Medical Billing Services Outsourcing to Improve Medical Practice Cashflow

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Medical Billing Services Outsourcing and Impact on Medical Practices Revenue and Cashflow

Identifying the right diagnoses, writing prescriptions, or operating on patients is only a small part of what it takes to run a successful medical practice. There is also the aspect of managing the business side of things when it comes to operating a medical office, or really any business. You may guarantee that you will compensate for all of the services you provide by putting in place medical billing service procedures and then ensuring adherence to those procedures.

 

Medical billing services:

Your medical practices RCM activities start with scheduling the patient appointment and that’s the point from where you need medical billing services. You have an agreement with the patient and continue until the bill will pay in full. It could appear to be a lot at first, but if you break it down into smaller steps. You’ll find that it’s not quite as intimidating. In order to maintain your healthcare practice operational, one of the most important things you can do is ensure that the team with the right experience is on board to provide appropriate medical billing services.

The Processes Involved in Medical Billing Services

Here are a few critical processes that shall include in your medical billing service procedures. Whether you are just getting started with medical billing services or if you are wanting to improve your present system:

  • Make a record of the patient in the EHR/EMR system.
  • Check on the insurance eligibility and benefits verification.
  • Document the details of each visit.
  • Sharing your medical procedure details such as charting the billing team
  • Add appropriate diagnosis and procedure codes
  • Prepare medical claim
  • Examine the claim.
  • Payment and follow-up
  • Prepare the patient statement

Develop a patient registration form:

Develop a patient registration form that compiles all of the essential information that you will require. Such as patient demographics, the patient’s referral provider, insurance identification, and any other necessary details. This data will be utilized during the subsequent visits, and the patient’s medical record will be kept current as circumstances warrant.

Verify the patient’s insurance information and coverage

Verify the patient’s insurance information and coverage before the appointment. And ask to see their insurance card to ensure that you have all of the necessary details. This step is necessary to ensure that there will be no unexpected charges further down the line. During subsequent visits, you will still need to verify that they have the same insurance data that will contain in your medical record and ensures the coverage eligibility with the insurance company.

Coders in the medical industry

Coders in the medical industry will make use of the medical clinical documentation in order to assign the codes. That is most appropriate for the services that will render. It is important to obtain a medical history during the first visit. And then monitor it for any changes during the following visits. The medical transcription will incorporate each and every one of these pieces of information.

Completion of the review of the medical notes, or transcription

Following the completion of the review of the medical notes, or transcription if the provider transcribes and doesn’t use the charting system. It will then prepare for delivery to your medical billers. Some healthcare providers handle the billing and coding on their own. While others contract out the work to a third party like medical billing services. Because of this, you need to make sure that the record of the visit is thorough and describes everything in detail. When this step of the process will complete, the charge entry process will be started to prepare the healthcare claim with the right diagnosis code, procedure code, date of service, and other necessary information to get the claim ready to transmit.

The medical claim will transmit:

Following this, the medical claim will transmit to the insurance companies, worker compensation, auto injury, or employer-funded insurance plans for the purposes of review and processing. Before sending the information to the insurance payers for reimbursement, the healthcare claim has to go through an internal audit generally known as “scrubbing,” during which any problems or errors that may have been applied will check for. Every medical billing company has its own rule-based engine to ensure the accuracy and completeness of the medical claim to avoid rejections. The claim scrubbing process is utilized to check the accuracy of each field in the claim HCFA-1500 Form or UB-04 form which also verifies each individual insurance requirement based on service type and the plan of care.

Review the claim and look for any discrepancies:

If the claim is rejected or denied, it needs to be checked if there are any errors or if the patient underwent any operations that were not covered by their particular insurance policy, if the policy was not active on the date of service, or if there is any incorrection information submitted on the claim. The majority of the time, insurance companies will provide an explanation for a claim that was rejected or denied so that any issues can be resolved.

 

The remaining balance (if any) will engage accounts receivable workflow to submit it to the patient, or financial granter once the claim will be processed or finalized by the insurance company and the final decision about reimbursement has been made. They will first generate a patient statement that explains the remaining balance along with reason or remarks, and then they will submit the invoice to the responsible party whether it is secondary insurance, the patient, or the financial granter of the patient.

Track down any past-due bills:

When the medical claim or bill is paid, this money-making cycle generally called RCM Process is over. Even so, you may require to track down any past-due bills, which is typically the most difficult part of the process for many medical practices that involve the whole denial management strategy. It is essential to take the help of medical billing companies that have experienced teams of medical billers in order to guarantee that you will be paid for the services that you provide. Sometimes heavy medical bills which are sent to patients as patient responsibility need a little more care from the billing team and healthcare provider end to ensure patients get the easy installment options with specific percentage write-offs as a professional courtesy in case they wanted to pay off the whole amount at once. This helps to retain the healthcare office’s clients (Patients) and on a practice level, keeps a steady cash flow.

Well-defined medical billing systems

It is important for your medical office to have a well-defined medical billing system run by an experienced medical billing company in place to assist guarantee that it runs smoothly. That will help to get reimbursed for all of the services that you perform in the healthcare facility. It is possible that getting everything organized will take a little bit of time, but in the long run, it will be well worth the effort.

