Saturday, February 26, 2011

Medical Billing and Coding Job Description, Training and Salary

If you've been thinking about taking some medical coding or medical billing classes online or getting medical coding or billing training you want to make sure you understand what this career and the job entails and have a good idea what kind of salary you'll make. Of course you may want to open a work from home business and it's certainly possible but may require a good education and training and an entrepreneurial ability to do so.

Going into a home business is not for everybody and getting on the job experience first is a good idea unless you have extensive education and feel like you completely understand the billing business.

Medical billing means you would be documenting patients' visits to a doctor, clinic or hospital or other type of health facility. Medical billers, assistants or Specialists enter clinic and patient information into expensive billing or practice management software so you can submit medical claims to health insurance companies. You would also be posting payments from insurance carriers and patients and run off management reports. You may also be required to make follow up calls.

Medical billing doesn't have to be done in a doctor's office. You can do billing from home, any office, clinic or hospital, billing service or facility that has the necessary software. Many doctors outsource their billing and may choose a home based business if the service is competitive in terms of cost. Or they may choose a smaller service and not necessarily one of the large billing services. So cost is a factor.

Medical coding is a totally separate function and not a part of the medical billing business. Medical coding cannot be done from home or outsourced to a service. Medical coders usually work right in the doctor's or clinic's office doing the coding before it is sent on to the billing service. Coder's salaries are comparable to medical biller's salaries.

So if you decide to get medical billing training you don't have to worry about coding and vice versa. People usually choose one or the other. Medical billing is more popular and offers more versatility since you can work from home in either your own business or for a doctor or clinic that allows you to do that.

Billing services often have graveyard shifts and may run around the clock. Salaries to start out run at least $10 an hour and up depending on your training, education and or experience, or related experience. You can move up fast as you gain the experience on the job and can command a much higher salary for the experience you're getting both from the clinic, practice or company you're working for when and if you leave for another medical billing job.

You don't need national certification, for example, as a billing specialist but it may help you get your foot in the door faster. There is money available for both your local on-campus and online medical billing training too. Make sure to check out online schools thoroughly to avoid any scams.


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Friday, February 25, 2011

Medical Billing Job Description and Salary Range

If you've been thinking about entering the field of medical billing I'm sure you're wondering what exactly a medical biller does and what salary you can expect. There is a lot of interest in this field and many ways to enter it. Although experience is best it takes getting a job in that field to get experience and it can be a vicious circle. But first the job description. Keep in mind that depending on the facility you may or may not be doing all of the following. And if you work for a billing service your job may be quite different since it is not a medical facility.


If you work as a medical biller or a certified Medical Billing Specialist you will compile and track outstanding balances that are owed to medical clinics, medical offices or other medical facilities. You would maintain the records of payment for all patients for that medical facility. You would make payment arrangements with the patient and collect on any past due accounts.


As a medical biller, medical billing assistant, billing clerk or billing specialist you would have access to a lot of confidential medical information. You would be working with collection agencies and even the courts to collect on delinquent accounts. You may also be working with lawyers and others on the estates of patients who have passed away on resolving their unpaid accounts. You would be working and coordinating the deductions from payroll for the employees of your clinic or facility. You'll be aware of the rules and regulations you must follow to be in compliance with any local, state or federal laws or regulations.


Now what skill should you have? You'll be working with a lot of numbers and technology. You want to be comfortable using a computer, software and office equipment. You'll be learning billing software if you haven't learned it in medical billing training. You don't need to learn coding as that is a separate function and coding is usually done before it reaches the biller, but some knowledge of it can only help. You will want to have good communication skills as you may be talking to people about their medical bills.


The salary you can expect will depend on previous experience and medical billing training you have had. You will make a higher salary as a certified Medical Billing Specialist which requires taking a national exam. But generally your range will be in the $31,000 to $45,000 range. The more experience the higher the pay generally. There are lots of ways to get experience and training including medical billing training online and at your local college. There is plenty of money and financial aid available for online courses and you want to check out every school thoroughly to avoid any scams.

Monday, February 21, 2011

Medical Billing - How Bad Are Things Really?

Everybody hears about how the medical billing industry is robbing us blind. Medical costs are out of control, or at least so they say. Medical billing software, just to be able to run your medical billing practice, costs an arm and a leg. Medical billing agencies like Medicare and Medicaid, Blue Cross, Blue Shield and even private insurance companies are ripping us off left and right. Nobody wants to pay claims, or at least that's the perception. But what's the reality? Does anybody who is doing the complaining really know? Medical billing statistics are posted all over the place, especially with the Internet being so filled with information. But does anybody really take the time to look up the stats to see how bad things really are?


