Blog - Advanced Reimbursement Solutions

5 Signs It’s Time to Change Your Medical Billing Management Company

The medical billing management company you work with can make or break your practice. After all, you rely on their services and workflow to remunerate your staff and keep your business running seamlessly. A slight mistake can, therefore, have a huge impact on your business. With so much at stake, you can’t afford to make mistakes. Sadly, some practices wait until it’s too late to change their medical billing companies. If you don’t want to make the same mistake, here are just some of the signs to watch out for:

Dwindling Level of Service

How long does it take your billing company to respond to your concerns? An ideal company should be proactive and contact you when they detect any anomalies. They should always have a standing appointment to report anything about your revenues. When issues arise, the company should respond promptly. They should act more like a partner than just an ordinary vendor.

Increasing Number of Denials

Denials can occur due to several reasons, such as wrong coding and inadequate documentation. But if your denials are on the rise, and it takes time to resubmit or appeal, it may be a sign of a serious problem.

Average denial rates of about 5% are not unusual, but if they’re higher or increasing, it’s time for a new medical billing management company. Rising denial rates reduce your cash flow and can adversely affect your running operations. A good billing company should understand the importance of cash flows and keep denials low.

Uneven Revenue Collections

The quick submission of claims is important to your revenue cycle. Any delays can adversely impact your cash flow consistency. In addition, delays can also lead to filing issues. You don’t want to keep payers, especially those relying on Worker’s Compensation, waiting for too long because they have short timelines to submit their claims.

Patient Volume and Revenue Don’t Match

Ideally, when the number of patients increases, you should notice a corresponding increase in revenue. But if your revenue collections are stagnant, it’s a sign of an underlying problem. For example, an uneven ratio of revenue collection to patient volume could indicate you’re losing money.

Lack of Transparency

If you’re not getting the right reports, you should think twice. Your medical billing management company should present all the data you need. If you discover they’re hiding some details, it’s time to part ways. Companies with good internal processes have no challenge generating information about your clinic’s performance.

Medical billing management plays a key role in any practice. When you get the right company, your growth will be seamless. But if you get it wrong, it could lead to slow and inconsistent growth. Advanced Reimbursement Solutions in Phoenix and Wilmington takes pride in helping you grow with the right company. Contact us today to speak with a medical billing expert.

What’s the Difference Between Medical Billing and Medical Coding?

While the terms medical billing and medical coding are often used interchangeably, they actually refer to two very distinct but related practices. The key to understanding the different responsibilities associated with each practice is to know the different tasks associated with each role.

How are They Both Related?

Medical billers and medical coders both work together to keep a healthcare practice running smoothly. Because of the important roles both of these providers play, individuals are often highly trained and prepared for success on the job. Both roles are critically important to the healthcare practice, and if either of them is not performed correctly, the results can be very detrimental to both patients and the healthcare agency. The modern healthcare industry heavily relies on skilled and certified medical billers and coders to record and manage each patient’s healthcare billing account.

What Does a Medical Coder Do?

Medical coders are health professionals who analyze a patient’s records to figure out what procedures were performed by a doctor, nurse, surgeon or related healthcare professional. They closely analyze these procedures in order to assign the right procedure or diagnosis code for any services received by the patient. This is a very important process in order to ensure the correct procedures are being performed and the correct diagnoses are being given. Because of the important role medical coders have in the healthcare services industry, they are often relied upon to get more info about a patient’s medical history.

What Does a Medical Biller Do?

Medical billers are involved in entering these into data logs and processing insurance claims. They are responsible for making sure that every patient is not being billed incorrectly. Medical billers often use highly advanced billing software for this process, which allows inputting medical codes and insurance claims to be sent to the insurance company for payments to be made. Because medical billers deal directly with insurance companies, they are expected to have a thorough understanding of the claims process and all other requirements that must be submitted in order to process the claim. They are also responsible for making sure the correct information was submitted to the insurer and that the billing format, all corresponding fields, and any supplemental documents to support the claim were included in the reports.

