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medical billing services, medical billing companies, outsourcing medical billing companies, Revenue Cycle Management, medical billing and coding, professional medical billers, HIPAA compliant billing services,

10 Steps of Medical Billing Services for Effective Revenue Cycle Management

Revenue cycle management is an integral part of medical billing services. Every company has its own process of catering to claims, but for effective revenue cycle management, certain steps must be in order.

These steps when are performed systematically enhances the performance of your revenue cycle.

Patient Registration

The process of medical billing and coding starts with patient registration.

The front desk staff takes the necessary data and information from the patient to set an appointment for the doctor before the treatment. As soon as the patient registers with the physician, medical billing companies take their medical record to cleanly create the claim.

Moreover, professional medical billers ensure the accuracy of the information provided in the first step.

Patient check-in and checkout are an integral part of the patient registration process. To be precise, the front desk staff hands over a form to the patient for the information collection. Even if the medical billing staff has the information, they confirm the relevant information via the passport or the driver’s license to verify the patient’s identification.

Once the patient checks out (after the appointment), the information and the rendered services are compiled as a superbill. The actual medical billing and coding process starts from here.

Insurance Verification by the Medical Billing Service

In this step, outsourcing medical billing services verify patient’s insurance completely. The Healthcare plan is thoroughly analyzed to check eligibility and policies’ compliance.

After the verification process, billing experts also check patient’s responsibilities such as, deductibles, copayments, and out-of-pocket expenses that they have to bear.

In some cases, prior authorization is necessary from the insurance companies before the service is rendered. It also takes place in this step.  Most medical billing services use digital mediums to store and verify the information.

Recording of Patient’s Encounter

The physician-patient encounter is generally recorded or documented to keep a record of the patient’s health condition. It helps medical billers and coders to bill and codes the performed services for accurate claims.

Medical Transcriptions

Medical transcriptions refer to the documentation of transferring video or audios of the patient’s encounter with a physician in an appropriate billing format.

After the billing company receives all the necessary information, they start with the actual billing of the services. The accuracy of information is always regarded, and outsourcing medical billing companies also ensure HIPAA-compliant billing services.

Medical Coding

As obvious, now is the time to assign medical codes to medical transcriptions.

The process is to simplify the billing process as it is hectic for payers to read the complete medical history of patients. Therefore, medical coding is important and saves time.

Only experienced coders are allowed to code who are familiar with the CPT (Current Procedural Terminology) codes, and ICD 10 codes.

Charge Entry/Medical Billing

Before sending claims to insurance companies, it is important to bill rendered services in proper order. Patients’ records are again monitored to rectify any errors. In case of any error, insurance companies deny claims or simply reject them, which dent the revenue cycle and increase the rate of accounts receivable (AR).

Charge Transmission

It is the step in which claims are submitted to payers either government or private via EDI (Electronic Data Interchange).  Extra measures are taken to compile clean claims when sent through EDI.

There come three situations in cases of claims with errors.

Mandatory fields are to be filled, otherwise, the system rejects the claim – a process known as scrubbing.

Claims with invalid information are also rejected by the system.

The system also rejects the claims that are not compiled as per the payers’ policies.

Here, the billing teams have to double-check every measure that no secret information gets leaked.

Accounts Receivable Management

The AR calling team checks up on every claim after it is submitted to respective insurance companies. The purpose of this step is to ensure payment posting in an efficient manner. This team is also responsible for sharing any additional information like account details and helps remove errors in claims.

They also correspond with the physicians, patients, and insurance companies and inform them about any updates.

Denial Management

This step caters to denied claims by the insurance companies. Sometimes, some claims are not compiled up to the mark. Denied claim management deals with such issues. Constant follow up services are part of denial management that timely acknowledges errors, rectify them, and reimburse physicians.

Follow up services, being part of the denial management, keep track of the claim performance. It is done to maximize the reimbursement rate. Ultimately, no claim goes to waste or gets rejected over minor issues.

