Practice Management – GoSoft

5 Tips for Medical Practice Websites

GoSoft Services — Mon, 21 Sep 2015 03:58:54 +0000

Medical Practice Websites are “the new storefront” these days, and medical practices should not be missing out on the opportunity, says one expert. However, he points out that they “are a constant evolution,” and so it’s important to “lay the right foundation.”

Mike Cuesta, director of marketing at CareCloud, a Web-based medical practice management software firm in Miami, offered some tips for medical practices when it comes to creating and maintaining websites.

[See also: 5 reasons medical practices should ‘check in’ to Foursquare ]

Patient registration and forms. Ensure patients can make appointments, register and access important forms no matter where they are. Cuesta says practices can use a patient portal or provide a PDF version of the registration form on their website. Putting the registration form under “new patient” or “welcome” on one’s site will allow patients to find it easily, he adds.

Timely news and updates. Make sure to display recent blog, news and other alerts or updates to make sure the website looks fresh and timely. This helps patients feel comfortable that their doctor is engaged with the community and current issues. It also makes the practice look “fresher, bigger and more sophisticated,” says Cuesta. Practices will also be “rewarded’ by Google, he says, if they show they are constantly updating, the site and “will rank higher than other practices.”

Accessible contact information. Display contact information clearly on every page. Cuesta recommends putting it in the top right corner. Also, make sure it shows up on local search results, and include the address on the footer of each page.
Patient education resources. Patients are relying more and more on the Internet for medical information and news, which can often lead to confusion and inaccurate diagnoses. Cuesta says medical practices should provide patients with their own content, links and resources to help with research while ensuring it’s aligned with their treatment plans.

Services and insurance. List all services and insurance companies your that are accepted, says Cuesta. Practices should keep this open-ended, he adds, so that if the patient’s insurer is not listed, he or she can call for options. “The financial responsibility is moving more toward the patient. The end goal is to educate on them on what their financial options are,” he said. For example, some practices are now taking cash, he said.

Cuesta also said practices should provide mobile access to the website and local search optimization. Local search optimization can be provided by using a free Google directory – called Google Places for Business – and Yelp, a directory that is driven by comments and reviews. Yelp is commonly used to find restaurants, he said, but there is no reason why doctors should be left out.

Best Practices in Revenue Cycle Management

GoSoft Services — Mon, 21 Sep 2015 03:49:50 +0000

Best Practices in Medical Billing: Steps Nine, Ten, Eleven
Billing and collections. It sounds straight-forward, routine even. Something that is done in thousands of medical offices with qualified professionals. Most physicians themselves have a general understanding of how the medical billing process works:
Enter patient information into an EHR software program.
Entering CPT and ICD-9 codes from the superbill into the patient’s record.
Electronically Transmit claims to insurance providers.
Receive an audit report, review/correct errors, resubmit rejected claims.
Post payments to patient accounts.
Review each patients account to access which bills have not been paid on time.
Follow through on delinquent claims, if any by calling insurance providers.
Repeat steps 1-7 every day.

However, just because a medical biller is performing these steps, it does not mean she/he is fully doing the job of a medical biller. As time goes on, most medical practices realize that there is more involved than just billing patients and collecting money. Some physicians and staff realize there are better ways to perform medical billing, but just don’t know where to start. These “better ways”, or best practices, can make turnaround time for collecting money more efficient, coding more effective and insurance claim approvals increase. But for others, figuring out the “how-to” to improve these items can be confusing and frustrating.

Who should be informing me of the best practices in medical billing?
Physicians are very busy people. Not only are they seeing patients, writing up charts, and keeping up to date on the latest medical innovations, they also have to run a small business if they are in private practice. Good physicians are always trying to stay on top of the latest medical research and technology to better take care of their patients; they must also use this approach to take better care of their business.
One way to solve the best practices issue is to outsource medical billing to a specialized company. But not all companies are equal in providing medical billing services. Sometimes, companies that are providing medical billing are only going through the steps listed above, routinely, day after day without any kind of feedback to the medical office they are serving.