Advanced Reimbursement Solutions has a highly qualified professional staff of medical billing experts that can increase the efficiency of your billing operations. Contact us today for a professional consultation with one of our specialists in Wilmington or Phoenix.

4 Medical Coding Mistakes That Can Destroy Your Patient Satisfaction Score

Medical billing management is an integral part of modern healthcare. After a patient visits a doctor or medical facility, their insurance gets billed. But the healthcare world is changing to meet new regulations, and medical billing specialists should do the same.

In most facilities, medical billing takes place outside the clinic. Many medical billing companies now offer their services remotely, and accuracy is imperative. A minor error can make patients infuriated. Why?

Imagine receiving medical billing errors that force you to spend many hours on the phone. As if that’s not enough, you’re forced to pay for services you didn’t receive.

The surest way to maintain a good relationship with your patients is to avoid such mistakes. And that responsibility lies heavily on your medical coding. So to give you an edge, here are four coding mistakes to avoid.

Balance Billing

Balance billing is not a walk in the park. Sometimes it’s needed, and other times it’s illegal. It is not uncommon to find health plans suing out-of-network providers for failing to balance bill their patients. The best way to avoid such mistakes is to know the law and verify the patient’s insurance before billing.

Code Mismatch

As a medical billing specialist, your team should know that diagnosis and treatment codes must always match. A common mismatch that often gets patients mad is an upcode. In such a case, the insurance company will reject the billing and the patient will be held responsible for any additional costs.

Failing to Verify Insurance Coverage

Medical insurance coverage varies widely on conditions, procedures, and treatments. It’s the responsibility of healthcare providers to verify every patient’s insurance coverage. Keep in mind that the coverage can change at any time. And sometimes, patients don’t know about it. So before billing, always double check and validate insurance coverage.

Duplicate Billing

When a patient is billed twice or more for the same service, it results in duplicate billing. This error can originate from a doctor or a nurse when they request for a patient to be billed for a service or prescription. Sometimes, it occurs when a patient gets billed for several “first days” in the facility. This mistake can be so enraging because patients may have to spend many hours on the phone trying to remedy it.

Medical billing management is not cakes and ale. It takes a good team and a great system to get things right and enhance patient satisfaction. For assistance, get in touch with Advanced Reimbursement Solutions to speak with an expert in Phoenix or Wilmington. Contact us today to schedule an appointment and get started.

The Importance of the Medical Billing Process

Medical billing is a vital component of every medical practice, as accuracy is essential for fast and efficient operations. The process needs skilled professionals who can interpret and record medical details accurately and still maintain patient confidentiality. But why is the medical billing process so important?

Patient Care

Medical billing gathers information on diagnoses and treatment through alphanumeric codes. The information comes from different sources such as medical notes, lab results, transcriptions, and electronic records. The codes are then transferred to the medical billing system. The system makes it fast and easy to access patient information and add updates.

Compliance (Regulatory and Contractual)

Medical billing management is part of many federal and state guidelines. Health Insurance Portability and Accountability Act (HIPAA) is the most significant when it comes to compliance. HIPAA requires every medical practice to protect patient information. Also, insurance companies bind medical professionals by the use of contracts which include negotiated rates for specific treatments and procedures. An accurate medical billing process ensures medics comply with this contract.

Insurance Claims

The medical billing process is a necessary step when submitting medical claims to insurance companies. It indirectly has an impact on medical care, especially when it comes to insurance reimbursement. Physicians will have to list the underlying conditions and preconditions and provide it to insurance companies for reimbursement. It is not the best idea to leave your staff in charge of the medical billing process. Hiring a professional medical billing company is vital to avoid errors and increase profitability in your medical practice.

Keep Information Current

Medical billing helps to manage patient accounts and ensures that they stay up to date. It takes a lot of time and effort to look for patient accounts that are not well-maintained. Also, a lot of revenue can be lost as a result of mismanagement. A high-quality system makes updating patient information seem effortless.

Smooth Flow of Payments

Medical billing enables the smooth operation of payments. Medical billing companies need to know the different public and private insurance plan policies and medical regulations. Also, they should be able to follow up a claim, appeal submissions, adjust billing, post payments and manage collections. Effective management is vital for revenue flow in any practice.