For example. Did you know that it costs between $8 and $10 to process the average medical claim? Now maybe if you're charging a procedure that costs thousands of dollars, that's not such a big deal. But what if you're putting in a claim for a $50 walker. That's almost 20% of the total cost of the item, which is absolutely absurd. So yes, in this case, costs are crazy. And the problem is very simple. To process a claim, the same procedure must be followed, regardless of what the service being billed is. If the walker could be processed at a cheaper cost, no problem. But that is just not the reality of it.


Forgetting about claim processing costs, what about salaries? Well, for the fortune 500 company like Prudential, paying a salary of $35,000 a year for a claims processor is not such a big deal. But when you're talking about a non profit organization like Medicare, which is actually running in the red and in danger of shutting its doors, paying these people that same $35,000 a year is insane. But they have to. Why? Because if they don't, where do you think they're going to go? To the private sector of course. So salaries must be competitive.


What about turnaround time for claims. Yes, we all complain that our claims take forever to get paid. But what we don't understand is that the people who are really getting killed are not the patients, because they will eventually have their claims paid, but the billing companies. Turnaround time for paper claims can be anywhere from 30 to 90 days or more and this really puts a strain on a company and its cash flow. So as bad as the patient may be having it, the medical billing company is suffering big time.


When you add all this to the cost of just starting a medical billing agency, you can see that the industry itself is behind the 8 ball before it even begins. Throw into this mix doctors who back in the 60s charged $15 for a doctors visit, now charge anywhere from $50 to $100 for a visit and what you end up having are costs that are totally out of control.


This is a spiral that is most likely to continue until people can no longer afford to get sick.