 

It is simple to lose track of payments or to find oneself dealing with patients whose bills have not been fully paid. You can spare yourself a lot of hassles in the future by having an experienced and well-recognized medical billing company like “iCareBilling LLC” to properly set up your medical billing and collection processes and workflow in place. If you are facing difficulty in getting paid by the insurance company in a timely fashion, you can reach out iCareBilling to schedule a free medical billing consultation to learn more about how the current workflow can be improved. It might be challenging to maintain a steady cash flow by yourself because you have been trained for years to treat patients, not to manage the RCM side of your business. Let the experts handle this task so you can focus on patient care.

Outsourced Medical Billing Company Advantages

Outsourced Medical Billing Company Advantages for Revenue Growth

 

There are many reasons why medical billing company outsourcing services are becoming increasingly popular. Medical billing, practice management, or healthcare RCM services outsourcing is no longer a traditional business but more of an innovative method to operate and grow in the healthcare industry. The use of outsourcing services has recently become extremely common. It simplifies procedures, improves systems, uses cutting-edge technology, and helps the economies of scale, and complexity in the healthcare system that ultimately create a need for an experienced workforce. These Healthcare IT businesses are mostly loaded with specialized knowledge and expertise, which often provides greater cost savings and outcomes to the healthcare industry.

 

Medical billing company Outsourcing Services:

In today’s world, the healthcare industry is both complex and constantly changing at the same time. Effective management of processes and workflows at medical billing companies is proving to be a strategic advantage point for healthcare practitioners not to jump into an industry they have not been trained so far. It should come as no surprise that medical professionals, healthcare facilities, hospitals, and practice managers generally start doing medical billing on their own until they realize they need medical billing experts to handle the revenue cycle management side of their healthcare businesses or entities. The Healthcare industry overall embraced medical billing and coding outsourcing as their ace in the efforts of improving their financial standing and keeping the medical practice at stability and having steady revenues and profits. Healthcare and health plan processing companies often need a hand outside of their business to look at the business dynamics from a different perspective and for that, they definitely need a highly professional and expert medical billing specialist. On top of this becoming a HIPAA-compliant entity while operating business as usual has become the ideal choice for hundreds of medical offices not because they want to but because they should and there is no question about it. There is not sufficient need to discuss how regulatory authorities try to enforce this as a part of the healthcare industry no matter if the healthcare business entity is small, medium size or big, or the medical office is a family practice, clinic, hospital, medical groups or even if that is medical billing companies or any healthcare corporations because all these are covered entities according to HIPAA (Health Insurance Portability and Accountability Act of 1996) and OIG (the Office of Inspector General) guidelines and all must comply. There is no doubt that outsourcing medical billing services companies have just established a foothold in the market as a cost-saving solution. In point of fact, it is the most considerable factor that is driving the trend among customers, but it also matters a lot to those who are increasingly perceiving it as a tool that delivers wide-ranging benefits to their businesses’ innovations and improving result-oriented care for their patients.

First, let’s have a look at some of the benefits:

1. Mainly Concentrates on the Treatment of Patients

Combining the responsibilities of a medical practitioner, along with the office administrative manager is never without its share of obstacles. Shifting your view from healthcare treatment to billing questions during the process of patient care is not an ideal situation. Healthcare providers can boost profits by adopting the most customizable workflow that fits the healthcare organization’s needs and not worrying about medical billing and denial management issues. These high-value activities not only bring in additional cash for the medical facilities but also contribute to the development and improvement of patient care standards and methods. The maintenance of a prosperous medical practice that is supported by a dedicated patient population is critical. It needs a lot of time and effort to focus on building a great healthcare business that can support the community in a greater way. And this is only if that healthcare business is backed by a top ranked medical billing company. As a result, medical professionals are freed from the need to negotiate with many payers and meet various regulatory requirements. This allows them to devote their whole attention to the areas in which they excel, “the practice of medicine and the care of patients” which is and should be the ultimate goal of healthcare providers.

2. Expert Medical Billers Help Reduces Inaccuracies in Billing

Medical billers who have years of experience and receive thorough training have a comprehensive understanding. The intricate processes are involved in submitting claims, payment posting, follow-up, and in overall RCM activities for any healthcare practice. Medical billing companies make it a point to ensure that their employees successfully complete rigorous process training, and they have needed quality and domain-driven knowledge testing. These medical billers are responsible for ensuring that their submissions are accurate and made within the appropriate time frame to ensure reimbursement from insurance companies in a timely fashion and not getting the medical billing denial of “exceeding timely filing”. Medical billing solutions providers not only cut down on the number of claims that are denied, but they also check and correct payers, claim coding aspects, and any other errors that might be in the claim before sending it off to the payer.

