Medical Billing, Coding and Documentation Services

5 Reasons Compliance is Best Left To Medical Billing Professionals

Posted by Harold Gibson on Tue, Oct 21, 2014

 medical billing
No matter the industry, every business looks for ways to cut costs without losing value. Certain services in the medical industry such as transcription and administrative management can be outsourced or handled in-house without much loss in quality or increase in risk. In fact, administrative tasks are among the more common areas for cutbacks, but the one area that is best left to the professionals is billing. Physician billing can be filled with numerous hazards, many of which you may not know how to protect against or have time to fully deal with. Chances are you would be better off letting a specialist handle them. So just in case you don't believe us, here are five reasons compliance is best left to medical billing professionals.

Better Protection Against Fraudulent Claims

Fraudulent and abusive claims can cost you thousands each year. While the larger cases are more likely to garner the most attention, small claims can be just as expensive cumulatively. Good medical billing professionals have the resources and time to focus in on these small claims just as much as the large ones. Additionally, they have greater awareness of the red flags that you might otherwise miss, meaning that they are more likely to catch the thieves that might otherwise slip away. And that means you save more money.

Better Informed of Changes in Law and Industry

Changes occur within all levels of the law and industry on a daily basis. From the Fair Debt Collection Practices Act to the National Correct Coding Initiative, it's a difficult task for you to keep up with everything. As soon as the laws and code changes, you are liable. With medical professionals handling the matter for you, you will know exactly what you need to know when you need to know it.

Better Poised to Adopt New Policies

Being aware of and understanding the new laws is only one step in effective billing practices. As the new laws come into effect, you have to know how it will affect your policies and how you need to change your policies to avoid being penalized or losing more money. Since medical billing professionals specialize in this field, they have significant experience in adapting current policies to reflect the trends in the industry and protect your interests. Failing to adapt your policies or making the wrong choice can both be expensive mistakes.

Better Supervision and Advice Billing Practices

Billing practices themselves can be time consuming in their creation, but they also have to be managed. You may find some of your services becoming more expensive, or you may want to offer additional ones. A physician billing service can help keep track of these changes and provide expert advice on the changes you should consider.

Better Protection Against Investigations

According to the Coalition Against Insurance Fraud, more than 80 billion dollars is lost each year. While the perpetrators may not be hospital staff or medical personnel, hospitals and their staff are often subject to investigation when these claims are submitted. A good medical billing professional will offer extensive documentation and reviews for both pre and post payments.  Additionally, they will use standardized formats and strategies for handling billing matters that will simplify the process, giving the investigators the information they need.
 

For more information on the services we offer and how our medical billing services can assist you to run a more profitable and efficient practice, please feel free to contact us at your convenience. We look forward to hearing from you.

Tags: Medical Billing

The Difference Between Good & Great Medical Billing Companies

Posted by Harold Gibson on Fri, Oct 17, 2014

 medical billing
Understanding the difference between good and great medical billing companies can elevate your medical billing experience from mediocre to extraordinary. For one, great medical billing companies are diligent about producing consistent accuracy. It’s their first priority. To achieve consistent accuracy, medical coders must stay updated with industry practices, offer superb professional training, and provide specialized knowledge of medical billing to their clients.

1. Great Medical Coders Know the Latest Industry Practices

A great medical billing company always stays on top of changes in software requirements, documentation standards, and can cross walk unspecified ICD-9-CM codes into highly specific ICD-10-CM codes. This requires medical coders to regularly attend industry events and read industry news. Great medical coders should be able to use their up-to-date medical billing knowledge to ensure that all documents reflect any changes that have been implemented.

2. Great Medical Coders Are Experts

Great medical coders should have in-depth knowledge of medical coding. They should know every coding requirement, payer guideline, and contractual obligation. This being said, it’s necessary for great medical billing companies to invest in providing top-notch professional training and to recruit carefully.

3. Great Medical Coders Have Specialized Knowledge

The best medical billing companies have specialized knowledge, which means they can tackle tasks at a more efficient rate. Furthermore, having specialized knowledge can ensure that claims are paid on time and accuracy is guaranteed.

4. Great Medical Coders Work Well with Physicians

Great medical coders should be able to work well with physicians and the rest of the healthcare team. With their expert medical billing knowledge, medical coders can be an imperative asset to physicians, physician assistants, nurse practitioners, and medical assistants.  
 