Sunday, February 20, 2011

Insurance - Medical-Billing EzineArticles

The Deal With Find-A-Code Medical Billing Code Database by Tyler S James There is a new face on the online medical resources block and his backpack is full of all the latest gadgets medical coders asked Santa for. Find-A-Code, the newest web-based medical billing code reference library just burst onto a field traditionally crowded by publishers and old-school desktop applications. They brought with them a shiny new website that is deceivingly powerful.How to Audit Your Hospital Bill by Adam Luehrs Many uninsured and underinsured people don't have means to pay their Hospital bills. Little do they realize you can actually audit your hospital bills for errors and double charges.Medical Billing - Do I Need A Degree To Get A Job As A Biller, Coder Or Insurance Specialist? by Helen Hecker If you've thought about entering the field of medical billing or coding or wondered what it would take to become a medical biller, medical coder or medical insurance specialist, you may be surprised to find out that you don't need a college degree to enter these fields. In fact any employer will hire you if you have experience over someone with no experience.What Factors Can Affect Your Medical Coding Salary? by Jane Tompsett The average medical coding salary can vary depending on the setting in which the coder works; whether it be in a small town or a big city, and whether is in a large organisation like a hospital or clinic, or a smaller, doctor's practice. Some medical coders even work from home. The rates of pay for a coder will also vary, depending on qualifications and experience. If you work from home your earnings will reflect how efficient you are and how many clients you have, so are likely to be more variable than those of someone with a full-time, fixed salary position.Medical Billing Services: Solution to All Your Billing Woes by Reuben A Shevlin With changing times there has been considerable change in the way professionals work and now there are specialists for everything. Growing scrutiny on part of the government has placed the onus of providing good quality services on the concerned professionals while maintain stringent standards.Medical Insurance Policy Basic For Medical Treatment Abroad by Greg Pierce Medical tourism has been very popular these days, many foreigners especially those coming from western countries are flocking to eastern and European countries for medical procedures which are expensive in their own land. Cosmetic surgery and dental procedures are just two of the many of the medical procedure which are given to tourist in a very affordable price but with the same quality as the procedure done in their home country. These medical procedures are covered by insurance which makes it more convenient for those who would like to avail this kind of service abroad.Medical Billing And Coding - How Much Money Can I Make As A Medical Insurance Specialist? by Helen Hecker A medical insurance specialist is an expert on both medical billing and medical coding. It's not necessary to get your education and or training in both of these fields. In fact most people don't. They specialize in billing or coding but usually not both. In terms of salary or how much money you'll make in either field you may make just as much if you focus on just one of these fields.The Benefits Of Using Medical Claims Billing Software Within Your Office by Shirley Condon A healthcare facility's medical claims billing involves a lot of work for more than a couple of individuals. Medical claims billing can be a complicated task that requires a great deal of work.Medical Billing: How Is It Done? by Nadine Torres When a person has a health insurance from a certain company, he/she is probably familiar with the process called medical billing. It is actually the process in which a medical billing specialist files a claim to the patient's health insurance company. This a way of making sure that the health care providers will be able to receive the appropriate payment for the medical services that were rendered to the patient. With this process the billing specialist will also deal with unpaid claims and other problems related to related to it.Big Brother Will Be Watching You by Douglas Cassel How providers practice is a matter of great professional pride and tradition. Well meaning people can differ in the evaluation and methods of treatment selected. Government mandated treatment protocols will incite tremendous opposition from many in the health care community.Health Insurance Leads Information by Robbie Lindsey G Walsh Health insurance offers coverage for the covered towards healthcare expenses incurred because of sickness or mishaps. Medical insurance applications generally include the price of regimen check-ups, preventive as well as emergency health care, as well as prescription drugs. The insurance provider can be a personal organization or a federal government company. One can define Insurance Leads as people who desire to be healthy. In the United States associated with America, a lot more than 80% from the population offers health insurance...Medical Billing Or Medical Coding Certification - Do You Have To Be Certified To Get A Good Salary? by Helen Hecker If you're thinking about getting into the medical billing or medical coding field and think you have to be certified to get a good salary or higher wages there are a few things to consider first. You have probably heard a lot about certification. But do you really need to be certified to get a job in medical billing or coding or both and make more money?The Pitfalls Of Health Insurance by Chuck Cox We all understand how health insurance generates a lot of paperwork which also includes a lot of fine print. However, the bad part of this is that most folks tend to not read any of this in as a result do not understand what your plan covers.The Four Steps of Developing a Medical Practice Compliance Program by Dallas Alford The health care regulation laws that now exist were created to ensure that the interest of every medical group will be protected. Failing to abide by such laws could pose significant risk due to fines, penalties and even potential criminal charges. A well designed compliance plan can ensure that your healthcare organization is compliant with CMS standards and therefore reduce any potential insurance audit risk.I Wouldn't Want to Practice in Massachusetts Either - Or the Real Reason for Doctor Shortages by Douglas Cassel There, I said it. Massachusetts, although a good place to train (I did), is a bad place to practice. It always has been. There are too many doctors coming out of training programs, and the state has a "model" health care plan which restricts salaries. Combined with a bad malpractice situation, people leave Massachusetts for better opportunities elsewhere.Medical Billing Office Mistakes - The 10 Biggest And How to Avoid Them by Brad Graham As we embark upon 2011, the necessity to improve the efficiency and profitability of our Medical Billing has never been more important. Here are some suggestions to assist your medical billers and some deadly pitfalls to avoid.A Medical Billing and Coding Salary Can Be Yours For the Taking by Jane Tompsett Your medical billing and coding salary, should you decide to enter this sector of the healthcare industry, will vary somewhat depending on a number of factors. The first is your geographical location and the second is the size of health care organization you are employed by.Medical Billing And Coding - What Kind Of Salary Or Hourly Rate Can I Expect? by Helen Hecker If you've been considering going into the medical billing or medical coding field you need to have some idea what you can make in terms of salary or wages and before you even think about getting any training in either field. There are a wide range of salaries and hourly rates offered depending on the type of facility, clinic, hospital or business or other places where you might work.A Discussion About Medical Professionals Insurance by Samual Ellis We all have various types of insurance policies that protect different aspects of our everyday lives, as well as our property. The average doctor has types of policies that are quite important to his or her practice and the following is a discussion about medical professionals insurance. The most popular type of policy that such professionals carry, is the one that is going to protect them and their practice from frivolous law suits.Who Needs Insurance For Medical Professionals? by Joshua Russell Individuals are becoming much more aware of the rights. There is a growing acceptance by society in general that anyone has the right sue and to claim compensation if they feel they are justified in doing so. Many people do when they believe they have received treatment which has been detrimental to them physically or mentally.England's Healthcare Crisis Sends a Warning to the Colonies by Douglas Cassel "It appears bureaucrats made decisions impacting millions of people in secret, with little or no disclosure." This is the exact procedure used when Ms. Pelosi and Mr. Reid rammed through Obamcare, with the vote coming before the actual bill was available for review.Two-Tiered Medical Care, A Possible Solution by Douglas Cassel Just because an idea doesn't succeed the first time around is not a reason to reject it outright. The Oregon medicaid plan, a failed idea from the 1980's, is a classic example. A two-tiered system based upon the Oregon plan may offer the best choice for addressing the many conflicts facing health care policy. Of course I have no power to institute such a plan, but I do feel it may be the basis of an honest discussion of health care in America, which sets me apart from the supporters of Obamacare.Insurance Companies Fined for Underpayments, Imagine That by Douglas Cassel Thirty years ago, one of our billing office employees told me an interesting story. While previously working for a large insurance company she had been instructed to throw away every third batch of bills. The insurance companies knew that a many of these claims would never be followed-up, further increasing their profits.Medical Billing and Coding Specialist Programs by Erik R Johnson If you are considering medical billing and coding specialist programs, you have many options to explore. After completing one of these degree programs you will be prepared for a job in a career field that is in demand and will continue to grow for years to come. Your schooling should prepare you to carry out a number of important duties that are integral to the healthcare system of today.Telling the Truth About Obamacare, It Depends by Douglas Cassel Lawyer: Doctor, before you performed the autopsy, did you check for a pulse? Witness: No. Lawyer: Did you check for blood pressure?Medical Billing And Coding - How Much Money Does It Pay? Salary Range by Helen Hecker First of all medical billing and coding are basically two different functions. You can focus on medical billing or medical coding or a combination of both. Oftentimes people think you must train in both billing and coding but that's not the case.How to Start a Medical Billing And Coding Business by Daljeet Sidhu The economy is in recession and most doctors want to lower their costs and improve collections. It is a great time to start a medical billing service. We discuss the steps needed to get started.What Are the Key Features of Medical Billing and Coding Certification? by R Subburam We live in a time where the so called "baby boom" generation is getting to the upper age bracket. In the US alone there are nearly eighty million adults who belong in this age group. Many of them are starting to show signs of old age which means they will start to get all of the inherent problems that come with aging such as illnesses. Another thing is that as the years go by, the medical world is developing new procedures and tests. This in turn means that medical billing and coding is growing in importance, for both, hospitals as well as insurance companies.Oops, You Mean Obamacare Doesn't Lower Healthcare Costs? My Bad by Douglas Cassel A new study, performed by the U.S. Centers for Medicare and Medicaid Services (CMS) auditors, predicts that Obamacare will not lower medical costs and may increase them. This is a direct refutation of the promises so recently made to us by President Obama, Congressional leaders, and other proponents of Obamacare.Sample Medical Billing Contract - My Biggest Mistake by Alice Scott Don't leave out important parts of a medical billing contract by using a sample contract. Make sure you cover all the issues you will run into later on. Sample contracts are not the answer for a successful medical billing business.[ Previous 30 | Display By Oldest | Display By Newest | Next 30 ]


