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Industry Update: Surprise Medical Billing Legislation

State and federal legislators are shifting more attention to an issue known as surprise medical bills. A surprise medical bill occurs when a medical provider sends a patient a bill for services that the patient thought his or her insurer would cover. See Consumers’ Responses to Surprise Medical Bills in Elective Situations, B. Chartock et al. (Mar. 2019). Such bills can leave patients with significant amounts of medical debt. An often-cited example is when a patient goes to an in-network facility, such as a hospital, but receives services from an out-of-network provider, such as an anesthesiologist. If the out-of-network provider is unable to collect the full amount for his or her services from the patient’s insurer, then the provider may bill the patient directly. Surprise medical bills, which are also known as “balance bills,” are at the forefront of the debate regarding the United States healthcare system.

Many states have passed legislation that addresses surprise medical bills. For example, New York law provides patients with different protections depending on what insurance they have. See New York Department of Financial Services, Surprise Medical Bills, available at https://www.dfs.ny.gov/consumers/health_insurance/surprise_medical_bills. If a patient has insurance through an HMO, New York law may cap the patient’s financial responsibility for a surprise medical bill, and the bill may not exceed an in-network copayment, coinsurance, or deductible. A provider may not hold the patient liable for any additional amounts owed. If the patient signed a form known as an “assignment of benefits,” the provider may be entitled to seek reimbursement from the patient’s insurer. New York law has even established an independent dispute resolution process where a provider and insurer can argue about the reasonableness of the reimbursement. See New York Department of Financial Services, Surprise Medical Bills, available at https://www.dfs.ny.gov/consumers/health_insurance/surprise_medical_bills.

Although some states have similar laws, many do not. However, the federal government is considering passing its own surprise medical bill legislation. For example, in June 2019, the United States Senate introduced the “Lower Health Care Costs Act.” See GovTrack, S. 1895: Lower Health Care Costs Act, available at https://www.govtrack.us/congress/bills/116/s1895. The bill is one of many divisive federal efforts to reform the healthcare system. Unlike New York law, the bill uses a benchmark rate to resolve payment disputes between insurers and out-of-network providers. Specifically, insurers must pay providers the median contracted rate that they have negotiated with other providers in a certain geographic area. Supporters of the bill argue that the benchmark rate will help eliminate surprise medical bills. Critics argue that, like other government price controls, the benchmark rate will create more problems than it will solve. One such argument is that if the benchmark rates are too low, out-of-network providers will have to see more patients to cover their expenses, thereby reducing the amount of time and care they can provide.

The issue of surprise medical bills demonstrates how complicated the American healthcare system has become. Pantheon Global Holdings is committed to working with providers regarding such complexities as our teams of analysts and attorneys stay current on the status of federal and state surprise medical bill legislation.

The materials available at this website are for informational purposes only and not for the purpose of providing legal, accounting, or other professional advice. You should contact your attorney, accountant, or other professional to obtain advice with respect to any particular issue or problem. Use of and access to this website does not create any relationship between Pantheon Global Holdings, LLC or any of its affiliated entities, and the user or browser. Pantheon Global Holdings, LLC and its affiliated entities are not responsible for any actions (or lack thereof) taken as a result of relying on or in any way using information contained in this website and in no event shall be liable for any damages resulting from reliance on or use of this information.

Why Do People Outsource Medical Billing Services?

For medical practices, the decision to outsource medical billing services allow them to avoid the hassle of in-house billing. By contrast, a practice that keeps billing in-house must stay on top of the latest changes in coding, legal regulations, technology and insurance industry trends. At Advanced Reimbursement Solutions in Wilmington, DE, we operate as a full cycle revenue management enterprise that provides medical billing services.

The Bottom Line: Outsourcing Results High Reimbursement With No Hassle

Practices that keep their billing in-house spend around 30-40% of their collections on the claim submission process. This is because handling claims accurately requires a high level of expertise that is expensive and time-consuming to maintain. Most medical practices would prefer to focus on providing care to their patients!

10 Reasons Why Practices Outsource Medical Billing Services

#1: They Save Money on Office Staff

When practices process claims in-house, they need to hire enough staff to handle the administrative aspects of doing so. Sometimes they need to hire temps when the volume is especially high. Larger practices need to create full-fledged billing departments. By outsourcing billing, a practice can save money on staff. Ultimately, this offsets the cost of the billing service.