3. Medical Billing Companies Helps Save Money

Among healthcare providers outsourcing has traditionally been the desire to realize cost savings. The cost of salaries, employee training, and benefits can be reduced by independent healthcare practices, medical group practices, hospitals, laboratory services, and other medical specialties. Apart from cost-effectiveness, workflow improvement is the major benefit any healthcare professional can get by outsourcing their medical billing tasks to top-rated medical billing companies. It is also possible for hospitals to avoid incurring expenditures associated with the acquisition of new or upgraded hardware or software such as EHR (electronic health record), EMR (electronic medical record), practice management, or medical billing software if the whole medical billing operations are not set up as in-house managed by the healthcare facility. Apart from these expenses, office supplies, furnishings, office space, and many other expenses can add up to a huge cost to the healthcare providers which is not quite the right decision when you can have everything managed outside of the office by someone who knows what they are doing. Many patients go with those medical specialists where they could get great onboarding patient experience rather than any medical professional who is trying to get everything done on their own and messing around between the tasks of patient care and medical billing or RCM Services. The same is happening with a medical office with multiple staff trying to manage the RCM and Clinical workflow at the same time. As a healthcare professional you can add more valuable services to your practice with a fraction of the cost and stay ahead of your competitors. The amazing part is that you can pay these outsourcing medical billing companies only a specific percentage of reimbursement received from the insurance companies, and no need to worry about matching 401K benefits or paying other benefits to your employees. Medical billing companies offer the highest value standards to their clients with proven medical billing workflows to improve their revenues and collections. Cost-effective medical billing companies are always there to help you make the most out of your time and money and your customers (patients) always feel the difference when their medical bills get paid without any trouble. In the long run, choosing the right medical billing company for your healthcare business would pay off by having more patients looking for your services, which means more revenue = more profit.

4. Use of Healthcare RCM Services to Increase the Cash Flow

Maintaining a regular and constant cash flow at healthcare practices is not easy unless you do not have a medical billing workflow in place. No matter you are a small medical practice or a larger healthcare group or hospital, you are able to maintain a regular cash flow and faster reimbursement when medical billing companies outsourcing services are utilized to help you to cut every corner for you. This is true regardless of the size of your healthcare business, type of specialty, the workflow of your patient care, or anything else. Healthcare offices often have staffing situations where they are not able to find the right person in the local community who could come and visit the office which doesn’t happen all the time. Many healthcare facilities end up hiring someone remote far away from their practice location, then why not outsource to a medical billing company that can deliver the best results? By outsourcing the time-consuming task of medical billing to a professional practice management company you buy the time for yourself that can be utilized to make your healthcare business more innovative and appealing to your customers. Bigger healthcare organizations, larger medical groups, and hospitals choose to outsource their practice management tasks to the outsourcing practice management companies in a very early stage of their business, and they make decisions in the favor of greater economies of scale in their operations to let the medical billing services providers help them out in the area they can’t help themself.

5. Well-Designed Healthcare RCM Workflow Improves Patient Satisfaction

The primary focus of the outsourced vendors in the revenue cycle management industry in healthcare is increasing and the major reason could be to focus on patient satisfaction. Customers who are actually patients always try to find healthcare solutions that are affordable, and they could have a great patient experience. Adopting a well-designed healthcare RCM workflow helps the healthcare practices to position themselves where patients could see that the services are affordable and they can solely rely on the treatment offered by the healthcare provider without worrying about anything else. The use of offshore medical billing services guarantees the healthcare professionals that their patients each CPT code for the services rendered will receive the appropriate compensation in a timely manner from the insurance companies, worker compensation plans, and third-party payers. If the medical billing workflow is well designed by the medical billing company and customized for the healthcare providers’ needs, any errors will be recognized promptly, and denials will be followed up on immediately to get you paid for the services rendered to your patients. On the other side, healthcare practitioners are able to provide their patients with outstanding customer service which is the key to success and this key factor is not going to go away anytime in the future. So healthcare businesses can have more potential to be more compassionate and humane which could win the hearts of your patients and everyone could fall in love with your services.

6. Medical Billing Companies Ensure Compliance Standards

Since the beginning of this century, all healthcare business were ought to comply with HIPAA, OIG, and other healthcare standards and they need to ensure that all of the business activities are in compliance without any exceptions to it. Medical billing companies always make sure that their internal processes, communications, work ethics, and standard operating procedures are in compliance with HIPAA while providing medical billing, practice management, or healthcare RCM services to the healthcare industry. Any healthcare outsourcing company that is providing back office solutions to clinics and hospitals is subject to the same rules when providing their services to healthcare businesses all over the United States. An organization that has reached a mature stage will always make sure that compliance is thoroughly ingrained in all of its operations, and internal/external audits are conducted on the regular basis to ensure the implementation of all the required rules and procedures.

Medical Billing Company Impact on Practice Revenue Growth

How does a medical billing company impact revenue growth and help to stop revenue leakage? 

Hospitals, physicians, and healthcare systems all rely on a complex revenue cycle to manage and collect compensation for the services they deliver to their patients. Patient registration, benefits, and insurance verification. Medical Billing Company follows the process of claims filing, payment posting, denials handling, and report generation that positively impacts healthcare practice’s revenue growth. Unnoticed revenue leakage at these stages might cost thousands of dollars due to inefficiency and negligence.

 

Strategies to Stop Money from Leaking Out of Your medical billing company:

With the resources provided by Right Medical Billing company, you can stop losing money even while you labor tirelessly to keep the lights on. You may boost profits and cut expenses by following these suggestions.

The primary goal shall be to avoid rejections and have sufficient expertise to perform all the clinic tasks. 