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Saturday, February 19, 2011

Medical Transcriptionist Salary

Medical transcriptionists' salaries fluctuate considerably. There is no fixed income for work of this kind, with earnings depending on the productivity and skill of the medical transcriptionist.


In 2002, the American Association for Medical Transcription (AAMT) conducted a survey, where an average annual salary of a little over $31,000 for the medical transcriptionist was reported. The highest-earning 10% of those surveyed had a salary nearing $18 per hour; the lowest-earning 10% earned a touch over $9 per hour. Of course, some earn distinctly more and some considerably less than that figure. All said and done, a medical transcriptionist's salary is situational. Sometimes it takes much more than mere skill. It helps the medical transcriptionist to be at the right place at the right time.


On average, a qualified medical transcriptionist can earn about $50,000 for full-time work and $20,000 if he is working part-time. Transcriptionists can bring in a greater salary if they have their own business or are prepared to work from home.


A really skilled medical transcriptionist can earn $25.00 - $35.00 per hour. The money in this field is substantial. More importantly, it can be a priceless add-on to your already existing income and career.


Medical transcriptionists are compensated in various ways. Some get their salaries based on the number of lines transcribed or hours worked. Others have a per-hour basic pay with bonuses for additional production. It is important to remember that independent contractors have a greater salary than transcriptionists working for others. However, working independently is fraught with drawbacks. The expenses are greater; they receive no or meager benefits, and there is no real security in the job.

Friday, February 18, 2011

Medical Billing Salary Range

Although medical billing career may not earn a very high pay like other medical related jobs, medical billers do bring home a salary that is enough to live a fairly comfortable life.


Medical billing salary is influenced by lots of factors. The training gained in the billing field accounts for the major part. The person who completed a relevant course in the medical field, gains special skills and knowledge and this is a clear indication that he/she is putting extra efforts in order to perform a good job as a medical billing specialist. Depending on the education qualification, the hourly rate varies from $12-$15. Another most important factor that affects billing pay is how long someone has worked in the field. Medical specialist with experience of 1 year earns around $12 per hour. Those who have more experience in billing earn up to $16 per hour. However, the geographic location also plays a role in pay scale. For instance, areas where cost of living is high, the pay will be more. Billers who work in New York City, Houston, Chicago and California are able to pull a good amount of salary. Work locations such as hospital, billing company or private practice will also affect the salary. Since there are lots of factors which affect the salary of billing, it is really not easy to predict the pay scale. Studies have shown that 50% of people earned around $35,000-$45,000 annually.