#2: They Save Time

When a practice keeps its billing in-house, administrative staff must divert hours towards billing that could be used in other ways. This is especially true for practices that do not have a separate billing department. Employees that do not have medical billing in their job descriptions end up keying in information, preparing claims, and following up on reimbursements. This time can be saved by outsourcing.

#3: They Avoid Training and Re-Training Staff

The technological and legal landscape of medical billing is ever-changing. When a practice keeps its billing in-house, it must provide extensive training to staff and continuously make sure they are aware of changes to the rules. By contrast, professional billing services make awareness of regulatory changes a routine aspect of running their business. They stay current on all the rules on behalf of their clients.

#4: They Avoid Employee Turnover

Practices that keep their billing in-house often experience high employee turnover. This happens because the process of submitting claims correctly requires high competency and focus, yet it tends to be tedious. There are few people with the intelligence necessary to do medical billing who find long-term job satisfaction in claims submission. When a practice outsources its medical billing, it no longer has to make the investment of training new staff every time there is turnover.

#5: They Reduce the Number of In-Coming Phone Calls

When a practice maintains a billing department or staff dedicated to billing, a high percentage of the phone calls it receives pertain to claims. By cutting down on these calls, the practice can respond to other types of calls more quickly.

#6: Their Billing Is Done by Experts

A medical practice is responsible for many things. It needs to excel at providing patient care and taking care of administrative duties. Given its other responsibilities, it may not be able to focus on ensuring that its billing is top-notch.

On the other hand, medical billing services specialize in claims submission and reimbursement as their main area of focus. This means that, in most cases, the quality of the service they provide exceeds that which a typical practice could achieve on its own.

#7: They Save Office Space

By outsourcing its medical billing, a medical practice can save space because records pertaining to the claims do not need to be stored within the office. Companies that focus on medical billing have sophisticated mechanisms to keep the records organized externally. Their organizational systems have an added benefit. Within the context of appropriate legal compliance, data within these databases is easy to access for analytical purposes.

#8: They Do Not Need to Invest in Billing Software

When a practice does not outsource its billing, it must stay technologically equipped to handle the job internally. This means spending money on the latest billing software. Updates to this software are expensive and unavoidable given the frequency of changes within the billing process.

This expense is more efficiently handled by a medical billing company than by an individual practice. This is because the billing company can provide services to many practices after making just a few software purchases.

#9: They Benefit From Automatic Insurance Verification

When a practice outsources its billing, it gets access to immediate insurance verification. This includes information pertaining to whether or not a patient has had the maximum number of visits allowed for a condition, whether patients have met their deductibles, and whether some event has made them ineligible for the coverage.

#10: They Reduce Coding Errors

In addition to staying current on the ever-changing rules, medical billing companies invest in state-of-the-art software that can check claims for errors and predict when they might be problematic. As they process a claim, these companies thoroughly check to make sure it is clean and ready for submission. Any problems they find can be fixed before payment is delayed. This ensures that claims are submitted with greater accuracy.

#11: Reimbursement Goes Faster

In part because of the reduction in coding errors, practices that outsource their billing get reimbursed faster than those that do not. A paper-based claim submitted directly from a practice can take up to two months to be paid. By contrast, a properly coded claim submitted by a billing service can be paid in as little as one week. Therefore, practices that outsource their billing can look forward to an increase in their cash flow.

#12: They Don’t Need to Communicate Directly With Insurance Carriers and Third-Party Payers

In-house claim submission is not always a straightforward or transparent process. Often, certain aspects need to be clarified by asking insurance carriers and third-party payers questions. Companies that provide medical billing usually have staff specifically dedicated to maintaining relationships with these entities. They handle the communication on behalf of the practices.

#13: They Gain Access to Expert Legal Resources

All legal aspects related to people’s health are complicated and at times controversial. Laws are always subject to repeal and revision. Regulations that govern medical billing are no exception, and the situation is especially complex given that there are different laws at the state and federal levels.

For a medical practice, keeping track of these laws and ensuring compliance is challenging. Fortunately, medical billing services specialize in having the most accurate legal information and often benefit from important connections within the field of law.

