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How to Choose the Right Medical Claims Clearinghouse for Your Office

You’ve made the decision that using a medical claims clearinghouse is the right avenue to take. Now you have the decision of choosing the right clearinghouse. Where do you start and how do you decide what is the best value for your practice? Here’s how to choose the best option for your facility.

Understand How a Medical Clearinghouse Works

When healthcare facilities install medical billing software, each claim becomes a file known as an ANSI-X12- 837. Software uploads the file to your medical claims clearinghouse where it is checked for errors, then transmitted electronically to the payer. Each transmission takes place over the secure connections required by the Health Insurance Portability and Accountability Act (HIPAA).

The payer will either accept or reject the claim. Once they make their decision, your clearinghouse receives a status update and adds them to the control panel on your machine. Your claims department can make changes from there and resubmit them for payment.

If the claim doesn’t require any corrections, the payer will send you money through an electronic funds transfer (EFT) and an explanation of benefits.

The process is similar to what happens in banking, with financial institutions sending secure transactions electronically, checking them for errors at each step along the way. If there’s a breakdown at any point, the transaction can be tracked so no information is lost and errors can be quickly corrected. Here are a few of the benefits of using a medical claims clearinghouse:

  • Healthcare providers can review and fix errors in minutes instead of waiting days before even finding out there’s a problem.
  • Clearinghouses drastically reduce error rates. Paper claims have errors that result in denial an estimated 28 percent of the time. The right clearinghouse can cut that number to between two and three percent.
  • Clearinghouses save manpower. Send claims in a batch instead of submitting them one at a time and spend less time correcting medical billing mistakes.
  • Your organization has access to more accurate data. Manage electronic claims from a single location and make more precise revenue forecasts with reduced payment cycles.

Evaluate Your Options

There are a wide variety of medical claims clearinghouses, and they don’t all provide the same value and services. Gather data on the ones you’re considering by asking the following questions of each:

  • Does the clearinghouse service organizations nationwide?
  • Are the insurances you bill on their payer list?
  • Do they offer online access for tracking and updating submitted claims?
  • What type of support do they provide once claims are submitted?
  • What type of contract do they require and what happens if you later choose to switch to another provider?
  • Do they charge on a monthly basis or per submission?
  • Do they offer analysis for rejected claims?
  • If insurance providers require paper-based claims, will the clearinghouse mail them for you?
  • How does the clearinghouse update your facility when payers process claims or send financial transactions?

Prioritize Customer Support

In order to select the best option for your facility and your patients, choose a medical claims clearinghouse that offers responsive customer service. For your facility, if your staff has to wait for hours on the phone to speak to a representative or wait days for a question to be answered, it costs you money.

Select a clearinghouse that lets you request support around the clock and will respond within 24 hours. Most clearinghouses include their customer service commitment in their contract. Qualified clearinghouses have a technical support line and are responsive when you have questions.

Ask About Claim Responses

One of the benefits of using a medical claims clearinghouse is receiving quick updates once you submit claims. Once you upload claims, scrubbing them for errors and submitting them to payers takes minutes. You should know the same day if claims were accepted or if they need to be corrected and resubmitted.

Select a clearinghouse that offers claim status for individual claims. Reduce delays to improve your relationship with clients and get paid faster.

Verify Accuracy with 835s

HIPAA requires healthcare insurance plans to use the 835 transaction set when paying providers and to provide an explanation of benefits (EOB). Some medical claims clearinghouses take weeks or months after the transaction is complete to send 835s to healthcare facilities.

When there’s a delay, your staff spends time waiting on them. Choose a provider that sends both 835s and payments within a dependable timeframe so you can post payments and reconcile information. The best services do not charge extra for ERA 835 transactions.

If you handle a high volume of billing, electronic remittance files can save you time. An electronic remittance is a digital version of an EOB. Download the file and post it to your clearinghouse software to avoid having to manually post payments from individual EOBs.

Evaluate Usability

Find software that meets the needs of your practice and is easy to access by all the necessary staff members. Not only do you need all the claim information accessible n your system, it’s often necessary for it to be accessible to multiple staff members at once. Give your staff the capability to update claims as they post payment or resubmit corrections so you can view all activity without having to pull up individual claims.

Verify compatibility with your current claims billing software and evaluate whether the error reports and control panel provide simple navigation. Check to see if claim errors are written in language that is easy for staff to decipher.

Select a clearinghouse that lets you verify patient eligibility in real-time and offers extensive searching functionality for data access. Advanced revenue cycle features also offer features like rejection analysis, secondary claims processing, patient statements and free summaries of your activity with the clearinghouse.