Medical transacting can be a work at home opportunity, which can fetch a descent salary in a comfortable home environment. Most of the medical billers are paid hourly, rather than annually. While biller who is experienced can earn around $40,000 a year as an independent contractor working from home, a billing and coding specialist who runs his own firm can earn $100,000 a year. However, people who are searching for home based job should be very careful. There is lots of fraud going on in this field. These scammers charge hundred to thousand dollars and in exchange they claim they will help to get a placement in billing. They also promise that medical billing job can earn a substantial amount of money and no experience required. But in reality, those who paid to get a job end up with no job, no money. Billing is a very competitive field, so without experience or training in medical billing field, it is almost impossible to get a job.


The best way to get a good salary is get trained, have few years of experience, and by doing justice to the job. A medical billing professional with all these qualities will definitely earn a good salary.

Thursday, February 17, 2011

Medical Insurance Billing and Coding Explained

Medicine is an art, a science and a business. Doctors learn the artistic and scientific aspects of their profession in medical school. But the business aspect of their practice - getting paid - requires a completely different set of skills - skills most doctors have neither the time nor the interest to acquire. Even if they did, few doctors would have to time to handle the complex administrative aspects of a modern medical office. Enter Medical Insurance Billing and Coding.


Medical Insurance Billing and Coding specialists work in doctors' offices, clinics and other medical facilities. Their primary job is to submit claims to insurance companies to ensure doctors and support staff are properly reimbursed for the services they render. Medical Billing and Coding professionals tend to deal mostly with private insurance companies and the agencies of state and federal governments who pay medical claims, e.g. Medicare. The Medical Billing department is often also responsible for collecting co-payments or deductible amounts from patients directly.


Processing a Claim


To process claims, the Medical Insurance Billing and Coding specialist first deals with the patient's medical record, which contains the physician's notes on what services were performed. The specialist must then translate this information into a five-digit numerical code drawn from the American Medical Association's Current Procedural Terminology (CPT) guide. The actual diagnosis is also coded based on a government guide called the International Statistical Classification of Disease and Related Health Problems (ICD). It is very important that the CPT and ICD codes match up, or a claim will likely be rejected.


In fact, according to the Healthcare Billing and Management Association, up to one half of all medical claims are initially rejected by insurance carriers. Medical Insurance Billing and Coding specialists must therefore need to learn how to skillfully adjust and resubmit claims in a way insurance companies are more likely to accept.


Paper vs. E-Claims


In the past, virtually all medical billing and coding was done on paper, which was slow, inefficient and expensive. Today, more and more claims are being filed electronically, although paper-based billing is still very common. In the coming years, computer skills will be increasingly important to Medical Insurance Billing and Coding professionals.


Training & Certification


To become a Medical Insurance Billing and Coding professional, one should take a specialized training program in this field from a recognized and accredited college or university. Such programs can normally be completed in about a year. After that, industry certification is also recommended. The Certified Medical Reimbursement Specialist (CMRS) accreditation by the American Medical Billing Association is one of the most recognized of specialized certification in this field.


Medical Insurance Billing and Coding is a highly specialized field that is critical to the operation of modern medical offices. The need for well-trained Medical Insurance Billing and Coding specialists is likely to grow significantly as America's population - and the need for quality medical care - grows over the next few decades.

Wednesday, February 16, 2011

Medical Billing and Coding Job Requirements and Salary

If you're thinking about entering the medical billing or medical coding field you'll be glad to know that there is a strong demand for qualified, experienced medical billers and medical coders. I discovered that medical coding first came into being because there was a need to standardize and organize all the new technologies and medical and surgical procedures. So much new information has surfaced over the years that improved medical billing and coding techniques were necessary.


Insurance companies and health care providers needed these codes to help classify claims. Because of this need for better coding and billing practices, the demand for billers and coders increased. This has made billing and coding jobs the fastest growing area in health care.


Besides working for large billing services, there is a huge need in insurance companies, large clinics, doctor's offices and other healthcare facilities. These companies are looking for experienced and educated people. Making mistakes in billing can cause a lot of problems legally. So usually they prefer that an individual has experience or good medical billing training.


There are no state requirements for certification. You can take one national certification exam to get a certificate in medical billing as a Specialist but it's not a state requirement. The organizations that offer the exams are not state or federal organizations. Medical coding also has no state requirements for certification.