Choosing a great medical billing company over one that’s merely good is well worth the investment. They can help reduce improper denials and audit risks as well as critically improve the entire medical billing process for clients.

To learn more about what makes a high-quality medical billing company, please feel free to contact us at any time.



Photo Credit: Flckr

Tags: Medical Billing

Two Essential Ways Specialized Medical Billing Companies Save You Money

Posted by Harold Gibson on Fri, Oct 10, 2014


doctor-40891_640 
Every year in the United States, hospitals, health care/medical facilities, and insurance companies spend nearly $400 billion on administrative costs. A substantial percentage of that money goes toward covering the costs associated with medical billing and coding. With these kinds of administrative expenses being as high as they are, doctors and physicians are having an increasingly difficult time maintaining their private practices despite the fact that such costs are considered an essential element thereof. It can be challenging, however, for healthcare administrators to find medical billers who do efficient, accurate, and timely medical billing and coding, particularly if they are looking for one that specializes in a specific area of the medical profession.

Healthcare claims require compliance and accuracy 100% of the time. Medical billing companies that perform billing work for all areas of the medical field tend to sacrifice some of that accuracy and compliance in order to grow their bottom line by having a broader client base. But there are distinct advantages to utilizing medical billers that focus on billing and coding only in specific areas of medicine and those advantages can end up saving you a lot of money.
 

Fewer Claims Issues

The billions of dollars that are spent every year on medical billing and coding represents not only the cost associated with the billing tasks themselves but the money spent on additional resources that are needed to compensate for the lack of specialty knowledge that should be implemented for many healthcare claims. That is to say, when medical billing companies do not have the knowledge required to bill for specific medical specialties, the chances for errors in billing and for claims being denied, underpaid, or flagged for audit increases exponentially. If medical billing was carried out exclusively by companies with specialty-specific knowledge, the annual costs associated with medical billing overall would decrease dramatically.
 

Less Time and Money Spent on Training

Medical billing and coding collectively constitute an endeavor that requires extensive training even for the specialty-specific variety. But extra time and resources must be spent when training to bill and code for all specialties and practices. People spend months or even years training and being educated for a medical billing career but that training does not end once the billing professional is hired by a hospital or health care facility. The industry is never static. It is constantly enduring changes and updates to processes and logistics that make ongoing training an essential part of accurate billing.

Specialization reduces the amount of time that is needed for billers to spend training so that they can spend that time doing what they’ve been educated to do. If medical billing companies don’t specialize, then they are forced to maintain ongoing training for all of their staff across all or many different areas. Specialization requires training only for the area or areas in which a particular company specializes and that means less training and more billing and coding.

ff you are looking to make your practice run smoother by with world-class medical billing and coding, feel free to contact us at any time to see what we can do for you. 

Tags: Medical Billing

How to Increase Revenue of a Clinic or a Physician Practice?

Posted by Harold Gibson on Thu, Oct 09, 2014

medical billing
The general public is well aware of the increasing cost of healthcare. Even with all of the new regulations that have been implemented over the past few years, many individuals and families are seeing higher costs with each passing year. 


For those who own or run a clinic or physician practice, the situation is even worse. While clinics and physician practices are also experiencing the same price increases that the general public is experiencing, they are also being squeezed from the other side as well. The fact of the matter is that, while the costs of treatments and procedures is in fact going up, insurance companies, as well as Medicare and Medicaid, have begun reducing their reimbursements at the same time. This puts clinics and physician practices in a uniquely difficult position, where they are being squeezed on the revenue side while also facing a demand problem as consumers find it increasingly difficult to pay for all but the most essential of procedures. This situation necessitates creative and aggressive means of increasing revenue for clinics and physician practices. 

There are three specific areas where clinics and physician practices can improve their revenue models: The front-end (or patient acquisition process), coding and management of records, and accounts receivable strategies. 

Front-end revenue generation 
 
Even the most efficient clinic or physician practice will be unsuccessful if there are no patients to treat. This means ensuring that there is both quantity and quality in the appointments that are scheduled. Before scheduling an appointment with a new patient, be sure to get their insurance information, and make sure they are aware of whether they are in or out of your network. If a patient is out of network and is not willing to pay the increased costs associated with seeing a doctor out of their network, the worst thing that can happen is that they show up at the office without that knowledge. Not only will you have a disgruntled patient in the waiting room, but they will have taken up an appointment space that could have been taken by an actual patient. Nobody wins in this scenario. 