Apex EDI has been processing claims for doctors, dentists, optometrists, chiropractors and other practices since 1995. Our software integrates with almost any billing software and we support more healthcare payers than any other clearinghouse. Contact us to find out how we can get you paid faster so you can focus on serving your patients.

Sources: the-right- clearinghouse-five- essential-qualities help-doctors- choose-medical- billing-clearinghouse/ right-clearinghouse- 5-essential- qualities/

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How to Prevent Medical Billing Issues with Self-Auditing

Medical billing is a complex task where many things can go wrong. It takes a seamless, highly efficient system to conduct medical claims processing without critical errors. Even minor mistakes can spell trouble for healthcare providers, insurance companies, and patients. One of the best ways to prevent billing mistakes and payer audits is with regular self-audits. Self- auditing the right way could save your office.

Common Billing Errors in Medical Claims Processing

To understand the value of self-auditing, first explore the many errors that could harm a physician’s office. Billing in the medical field requires innumerable charts, codes, and communications between parties. It’s easy to make an error that snowballs into a massive problem. Before a billing error gets out of hand, there are steps you can take to prevent it from ever happening in the first plane. You may already have examples of errors from real life, which is why you’re reading about self-auditing. If not, here are three of the most common medical claims mistakes:

1. Coding problems. Every medical biller knows the job depends on codes. CPT codes, point of service codes, and ICD-9- CM codes may all come into play during claims processing. Entering the wrong code, getting codes confused, or entering too few or too many digits can be disastrous. Coding problems can lead to major issues down the road. Organizations update the three principal medical coding sets annually. It’s important to update manuals every year.

2. Processing errors. Medical billing specialists may overlook parts of a claim or enter them incorrectly when processing many claims in the same day. Common mistakes include entering incorrect patient and/or provider information, failing to verify the patient’s insurance coverage, or confusing two different claims. It is imperative for billing specialists to enter every piece of information correctly on a claim for it to process correctly.

3. Security breaches. One of the scariest things that can go wrong in medical billing is a security breach. Sensitive patient information can become vulnerable if there are holes in your electronic security, opening the company to disaster and possible lawsuits. A major security breach can make a physician’s office close its doors forever. Regular self-audits can ensure the security of the office’s electronic systems, helping to keep bugs and hackers away.

These are just three of the many things that can go wrong during medical bill processing. Despite years of training and education, even the most prudent specialist can make a mistake that leads to issues with the bill down the road. It’s always better to prevent billing issues before they occur rather than to try to repair damage an error already made. Self-audits are the ultimate way to safeguard an office from billing, claims, and processing errors.

What Is a Self-Audit?

If you’ve been in the billing industry for any amount of time, the word “audit” may strike fear into your heart. You may associate it with payer audits, and in-depth examinations of how your office and specialists perform their jobs. Audits may occur at random, or they may happen after a significant error. Either way, they are something that every physician’s office wants to avoid. Self-audits can provide a means of preventing payer or federal audits, by keeping the system performing according to accepted standards year round.

During a self-audit, everyone involved in coding, billing, and processing will scan the system for issues, red flags, and potential patterns that could develop into errors in the future. The entire team will work together to assess current processes, check for problems, and discover if there is room for improvement. Self-audits are opportunities to find bugs, fix them, and minimize errors in the future. Experts recommend performing self-audits at least once per year, or more frequently depending on resources and the individual situation.

The size of the practice and the adoption of new systems may require more frequent auditing. New systems may have transition periods where the rate of error is higher as coders get familiar with new software. Increasing the rate of self-audits during this time can help prevent small and large issues with new programs. The same is true if an office hires a new staff member. Auditing the new addition within 30 days or so can assess his or her performance and optimize training.

Benefits of Self-Auditing

Conducting annual or bi-annual self-audits may feel like a burden on your team. However, the time and effort it takes to audit yourself once per year is minor compared to the hassle of a major payer audit or serious mistake on your end. Major billing errors can disrupt the system, look bad for your office, and potentially cause problems for the patient. Instead of waiting for an accident
to occur and then scrambling to fix it, conduct regular self-audits to catch potential problems before they ensnare you.

The main benefit of self-auditing is to find and fix information gaps, poor documentation, incorrect coding, and other mistakes. Yet the practice is also good for more than just problem solving. An office that performs annual self-audits on medical claims processing can enjoy fully optimized operations, with no subpar processes that cost the company money. It can also help your team prepare for external audits in the future.

