Medical Billing Myths Debunked
The idea behind this blog is to clear up any confusion or misleading information surrounding what we do.
For any medical practice to succeed, or even exist, there needs to be a reliable and predictable flow of incoming revenue. Hiring employees, purchasing equipment, or thoughts of expansion are impossible because you can’t rely on a predictable flow of incoming cash. Without a steady flow of incoming revenue, there is no way to properly plan for the future.
So, what is one of the best ways to secure a reliable and predictable flow of incoming revenue?
Through proper and accurate medical billing and coding. Making sure that your medical practice properly codes and bills your patients should be one of your most important priorities.
Even with that knowledge, we still see many myths exist surrounding medical billing and coding. Let’s examine, and debunk, some of the most common myths out there:
Billing and Coding are the same - Although medical billing and medical coding are part of the same process and can be done by the same medical professional, they are distinct and independent tasks that require different skill sets.
Coders need to understand the codes that correspond to various procedures, diagnoses, and prescriptions. The coders then hand the codes to the medical billers so the patients and insurance companies can be billed accordingly.
Medical Billing and Coding is just data entry - While there is a fair amount of data entry that goes into medical billing and coding, thinking of it as “just data entry” would underestimate the value and importance of the job.
Medical coders and billers must have a good understanding of ICD-10, work with doctors and nurses to ensure the proper codes are used, and be able to recognize incorrect codes. In turn, billers must provide a check on coders.
This is all part of a checks and balance that will help ensure that your practice gets paid on time for the services you provide.
Errors - When billing and coding is done in-house, errors are to be expected. However, errors delay payment, and too many errors will negatively impact your revenue cycle.
This is why every measure should be taken to ensure that these errors are kept to a minimum.
Too expensive to outsource - This is a common misconception. If you consider the opportunity cost of assigning someone in-house to handle medical billing AND factor in the cost of payment delays caused by errors, outsourcing your medical and billing will most likely save you money in the long run.
If I outsource, I lose control - It may seem counterintuitive, but outsourcing your medical billing and coding may give you MORE control. Most medical billing and coding companies, like Mednet, focus solely on medical billing and coding.
This means that their goal is to ensure that you get paid on time for the services you provide. The key is finding a company that you can trust and that will be aligned with the goals of your practice.
Proper medical billing and coding is essential to the current and ongoing success of your practice, and understanding their impact is the first step towards securing your future. If you need help with your medical billing and coding procedures, please contact Mednet today.
Six of The Most Common Billing Errors and How to Avoid Them
Part of what will determine the success of your medical practice is the ability to generate a reliable and predictable cash flow. To do this, you need to have confidence in your medical billing and coding procedures.
Incorrect billing and coding lead to a higher rate of denied claims, loss of time and productivity, and a loss in revenue. It can even lead to legal troubles if the problems get serious enough.
To help you prevent issues with billing and coding, let’s examine some of the most common errors and what you can do to avoid them:
Incorrect Procedure Codes
The most common and straightforward issue is using incorrect procedure codes. Whether caused by incomplete or incorrect documentation or an unfamiliarity with the coding system, the result will likely be a rejected or disputed claim. This will end in a delayed payment or other problems.
Solution: To correct this issue, institute a process of documentation review to eliminate as many errors as possible. Stay up to date with changes or updates to the medical coding system. Relay those changes to whoever needs to understand those changes.
Missing or Incorrect Information
Another common issue is missing or incorrect information. This can be a result of changes in address or phone number or the incorrect entry of information such as name, date of birth, or insurance details.
Solution: Develop procedures that require multiple checks or reviews conducted by different people. Also, ask patients to review their information to ensure that their basic details have been recorded properly. It may also be necessary to do periodic checks to ensure a patient has changed their phone number or moved to a different address.
Upcoding and undercoding errors are a subset of incorrect procedure codes, but are worth examining because of their specific nature.
Unlike upcoding errors, which occur when a patient is billed for a more complicated procedure or for a procedure they never received, undercoding errors happen when your patient is not billed enough. Both types of errors can have a serious impact on your practice, including negative impacts to your cash flow as well as suspicions of fraud (even if errors are honest mistakes).
Either type of error is sloppy and does not reflect well on your practice.
Solution: To prevent these types of errors, ensure that you have a communication plan that allows for people to ask questions when needed and to communicate important changes to the medical coding system. Also, do periodic reviews and spot checks so you can ensure the proper codes are being used.
Due to the pandemic and the rise of telemedicine, this type of coding error has gained more attention. Telemedicine was a forced change in a truncated, high-stress period of time. It is also a fairly new technology, especially for older patients. Given everything that has occured over the past year, mistakes should be expected.
Solution: As we have written before, telemedicine is here to stay. To ease the transition, update your internal procedures to account for the changes in workflow for telemedicine. Additionally, make sure communication channels are open so that everyone on your team is on the same page.
Another common issue that appears to have a simple fix is duplicate billing. This occurs when a patient gets billed multiple times for the same procedure. Most often this occurs when you have multiple people handle the billing or when someone fails to note that a patient has already been billed.