Although on occasion an employer may hire someone with no experience, it's possible that if you have related experience they may decide to hire and train you using their expensive software. But generally they would like you to have some experience or medical coding or medical billing training through a college, university, trade school or online school.


Can you get a job in coding or billing? This is a copy of the wording in a classified ad in our local newspaper today to give you an idea of what to expect. Make sure to check all your local newspapers and surrounding newspapers to see what's stated in the ads. Here it is: "Medical Billing Specialist, full time, permanent position, Monday through Friday, flexible hours, requires insurance/Medicare billing experience. Electronic billing required. Long term care experience helpful. Basic computer skills required. Competitive salary. Submit resume."


Ads can vary in many ways. You can call these companies and find out a lot of information too about future hiring and if they ever have any other medical billing or coding jobs that don't require as much experience or education.


Medical coders with little experience may start out their career at $9 to $10 an hour and work up to $35 to $45 an hour. You can see it won't take long to get experience and your value as an employee will be rewarded with a higher hourly rate. Once you have this experience you'll be able to move into other companies at a higher salary. But there is much more to know about how to get your training online or offline and how to get it cheap and avoid scams. Federal money is available for online classes too.

Tuesday, February 15, 2011

Medical Insurance Claims Editing - What Does it Mean to Scrub an ...

During the rigorous training physicians undergo to learn their craft, very little education is received on how to deal with submitting claims to insurance companies. It's unfortunately a necessary evil, as physicians who contract with insurance companies rely on that reimbursement as the lifeblood for practice survival.


Receiving payment from insurance payers involves submitting claims after providing treatment. Whether it's in an office setting, emergency room, or an operating room, filing a claim involves supplying the appropriate procedure and diagnosis codes along with any appropriate modifiers pertaining to the treatment performed. However, simply filing a claim does not assure that it will in fact be paid.


The policies of insurance companies for accepting or rejecting claims change often. A claim that got paid last month may be currently denied without notice depending on carrier specific modifications. This results in a large batch of denied claims for physicians performing many of the same procedures. Not only is it confusing for a practice to attempt following up on these adjustments, it can result in lengthy days in accounts receivables along with rollercoaster collection periods.


Is there a secret weapon physicians can use to assist with streamlining claims to maximize acceptance? That's where claim "scrubbing" enters the picture. The term "scrubbing" refers to an intricate cleaning of a claim prior to submission. Over the past 10 years, automated claims editing has been developed which helps to validate that a claim is appropriate and accurate for submission.


There are two components in scrubbing claims. As the most common error for denied claims is data entry errors, the patient demographic data is reviewed for the most common mistakes. For instance, keying in an incorrect procedure code that is age specific would make the claim invalid, and the scrubber flags those types of errors for correction prior to submission. This is the easy part of the automation.


The complicated portion of scrubbing involves a thorough review of the codes and modifiers to ensure complicity with carrier specific guidelines. This is commonly referred


to as the "rules engine." In some fashion, every data element of the claim is analyzed. If a physician submits a claim for a hysterectomy and the scrubber sees a male gender it will obviously be flagged. The scrubber verifies that a procedure performed is associated with a diagnosis code that justifies the medical necessity of that procedure along with variables such as gender, age, date and place of service and any required modifiers.


The complexity of scrubbing should not be underestimated. By the time one multiplies the total number of Medicare local and national coverage determinations, along with data from the Correct Coding Initiative (CCI), ICD-9 codes, and modifiers the potential numbers of editable combinations surpasses ten million. Advanced claim scrubbers, though, can review about ten claims per second.


By including national and local coverage determinations from all of the Medicare geographical regions in every state along with data from the Correct Coding Initiative (CCI), approximately 35% of existing CPT codes are represented as a baseline in claims editing programs. There is no Medicare medical necessity guidelines for the remaining 65% of codes, therefore claim scrubber software companies hire clinicians and nurses who work full time evaluating up to the minute medical necessity data posted by insurance carriers around the country on their website as mandated by law. In addition, procedure codes are matched with all feasible diagnosis codes that are believed to be clinically defensible for claim acceptance. As one might expect, this is a costly endeavor so most claim scrubbing software companies license this portion from the few companies performing the research.


So how good are existing claim scrubbers? There's a wide range available, either as a standalone product or integrated with practice management software. Often the billing company utilized will incorporate a scrubber. The best ones will routinely achieve over 95% claim acceptance on the first pass. Practices who were previously performing manual edits typically find that after instituting the technology the scrubber flags over 30% of claims. This means about 30% potential claim denial prior to scrubbing, which drags out the revenue cycle. By having the scrubber flagging problem claims, changes can then be made instantly prior to submission, rather than waiting weeks for a denial. As a result, the practice will see more reimbursement and receive those funds faster. There will also be less back-end work secondary to denied claims.


