We believe that most of your uncollected revenue is tied-up within secondary and patient balances and represents a significant percentage of your profit. While any competent billing company can collect primary claims, collecting secondary money and patient balances is the difference between an ordinary medical billing service and the true experts. By shortening secondary collection times and minimizing all uncollected amounts, Experics puts more revenue into your practice – promptly and efficiently – so you maintain a positive cash flow.

Here are some other advantages Experics has to offer your practice:

1. Experics’ reports are accurate, timely and easy-to-read. We’re always available with information or to answer any questions.
2. Experics immediately follows up and resolves claim disputes and appeals.
3. With our extensive experience in successfully dealing with audits, we’ll never leave you hanging; by ensuring that you and your staff possesses all necessary documentation to protect your claims and reimbursement.
4. As you’d expect, Experics web-hosted medical billing platform is HIPAA 5010 and ICD-10 compliant.
5. Our system allows on-line patient scheduling with Wait-List Prioritizing to track patient’s appointments, eligibility and determine co-pays in real time.
6. Your claims, patient bills and payments are posted Monday through Friday, so unbilled claims and unposted payments will never pile up.
7. We assess data and claim errors to determine if there are improvements your staff could be making in order to increase cash flow within the shortest timeframe.
8. Your practice will be assigned a dedicated Account Manager, so you’ll always have someone you know who can help answer any question you may have.
9. Our web-hosted medical billing service alleviates the need for expensive IT personnel, training and software updates.
10. Our team of medical billing experts handles all of the daily issues that come with invoicing numerous insurance carriers, Medicare, Medicaid and patients.

Why trust your practice’s cash-flow with anyone but the best? Contact the medical billing experts at Experics today.

Start the Verification Process at Stage 1: 

Electronic Health Records (EHR) Attestation is the first hurdle in qualifying for meaningful use with the Centers for Medicare & Medicaid Services (CMS). There are many criteria that a provider is required to meet in order to attest to use of certified EHR technology as part of their practice.  A medical practice must identify the certified EHR technology they are employing and submit reports on product use to be designated as an EHR-eligible provider and will then be required to provide attestation through a secure medium in 2012.

Eligible providers must also register their intent to seek incentive reimbursements prior to EHR attestation. For more information on EHR attestation criteria, meaningful use and EHR incentive programs, visit the CMS web site.

Beginning in 2011, a web-based registration process was launched on the CMS web site. Eligible providers simply input the following information when registering.

• Name, practice address and business phone
• Tax Identification Number (TIN) to where you want the incentive payment made.
• All Medicare eligible providers must be enrolled in the Provider Enrollment, Chain and Ownership System (PECOS)

During the EHR attestation process, what Information will CMS require? 

To meet Stage 1 qualifications, at least 80% of your patients must have their records filed utilizing certified electronic health records technology. Your web-based medical billing service should provide reports that show your percentage of system usage for each of the Core and Alternate Core measures. As an eligible practice, you’ll be required to report on at least 20 of 25 meaningful use (MU) objectives. Your billing service’s EHR system should provide reports that attest to your use of EHR technology.

Your staff must be capable of performing and reposting the results of a complex calculation required by CMS that is called a “percentage base response”. The determining factors will be the total number of unique patient visits for the reporting period, combined with treatments rendered on behalf of patients whose records are kept using certified EHR technology. Additionally, your medical billing service’s electronic health records technology will need to provide a report on the Clinical Quality Measures you have specified to use for your Stage 1 EHR attestation requirements.

Once you’ve attested to the use of EHR technology, how soon will your practice collect reimbursements from CMS?

Medical practices began registering their intent to use certified EHR technology in early 2011. Then, CMS launched their Meaningful Use Attestation Portal in April of 2011. A useful link is available from the Official Web Site for the Medicare and Medicaid EHR Incentive Programs. CMS began distributing payments in mid-May of 2011 for those attesting in April 2011. CMS payments – on average – take 15-45 days to process, following validated and attested use of your certified EHR technology.