Solution: The solution for this is fairly straightforward—assign one person to do billing. If your practice is busy enough that you need more than one billing person, institute a policy of checking when a patient was billed or a claim submitted.
Issues with insurance are another common problem when it comes to coding and billing. A patient’s insurance may have lapsed or they changed insurance policies or providers. Additionally, their insurance information could have been entered into your system improperly, whether due to internal error or incorrect information given by the patient. In any case, issues with insurance will almost always delay payment in one way or another.
Solution: The best way to avoid these types of problems is to verify your patients’ insurance at every visit.
The medical coding system is complex and forever evolving, so it is understandable that errors will happen from time to time. However, by identifying which errors are most likely to occur and creating safeguards against them, you can minimize the occurrence and impact.
Another solution that we did not mention yet is to outsource your medical billing and coding. Your practice specializes in taking care of your patients. A business that focuses on medical billing and coding, like Mednet, specializes in ensuring clients get paid for the services they perform. If you are interested in learning more about how Mednet can take the stress out of billing and coding and help you increase your revenue, please contact us today.
The Cost of Billing and Coding Mistakes
Think you know what potential billing and coding mistakes are costing your practice? You might be surprised at the TRUE cost. Check out this infographic for more details.
Six Steps To Make 2021 Great For Your Practice
Welcome to 2021!
After the challenging year that was 2020, it is comforting to look at this new year as a fresh opportunity to strive for new goals and take your practice to new heights.
With two vaccines in use, there is light at the end of this pandemic tunnel. Now is the time to position yourself, your staff, and your practice to come out of the pandemic stronger than ever.
Let’s take a look at the six steps you can take to make 2021 the year for your practice:
Update Procedures - We are all familiar with the phrase “Necessity is the mother of invention.” The pandemic forced most businesses to change how they operated to accommodate social distancing guidelines. Suddenly, there were many new policies and procedures, most of them created on the fly. Chances are that some new procedures were actual upgrades to old ones.
As we begin the new year, it is an ideal time to review all your procedures to determine which new procedures were an improvement and make those changes permanent. Additionally, take a look at which procedures are not producing the desired results and make the necessary adjustments. The goal here is to ensure your practice is operating at optimum efficiency.
Review Your Billing and Coding - This is a big one, and something that we at Mednet are very familiar with. You want to make sure that your practice gets paid for the services you provide and that you get paid on time. To do this, you have to review your practices around coding and billing.
Here are some questions to ask:
- Who is in charge of quality control?
- What happens when a claim is sent back?
- What happens when a patient does not pay?
Asking and answering these questions will help you decide whether or not you have the proper procedures in place to collect the money your practice is owed.
Keep Telemedicine a Part of Your Practice - For many practices, telemedicine was a new service that required them to develop new policies and procedures quickly. Regardless, if you were an early adopter or did so out of necessity, telemedicine is here to stay.
Patients who have experienced the ease of visiting their doctor from the comfort of their home will now expect the experience moving forward. As we move past this pandemic, you should plan on telemedicine being a core part of your business model.
Focus on Your Patient - Properly managing the customer experience is essential for any successful business. As a medical practice, your customers are your patients. You need happy patients who trust that you have their best interests in mind when they visit your office.
Earn and keep your patients’ trust by focusing on their needs and making each visit as pleasant as possible. Make sure they understand your payment policies and that your staff is following all COVID-19 safety guidelines recommended by the CDC.
Consider Outsourcing- Although we highlighted the importance of proper billing and coding above, that does not mean it is easy to achieve. A lot goes into operating your business, and it is easy for things to fall through the cracks.
If you find this happening consistently, it might be time to consider outsourcing your coding and billing (potentially to a company with over three decades of experience and a 98% collection success rate).
Stay Safe - Although we are close to the end of the pandemic, the risk has not abated. The best thing you can do right now for your practice is to make sure you operate as safely as possible. Follow all guidelines recommended by the CDC and your local government.
The start of a new year represents a fresh start. The steps detailed above will help you position your practice for success. As we alluded to earlier, if you need any help with billing and coding, then all you have to do is reach out and let us know.
Five Ways You Can Get Paid Faster
Properly managing incoming revenue is a task that every business must master if they wish for long-term success. The importance of this is heightened during a pandemic where so many people and businesses are struggling with their finances.
For medical practices, managing incoming revenue becomes complicated because, in most cases, you aren’t collecting a lot of the money from the patients themselves; you’re collecting much of it from the insurance companies. And collecting that money requires an enormous amount of documentation and approval to get paid.
It is absolutely essential that you have a firm grip on your internal procedures if you want the incoming revenue to come in at a steady and predictable rate.
In this blog, we’ll examine how you can ensure your practice gets paid faster for the services you provide.
Make Communication a Priority - The first thing that you can do to ensure you get paid faster is to make sure everyone, both inside and outside your practice, is on the same page.
For your staff:
- Ensure everyone involved in the billing process understands their role and how to carry out their responsibilities.
- Detail your procedure and if needed, do multiple training sessions.