An audit can revise and improve procedures until they are the best they can possibly be, leaving no room for costly errors or losses in productivity. An audited workforce is one with the tools and knowledge to move forward using tried and true processes, with no time wasted. Audits can turn any office into a well-oiled machine – saving the company money and headaches. Improved claims acceptance translates into more cash flow for the physician’s office.

How to Complete a Self-Audit

The ability to prevent medical billing issues comes down largely to the efficiency of the self- auditing process. Learning best practices for billing self-audits such as what to look for and how to revise issues can keep this task as fast and simple as possible. The point of a self-audit is to benefit your company. Use an audit to its fullest potential by following this general three-step outline:

1. System inspection. Select a group of charts for your team to examine within the last six months. Examine the records for missing information, lack of documentation, and incorrect coding. Make sure everyone performing the audit uses the same techniques. Provide a checklist of what to search for with each chart check.

2. Problem detection. If coders have the time, use them to conduct your self-audits. Otherwise, you may want to hire an external auditor. Put coders on alert for potential problems. Coders will report to a designated manager if they see anything suspicious, for immediate appraisal and appropriate action. Appoint a compliance manager who will be in charge of investigating potential problems.

3. Issue revision. If the auditors find anything wrong or suspect within the billing system, take time to investigate the issue and to come up with an appropriate response. This is your chance to fix holes before they turn into major leaks for your company. Think about whether a system upgrade would solve or prevent the problem in the future. Self-audits are great for performance reviews, assessments, and new technology integration.

Every office’s self-audit will look different. The most important thing as that the process works for you and your team of specialists. Tailor a self-auditing plan and timeline for your specific office’s needs and goals. Train those involved on how to perform the audit, and make sure a manager oversees the process. Don’t let coders audit their own work. If your self-audit shows signs of outdated equipment and inefficient processes, consider upgrading your medical billing software.

Optimize Billing with the Right Software

The goal of a self-review is to revise and optimize your procedures. Stay vigilant about even the simplest of mistakes. You’ll find that your team can avoid most medical billing mistakes well before sending claims for processing with the payer, all by keeping an eye out for common errors. It’s up to your office to move the claims through the system as quickly and accurately as possible. To stay on track, look at whether you need to enhance key elements such as communication, coordination, or billing and coding technology trends.

As you uncover issues, you may find that it would be in your office’s best interest to invest in new claims processing software. Medical billing software from a trusted medical billing clearinghouse can help streamline processes to avoid future billing errors and “real” audits. Upgrading your system to implement a new billing management program can be exactly what your office needs to operate smoothly and effectually in the future. Billing and coding in the medical industry are important jobs. The right software can minimize costly mistakes.

Apex EDI provides simplified medical claims processing, with much less room for human error. You can instantly eliminate many common mistakes in coding and processing when you use Apex EDI to process your insurance claims. The system works perfectly with any practice management software, allowing effortless communications between health providers and insurance companies. It has a simple user interface for smooth adoption and no-hassle employee training. Apex EDI is a cutting-edge software that can bring medical billers into the 21 st century. With the right program, you won’t have to dread audits.

Sources: coders-first- line-of- self-audit-defense/ billing-issues- with-a- self-audit/ Easy-Steps- to-a- Great-Chart- Audit-to- improve-medical-billing Coordination/Fraud-Prevention/Medicaid- Integrity-Education/Downloads/ebulletins-self- audit.pdf errors/ for-Service-Payment/HospitalAcqCond/Coding.html

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How to Maximize Telemedicine Billing

Telemedicine is not a passing trend. It’s the future of healthcare, with 60 percent of millennials supporting telehealth options and 71 percent desiring a mobile app from doctors as of 2015. There is no stopping the train that is telehealth – there is only acceptance and adaptation. One facet of telehealth that will need to change is billing. As the field of telemedicine continues to grow, insurance companies and healthcare providers will need to upgrade to claims processing software to optimize modern billing.

Tracking Telemedicine’s Recent Growth

Telemedicine, or telehealth, has come into its own in the last several years. As patients become increasingly busy, they vastly prefer the convenience of a telephone and/or video consultations when they have minor medical concerns. The “connected patient” values online reviews from other patients, the ability to book appointments online, and the ability to pay bills digitally. Millennials report interest in technologies such as mobile devices, wearables, 3D printing, and telehealth when it comes to their healthcare experience.

The federal government is also supporting telehealth. The Health Resources and Services Administration (HRSA) recently named two medical centers in Mississippi and South Carolina “Telehealth Centers of Excellence,” turning them into research facilities focused on telemedicine. Each center received $600,000 in grants with the opportunity for $2 million in funding for two years of telehealth research. This development coincides with the Senate’s recent approval of new Medicare coverage of telemedicine for people with chronic illnesses.