For more information on how EHR technology can reimburse your practice through meaningful use validation or to learn more about our web-hosted medical billing service, please visit the medical billing experts at: www.experics.com or call 772-494-2700. There is no obligation and no high-pressure sale tactics, just professional advice and answers. You have nothing to lose and everything to learn.

 Many physicians are using their systems to document Evaluation and Management ­­­– or E&M – visits but aren’t coding them, because they fear they’d be liable for any errors. Despite the fact that most electronic health record (EHR) systems can assist physicians in assigning codes for evaluation and management services, most Medicare physicians still choose to do it manually.

 The office of the National Coordinator for Health Information Technology under HHS asked the Office of the Inspector General to compile a report examining how Medicare physicians use EHRs to document codes for E&M services. The OIG report found that 57% of Medicare physicians use EHR and 90% of them use their systems to document E&M services, yet most doctors are still assigning codes manually. This indicates a problem: doctors are under-coding services that could qualify for a higher pay rates.

 The report maintained that many physicians don’t have enough trust in EHR systems to use the features that assign codes. Some doctors feel that HHS and the US Dept. of Justice need to create a relaxed atmosphere of trust – meaning that if something is coded incorrectly and physicians can demonstrate they didn’t alter software, they won’t be held accountable to face charges of fraud.

 As it stands now, if fraudulent coding is detected, HHS and the DOJ do not go after the software developers; they go after the physician.

 The number of physicians using EHRs has increased significantly due to the meaningful use incentive programs that were launched last year (2011). Practices can receive up to $44,000 per physician over five years from Medicare and $64,000 over six years from Medicaid if they show meaningful use of EHRs that are certified for the program.

 A report by the Office of the Inspector General of the United States (OIG) found that of the 57 percent of Medicare physicians using EHR at their primary practice location in 2011, 22 percent were brand-new to using EHR. Three of every four physicians using an EHR to document E&M services were using a certified EHR.

 “Something that is lacking in the certification process,” wrote James L. Madara, MD, executive vice president and CEO of the AMA, “is “testing to ensure coding recommendations are consistent with coding guidelines and data entered.”

 The AMA recommends that those charged with testing EHR products for certification ensure that EHRs do not facilitate up-coding and that this safety feature is built into the process.

 While it’s impossible to gauge how manual code assignments are affecting physician revenue, the OIG report said E&M services represented 45% of the top 20 procedure codes billed to Medicare in 2010. This means that if a physician is risk-averse, he or she may tend to under-code, believing it might be less expensive to under-code than trying to handle an HHS/ DOJ investigation.

 Calculating the hard costs is the easy part. Only a few factors need to be taken into account in order to calculate this number. These are the costs of:

1. Salary plus benefits for your billing personnel and supervisors
2. Computers, software, manuals, forms, and office equipment
3. Technical support, software licenses, updates and maintenance
4. Training – including ICD code and 5010-version updates
5. Additional office space for staff and equipment
6. Phones, Internet, heating/cooling, and other basic utilities combined

 A simple worksheet can guide you through making this rough estimate of the percentage of monthly revenue needed to properly administer the billing portion of your practice. It’s not unusual for practices to discover that they’re spending as much as 25-30 percent of their monthly revenue on medical billing, when the average (2012) rate for outsourced medical billing is only 8 to 10 percent.

 Are the above costs all that you’d need to consider?

 When working to assess whether it’s in the best interests of your practice to outsource your in-house medical billing needs, you may also want to take other factors into account.

 The first is absenteeism, which is a common cause of delayed billing. Your practice should not stop collecting receivables just because an employee has a family emergency or death, becomes pregnant or has other extenuating external issues.

 Every procedure performed needs to be billed, yet quite often a physician fails to document one or more procedures because of the harried nature of an average office workday.