In addition, when a new patient comes to the office, the front office staff should make a copy of their insurance card and their driver's license. This will make it easier to find out the specific insurance information if and when it is needed without contacting the patient, and it will also ensure that your office has the most up to date information about where the patient lives. 

Increasing revenue through coding and records management 
 
Depending on the size of the practice, there should be at least one person in the front office whose sole (or primary) responsibility is coding and records management. These have always been important tasks, but with the rapidly changing and increasingly-complex nature of medical billing and coding, these tasks are more important than ever before. Whoever is in charge of coding and records management should also be responsible for staying up to date on any and all changes that are made on a national, state, and local level. 

Increased revenue through aggressive accounts receivable strategies
 
 
The last thing your clinic or physician practice needs is to not get paid by patients after a procedure or treatment is completed. One of the best ways to ensure payment is to set up an electronic remittance process, which allows payments to be automatically deducted once they are approved and sent to the paying party. The other key element to aggressive accounts receivable is to have well-published and followed collections procedures, so patients know exactly what to expect when they owe your office a payment.


To learn more about how to streamline your front office through outsoucred medical billing and coding, please free to check out out website and/or contact us at any time, and if you would like to read more about what we do and how we can help you, please see our recent blog article.





Tags: Medical Billing

How To Improve Your Practice's Front Desk Collections?

Posted by Harold Gibson on Tue, Oct 07, 2014

Front_office_and_profitabilityMany physicians still hold the traditional belief that their front desks are a cost, not a profit, center. However, in the modern world of healthcare, while a front desk can certainly be a cost center, a practice's profitability is often dependent on making front desks a profit center.

Necessity of Front Desks as Profit Centers 
The changing face of the healthcare industry and medical practice management has made this front desk staff attitude a necessity--not a practice luxury. The factors requiring front desk employees to recognize this requirement are many. The most important reasons for physicians to encourage or mandate a collections approach for their front desk personnel include the following factors. 
* Existence of Obamacare and the Affordable Care Act (ACA), 
* Changing realities of medical billing, 
* Impending changes in medical coding rules, 
* Physician Quality Reporting System (PQRS) responsibilities, and 
* Installation of Meaningful Use 2 regulations. 
These are but the most important factors influencing the philosophy and behavior of front desk personnel as primary collectors. While this attitude has been vital to practice profitability for at least five years or longer, front desk collections is now a necessity because of the noted factors. 

Improper or Inadequate Front Desk Staffing 
The risks of not treating the front desk as a profit center impact more than profitability. The fallout from not staffing a front desk properly or adequately leads to the following negative results, at a minimum. 
* Front desk employee "burnout," 
* Unhappy, irritable patients, and 
* Crowded, disorganized work space, increasing employee and patient dissatisfaction. 
Not instilling an outstanding customer service philosophy in front desk staff provides unwelcome results in both short- and long-term situations. Conversely, encouraging front desk employees to adopt a superior customer service and profit philosophy can increase practice collections by 5 to 10 percent. 

First Impressions 
The phrase, "You never get a second chance to make a good first impression," is never more true than with a practice's front desk. Patients form opinions, consciously or subconsciously, about a physician's quality of care by viewing the front desk area and staff communications. 
A disorganized, crowded front desk area and unacceptable personnel behavior diminish patients' evaluation of the care they are about to receive. However, a neat, organized front desk, with welcoming staff, heightens patients' perceptions of the care they'll receive. 
According to the St. Louis Pediatric Associates, Inc., having multiple (up to 10) physicians, they use a "Snap" introduction to welcome patients and their adult caregivers. 

"Snap" is an acronym for 
* Smile, 
* Say the Name of the patient, 
* Asking, "May I help you?" and 
* Making a positive Parting comment. 

Increasing Front Desk Collections 
Higher copays and high-deductible health insurance coverage mandate that front desk collections increase to better ensure profitability. Research indicates that copays and front desk collections can account for up to 20 percent of a practice's revenue currently. To say that indication is significant is an understatement of reality. 

Front desk collections typically involve two components at a minimum. 
* Copays and deductibles, and 
* Collecting previously incurred, but overdue, balances. 
Increasing front desk collections is not terribly difficult. In fact, it is relatively easy. Here are some simple tips that work. 
* Ask patients (with a sincere smile), "Did you realize you had an outstanding balance?" 
* Install a credit/debit card device at the front desk, making it convenient for patients to settle copays, deductibles and outstanding balances. 
* Keep front desk staff up-to-date on each patient's account standing and current insurance plan. 
* Always verify patients' in-force health insurance coverage--and its terms. 