Clinics need to know that ignoring a doctor’s other doctor’s referrals to accept patients from certain insurance plans can have a big cost. But you can only accept patients from all plans if your practice is credentialed with insurance plans. Being in-network with insurance plans helps you to take in more patients, and medical billing companies can help you to get credentials so fast. If the doctor has credentialing issues, it may lead to more claims being denied. The complexity of payer-specific credentialing standard are associated high rate of credentialing application denials, and these can be reduced by using a professional credentialing service from experts. Identifying and getting the healthcare professional re-credentialed with the help of medical billing services professional team will decrease the number of denials and improve revenue and collection. Your practice might consider having the credentialing process handled by an outside business.

 

Procedures That Were Not Billed

Physicians need to be familiar with valid specialty CPTs / procedures codes to reduce the number of unrecorded small procedures, and such errors can be reduced by utilizing a billing company. The ability of physicians to check and verify the valid CPT codes and diagnosis codes reduces the number of bad claims billed to the insurance companies that come back with good check amounts which increases the revenue. In most cases, revenue leakage is caused by unbilled treatments that can identify by a medical billing expert following an in-depth analysis of clinical documents and a treatment plan signed by the rendering provider.

 

Claims That Are Not Yet Bill

The loss of revenue due to unbilled claims is greater than the loss due to any other cause. By correlating reports of patient appointments, procedures performed and claims made medical billing company expert staff can easily identify the unbilled claims and submit them within the insurance’s timely filing limit to get the claims paid without any late filing denials.

 

Managing Patient Balances

Creating an effective procedure for managing patient balances is as important as treating the patient and checking other areas of practice. The billing company always designs an effective follow-up strategy for patient balances followed by patient recall/texts, electronic statement generation, and paper statement generation along with flexible payment options and flexible payment plans. These standard procedures from Healthcare RCM Companies will ensure that the patient receives the due balance on time. They are constantly reminded to pay the patient’s responsibilities to the physician’s offices as soon as possible.

 

Underpayments

Knowing the exact cost of the medical billing service always seems cheaper when you know the cost you could pay for any medical procedure underbilled and paid less than average. As a healthcare professional you provide the best treatment to the patient but are still unable to collect money and generate income because the top-rated medical billing company did not handle the Billing process. By preparing ahead and making necessary adjustments to your fee schedule as soon as possible, you can prevent having deductions taken from your pay at various insurance companies. Ask medical billing experts for support in putting up your enhanced fee schedule.

 

Inefficient Claim Denial Management

The management of denied claims is necessary along with the other healthcare RCM activities. Management of denied claims needs the hand of medical billing experts. Outsourcing to a medical billing company that has expert staff will help you resubmit the wrongly denied claims with proper corrections to avoid the previously received denials. These experts figure out the reasons why denials occur and then take corrective and preventive measures to ensure these denials don’t happen again and claims get paid on the first attempt.

 

In-House Billing Workflow Issues

The workflow issues between staff cause inefficiencies in the billing departments that may be caused by inadequate training or not designing a proper workflow. Having a medical billing company doing the medical billing helps you to focus on your clinical staff training to treat patients in an effective manner that will improve the overall patient experience. Put your faith in your passion to deliver the best healthcare services to your patients who will market your healthcare business resulting in more patients and revenue.

 

Make Full Use of Data and Analytical Tools

The majority of medical billing companies billing software includes several reporting functionalities. You may quickly generate reports on the operational and financial performance of your practice by making use of these tools. Make the appropriate judgments while keeping in mind the most important things you’ve discovered through root cause analysis.

 

Prioritization of the Patient

Your organization in the healthcare field has the primary obligation to ensure the health and happiness of its patients. Outsourcing complex medical billing tasks gives you more time to focus on your responsibilities as a healthcare professional and treat patients better, provide more robust and flexible solutions and train your clinical staff members. You can dedicate your staff to maintaining healthy and constant communication with your patient to reduce barriers and improve patient connections.

Medical Billing Practices to Maintain a Healthy Cash flow:

The majority of doctors start their private practice because they want to help people and built trusting relationships with their patients. However, it is challenging to remain profitable in the current market due to the Affordable Care Act and ICD-10 changes. The impact of all these variables can be reduced if you Outsource the RCM activities to the medical billing company this way you can save a lot of money and buy more time for you and your business growth.

It’s common to wish you could leave the stresses of running a private practice and join a hospital or large healthcare organization. The medical clinic you run is a business just like any other. The flow of money is important to main a healthy cash flow. The challenge, of course, is to increase the former while decreasing the latter. Your medical practice’s bottom line is directly affected by certain factors.

 

Outsourced Medical Billing Companies 

The best idea is to find a top-rated Medical Billing Company that can help you with Practice Management and RCM tasks so you can take control of your practice. When you get more time, you can perform the tasks such as internal audit, financial control, patient experience improvement, communication improvement with patients, sending educational material to your patients to improve their wellbeing, negotiating with insurance on contracts, testing other modern technology to enhance business efficiency, and much more. Need help? Call iCareBilling today and get a free consultation on how we can improve your office workflow, revenue, and collections.

