Are you losing 20% of your Medical Billing Revenue?
Twenty Percent. This is how much of your practice or facility’s collections you are allowing payers to keep if you are not properly tracking and pursuing medical billing denials. This is a lot of money during the best of times, but particularly during tough economic times. Your practice needs an effective Revenue Cycle Denial Management system if you want to recapture this lost income.
Some medical billers believe denial management is the same as follow-up, others believe denial management is primarily geared towards dealing with issues around medical necessity. Many medical billing experts simply think as denial management as a description for the overall medical billing process.
A good start to finding out if your practice is suffering from improper denial management is to find out from your medical billing service (or in-house medical billing manager) how they manage denials and how they measure success in this area.
Few billing departments appreciate the value a good Revenue Cycle Denial Management system can bring to a medical practice or facility. A robust Revenue Cycle Denial Management system provides methodical management data for the billing process; the data are then used to (a) increase and (b) accelerate cash flow.
The system accomplishes this needed service by tracking, quantifying, and reporting on every claim billed for which any payer denied the service. The reporting should be comprehensive, tracking all denials (not just selected denials). If used properly, the system can reduce first-time claim denials by over 50 percent. Many practices have no way of monitoring if payers are denying their claims at excessive or unwarranted rates, or even for what reason. These practices are probably losing 10 to 20 percent of their total revenue.
Three elements are typically missing from a practice or medical billing company’s denial management process: data, filtering/sorting methodologies and feedback to systematically correct errors. Most practice management systems do not properly track denials - at least not in the form in which they are typically used (i.e., they may have the capability, but only if properly implemented and used). Those PMs that do track denials typically overwhelm the practice with data that is difficult to utilize for high level denial management. Finally, even if the data is captured and can be properly utilized, most billing groups do not have a systematic way to get the information back into the billing process in a manner that prevents the denials from occurring again in the future.
The standard denial management output should track by payer, the number of claims denied and the reason for the denials. This must be coupled with a dashboard reporting tool for quick visual management. With these reports the billing team can easily identify which payers are inappropriately denying claims; they can also compare these payers to their peers for proper trending and follow-up. This output allows the medical billing team to develop and refine payer specific rules to prevent future payer denials by insuring all claims are clean when they are submitted.
Payers that are chronic violators are pursued to resolve how and when they intend to process and pay outstanding claims. If the issues persist, there may be grounds to charge penalties stipulated by the Clean Claim Law. Only by quantifying and analyzing the problem can a medical billing team discover how to improve on the process.
If you implement a powerful denial management system you can optimize your medical billing and speed up your cash flow. As previously mentioned, a strong denial management system can increase your collections by 20 percent or more.
Copyright 2008 by Carl Mays II
Need Custom Content? Hire a Ghostwriter!
What do presidents, candidates for political office, political debaters and Internet Marketers have in common? Writers. They all need original content.
The political leader engages a speech writer; the webmaster outsources to a freelance article writer. Both entities are ghostwriters who receive no credit for his work. The speaker or webmaster receives all the glory.
Ghost (speech) writers have been utilized by our political leaders for 100’s of years. Perhaps you’ve heard that Alexander Hamilton was the speech writer for George Washington. If that is true, then Alexander Hamilton is probably the most famous ghostwriter of all times.
A ghost writer is a writer who works for hire and upon culmination of the project relinquishes all rights to the project. Nearly all politicians use ghost writers to write their memoirs, correspondence and speeches. Webmasters use ghost writers to write their articles because they either don’t have the time or talent to keep their website updated with original, tailored content.
In this article we are going to explore the process of hiring a ghostwriter to write those original articles for your internet site. Following are a few tips to help with the process:
Be prepared. Do not talk with a ghostwriter without being aware of what you want. Do you require technical data? Will the articles demand in-depth research? How many words do you require? What idea do you wish the article to communicate?
Don’t tell the ghostwriter to “write me an article on weight loss” - a subject that has a multitude of subtopics and methods. If you don’t understand what you want I can promise you the ghostwriter will not please you, no matter how much they charge or how seasoned they are. They are writers, not wizards.
Be professional. If you need to hire a freelance writer but you are clueless as to how much they charge or how they work you could end up losing your shirt. Hop over to Google and search for “custom articles”, “freelance writers” and “ghost writers” and see what they are charging.
Some will post their rates on the Internet. When you find what the “going rate” for ghostwritten articles is you can develop your budget for the expense. Or, after the research you may determine you can’t afford a ghostwriter.
Ask for a quotation. Many times web sites will post their fees so you can easily determine what the project will cost. At other times you may need to ask for a quotation.
Or, perhaps you are posting on one of the freelance websites such as elance.com or getafreelaner.com. As indicated in Item #1 - Be Prepared. Cover the following points in your query or posting: a) article length (words) b) article Topics c) deadline for the finished work d) your budget for article writing, and e) the method of payment.
Be Specific. What do you want? Whether you believe it or not there is a difference in “content articles” for your web visitors to read and “keyword articles” written to improve your SEO (search engine optimization).
Maybe you want both. If so, does the ghostwriter have skill in creating people-pleasing content that will also delight the search engines and boost your search engine position?
Keep in mind your profit margin. Never overpay for your articles. Be sure to keep good records of income vs. expenditures and don’t forget that the reason you are hiring a ghost writer to write those custom articles for your website is to increase the flow of traffic, hence the earnings, to your website.
Slash Your Wage Costs By Using Offshore IT Recruitment Agencies
The Australian Information Technology labour hire is extremely competitive. An outsourcing business could be the answer to your IT staff retention. Not only that offshore IT recruitment agencies will save you up to 60% off labour hire costs. Australian IT staff are expensive due to the many skill shortages in Australia.