Ultimately, it is essential to have accurate patient details to avoid getting into trouble with insurance companies. Hiring a reputable medical billing company like Advanced Reimbursement Solutions is crucial for effectiveness. Contact us today to book an appointment with a team member in Wilmington or Phoenix and get started.

6 Strategies to Boost Your Medical Bill Collections

Managing medical bill collections can be a challenge for healthcare providers. And the fact that over 70 million Americans have pending medical bills or debts adds salt to injury. So if you want to improve your billing collection process, here are six simple ways to do so.

Allow and Automate Financial Assistance

Some patients are eligible for financial assistance. So instead of accumulating bills until they’re written off as bad debts, allow your patients to get financial assistance automatically. With the right technology, you can perform financial assistance screening when registering new patients. This allows your practice to determine whether a patient is eligible for financial assistance. This can increase your chances of collecting payment.

Verify Patient Data

Most data needed for medical bill collections is usually obtained at the point of access. As such, ensure the data is correct for an efficient collection. When the data obtained is wrong, or entered incorrectly, it creates an obstacle when it comes to getting paid.

Verify Eligibility

The process of verifying eligibility can be time-consuming. To increase your odds of getting accurate data, employ both EDI and web-based searches. Scheduled batch queries enable you to check for new updates and changes in insurance coverage, while real-time queries give you the opportunity to get current information about a patient. Both strategies give room for collecting accurate information, improving patient expectations, and getting updates quickly. Taking time on eligibility verification also minimizes your chances of denials, which can increase your medical bill collections.

Set Up Payment Plans

With the right technology, you can set up suitable deposit and payment schedules for your patients. Most healthcare practices are even using retail-style collection techniques, such as upfront deposits and secure storage for credit card information to boost future collections.

Create an Easy Process of Collecting Payment

Most medical practices are now using online systems that allow patients to post payments. These practices often report increased medical bill collections. You can borrow a leaf and take your practice to a new level.

Make the Billing Process Simple and Clear

The surest way to improve your medical bill collections is to remove obstacles in your payment processes and make it clearer. For instance, you can consolidate family payment information, bills from the lab, physician, and hospital, and provide online payment plans. These approaches can even reduce the cost of your billing process.

Medical bill collections can be improved with the right approaches. To learn more, please consult the specialists at Advanced Reimbursement Solutions. Contact us today to book an appointment and speak with a member of our team in Phoenix or Wilmington.

5 Medical Billing Management Game-Changers

Technology is changing and revolutionizing the healthcare industry at breakneck speed. For most practices, medical billing management is still an important area that needs a closer look.

Medical costs have risen exponentially, and patients expect transparency and various payment options. As a healthcare provider, you may still be using an inconvenient solution. But it is important to improve your services. Ensure that patients get the best treatment, pay easily while keeping your workload seamless and ensuring you get reimbursed. Wondering how?

Automation

Automating most of your processes can improve patient experience and cost efficacy. Using an automated system for billing frees up time and effort for you and your patients. Although you may have a few employees who will require assistance or direction, most of them will be happy with an automated and streamlined medical billing process.

In some instances, automation can take over many tasks typically performed by your billing staff. This allows your employees to focus on what’s important: interacting with your patients.

Artificial Intelligence

Most artificial intelligence applications in medical billing management fall under computer-assisted coding (CAC). Giant companies have already invested heavily in machine learning and natural language processing (NLP). These technologies will automatically recognize and extract data from documents for correct coding and billing.

In-House vs. Outsourcing Billing

Most medical providers today prefer to outsource their billing services. This is because of the ever-changing healthcare regulations and the increasing risk management and compliance concerns linked to in-house billing staff.

Both in-house and outsourcing billing services have their benefits and demerits. You have to carefully examine both options based on cost and operational factors before selecting the best one for you.

Blockchain

Blockchain is a safe technology that generates authentic data records that are shareable between connected database systems. The technology also records digital events without allowing the data to be changed or recognized unless it reaches the recipient.

