  6. The claim contained duplicate items, which can result from multiple same day visits, or resubmitting a claim instead of submitting a follow-up claim, or cancelling a procedure or test but not removing it from the patient account.
  7. The claim contained a higher code than is typical for the diagnosis, such as a code for a higher-paying service than would be expected. Referred to as upcoding, and done repetitively this can be considered fraud and is thus illegal. Payers will automatically deduct funds from a doctor’s account in order to recover overpayments.
  8. The claim contained unbundled tests or procedures. Known as unbundling, this practice involves billing separately for tests or procedures that are required to be billed together and is also illegal.
  9. Prior authorization was needed. Although prior authorization is not a guarantee of payment, it’s critical to obtain one for any visit or treatment the patient’s insurer specifies as requiring it.
  10. The patient’s benefits were not eligible or coverage was terminated. Insurance information can change at any time, so it’s vital to verify eligibility on the day of service to make sure the patient’s coverage has not been terminated and their maximum benefit has not be met (e.g., for physical therapy and behavioral health).

MANAGEMENT REPORTS

If you can’t measure it, you can’t manage it. The Practice of Management

Payment

The time from a patient visit until full payment is received can be weeks or months. The billing cycle, known as the revenue cycle, can involve several interactions between the healthcare provider and insurance payer. If the patient is responsible for a portion of the visit, that bill must also be generated and collected on. The longer the revenue cycle, the more difficult the provider’s cash flow is to manage. Such is the case in a workman’s compensation claim, a prolonged hospitalization, or an auto accident, which is why revenue cycle management controls are included in the more advanced practice management software systems and why some providers outsource complex or difficult billing to third-party billing companies that have the expertise to speed up the payment cycle.[5]

The payment process is further complicated by the fact that providers typically charge more for services than what has been negotiated by the physician and the insurance company. The amount paid by the insurer is known as the allowable amount, and the difference between what was billed and what was paid is know as a provider write-off or contractual adjustment. The insurance payment will be further reduced if the patient has a copay, deductible, or coinsurance. The provider is typically responsible for collecting this amount from the patient.[6]

The amounts patients are responsible for have risen steadily over the last decade and continue to do so. In 2017, patients were responsible for 12.2% of their total healthcare bill, compared with 8% of their bill in 2012.[7]

The chart below demonstrates that the need for an experienced biller along with solid revenue cycle management software begin with the very first claim. It then rises at a one-to-one ratio as claim volume increases.

The Role of Software

Modern medical coding and billing software is designed to help billers quickly create a claim that ensures accurate patient information and correct codes for the visit. It also provides secure storage of patient health information and financial information and the ability to electronically submit claims to payers. Software packages may also provide:[8]

  1. Accessibility from any device with access to the internet
  2. Automatic updates as coding rules and regulations change
  3. Multiple choices for patient look-up (name, date of birth, etc.)
  4. Ability to easily create patient statements
  5. Ability to create customized letters to payers, work-comp, attorneys, and patients
  6. Clearinghouse integration within the practice management system
  7. The ability to track unapplied money and monitor write-downs
  8. The ability to create payment plans for patients
  9. The ability for providers to quickly review claims for accuracy and make suggestions for fixing denied claims (claim scrubbing)
  10. Insurance balance report that shows the patient information and payer contact
  11. The ability to manage collections for improved cash flow
  12. The ability for front-office staff to view patient balances, enter patient demographics, and enter insurance information from the scheduling module
  13. Integration with the practice’s electronic health record (EHR) so coders can view the medical notes and create the most accurate bill possible
  14. The ability to help administrators manage the revenue cycle via a claims-performance dashboard and integration with the practice management system

Billing Service Benefits

There are many drivers for outsourcing a practice’s billing function. For example, some providers seek to reduce the number of administrative tasks being performed in-house and the costs associated with them, including personnel, computers, and secure offsite electronic storage, and office space. Other drivers include:

  • Better integration between billing, patient records (EHR), and practice management systems
  • A desire to speed up the revenue cycle, reducing the time it takes from claim creation to payment
  • Reducing the need to continuously track changes in medical billing regulations
  • A desire to ensure all bills are maximized in terms of insurance payments

A tangible and equally important driver of outsourced physician billing is the desire to decrease time spent on administrative tasks in order to increase time spent with patients.