- Remove as much ambiguity from the process as possible, so your staff knows what to do.
For your patients: help them understand their responsibilities. Detail what your policies are and have them acknowledge their awareness by signing before each appointment. If possible, secure prior authorization for whatever procedures you know will need to go to insurance. Similar to your staff, your goal should be to remove as much ambiguity as you can.
Collect at Time of Appointment - The fastest way to secure payment is to collect at their appointment time. When you patients check in, make sure to check for any necessary co-payments and collect them then and there. This is where detailing your payment policies can truly help you get paid faster.
If there are any balances remaining after the appointment, make sure you have a procedure in place to collect what is due. Again, this is where proper communication is vital for getting paid for the services you provide.
Make it Easy for Patients to Pay - In today’s world of commerce, people have several different ways to pay for the goods and services they purchase. Make it easy for your patients to pay by giving them options, including check, cash, credit card, or a newer payment method like Apple Pay. The more options your patients have to pay, the easier it will be for them to do so. This will result in more patients paying at the time service is provided.
Review Your Billing and Coding Procedures - Having a clear set of procedures and policies surrounding your billing is essential to getting paid faster. As we detailed above, your staff and patients must know what is expected of them when it comes to billing.
If your employees or patients are unsure of any part of the process or about which policies apply to them, this won’t happen. Take some time to review your procedures, so you and your staff are in lockstep. Update your policies and make them visible to detail what is expected from your patients.
Make sure to periodically review these key documents to remain up to date on changes to the industry and make potential improvements when needed.
Consider Outsourcing Your Billing - If you do the above steps and still find yourself struggling to get paid on time, then you may want to consider outsourcing your billing.
A billing company’s primary focus should be ensuring that you get paid faster. Hiring an outside billing company will end up saving you money in the long run by saving you time and hassle and allowing you to focus on other areas of your practice.
A steady stream of incoming revenue provides a reliable cash flow source thatfive will allow your practice to flourish and grow. The above steps will help you get paid faster for the services you provide and give you the security you need to ensure your practice thrives.
Four Reasons Why You Should Hire Outside Help For Your Billing and Coding
As the owner or manager of a medical practice, you know how much work it takes to operate a successful practice. You are always busy and wear multiple hats. There are days where you feel you worked yourself to the bone, yet your to-do list only seemed to grow.
We at Mednet understand this feeling. Outside of being in business for ourselves for over thirty years, we have worked with many medical practices, of all sizes, helping them grow and be more successful. We understand how much work goes into operating a successful practice.
What if we told you that there was a way you can take a major task off the list of things that you have to worry about? And that this task was vital to the very success of your business? How would you feel if taking this task off your plate would allow you to focus much more time and energy on other aspects of your practice?
That task is the billing and coding for the services you provide for your patients, and those statements can all be true for you.
There are organizations, like Mednet, who specialize in medical billing and coding who could take this vital task off your plate.
Let’s examine four reasons why you should consider hiring outside help for your medical billing and coding.
- Trained individuals who are experts - When you hire outside help for your medical billing and coding, you are really paying for individuals who are trained and have many years of experience. In Mednet’s case, our team has decades of experience. There is nothing that we have not seen or had to deal with.
- Access to a team that is dependable, consistent, accurate - Because you are hiring experts who have years, even decades, of experience, you get results that are dependable, consistent, and accurate. Instead of hoping that your billing and coding is running smoothly, you know that it is. 97% of medical insurance claims submitted by Mednet pay on first pass. Imagine what you could accomplish if you didn’t have to worry about getting paid on time.
- Predictable cash flows - By hiring outside help, you are hiring a team of people whose sole job is to ensure you get paid on time. As stated above, Mednet has a 97% success rate on getting paid the first time. The result is cash flow that you can depend on. Predictable cash flow gives your practice security and allows you to plan for a better future.
- Superior results - In the end, you get superior results by hiring outside help to manage your billing and coding. You get a team of people who are trained and have decades of experience. You get results that are dependable and consistent, which leads to predictable cash flows. Additionally, because you are not paying someone internally to do the medical billing and coding AND the results are better, you end up saving money in the long run.
You have a lot on your plate when it comes to managing your practice. When possible, you should try to make your job easier. Hiring outside help for your billing and coding takes a major task, which has a direct impact on the success of your practice, off your plate and into the hands of trained professionals whose only job is to make sure it is done correctly. Make your job easier and get the peace of mind knowing that it is being done properly so you can focus on other aspects of your practice.
Managing Your RCM During COVID-1
We are not going on a limb by saying that the COVID-19 has had a HUGE impact on the medical industry. Many independent practices have been forced to close due to quarantines across the nation. Others have had to change how they operate in order to stay in business.
Before the pandemic one of your primary concerns was your revenue cycle management, or RCM. Now, during a pandemic that has altered the global economy, properly managing your RCM takes on added importance. Doing so will ensure that you have a steady stream of revenue coming in so you can pay your staff and your bills.
Let’s examine some ways that you can manage your RCM during the pandemic.