With support from the federal government, millennials pushing for a change, and advances in telecommunications technologies, it’s only a matter of time before telehealth becomes the new normal for the modern patient. Utilization of telehealth services is expected to increase from 250,000 in 2013 to 3.2 million in 2018, with the value of the industry in the U.S. reaching $1.9 billion in 2018. Forecasts of the global telehealth industry place its value at $48.99 billion by 2021. Telemedicine is only increasing in importance and demand around the world.

Telemedicine for Patients of All Ages

Although millennials are some of the greatest supporters of telehealth in the form of apps and wearables, it is not just the younger generation that supports the transition of healthcare to digital. As older patients move away from primary care doctors, enter into retirement, and find it more difficult to get around, they too could benefit from digital alternatives to traditional doctor’s office visits. Telemedicine could break down common barriers to healthcare for senior citizens.

One study of 646 senior patients found that at least 38 percent of acute care episodes were appropriate for telemedicine care, and 27 percent of emergency department visits were eligible. Transitioning to telehealth for acute care and other visits could increase the efficiency and effectiveness of senior citizen healthcare. Getting the help they need, when they need it, right from home could make all the difference to seniors with injuries or illnesses. The trend toward telehealth will only increase in the coming years. It’s up to providers to stay up to date.

The Impact of Telehealth on Medical Billing

Telemedicine will make significant changes to the way providers handle medical bill processing. Since the Medicare, Medicaid and Benefits Improvement and Protection Act of 2000, Medicare
payments for telehealth services expanded to include a variety of telecommunications between doctor and patient. Coverage includes office visits, consultations, psychotherapy, and more, all delivered through telecommunications in lieu of an in-person encounter. The list of covered telehealth services later expanded further to include emergency visits, nursing care, and more.

For Medicare to make a payment for telehealth services, the patient must have used an interactive audio/video telecommunication system to communicate in real time with a remote practitioner. The patient must have been present during the virtual visit. The medical practitioner (if eligible) will then bill the insurance company for the telehealth services. For an optimal patient experience, the billing process for telemedicine must work as seamlessly and intuitively as possible. Medical billing had to undergo a transformation to keep up with the tech of telehealth.

Today, medical billers must understand Medicare’s telehealth regulations, determine the type of telehealth service the patient needs, learn the laws in the state, and know how to accurately bill patients for these services. The process can be tickly and complex. Guidelines for billing are still in development as new telehealth methods continue to emerge. Furthermore, the rules can vary
from payer to payer. Until clear guidelines exist across all payers, billing providers must obey a few best practices for successful services.

What to Know About Billing for Telemedicine

Telemedicine comes with its own rules and regulations, completely separate from typical medical billing. While all major private insurers cover telemedicine, the coverage may depend on the patient’s policy. Some providers, such as Blue Cross Blue Shield, put telemedicine services on exclusions lists. Billers must pay special attention to the patient’s insurance policy to verify that it covers telemedicine beforehand. Call and verify the coverage before the patient’s first telehealth visit to avoid billing and collection issues down the road.

Next, recognize that each payer will have its own telemedicine billing guidelines. If you’re dealing with multiple payers, this can seem overwhelming. You will need to call each payer and ask whether or not healthcare providers can bill for telemedicine, as well as which services the payer covers and if there are any restrictions. Most insurers request that providers use proper CPT codes and GT modifiers when billing telemedicine. This may vary based on the payer and your state. You may need to request a list of covered codes.

Finally, find out about any applicable facility fees you may be able to charge to payer. Telemedicine programs that bill through Medicare may request facility fees to cover hosting the patient as a telehealth site. The healthcare provider can charge using bill HCPCS code Q3014. When billing for telemedicine, best practice is to double-check everything with the payer before sending the bill. Each payer’s policy may differ, and you may find yourself tangled in a web of red tape to bill a single telehealth visit. Luckily, there are systems to make telemedicine billing much simpler.

