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Medical Billing Software: How to Close the Loopholes in Your Medical Claims Billing

Medical Billing Software: How to Close the Loopholes in Your Medical Claims Billing

Recent findings have proven that medical bills are among the leading causes of bankruptcy. But the high costs of staying healthy aren’t just tough for your patients – they can also be a financial strain on your practice. 

In this post, we’re outlining the best ways to close the loopholes in your medical claims billing by pointing out common errors and the best ways to prevent them by using electronic billing and tracking software, talking to staff, and more.

You can’t afford to skip this article. 

Tip 1: Stop Pushing Paper

It’s easy to make mistakes in your medical claims billing process when you’re doing things the old-fashioned way. Software can not only help to save you time and streamline the efficiency of your billing process. It can also help you to catch serious, costly errors. 

This automated process should begin with the scheduling of your appointments.  Look for software that sends out automated email reminders and other notifications when it comes to both the booking and billing process. 

You should also use digital forms and record keeping strategies to make sure that nothing slips through the cracks. Plus, you won’t have to waste your customers’ time asking them to fill out a form again if a hard copy gets lost. 

Your software should also be able to check your procedure codes, keep records of the services your practice provided that day. Also accurately keep track of all the costs to both patient and practice. 

Tip 2: Make Sure You’re Always Keeping Up With Regulations

Even if you’ve only been in practice for a short while, you’ve likely already experienced several changes to the medical claims billing process. 

These claims and the regulations surrounding them are changing all the time. To avoid problems and errors that cost you both time and money to correct, make sure you’re always keeping up with the latest regulatory news and standards. 

How can you accomplish this? Make sure that you’re always implementing new staff training programs.

Also, are you using the right technology and software to alert you when regulations have once again changed? Are you keeping in touch with other professionals in your industry?

Tip 3: Don’t Let EOBs Fall Through The Cracks

EOBs, or Explanations of Benefits, can be a lot to unpack. We get it: there’s a lot to handle and keep track of when it comes to your medical claims billing.

Still, just because a claim has been denied doesn’t mean it’s OK to move onto something else. 

Make sure that you’ve created a system to keep track of denied claims that works for you and your practice. Also, take the time to ensure you’ve followed up on any claims that come with EOBs. Always follow up!

Talk to your team about their ideas to improve this part of the medical billing process.

Then create a firm schedule and plan to implement their ideas.

Tip 4: Watch Out For Improper Coding and Payments For Services

Look, mistakes can happen when it comes to medical claims billing. But, they can also be very costly.

Always run audits as often as you can, and make sure that you’re not over-billing for the services your practice provides – or worse, under-billing. Also, scrutinize the bills you get for ordering medical equipment. Especially look at shipments of medical supplies. Vendors can make mistakes in billing, too. 

Especially if you’re on an automated order system, this is crucial to prevent a serious hit to your budget. Make sure too, that you’re accurately billing for each part of a service. Use separate codes for each service provided. Not just one overarching code. 

Anything you can do to cut down on errors is going to save you money in the billing process. Not to mention, prevent a lot of headaches for both your patients and your practice. 

Tip 5: Make Sure You’re Managing Your Staff Effectively

When it comes to properly handling your billing methods, communication is key. That should start with intraoffice correspondence. It should also cover a thorough examination of how your employees are communicating with your patients. 

To get a feel for how errors are happening, and the most common problems your staff are facing, start by talking to and surveying your medical billing staff. 

What are the parts of the billing process that are causing them the most headaches? What are their most frequent errors? What do they wish was easier to handle when it comes to the billing process? What are their ideas for improvement? 

Remember that when it comes to medical billing, one small error can often lead to several more. The cost to your practice can increase exponentially. 

Ask yourself and your staff how you can be more clear when it comes to the billing process. How can you reduce the number of claim denials you’re seeing? Are you being clear with your billing policies? Is your staff clearly communicating those policies to your patients?