 For example; a patient arrives with a “possible fracture,” yet your coding person fails to document an x-ray. Without the support of a professional billing company, compensation for this procedure will (at best) be delayed or (worst case) be lost. A good medical billing service would recognize that – due to the diagnosis ­– an x-ray must have been done and verify the type, number and other details with your office. Medical billing experts are trained to look for situations like this and ask these types of revenue-increasing questions. This scenario or one very much like it could play-out several times in a single month. How many thousands of dollars could your practice be losing because your medical biller is not educated or experienced enough to know what questions to ask?

 With a truly professional medical billing company, you’ll have the benefit of their experience as well as their investment in their employees training and education. They know what questions to ask when reading encounter forms, charge slips or operative notes. They are experts and know what to look for to increase your reimbursements.

A medical billing company offers you technology, the cost of which has been spread over a wide client base, which is usually not available to the average medical practice. The proper technology provides electronic transmissions, which not only reduce the time that elapses between submission and reimbursement, but also improves your cash flow and can even deter rejections before they happen by analyzing the content of a claim to ensure it meets payer-specific guidelines.

With an outside, or third party, medical billing company, rejections are aggressively pursued, because they don’t get paid until you get paid. They have a vested interest in making sure you get paid by promptly amending claims and writing rejection appeal requests.

Finally, remember that software upgrades and the training requirements they create are an ongoing expense. With the recent version-5010 implementation and ICD code requirement, your billing staff will have much more to do than just the day-to-day medical billing function.

These “soft costs” are not as easy to calculate and are often lost or hidden as basic overhead. But when lumped together, they clearly warrant an educated decision on whether to outsource your billing operation or continue to do it yourself. Wouldn’t it be nice to allow your staff the freedom to do what they do best: caring for your patients?

The report outlined the five ways that telemedicine can play an important role in decreasing overall healthcare costs.

1. Remote monitoring technologies. Remote monitoring technology enables patients to be monitored on an ambulatory basis when previously they could only be monitored as inpatients. The shift toward outpatient status substantially reduces the costs carried by the healthcare system.
2. Remote analysis services. Remote diagnostic services can contribute to lower costs and improved quality of care as they enable highly trained professionals to work together as a pooled resource. In smaller communities, there may not be sufficient volume of traffic to keep a pathologist or radiologist fully occupied. Low-volume providers can still employ round-the-clock coverage at a reduced rate.
3. mHealth monitoring technologies. mHealth, also known as mobile health, is the practice of medicine supported by the most commonly used mobile devices. mHealth monitoring technology can reduce the cost of complications due to chronic disease. For example, by detecting an increase in body weight due to fluid retention, it can be deducted that a patient may soon require hospitalization due to congestive heart failure. Health care managers with access to their patient’s daily weight information may be able to help them reduce the fluid retention before a crisis arrives. Crisis aversion improves the quality of care and lowers costs.
4.  At-home triage services. Televisits with nurses or primary care physicians reduce unnecessary and expensive emergency room visits.
5. Telemedicine appointments. By offering telemedicine appointments, providers can reduce the amount of their unused time that might otherwise go to waste. Providers are able to create additional revenue while providing remote patient visits at a lower rate.

Working Together:

The New England Journal of Medicine further reported that by engaging regulators, providers and payers to together, between 50-75 percent of the costs attributed to medical errors could be eliminated as early as 2018. This would reflect an effective cost savings of $8 – 12 billion annually through the application of best practices, telemedicine and the adoption of an improvement methodology that builds upon applied performance data.

 All Medical billing specialists need to be familiar with specific codes and strict guidelines for any type of medical billing. However, cardiovascular billing is considerable more complex, requiring highly specialized skills that come with training and extensive experience.

 As the cost of cardiology-related healthcare services rises, medical clinics, hospitals and cardiology practices can’t be lax in recovering uncollected revenue due to inexperienced medical billing services or at-home freelance billers who are not familiar with the intricacies of cardiology billing. Be mindful that some medical billing services may promote themselves as an experienced cardiology billing service, but have no experience whatsoever.  Some of these companies simply farm out their cardiovascular billing to freelancers who work from a home office. Hiring such companies will lead to lost revenue attributable to their lack of timely processing and proper training.