Blockchain can improve data integrity by safeguarding healthcare data, such as electronic health records, patient health information, and medical billing and claims. With this technology, all the data is safeguarded in an immutable register that can be readily available.

Virtual Medical Care

Virtual health is here to stay. It combines digital and communication technologies in a bid to bridge the gap between patients and healthcare practitioners. This allows you to coordinate patient care more efficiently.

Medical billing management is evolving with technology. Patients will continue to demand better services, and medical practices that embrace these emerging technologies are more likely to succeed. To learn more, consult the specialists at Advanced Reimbursement Solutions in Wilmington and Phoenix. Contact us today to book an appointment.

The Benefits of Outsourcing Your Medical Billing

As a healthcare provider, you will no doubt understand how frustrating and time-consuming medical billing can be. From negotiating disputes between patients and their insurance company to struggling to increase your reimbursement rates, medical billing takes your time and energy away from helping patients. Fortunately, there is another option. Consider just some of the many benefits of outsourcing your medical billing to a third-party company.

More Time to Spend with Patients

As an owner or manager of a medical practice, your time is incredibly valuable. By outsourcing your medical billing process, you will no longer have to sacrifice your time communicating with insurance companies and organizing billing; instead, you can focus your time on improving your practice or spending more dedicated time with patients. If you already have an in-house member of the staff who is tasked with medical billing, you can redirect their time to more productive tasks, such as developing digital marketing strategies for your practice and researching industry developments.

Increase Your Profitability

While a sole member of a staff or a small team may be able to send out statements to patients fairly regularly, a dedicated medical billing company will be able to work much more efficiently and quickly as that is their specialist area of knowledge. The faster bills and statements are sent to patients and claims are made, the faster money will be coming into your practice.

Improve Your Efficiency

A billing company is able to compile data and statistics about your medical practice in a regularly updated performance report. This will provide you with an objective report that compares where your practice is successful in achieving a high reimbursement rate and what services/areas of your medical practice need improving. This will not only keep you updated on your own performance but also the performance of the billing company.

Advanced Reimbursement Solutions is the medical billing company you can trust to handle all of your medical practices billing needs. We have offices located in Phoenix and Wilmington and are at the ready to assist you. Contact us today to book an initial appointment and learn more information about our process. We look forward to hearing from you!

6 Medical Billing Management Mistakes to Avoid

Medical billing management mistakes can cause devastating problems for your practice, and more importantly, your clients. Identifying the common mistakes and taking preventative measures goes a long way in ensuring your practice runs smoothly and keeps your patients happy. Here are some of the most common medical billing management mistakes to avoid this year.

Missing Details or Misinformation on Claims

Missing details or misinformation are usually the most difficult and time-consuming mistakes to correct. These errors can include an incorrect birth date, incomplete information or failure to update information on insurance claims. Some patients may also forget to provide changes in their insurance information, and medical billing specialists also assume nothing has changed. Remind your patients to update their information, and make sure to use the updated information.

Incorrect Coding

Medical coding is an art and skill, and some insurance companies request for specific coding and they can even deny the claim if not as required. A correct code can, therefore, make a difference between a denial of benefits and a patient enjoying full coverage. So, follow the exact coding for your billing to be processed correctly and on time.

Multiple Claims

With thousands of patients and hundreds of insurance companies, it can be overwhelming to manage your billing. A good medical billing management system can help reduce errors and keep your practice running smoothly. As such, train your employees and have the best billing management strategy to make sure that claims are filed and processed effectively and efficiently.

Prior Authorization

Most insurance companies need prior authorization for specific services. With numerous administrative requirements, this is often assumed and can be costly for your patients and your practice. The rule of thumb is to ensure all procedures that need prior authorization receive it on time.

Services Not Covered

Insurance firms may not cover all of your services. Although it can be repetitive and time-consuming to check with the insurance company, it is crucial to do so. Similarly, also verify that any additional provisions are covered by the company to avoid denials.

No Referral on File

Generally, patients must get referrals from their primary care doctors before visiting a specialist. But this can differ from one insurance company to another.