#14: They Gain Access to Experience

When a billing problem arises for a practice that keeps its billing in-house, it can only determine a solution based on its own past experience. By contrast, companies that specialize in medical billing services handle thousands of claims for many different procedures and a huge variety of practices. Chances are, when an issue does arise, they have seen it before and know what to do.

#15: They Are Prepared in the Event of a Payer Audit

Payer audits are common scenarios for billing services, and ones they are equipped to handle as a result of working with many different practices. To a billing service, this is a routine aspect of billing that they can handle easily. When they are called in to support a practice through an audit, billing services have valuable experience and documentation that can help make the process move smoothly.

#16: They Are Less Affected by Changes to Coding Procedures

In the case of in-house billing, the staff are not always aware of important changes before they result in rejected claims. This makes re-submission a frequent and costly process that takes employee time and delays cash flow. A company that provides medical billing services uses preemptive measures to keep on top of regulatory trends and to ensure that the maximum number of claims are paid the first time they are submitted.

#17: Their Patient Information Is Secure

A private medical record is one of the most valuable commodities on the black market. It can yield 10 to 20 times more profit than a credit card number. For a medical practice, maintaining the IT systems necessary to provide adequate security is expensive. Medical billing services have the resources to invest in the most advanced technology, keeping patient records secure. Their processes are HIPAA-compliant and check all the legal boxes related to keeping medical information safe.

#18: They Can Make Better Business-Related Decisions

The electronic databases used by medical billing companies can easily show which payers are more timely with their reimbursements and which procedures are most likely to yield rejected claims. This information can help a practice identify which procedures it should offer and which payers it should accept.

These databases can also show the percentage of claims that are paid on their first submission. Additionally, they can identify frequent issues in the submission process. With this information, practices can better train their providers and staff to submit claims correctly.

#19: They Can Stay Focused on Their Patients

A practice that does not have to devote time to billing can focus on the most important aspect of its work: caring for patients. Time previously spent keeping up to date on coding and billing regulations can be spent learning about advances in medical treatments. Staff that would otherwise have to keep on top of the reimbursement cycle can spend more time nurturing relationships with patients. When doctors don’t have to navigate the complicated billing process, they can direct more energy towards providing care.

#20: They See An Increase In Patient Satisfaction

For patients, a visit to the doctor’s office or hospital must be as straightforward as possible. Having a medical condition that needs attention is unpleasant enough without the added stress of dealing with complicated financial matters. When practices outsource their medical billing, patients benefit from an accurate, simplified billing process.

Why Outsource Medical Billing?

The main reason practices outsource their medical billing is that doing so increases revenue, improves accuracy, and reduces administrative expenses. When a practice does not have to worry about submitting its claims according to ever-changing requirements, it has more time to spend cultivating positive patient relationships.

Benefits of outsourcing include:

Expedited cash flow
Greater accuracy in claim submission
Reduction in staff costs
Overall reduction in resources devoted to medical billing
Access to legal expertise
Access to the most advanced medical billing technology
Increased security
Access to collective knowledge pertaining to many aspects of billing
Increased organization of medical billing information
More time to spend with patients
Greater patient satisfaction

For additional information, contact Advanced Reimbursement Solutions in Wilmington, DE today. We are happy to let you know more about our services!

Helping You with Your Medical Reimbursement Needs

Whether you run a single-physician practice, a group practice, or a larger surgical center where a mix of basic and complex procedures are routinely performed, it’s safe to assume you have regular billing and medical reimbursement tasks that need to be completed in a timely and efficient manner. Because there are so many factors that can affect your ability to generate sufficient revenue to maintain your practice, it can be helpful to have the right kind of assistance. Fortunately, we’re prepared to help you with all of your medical reimbursement needs at Advanced Reimbursement Solutions.

Avoiding Medical Coding Errors

Based on current American Medical Association terminology, the Healthcare Common Procedure Coding (HCPC) System is one example of the type of coding knowledge that’s important to have when making patient data entries. Even if oversights with coding are innocent mistakes, errors discovered later can raise red flags and be considered forms of fraud and abuse.