 A company that doesn’t retain an experienced medical billing specialist in cardiology billing will lack the familiarity of the procedures and proper terminology. Additionally, some medical billing companies may serve one or more cardiologists, yet lack the deeper expertise required for successful cardiology billing.

 Furthermore, if the company is not familiar about cardiology billing, they are not likely to possess the expertise necessary to effectively appeal denied claims, answer questions posed by insurance carriers or support you in an audit.

 A billing service that does not incorporate a wide range of cardio billing experience will find it difficult to track underpays, since multiple procedure rules, gamma camera use and other cardiology procedures have significantly more complicated code variations than typical, family practice claims.

 Often, the billing software and design of a medical billing company will be insufficient for the more complex requirements of reporting and insurance follow-up required in cardiology billing.

 Billing complexities may also extend to patient collections. Patient collections for cardiologists are more complicated, due to larger co-pays owed. Patients who are confused by their bills (often elderly patients) will need them to be explained in clear, easy to understand terms.

 A medical billing specialist with expertise in cardiology billing will handle all of these problems adroitly. Billing services without proper training and adequate experience will increase the risk of lower patient collections and upset or confused patients.

 By utilizing specialized medical billing specialists, cardiologists can avoid all of these billing-related pitfalls.

 You’d never hire a plastic surgeon to perform cardiac surgery! Accordingly, a cardiologist should never hire a medical billing company that lacks experienced cardiology billers.

With fewer medical resources to go around it stands to reason that there is no room for waste. They must all be used with the utmost efficiency.

This is the objective of the new Accountable Care Organizations (or ACOs). Until recently, physicians and other practitioners have been paid per-procedure. Under this pay structure, many providers tended to over-treat. The more tests they ordered, the more procedures they performed and the more times they got a patient to return to the office; the more they got paid. With an ACO, the emphasis is on thorough and accurate preventive medicine.  

Since there is an ever-growing shortage of physicians, ACO practices are rethinking traditional practice structuring and allowing nurses, care managers and other medical professionals to help carry the load. Since ACOs are set up by providers rather than insurance companies, they are nothing like the HMO’s of the past. Patients are not restricted to specific doctors in a plan, but rather can see any physician as long as they fulfill the provisions of their contract with the insurer.

It is encouraging to know that there have been significant improvements reported overall, with improved clinical outcomes, reduced costs, lower re-admission rates and better coordinated care heading the list.

To learn more about the impact Accountable Care Organizations will make on your practice, read our entire article at: http://www.experics.com/?white-papers=accountable-care-organizations-are-one-of-the-latest-new-healthcare-trends  

 There are exciting new ways to tap into the power of social media, which will improve your overall reach and contribute to the success of your practice.

 Social media can provide additional value to you and your medical practice in ways you may not have considered. Patients will appreciate social media access for the available dialogue with physicians who can provide access to health-related educational material.

 According to reports from large consulting organizations released in 2012[i], social media can now contribute to business objectives beyond basic marketing. The reports examined social media as a valuable business communication tool, a customer service strategy and as a way to promote improved healthcare.

 If you own a small family medical practice, it is not necessary to hire a social media team and provide constant monitoring. It’s often as simple as finding communities of people that you or your practice’s physician can monitor and learn from. Using information gathered from these resources will go a long way towards further enhancing your medical practice.

 How can physicians utilize social media to their advantage? We have identified the following 5 types of opportunities:

 1.    Identify needed services. Social media will help you establish insight into what patients need to do to improve their health. Social media feedback provides a means of finding out what services interest patients. For example, you could post an idea for an event, like a blood screening to be held in the community, and ask people what other events they would like to see available.

 2.    60% of patients claim they trust information posted by physicians on social media. From a social media perspective, doctors are becoming aware that posting more healthcare information will benefit their community. Many trends develop on Twitter that could indicate a healthcare need in a community. Social media could also provide a new way of tracking population health. Tracking health trends is becoming increasingly popular and may eventually identify hot spots for disease outbreaks.