Stay On Top of Reimbursement
Even before the pandemic, ensuring that your practice was receiving reimbursement for services rendered should have been a key component of your RCM strategy. During the pandemic, when many businesses and individuals are struggling financially and other ways, making sure you get paid takes on extra importance.
Here are some tips that will help you get paid:
- Make sure you are using the correct billing codes
- Make sure your patients know what they will be responsible for
- Make sure you have a procedure in place to follow up with past-due billing
Ensuring that your practice gets paid for the care you provide is the number one way to manage your RCM.
If Possible, Allow Staff to Work from Home
The idea of remote work seemed foreign to much of our population prior to the pandemic. These days, however, you would be hard pressed to complete a conversation without the word “Zoom” being said at least once or twice.
If you have people on your staff who are responsible for billing and coding that do NOT have to be in the office to do their work, consider letting them work from home. Fewer people in your office means there is less risk of someone becoming sick. This will help both your staff and patients feel safer.
Work On Communication
Keeping everyone on the same page is a challenge, regardless if everyone is working in the office or from home. Proper communication amongst your team will help you stay on top of your reimbursements and allow your team members to work efficiently even while working remote.
This could include weekly meetings, an email check in where everyone shares what they are working on, or some other solution that works for your practice. The idea is to make communication and teamwork a central part of your operations during this pandemic and beyond.
Use Data to Make Smarter Decisions
The phrase “uncertain times” has been overused and become cliché at this point. That said, we are living through a period of time with a lot of uncertainty. This can make it hard for a business owner or manager to make decisions that could impact the future of their business.
If you find yourself struggling to make decisions for your practice, take time to look at your data to get a deeper understanding of what is happening in your business. Understand what types of patients you are seeing, how often are billing issues coming up, and how these numbers compare to previous years.
Being able to look critically at the numbers relating to your business will help you make smarter decisions because you have a deeper understanding of what is really happening.
This is an easy one. It does not matter what else you do to manage your RCM if you are putting yourself, your team, or your patients at risk. If in doubt, err on the side of caution.
After ensuring the safety of your team and patients, your next priority should be protecting the revenue you need to keep your practice running. The above steps will help your staff stay focused and motivated during a time when it is too easy for them to become frayed.
How To Prepare Your Practice For The Flu Season During COVID-19
Flu season is almost here. Under “normal” circumstances flu season can be a hectic time for medical offices everywhere.
But what about in the middle of a global pandemic?
Patients looking to you and your staff for guidance on how to make it through what will be a difficult fall and winter will heighten stress and anxiety.
However, it doesn’t mean it has to be a chaotic period of time for you and your team.
Let’s look at how you can set yourself, your staff, and your practice up for success this flu season.
Prepare Your Staff and Your Practice
The first thing you need to do is make sure your practice is prepared by ensuring you have the adequate amount of supplies and equipment needed to get through a normal flu season. Determine if you need to increase any of your stock and make plans to start increasing your supplies now. Consider assigning someone you trust to pay special attention to your supplies so you can be prepared if you start running low.
Communicate With Your Team
Speak with your staff about what is coming and make sure everybody knows what is expected of them. Go over any special, new, or temporary rules and regulations that might apply to your practice, city, or state.
Encourage Flu Vaccinations
As you speak to your patients, encourage them to get a flu vaccine. If your practice offers a vaccine shot, make sure your patients know when they can get one. If your practice does not offer vaccinations, recommend a place (or places) they can go.
When possible, use telehealth for any appointment. Try to limit the number of times your patients have to go into your office. If someone does not have to visit your office in person, do not force them to.
Maintain "Pandemic Protocol”
During busy and stressful times, it can be easy to forget things like mask wearing, washing hands, and social distancing. However, all these details help prevent the spread of COVID-19 and the flu. Make sure your staff maintains “pandemic protocol” so that you operate your practice as safely as possible (and ensure your patients that it is as safe as possible to attend appointments).
Create Guidelines for Your Patients
Ensure that your patients know what is expected of them when they visit your office during flu season. Mask wearing, washing hands, social distancing, and temperature checks are steps that every patient should expect when visiting your office. Make sure they know this and any other safety measures you wish to enforce. Also, reinforce the point that these precautions are in place to keep everyone as safe as possible.
Burnout is a real concern during times of high stress. Make sure you get the proper amount of sleep, eat well, and get some exercise, and encourage your staff to do the same. Try to make time for fun like reading a book, watching a movie, or spending time with loved ones. These actions will help you prevent burnout and potentially becoming a patient yourself.
This has been a LONG year for everyone, but especially for those working in the medical industry. The upcoming flu season seems like the last mile in a marathon or the final exam after an especially tough class. However, with proper preparation, communication, and self-care, you and your practice can make it through this difficult time.
Protecting Your Revenue
With COVID-19 virus still very much a dangerous presence still disrupting our lives and communities, it should not be surprising to hear that the pandemic has caused financial woes for many private practices. Some may even shut down permanently.
It should go without saying that your safety and the safety of your staff and patients should come first. That said, if you have already opened or are in the process of reopening, you must keep an eye on protecting your stream of revenue.