“Fraud” is an intentional coding discrepancy. However, the AMA considers “abuse” as the type of coding errors that may be honest mistakes. For example, a misunderstanding of the coding system may result in a coding error related to a more complex procedure or service that was provided. By letting our medical reimbursement specialists review your codes, you could avoid one or more of the following common coding mistakes:

• Unbundling: Using multiple codes when a single code is available that covers the various components of a procedure.

• Upcoding: Billing for excessive services or patient time – e.g., a patient asks a question that takes about 10 minutes to answer and their insurance provider is billed for a standard 30-minute visit.

• Incorrectly using injection codes: If a patient has multiple injections done during a single session, only one injection code needs to be used.

• Not documenting unlisted codes: It’s perfectly fine to use an unlisted code to bill for certain services that do not have an appropriate code. However, these codes need to be documented.

Addressing Contract and Billing Rate Issues

The purpose of a medical contract is to establish specific terms for medical reimbursement procedures. A well-drafted contract defines the roles and responsibilities of all involved parties with regards to details such as pricing, terms of the arrangement, clarification of what constitutes a violation of the contract terms, and how the reimbursement process with be handled.

Our medical reimbursement staff can review your medical contracts to determine if responsibilities are clearly defined. Furthermore, we can look for any billing rate issues that may need to be addressed sooner rather than later.

A State-of-the-Art Billing System

One of the things HIPAA (Health Insurance Portability and Accountability Act) does is establish and manage electronic medical transactions. Medical providers are also required to keep patient records in electronic form. However, it’s not always easy to stay current with the software and related technology that’s needed to accurately and efficiently record and maintain updated patient billing information.

In order for the medical reimbursement process to be effective and beneficial for your practice, you need to have updated records. If obtaining the technology required to do this isn’t in your budget right now, we can lend a hand. We have a state-of-the-art billing system you will have access to once you become a client.

Having your patient billing data safely and conveniently housed in a state-of-the-art system also allows our staff to request redeterminations, when appropriate, if you are not satisfied with the initial decision involving a submitted and filed claim.

Additionally, our state-of-the-art system can be used to spot instances of an account that was overpaid. If we find that an overpayment was made, we’ll quickly initiate the recoupment process to secure the appropriate medical reimbursement. Over-payment sometimes occurs for the following reasons:

• A lack of awareness of other health insurance coverage a patient has
• Payment was made for the same charge more than once
• A claim was paid for an ineligible beneficiary
• Payment was made to the wrong health care provider or individual

Also, since our system is Web-based, our services are accessible to any health care facility or medical provider in the United States. Additionally, the use of updated technology on our part means the errors discussed above may be avoided in the first place, which could contribute to fewer instances of recoupment.

Tracking Your Initial Billing Efforts

One of the challenges with medical reimbursement is keeping track of the initial billing process. Because an important goal we have is to increase the profitability of our medical clients, one of the steps we often take is to track the response to initial billing efforts. If we spot instances of late, delayed, or incomplete reimbursements, we can take the necessary steps to attempt to remedy the situation as quickly as possible.

Minimizing Commercial Health Insurance Claim Headaches

Most medical practices deal with a combination of medical reimbursement processes. Some claims are handled through Medicare or Medicaid. Other claims are handled through commercial health insurance companies. Normally, any type of claim is submitted and reviewed and a decision is made.

While Medicare and Medicaid often have very specific and uniform reimbursement guidelines, this isn’t always the case with commercial health insurance. One of the most common and costly headaches for a medical practice is to have a commercial health insurance claim unexpectedly denied.

Because of our knowledge of various appeals processes, our medical reimbursement staff can quickly find out why a claim was denied. Common reasons for denial that we may be able to resolve or respond to include:

• Inaccurate or incomplete patient insurance information
• Lack of prior authorization for the service(s) provided
• Insufficient information about the reasons for tests or procedures
• Failure to file a claim in a timely manner
• Deeming a procedure medically unnecessary based on the information provided

With denials of this nature, we can find the reason for the denial and determine if there is a way to resolve the issue. If this isn’t possible, then steps can be taken to file an appeal. In some instances, a denial is overturned once the necessary information is provided. While we can’t predict what the outcome of an appeal will be, we can tell you that we’ll ensure a proper appeal is filed in a timely manner.