These simple steps for personnel to follow will increase front desk collections enormously. Along with increasing the practice's cash balance on a daily basis, these tips will help keep claim delays and denials to a minimum. 

To know more about how to increase profitability for your practice - 

Five simple steps to streamline your medical billing process

Along with increasing revenue, treating a front desk as a profit center changes the mindset of staff, physicians and practice managers. This change in approach makes this group more efficient, reinforces the wisdom in outsourcing medical billing functions and creates a more pleasant job and patient experience. 


 

Tags: Medical Billing Service, revenue cycle managment

6 Bits of Information That Will Improve Medical Billing Collection

Posted by Harold Gibson on Fri, Oct 03, 2014

 physician billing
Physician billing can be a daunting process. Those working in doctors' offices have enough to worry about without constantly trying to keep up with the ever-changing regulations behind collecting medical payments. Unfortunately, collecting payments efficiently is the key to running a successful medical business. So in order to help you achieve that goal, we created this list of the 6 most important pieces of information that will improve collection procedures:

  • Name
  • Address
  • Phone Number
  • Employment Information
  • Social Security number
  • Driver's License Number

 
It also helps to verify a patient's medical insurance before the date of the appointment. The reason for this is it can lower the cost of securing a loan and reduce the odds of forgiving a loan, and it can increase your cash flow. This is also a good time to discuss outstanding balances and co-pays. The more funds you have at your disposal the more you will be able to acquire. It is important to understand some billing systems are simply out of date, so your staff may need proper training to take the next step. Relying on technology is a given these days, so you might as well embrace it sooner rather than later. 

The revenue cycle will be supported by having a financial policy in writing with the approval of legal counsel and the patient's signature. The patient should also have a copy. This document should detail the collection of co-pays and unpaid balances, other payment options for services not covered by insurance, and a description of pre-paid services. Your collection modules  automatically make statements with messages and ongoing collection letters. The beginning stages of the cycle includes a check sheet to confirm all relevant information is recorded at the time of appointment setting.

All basic demographic information should also be verified. The patient information form must be filled out by new patients. For established members they should review their information once a year. Copies of their insurance card will assist in keeping track of patients. Always look over the form to make sure it is complete and all signatures are in place. Another point that must be noted is it may be imperative to have a staff member entrusted to work on pre-certification and prior authorization work. This is an essential position in surgery, orthopedic, and neurology offices.

Lastly, reimbursement from the government is projected to decrease and it is in your best interest to monitor all areas of the collection procedure. To reduce gaps in physician billing you need access to quality resources. So if you would like to ask us any questions about how we can make your practice run more efficiently, please feel free to contact us at any time.



Tags: Medical Billing

How to Accomplish Provider Credentialing

Posted by Harold Gibson on Thu, Oct 02, 2014

Physician_Credentialing_ProcedureSince Obamacare and the Affordable Care Act (ACA) have become reality, along with Meaningful Use 2 guidelines, provider credentialing has taken center stage for health centers. According to the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) in Policy Information Notice (PIN) 2001-16 credentialing requires that "all Health Centers assess the credentials of each licensed or certified health practitioner to determine if they meet Health Center standards." 


The issue of provider credentialing poses some challenges to offering a simple explanation. Since this is more a "process" than a condition, explaining credentialing does not lend itself to a short, all-encompassing definition. Yet, provider credentialing is vital to ensuring quality care, which has become a critical measurement rule for healthcare providers. 

HHS Definition 
The Department of Health and Human Services (HHS) definition of "credentialing" reinforces the process-focus of this requirement. According to HHS, credentialing is "the process of assessing and confirming the qualifications of a licensed or certified healthcare practitioner." 
This official definition area of PIN 2001-16 also offers primary and secondary sources of information to properly vetting healthcare providers' credentials. HHS suggests the following sources to verify physician credentials. 

Primary Verification Sources 
* Electronic or mail correspondence, 
* Telephone live-person verification, 
* Internet investigation that offers verification, and 
* Published reports offered by credential verification organizations (CVOs) and entities. 

Secondary Sources of Verification 
Should primary source verification be unnecessary, HHS recommends using these secondary sources to credentialing healthcare providers. 
* Get evidence of the original credential, 
* Secure a notarized copy of the credential, and 
* Make a copy of the credential from the original document (must be approved by appropriate Health Center staff). 

