Blog - Advanced Reimbursement Solutions

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.

What are the Advantages of an HRA?

Also known as a health reimbursement account, a health reimbursement arrangement or HRA is a tax-advantage, employer-funded, and IRS-approved health benefit plan that is used to reimburse employees for not only out-of-pocket medical expenses but also personal health insurance premiums. It helps to measure the value of managers and employees in an organization by analyzing the cost incurred in hiring, training and developing them.

How Does It Work?

HRAs are notional arrangements where no expenses are incurred until reimbursement is paid. This helps an employer reimburse an employee after the employee has incurred an approved medical expense. This is mainly useful for companies that want to control and retain their cash flow.

Below are a few advantages of an HRA for both employers and employees.

Advantages for Employers

1. Cost Control

An HRA allows employers to decide on the amount of money they want to contribute to each of their employee’s HRA accounts. This helps employers plan ahead since they know the amount of money they are likely to spend on these benefits. In addition to HRAs, most employers also offer a high deductible health plan, which results in reduced premiums for both employees and employers.

2. Talent Recruitment

An HRA benefits package ensures employers are always attracting and retaining talent. Besides, the benefits to employees ensure a company’s benefits package shine such that they can convince prospects to accept the company or employer’s offer.

3. Flexible

Since the employers are the ones who plan and contribute, they have the ability to plan something that suits them.

Advantages for Employees

1. Reduced Healthcare Cost

Paying for healthcare services is usually very costly. If an employee is offered an HRA as well as a high deductible health plan (HDHP), there will be a low premium cost, which will lead to a reduction in the cost of healthcare for employees. Moreover, employees can use HRA funds to pay for their deductibles, co-payments, and co-insurance.

2. Rollover

If the employer’s benefits plan allows for rollover, the unused balance will always roll over to the next year. This is beneficial to employees since their healthcare expenses can decrease or increase depending on the yearly rollover.

3. Tax-Free Reimbursement

Whenever employees file claims about a qualified medical expense, the reimbursement is usually tax-free.

For more information, simply contact Advanced Reimbursement Solutions in Phoenix and Wilmington. Contact us today to book an appointment to speak with one of our team members!

Key Facts About HRA Insurance Plans

If you have a medical practice, then you’re well aware of the wide range of ways people pay for healthcare, from private insurance to out-of-pocket costs and more. Health reimbursement arrangements (HRAs) allow employers to provide insurance-like coverage for employees through a private savings account. Here are just some of the key facts to keep in mind regarding HRA insurance plans.

HRAs are Employer Funded

HRAs are a kind of employer-provided insurance intended to either replace or supplement traditional insurance. Patients with an HRA may or may not also have traditional insurance. If they do have traditional insurance, then you will usually bill that first. The patient can use the HRA for the remainder.

Employees Cannot Legally Fund HRA Accounts

Whatever money is available in the HRA is what’s available. If the HRA runs out of funds, then the patient will have to pay you out-of-pocket for the remainder.

HRAs are Different from HSAs (Healthcare Savings Accounts)

With HSA insurance plans, employees contribute tax-free income to a savings account, which they can then access as needed throughout the year. In contrast, the HRA does not count as income in any way, because the money never belongs to the employee. Where patients often use HSAs together with high-deductible plans and/or elective medical procedures, you’re more likely to see HRA insurance used together with standard insurance and non-elective medical needs.

Do you have patients with HRA insurance? Do you have questions about medical billing? Medical billing services like the ones offered through Advanced Reimbursement Systems can help bridge the gap between your medical practice and the many parties involved, including HRA insurance plans. To learn more information, set up a time to speak with one of our professionals in Phoenix, AZ or Wilmington, DE. Contact us today to book an appointment and get started.

5 Important Financial Practices for Healthcare Agencies

Along with primary clinical and medical treatment services, financial service planning is among the most important operations of your healthcare agency. How you manage your finances will have an overall impact on how smoothly your business runs. It is very important for all medical service providers to be realistic about their financial needs to avoid making costly financial mistakes in the future. Proper financial planning and medical billing management must be implemented to maintain the long-term financial health of your business. If you’d like to learn more information, you are warmly invited to learn about some of the best financial practices for healthcare agencies.

1) Create a financial timeline

Healthcare organizations should always have financial advisors, assistants and other appropriate professionals to help create a timeline for establishing deadlines for important financial objectives. This timeline should include a number of parallel tasks essential to the growth and maintenance of your business. To avoid the risk of delays and additional costs associated with achieving goals in your financial timeline, you should spend some extra time carefully studying how long it will take for you to achieve your goal(s) and exactly how much it would cost.

2) Set up multiple payment options

The state of money has come a long way since the days of cash and bank checks. One of the best options for convenient medical bill collection is to create multiple payment options. This allows for faster payments and helps in removing the potential burden of having to negotiate alternative payment plans with your patients. Also, there are medical billing companies such as Advanced Reimbursement Solutions you can use to offer much more convenient payment options for your patients.