Medical reimbursement steps can also be taken if claims are underpaid or unfairly delayed. Because we deal with commercial insurance providers throughout the United States, we maintain knowledge of various state laws. This knowledge allows us to spot possible violations of state insurance regulations pertaining to claims that may apply to your situation.

Avoiding Patient-Provider Conflicts

If your practice isn’t receiving medical reimbursement payments on a regular basis, you may have instances where you’ll need to bill the patient directly. While it’s understandable to take this step in an attempt to receive payment for services, doing so may create unintended conflicts between billed patients and their health insurance providers.

By setting up a reimbursement process that works best for your practice, we may be able to minimize the need to revert to direct patient billing. One way we do this is by tracking the status of your claims. Being diligent about reimbursement can also make things easier for your patients since they won’t have lingering concerns about whether or not their medical expenses have been sufficiently covered.

Providing an Added Incentive for Patients

Turning to ARS for your medical reimbursement needs can have some unexpected perks. One of these is your ability to retain existing patients and attract new ones. You are also welcome to emphasize the fact that you are working with a top-notch medical reimbursement company in your marketing materials. Both existing and potential patients may find this detail appealing for a number of reasons.

Handling Complex Claims

Not all medical reimbursements involve simple office visits or procedures. If you are running a surgical center, for example, you may routinely perform complex procedures that involve many different steps and services. From the initial diagnostic testing to the administering of the anesthetic and the performing of the actual procedure and the various processes involved with it, every billable step involved with complex surgeries needs to be properly accounted for so requests for reimbursement can be submitted as per insurance guidelines. A more efficient reimbursement of complex claims may contribute to benefits that include:

• Increased reimbursement
• A boost in total revenue
• Reduced stress about having to attract new patients primarily to offset an uneven flow of revenue from reimbursement issues or delays

Improving Initial Reimbursements

Of course, every situation is different, but when medical reimbursements are handled diligently and meticulously, you may notice a spike in initial reimbursements. An increase in initial reimbursements could ultimately contribute to a pure profit boost. Part of the reason for this is because of a reduced need to directly bill patients and deal with payment collection delays.

Streamlining Reimbursement for Nursing/Physician Assistant Services

We also submit initial claims and redeterminations for services provided by physicians’ assistants. We can take care of the same processes for medical facilities that provide certain nursing services that are normally covered by a patient’s insurance. Similar steps can be taken with services provided at physical therapy or rehab centers.

Talk to the Experts to Learn More Information

Spend more time on patient care and less time dealing with medical reimbursement and the related steps involved with this process by taking advantage of the resources and services available from Advanced Reimbursement Solutions. We have offices in Wilmington and Phoenix. Contact us today to learn more about our services and how they can help you and your medical practice. We look forward to hearing from you!

4 Smart Strategies to Streamline Your Medical Billing Process

The medical billing process is one of the most important tasks in any practice. It is also an activity that is carried out regularly. Sadly, most medical centers face challenges in streamlining their processes in the ever-evolving laws and regulations regarding medical billing services. If you’re facing the same challenge, here are four smart tips to make your medical billing process more efficient and effective.

Ensure Patients Sign the Right Documents

When running any medical practice, having a claim delayed or rejected can be extremely frustrating. This often occurs when patients don’t sign relevant documents or provide incomplete information. The surest way to address this challenge is to have a standard process through which your front office employees can gather the right information and ensure your patients sign relevant documents.

Have the Right Medical Billing Specialist

Streamlining your medical billing process will be impossible without the right personnel who pay attention to detail when billing and coding. If possible, the staff should not be interrupted by other activities in the facility. So, try as much as possible to hire the right medical billing specialist whose sole responsibility is to ensure billing and coding are done properly. And if your patient numbers increase, it is wise to have more billing specialists because the job can be tedious and monotonous. Alternatively, consider outsourcing the service.

Standardize Processes on Delinquent Claims

Piling up delinquent claims can have a huge impact on your cash flow and overall revenue. As such, it is imperative to implement a standard process of handling these claims to save time and get paid on time. For some practices, this means investing in the right software. For others, it could mean outsourcing the service to medical billing companies.

Update Your Patient Data

Today’s patients have more data than decades ago. It is not just an address, phone number, and insurance provider. Having other details, for instance, their email addresses and preferred time and method of contact, can boost your relationship with your patients. It increases the chances of patients contacting your practice. Similarly, it’s important to ensure you comply with HIPAA and other regulations.