How then, can a physician’s office stay on top of changing billing information while also learning of best practices to improve the medical billing process? The answer is having an outsourced medical billing company consistently review their medical billing practices and then discussing this review with physicians.

The Ninth and Tenth Steps… and why they are important
Most people could agree than in any profession, reviewing processes and procedures in place to determine if any changes could be made for improvement is a good idea. If a new process saves money, improves efficiency, and increases productivity, these are all beneficial to a practice. The same can be said for medical billing as it deals with the primary cash flow in a medical office. By reviewing processes and procedures in medical billing, improvements for coding and billing insurance companies will reduce the number of bills not paid over 120 days. And which medical practice would ever admit that they like it when bills routinely run over 120 days? None that we have found!

Ultimately, consistently reviewing and implementing process improvements in all the tasks listed above is an essential ninth step for medical billers. How would they do this? First, having procedures in place that they consistently perform. Second, creating a plan to review these procedures, how they are implemented, and when. Third, strategies or ways to make the changes needed, then communicating them to the physician and/or practice manager.

Discussing and reviewing these changes with the physicians is an essential tenth step for qualified outsourced medical billing companies. This type of feedback to physicians will explain what has changed in the industry and recommendations for improvement. These improvements, as noted, usually lead to increased cash flow, reduced billing times, and improved claim acceptance to insurance providers. Discussing this information with physicians and practice managers leads them to make better business decisions and helps them plan for the future of their practice. It also has an additional benefit of strengthening relationships between the outsourced company and internal staff, building trust and goodwill.

How do I know if my medical billing partner is performing this task?
Now that you know how important the ninth and tenth steps are, how do you determine if your outsourced medical biller is providing you with this feedback?

Here are some questions to ask:
Is my medical biller looking for ways to increase productivity and profitability?
Are they looking at performance standards of staff, both in the office and the outsourced staff?
How often will my outsourced company provide me with helpful recommendations that will improve my processes?
Will they help train my staff if any problems arise after feedback is given?

A good outsourced medical billing service will provide feedback in all of these areas. They will routinely review procedures of medical billing to improve billing, payment, and records keeping. They will also have extra materials for training, staff on hand to answer any questions for office staff, and will perform a best practices comparison.

But they will also do more than that. Knowing the unique needs of each physician’s specialty is important. Providing unique, specialized feedback based on a physician’s specialty is crucial. Coding issues or insurance changes to specific specialties need to be incorporated into procedures and done in a way that increases productivity, not bogging it down. This is the eleventh step of an outsourced medical billing company: recognizing unique billing requirements of various specialties, and providing solutions for these requirements.
Clinic Service performs all of these tasks, offering free, ongoing consulting to continuously improve, performing a best practices comparison, and providing quarterly reports to physicians and staff. We have a team of full-time pro¬grammers who work constantly to upgrade and audit our system in order to address the ongoing insurance carriers’ changes and to provide solutions for the unique billing requirements of various specialties. We address unique billing challenges, specialty by specialty.

When choosing a new medical billing outsourced company, see if they offer steps 9, 10, and 11. If they don’t, keep looking.
Medical Billing Process Explained
The billing process of medical billing is simply stated as the process of communication between the medical provider and the insurance company. This is known as the billing cycle. The medical billing cycle can take in upwards of days to months to complete, and at times take several communications before resolution is reached.

The medical billing process begins with the medical care provider patient visit. The patient’s medical record is then updated summarizing the diagnosis, treatment and any pertinent information. This information is then recorded electronically for future account updates.
From the patient record an evaluation of care is determined and a five-digit procedure code is assigned from the procedural terminology database. The verbal diagnosis is also dictated in the record as an additional numerical code. These codes are used in claims during the medical billing process.

The next step in the medical billing process is to transmit these codes to the proper insurance company(s). In most cases this is done electronically using an ANSI 837 file, and is transmitted directly to the company. This claim is then processed.
Medical claims adjusters or examiners usually process claims, but when higher dollars are involved sometimes a medical director will evaluate the validity of the claim. Once the claim is approved the medical provider is reimbursed based on a pre-negotiated percentage. Any rejected claims are sent back in the form of Explanation of Benefits or Electronic Remittance Advice.
If the provider receives a rejection during the medical billing process they must review the message, reconcile, make corrections and resubmit the claim. This exchange might be repeated several times before full reimbursement is made. Trying as the rejection process may be, the provider has to show patience during this time.