Otherwise your practice may not survive for long.
Let’s take a look at three ways you can protect your revenue stream so you can survive through this difficult time and set your practice up for a profitable future:
Make Telehealth a Permanent Offering - If you were not offering telehealth services prior to the pandemic, you mostly likely are now. As we wrote a few months ago, telehealth is here to stay.
This can be a very profitable stream of revenue because many of your patients have become accustomed to being able to “visit” their physician from the comfort of their living room.
Many industry experts believe that some of the restrictions that originally made integrating telehealth into practices more difficult will come back for security reasons. But the cat is out of the bag. For your practice to succeed moving forward, you WILL have to offer a menu of telehealth options to survive.
Keep an Eye on the Patient Experience - Conducting medical visits virtually helps your patients get care they need while keeping them, you, and your staff safer. However, there is a level of personal connection that cannot be created virtually.
To make up for that lost personal touch, do what you can to make the experience as positive and as personal as possible. Keep the process simple and convenient, and try to make the virtual appointment feel familiar. If possible, send a follow-up survey, and if any complaints get back to you, make contact to see what you can do to make the next virtual appointment better.
By making the virtual experience a positive one, you will increase the chances of your patient remaining loyal and potentially referring others to you.
Focus on the Basics - By basics we mean proper coding, filing claims in a timely manner, and working accounts receivable consistently and aggressively. These are basic accounting tasks that have always been important but take on extra significance now.
With all of the uncertainty in the industry, economy, and the country, the bottom line is you can ill-afford to do work that you cannot get paid for. You must keep a close eye on your billing and coding, ensuring your claims are filed properly, and that someone is working accounts receivable.
Fortunately, Mednet offers end-to-end medical and billing solutions. Get a free estimate.
- Bonus: Keep It Safe - As we mentioned above, your safety and that of your staff comes first. Protect your revenue by protecting yourself and your employees.
It may seem crass to focus on revenue during a time like this. However, as a business owner, you have the right to maintain that business and ensure it is in a position where it is most likely to succeed. Otherwise, why risk reopening? Focusing on the areas listed above will go a long way in ensuring that your practice will make it through this pandemic.
Staying Healthy During COVID-19
Working in healthcare you are used to long hours and stressful situations. During a pandemic, the long hours and stress can lead to you becoming a patient yourself. Below is a helpful infographic we put together to help you manage your mental and physical health during these trying times.
A Brave New World: 6 Steps to Prepare Your Practice for a New Reality
You know the reality: COVID-19 is here to stay for now. The goal facing us all now is how to move forward, and your practice is no different. Even with the risk of the virus, the world, and your practice, must be prepared to face a new reality.
How can you do this successfully?
You need to develop a strategy that prepares yourself and your practice for the challenges to come.
Let’s examine the six steps to get this done:
Focus on Patient Safety - Your patients are the lifeblood of your practice. Your number one priority is to ensure they stay, and feel, safe when visiting your office. Following federal guidelines on preparing your practice is one of the best ways to achieve safety.
You also must communicate your safety practices with your patients. Post signs, spread the message across your marketing channels, and make sure your employees know everything you are doing to keep your patients healthy so they understand, follow through, and can answer questions.
Keep Your Staff Healthy - Speaking of your employees, you must make sure they feel safe and secure working in your office as well. Not only do you need to keep them safe for their good, but if the front desk receptionist or the tech taking vitals show signs of nervousness, your patients may feel uneasy about coming back to your practice. Worse, they can spread the message that your practice is not where people should go.
Put your staff at ease by letting them know the practices and policies you are implementing to keep everyone safe. Create an environment of communication where everyone feels comfortable expressing concerns to you or other members of your management team. Allow your staff to share potentially helpful tips or information.
Telehealth is Here to Stay - You hate to declare someone or something a “winner” during a pandemic that has (at the date of publication) claimed over 100,000 American lives. That said, with regard to the medical industry, telehealth has come out ahead during the COVID-19 crisis. In 2019, only 11% of Americans used telehealth. During the pandemic, that number has jumped to 46%. An easing of regulations allowed providers to use telemedicine areas not previously available.
While it is likely that we will see at least a small retightening of restrictions as the country opens up, they will NOT go back to pre-COVID-19 levels. The genie is out of the bottle, and preparing your practice to handle more telehealth visits is vital. You have to think, on an operations level, how to handle an increase in these types of visits.
Coding and Billing - We broke this down into two parts: general coding and billing and COVID-19 coding and billing. Let’s look at them individually:
- General - Your coding and billing procedures have always been important. Now, as your office tries to get back on its feet, how and when you get paid for services rendered becomes even more important. You cannot wait for weeks or even months to get paid, and you probably will not have the time it takes to resubmit claims. Take some time to review how often claims were denied before the pandemic so you can root out the cause. Look into your prior authorizations. Work with your coding and billing team to try to make this process as streamlined as possible.
- COVID-19 - If you are providing any services related to COVID-19, you must understand how to submit claims correctly. CMS has released guidelines for this. We suggest that you search for and study these guidelines so your knowledge and practices are up-to-date.
