Healthcare IT

Keep yourself updated on healthcare news regarding practices and medical software. The new regulations and trends in the health industry and all that you need to know.

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Can a practice successfully outsource medical billing before the ICD-10 deadline?

Less than 140 days are left for one of the biggest changes in US healthcare industry to take place. Yes, ICD-10 is hiding just around the corner, waiting to pounce upon us on October 1. About now, most physicians are finally convinced that they cannot run from ICD-10 anymore, and many medical practices have started taking appropriate steps in preparing for the new coding system. The only problem is that they don’t have enough time left! Credible sources such as Cecil Bohannon, consultant at CTG Health Solutions, have also come out to state that the ICD-10 implementation will not be delayed any further. Statements such as Cecil’s are growing by the week.

medical billing  company

Upgrading an existing medical billing system is one of the biggest hassles currently faced by numerous practices in the healthcare community. The software and training are going to cost both money and time, and practices rarely have enough of either as it is! Industry experts have advised small and medium practices to outsource their medical billing to third parties instead of going through the trouble of make the changes themselves. The question which remains now: Can a practice successfully outsource its medical billing before October 1?

Although some physicians have given up on the idea by now,  you must know that it’s still achievable. Physicians should first make a list of Medical Billing Services that have experience dealing with specialties similar. The selection process would take a couple of days because practices must be careful while choosing their vendor. The medical billing vendor you choose must have good online reviews and ratings. That’s because if current clients aren’t satisfied with their services, there’s little chance that you will be. It should also have a well trained team of coders and billing specialists who are up-to-date with the recent healthcare and coding regulations. Most of all, the vendor must increase the practice revenue by reducing the number of claim denials.
Once the practice has entered a contract with a suitable medical billing service, the next step is to formulate a plan for ICD-10. The plan must be divided in two phases; pre ICD-10 and post ICD-10. The practice and medical billing service must collectively decide on timelines for each step of the phase. These steps include patient data transfer, documentation training for physician and office staff, coding training for billers and pre-testing of ICD-10.

It is confirmed that medical practices will suffer from a direct revenue loss after ICD-10 for some time, which is why it is necessary for practices to make plans for post ICD-10 as well. The plan for post ICD-10 includes managing the financial budget as well as keeping a follow up plan for the ICD-10 workflow strategy. This way, any loopholes in documentation or billing process that are affecting practice revenue can be identified and improved.

Outsourcing medical billing is the best current alternative for physicians who own small practices and cannot afford in-house billing in such a short period. As mentioned earlier, ICD-10 is set to be implemented this year, so medical practices must starting looking for suitable vendors immediately to meet the deadline.


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No ICD-10 Penalty till 2017?

With the SGR repeal bill signed into law, the ICD-10 transition deadline of October 1 2015 is almost certain. However, an interesting recommendation surfaced last week during a hearing about HHS’ proposed 2016 budget.

Senator Bill Cassidy recommended that ICD-10 penalty be delayed for two years. This essentially means that CMS will continue accepting, processing and paying claims filed in ICD-9 even post October 1 for the next 2 years.

Secretary HHS Sylvia Burwell , countered by saying that many large payers and providers are ready and waiting for ICD-10 and that HHS is working to provide technical assistance and training to those organizations that are not at this point prepared.

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How can I safeguard my practice from Claim Denials?

Claim denials are the main reason behind the decreasing bottom line and low profit margins of many small, medium and large practices. Physicians put patients first in their practice, which is why providing quality care is their main priority. However it’s quite impossible for physicians to receive the ‘fair reimbursement’ for their services.
It is estimated that 20 to 30% of claims are denied by insurance companies on first submission. The main causes of these denials are errors made by the administrative and billing staff. Entry of incomplete or inaccurate information and failure to keep up with new billing regulations and insurance policies are the most common mistakes that lead to an increased claim denial rate. COO of RemitData, Brian Fugere, identified the five most common claim denials that affect practice revenue; duplicate claims, claims lacking information, eligibility expiration, claims uncovered by insurer and time limit expiration.
After identifying the problems, I got in touch with several renowned physicians and medical billers to find solutions for these problems. The three most effective techniques to reduce claim denials are

Claim Scrubber-CureMD

1. Making use of Claim Scrubber tools:

Claim scrubber is the latest technology being adopted by clearinghouse vendors for aiding billers in catching errors in claims prior to submission. Unlike Clean Claim Checks, A claim scrubber ensures that CPTs and ICDs are entered correctly in the claims. Other features of claim scrubbers include checking formats and validity of insurance policies, suggesting corrections for proper coding and providing quick results. Claim scrubber eliminates the need to manually check claims before their submission to insurance companies, and thus contribute in reducing denials by a large extent.

