Durable Medical Equipment Billing SoftwareIn House or Outsourced Medical Billing - Which Model Is Right For Your Practice? Durable Medical Equipment Billing Software Durable Medical Equipment Billing Software The decision to change an existing medical billing model should not be taken lightly. After all, it's only cash flow right? Even the best case scenario involving a change to/from an in-house or outsourced medical billing model will involve some degree of short term cash flow disruption and we won't even bring up the worse case scenario. A health care provider's first step is to determine whether or not his/her current medical billing model is achieving the desired financial result. Although financial analysis is beyond the scope of this discussion, the provider, accountant or other financial professional must be able to compare actual financial data to revenue and operating budgets. Assuming the integrity of the practice's financial data is intact though accurate and timely data entry, the provider's medical billing software should possess the capability of generating actionable management reports. In the end, basic financial analysis will shed light on the strengths and weaknesses of the provider's medical billing model. Some things to consider when evaluating a medical billing model: the inherent strengths and weaknesses of in house and outsourced medical billing models; the provider's practice management experience & management style; the local labor pool; and medical billing related operating costs. In House versus Outsourced Medical Billing Models No medical billing model is without unique advantages and pitfalls. Consider the in house medical billing model. Approximately one third of independent health care practices utilizing an in house medical billing model experience cash flow issues ranging from periodic to persistent. The degree of action required by a provider to resolve his/her cash flow issues may range from a simple adjustment (adding staffing hours) to a complete overhaul (replacing staff or switching to an outsourced medical billing model). The provider with an under performing in house medical billing model has a clear advantage over the provider with an under performing outsourced (also known as third party) medical billing model: proximity. An in house medical billing model is within walking distance. A provider has the opportunity to observe, assess and address - observe the process, assess the system's strengths and weaknesses and address issues before they become full blown problems. Consider the provider with an outsourced medical billing model. The relatively low entry barriers of the third party medical billing industry have led to a proliferation of medical billing services scattered throughout the United States. Chances are the provider's medical billing service is located in another geographic area making first hand observations and assessments impossible. The role of management reporting in a third party medical billing model is critical. A provider must regularly review charge entry, posting, write offs and account receivable balances to insure his/her cash flow is properly managed. A report as basic as 30, 60, 90 days in receivables will quickly give a provider a good idea of how well their medical billing and account receivable processes are being managed by a third party medical billing service. A common mistake for many providers with an outsourced medical billing model is to gauge the effectiveness of the process in the very short term, i.e. week to week or month to month. Providers maintain a vague and informal sense of their cash flow position by keeping mental tabs on the checks they received this week versus the prior week or if they deposited as much money this month as last month. Unfortunately by the time a weakened cash flow gets the provider's attention a much larger problem may be looming. What causes a slow down in cash flow in the outsourced medical billing model? The most commonly cited scenario is lack of follow up on the part of the medical billing service. Why? Like any other business, medical billing companies are concerned first and foremost with their own cash flow. A medical billing company generates 99.99% of their revenues on the front end of the medical billing process - the data entry process that generates claims. Medical billing companies that devote nearly all of their manpower to data entry will be understaffed on the back end of the medical billing process - the follow up on unpaid claims. Why? Every hour of data entry generates an additional one to two hours of claim follow up. Unfortunately for the provider, a medical billing company that ignores does not devote enough manpower to the diligent follow up of 30, 60, 90 days in receivables can mean the difference between a provider making a profit or suffering a loss during any given time. Practice Management Experience & Management Style Providers with practice management experience will be able to effectively manage or recognize and resolve a problem with his/her medical billing process before the cash flow crunch gets out of hand. On the other hand, providers with little to no practice management experience will more likely allow his/her cash flow to reach a critical stage before addressing or even recognizing a problem even exists. Whether a provider with medical billing issues chooses to retain and fix their current medical billing model or implement an entirely different medical billing model will depend to a great extent on his/her management style - some providers cannot fathom having their medical billing staff out of sight or ear shot while other providers are completely comfortable with turning their medical billing process to a third party medical billing service. Local Labor Pool Whether a provider chooses an in house or outsourced medical billing model, a successful medical billing process is still contingent on the people involved in executing the medical billing process. On a side note, choosing office staff for an in house medical billing model is similar to choosing a third party medical billing company. Regardless of the model, a provider will want to interview the potential candidates or an account executive of the third party billing service for experience, motivation, team oriented