Benefits of Software for Telemedicine Billing

Simplified claims processing for telemedicine can streamline the process to save time, effort, and money. Investing in the right medical billing software can make all the difference when it comes
to complex billing procedures for telehealth services. As the telemedicine industry continues to bloom and evolve, it’s more important than ever for healthcare providers and others to keep up with changing trends. A medical billing clearinghouse can ensure efficient, ethical, and accurate claims processing. Here are some compelling benefits of telemedicine billing software:

• Cutting edge technology. Medical establishments of 2017 and beyond need the latest software and technology to stay ahead of burgeoning trends. Falling behind can be devastating to the company and the patients, as it can result in reduced productivity, higher costs, and detrimental billing errors. Investing in current software ensures a business is up to date.
• Revenue cycle management. Billing and collections revolve around the management of a provider’s revenue cycle. In the medical industry, there are often long gaps between billing the payer and receiving the money, as well as receiving the rest of the payment (if applicable) from the patient. Efficient revenue cycle management can make reduce gaps in payment and keep a company on its feet.
• Direct claims processing to payers. The right billing software can send telemedicine service claims directly from your software to the payer, cutting out the traditional in- between actions. This system is easier for you and it saves time. With Apex EDI, you’ll see your real-time claim status and have the power to manage your web-based claims from your software.
• Real-time claims support and customer service. Telehealth claims can be confusing, and require the verification of patient eligibility, rules, and guidelines fro payers. A software system can make these communications easy, offering unlimited technical support and customer service.
• Online access to patient medical records. Many services also offer patients access to their health records and information, all securely online. This can lead to better-informed patients, as well as take the load off of nursing staff in gathering records. Fifty-seven percent of patients say they’d be more involved in personal healthcare if they had access to their medical records online.
• More attention on the patients. Telemedicine is all about optimizing the patient experience. When you adopt telemedicine billing software, you give your facility the ability to focus on the patients. Software makes billing a breeze, allowing you to receive payments faster and spend more of your time and energy on the patients.

The power to create and manage email lists, create health apps, offer virtual physician visits, become mobile-compatible, and efficiently bill for telemedicine services is at your fingertips. Apex EDI medical claims processing software is a simple yet powerful way to manage telehealth billing in the modern medical industry. It uses state-of- the-art software, yet integrates seamlessly with existing processing systems for easy adoption. It is a software system that can help you master telemedicine billing without any missteps. Contact us for more information about how claims software can help your establishment.

Sources: get-reimbursed- for-telemedicine- services/ expands-telehealth- centers/ access-
hospital/how-bill- medicare-telehealth- services of-the- connected-patient- 2015-
infogrpahic.html about-telemedicine- healthcare shortage-to- spur-2-
billion-telehealth- market/#64a5d68c2abe US-Telemedicine- Industry-Benchmark- Survey-
REACH-Health.pdf bill/5661 tips/ Education/Medicare-Learning- Network-
MLN/MLNProducts/downloads/TelehealthSrvcsfctsht.pdf sets-telehealth- site-facility- fee-payment/

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How to Prepare Your Practice for Medical Billing During a Disaster

The U.S. recently faced back-to- back major hurricanes. Texas and Florida had regions that were
underwater for days. Several other natural disasters caused serious problems for medical
facilities. When medical providers are inundated by natural disaster victims, medical claims
processing is the last thing on their minds. There are steps health-care facilities can take ahead of
time so they do not lose revenue for their hard work.

Preparation should include a plan for how providers will collect information and keep it safe.
Medical billing software can help quickly capture patient information and send it electronically
to the medical billing clearinghouse. Employee portals on their website can keep communication
with employees open. Here’s a look at some previous natural disasters, the problems they
caused, and the lessons they offered.

3 Natural Disasters that Threatened Hospitals

These uncontrollable events interfered with hospitals across the nation.
Loma Prieta Earthquake – On October 17, 1989, the Loma Prieta earthquake struck California
10 miles Northeast of Santa Cruz. It destroyed bridges and roadways and caused 63 deaths,
affecting 51 northern California hospitals. Twenty-two hospitals had to evacuate. Peralta
Hospital in Oakland experienced structural damage. Watsonville Community Hospital had to
evacuate an entire floor because it lost exterior windows and elevator capability.

Forty-three percent of hospitals in the region reported insufficient backup power. Five had total
generator failure. All reported a widespread lack of communication from within the organization
and from outside sources. With chaos inside and out, medical billing and patient care were
extremely difficult to manage.

Hurricane Katrina – Katrina first hit Florida as a Category 1 hurricane before sweeping back
out into the Gulf to gain strength and eventually devastating the Mississippi and Louisiana
coastline, taking an estimated 1,836 lives.

Several hospitals closed after they were damaged by the storm surge. Officials investigated
Memorial Medical after 45 patients died. After floodwaters disrupted power from generators,
seventh-floor patients were unable to use ventilators. Staff carried as many patients as they could
down several flights of stairs and saved lives.

However, patients’ families later accused the hospital of not doing enough to help patients with
Do Not Resuscitate orders. Resulting lawsuits questioned how much a provider can be held
responsible for in the event of a natural disaster.