Rethink the Patient Experience - We touched on an aspect of the patient experience with safety. But as important as safety is, it does not encompass the entirety of the issue. Create the best possible experience for your patients by rethinking the experience you want your patients to have.
Your patients may be more nervous than usual, or even scared. Part of your job as a healthcare provider is to ease those concerns as much as you can. For your practice, this could look like funneling people towards telehealth so they do not have to visit your office in person. For those who need an in-office visit, make sure your staff understands their expectations in terms of the healthcare they are receiving.
Remain Flexible - This pandemic is an evolving situation, which means things like regulations, patient expectations, people’s attitudes, etc. are likely to change. Remain flexible so your practice is able to respond quickly to changes on the ground. Set the tone with your staff by keeping a positive attitude and asking them to help you keep on-top of the current and future needs and demands of the field.
The COVID-19 pandemic has ushered in a brave new world. For your practice to succeed in this current reality, you must prepare yourself by thinking strategically.
How Telemedicine Will Impact Your Practice
The medical industry is in a perpetual state of evolution. Why? It’s an industry that must continuously evolve to answer the demands and challenges that come with new technologies.
In the 90s, the advent of the Internet introduced a way for providers and patients to be able to communicate more efficiently, especially across long distances. However, with that came concerns about security, patients’ privacy, and misinformation surrounding medicine and medical conditions. The industry has had to develop systems and policies to address these concerns.
The same is happening now with a new technology that similarly could impact healthcare in a similar way as the internet: telemedicine.
Telemedicine is “the remote delivery of healthcare services.” Although telemedicine has technically been around since the late 1950s, the Internet, combined with video streaming platforms like Skype and Facetime, allows doctors and patients to “meet” virtually across pretty much any distance.
Telemedicine is making healthcare more accessible and cost-effective, and it’s increasing patient engagement. However, just like the advent of the Internet, telemedicine is introducing some new challenges and concerns for healthcare providers.
Let’s examine a few:
- Know The Rules and Regulations - Before you decide to take on telemedicine as part of your practice’s offerings, make sure you understand state and federal rules and regulations. You must also keep in mind that, as with most new technologies, regulation is usually a few steps behind. This means if you do take on telemedicine services, you must be diligent and stay current on any changes that could impact what you are doing.
- No Standard Set of Rules - Another regulation-related concern associated with new technologies is it takes time for a standard set of laws to be written and adopted. This is particularly evident on the state level. What is right for your state may not be correct for a potential patient in another state. Make sure you understand not only your state’s laws that apply to your practice but to the laws that apply to your patients’ states as well.
- Be Mindful of HIPAA - HIPAA regulations still apply to telemedicine patients. Review your current internal processes relating to HIPAA to ensure you are following everything you should, and then apply those processes to your telemedicine efforts.
- Data Management and Security - Conducting medical appointments online will open you up to hackers and other people intent on accessing your patient’s data and your data. Before taking on any telemedicine patients, review your security measures, and make sure your data is stored correctly and securely.
- Internal Processes - Taking on telemedicine will be a significant change for many practices. Prepare your practice by speaking with your office manager, any physicians who intend to take telemedicine patients, and any key personnel to ensure everyone understands the policies and procedures you need to follow. Draft a set of guidelines and distribute them amongst your staff so everyone is on the same page.
- Must-Have Insurance Contracts - Before you take on any telemedicine patients, make sure you speak with the insurance companies to get the contracts you need to have the telemedicine visits covered.
- Codes Will Change - A virtual visit is not the same as an in-person visit. We understand that you know this, but this means that the coding for telemedicine patients will be different. Make sure whoever does your billing and coding understands this and is aware of the codes they need to use.
Telemedicine presents an excellent opportunity for healthcare providers to help more patients and grow their practices. However, if you are not careful, you can end up causing some major short- and long-term problems for your practice AND patients. Before you get started, make sure you have all your bases covered and prepare your practice to take on this new challenge.
As always, if you need help with the coding, billing, or contract part of the process, please let us know!
Three Signs You Need Coding Help
One of the most critical components of operating a successful medical practice is correct medical coding. Improper coding can result in the loss of revenue and have legal and financial consequences for a medical practice.
Mednet focuses on assuring that our clients bill for and get paid for every dollar they are entitled. We stay focused on the financial aspects of proper coding so you can focus on your patients.
But how do you know when your practice needs help coding? Here are three signs:
Reimbursements are Less than They Should Be
As a doctor, you know how many patients you see each day and the services you provide. While you may not be able to guess the exact amount of revenue you’re bringing in, you have a general idea.
Common coding errors, like missing information or incorrect procedure codes, may result in a lack of payment to your practice. You may also be failing to recognize a billing opportunity, which can also affect the revenue you earn.
Have ever reviewed your monthly or quarterly numbers and thought, “Wow, I thought the revenue for this last period would be higher?” You may want to trust your gut and review your coding procedures to ensure that you are collecting the correct amount on every service you provide.