The seamless medical billing process is more important now than it was years ago. Advanced Reimbursement Solutions understands all these processes and has a team of experts ready to help. Contact us today to speak with one of our consultants in Phoenix or Wilmington. We look forward to hearing from you!

Technologies That Can Help You Increase Revenue and Efficiency in Medical Billing

The average hospital loses 5% of its margin due to claims denial, contract negotiations, and underpayments. Inefficient medical billing management practices can have a severe impact on your organization. Besides, they also add to your operational costs. Every medical billing business seeks to minimize costs and maximize profit, but how can you achieve this? It’s simple – you need to adopt the latest innovations. Taking advantage of some key technologies will take your billing and coding to the next level. Also, they will significantly increase your savings while their higher efficiency boosts patient satisfaction scores.

Eligibility Verification Software

The average medical practice submits approximately 83 claims every day. Tie that in with the fact that half the accounts receivables are collected within 30 days, and a slow eligibility verification process can complicate your medical billing procedures. Without an efficient verification process, your practice will be at risk of losing revenue through denied claims or billing leakages. Eligibility verification software eliminates the need to keep calling to check verification for each patient individually.

Additionally, the software runs in the background to check a patient’s co-pay, eligibility, and coinsurance, sending all this data in batches. It even notifies you if a patient has met their deductible or not.

Artificial Intelligence

Historically, medical coders manually transcribed all of the information from a patient’s visit. They would transcribe it on to an electronic code that would sit on the practice’s database. Although professionals today use encoders to get this information down, they still have to rely on medical coders due to information errors.

Artificial intelligence (AI) is increasingly being used to run computerized coding systems. It can proficiently identify any data mistakes and fix them. Moreover, it provides real-time analysis to medical coders to help them increase their efficiency. As a result, the rejection rates of medical bills go down due to fewer errors. AI also helps bring down medical bill collections and coding costs. You can then pass these savings on to your patients, giving you a competitive edge.

Stay Ahead of the Curve

Inefficient medical billing and coding can result in your practice losing out on revenue and incurring higher operational costs. Embrace innovations in technologies that streamline your medical billing and coding systems. These technologies will work to improve your revenue and customer satisfaction.

Advanced Reimbursement Solutions in Wilmington and Phoenix is passionate about helping you bill efficiently and at a better cost. Talk to us to learn how you can streamline your medical billing. We are happy to help. Contact us today to book an appointment.

Managing Common Challenges Facing Medical Practices Today

Whether you’re running a private practice or you want to open one, knowing ways to manage common challenges can give you an edge. Most practices in the US report facing similar challenges, from high operating costs to medical billing management and retaining high-talent employees. So here are just some of the common challenges and ways to address them to help you get started.

High Operating Costs

Fewer patients, high technology costs, and decreasing payments to physicians can cripple your practice financially. The surest way to manage these high operating costs is to closely monitor them and find ways to cut costs.

Some of the best areas to focus on include:

• Office supplies: Go paperless.
• Medical supplies: Buy in bulk and look for free trial opportunities.
• Medical equipment: Buy used instead of new equipment and look for online auctions. If you’re worried about cash flow, consider medical equipment financing.

Attracting and Retaining High-Quality Talent

Outsourcing your HR duties can reduce your costs significantly. If you prefer to keep it in-house, you must be proactive in attracting, recruiting, and retaining high-quality medical staff. High employee turnover can hurt your practice’s efficiency, patient satisfaction, and bottom line. So focus on offering great perks, having a solid recruiting strategy, and being creative when motivating your employees.

Negotiating Managed Care Contracts

Medical contract costs can add up quickly and hit thousands of dollars, so it is useful to know how to cut great deals. This requires a wide knowledge of contracting processes, such as understanding reimbursement rates, payment terms, effective dates, claim filing procedures, termination dates, and more.

Medical Bill Collections

Most practices have become aggressive in their medical bill collections. This may be due to the high operating costs that could cripple most of them. If you don’t maximize your reimbursements, you will most likely be out of business soon.

Nonetheless, collecting payments from your patients can be a breeze if you borrow a leaf from the following strategies:

• Advise your patients about your collection policy before they visit, such as during the initial scheduling.
• Post signs in your practice informing patients about your medical bill collection policies.
• Offer great discounts to patients who pay their bills on time.