 

Benefits of Outsourced Medical Billing Company

Benefits of Outsourced Medical Billing Company

In the complex and growing healthcare economy of today, the best strategy is to have an Outsourced medical billing company on board for your healthcare business to optimize the RCM Services and practice management administration needs and it is also necessary to use it for in the favor of your strategic planning and management. Because medical billing companies can help you in streamlining procedures, and adopt superior systems, state-of-the-art technologies, and bring your business up for scalability. Experienced medical billers with specific expertise and experience can make healthcare professionals’ jobs easier. It frequently results in more significant cost reductions and enhances patient experiences at healthcare practices.

 

Medical billing company Professionals and their Expertise

Imagine your healthcare business is in contract with a medical billing company that has professionals who possess vital skills. You are just getting started, and as a result, you have recently made significant investments in your offices. Business hardware and software, furniture, medical equipment, marketing, hiring office and medical staff, purchasing people, and practice insurance. You are looking forward to seeing more patients and developing your practice. On the other hand, you’re observing a widening disparity in income.

Surprise! Some of the patients you provided services and their claims are getting paid to get reimbursement because of mistakes made in medical billing and coding or the filling out of the documents. Payments from insurance companies entirely depend on medical billing companies and their well-designed workflow to keep a healthy cash flow for healthcare businesses.

 

Focus on patient Care vs Healthcare RCM Services

It should come as no surprise that reimbursements in the healthcare sector by medical insurance companies are decreasing day by day and they often implement penalties and cuts to reduce the payment percentage. In such cases, every healthcare business needs a reliable medical billing company that can help to identify under-payment scenarios where billable charges are not enough to achieve the highest level of payment, help your office to comply with requirements to avoid payment reduction, and provide help in denial management. If the workflow is designed, you can improve the smaller tasks such as the amount of necessary documentation to be completed, and make sure it’s HIPPA-compliant which is necessary as well. All these efforts can definitely help your healthcare business. This will improve the likelihood of successfully operating a healthcare business that brings in more revenue and increases the revenue-to-profit margins.

Seventy to eighty percent of patients owe at least $500 to their respective healthcare providers, on average. More than half of the patients have debts that are greater than one thousand dollars. If a bill is not eventually paid or settled, and it has not been billed to the patient to collect the patient responsibility portion then the cost of medical treatment cannot be repaid at any point in time which is the ultimate loss in business.

When operational costs are so high and the majority of rates are set by regulatory authorities, only hiring a top-ranked medical billing company can help to get higher reimbursement, and that is the key to how a small or medium-sized medical practice can thrive and remain successful.

 

Healthcare RCM Services and Process Can Be Time Taking, or Can be Even Expensive

The patients have always been the primary focus of healthcare practitioners, and they maintain current knowledge of the most effective medications, treatments, and therapies available to ensure that resulted-oriented care is delivered at the medical facility. The vast majority of their workforce is currently experiencing treating patients to recover from their health problems. Therefore, it should not come as a surprise that medical billing is relatively low on the list of priorities and they will have the required skills and knowledge to cope with changes in the medical billing industry.

The clients of independent healthcare practices or hospitals (the patients) may expect a level of service that is on par with the best in the world and healthcare business owners should always consider the best medical billing company to outsource medical billing services to keep the focus on patient care standards. By using the most recent technological innovation and experience, healthcare providers can reduce the costs of billing and receiving payments by as much as 30 percent.

If you are looking for the Best Medical Billing Services for small, medium, or large size medical practices, contact us today.

What is RCM

What is RCM? Revenue Cycle Management in healthcare is a process of engagement of resources to manage the healthcare practices’ various tasks starting from patient appointment scheduling, updating patient demographic and active coverage records in the EHR/Practice Management System, providing healthcare services, updating patient charts in EHR, transmitting claims to insurance carriers and patients, maintaining all healthcare industry requirements up until getting the medical claims finally paid either by insurance companies, patient or third party processor whichever is applicable. During the process of RCM, medical billing, or practice management software can be utilized and integrated with a healthcare clearinghouse along with certified EHR (electronic health record) or EMR (electronic medical record) and an automated patient portal to streamline the process and improve the overall patient experience at the healthcare office.

Healthcare RCM simplifies the business process and improves the clinical sides of the healthcare sector by maintaining the administrative data, such as a patient’s name, insurance carrier details, clinical data such as procedure and diagnosis, along with complete medical treatment history, the transmission of data over the EDI (electronic data interchange) through clearinghouses to achieve the goal of getting the reimbursement from insurance carriers and patients in a timely fashion. Medical billing companies like iCareBilling offers RCM Process workflow improvement to help healthcare providers achieve their goals to improve patient care.