The number of rejections, denials etc. has been known to reach as high as 50%. This is mainly because of the complexity of the medical billing and coding system. Another reason for this is insurance companies denial of services not covered under the policy. Proof comes into play here and one can usually see success in overturning the original decision of denial.

5 Best Practices To Ensure A Smooth, Expedient ICD-10 Transition

GoSoft Services — Thu, 27 Aug 2015 05:51:24 +0000

5 Best Practices To Ensure A Smooth, Expedient ICD-10 Transition
by Jasmine Pennic 08/11/2015

The ICD-10 Compliance date is looming and it is imperative that healthcare providers be prepared to make the transition. It affects everything from claims processing, physicians’ workflow, and patients’ access to care. Many organizations may be rallying employees and resources in order to make the switch from the ICD-9 to the ICD-10 coding for medical diagnoses and inpatient hospital procedures before the implementation date of October 1, 2015.

To make matters worse, the transition is not easy, but a major undertaking with nearly 19 times as many procedure codes and almost five times as many diagnosis codes in the ICD-10 than in the ICD-9. While the ICD-10 switch is definitely necessary, as the outdated and clinically inaccurate ICD-9 has not been updated since its installation, in 1979, the ICD-10 stands to enhance the quality of healthcare, improve data for epidemiological research, as well as enable physicians to make better clinical decisions. However, this is dependent on the ability for the healthcare industry to make a smooth and accurate transition to the new International Classification of Diseases, according to Richard Milam, president and CEO of EnableSoft

In order for healthcare providers to successfully meet the ICD-10 deadline, Milam suggest five best practices to ensure an expedient, smooth ICD-10 transition:

1. Employ Robotic Process Automation That Does the Work for You

“You” is meant to imply the entire organization because that is how many resources it will take to have the ICD-10 switch completed by the deadline if Robotic Process Automation is not used to update and add the multiple new codes into EMR, NDC, medical billing, and claims processing data systems. Certain softwares may have to upgraded or replaced to support the 68,000 diagnoses codes and nearly 87,000 procedure codes; however, through a series of human-directed scripts, Robotic Process Automation technologies will populate the specific fields in the data systems with the ICD-10 data required. The already costly transition to the new ICD-10 can be mitigated by not having to outsource or hire new employees to enter the new codes manually. Furthermore, the data transition can take place over the course of a few days, not a few months, ensuring healthcare providers will be ready to transition to using the new ICD-10 codes.

2. Test Your Software

Not only should you confirm with your clearinghouses, billing service, and payers that they will be upgraded and compliant with the ICD-10, but when they will be ready for testing to occur. Robust end-to-end testing must occur with your software in order to ensure claims are being accepted properly and processed by insurance contractors, Medicaid, Medicare, and other payment processes are operational. Test internally to ensure transactions can be generated and sent with the ICD-10 codes and test externally to ensure the transactions are successfully received by payment providers and that the payment can be processed correctly. After October 1, any ICD-9 codes used in transactions will not be accepted for services and will be rejected for payment. Failure to test your software properly can result in disruptions in patients’ receiving the treatment they need and receipt of due payments.

3. Educate or It All Falls Down

The updated, enhanced medical coding that is to enhance and improve patient diagnoses, performed procedures, treatment, and billing will not prove capable of these abilities without humans to employ its codes, terminology, and procedures appropriately and correctly. You must educate your staff about the changes to the ICD-10 and perform practices and routines in order to prepare for the change. Have each of your staff participate in educational seminars in order to become informed of the changes and how that will affect their position, the procedures patients are to undergo based on the new diagnosis codes, as well as the improved treatments that patients are to have performed. Assist and inform staff by identifying the 50-100 most commonly used ICD-9-CM diagnosis codes based on specialties and determine the equivalent ICD-10-CM codes, and have this information accessible before and after the implementation of the ICD-10. Having your staff prepared and knowledgeable about the ICD-10 will reduce delays in patient care and procedures, which is the reason for the ICD-10—to deliver improved diagnosis and advanced medical treatments that will enhance patients’ quality of care.