Payments Are Delayed, Reduced, or Do Not Occur
This next sign is often the main culprit of loss of revenue. When you submit claims with incorrect coding, payment for those services is most likely going to be delayed or reduced, if they happen at all.
Insurance companies wil not pay for services that are not covered in their contract. And it is always difficult to collect from patients who thought their insurance covered a service provided by your practice.
This is why proper coding is so necessary to your revenue cycle. You want to correctly document services rendered for the patient so that insurance companies reimburse you in full for everything that you do.
Productivity of Entire Practice is Lessened
This last sign may very well be the most insidious because it is the hardest one to recognize. If insurance companies are denying claims because of improper coding, then you will have to have someone on your staff rework that claim. But there is an opportunity cost to this. For every claim you have to revise, there is a task that may be delayed or not done at all.
A lot goes into operating a successful practice. If you spend too much time redoing work that should have been done the first time correctly, you are losing out on ways to improve how your practice operates.
These are no easy metric to recognize or quantify, so it may be weeks or even months before you understand why your practice is not operating as smoothly as it should. This is another “trust your gut” situation. If there are projects or tasks not being completed, or if you recognize one or both of the first two signs, then chances the overall productivity and revenue of your practice is suffering.
Incoming revenue is the lifeblood of your practice. You need it to pay your staff, for the office, for supplies, and everything else that goes into operating your practice. To keep the revenue flowing at the maximum level, you need to ensure your coding is correct.
If you see any of the signs listed above, then you must investigate, or you can risk the long-term success of your practice.
How to Find Success in 2020
A new year, and a new decade, is upon us. This time of year presents an excellent opportunity for reflection and looking back at our successes so we can take a moment to appreciate them. It’s also a time to take a look at our shortcomings, so we can learn and grow from them.
And we can use these lessons from the past and apply them to the new year to see how we find success. We want to assist you in this by looking at which billing and operational trends you can look forward to so you can plan for a more successful 2020.
Medical Billing and Coding Trends
If the physicians and the staff are the engines that keep your practice going, then it is safe to say that the billing and coding is the fuel. After all, if you don’t get paid for your services, your practice won’t be around for too long. The following trends utilize technology with one goal in mind: make the process of getting paid more accessible and more efficient.
- Cloud-Based Medical Billing Software - The “cloud” has become a popular mechanism for many industries. For medicine, it remains a bit controversial due to concerns with security. It is safe to assume that companies are taking significant measures to make the cloud a more secure option for medical billing. As this happens, you can count on the cloud becoming a more attractive option for practices needing to access their patient info on the go.
- Electronic Claims Processing - This is not a new trend as the software for processing claims electronically has been around for quite some time. However, in the coming year and beyond, the software developers will improve the capability of their programs. This will open the door for automated billing options that are more useful and easier to operate.
- Computer-Assisted Coding - Designed to make the coding process more efficient, Computer-assisted coding, or CAC, helps determine which codes might be needed and highlight any errors. As with any new technological development, when first introduced, there was skepticism around CAC. Like other technological developments, it is more widely used now that the technology has improved (and will continue to do so).
The big takeaway for billing trends is to keep an eye out for how technology is impacting the process of submitting claims and getting paid. Chances are there is something in development that can help address a problem you are experiencing. As always, you can contact us with any questions you may have.
Many things can impact how well your practice runs on a day-to-day basis. Let’s look at a couple of trends that might help your practice run a little smoother:
- Outsourcing RCM Services - In 2019, a record number of practices outsourced their revenue cycle management (RCM) services. The trends mentioned above take time and effort to learn and monitor. And if you choose to implement a change, that is time, money, and effort that you have to invest in making the change. It may be more cost-effective to outsource your RCM services so you can focus on taking care of your patients and managing your staff.
- EHR Integration/Interoperability - The global digital health market is forecasted to surpass $379 billion by 2024. Integrating electronic health records (EHRs) with other technologies practices daily has helped propel this trend forward. One of the most significant inefficiencies many practices face is having an EHR that is not integrated or does not operate with another essential program or service they use. In 2020 and beyond, addressing this inefficiency will be a priority.
As with billing, keeping an eye out for what may help you manage your practice more effectively and efficiently will be essential. Start with writing down where you believe the most significant problems or inefficiencies rest and research how you can address them. If you need any help, you know who to call.
Bonus: Patient Experience
We would be remiss if we did not take a moment to highlight what may be the essential part of your practice: your patients. They are truly what keeps your practice going, and like any other business, you have to keep your customers happy. So whether it is setting up virtual visits or making a bill easier to pay, make sure to take the time to make your office experience as pleasant as it can be.
How to Prevent Claims from Being Denied
Last month, we shared the five ways Mednet makes you more money. Although the list was in no particular order, the first item was submitting accurate claims. As this infographic illustrates, the average cost to file a claim is $6.50. The infographic also details that the cost to resubmit a claim ranges anywhere from $25-$118. The total cost to submit, correct, and resubmit a claim can range anywhere from $31.50 to $124.50 — costing your practice thousands of dollars per year.