Running a medical practice can be easy if you handle these challenges well and work with partners like Advanced Reimbursement Solutions in Phoenix and Wilmington. We want to help you discover more ways to manage your practice successfully. Contact us today to book an appointment to speak with a specialist and get started.

How to Make Your Medical Bill Collections Follow-Ups More Effective

Effective medical bill collections results in a quick resolution of your claims. Sadly, most practices ignore the fact that timely claim follow-ups can make a huge difference in getting paid. In well-established practices, follow-ups begin as early as 7 days after submitting claims for payments. These businesses understand that immediate efforts reduce accounts receivable days and boost their cash flow.

The good news is that you can borrow a leaf from these practices. You may not have adequate staffing due to limited resources, but here’s what your medical billing specialist can do to make your follow-ups more efficient.

Be Prepared for Initial Contact

Make sure you have all the necessary information before getting an insurance representative on the phone. This means thoroughly researching the account to help you ask proper questions. For starters, make sure you have the insured’s personal details, like date of birth, policy number, etc. And while on the phone, strive to get information about the insurance representative. Be sure to get his/her name, employee ID number or extension number and a call reference number before hanging up. This will make it easier to provide feedback when you make subsequent follow-ups.

Ask Several Questions

The main goal of medical bill collections follow-ups is to determine when to expect payment. If 30 days have elapsed since you submitted the claim for payment, the insurance representative should provide a reason for delayed payment.

At the end of your conversation, you should have detailed information about:

• Status of the claim
• Payment schedule
• Payment process
• Amount of payment
• Check number
• Reason for delayed payment
• Medical records needed

Be Assertive

Sometimes, insurance companies find ways to delay payment, so don’t be afraid to challenge their representatives. For instance, don’t let them get away with bogus information when discussing claims. Instead of giving up, ask to speak with their supervisor or someone of authority.

Take Appropriate Actions

After finding out the status of your claim, take the right steps to speed up the process. The action you take will greatly depend on the reason given for delayed payment. Fortunately, most medical billing specialists know how to resolve them.

Involve the Patient

Most practices avoid this strategy, so use it as a last resort. Find creative ways to get patients involved without bothering them.

Sometimes, medical bill collections need follow-ups to yield quick results. How you conduct the follow-ups can expedite your claim payments or cause more delays, and these simple tips can help. Want to learn more? Turn to Advanced Reimbursement Solutions to speak with an experienced medical billing specialist in Phoenix or Wilmington. Contact us today to set up your appointment!

Medical Bill Collections: Is Your Practice Crossing the Line?

In recent years, healthcare practices have become more aggressive in their medical bill collections. With the high costs of providing services, it is extremely important for practices to maximize reimbursements which largely depend on patient payments.

You can lose thousands of dollars if sufficient strategies are not geared towards collecting deductibles, coinsurance, and copays. Collecting these expenses from your patients is as important as collecting from insurance companies. But some efforts can lead to poor customer service. So, when do medical bill collections cross the line?

Not Giving Enough Time for Payment Preparations

Some practices don’t give patients enough time to make payment arrangements. This can discourage patients from coming back to your medical facility. It is wiser to give them enough time to make arrangements before initiating the collection process.

Overlooking Delinquent Bills

After offering services, most patients will not have the urgency to pay on time unless they’re prompted. Therefore, remind them of their bills when they visit and encourage them to pay.

Allowing Bills to Accrue

Unless it is an emergency, it is not good practice to allow patients to accrue bills even when they cannot pay. For example, allowing them to continue receiving treatment without paying sends the wrong impression about your practice. If you want your medical bill collections to be better and make your patients happy, avoid the mistakes above and adopt these strategies:

Advise Your Patients in Advance

Before patients visit your facility, inform them of your collection policy. This way, they will be more prepared to make payments on time. This is particularly important for patients who have to meet a certain deductible on an out of pocket basis.

Offer Self-Pay Discounts

For self-pay patients, offering discounts for timely payments can make a huge difference in your cash flow.

Offer Different Payment Plans

Out of pocket expenses can be extremely high for some patients. And the best way to manage them is to offer different payment options. That way, patients can continue receiving treatment without feeling the huge burden of paying bills.

