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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
result.

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
resistance.

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.

Communication

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
informed.

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:
http://www.healthcarefinancenews.com/news/5-natural- disasters-caused- serious-trouble-
healthcare-providers
https://www.practicesuite.com/practicemanagement/weathering-natural- disasters/
http://www.physicianspractice.com/managers-administrators/disaster- planning-your- practice
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3959913/
http://www.apexedi.com/free-live- 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
occur.

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:
https://revcycleintelligence.com/news/4-medical- billing-issues- affecting-healthcare- revenue-
cycle
http://www.all-things- medical-billing.com/healthcare- claim-processing.html
https://revcycleintelligence.com/news/examining-the- basics-of- the-health- care-revenue- cycle
https://revcycleintelligence.com/news/what-are- the-front- end-steps- of-revenue- cycle-
management
https://revcycleintelligence.com/news/ahima-reviews- top-icd- 10-implementation- coding-
challenges

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