personalities, highly developed communication skills, responsiveness, reliability, etc. Providers with an in house medical billing model will have to rely on their human resource and management skills to attract, train and retain qualified candidates from the local labor pool. Providers with practices located in areas lacking qualified candidates or with no desire to get bogged down with human resource or management responsibilities will have no other choice but to choose an outsourced medical billing model. Medical Billing Related Costs As a business owner, the provider's primary responsibility is to maximize revenues. A responsible business owner will scrutinize expenditures, analyze returns on investments and minimize costs. In an in house medical billing model, costs associated with the medical billing process range from the Internet access used to transmit claims to the office space occupied by the medical billing staff. The most effective way to manage medical billing costs is for the provider to think of the sum of those costs as a percentage of the practice's revenues. The provider's accounting software should allow for him/her to classify and track medical billing related costs. Once the medical billing related costs are identified, dividing the sum of the costs by total revenues will convert the medical billing related costs to a percentage of revenues. The exercise of converting medical billing related expenses to a percentage of revenues accomplishes three things: 1) gets the provider, business manager or accountant in tune with the medical billing related costs of the practice; 2) provides a basis for more in depth analysis of the practice's cost and revenue components; and 3) allows for easy comparison between the cost impact of the in house versus outsourced medical billing models. The cost of an outsourced medical billing model is fairly straight forward. Since the fees of the vast majority of medical billing outsourcing services appear to be a percentage of a provider's revenues, the annualized cost of the medical billing service's fees will be a fairly close approximation of the provider's medical billing related costs for this model. In the event a provider is considering an outsourced medical billing model, he/she should keep in mind that this model is not necessarily the silver bullet to ending all medical billing related costs and headaches that medical billing services tend to advertise. True the medical billing company will acquire some of the costs associated with the medical billing process but the provider will still need staff to act as the intermediary between the provider's office and billing service, i.e. someone to transmit data to the billing service. Costs will further increase for the provider if the billing service charges additional fees for add-on services such as on line access to practice data, practice management software, management reports, handling patient inquiries, etc. The actual cost of the service will increase even more if claims 30, 60, 90 in receivable are not properly worked to facilitate adjudication. Summary In summary, the provider must carefully weigh the pros and cons of each medical billing model prior to making a decision. If the provider is not comfortable or experienced analyzing financial data he/she must enlist the services of an accountant or other financial professional. A provider must understand the costs as well as the inherent pros and cons of each medical billing model. Providers employing an in house medical billing model need to understand the true cost of their process. Determining the true cost not only requires accurate financial data and accounting but an objective evaluation of the components of his/her current process, i.e. technology and staff. Why? Outdated technology, under staffing, turnover, or unqualified staff may contribute to the appearance of a low cost of ownership but those shortcomings will ultimately cause a loss of revenues. In the event a provider is determined to utilize a third party medical billing service, he/she should invest the time to thoroughly familiarize him/herself with the medical billing outsourcing industry prior to interviewing prospective billing services. The provider must understand the hidden costs associated with the outsourced medical billing model in order to make an informed decision. About the Author David George is founder and CEO of Accuclaim Medical Billing Services. David is also author of the Accuclaim blog [http://www.accuclaim-medical-billing-services.com/medical-billing-blog] where he enjoys offering opinions, advice and news on medical billing issues of the day. Article Source: http://EzineArticles.com/?expert=David_George Durable Medical Equipment Billing SoftwareDurable Medical Equipment Billing Software Medical Billing And Coding Profession Medical billers and coders are in high demand among the allied health occupations. According to the US Bureau of Labor Statistics (BLS), health information technicians are one of the 10 fastest-growing allied health occupations. It is a challenging, interesting career where you are compensated according to your level of skills and how effectively you use them. Medical billers and coders know this and feel good about the support they provide to physicians, clinics, hospitals, and patients. They know they play an important role in the business office where they are employed. Their work consists of submitting the proper documentation to a number of insurance companies and federal agencies for reimbursement in order for their employer to financially succeed and avoid fraud charges. Their specialized training and expertise lets them find work any place, any time. Numerous opportunities for trained individuals exist in medical offices, clinics, hospitals, insurance companies, and in form of freelance home-based businesses. Advancement opportunities are unlimited! The U.S. Department of Labor states that continued employment growth for medical coders and billers is spurred by the increased medical needs of an aging population and the number of health practitioners. The Occupational Outlook Handbook reports that earnings vary widely and pay levels are governed chiefly by experience and qualifications. Healthcare Careers Offer Job Security, Personal Satisfaction, Challenges, and Rewarding Experiences Many interested in a career in the healthcare field decide to specialize in the medical billing and coding profession. Medical billers and coders are no longer restricted to only the doctor's or dentist's office but are now working in hospitals, pharmacies, nursing homes, mental healthcare facilities, rehabilitation centers, insurance companies, health maintenance organizations (HMOs), consulting firms, and health data organizations, or even from home. These highly skilled professionals are earning impressive wages everywhere they are. Typical duties of medical billers and coders include:
Other job opportunities for medical billers and coders include:
What is Medical Billing? Medical billing is better described as medical practice management and a doctor's key to getting paid. Although most doctor's offices request that payment be made at the time a medical service is provided in order to minimize billing, every medical office has a need to maintain patient financial accounts and for collecting money. In a small family practice or suburban clinic this task may be simple and assigned to the medical assistant or nurse but in bigger practices and clinics this is the medical biller's job! Medical billers and coders usually work forty regular office hours from Monday through Friday on a desk in the billing office or billing department of the professional healthcare office. They must know the different methods of billing patients, understand various collection methods, ethical and legal implications, have a good working knowledge of medical terminology, anatomy, medical billing and claims form completion, and coding. They also must understand database management, spreadsheets, electronic mail, and possess state-of-the-art word processing and accounting skills, be proficient in bookkeeping, and be able to type at a speed of at least 45 words-per-minute. The work area of medical billers and coders usually is in a separate area away from the patients and public eye. However, even though they are not involved in the actual process of doctors and healthcare professionals providing medical care they need to possess excellent customer service skills when it comes to making contact with clients, insurance companies, and often patients. Medical billers must know how to explain charges, deal with criticism, give and receive feedback, be assertive, and communicate effectively without becoming confused as the person is asking questions. Patients can quickly become frustrated when trying to deal with healthcare providers and bills over the phone. While an increasing amount of patient care is being funded through HMO related insurance, where the patient makes a small copayment at the time of service and the doctor bills the managed care company for the balance, a number of patients still need to make arrangements to pay for their medical services over a period of time. Part of the medical biller and coder's job is to contact some of these patients from time to time regarding a past due bill. Incoming calls from patients who have questions regarding a bill are also directed to the medical biller's office. The way s/he communicates over the phone can make or break business relationships. Other specialties closely related to the medical billing and coding profession are:
What is Medical Coding? Every healthcare provider that delivers a service receives money for these services by filing a claim with the patient's health insurance provider or managed care organization. This is also referred to as an encounter. An encounter is defined as "a face-to-face contact between a healthcare professional and an eligible beneficiary." Codes exist for all types of encounters, services, tests, treatments, and procedures provided in a medical office, clinic, or hospital. Even patient complaints such as headache, upset stomach, etc. have codes which consist of a set of numbers and combinations of sets of numbers. The combination of these codes tells the payer (health insurance companies or government entities) what was wrong with the patient and what services were performed. This makes it easier to handle these claims and to identify the provider on a predetermined basis. In addition, the services rendered (CPT) codes have to match the diagnosis (ICD) codes to justify medical necessity. To do this correctly for each third party payer choices have to be made from a combination of 3 coding systems totaling over 10000 codes, and which change annually. In addition, a completely new coding system, ICD-10, is proposed for reimbursement purposes in the near future. Tools of the Trade CPT books provide all the procedural terminology and ICD-9-CM code books have the most up-to-date information on medical diagnosis coding. The medical coder must stay current on any new ICD-9 code changes that would impact code accuracy and claims submission. HCPCS books contain the complete lists of HCPCS Level II codes with descriptions. They will guide the medical coder through current modifiers, code changes, additions and deletions. HIPAA books help to develop an effective HIPAA compliance plan and DRG books are needed for Medicare's classification of inpatient hospital services based on principal diagnosis, secondary diagnosis, surgical procedures, age, sex, and presence of complications. Training Training of the medical billers and coders can range from two to four years of college, a technical school diploma, certificates from correspondence courses, to simple home study programs. Upon completion of such training many coders may seek professional certification. Though not necessary, it is recommended and national associations are available for the certification processes. Vocational Training Professional medical billers and coders are in very high demand. Billing for services in healthcare is more complicated than in other industries. Government and private payers vary in payment for the same services and healthcare providers and organizations provide services to beneficiaries of several insurance companies at any one time. Therefore, to reach proficiency in this business, basic training, clinical supervision and continued professional development is essential! Typical Course Requirements are:
Professional Advancement Opportunities A recent American Hospital Association survey showed that about 18% of billing and coding positions remain unfilled due to a lack of qualified candidates. Most companies and practices are looking for schooling and experience mostly because of the legal ramifications of incorrect billing practices. However, medical billers and coders are also able to work independently out of their homes where they established a home based billing office. There are plenty of electronic billing programs available that can be set up through home office computers. Also, there is the possibility to become an independent insurance specialist or consultant who helps patients understand their insurance bills and what they should be paying. Opportunities also exist as patient account managers, physician office supervisors and management, various types of personnel managers in the healthcare industry, health claims examiners, and medial billing and coding instructors. The more education the individual has, the more employment options are available and advancement opportunities become virtually unlimited! Professional Certification As in so many healthcare professions certification in the medical billing and coding field is not required but highly recommended. The days of the single family practice medical assistant or nurse typing out an invoice after office hours are history. Even the smallest offices and clinics have changed to computer billing because it offers greater coding accuracy, saves time, and can be used by administrators and auditors to ensure that visits are being coded to the appropriate levels which increases revenues. Understandably, these offices and companies are looking for individuals who are certified in their field to ensure the employer that the individual whom they hire is competent and proficient. There are numerous well known and well respected organizations sponsoring these types of examinations. Intersted candidates should research each one and find the one that most suits your needs: American Association of Medical Billers (AAMB) offers Certified Medical Biller (CMB) and Certified Medical Billing Specialist (CMBS) examinations. The National Association of Claims Assistant Professionals (NACAP) offer Certified Claims Assistance Professional (CCAP) and Certified Electronic Claims Professional (CECP). The examinations for Certified Procedural Coder (CPC), Certified Coding Specialist (CPS), Accredited Record Technician (ART), and Registered Record Administrator (RRA), are administered through the American Health Information Management Association (AHIMA). The National Healthcareer Assosciation (NHA) is offering their Medical Billing and Coding (CBCS) credential. If your objective is to work for a medical office, group practice, healthcare provision network, or hospital as the medical billing and coding specialist keep in mind that most private practices, organizations and hospitals throughout the country not only prefer but often require national certification as a competency standard. To learn more about this very rewarding career visit the Medical Billing and Coding Net web site at http://www.medicalbillingandcoding.net © 2003 Danni R. of the Medical Billing & Coding Net. Reprint permission available by request. Article must be complete and must include all contact information. About The Author Danni R. is a certified medical assistant through the AAMA and NHA, and MA Instructor at such well known vocational training institutions. Her background is a unique blend of healthcare sciences and freelance web design and graphic arts, which makes her the ideal author for medical assisting articles, web sites, and various online courses. It is this fusion of contrasting disciplines that makes her work so successful on the Internet! You may also visit her web sites at http://www.certmedassistant.com, http://www.medicalassistant.net, and http://www.medicalbillingandcoding.net to get better acquainted with her work! Article Source: http://EzineArticles.com/?expert=Danni_R.
Medical Billing - DME Software Overview In this installment, we are going to be starting a series on DME software for medical billing. This is probably the most popular software on the market because it is responsible for billing more claims than probably any other branch of the medical billing industry. DME stands for Durable Medical Equipment. This is equipment that is either sold or rented to various Medicare, Medicaid, Blue Cross, Blue Shield and many private insurance companies including Prudential and Web MD. This equipment ranges from wheelchairs to concentrators. The amount of money involved in this industry is staggering. Because of this, there are many brands of software on the market that billers can use to bill these medical claims. Logistically, it would be impossible to review each piece of software. However, because there are so many similarities between the various brands, it is simple enough to go over the main parts that each software covers. This way you will have a decent idea of what is involved in billing DME claims. The first part of DME software that we'll be going over in detail, in a future installment, are the setup options. These options allow the user of the software to customize it to their liking. Some of this is just cosmetic, such as screen appearance. But much of the setup also involves setting up the type of DME billing that they'll be doing, including designating what kind of provider the software will be billing for, whether it be single or multiple provider. The next part of the DME software that we'll be going over is how patients, doctors, facilities, items and other things are setup in the system. There is a complex process involved in medical billing of claims that requires everything in the system to be pulled together when either printing out a paper claim or billing electronically. This is probably the most complex part of the whole system. This will be covered in great detail. The third part of the DME software that we'll be going over is how billing itself is actually done, whether it be via paper or electronically. We'll cover the various ways to print or transmit a claim. We'll also cover the legalities involved with doing so, such as what needs to be signed and when. The fourth part of the DME software that we'll be covering involves what they call add-ons. These are additional services that many billers use, such as purchase order processing and barcoding of products. This part of the system must also be integrated with the main part of the system so that it works correctly. Finally, we'll cover some common problems that billers should be aware of with each part of the system. Medical billing, because of all the things that can be billed and all the medical regulations, is complex and confusing, even to the seasoned pro. To the beginner, it can be a total nightmare. Hopefully, after reading this series, you'll have a very clear understanding of the basics of medical billing and the DME software used to bill DME claims. Michael Russell Your Independent guide to Medical Billing Article Source: http://EzineArticles.com/?expert=Michael_Russell