Get Started

For your facility to offer great services and satisfy patients, you must find the right process to collect coinsurance, deductibles, and co-payments. Advanced Reimbursement Solutions wants you to have the best process. Contact us today to consult with an expert in Phoenix or Wilmington. We look forward to speaking with you!

How to Retain the Best Medical Billing Specialist

The Bureau of Labor Statistics (BLS) estimates that the demand for medical billing management specialists will increase by 13% between 2016 and 2026. This implies that the medical industry is growing faster than the national average for all occupations. So it will continue being extremely difficult for medical practices, particularly SMEs, to attract and retain top talent. Why?

Let’s face it. There are other medical practices out there. So what makes you unique from the herd? Offering more money can only do so much. The best medical billing specialist will be considering many options. The good news is that there are ways to attract and retain these specialists. And here are some simple ways to do just that.

Improve Your Employee Engagement

A 2016 Gallup study warned that only 32.7% of employees are fully engaged at work, which is unfortunate considering the amount of resources companies spend attracting, recruiting and onboarding new hires. If you want your medical billing specialist to stick with you for a long time, you must up your game.

Career Growth

Although this isn’t easy for startups and younger companies, it is important. Most medical billing specialists want jobs that allow them to advance their careers. So find ways to show them where they can go and how to get there. Show them that you can provide the right resources and guidance for professional development.

Upgrade Your Technology

Take a look at your billing management software and your computers. Nothing frustrates a talented employee more than outdated software or hardware. It makes them efficient and implies that your medical practice has no interest in investing in the latest technology.

Recognize Hard Work

Everyone likes to be appreciated for their hard work, and a medical billing specialist is no exception. So whenever you notice any improvement, please appreciate them. Employees who are appreciated feel more engaged and are more likely to be highly motivated to continue working with the same company.

Mission and Purpose

Finally, it is important for any employee to understand why and what your practice or billing company does. They need to believe in the mission, so when on-boarding, make it a priority.

The medical billing management industry will continue growing exponentially. Companies that find the right talent will succeed in their mission and purpose. Advanced Reimbursement Solutions wants you to succeed by retaining the best billing specialists. Contact us today to consult with an expert in Phoenix or Wilmington.

Choosing a Medical Billing Management Program? Avoid These Costly Mistakes

If you’re just starting your practice or restructuring, a medical billing management program is often the first thing to consider. Billing isn’t one-sided. So you want a program that benefits you, your patients, and insurance companies. Fortunately, it is extremely easy to get any billing program. Just request for quotes and you will be shocked by the many offers you’ll receive. But getting the right program that works well with your medical billing process can be frustrating. In fact, some practices make hasty decisions only to regret them after losing thousands of dollars. If you don’t want to be one of them, avoid the following common mistakes.

Overlooking Future Requirements

Most practitioners focus on what they need when starting. They invest in billing programs that only solve the challenges they’re facing today without thinking about the future. This can be due to financial constraints.

As an entrepreneur, it is important to remember that your practice will grow. The number of patients will double, and billing constraints will kick in. Therefore, it is better to get a good medical billing management program that can adapt to these changes.

Picking Renowned Brands Only

There are many popular billing programs today. But popularity doesn’t always mean they’re the best for your practice. It is not uncommon to see practices make a decision based on the ‘talk in town’ and later abandon the software.

Focusing on Features Instead of Functions

The competition for software-based services is cutthroat, and companies go the extra mile to outshine each other. As a result, most providers focus on features to make their products attractive to medical practitioners.

Features are great, but they should not surpass functions. Remember, a user-friendly interface and great customer support are only good as long as the software satisfies the requirements of your practice. So focus more on its functionalities.

Opting for Complex Programs

Let’s face it. Some medical billing management programs offer so many features that they’re too complex. And a complex system tends to take time and effort for employees to understand.

Therefore, it is important to choose a program that is specific to your practice. This doesn’t mean the software isn’t great, but you know what’s good for your practice. So choose a program that makes business operations efficient.

Getting the right medical billing program for your practice can be easy if you know what you want. Advanced Reimbursement Solutions helps practices get the right software to make them secure, profitable and efficient. Contact us today to consult with a specialist in Phoenix or Wilmington.