 3.    Gaining feedback on medication and therapy: Collecting feedback on medicines and therapy can be one of the most valuable assets offered to a medical practice via social media, as well as one of the easiest to facilitate.  When hundreds of patients begin talking about the side effects of a drug, doctors and nurses have immediate feedback at their fingertips. By monitoring a “buzz” or trend surrounding a certain drug, you will gain real-time insight into how patients are reacting to it. You may learn of a treatment you have yet to try, or an alternative therapy you discover by monitoring patient interactions on social media. Patient communities can be a great source of information for you and other physicians.

  4.    Comparing to improve quality: Social media makes it simple for your practice to observe how it compares with your competition in terms of services offered and patient satisfaction. For example, observing a competing practice’s social media site could provide a family medical practice a “fly-on-the-wall” perspective. And by monitoring the social media activities of competitors, practices still developing their online presence can gain insight on how to fine tune their efforts.

 5.    Improve your customer service. How your practice, clinic or hospital responds to negative comments or complaints may be more effective than positive patient feedback. Complaints made on social media boards can often be addressed or even remedied on-the-spot, because it provides an outlet for doctor-patient dialogue. Practices can respond in public with an offer to correct negative situations so that others can see positive action being taken in real time. Potential customers will also realize that customer service is taken very seriously. This allows a medical practice an opportunity to know about situations immediately, so they can be remedied – not exacerbated by an upset patient. In fact, organizations that are not responsive to patient criticisms through social media are already paying the price. Responding to online feedback should become a priority for every practice.

[i] PwC Health Research Institute and Global Institute for Emerging Healthcare Practices

One of the intended advantages of an HSA was to reduce growing healthcare costs by combining these accounts with high deductible insurance plans. This places a larger portion of the expense on the individual, while lightening the financial load on employers.

In February 2012, a guidance bulletin was issued by the U.S. Department of Health and Human Services (HHS). The bulletin relates primarily to changes in how actuarial values will be determined for health insurance. Though the wording is somewhat complicated, in essence, it takes away the tax advantages to individuals that purchase their own insurance, but leaves the tax incentives to employers intact.

While HSAs make up only a small percentage of insurance plans in the US, this is just another example of how the Affordable Care Act is attempting to reduce the cost of health insurance to the government. Health savings accounts still make sense for employers to offer to their employees, but they are not likely to find their employees as receptive to this type of plan in the future. 

1.  Do annual security awareness training. A HIPPA awareness primer is something everyone in your office should read, understand and sign. Keep it simple: a one-page procedure for understanding protected health information should be all that’s required. Your office should reprimand violators in real time and do random spot checks on the read-and-understand procedures. You should also apply demerits to managers when their employees don’t pass a simple spot check.
2.  Ask your vendors difficult questions. After performing an analysis of any risks or exposure to attacks on your protected health information (and your IP) you’ll know what policies, procedures and technologies are the most effective security controls. Be prepared to ask difficult questions and negotiate terms with your chosen vendors. While it’s advisable to hold your practice’s protected health information close to your chest, it’s also important to discuss security with your colleagues at other companies in order to get a sense of how well their controls perform.
3.  Resist the temptation to do a healthcare data integration project. Healthcare data is stored in many applications and locations within an organization. The typical reaction of IT people is to herd all of your healthcare data into one big data storehouse. You should avoid this at all costs. Most of these projects never deliver their promised value. Even if you are successful in getting all the data in one place, you will also have created a new security risk; all of your data is now neatly documented in one location and easier for identity thieves to capture in one large haul. Would Google have succeeded if they’d pushed all of their global data integration into one data bank? It’s a recipe for disaster.
4.  Prepare for protected health information data loss before it happens. Despite claims that safeguarding your protected health information is strategic to healthcare providers, most practices will not do anything until they’ve had a security breach. This is the equivalent of closing the gate after the horses have run away. The first step to protecting EHR and other sensitive data in your practice is laying the responsibility at the feet of your practice’s management team. Executives need to assume a proactive leadership role with a clear-cut standing on which data assets are important and how much they’re worth to your company.