Hurricane Katrina led many medical care providers to begin employing Electronic Health
Records (EHR) systems that can help prepare for cost-effective, suitable care during a disaster
that damages buildings and disrupts power. Record maintenance is also necessary for medical
claims processing after the disaster is over.

Buffalo Snowstorm – In 2014, 60 inches of snow fell in Buffalo, New York, a week before
Thanksgiving. Hospitals in the storm area had the power and plenty of supplies like medications,
oxygen, and food.

What they didn’t have was personnel. Many medical employees were snowed in, unable to get
out of their driveways. Mercy Hospital was the hardest hit and had to find strategic solutions to
continue patient care. When staff is exhausted and overworked, medical billing issues inevitably

Lessons from Superstorm Sandy

The National Center for Biotechnology studied the impact of EHR access during a disaster and
found that an EHR system enables providers to be in a better position during a disaster than those
who depend on paper records. EHRs provide clinical and financial benefits during everyday care
and can be especially helpful during an emergency.

When facilities use EHRs daily, the habits they create carry over during times of disaster. The
National Planning Frameworks outlines the five areas in which communities should prepare for
disaster response:

  • Prevention
  • Protection
  • Mitigation
  • Response
  • Recovery

An EHR system enables all facility personnel to work together to prepare, coordinate care, and
respond. Technology helps prevent duplicate treatments, alert providers to possible medication
interactions, and supply information that leads to a quick and accurate diagnosis. These factors
make treatment more cost-effective and reduce medical claims that may later be denied.

Hurricane Sandy tested Health Information Technology (HIT) effectiveness in late 2012, eight
years after Katrina. Sandy caused 147 deaths and an estimated $50 billion in property damage.
Planning officials advised hospitals to back up data before the storm so it would be up-to- date
and available in case of disaster.

Long Beach Medical Center (LBMC) was one of the facilities hardest hit. It had been using an
EHR system for three years when systems were knocked offline by Sandy’s storm surge. Ten
feet of water flooded the basement where all the hospital’s communication, electrical, and
emergency alarm systems were stored.

Innovative technology helped providers function despite the disaster. A mobile unit provided
remote access to the hospital’s existing patient records. Staff was already familiar with the
system, so they could archive information for new services, even after they moved to a
temporary facility.

LBMC stored data at a multistoried building a distance from the main facility where it was not
vulnerable to flooding. Since staff couldn’t access data through fiber optics that had been
damaged by the storm, they used a microwave link system that had been set up and tested as part
of the facility’s preparedness program. They connected a digital X-ray system to a secure
network so remote radiologists could access images for diagnosis.

Throughout the disaster, the EHR system provided and captured the data necessary to
successfully treat patients and it created and submitted claims so the hurricane did not disrupt
revenue. Existing providers can implement some of the same steps LBMC did to prepare for
unforeseen events.

How to Prepare for Disaster

Disasters come in all sizes and forms. Medical facilities might be affected by a local tornado or
blizzard, or something as simple as a surge of seasonal illness that brings waves of patients and
makes staff unable to report to work. Here are some steps to take before disaster strikes.

Create a Plan to Secure Data

You can’t provide proper medical care without access to your information. Store data in a secure,
offsite location and back it up regularly. If you work with a medical billing clearinghouse,
choose one that makes it easy to transfer data to their location remotely. If you rely on paper
documentation, keep records in storage units or locations rated for smoke, water, and fire

If you face danger from bad weather, unplug electronics and diagnostic equipment in case of a
power surge. Make a detailed plan detailing who will handle each part of the facility and drill for
different types of disasters.


Disaster impacts communication. Don’t rely on just one method to distribute information, set up
multiple channels for distribution and make sure all employees are aware of how they can stay

Set up an employee portal on your website and designate an off-site user to keep it updated. Set
up text messaging apps that allow you to distribute information to all employees at once and
avoids breakdowns in a calling tree.

Let employees know what your expectations are in case communication breaks down. For
example, if there’s a forced evacuation, instruct employees to return to their duties within 24
hours of the evacuation being lifted.

It’s just as important to communicate with patients. Update your website with information on
closing or relocation and let them know how to reach their practitioner if they have an
emergency. Use your patient email list to make sure they’re aware of updates. Patients appreciate
you taking the time to inform them during the disaster, and you will experience increased
goodwill toward your practice.

Plan for Relocation

The type of practice you have helps decide what your grab-and- go emergency kit should contain.
If you are a small dentist’s office, you will probably not see patients during the worst part of the
disaster. Once your records and equipment are secure, you only need a way to communicate
when you will be open again. If you are a major medical center, your preparations will be much
more extensive.