4. Implement an Effective Communication Method and Coordinate Conflict Resolution

While making the data transition and update to the new and diverse medical coding that is in the ICD-10, it is imminent that there may be delays in processes, confusion over coding and form completion, as well as workflow changes. Make sure your employees know who they can contact or call on if they are unsure of what code to report, how to complete a form, or other transitory questions that may arise following the implementation of the ICD-10. Identify leads and supervisors for each workflow and specialty area that will be available for their staff requests and questions, and make sure those individuals are highly educated on the ICD-10 and have the authority to execute a resolution. Additionally, determine how transactions handled just prior to the compliance date will be handled in order to ensure payment processing will occur—and more importantly—patients are covered financially and receive the best treatment. Identify critical areas or procedures that may be challenging to transition to using the ICD-10 and have practical resolutions for those practices ready to be executed if, and when, needed.

5. Obtain the correct medical documentation and update your forms to support the ICD-10.

Patient intake forms, EMR forms, insurance forms, and superbills must be updated to support the ICD-10 codes. In order to have patient medical records completed correctly and treatments performed effectively, in addition to have payments process, healthcare providers, clearinghouses, and payers must update their forms to reflect the codes in the ICD-10. Physician forms must be updated with the new medical terminology and diagnoses and procedural codes, along with superbills. Identify categories of uncommon services and diagnoses and determine units, time, and cost for each category in order for physicians to be able to report in the EMR and on superbills. Determine and have readily available a list of common or most frequently used abbreviations to ensure they are utilized correctly and correspondently with the ICD-10 terminology and codes. Lastly, and this goes without saying, obtain the updated and correct documentation that will stand as educational and reference material in regards to the ICD-10. The American Medical Association publishes the ICD-10 codebook and other supplementary documentation on topics such as anatomy and physiology, mappings, and coding workbooks. Make sure to have these ICD-10 Bibles available, and in all areas, for staff and physicians to reference when needed or desired.

The healthcare industry is about to embark on an intense change in treatment, reporting, and payment processes as the ICD-10 Compliance date approaches. While the ICD-10 is definitely necessary to reflect advances in medicine and detailed diagnoses, the change is extremely disruptive for healthcare providers. By employing efficient technologies and engaging effective strategies, healthcare providers can execute the ICD-10 transition quickly and accurately by the compliance date.

Meaningful Use Reporting Span Will Shrink to 90 Days in 2015

GoSoft Services — Fri, 14 Aug 2015 20:38:05 +0000

Robert Lowes
Disclosures | April 10, 2015

As promised, the Centers for Medicare & Medicaid Services (CMS) today formally proposed to shorten the reporting periodfor its meaningful use incentive program for electronic health record (EHR) systems in 2015 from 12 months to 90 days.

The shorter time frame applies to physicians who are new to the program in 2015 as well as those who’ve participated before. In 2016, only first-time participants will be eligible for a 90-day reporting period.

The shorter time frame, sought by organized medicine, will make it easier for physicians to satisfy the requirements of the incentive program and avoid a penalty. Physicians also will be able to schedule their 90-day reporting period for the latter half of 2015, giving them more time to install an EHR system and train on it.

The program is designed to encourage physicians to use EHRs in specific ways — such as prescribing electronically and compiling medication lists — that improve patient care and lower costs. However, medical societies have complained that the requirements are overly burdensome and not always relevant.

Today’s CMS proposal relaxes the meaningful use program in other ways besides shortening the reporting period. The government said in a news release that it would reduce the number of reporting requirements by winnowing out those that “have become duplicative, redundant, and reached wide-spread adoption.”

And some requirements that make the cut will become less onerous. Right now, 5% of patients in a physician’s practice must access their records electronically under a requirement in the program’s Stage 2 phase. Criticized for making compliance dependent on something a physician can’t control, CMS is proposing to lower this threshold to 1%.

More information on today’s announcement is available on the CMS website.