3) Allow advance payment

Allowing patients to pay for clinical or medical treatments in advance through pre-funded accounts will provide the convenience of more effective medical bill collections. This will take the stress out of customer service payment processing and settling healthcare bills. Patients will thank you for giving them an easier payment option and you, the healthcare provider, are spared from the burden of having to chase payments.

4) Make use of modern technology

Your business can save a lot of money by switching to paperless methods of accounting and payment processing such as sending out billing updates through email and sending electronic statements to patients. You can also use this technology to follow up with patients about missed medical bill payments.

5) Establish clear patient financial policies

Make all of the services you offer and all billing and communications clear, concise and patient-friendly. Practice good judgment in the ways you communicate with your patients about bills, and establish policies for payment methods and debt resolution that are both consistent and clear for your patients to understand.

To learn more about the best financial practices for healthcare agencies, talk to the specialists at Advanced Reimbursement Solutions in Phoenix and Wilmington. Contact us today and book an appointment!

5 Qualities of a Great Medical Billing Specialist

The use of electronic health records and highly computerized databases is becoming standard practice in the healthcare industry. Consequently, the demand for medical billing and coding experts is high and is expected to grow by 13% in 2024. Finding the best medical billing specialist can, therefore, be a challenge to most healthcare practices, particularly startups and SMEs. If you’re looking for a medical billing specialist, here are five great qualities you should keep in mind.

Analytic Abilities

A medical billing specialist should be able to understand and analyze patient information as quickly as possible. Analytical skills can help them to accurately review patient details in previous medical records. They may also need to determine which codes to use for each treatment or procedure that was conducted. Analytic skills are also crucial in processing insurance claims and determining medical bills. Without these skills, your billing team may over-bill or under-bill patients, which can have devastating consequences on your practice.

Detail-Oriented

Attention to detail and accuracy are must-have skills when processing and coding medical insurance claims. When reviewing a patient’s records, a medical billing specialist must pay attention to both large and minor details so that they can understand and code each procedure correctly.

Solid Moral Values

A medical billing specialist must have strong moral values. That means they must be professional, ethical and fair. Working in this sector requires employees to keep patient information and records confidential. Medical billing experts with questionable character often fail to observe this regulation and can jeopardize your practice.

Social Skills

On a typical day, a medical billing specialist will communicate with supervisors about a discrepancy, contact nurses and other physicians to clarify issues, or discuss patient information and procedures. Therefore, it’s imperative they’re able to communicate effectively with other professionals so that workflow is smooth.

Tech Savvy

A medical billing specialist must be able to quickly adapt to changing technology. Currently, most healthcare facilities use electronic health records software to record, process and store patient information. Since technology is a must, all employees should be able to use the software effectively.

The demand for medical billing and coding specialists will continue to increase. If you need help, please don’t hesitate to get in touch with Advanced Reimbursement Solutions in Wilmington and Phoenix to consult with one of our experts. Contact us today and book your appointment!

Medical Billing Allowables: Why Charging More is Good Practice

Unlike most businesses expecting a bill to be paid in full, medical billing companies typically expect to receive a fraction of an outstanding amount. In medical bill collections, it is quite common for a $500 bill to be sent out with the expectation that only $300, $150, or far less than that will be paid back. Charging much more than one expects to collect, which is typically known as a medical billing allowable, takes care of this problem and boosts profitability by ensuring that an actual payment will be received. That is just one reason why charging more is good practice in medical billing management.

It Simplifies the Medical Billing Process

Because medical procedure costs vary, medical billing companies would be mired in the time-consuming task of maintaining multiple fee schedules if they tried billing patients and insurers the exact amounts owed. All of these fee schedules would require constant updating given that many insurance plans change their own fee schedules and the amounts they pay every year. This would also have a detrimental effect on any internal data that tracks and compares charge volumes in the medical billing process.

It Boosts Revenue

Most medical practices often see patients with out-of-network insurance providers. Some of these insurance plans pay a percentage of the charges that are billed. In this instance, charging more gives medical billing companies the chance to collect more money on that percentage.

It Maintains Legal Compliance

According to US law, a medical practice that accepts Medicare cannot charge an insurer or any other entity a lower fee than it charges Medicare. The amounts charged must be the same, or the practice risks breaking the law. Charging all insurance plans and patients the same amount helps maintain legal compliance, even if it is set at a higher fee schedule.

At Advanced Reimbursement Solutions, we understand the intricacies of the medical billing process. Our state-of-the-art billing system handles all stages of a medical claim in a manner that boosts profitability for physicians, surgery centers, and durable medical equipment providers. Contact us today to book an appointment and speak with one of our professionals in Wilmington or Phoenix.