2. Keeping a Claim denial log

Claim denial logs can help billers in identifying claim error trends early, and react accordingly. These logs can be maintained both electronically or via paper. They should include important information like written documentation of insurance companies, date of submission and rejection, amount, reason of claim rejection or denial, and how effectively did the billing team of the practice handle the process. Physicians need to understand why their previous claims were denied so they can avoid such mistakes in the future.

3. Consider outsourcing billing

Errors on the biller’s part are responsible for more than half of all claim denials and rejections. The best alternative is to either assign each of your billers to one or two individual health plans, because of the difference of policies and reimbursement contracts among insurance companies. This can help the billers gain expertise in the plans they are assigned to. For small and medium practices, an even better alternative is to Outsource Medical Billing to a third party vendor. The reasons: they are up-to-date with billing regulations, healthcare policies, and upcoming major changes in the healthcare system like ICD-10.
After implementing these techniques at your practice, you will observe a significant reduction in the claim denials at your practice. Do let us know if the strategies made a difference to the billing revenues at your practice in the comments section below.

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Redefine your ICD-10 Costs to implement them on time

The most important reason that makes physicians reluctant to implement ICD-10 is the entire cost of conversion perceived by many in the healthcare industry. A study published in the Journal of AHIMA (JOA) has tried to counter the fears evoked by past researches that gave huge ICD-10 implementation costs.

ICD 10 Guide

The new study puts the price of ICD-10 conversion for small practices from $1,960 to $5,900. Let’s see what parameters were applied for JOA research to identify the range of ICD-10 implementation cost for small medical practices.

ICD-10 Training of practice staff

The research set strict number of hours for training of the medical and non-medical staff of the practice. The cost of 32 hours of training for each practice staff member and three hours for the physician was capped at $3,100. Another $600 was set for buying the two ICD-10 code books.

The cost estimated included the following aspects of ICD-10 training:

  • Education of entire medical practice staff about ICD-10 code sets and tools of implementation.
  • Awareness and training of the actual codes, covering the practice specialty.
  • In-depth training sessions on comprehensive diagnostic and procedural ICD-10 codes.
  • Special training sessions on dealing with specialty codes.

Given the number of staff in a small practice; the cost of training can also go down further.

Updating EHR systems

The estimated cost for software update for ICD-10 given in the JOA research is zero. This is a surprise for those physicians whose vendors are asking for a good amount of money for the updates. As quoted in the study, “Many vendors are including the ICD-10 software update as part of their routine annual software update at no addition cost resulting in physician offices having no incremental ICD-10 related costs associated with their billing, Practice Management and EMR software.”

Depending on your vendor contract, this is a considerable sum of money that you wouldn’t have to pay for ICD-10 conversion. However, if you are among the less lucky ones, then it’s time to replace your EHR vendor.

A word of advice

Being a small medical practice, you don’t have a huge budget that will allow you to experiment around. Therefore, the best possible option is to outsource your billing to a professional billing company. This way you will save your cost of staff training and software updates or replacements.

Download your free ICD 10 Guide and jump start your ICD 10 training now!


Optimizing Revenues With a Pediatric EHR

When I’m told of a generic Electronic Health Record (EHR) deployed at a pediatrician’s practice, the image of a small child wearing a free-size shirt comes to my mind. In simpler terms, it is too big for the child.

Similar to the oversize shirt on a six-year-old analogy, a generic EHR has been built keeping in mind the specifics for adult care. With a Pediatric EHR Software, however, vendors have incorporated the requirements of pediatricians into this specialty-specific software.

In addition to children-specific ranges, different categories such as more precise dosage scales (as children have less intake capacity than adults), growth charts and pediatric templates are also available.

Pediatric ehr (2)

Stop viewing your EHR as a government-enforced requirement and start focusing on how your practice can benefit from it. Here’s how you can do so:

Customize your templates

There are numerous customizable templates including those for abdominal pain, weight loss and adolescent psychiatry to choose from. Customize your favorites list to save time during patient encounters.

Next, tweak your templates to best suit the needs of your comfort and practice. Vendors offer free customization of a particular number of templates during the initial implementation process, so I’d advise you to do so right at the start.

However, if you haven’t done so or if you realize the need for changes later on, the vendors will charge a modest price. Don’t think of it as an added cost, but instead as an investment. This is because you’ll save a lot of time and effort if you accumulate patient visits over time, and that will be a huge cost saving in itself.

Tracking your patient

A pediatrician’s relationship with a patient is a long and delicate one; one that needs to be handled with the utmost care and responsibility. The effective documentation of clinical encounters, sick and wellness visits for example, will be pivotal in the estimation and analyses of different growth trends and illnesses.

You must also integrate customizable screening questionnaires with your progress notes for tracking behavioral issues such as anxiety and autism to identify if the patient suffers from such conditions. The results can be electronically shared with relevant industry specialists such as psychiatrists to cure the issues early on.