How to Accomplish Physician Credentialing 
To accomplish sufficient credentialing, the following are acceptable evidence of primary and secondary verification of credentials. (P = primary source; S = secondary source) 
* Current, in-force license for a licensed independent practitioner [LIP], (P) 
* Evidence of appropriate education, training and experience, (P) 
* A statement of satisfactory health fitness from the health care provider and confirmed by the chief of staff, training program director or another licensed physician appointed by the health care facility. (P) 
* Government-issued picture ID, (S) 
* Drug Enforcement Administration (DEA) registration confirmation, (S) 
* Hospital privileges verification, (S) 
* Immunization and PPD (purified protein derivative) skin test status, (S) and 
* Current life support training evidence. (S) 
Please note: These requirements are somewhat different than health center accreditation standards. When a health care facility seeks accreditation, management should consult the HHS standards for accrediting a health center.

Outsourcing Medical Billing, Coding and Meaningful Use 2 

These requirements also generate challenges in medical billing and coding. While the Centers for Medicare and Medicaid Services (CMS) initiated the Meaningful Use regulations, other payers are adopting some provisions, particularly the use of electronic health records (EHRs). 
Physicians who began complying with Meaningful Use Stage 1 in 2011, are ready to advance to Stage 2, satisfying the required two years of Stage 1 compliance. After releasing a final rule in August 2014, CMS permits physician flexibility in using Certified Electronic Health Record Technology (CEHRT) due to the delays in CEHRT certification implementation. 
In many cases, physicians involved in becoming credentialed, have little time to install CEHRT. Providers and facilities involved in credentialing should consider outsourcing their medical billing, coding and documentation tasks.

Five-Steps-to-Easy-Physician-Credentialing

By outsourcing these duties to a top firm, such as M-Scribe Technologies, physicians, hospitals and health centers reap multiple benefits. Two primary benefits alone are worth evaluating this option. 

First, physicians can control their practice costs. With cost certain accuracy, third party billing and coding organizations afford physicians with impressive budget control. 
Second, since the best firms offer compliant billing and coding efforts by well-trained staff, physicians have the comfort of knowing their critical billing/coding functions are being properly managed. 

Follow the HHS roadmap to properly credential physicians. The way you implement the process is your call, but the HHS is specific on the best primary and secondary evidence needed to fulfill this necessity.

Tags: Provider Credentialing

Advantages of Outsourcing Medical Billing Services

Posted by Harold Gibson on Thu, Sep 18, 2014

BENEFITS OF MEDICAL BILLING OUTSOURCINGThe medical industry has been undergoing significant and rapid changes over the past several years. With the passage of and increasing implementation of the Affordable Care Act (also known as “Obamacare”, or the ACA), the business of medicine is developing at a pace not seen since the federal government involved itself in the medical industry over a generation ago.

While the benefits and problems of the ACA are still hotly debated, the fact of the matter is that the law has brought with it a significant increase in the amount of paperwork and regulations that medical offices must contend with on a daily basis. At the same time (and partially as a result), the expenses associated with running a medical office have increased, while margins has subsequently decreased.

For example, according to a recent study, the profit margins among not-for-profit hospitals has fallen to just 2.2%, which is due to the fact that their overall expenses have increased by 4.6 percent. This increase in expenses and decrease in overall profit margins is repeated in many segments of the overall medical industry, and the majority of experts expect it remain the same (or get worse) over the next several years.

How changes in the medical industry are negatively impacting medical offices

While many consumers of medicine are complaining about increasing costs, it often seems as though it is the practitioners themselves who are being squeezed on both sides. Not only are expenses going up, but insurance companies have new tools and methods to decrease payouts to practitioners. At the same time, the increase in administrative work for front office staff is increasing staffing costs for the front office.

Medical coding and billing has become more complex and accident-prone as well. While it is true that medical billing and proper coding has long been a sore subject for medical administrative staff, the new regulations from the passage of the ACA have made it so that same administrative staff must learn a largely new coding and billing process, which many consider to be more complex and difficult than before.

All of this leads to lost revenue, partially from increased administrative costs, and partially due to incorrectly coded records. In fact, according to a study by the Department of Health and Human Services, it is estimated that more than 42% of Medical records are incorrectly coded. This equates to billions in misappropriated revenue.