When medical billing services submit claims to payers, the follow-up team analyzes the processing of claims systematically. They are responsible to segment denied claims with the accepted ones and communicate with stakeholders (insurance companies, patients, clearinghouses, and more).

Payment Posting

This is the end of the medical billing and coding process that helps the team to be updated about the payment situation.

EOB (Explanation of Benefits) and ERA (Electronic Remittance Advice) all are provided to the concerned patients. The team concerned with the Payment Posting also checks if the payment received is accurate.

These ten steps describe the complete process of medical billing services and are crucial to keeping the revenue cycle running smoothly. For more information, visit our website – www.p3care.com

Medical billing services, Professional healthcare, Healthcare professional, HIPAA, Healthcare services, Medical Billing Company

Telemedicine Emerges as Cure Outlet Amid the COVID-19 Outbreak

Got allergies? You can still see a healthcare professional if you are at home during the coronavirus outbreak.

U.S. health officials, clinics, hospitals, and insurance companies are insisting on people to try telemedicine for minor health problems such as ear infections, rashes, and earaches and skip the doctor’s office.

It is also a way to get screened for COVID-19 if you think you have the symptoms.

The Goal: Prevent it from spreading, especially to the elderly, infants, and those who are most vulnerable with existing health conditions.

Instead of waiting for the doctor for days, virtual care has long been a solution for the Americans; it is just that they have been slow at adopting it. Now is the time to embrace and make use of it in our best interest.

Let’s take a closer look at how Telemedicine functions.

What is Telemedicine?

Medical billing services, Professional healthcare, Healthcare professional, HIPAA, Healthcare services

Telemedicine is a means to connect with a healthcare professional via smartphone, tablet, or computer. That is all you need to hop on this train. Sometimes, we use words like telehealth and virtual visits to describe it.

Ordinarily, it connects you with a provider like a doctor or a therapist remotely over a secure line. As a matter of fact, the patient makes use of an app to connect with them.

Sometimes telemedicine portals use a version that involves texts only for patients who may not speak or see each other.

Telemedicine often serves as a tool to diagnose and treat a new health problem, but it is also used to see a long-term diabetic or chronically ill patient. It is more than going for a prescription refill, although doctors can write prescriptions, if needed, after a virtual visit. That involves antibiotics, anti-allergies, or dietary supplements.

Where Can I Get Telemedicine?

Providers such as individual practices and hospitals are rich outlets of telemedicine. Providers are urging the patients to see them using telehealth channels during the outbreak. Search by calling your local hospital or simply put a query in Google to search for the best telehealth companies.

The federal government is committed to helping people with Medicare, i.e. citizens aged 65 and above as well as the younger slot who qualify due to disability through telemedicine. This trickles down to the state level where local governments are urged to expand telemedicine access to help people with Medicaid, i.e. people with low incomes.

Until now Medicare coverage of telemedicine was limited to rural areas where patients did not have care facilities like state-of-the-art hospitals and private clinics. Many Medicare Advantage plans also provide support for telemedicine. While the providers are busy treating the patients, telemedicine returns in the form of collections are good enough. Medical billing services play their part to full effect.

How Much Does It Cost?

Prices are variable. However, since the telemedicine initiative is being promoted, the prices are being waived off by many companies. It is to inspire them to use this outlet as their health companion.

It helps to check with your insurer or employer to see if it is part of your health plan. The plan may not offer specialty services like virtual therapy sessions or include only limited access.

For people without insurance, some telemedicine providers do give the option to pay out-of-pocket. The charges differ from provider to provider. Whichever company you choose, under the law of HIPAA, the texts of diagnosis and treatments are completely secure.

What Illnesses Can Be Sorted Out by Telehealth Services?

Some of the illnesses under telemedicine include sinus infections, seasonal flu, minor injuries, fevers, etc. Before you begin to doubt it, let me assure you that telemedicine saves you physical visits to the doctor’s office or pharmacy store.