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Coordinating with insurance carriers is a fundamental part of the Revenue Cycle Management Services (RCM). When an appointment is scheduled at the healthcare office, the doctor’s office intake department generally verifies the patient’s insurance details if the patient has active coverage before the actual visit date to ensure the accuracy of insurance data. After an insurance-covered patient receives the treatment for their relevant diagnosis and paid any applicable copays, a medical professional or medical coder analyzes the nature of the treatment provided in accordance with the international classification of diseases (ICD-10 codes) and assigns the relevant codes. The medical billing department of a healthcare facility or in case of having an outsourced Healthcare RCM Services provider, Medical Billing Companies then send the patient’s treatment, diagnosis, and date of service, along with the patient and healthcare provider required information to the patient’s insurance company to get the maximum reimbursement that can be covered by the insurance. Based on the mutual agreement between the patient and insurance, some portion of the medical claim might be covered by the patient such as co-insurance, deductible, or in some cases the treatment that is not covered under the patient plan, and all such patient responsibilities are then being billed to the patient if they have not paid upfront. Depending on the specialty of the healthcare facility, or provider specialty, and the patient’s insurance plan sometimes patient responsibility can be determined before even providing services which will result in the reduction of expenses that occur for patient billing that includes mailing out paper statements and/or e-statements or in some cases text message or phone call reminder but it also enhances the overall RCM Services for the practice because full payment on the claim can be made with less time so no more following up patients.

 

RCM or Revenue Cycle Management

The Best Healthcare RCM Companies always focus on developing the RCM Process to ensure result-oriented and quality service delivery. The RCM or revenue cycle management involves the process related to all the clinical and administrative aspects of the healthcare business that will include collection and management of patient clinical and non-clinical data, charge capture or generally called charge posting, and ensuring the accurate healthcare claims data management, handling rejection and denials, payment posting or electronic funds transfer (EFT) management, account receivable follow-up and denial management. Medical billing companies have separate EDI Enrollment departments to help streamline the whole process to make it easier for healthcare providers.

Here is what’s involved in the revenue cycle management process:

  • Pre-Registration before Visit: Collection of patient information before the actual visit date, patient name, date of birth, address, phone, email, and active insurance coverage details, before a patient arrives for outpatient or inpatient services at the healthcare office.
  • Registration a the time of Visit: Collection of necessary information related to the previous history, any referral or prior authorization in case of being seen by a specialist or surgeon, or others, and collection of other necessary information to establish a medical record and to meet various healthcare regulatory and industry clinical requirements.
  • Charge Posting: Providing healthcare services to patients and converting them into billable claims
  • Medical claims transmission: Submission of healthcare claims with an appropriate fee schedule to the insurance companies, and others.
  • Medical Coding: Conversion of patient chart notes into the ICD-10 diagnosis codes, procedure codes, modifiers, units, etc.
  • Patient Payment Collections: Identifying the patient balances and collecting the patient payments.
  • Electronic and Paper Remittance Processing: Working on denied claims and taking appropriate actions and applying the payments into the practice management software to settle the claim or to bill the patient for patient responsibilities.
  • Denial Management and Claims Follow-up: Following up on unpaid claims that cross a certain threshold and payments have not been received either electronically or via paper mail EOB (Explanation of Benefits) to ensure and resolve denied claims for possible resolution to get the reimbursement.
  • Audit Review: Auditing the Healthcare RCM process to ensure the highest accuracy and maintain all industry requirements.

 

Revenue Cycle Management Process and Factors:

RCM Services offered in healthcare by a medical billing company are directly connected with financial matters and there are a few factors (internal and external) that directly impact revenue cycle management and collection.

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A healthcare entity can be flexible with administrative control over internal dynamics, such as healthcare provider productivity, new and established patient volume, and fees for services (FFS). However, it is more challenging to make an impact on external factors, such as patient insurance payments or claims reviews and denials from insurance companies. Even though we at iCareBilling believe that somehow external factors can also be influenced by talking to the insurance and raising the issue to the level where it could get some solution or adopt more compliant practices to reduce denials and improve collections at healthcare offices. It’s an important part of Medical Billing Services to provide such valuable inputs to healthcare providers.

RCM or Revenue Cycle Management Systems

Medical providers often purchase and deploy designated RCM (revenue cycle management) systems to store and manage patients’ clinical and non-clinical records. An effective Revenue Cycle Malmanagement (RCM) system can reduce the amount of time spent while delivering medical and related services and receiving payment by interacting with other healthcare IT systems — such as EHR (electronic health record) or EMR (electronic medical record) (EHR) and/and practice management/medical billing systems — as patients move through the care process.

An effective healthcare RCM system can also save healthcare staff time by automating the medical billing and other clinical processes that were previously handled by employees. These tasks include administrative tasks, such as coordinating with patients regarding their upcoming appointments, reminding patients about their due balances, sending balance statements on time, enhancing EDI (electronic data interchange) capabilities between EHR / Practice Management System and the clearinghouse to fetch the data from insurance companies, and having an audit review system in place to identify and fi the denied claims and have the team work on them to fix the errors/issues.

Revenue Cycle Management Systems offered by a medical billing company can help healthcare providers to save a lot of financial resources by giving having a good designed RCM Process in place to automate patient appointment scheduling, patient intake entry, clean claim submission, and getting the desired reimbursement. We have learned throughout the years that if you have specialty-focused RCM Services, or medical billing services in place, that can help you not only comply with your specialty healthcare and regulatory requirements, it gives you a better insight into patient experiences, analyze key performance indicators at the patient treatment level as well as employee’s productivity and this refines the overall patient experience and improve the care standards within the specialty and overall, in the healthcare industry.