Examine what your follow-up process looks like. Ask how you can shorten the timeline of the process. Do this by tracking the claims across the entire billing cycle. Also work with the healthcare payers to make sure that claims are quickly filled out and filed.

You’ve Got The Information You Need To End Medical Claims Billing Errors

In recent years, the margin of error when it comes to medical bills has been as high as 70%. No wonder so many patients are challenging their medical bills.

Not only does this affect the efficiency of your office and practice. It also makes you appear disorganized and even untrustworthy in the eyes of your patients.

It’s time to put a stop to costly, time-eating errors in your billing process.

Want more information about how you can prevent and correct errors in your medical billing process? What about the types of software you can use to make it happen? Get in touch with us today. Check out our website to learn more.

Make this the year you reduce your margin of error on medical billing. Make it the year that your patients are happier than ever.  

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Medical Billing Software: How Do I Spot Medical Billing Errors?

Medical claims can be difficult to understand. When a patient has a serious health condition, there may be several provider, specialists, and medical facilities involved in their care. Bills can be loaded with abbreviations and medical terms that the average patient may not be familiar with. It’s important to arm yourself with the confidence to question a potential billing error.  

Medical bill from the hospital, concept of rising medical cost, selective focus.  All data on the bill and form design are fictional, created specially for this concept.

The first step in questioning a medical claim received for services is to make sure you review each detailed charge. If you receive a summarized statement, you may need to request an itemized bill. Read through the dates of service, provider, and insurance information to confirm its accuracy.


Check for obvious duplications. If a service is charged multiple time, it is most likely a mistake. Also check for omitted or missing information. For example, you may receive a statement summary that does not indicate past payments made. It will not hurt to be certain all previous payments are accounted for before submitting your final payment.

Errors in coding services received in the bill can be more difficult to spot. If your bill contains any charges that seem suspicious, mark them so you can ask your provider about them later. It’s not uncommon for billing specialists to miscode a charge.  

Take your time with the call the provider and ask any questions you have about the statement. Your healthcare provider wants to work with you to make sure you are happy with the overall care you receive. Apex EDI helps doctors focus on healing by supporting them with the best technology for medical claims.

Contact Apex EDI to watch a free demonstration of our software today.

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Medical Billing Software: The Number One Medical Claims Billing Problem

As a healthcare provider, it’s safe to say that you have had your fair share of medical claims billing problems. However, one problem seems to stand out above the rest. That problem being billing disputes.

041019-N-5821P-019 Yokosuka, Japan (Oct. 19, 2004) - Airman Lauren Thurgood of Las Vegas, Nev., pulls patient medical records in the inpatient ward aboard the conventionally powered aircraft carrier USS Kitty Hawk. Kitty Hawk's medical department services between 80 and 100 patients daily, providing around the clock, quality health care. Currently in port in Yokosuka, Japan, Kitty Hawk demonstrates power projection and sea control as the U.S. Navy's only forward-deployed aircraft carrier. U.S. Navy photo by Photographer's Mate 3rd Class Jason T. Poplin (RELEASED)

Billing disputes can occur for a variety of reasons.

Perhaps a billing code was entered incorrectly or maybe a claim was denied for not being a covered service through an out-of-network payer. Or perhaps a claim was denied due to the patient not yet meeting their own out-of-pocket deductible. Regardless of the reason, billing disputes are a hassle for you as the provider and for the patient expecting the service to be covered by their insurance.

What is the solution to this claims nuisance? The solution is to implement a medical claims billing software that partners with your existing practice management software to ensure cohesive and credible claims billing within your healthcare practice.

Apex EDI is the software you have been waiting for. Apex EDI partners with your existing practice management software to provide seamless medical claims billing. Apex EDI verifies medical claims before they are submitted to the payer in order to ensure correct billings and payments to you, the healthcare provider.