Here are some other troubling numbers from a report on beckershospitalreview.com:
- According to recent estimates, gross charges denied by payers has grown to an alarming 15 to 20% of all claims submitted
- As many as 65% of claims denials are never worked, resulting in an estimated 3 percent loss of net revenue
- Roughly 67% of all denials are appealable
We are not sure about you, but losing 3% net revenue does NOT sound like the best way to run a business.
Mednet gets paid on over 98% of all the claims we submit, so we firmly believe we are experts in preventing claim denials. Here are some of our top tips to help you prevent your claims from being denied:
Do Your Homework: Part I
The only real constant in the medical industry is the change. Your staff must be on top of any and all changes in rules and regulations. By fostering an environment of constant learning and improvement, everyone on your team will understand the importance of staying up-to-date, eliminating denials due to failure to keep current.
Do Your Homework: Part II
Look internally and investigate the cause of past denials. Understand where mistakes may have occurred and how you can avoid them in the future. If necessary, implement corrective actions to curb future denials.
Work As A Team
Denied claims affect the entire practice. Everyone on your staff should understand this. Even if they do not work directly with billing, each staff member should do their part to ensure the billing process is a smooth one. Help your team communicate what is needed, and, when a mistake happens, do not rush to place blame. Take time to search out the cause and help them understand how to prevent it from happening in the future.
Make Sure Pre-Authorizations Are Done Correctly
Pre-authorizations can help lower the number of claims denied, but only if they are for the scheduled procedure. Carefully document what was authorized and do checks before the procedure. If anything changes, document what was changed and double-check everything before submitting the claim.
This is a broad category that encompasses the above points, but also includes:
- Incorporate automation: Many software providers have tools that will help automatically update codes and procedures. Tools like this, as well as other project management tools, streamline the billing and claims process.
- Review your work: This seems like a simple step, but for one reason or another, it is often overlooked. Working as a team can help with this step because it is easier to spot someone else’s error than to catch your own.
- Meet deadlines: Meeting deadlines is essential. There is no excuse for having a claim denied because you missed a deadline. Again, working as a team can prevent a missed deadline.
In the end, you can help prevent claim denials by setting up a process for your team to follow. Set up a system that you can repeat for each claim that also allows for periodic review so you can determine where you need improvement.
It may seem daunting, but can you truly afford not to follow a process? It can cost you as much as 3% of your net revenue.
If it’s still too overwhelming, remember that Mednet is here to help with your medical billing needs. It might be a worry we can take off of your plate so you can focus on more important things, like your patients.
Five Ways Mednet Makes You More Money
Running a medical practice is difficult. No matter your specialty, you most likely face many challenges: compliance, administrative requirements, staffing issues, managing your revenue cycle, and cash flow. That is a lot to deal with, and we did not even mention ensuring your patients are happy and healthy.
Given all that goes into properly operating a medical practice, it’s important to know that help is out there and, even more importantly, how that help can propel your practice towards growth.
That’s where Mednet comes in. And there is one challenge we are exceptionally good at: ensuring your practice makes more money.
Let’s take a look at exactly how we do this:
Accurate Claims Billing
It all starts with submitting accurate claims. Because claims is how your practice gets paid for the services you provide for your patients, if the claims you submit are not accurate, they can be rejected or denied. And the process to clarify any errors can be costly in terms of both time and money.
Mednet gets paid on over 98% of all claims submitted. When we submit a claim for you, you’ll know that it is accurate. You will not have to worry about wasting time and money fixing inaccurate claims and delayed payments.
Improve Coding for Higher Reimbursement
A major part of submitting accurate claims is proper coding. Knowing which codes and modifiers to submit for which services you provide ensures that your practice does not lose any revenue. But it can also be a very complicated process, and one you need special knowledge to do correctly.
Mednet’s team of certified coders are trained in coding and chart audits. No matter your billing coding needs, we can meet them.
Aggressive A/R Management
No matter how experienced or good you are, claims do get rejected or denied. As stated above, resolving these issues can be costly. And if you fail to resolve the issues, you are leaving money on the table.
Mednet is aggressive in A/R management and and follow best practice standards. If a claim is rejected or denied, we quickly and efficiently follow up on your behalf to ensure there is no lost revenue.
Dedicated Account Managers
When you work with Mednet, we assign a dedicated account manager who handles all aspects of your medical billing needs.
Over time, your account manager comes to know your business and will feel like part of your staff. This strong relationship is important when it comes to handling the day-to-day challenges of medical billing.
Extensive Knowledge of the Industry
Mednet has been in business for over 35 years. Our Management Team has over 100 combined years of experience working in the medical billing field. We know the “ins and outs” of revenue cycle management, and you will feel confident that you are working with trained, experienced, and educated professionals who know how this industry operates.
You have a lot to worry about when it comes to operating your practice. Why not take something off your plate, a worry off your shoulders? Mednet gives you peace of mind because you know that the billing and coding is being taken care of.
Don’t waste any more of your precious time or money. Contact Mednet today to see how we can help revolutionize your medical practice.