Social Media Tips for Medical Practices to Improve Patient Visits

The recent changes in trends of social media and different approaches and their outcomes bring new results on how to improve engagement for companies and individuals. The most recent research approach that was circulated on the internet was from Connecting Healthcare + Social Media Conference in New York where those healthcare professionals who practice their medicine daily and use Social Media platforms as a tool to blog, tell stories and engage their target audience to make sure that they are well connected with them. We should not ignore the importance of social media and why healthcare professionals should take advantage of it. Now healthcare professionals would like to connect with patients through social media platforms for better engagement. The most recent article was published on Business Insider about the insights healthcare professional connecting with patients through YouTube.

 

To be precise, you have to write about what you do, what can bring readers into the exam room, and how were your patient’s overall user experience with your practice, staff, and your overall practice management starts from the initial appointment scheduling to getting their claims paid by the insurance companies. We know it’s a bit more to talk about Medical Billing Services here but that’s a vital part of any medical practice. If you do not have the right Medical Billing Company standing beside you, you can’t have a great patient experience at your Medical Practice. Anyways, let’s go back to the topic and explore what you can do at this point if you are looking to have more patients in your practice and want to use social media and blogging as a tool to make an improvement.

  1. Brand Endorsement.  In general consumer trust, it’s observed that customers generally trust brands rather than non-branded companies who are not popular in their industry. It is really important to build the brand of your business and then maintain a steady consistency to give confidence to your users that you are an established business with a mature workflow designed and you have reached a level where you can innovate and meet the demand of the clients. To change the world’s perspective, you need to focus on your brand and you can start this journey by doing small things regularly and continue to do it to build consistency.

 

  1. Story Telling.  It doesn’t matter what is your specialty, having a social media presence, and even a blog presence, is all about having a voice over the internet. In today’s world, you can use social media to tell stories and engage with your community and make a conversation tool with your targeted audience. No one can tell your story, but you can help your target audience to clarify how and why you have started.

 

  1. Find Target Audience. Healthcare professionals have online communities, and they love to connect, talk about their experiences and share their wealth of knowledge with others. As a doctor, when you have your own community, you can share your experiences and be more interactive and it brings life to your social media fan club, and you can share the amazing experience of how you find out the solutions to your problems.

 

  1. Express Your Opinion. If healthcare professionals discussed patients’ experiences in their blogging and social media in the 2000s, that wouldn’t make such a huge impact as it could make a difference today. But now it can make a huge difference when everything is available online and the community relies on the information available rather than finding the old traditional methods. Along with Social Media Blogging, the new trends are to use YouTube Videos, use the same videos on other social media channels, use podcasts, and use all platforms together to make your business brand more consistent.

 

  1. Discover Your Passion. If you are passionate about something, you would have to find your passion during blogging as it could help to brainstorm and be more creative in ideas generation. From nobody to somebody is a journey we all have to take, and it couldn’t be best than that if you could find it in your medical practice. You can talk about it, and discuss problems, solutions, and your personal experiences and this can strongly encourage your audience to connect.

 

  1. Social Media Marketing. One great advantage of being active on Social Media is to be the person whose opinion matters. But that’s only possible if you have a strong Social Media Marketing Strategy in place. Let’s take the example of Healthcare RCM Companies that constantly strive to improve their brand visibility and keep themselves on top of other Medical Billing Services brands to create a valuable addition to the marketplace. That’s only possible and will get noticed if they would have social media marketing to help them grow their audience. Tweeting only on Twitter alone won’t help unless you do not take it to the next level.

 

6. Share Experience with Medical Billing Companies. Every healthcare professional at some stage found themselves vulnerable in terms of finding the right Medical Billing Company. Finding the best medical billing companies has always been hard as you have to rely on them for your whole revenue and cash flow management. If you discuss the issues you had with your practice management and then could discuss the solution, this can help your other industry fellows to connect and learn from your experiences. You can even share your thoughts and ideas on how you improved the situation in your blogs and share it with your audience in the closed group of healthcare professionals and that can add a lot of value in the marketplace.

Medicare Cost Sharing Information Regarding Medicare Advantage and Prescription Drug Plans

CMS Releases 2022 Premium and Cost Sharing Information Regarding Medicare Advantage and Prescription Drug Plans

The CMS (Center for Medicare & Medicaid Services) released this year 2022 premiums, deductible, and other informative details for Medicare Advantage and Drug Prescription Part D Plans earlier this year at the time of the annual Medicare Open Enrollment to help Medicare participants decide which coverage may fit their healthcare needs according to their budget and requirements. The average premium for Medicare Advantage plans is generally lower in this year 2022 which is $19/month as compared to $21.22 in the last year 2021. While projected enrollments continue to decrease. According to the previous announcements, the average 2022 premium for Part-D Drug Prescription Coverage will be $33 per month which is lower compared to the 2021 year which was $31.47.

CMS Administrator Chiquita Brooks-LaSure said, “We are committed to ensuring that the health system and Medicare work for people, their families, and their providers”. “Open Enrollment is the one time each year when more than 63 million people with Medicare can review their health care coverage to find new plans or change existing plans, discover extra benefits and help them save money.”

The increasing number of Medicare Advantage with dual-eligible special needs plan covers both Medicare and Medicaid Services for people who are dually eligible. In the current year 2022, a total of 295 plans will cover the Medicare Services and Medicaid Covered Behavioral Health Treatment or long-term services and support through a single organization which is higher than the last year 2021 and total plans were only 256.