Store contact information for insurance providers, staff, vendors, and financial representatives in
an accessible location. Automatic transactions with insurance payers can protect cash flow even
when your business is being conducted from another location. Using a medical billing
clearinghouse that processes your claims remotely can streamline revenue seamlessly.

Simplify Electronic Claims Processing

Processing medical claims can be a chore even under the best circumstances. When health-care
providers are focused on saving lives in the most extreme and difficult situations, claims
processing can be even more of a challenge.

During a widespread disaster, medical personnel are often unable to get to the hospital. When
current staff is exhausted and overworked, they don’t have the time or the patience for complex
data entry. Avoid errors by choosing integrated, user-friendly medical billing software.

Apex EDI’s Electronic Claims Processing software lets health-care providers use their own
practice management software to submit claims with one click. After submission, Apex EDI
scrubs each individual claim to check for errors then submits it directly to the insurance payer.

Our tools require very little training and offer turnkey processes that allow you to focus on your
patients. No one wants to be faced with offering medical services during a major disaster. In
these scenarios however, you’ll want to be able to verify patient eligibility in real time, adhere to
health-care legislation, and get paid when the disaster is over. Choose the medical billing
clearinghouse that can make medical claims processing easy. Schedule a live, personalized
medical billing software demonstration today.

Sources: disasters-caused- serious-trouble-
healthcare-providers disasters/ planning-your- practice demo/

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Medical Billing Mistakes That Impact Healthcare Revenue

The health-care revenue cycle involves more than just mailing out bills and collecting payments.
In fact, one of the most frustrating aspects of running a health-care organization can be tracking
claims throughout their life cycle. An efficient revenue cycle, along with the right claims
processing software, can keep things running smoothly. Working with a medical billing
clearinghouse can be the first step in ensuring medical claims processing goes smoothly. Here’s
how to avoid some common mistakes.

Understand Revenue Cycle Management

The revenue cycle is like a health facility’s circulatory system. It requires that several complex
processes function together for the overall health of the organization. Providers use revenue
cycle technology to track claims, isolate potential problems and regulate the billing cycle. Just
like the body’s circulatory system requires all parts to function correctly and in sync, every phase
of the revenue cycle must be integrated and optimized for efficiency.

The cycle starts when patients schedule their appointments and ends when the account balance is
zero. If mistakes impede progress at any point along the way, it wastes time and may result in
lost revenue.

Use Technology Solutions for Revenue Cycle Management

Technology problems can lead to medical billing issues that interfere with medical claims
processing. Health-care organizations should invest in solutions that avoid lost income due to:

  • Systems Lack Integration – When organizations use separate claims processing software for patient accounting, billing, health records, and collections, they might experience lost revenue. The more systems your organization uses, the greater the opportunity for error.
  • Improperly Trained Staff – When staff members don’t understand the denial management process or know how to reduce patient billing delays, it can result in rejected claims and an increased number of denials.
  • Physician Coding Errors – A mistake in correct ICD-10 coding can cause overbilling that results in failed audits.
  • Contracting Process Mismanagement – Hospitals and medical providers must use technology that allows them to negotiate rates within the contracting process to maximize the available revenue from payers.

Research Top Reasons Claims Are Rejected

When health-care providers receive an Explanation of Benefits (EOB) showing the claim is
denied, it is most likely for the following reasons:

  • Patient demographic information (age, birthdate, gender, address, etc.) is incorrect.
  • Provider data contains errors.
  • The patient’s insurance ID contains mistakes.
  • Insurance information is out of date or the policy no longer covers the patient.
  • Diagnosis code and treatment code do not match.
  • Pre-authorization was required but not obtained.
  • Error in place of service code.
  • The service was not deemed medically necessary.
  • Provider ID or NPI number was omitted.
  • Modifiers are in error.

Providers should keep in mind that just because insurers reject a claim, this does not mean it has
been denied. Rejected claims are often not processed because information was missing or
insufficient. Oftentimes, a claim will be accepted and paid if the applicable information is
corrected and resubmitted to the insurance company.

If a claim is denied, the insurance company determined it was not eligible for payment. They can
still be resubmitted and appealed if there is additional information that supports its validity.

Avoid Error Causes

To reduce the number of errors that result in denials, providers should take steps to identify the
most common causes. Medical claims processing is a complex process, so errors will inevitably

Superbills are complex and vary by the provider’s specialty, the services rendered, and other
requirements. Medical billing employees may not be able to identify how best to enter
information, and if the provider is not available for clarification, they often use their best
judgement. This can result in errors.

Front desk employees can cause mistakes that lead to claim denial. If they don’t ask about
insurance or address changes when the patient signs in for an appointment, old information
might be all that’s available on file.