Medical Billing - DME Software Item Inventory In this installment of medical billing and DME software, we're going to cover the topic of item inventory. We're going to explain how the inventory functions work, what information inventory tables contain and how this all ties in with the medical billing of a claim. Item inventory is a very large part of the DME system. Because DME billing is for durable medical equipment, thus the name DME, a lot of items get dispensed to the patient. These items range from small things like test strips for diabetics, to large items like wheelchairs, beds and oxygen concentrators. Some of these items are sold and some are rented. There alone lies a big distinction and the reason why the inventory tables have to be broken up into what are called purchased items and serialized items. Purchase items are pretty well self explanatory, but some explanation is needed for why rental items are referred to as serialized items. Rental items are referred to as serialized items because each item that is rented has a unique serial number attached to it. This serial number is tracked for the purposes of billing monthly rentals, which is usually how either the patient or insurance company pays for these items. If a rental item has to be replaced because it is defective or broken, then a new item has to be issued and its serial number noted for future billing. The old item is then put back in inventory and either fixed or thrown away and deleted from inventory. The information that is contained in inventory is more than what most people realize. It is more than just the description of the item. For purchase items, it includes how many of the items are in stock, how many sales of the item were made, so that companies can track how well an item performs, reorder points so that they don't run out and a number of other things. For rental items, the information includes when the item was rented, how many months of billing have occurred, when the item is scheduled for maintenance and a host of other items. Most normal inventory records contain anywhere from 30 to 100 fields depending on how much information the company wants to track and the capability of the software itself. How does this all tie in with medical billing? Well, the biller has to know how each item needs to be billed. So for starters, they have to know if it is a rental or purchase item. They have to know the price of the item. They have to know when maintenance is due on a rental item so they can send a bill for that maintenance. They have to know when an item is low so that they can notify inventory, just in case they're not aware of it, which they should be. If a biller has to replace an item, they have to know what replacement items are available. The list of things that a medical biller needs in relation to inventory is endless. Without item inventory tables, the medical billing process would be a total nightmare because billers wouldn't know where anything was, what it cost and if it was even in stock. Michael Russell Your Independent guide to Medical Billing Article Source: http://EzineArticles.com/?expert=Michael_Russell
Medical Coding Software Medical coding software is a tool that provides the coder with critical coding information and related data in one package. This makes the process of coding easier and faster. A coder sometimes has to face rejection since the claim is declared unfit for processing because of some errors. This software helps the coder to achieve precision, accuracy, and specificity. Complying with the correct codes is very important in this field and mistakes are not tolerated because the sum total of money that is involved is usually enormous. This type of software also prevents the coder from using invalid codes, which are the main reason behind rejection of claims. The software also has decision support screens that calculate complicated fee schedules thus saving time and producing a more accurate claim. Some software also enables a coder to directly contact a certified and experienced coder for any queries or doubts concerning IC-9 codes. Simply put, this is soft ware that allows the coder to look up codes, produce codes, and perform edits at the same time. This type of software usually takes up around fifty megabytes of space and is easy to install. The price range of this software ranges from $250 to $500 and many packages are available online. Some of the expensive software include features such as laboratory fee calculations, durable medical equipment fee calculations, creation of custom fee schedules, and search tables for neoplasm, drugs, and chemicals. Medical coding software also helps coders to determine the accuracy of medical bills thus ensuring correct payments from the patients or the insurance companies. Medical coding software is used in ambulatory surgical procedures, rehabilitation centers, hospitals, and independent practice associations. This software is becoming indispensable for hospitals and medical coders because it helps to save time and improves the qualitative as well as the quantitative aspects of medical coding. Medical Coding [http://www.e-MedicalCoding.com] provides detailed information on Medical Coding, Medical Coding Salaries, Medical Coding Certification, Medical Coding Specialists and more. Medical Coding is affiliated with Medical Billing Services. Article Source: http://EzineArticles.com/?expert=Kent_Pinkerton
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