This topic needs a detailed discussion and for more information please read CMS 2022 Premium and Cost Sharing Information Press Release.

What it means for Healthcare Providers:

  • Increased number of elderly patients covered by Medicare
  • Increased number of claims to be billed to Medicare and Medicare Advantage Plans
  • Need a Reliable Healthcare Management System such as EHR or Practice Management System to ensure that you can deliver great quality services
  • Need a great Medical Billing Company that can help your healthcare organization submit clean claims submission and get the possible reimbursement
Medical Billing Companies Workflow Effect on Healthcare Revenues:

You may be wondering how Medical Billing Companies‘ internal workflow can help to improve the healthcare facilities’ revenue. We believe that healthcare professionals are trained for many years to focus on patient care and we should not let them provide divided attention to their patients and spare some time for Medical Billing tasks. The finest way to get things done in a timely fashion and get the maximum reimbursement is to let the industry experts work on their tasks so we all could focus on something we are passionate about. A Medical Billing Services Company that could focus on your claims pre-submission audit, clean claims submission, claims clearinghouse rejections, denials, and payment posting could be a great addition to your business to make improvements this year.

If you are looking for the right Medical Billing Solution Provider, to streamline your healthcare practice workflow, contact us today and we will reach out with a customized RCM Solution for you.

iCareBilling Wins 2022 Clutch Leaders Recognition for Best Medical Billing Services Provider

In the medical industry, you need undivided focus because the lives and health of other people are on the line. Here at iCareBilling, we strive to help medical professionals and institutions focus on their patients while we take care of the nitty-gritty. We are a healthcare information technology company that’s dedicated to providing different solutions including:

It’s with grateful hearts that we share with you all incredible news. Just recently, iCareBilling was officially recognized as a Clutch 2022 Leader for medical billing services!

Clutch is a review and market research platform that highlights the best B2B companies from different industries and specialized categories. For their annual awards cycle, Clutch factors in several dynamic variables such as case studies, market presence, and client testimonials. Needless today, we received this wonderful honor because of our supportive partners.

Thank you to everyone who believed in our team’s capabilities! Your constant support powers our team and opens different opportunities. This recognition is made possible because of your amazing reviews. iCareBilling genuinely appreciates your trust! 

“If you are looking for a professional Medical Billing company that consistently believes, iCareBilling is the place.” — CEO, Dabney Behavioral Health Hospital

“iCareBilling has been managing billings for the clinic’s patients, as well as the insurance. They coordinate all tasks by holding monthly meetings on Zoom and email. Moreover, their communication is painless.” — CEO, Internal Medicine Practice

“Thanks to iCareBilling’s efforts, the client is able to receive contracts from their target partners. The team has executed a seamless workflow to ensure the project’s success. They’ve been accessible and skilled throughout the partnership.” — CEO, Rockford Optometry

Focus on what matters most and leave the rest to us! iCareBilling is ready to help you. Send us a message and we’ll gladly walk you through our different solutions.

Annual Wellness Visit Codes

Healthcare professionals who have automated workflow for Medical Billing with Built-In Scheduling systems always remind their patients not to miss the annual wellness visits. The reason is that it’s covered fully 100% without processing towards the member’s “out-of-pocket maximum,” such as deductible, copay, or co-insurance and on the patient end it’s good to have an annual wellness visit once a year to make sure a healthy life. Insurance companies also encourage patients to take advantage of this opportunity to improve their overall health. To avoid medical billing denial on the Annual Wellness visit and get the full 100% reimbursement, it’s essential to bill the correct code in Medical Billing Software and keep track of the annual maximum limits and other factors. The Medical Billing Companies mainly keep track of such denials to resolve issues and improve RCM workflow at healthcare practices.

Insurance companies also appreciate their members receiving an annual wellness visit and a physical exam each calendar year. Here are brief details about the applicable codes based on age and intervals between the services.

Wellness Visits
CPT G0402 – The Initial Preventative Physical Examination with EKG (IPPE) is offered once in a lifetime and must occur within the first 12 months of Medicare eligibility. This is the “Welcome to Medicare” visit that consists primarily of discussion and personalized prevention planning.

CPT G0438 – The Initial Annual Wellness Visit with Health Risk Assessment (Initial AWV w/ HRA) is offered once in a lifetime and must occur after the first 12 months of Medicare eligibility and if the member did not receive an IPPE (G0402). This is very similar to the “Welcome to Medicare” visit, as it consists primarily of discussion and personalized prevention planning.

CPT G0439 – The Subsequent Annual Wellness Visit with Health Risk Assessment (Subsequent AWV w/ HRA) is offered once per year and must occur after the first 12 months of eligibility and 11 months after receiving, and IPPE (G0402) or Initial AWV (G0438).

Physical Exam CPT Codes and Descriptions
CPT 993XX – The preventative visit with the physical exam is offered once per year as an added benefit through WellCare. (Preventative visit code selection is age-driven).

If you are a member and would like to know more about your coverage guidelines, please reach out to your insurance member services line and check your benefits and coverage details. If you need outsourced medical billing services Contact iCareBilling for a Practice Management consultation today.