Dermatologists can use it to treat moles and warts. Acne, pimples, blisters are additional examples for which they can offer their services. Moreover, therapists can be a source of calmness to patients suffering from anxiety, depression, and stress episodes during the pandemic.

Cyber consultation in case the patient has flu-like symptoms can be a relief. They have preprogrammed questions to gauge the health condition, and, immediately prescribe a remedy.

The Limits

With benefits come certain limitations.

A virtual doctor is unable to treat medical conditions in which the patient suffers from chest pains, fractures, or wounds in need of stitches. The virus test is also not available through this source.

Patients Need Time to Adapt

The association of gadgets such as your smartphone with healthcare has been there for a while but it is put to use with the spread of coronavirus nationwide. It will have lasting effects on the future of healthcare; patients who will get better will become its promoters.

If it doesn’t involve their regular doctor, they may be reluctant to try it all together. Additionally, awareness to make use of telemedicine in routine when the pandemic is over could send help where it is needed the most.

PHI, Protected Health Information, EHRs, Electronic Healthcare Records, Healthcare, Healthcare Solutions, HIPAA, Medical Billing and Coding, medical billing company, Medical Billing Services

What every physician needs to know about PHI?

Protected Health Information (PHI) refers to data that is collected and managed during the diagnosis or treatment process and identifies each patient.

In simple words, PHI is all the information in medical records including the conversations during the treatment, medical billing and coding, and the health insurance data. Generally, medical billing services have to deal with all such information. Therefore, they must conform to the HIPAA rules.

HIPAA – Compliant Medical Billing Services

Any information related to patients and their healthcare plans is sensitive and can be misused. Thus, medical billing companies should compile medical claims in a protected environment to prevent confidential data from being leaked under the rules of HIPAA.

HIPAA – Health Insurance Portability and Accountability Act focuses on:

  • Making identification information private
  • Using patients’ information only during the course of healthcare
  • Disclosing private information only to relevant and trustworthy parties

PHI Includes

  • Billing information from medical billing services or clinicians
  • Contact information
  • Medication and prescription statements

Information like blood pressure reading and burned calories are not considered in the PHI category.

Securing healthcare information is one of the major responsibilities of medical billing services. Any medical billing company failed to take measures in this regard unconsciously exposes their clients to a serious financial threat.

It is to remember patients have the right to access medical records anytime. However, HIPAA restricts access only in specific circumstances.

Healthcare organizations or medical billing companies on their behalf need to educate patients about their rights; otherwise, the idea of the progressive healthcare industry won’t work.

HIPAA Compliance Is a Must for PHI

Data that is personally identifiable to the patient and that can be disclosed to a covered entity is considered HIPAA-protected PHI.

Therefore, HIPAA compliance is a must factor while catering to PHI. It is also to remember that these rules fall under the jurisdiction of the law. Any healthcare organization or medical billing company that fails to meet the compliance rule may have to face penalties from authorities.

What Can We Do to Protect Data from Hackers?

As technology is evolving and offering reliable storage solutions, managing data on papers is not feasible. Electronic healthcare records (EHRs) propose a better solution, provided strict actions are taken to secure data in all formats.

Healthcare organizations and other stakeholders of the healthcare industry need to design and implement a strategy that safeguards the integrity of data on all levels be it technical, physical, and administration.

Such small steps lead us towards a reliable and seamless data transmission, making an empowered healthcare system.

EHR system, EHR technology, EHRs, Healthcare, HIPAA, Meaningful Use of EHR

The Future of Meaningful Use (MU) of EHR Systems

The Healthcare industry is moving at a fast pace via Healthcare Information Technology (HIT). Everybody knows that electronic healthcare records (EHRs) are the most advanced practice of innovation in the healthcare industry. The meaningful use of EHRs (MU) is not limited to a certain sector of healthcare, which is capable of heavy investment. In fact, it is widely accepted by physicians of every scale and expertise.