Reaction to changes in the medical industry

The dust certainly has yet to settle in the medical industry, and it will be years before the long-term direction of the industry is truly known. However, in the meantime, local hospitals, doctor’s offices, and medical facilities throughout the United States are adapting to the changes as effectively as possible.

One of the more effective changes within the industry is the increased outsourcing of medical billing and coding to companies that specialize in performing those specific tasks. The reasons for this are numerous, however the two primary reasons are that it reduces liability and increases margins.

For a long time, the medical industry seemed to resist the idea of outsourcing medical coding and billing to other companies. Part of the reason for this was the fact that many believed the cost of doing so was prohibitive for their business. Medicine has never been a particularly high-margin industry, and many medical facilities believed that they simply could not afford the lost margins that would come from hiring such a service. One of the other reasons was a desire to retain control of the administrative workings of the office. By ceding control of the medical billing and coding process to a third-party, some hospitals and doctor’s offices believed they would lose control over the patient’s overall experience, and would have to deal with an additional bureaucracy.

However, the implementation of the ACA has compelled medical facilities to reconsider outsourcing, and many of them have found it to be a worthwhile endeavor. Contrary to earlier beliefs within the medical industry, outsourcing medical billing and coding turns out to be a positive experience overall. As a result, the Bureau of Labor Statistics projects that the outsourced medical billing industry will grow by more than 20% over the next decade. As more and more medical facilities reap the benefits of outsourcing, that projected number could increase even further.

To know more about M-Scribe medical billing and coding services.

Advantages of outsourcing medical billing services

Outsourcing medical billing to experts significantly reduces overall provider liability since certified billers and coders keep themselves abreast with changing laws and regulations. Instead of being solely responsible for miscoded records - corresponding procedure and diagnosis codes (CPT and ICD-9), practices can share that responsibility with the billing company who has coding expertise on board. Providers can discuss all the changes with certified coders to educate themselves as well as help billers to prepare cleaner claims. If nothing else, this offers peace of mind for administrative staff and medical professionals, so they can focus on their jobs instead of being distracted by medical billing and coding ever changing requirements.

Most significantly, however, is the fact that properly billed and coded records will mean prompt and maximized payments from insurance companies.

Tags: Atlanta Medical Billing, Boston Medical Billing

Intricacies involved in Dermatology Billing with pathology

Posted by Harold Gibson on Tue, Sep 16, 2014

Dermatology BillingIt is likely that most dermatology practices strive for higher rates of reimbursement. When providing medical billing services in any specialty, you should be aware of how serious the national increase in bad debt write offs is. Coupled with Medicare's reduction in provider fees, extreme care must be taken to ensure reasonable return on investment. To avoid denials and lost revenues, it's imperative that procedures be accurately reported and coded and that the consequences of both state and federal regulations are adhered to. 

Direct Billing Laws for Dermatopathology 

Direct billing laws vary from state to state. In some states the dermopathologist must be an employee, owner or partner of the practice. This means that a practice must provide such a staff member with expensive benefits like holiday pay, health insurance, retirement benefits and perhaps profit sharing. Other costs of in-house Dermatopathology include the expenses of producing necessary reports. The technical component includes creating a laboratory with equipment such as cryostats, fume hoods and slide baths. So in the states where such practice requirements are legislated, a large startup investment is most certainly necessary. Please call us at 888-727-4234 to know more about your state laws about dermopathologist.

In practices that want to avoid building a laboratory but still want to charge for professional treatment and analysis, hiring a part-time dermatopathologist can work. In this case, the outside lab bills Medicare and other third-party payers directly for technical work. The dermatopathologist must read the slides in an onsite office to avoid the Medicare anti-markup restriction and also fulfill the "Stark same building" criteria. Three salary restrictions are Stark, Medicare safe harbor rules and Medicaid's anti-kickback law. 

Awareness of government regulations and payer regulations will lead to a minimization of claim rejections and a reduction in bad debt. Anyone with a dermatology practice must be aware of the complex network of laws and regulations governing billing and provisioning of laboratory and pathology services. In many cases private payers may impose restrictive policies on these services as well. 

The American Academy of Dermatology (AAD) has made a position statement on pathology billing.

Here are some of their main points: 

1. The Association supports the right to bill for one's own work: The ability to bill for pathology work and technical work whenever when there is a lab is essential. 

2. Board certified dermatologists should continue billing for pathology work whenever they interpret their own slides. Outside reference labs should be relied upon for preparing slides outside the office. External reference labs bill for the technical work they perform.