By partnering with more than 30 practice management software systems, Apex EDI implements a complete integration that allows your existing software to plug and play into our desktop app, Apex OneTouch. Apex OneTouch allows you to submit claims electronically, verify patient eligibility in real time, as well as review claim history and send and organize claims with custom fields. The Apex EDI system also maximized patient security through secure portals that uphold patient privacy and HIPPA practices.

Apex EDI works to process medical billing claims faster, so that you can focus on providing exceptional healthcare to your patients.  For more information or to review plans and pricing, be sure to contact us with your questions or to sign up for Apex EDI.

Articles with this disclaimer may not represent the beliefs or core values of Apex EDI. The following is simply a summary taken from the industry’s general community to help readers stay up-to-date on what people are talking about. 

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Medical Billing Software: Turns Out Advance Care Planning Is Worthy – Medicare Now Covers End-of-Life Conversations.

 Is Your Medical Claims Billing Software Ready?

The discussion around paying doctors for helping patients with advance care, or end-of-life planning, isn’t a new one, but it finally got traction in 2015. After years of debate around the issue and countless conversations about whether reimbursing physicians for their time consulting the terminally ill is worthy, at the stroke of midnight on January 31, the country decided it finally is.

It’s difficult to talk about death. And difficult for doctors to tell their patients (and their patients’ loving families) that there’s really is no way to avoid it. In America we pull out all the stops to prolong life and pride ourselves on doing “everything we can” to keep folks alive. The reality, however, is that people die every day and the majority of people facing terminal illness don’t necessarily want to exhaust every medical option available. Most want to live out their final days free of pain, in relative peace and with the people they love.

Hence the advance care payment debate. Do we force the difficult conversations?

The government’s first attempt to reimburse for end-of-life planning occurred in the summer of 2009. The proposal was met with swift and furious opposition and so it was tabled until the winter of 2010. That year the administration quietly included the new benefit in a list of regulations that determined the value of various procedures for Medicare. It was a softer approach, but when the inclusion finally made the news, skepticism set in and the attempt was again abandoned. Why? It wasn’t that anyone felt doctors shouldn’t be paid for providing sound medical advice; it was that some considered it an example of the government’s intrusion into health care.

What was the catalyst for change?

In 2012 the medical community joined the conversation. At the meeting of the Illinois State Medical Society that year, several doctors proposed a resolution to ask the American Medical Society to create a billing code for advance care planning discussions. (The AMA creates all the medical billing codes for Medicare. The government regulates how much to reimburse for them.) The doctors based their request on their personal, clinical experience and with that, the AMA agreed. They created 2 new codes and finally, in early July 2015, Medicare published plans to pay for them.

Why should medical billing companies care that such a change has taken place?

Dying is expensive. According to research, the 6% of Medicare patients who die each year account for up to 30% of the program’s annual spend on health care. That means nearly a third of the Medicare’s resources are invested on the dying – and for many of them, the care doesn’t change the outcome. Medicare spent an average of $33,500 on recipients who passed away in 2011 — four times the amount it spent on the recipients who lived.

And in more practical ways, we need to ensure our medical claims billing software can manage the changes. Here’s what you need to know.

In the final ruling on the issue, published late in 2014, the Centers for Medicare and Medicaid Services established the two CPT codes for physicians to document advance care planning conversations. The first covers the initial 30 minutes of discussion. The second is an add-on code for additional 30 minute conversations.

The new codes went into effect for services provided on or after January 1, 2016 and are billable under Medicare Part B. Medical billing companies should be aware (as should administrative and billing staff) that these codes can be used by any physician or non-physician practitioner who bills Part B for their services. Palliative service providers can also bill for advance care planning while most hospice physicians will not.

The conversations included in paid discussions should cover patient goals for care and outcome, specific wishes in terms of advance care, and instruction on advance directives which are necessary for patients, family caregivers and professionals providing terminal care to understand and agree to.

Does your medical claims billing software help keep you compliant in terms of policy changes like this one? Apex EDI’s OneTouch® electronic healthcare claims processing certainly does. Ask us why we’re one of the top-rated medical billing companies in the industry.

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