Medical Billing Blog

You'll find anything and everything related to medical billing on this blog. Great tidbits to solve common problems, medical practice management tips, coding info, how to find great medical billing software within your budget. Troubleshooting tips and much more!

Jul 21, 2013

Protect Your Medical Billing Data. Back It Up!

Consistently backing up your medical billing software data is essential for maintaining the financial health of your practice. Hard disk crashes happen more often than you think and they expose you to significant financial risk to say nothing of the time needed to recreate your data. The need for a consistent backup procedure is even more urgent when you consider the addition of electronic health records to your practice.

I have received more than my share of technical support calls requesting that I restore the practice data after a hard disk failure only to find that there is no current backup available.

How does this happen?

First, at the risk of stating the obvious, what does a backup program actually do? It finds your medical billing data on the server or hard drive and makes a copy of it and places it at another location you specify: a tape drive, external hard drive, CD, flash drive etc.

How do problems occur?

Common reasons include: the source data location changes during a software upgrade. The backup device is full, is moved, or simply fails. The backups are no longer created because the scheduling function on the backup program terminates.

What can you do to prevent backup failures from happening to your practice or medical billing service?

  • If you have an automatic backup system on your server, your hardware technician should make regular visits to your office to ensure that everything is working properly. Ask the technician to explain to you, in detail, how the backup system works. You should know the location of the source data on the hard drive and what device the data is being backed up to. Find out how to check the device to verify the backups are actually being created. Document these steps on paper.

  • If you perform manual backups, educate yourself and other office staff on basic computer skills like copying and pasting files, how folders work, the path of your data, etc. Your hardware technician can also help you with this. You need to know where the data is located (what path) and where you want to back it up to i.e. a flash drive, tape backup, CD, external hard drive.

  • It’s a good idea to rotate your backup disks and routinely take a current copy of your data offsite.

  • In addition to backing up your data in the office, consider using an online backup service. These backup systems are reasonably priced and easy to set up. Once the original backup is done, the service backs up file additions and changes throughout the day and stores the files securely offsite.

  • Finally, if you don’t want the hassle of maintaining backups at all, consider web-based medical billing software or an ASP model instead of desktop software.

Jul 03, 2013

EHR - Evaluating Office Visit Templates

It’s important to have realistic expectations when choosing an electronic health records system because seldom do we get 100% of what we want out of our software. There are many features to consider and they depend on your type of practice. If you treat diabetic patients, you want great lab functionality. If you are a specialist who wants a specific layout to the chart note that you send to referring physicians, then note format customization will be important to you.

Ultimately, providers are most interested in how an EHR will help them to create chart notes and there are almost as many methods to create notes as there are EHR systems. Generally, it’s safe to say that the lower the cost of the EHR system, the more simplistic the features are when it comes to creating a chart note. That means more typing and more mouse clicks.

I’d like to start this discussion with one of the simplest type of template so I am using Practice Fusion as my first example. You can see a very brief video of the visit note template on the Practice Fusion page of our website. Here are some details regarding Practice Fusion charting:

  • Pre-populated with templates for your specialty
  • SOAP note or a blank note formats are available
  • You begin with a blank slate and click on template line items and pull them into the note
  • Type in your variables using a fill in the blank style
  • Diagnosis codes must be entered manually. Templates do not contain diagnosis codes
  • Customization features are very limited at this time
  • You can use voice dictation software although speed can be an issue
  • Iphone type devices can be used via remote desktop or android tablets with honeycomb

The one thing that’s great about Practice Fusion is that it is a free system so it doesn’t cost you anything to try it out to see if it will work for you. It is important to realize that you are charting from scratch on every note. You don’t begin with pre-organized text that you just add or detract from.

Convenience always has a price. Still, if your chart notes are straightforward or you can use voice dictation software, it may be adequate for your practice.

Jun 26, 2013

Outsourcing Your Billing - A Cautionary Tale

Outsourcing medical billing is one of the most important business decisions that a provider can make in his practice. Lack of time and pressure to cut overhead costs often lead practitioners to make choices based solely on price. This can have disastrous results as demonstrated by the following true story. It perfectly illustrates the English proverb, “if it sounds too good to be true, it usually is.”

My experience in medical billing software training and support gives me an opportunity to directly observe what works and what doesn’t work in the small medical practice and to share that information on our site.

Several months ago, I observed firsthand what can go wrong when outsourcing medical billing and coding is based solely on price. Only the names have been changed in the following true story:

Recently, a medical biller named Mary called me to request my help exporting patient data from her medical billing software for one of her physician clients, Dr. Smith. He had given her 30 days notice that he was switching to a new medical billing company. This surprised me because I’ve worked with Mary in the past and she is very knowledgeable, meticulous, and conscientious. Mary felt she had done a good job for this doctor and asked what prompted him to make this decision. The answer was simple. Dr. Smith had been approached by a medical biller named John offering a rate of 6% rate instead of the 7% he was paying Mary. I agreed with Mary that 7% is a very reasonable rate for Dr. Smith’s pediatric practice. Based on the amount of work required, there was no way she could afford to match the rate John offered.

I exported the doctor’s data as requested and sent the data file to John. A week later, he called me with some questions and I discovered he was doing Dr. Smith’s medical billing on a free web-based system. I knew Dr. Smith ran a busy practice and I suggested to John that he might need a more robust and efficient medical billing software product which he eventually purchased from us.