Having a good medical management team and systems can improve your practice and make life easier for your patients and staff. Get in touch with Advanced Reimbursement Solutions to consult with one of our experts in Wilmington or Phoenix and learn more about medical billing management. Contact us today to book your appointment.

4 Ways to Increase Reimbursement

Running a medical practice can be tricky – and it only seems to get trickier with time. In addition to ever-evolving medical treatments, privacy laws, and technology, you need to worry about getting paid by a variety of different insurers and patients. Today, we’re going to look at four ways you can help improve your bottom line and keep your practice running smoothly by increasing reimbursement.

1. Hire a medical billing specialist

The number one way to improve insurance reimbursement will always be to hire the right medical billing team for your business. As one source puts it, “Good medical billers boost company bottom line.” It’s that clear-cut. With the right claims team in place, such as the team offered by Advanced Reimbursement Solutions, you could actually stop the list here, because your billing partners will handle the rest in-house.

2. Use up-to-date software

Insurance codes are constantly changing, and so must you. In order to track patients, visits, and treatments, you need up-to-date software on both sides. Receptionists and medical professionals need software to tell them what patients have appointments for what purpose, and insurance companies need matching data using their in-house codes. Without the right software, billing – and getting reimbursement – will be that much more difficult.

3. Track charges for follow-up

Of course, billing is only half the work when it comes to getting paid. Even if you send the bill correctly, there’s no guarantee that you will be paid in a timely manner. Electronic files can get lost or misfiled in an insurer’s system. A timely email or phone call may be all you need to get that insurance reimbursement, but someone needs to know to make that call.

4. Keep necessary information secure but accessible

A critical component of insurance reimbursement includes sharing confidential information involving medical procedures. In order to receive payment without costly delays, you need a reliably secure system for sharing necessary information – and only this information – with a large number of insurers in a small amount of time.

In the healthcare industry, keeping patients healthy is your first priority. In order to do so, though, you need to be able to pay your bills – and that takes money. By hiring trained medical billers, you can stay focused on patient care without having to worry about the rest. Contact us today at Advanced Reimbursement Solutions to speak with one of our experts in Wilmington or Phoenix!

Is an HRA Right for You?

In the past five years, there has been an increase in the number of employees opting for high-deductible health plans. High-deductible health plans are defined as those with deductibles for family coverage and individual coverage. The growth of these deductible health plans has led to the increase of health savings accounts (HSAs) and health reimbursement arrangements (HRAs). As an employer, you need to be conversant with HRA info to determine whether they are right for you.

What is an HRA?

An HRA is an arrangement, which in combination with high-deductible health accounts pays for those medical expenses that your insurance policy does not cover. If your medical expenses are less than the deductible, you can cover them with an HRA.

Should I Consider It?

There are 3 main reasons why you may want to consider an HRA:

• Flexibility and control. Employers retain control over HRAs and determine how the funds within them can be used.
• Unused funds are retained in the account. If an employee has not spent the funds in the HRA at the end of the year, the employer can retain them in the account.
• Non-portability. The funds in an HRA are not accessible to employees. These funds are referred to as notional dollars and can only be spent when submitted to the HRA to be reimbursed.

How Does the Funding Work?

Contributions for every individual within the medical plan are made by the employer. To determine how much money can be spent, the funds must be included annually in the expense line of the employer for financials.

Since 100% of the contributions to the HRA are made by employers, they can be accessed at any time by employees for medical expenses. However, the funds are not portable, meaning that the employee cannot cash the money out as in HSAs.

Many employers utilize the carryover function, which is a unique feature of the health reimbursement arrangement. This function allows them to roll over all or a part of the remaining money year to year. Usually, employers build up the dollars over a cycle of 3 years and use them to cover the expenditure of their medical plans.

An employer has many freedoms and choices within a health reimbursement arrangement. Covering the medical expenses of employees should be a priority, and the team at Advanced Reimbursement Solutions helps with determining how to structure contributions to the HRA among many other services. We have locations in Phoenix and Wilmington. Contact us today to book an appointment and learn more.