Sources:

1. “Everything You Need to Get Started in Coding,” //www.medicalbillingandcoding.org/billing-process/
2. “What is the Function of a Clearinghouse?”
3. “Differences Between a Rejection and a Denial,” Alex Tate, June 25, 2018, //electronichealthreporter.com/differences-between-a-rejection-and-denial-in-medical-billing/
4. “10 Common Billing Mistakes that Cause Claim Denials,” /practicemanagement/10-common-medical-billing-mistakes-that-cause-claim-denials-part-1/
5. “Revenue Cycle Management (RCM),” //searchhealthit.techtarget.com/definition/revenue-cycle-management-RCM
6. “Provider Write-Off,” //www.insuranceopedia.com/definition/5622/provider-write-off
7. “The Amounts Patient Owe After Insurance Continues Steady Rise,” Fred Bazzoli, July 2, 2018, //www.healthdatamanagement.com/news/patient-balances-after-care-continue-steady-rise
8. “Software—Beyond Codes and Claims” /practicemanagement/medical-billing-software-beyond-coding-and-claims/

This RCM pictograph shows how the need for an experienced billing manager and the implementation of state of the art technology are essential to managing the revenue cycle

Where does your medical practice fall on the Revenue Cycle Management Risk Matrix?

The RCM pictograph above demonstrates how the need for an experienced billing manager and the implementation of state of the art technology are essential to effectively managing the revenue cycle. Are you achieving preset revenue benchmarks on a regular basis?

Our question is, can any practice afford not to have RCM Best Practices in place – managed by an experienced billing staff who utilizes advanced cloud software that features proactive RCM controls?

Understanding where you are at risk can help you make the needed decisions to achieve peak revenue performance for your practice. A walk through the matrix will show where your practice falls. The Risk Matrix reveals that the determining factors in maximizing practice revenue are having an experienced billing manager along with the deployment of enterprise-wide Revenue Cycle Management software. When this is not possible or available, the fractional benefits of outsourcing must be looked into in order to achieve peak revenue performance.

Maximum Risk

If your practice falls in the top left quadrant, you’re at the highest risk. You have a large practice with high claim volume and low technology sophistication with inexperienced personnel managing the revenue cycle. The model is unsustainable. Financial survival will necessitate hiring an experienced billing manager who will require the proper RCM software and HR resources to gain control of collections and plug revenue leaks.

Gold Standard

The top right of the matrix is the optimal position. You’re a mature practice with experienced personnel and state of the art technology. You’ve succeeded in attracting and retaining top talent. You’ve evolved from a desktop software package, to a local network server, to VPN’s, then possibly to the ASP web-based model, and now you are finally using a cloud-based office/billing solution that is accessible securely from any location and any device.

New Practice

If your practice falls on the bottom right of the quadrant, your low claim volume likely means you’re a solo practitioner or a new practice. You don’t have a lot of extra cash on hand which means that maximizing every dollar is paramount. Purchasing expensive RCM software or hiring an experienced office manager is unlikely. The lack of money for both human resources and needed RCM controls makes the consideration of outsourcing your insurance-billing to a physician billing service a high return option.

Mature Practice

If you fall on the bottom right of the matrix you have a mature, possibly low-tech practice, perhaps with a trusted office manager that’s been with you for years. You’re may be thinking of retiring, and so will need a well thought out exit strategy. Making your practice’s financials stand out will be the cornerstone of making your practice attractive to today’s young physicians who are more business minded and tech savvy.

Moving Up and to the Right

Regardless of where your practice falls in the Risk Matrix you should be focused on moving further up and to the right of the matrix towards the gold standard. How does a practice accomplish this? It’s through a mix of expert level revenue management and the necessary RCM cloud-ware that allows it to happen.

Insourcing vs. Outsourcing

The answer to two simple questions can determine whether insourcing or outsourcing your revenue cycle management makes the most sense:

  1. Am I able to attract, afford, and retain an experienced in-house Billing Manager?
  2. Can I afford the necessary human resources and enterprise-wide technology they’ll require to ensure that my practice’s revenue is maximized?

A “no” answer to either question could mean that the ‘fractional’ benefits of outsourcing your revenue cycle management to a physician’s billing service that offers cloud-based software might be worth entertaining. The hard conclusion? Whether in-house or outsourced, experienced personnel + cloud-RCM-software are minimum requirements for maximized revenue.

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control into each step of the Medical Billing Process

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