3. Dermatologists must continue to select any qualified dermatopathologist they choose. This should include any dermatopathologist that works in the same group practice as the referring party. This should be true even for small single specialty groups. The dermatologist and dermatopathologist must work together to deliver the best care for the patient. It is necessary for the dermatologist to be able to choose the dermatopathologist with whom they work best, based upon their confidence in that dermatopathologist's ability and their ability to communicate.

4. They cautioned against dermatopathology lab requirements interfering with the ability of dermatologists to run their own in-office labs. 
They also warned against risks posed by several different lab models, including those involving outside pathology labs that markup fees for work not performed by the billing dermatology practice. This type of billing action is considered egregious by the AAD. 

It's clear that the laws surrounding dermatopathology are deep and murky, with the many fingers of governments both federal and state muddying the waters. To tread them safely, you might enlist the aid of a dermatology billing expert. This type of expertise can help you avoid costly errors and protect your hard earned revenues. 

To know more about intricacies involved in Dermatology Billing with pathology please visit M-Scribe dermatology billing services or call us to talk to one of our Dermatology Billing specialists at 888-727-4234.

Tags: Medical Billing, Atlanta Medical Billing, Dermatology Billing

Five Steps to Easy Physician Provider Credentialing

Posted by Harold Gibson on Tue, Sep 09, 2014

Credentialing1. Start the credentialing process early. Most credentialing can be completed within 3 months, but that doesn’t mean you should take that long, as complications can arise. Payers have recently been merging into larger organizations. As a result a practice's ability to expedite an application has diminished. You’re working on the payer’s internal timeline for application processing, so it makes sense to allow additional time for any difficulties that occur.   

2. Ensure that you application is complete. According to Joellen Scheid, an Anthem for Virginia credentialing manager, only 15 percent of applications are complete, while the rest are missing critical information required for processing. The most common areas of application deficits are missing data and obsolete data. Examples are:

  • Missing work history and current work status
  • Physician's practice and effective date with the practice
  • Hospital privileges and covering colleagues
  • Attestations
  • Malpractice insurance details

3. Update and attest with CAQH for quicker processing that is easier to access. The Coalition for Affordable Quality Healthcare started its uniform credentialing program about 15 years ago. Since then, most payers in the nation have adopted this program. Physicians who regularly update and attest with Coalition for Affordable Quality Healthcare find credentialing and re-credentialing much easier. The Universal Provider Data source is a part of CAQH's credentialing application database project. Its goal is to make provider credentialing more efficient for providers as well as for healthcare organizations. CAQH’s online database collects all provider information necessary for credentialing, with the goal of eliminating much of the administrative overhead, paperwork and errors that providers face during the process of credentialing.

Billing and insurance tasks contribute to a major portion of administrative costs for both providers and hospitals. Federally mandated CAQH CORE EFT and ERA Operating Rules also streamline and simplify provider payment and claim reconciliation.

4. Prepare for telemedicine credentialing. Some say telemedicine is the future of the healthcare industry. More than 36 million Americans have already used some form of it. It’s estimated that 70 percent of doctor visits can be handled over the phone — costing far less than an in person visit. The US military is one of the largest users, with about 55 percent of the Army's telehealth programs focused on behavior health.

When your goal is to provide widespread patient services in both rural and urban communities, you’ll be able to offer services to more people at lower cost with telehealth. But this type of credentialing can be especially tricky when granting privilege to practitioners for either first-time procedures or disaster service. More information about telehealth credentialing is available.

5. Abide by your state’s regulations. Each state has its own laws for timely credentialing, including in-state credentialing and reciprocity.  Your state Medical Group Management Association can help you ensure you are adhering to your state's standards and using them to your advantage. Your credentialing process will be easier when you gather all the information you need on new providers up front. State requirements are quite varied.  For example, in accordance with HCQA, NJ carriers must be willing to accept the NJ universal physician application form. Oregon’s universal credentialing application, created and maintained by the ACPCI eliminates the need to complete multiple unique applications for each health plan, hospital and insurer. Ironically, this state’s credentialing is not governed by the state. 

In short, compiling all the information well ahead of time and making certain that it is both accurate and complete will save you from delays and administrative nightmares that can delay your credentialing. Assembling your information to meet state, national and practice requirements and completing your documentation correctly the first time is likely to be the swiftest way to attain your goals.

Tags: Provider Credentialing

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