Can relying on an experienced coder achieve the same acceptance rate? In all likelihood, no. As mentioned, scrubbers check demographic information along with the codes. Also, if a payer changes a filing guideline on its claim form or a medical necessity requirement, a certified coder would probably not be aware of it in a timely fashion. If a physician is contracted with a large amount of carriers, the chances of being subjected to rejected claims increases dramatically without a way of continually monitoring these myriad and often complex requirements.


Embracing an advanced claim scrubber, whether directly or indirectly, will allow one's practice to effectively combat the convoluted world of insurance claim rules and regulations. Practices that incorporate claim scrubbing rarely move away from the process. When the bottom line receives a significant boost along with peace of mind from knowing the latest technology is in their back pocket, why would they?


David L. Greene, MD is National Sales Director for Superior Medical Billing.


He can be reached at dgreene@superiormedical.info and (866) 989-8918 ext 320.


The website is [http://www.superiormedicalsolutions.com]


Superior Medical Billing is a Full Service medical insurance reimbursement company providing services spanning the entire revenue cycle from A to Z. The company utilizes top notch technology with first rate customer service.


If you would like to collect more money at your practice and faster, Superior Medical can help you achieve that goal. On average, practices collect 20% more and it's collected 33% faster within 6 months of going live. In this day and age of stagnant reimbursement and economic recession, wouldn't you like to collect more and not work any harder?

Monday, February 14, 2011

Medical Billing Training and Support Technology - Three Key Components

By Yuval Lirov Platinum Quality Author Yuval Lirov
Level: Platinum

Yuval Lirov, PhD, author of Medical Billing Networks and Processes - Profitable and Compliant Revenue Cycle Management in the Internet Age (Affinity Billing), Practicing Profitability ...


As medical billing system complexity and functionality grow in step with growing number of users, the number of training hours per month grows by two orders of magnitude, as a product of increasing training frequency and increasing number of training hours required for each user. The development or billing managers, who must juggle training and support in addition to their main responsibilities, reach a point of over-extension, where none of the responsibilities are delivered well enough. A new, better scalable training and support approach is needed to meet the additional requirements.


The typical scaling up path for training and support includes a three-pronged approach:

Introduction of formal training and support tracking systems,FAQ analysis, andDevelopment of knowledge repositories aimed at reusing training and support expertise according to the results of the analysis stage.

First, a formal tracking mechanism for both training and support provides continuously updated information about frequently asked questions (FAQ), individual training and support workloads, response delays, and customer success in absorbing instruction. Predictably, the analysis of most frequently asked questions and answers often shows that a comprehensive and effective initial training eliminates a significant number of help requests. Moreover, customers can find answers up to eighty percent of FAQs immediately and directly by using some sort of a shared knowledge repository, e.g., wiki. Most billing companies using Vericle billing network, follow a two-step approach: first, they create a shared knowledge repository for instructional and support-related material, and second, they establish a training department, staffed with instructors who are able to develop a minimal set of training classes for various user categories (providers, front office managers, billers). The classes typically address various functional parts of the practice management system, such as Help system, Initial Patient Intake, Workbench, Scheduling, SOAP notes, Reporting, Billing, Personal Injury, Care Plans, etc.


The shared knowledge repository gradually accumulates educational mass, starting with frequently asked questions and answers, and with time adding videos of instructional sessions and various support email threads. The instructors move away from ad-hoc individual classes to a predetermined monthly schedule of live daily classes over the Internet (webinar format). In spite of the concern about diminished personal attention, subsequent surveys confirmed that majority of clients valued their own time more than personal handholding, and preferred the immediate automated response to a delayed personal conversation over the phone.


In summary, the increased scale of medical billing systems generates more sophisticated training and support requirements, which can be characterized as:

Training and support proximity: High - The separate training and client support departments converged as billers outside of the training department grew more comfortable with shared knowledge bases and began contributing instructional material and answers to FAQ;Degree of personal accountability and transparency: Significantly improved accountability and transparency generated important requirements and prepared the content for the next step; andEfficiency: High - The Internet infrastructure provides the minimal level of scalability that enables a single training session delivered remotely to handle an unlimited number of users, liberating the development and billing managers to focus on their own tasks.