If your business is primarily based on the use of computers then the use of IT recruitment agencies may solve your IT staffing needs. By reviewing the positives and negatives of using an outsourcing business you can establish whether it is the right decision for your business. It is now even common for people to work from home instead of going into the office. This is an ongoing change in modern society.
Using an outsourcing business will reduce your costs significantly. Offshore IT recruitment agencies can be used for graphic design, web development and search engine optimization. They are all essential tasks for any business wanting to go online or increase their online profile. Some people use offshore IT staff for copy writing but sometimes jargon between English speaking places is confusing for example Australia and England.
Using offshore IT recruitment agencies also provides you with a larger pool of people to choose your staff from. It is possible to get highly educated, English speaking people to do work of the highest standard if you are to use an outsourcing business. The Philippines has the opposite dilemma to Australia. They have too many degree educated IT staff in the labour hire market. This results in the wage cost being reduced.
Offshore IT recruitment agencies can enable you to get your business online. If your business isn’t doing sales and promotion online, you should start doing so quickly by outsourcing business tasks and skills you can not perform. Nearly 60% of businesses that move to an online presence (requiring offshore IT talent to handle the programming and graphic design duties) get an immediate boost in sales. When factored in this way, you can see how the use of offshore IT recruitment agencies and staff can pay for itself quickly in increased revenues.
If you’ve already got your own business and an online presence, think about using an outsourcing business to cut down on your work load, and focus on the things that make your business excel. People who can code databases are available anywhere. The only person who can really drive the growth of your business is you. Paying for other people to do things for you, enables you to focus on the things only you are able to do. Plus, you get the opportunity to tap into wider range of skill sets.
Offshore IT recruitment agencies are essential tools for improving your business in the modern world. Outsourcing business processes will enhance its abilities without all the financial problems normally associated with business growth and development.
If You Are Not Scrubbing Your Claims You Are Losing Money
Submitting clean claims is critical to a strong medical billing process. A fundamental element of good process design is to catch problems as soon in the process as you can. Correcting a diagnosis error before a claim is submitted may take 5 minutes; correcting it after the claim has been denied will take well over an hour (and it will delay collections by 3o or more days).
Implementing a process that submits clean claims can lead to days in AR of less than 45.
One of the best tools for insuring claims are clean before they are submitted is a claim scrubber. A claim scrubber takes the rules that payers use to adjudicate claims and applies them to the claims befroe they are ever submitted. This eliminates avoidable denials and thus speeds up collections. In addition, it frees up time in the billing process for staff to focus on activities that help increase collections instead of just correcting avoidable problems. Every Medical Billing Company should utilize at least the following scrubbers:
- A minimum requirements scrubber. Such a scrubber insures that the basic elements of the claims are in place (for example, a 9 digit social security number that is not composed of repeating numbers, a valid date of birth, etc).
- Core coding scrubber that compares the claim’s coding to local Medicare and Correct Coding Initiative rules. Such a scrubber should not only identify negative issues (e.g., a diagnosis/procedure mismatch) but also improvement opportunities (e.g., this procedure is typically performed in conjunction with a second, billable procedure, that is missing from this claim).
These scrubbers will lead to a marked improvement versus a billing process with no scrubbing; they are, however, not a complete scrubbing solution. A full solution requires a scrubber that can have a customized rule set that takes the knowledge of the billing company or medical practices and codifies it so that it can be applied to every claim before submission. This scrubber is:
- Knowledge Management Scrubbers that allow the medical billing operation to continually reevaluate the adjudication rules of each payer and update the rules accordingly. The proper implementation of the scrubber requires a clear feedback loop from the follow-up department to the scrubber so that the lessons learned from denied claims can be quickly incorporated in to the scrubber. Any top notch medical billing service utilizes a scrubber like this.
Consistent use of the scrubbers outlined above can decrease a medical practice’s collections cycle by up to 50 days. This is why you need to insure this critical step is being completed no matter who is doing your Medical Billing.
Copyright 2008 Carl Mays II
Use Clean Claim Laws to Make Payers Actually Pay
Clean Claim Laws are currently in place in every state. The assistance provided by the laws ranges from states like South Dakota which has no economic penalty to Texas where the payer sometimes is required to pay billed charges
Clean Claim laws can be a powerful medical billing tool because they are built upon the concept that insurance companies have a responsibility to quickly adjudicate clean claims. The typical law provides 30 days for a payer to process a clean electronic claim. To properly benefit from Clean Claim laws a medical billing company or medical practice must be capable of reliably and systematically keeping track of:
1. Which payers are subject to the clean a claim law (not all are),
2. The date the clean claim “clock” begins (i.e., the claims submission date),
3. When a request for information was received from the payer (if you receive one then it stops the 30 day clock until you respond),
4. When your practice has taken actions in response to payer requests;
5. The date from the payer’s communication about the final disposition of the claim.
The idea of systematically tracking all of this information may be daunting, but with a smart system design it is possible and most definitely a worthwhile undertaking. After submitting a few Clean Claim law violation reports you will see your claims pay faster. I have seen situations where payers have actually called just to assure the practice that claims will be quickly processed.
A quick way to get started with using the clean claim law is to pick a specific payer that you believe habitually delays claims beyond 30 days. Find a handful of claims that have gone past 30 days and then test the water with those claims. This will allow you to learn the basics of using the on-line tool provided for submitting complaints and see the impact of your initial complaints.
Copyright 2006 by Carl Mays II
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