Inexperienced or untrained billing and coding employees cause errors. Medical billing software
is continually updated, so regular training updates are necessary. Providers who cut costs by
paying less for billing and coding may lose money because employees don’t understand the
insurance claim process.

Providers don’t post charges. Part of effective claims processing involves posting payments from
both patients and insurance. Unposted payments mean the balance still due can’t be collected.
Financial reports don’t tell you accounts receivable or give information on how much insurance
companies have paid so far.

Best Practices to Avoid Medical Claims Processing Errors

Eight percent of claims submitted are rejected over eligibility issues. Something as simple as a
missing signature can result in a denied claim. Prevent errors throughout the billing life cycle by
implementing the following changes.

  • Avoid errors by submitting clean claims. Enter information directly from primary sources like the superbill or the patient’s insurance card.
  • Train front desk employees to ask patients to update information when they sign in for every visit. Verify insurance status and coverage at every visit. It’s much easier to enter changes with the original claim than it is to correct errors and resubmit.
  • Teach employees to ask patients if they are covered by additional insurance and to inform patients if there are a limited number of visits allowed and how much of the cost is the patient’s responsibility. Questions should be repeated on every visit.
  • Analyze reports from your claims processing software. Use reporting features to scrutinize unpaid claims and accounts receivable to find recurring reasons for denial. Sometimes one insurance company can be more problematic than others.
  • Use a medical billing clearinghouse to scan for information that is missing or incorrect.
  • Code carefully so errors don’t occur.
  • Employ seasoned billers and coders. It takes practice to correctly interpret EOBs and understand why claims have been denied or rejected. When you hire new employees, invest in quality training.
  • Follow up on claims immediately. The longer you wait, the less likely you are to get paid.
  • Solicit input from billers and coders. Often, they can provide insight on why errors occur and how to streamline the process.
  • Simplify patient bills. With an increasing shift toward high-deductible plans, patients find themselves owing more for services. To plan for payment, they need to see a clear breakdown of what part of the bill is their responsibility.
  • Train for top coding challenges. The American Health Information Management Association states that some coding processes create more errors than others. These include incorrectly inputting trauma and fracture codes, the misidentification of respiratory failure, and errors in documenting devices, components, and grafting materials. Offer regular ICD-10 coding updates to prevent these types of errors.

Ensure Successful Appeals

When insurance companies deny a claim, they sometimes require an appeal letter to reconsider
it. Send letters by certified mail so you have proof of delivery. Incorporate any information that
needs to be corrected along with documentation that supports your claim. Lab results,
physician’s notes, and any reconsideration request forms are helpful for a successful appeal.
Get to know the representatives responsible for denied claim resolution. Often, they can make
suggestions for successfully navigating the process and can explain the conditions and timeline
for claims appeal.

If you’re resubmitting a claim that was denied due to inputting mistakes, send the corrected
claim with a letter that explains what corrections you made to clarify and speed up the process.
If you have an unusual amount of trouble from one insurance carrier, realize health-care claim
processing standard requirements are different from one insurance company to the next. That
company may have an appeals process that is purposefully burdensome to reduce payouts.
Contemplate reporting them to the insurance commissioner for your state.

Work with a Medical Claims Clearinghouse

Each health-care organization generates mountains of electronic claims information. Each claim
has the potential to result in multiple denials, phone calls, resubmittals, and appeals.
Clearinghouses help providers and billing managers consolidate claims and administer them
from one location.

When health-care providers use medical billing software to create a claim, they will send it to a
clearinghouse for error checking. After the clearinghouse inspects the claim, they transmit it over
a secure connection to the patient’s insurance provider.

At this point, the insurer either accepts or rejects the claim. They are more likely to accept the
claim because the clearinghouse has already checked for missing and inaccurate data, blank
signature lines, and other issues that slow down the process. Once the claim is accepted, the
insurance company sends an electronic funds transfer along with an EOB.

Premium clearinghouses allow you to fix claims before submission, so they are corrected in
minutes, not weeks. They process claims electronically so reimbursement often occurs in less
than 10 days. Upload claims in batches instead of sending them one at a time to providers and
manage them all from one location.

Apex EDI simplifies medical claims processing. Our claims processing software streamlines
every step of the process. Contact us to find out why so many clients use Apex EDI as their
medical billing clearinghouse.

Sources: billing-issues- affecting-healthcare- revenue-
http://www.all-things- claim-processing.html basics-of- the-health- care-revenue- cycle the-front- end-steps- of-revenue- cycle-
management top-icd- 10-implementation- coding-

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