Know any health care providers who complain about shrinking insurance payments and increasing audit risk? Help them learn winning Internet strategies for the modern payer-provider conflict by steering them to Vericle - Medical Billing Network and Practice Management Software, which powers such leading-edge billing services as Affinity Billing ( http://www.psychiatry-billing.com/ ) and Billing Dynamix ( http://www.pt-billing.com/ ), and is home for "Medical Billing Networks and Processes" book by Yuval Lirov, PhD and inventor of patents in artificial intelligence and computer security.

Sunday, February 13, 2011

Medical Negligence FAQs

What is medical negligence?


Medical negligence occurs when a medical provider fails to exercise the kind of care and prudence that other providers in the same field of medicine provide. Medical negligence can occur in the form of recklessness, inattentiveness, or an omission. Common types of malpractice include misdiagnosis, failure to provide proper treatment of a patient's ailment, administration of the wrong medication, and the failure to inform the patient of the risks associated with a treatment or with information about alternative treatments. Tort law governs medical negligence. To establish that a provider's negligence was malpractice, a claimant must establish the following:


1. The healthcare provider owed a duty to the plaintiff;
2. The healthcare provider breached the duty;
3. The healthcare provider's breach caused the injury; and
4. The patient suffered damages because of the defendant's negligence.


Sometimes it is apparent that a medical provider's actions were the cause of a patient's injury. When this happens, a claimant can use the doctrine of res ipsa loquitur to establish negligence. Res ipsa loquitur means "the thing that speaks for itself." When the injury itself presents a reasonable basis for the inference that the medical provider breached the duty of care, a claimant may use this doctrine to establish fault. The claimant must prove the following to establish medical negligence using res ipsa loquitur:


1. The type of injury would not usually occur in the absence of negligence;
2. The instrumentality that caused the injury was in the sole control of the defendant; and
3. The plaintiff's conduct did not produce or contribute to the injury.


What is the "standard of care" for medical providers?


The "standard of care" for a medical provider is based on the kind of care and knowledge that a healthcare provider in the same field would exercise. Every person owes a duty to act as a reasonable and prudent person would, but a higher duty exists for healthcare providers. Medical providers have a special skill, and consequently, the law requires that they possess the same kind of knowledge and skill that a person in the same profession would exercise.


A court will likely find that a provider failed to meet the standard of care when he or she was unable to exercise the same kind of care as others in the same profession. A general practitioner is expected to act as a general practitioner would in the same geographic area and a specialist must possess the skills that a member of the specialty normally would have. A court will use medical experts in a particular field or experts with expertise with a procedure to establish the standard of care in medical negligence cases.


Who is liable for medical negligence?


Any type of medical provider, such as a doctor, nurse, or technician, can be liable for medical negligence. In addition to a medical provider, a hospital is sometimes liable under the doctrine of vicarious liability. Most of the time, another person is not legally responsible for the actions of others. However, sometimes an employer is liable for an employee's actions when the employee's actions occur during the course of employment. This means that even if the employer did not directly cause the injury, liability may attach when the employee was performing a job function. Consequently, a hospital may be liable for the actions of the medical providers it employs. In some circumstances, a court will hold a hospital liable for the actions of a healthcare provider it does not employ if the hospital led the patient to believe that the hospital employed the provider. This may occur in a situation where the medical provider was a contractor.


What is informed consent?


A healthcare provider must provide a patient with information about risks, benefits, and alternatives to a medical procedure or a type of medical treatment. This is called "informed consent." Informed consent is unnecessary in the following situations: in an emergency when the patient is unconscious or when a family member is unavailable to give consent. In these situations, a medical provider may perform a procedure without receiving consent from the patient or family members. The failure to give informed consent in other situations may amount to medical malpractice.


What kind of compensation is available for medical negligence?


Every state has regulations that determine the type of compensation a claimant may recover. Most states will allow a plaintiff to receive damages for past, present, and future medical treatment, lost wages, and pain and suffering. A court will determine noneconomic damages, such as pain and suffering, by evaluating the impact of the injury on the claimant's life. The embarrassment caused by the injury, the permanency of the injury, and the emotional distress are factors that determine the damage award.


Can a third party recover compensation for medical negligence under the doctrine of "subrogation"?


An insurance company or another party that pays for an injured person's medical treatment can recover compensation from the party responsible for the medical negligence. In effect, the third party inherits the rights of the injured claimant. Consequently, the third party can sue the healthcare provider and recover damages for the claimant's injuries.


What is the statute of limitations for medical negligence?


A statute of limitations governs how long a claimant has to file a legal claim for injuries caused by a defendant. As with all legal claims, every state has a statute of limitations for medical negligence. In general, a claimant has one to seven years to bring a lawsuit. The statute of limitations will typically begin to run when the injury occurred or when the claimant learned of the medical malpractice.