Healthcare Chief Information Officers (CIOs) are making sure that their organizations maintain a certain standard of interoperability. Only this way, the actual progression in the industry will be observed.

HIT leaders’ investments in EHRs are not substantial only for today’s use, but they have an eye on the future of meaningful use of EHRs. EHRs are already an advanced form of technology, making patients and physicians empowered.

So what is the Future of Electronic Healthcare Records (EHRs)?

According to the officers of Healthcare IT and the leading EHRs vendors, automation, telemedicine, and advanced analytical tools will have a huge impact on EHR technology.

Impact of Automation and the Advanced Analytical Tools

The automation in the care services in diagnostic, treatment procedures, and in administrative processes has cut down costs. It helps physicians to focus their attention on the work of their expertise, rather than on managerial issues.

The same is the case with Genomics – Informed Medicines which require the genomic information of a patient for his treatment. This approach is quite useful in understanding the diseases’ causes and their impact on patient’s health. This type of medicine also facilitates preventive medicines. Thus, the dimension of reporting of medical records will change drastically.

Telemedicine is the discipline, in which patients and physicians are not present in front of each other. As this technology will strengthen its place in the near future, the way one access, and views EHR will be changed. The virtual delivery of healthcare services has transformed, and this will affect the outcomes of the interoperability measures.

In short, there are different ways to leverage healthcare services. Thus, the devices and algorithms to process or detect illnesses will require a different recording method.

For Example,

How EHR will react towards diagnostic procedures conducted in a home setting, but the test result been given back to the medical organization, especially, when they are to be given to an algorithm or machine as well.

How Increased Interaction Influences Meaningful Use of EHR?

With technology advancement, the virtual diagnosis will move towards increased interaction and user satisfaction. In addition, it will reduce unnecessary cost expenses.

The accommodation of innovation techniques will be difficult to manage as tangible results. Thus, the Meaningful Use of EHR in the future will be helpful in recognizing serious health areas, and it will be using machine learning and predictive models to support the latest technology.

Developing such, intelligent EHRs will be challenging when there is a big issue that is the complexity of the EHR system to handle a large amount of data.

Health IT leaders predict that human-centered designs will resolve this problem. Cloud-based service and aligning work operations to support mobile services will increase the efficiency of electronic healthcare records (EHRs).

With a cloud-based EHR platform, interoperability will also increase via improved security features and the HIPAA-Compliance will be possible to a greater extent.

Mobile-Based EHR Systems

Even today, many professional EHR vendors have developed systems that offer specific functionality of EHRs on smartphones. Everybody knows the accessibility and the scalability of mobile-based systems. By completely incorporating this method into reality, medical records will be at their fingertips and the physicians-patients engagement will be easy.

The main purpose of EHR technology is to support a large population of data without any redundancy. The second purpose is to streamline artificial intelligence to increase a better understanding of healthcare data and remove vulnerabilities in the healthcare system.

Get Ready for the Highest Level of Interoperability via Meaningful Use EHRs

Cloud-based APIs will have a great say in the progressive healthcare system. Smart applications and the additional medical components will form the base of a more secure healthcare system.  The only need is to accept change with open arms.

Healthcare, Healthcare professionals, Medical Billing, medical billing company, Medical Billing Services, Medical professionals

4 Definitive Methods To Skyrocket Your Medical Practice

When we talk about regaining health, it is time to stay in that thought for a little longer and think about those who cure us – the healthcare professionals. We can’t leave them too far, behind when we know health is only a matter of time. Falling ill to a disease awaits us at the other end of the road we know as life.

Since medical professionals are the healers, the motivators, the role models, the mentors in some cases, and without them, the US healthcare system will come to a halt, we will find ways to uplift their practice.

If anyone deserves a reward, it is them. The system depends on them to survive and move forward. Whatever the case may be, when we get sick, we go straight to the hospital. If we decide to stay at home and do nothing about the situation at hand, we only make things worse.