While installing the new system, I asked John how many modifier fields he wanted displayed on the transaction entry screen. He asked me, “What’s a modifier?” I could hardly hide my shock when I explained what a modifier is. It was at this point John realized why some of the Dr. Smith’s procedures were not being paid. I recommended that, if he wanted to keep this account, he obtain some medical coding training. I emphasized the importance of acting immediately to avoid any further impact to Dr. Smith’s cash flow. John was clearly in over his head.

It is perfectly legitimate for Dr. Smith to seek the best price possible when outsourcing services. However, in this case, I suspect he won’t be realizing that 1% savings anytime soon. The most important thing he failed to do was request references and then CALL them.

Jun 13, 2013

Data Conversions – Avoiding The Pitfalls

I recently worked with a practice that purchased new medical billing software and encountered a problem with their data conversion. Their experience prompted me to write this blog about how to successfully navigate the process.

When moving to a new medical billing software system, it’s helpful to populate your new database with your existing patient records. This saves time and eliminates a lot of data entry. This process is called a data conversion. Usually the data converted are the master files, i.e., patients, responsible parties, providers, insurances, CPT and diagnosis codes, etc.

Some practices opt to also convert transactions and claims. While this programming task is possible to do, it can be very expensive and yield unexpected results. As a practical matter it is easier and less costly to do a demographic conversion only (without transactions and claims). You choose a point in time to begin entering transactions into the new system and continue with the old system until the Accounts Receivable is small enough to manually convert balances. This is called running parallel.

Back to my client who had the problem. The programmer handling the data conversion was familiar with the new system but not the old software they were converting from. He spent all of five minutes talking to my client in preparation for the conversion.

Unfortunately, there was erroneous insurance information in the old system that should not have been converted into the new database. When they asked the software vendor to correct the problem, my client was emailed a long disclaimer… bottom line they will have to pay to have the problem fixed.

What can you do to avoid this problem?

Find out if your existing software vendor can provide assistance in the process. For example, I have helped many offices export their data from Medisoft to a new system.

You have a lot more leverage before you make your purchase. Get a commitment from your vendor for assistance from someone on their staff, (perhaps a trainer or implementation coordinator) to guide you through the process. A data issue is more likely to reveal itself with a fresh pair of eyes.

If you have no one to assist you but the programmer, insist that he review the mapping of data from one system to the other. Maybe you have an unusual data setup due to a quirk in your existing system. This information is likely to be discovered during this conversation.

Ask questions. Don’t assume that your programmer understands the nuances of the medical billing process. Some are very good at what they do because they have learned from previous mistakes.

An ounce of prevention is worth a pound of cure. Following these data conversion tips can save you time, money, and aggravation.

Jun 12, 2013

TotalMD Online - A Great Choice

TotalMD Online is a great fit for the 1-3 provider practice but it is particularly well suited to the medical billing service. Here’s why:

Great Price

TotalMD Online is very popular with medical billing services for good reason. Most web-based medical billing software systems have monthly subscription fees based on the number of providers. With TotalMD, the number of providers you bill for doesn’t matter. The price is a low $99 per user (with discounts over 4 users). This pricing structure has definite advantages for small medical billing services with 1-3 billers whose clients consist of 1-3 provider practices.

The TotalMD per user pricing model is a boon for medical billing services and start-ups whose client base consists of part-time providers who don’t generate much income. They simply can’t justify the higher cost of the per provider monthly fee. Using TotalMD Online, they can finally afford to move from desktop software to online application with all the convenience it offers. No extra hardware costs or backups to worry about.

Most online practice management software services have tiered pricing. Usually, the most affordable package offers basic billing features but you need to upgrade to get other nice-to-have features like automatic EOB posting. Kind of like a basic cable TV package that doesn’t include your favorite station. With TotalMD Online, you get ALL features AND technical support in one low monthly fee.

Great Features and Easy to Use

TotalMD Online is easy to learn and use. The patient ledger is very well designed for easy navigation. Patient account transactions are color coded and easy to read and payment application is simpler than most programs. TotalMD integrates with several clearinghouses, has electronic remittance posting and other great features like email appointment confirmation and integrated insurance verification.

Great Support

If you work in the medical practice or a billing service, you never have enough time so good technical support is really important. When I have a system problem, I don’t want to wait on the phone on hold for an hour, or get an online ticket, fax, email, or chat. I want a live person to solve my problem.

I recently had the need to modify our electronic claims file format to accommodate eight diagnosis codes for a new client. We use TotalMD Online for this practice so I called technical support and I had the new file format I needed by the next day. With my busy schedule, this is the kind of support I really appreciate.

Jun 05, 2013

Use Box 19 To Improve Your Reimbursement

Box 19: The Secret Weapon To Improve Your Medical Billing Reimbursement

The following is a medical billing tip to help improve your reimbursement. In medical billing, we use CPT, diagnosis codes, and modifiers to “tell the story” to an insurance carrier of the services provided to the patient. As a general rule of thumb, it is a good idea to include additional clarification regarding multiple procedures in the event that the codes themselves don’t fully tell your “story”. This is where Box 19 or line item notes come in.

Oftentimes, Box 19 is used to add a 5th or more diagnosis code. However, it is also a useful medical billing tool which may help prevent downcoding and improve your overall reimbursement. Appropriately adding modifiers and line item notes to your procedures may reduce your denials for the reason, “included in another service.”

How your practice management software generates electronic claims will determine where your explanatory notes are entered. Generally, if your claims are sent electronically in ANSI 5010 format, you will probably use an EMC note attached to each charge line. If your claims are sent electronically via print image (or if your claims on printed), you will use the input field for Box 19 (Reserved for Local Use) on the CMS-1500 form.

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