In addition to the time-saving by which you can see more patients and earn more money, you’ll attract a lot of new patients. How? As you’re ensuring better care, satisfied parents will refer your practice to other parents. Moreover, industry specialists to whom you’ve referred patients for further treatment will refer your name to those seeking pediatric care.

Additionally, this Top Ranked EMR Software automatically creates growth charts via clinical calculators using data such as patient BMI, length, etc. This way, you won’t have to spend additional time and schedule more visits diagnosing issues that the system has calculated for you, and you can move to the treatment straightaway.

The family profile feature can help enhance efficiency. If the records of a child’s siblings are present in your database, the data doesn’t need to be re-written and can simply be attached. In addition to identifying genetic trends, you must use this tool for group scheduling patients belonging to the same family to save time. Numerous new clients will also come your way as parents usually take all of their children to the same pediatricians.

Testimonials CureMD from CureMD

Patient Portal

Use pamphlets, kiosk computers at the reception, other such mediums to get your patients (or parents in the case of younger patients) to use your patient portal. The younger generation in particular is very tech savvy; make the most of this.

Once they realize that they can receive education and wellness material online, view their lab results and clinical encounter data, and order refills online, they will rush to this medium.

Moreover, when they can communicate online, you will be able to solve most of the simpler problems without scheduling visits.  The time saving will be immense, and you will be able to schedule other patients during these slots.

You can always assign your nurse or some other staff member to handle the portal, and to direct the more important issues your way.

These are some of the most efficient methods you can use to optimize revenues at your pediatrics practice using an EHR built specifically for a pediatrician. The key here is to optimize the usage of your EHR, which will automatically optimize revenues for your practice.

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Options for Conversion of EHR when Replacing the Current EHR Vendor

The question that the healthcare providers need to answer in 2014 is that whether to stay with their current EHR vendor or not.A young caring doctor

According to the poll of 17,000 EHR users by Black Book Rankings, around 1 in 6 medical practices might convert to using another Electronic Health Records System in the near future. Also CMS has made it clear that the exemptions related in achieving Meaningful Use requirement will be evaluated on a case by case basis. Opening a new hospital would qualify but upgrading to 2014 certified electronic health records technology (CEHRT) does not. Changing EHR vendors, physician or hospital office acquisitions would not qualify for hardship exceptions. These objectives required well defined plans, operations and experienced team to successfully execute them.

Final rule for Stage 2 criteria was released by Center of Medicaid and Medicare (CMS) on September 4, 2012. It was for both Eligible Professionals (EP) and Critical Access Hospitals (CAH) to achieve incentive payments. Furthermore to the Stage 2 criteria an exception was also made which reduced the reporting period to 90 days despite the Meaningful Use. This delay was applicable to both the EP which followed the calendar year starting from January 1st, 2014 and for CAH it starts in 2013 from 1st October.

Does CMS have provided any opportunity for healthcare organizations to switch their EHR vendors in 2014?

About 17% of EHR users will be transforming to use a different EHR system, the 90 day reporting period will provide a lesser risk time frame for system conversion. For the second year of 2014 CEHRT will need a 365 day collection period. It is a great risk if you are converting before or after the 90 day period. But with a well thought out plan CAH and EP can take advantage of this small time frame available. Those providers that have already received EHR incentive payment will be subject to audit according to CMS.

There are various things to be considered if you and your healthcare organization is looking to make use of the small time frame that is available to transform to another EHR system. First option is that those healthcare organizations that have updated their EHRs to 2014 CEHRT EHR they will attest the first quarter of the year for second year attestation. The stage 1 for the second year allows the flexibility to attest for first quarter. After the attestation is done, the group needs to focus on adoption level and for new functionality in order to prepare for the second stage.

Second option for healthcare organizations that are using 2014 CEHRT and are either reporting on stage 1 or stage 2 and want more time to further prepare for first or second quarter of the existing year. The extra time can be used to implement the new EHR system in parallel with the existing EHR. Carrying out conversions in parallel will test run the process so that right after the 90 day attestation a final conversion and a go live system can occur. The extra time in the year will allow the healthcare organizations to enhance the adoption levels and implement new system workflows and configurations to meet the selected and core menus for stage 2.

Third option is to instantly convert to the new EHR after the attestation period on stage 1 certified software and to attest in the last quarter of 2014 CEHRT year. This option is best for healthcare organizations that have to switch EHRs and have further time to configure, revise their workflows and implement new technologies for stage 2.

Attesting for the 2nd year at stage 1 in the last quarter of the year will offer a large amount of time to transform while avoiding big changes in the attestation period. This option can also be followed by organizations that are attesting for first year at stage 2 by transforming early in the year and later focusing on increasing adoption processes and levels to support new core and menu objectives for stage 2.

5 Secret of EHR Buyers