It’s time to give something back to them which may benefit them in some way.

Revenue Cycle Management (RCM) is like the central nervous system of medical practice. If it flows flawlessly, it enables steady revenue and things are good. We will touch upon medical billing services, accounts receivables (AR Management), follow-up on the pending claims, patients engagement,  promoting interoperability (PI), and HIPAA compliance. All of these factors contribute to the success of the medical practice.

1. Outsource Medical Billing Services

It may come more as a reminder to you. By relieving the in-house staff of the medical billing process, providers are able to improve the cash flow. It allows them to care for visiting patients and listen to their problems attentively.

The nurses and clinical professionals are not there to figure out the next accounting glitch or remember thousands of medical codes. It is the job of the medical billing and coding professionals to do that for the practice.

P3Care is one of those positive startups which only recently came to the scene and made it big. To reach the top in only a few years pays heed to their hard work and willingness to excel.

To find and hold on to the right medical billing solutions is probably the best way to increase overall collections. When someone authentic comes on board, physicians are able to see the overlooked pile of accounts receivables and ample delay in claim submissions.

The first-time clearinghouse acceptance rate suddenly goes up in the mid-90s. No matter what you do, denials are still going to happen but what matters is the time you take to work the appeals and resubmit the claims.

2. Demonstrate HIPAA Compliance

It is necessary for medical professionals to show HIPAA compliance. Every individual or organization that interacts with Protected Health Information (PHI) is bound by law to implement measures for its safety, physically and virtually.

You must be aware of the minimum requirements of HIPAA as a covered entity and a business associate because they will keep you safe from penalties. When there are no extra fines, the practice becomes an automatic success with a smooth flow of revenue.

OCR penalties are happening and relate to the nature of HIPAA violations. Therefore, get rid of the non-compliance issues as early as possible to save your medical practice from a big financial & reputational loss. Patients are aware of their rights and if there is a breach in their electronic health records, they may just never see you again.

As a doctor and a hospital, HIPAA compliance brings in reputational advantages along with the trust of the patients.

3. Make the Practice Interoperable – Meaningful Use (MU) of EHRs

Meaningful use of EHR

The EHR incentive programs now turn into Promoting Interoperability (PI) programs. The name says it all for them. CMS changed its name to promote interoperability – The health information exchange (HIE) between providers and hospitals regardless of the variety of EHR systems.

PI becomes the new meaningful use of EHRs. All of this facilitates and spreads the data across networks so that it is available to the healthcare professionals on demand. If you use a CEHRT and you are on the list of providers signing the Trusted Exchange Framework and Common Agreement (TEFCA), it will take you a step ahead of others and the Department of Health and Human Services (HHS) may consider you as a compliant healthcare services provider.

It adds to your reputation and status as a medical practitioner. Patients vote in favor of those providers who follow the principles and regulations in order to improve the quality of care.

4. Focus on Increasing Patients’ Engagement

Another factor that contributes greatly to efficient revenue cycle management and is patients engagement. “Empowered Patients” is the motto of the modern healthcare system. Technology does not only make everyday life easy. It also supports the idea of easy accessibility and affordability of value-based healthcare to everyone.

If a medical practice incorporates technology to makes things convenient, there is nothing better than that.

For this:

  • Implement tech-integrated practical solutions to reduce the administrative burden
  • Make a user-friendly website to book online appointments
  • Offer friendly reminders to patients beforehand appointments

These small steps need a little investment in the start, but the outcomes are worth a try for increased revenue and a prominent reputation among competitors.

Final Thoughts

The above-mentioned techniques can push your practice to a new level that favors you and your patients. In addition, if you take these three steps, the federal authorities will be on your side. They will mention your name as someone showing compliance with the law on their social channels, web portals, and newsletters.

The methods are unique to what people usually expect to read under this topic. They bring in more patients as the ‘trust’ in the institution motivates them to do so. Apply them and become a successful value-based clinician.