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healthcare key performance indicators

Measuring Healthcare Outcomes

Healthcare Practice Key Performance Indicators Matter

So, your healthcare practice is running smoothly. You’ve hired fantastic people, followed a marketing plan, placed the right technology and your patient retention policy is in full swing with a low churn rate. Things are going great, right? Well, there’s no way of really knowing for sure unless you’re measuring your performance.

Only by carefully tracking metrics (Key Performance Indicators or KPIs) in your medical practice can you actually improve efficiency, profitability and yield better results across your entire practice and revenue cycle management operations. 

Choosing what to measure and what to report, however, is as important as deciding to start tracking measurements in the first place. In this post, we will cover some of the key metrics that will measure the pulse of your medical practice.

To begin, exactly how would you describe these Key Performance Indicators (KPIs)?

  • They are measurable financial and non-financial goals that reveal the essential success components of your medical practice.
  • They are precise measurements utilized to formulate future performance objectives.
  • They’re a method to accurately gauge your practice’s performance.

How best to define the nature of these KPIs?

  • Should reflect the healthcare practice’s goal
  • Should describe factors that are key to success
  • Must be quantifiable (measurable)
  • The choice of KPIs may change as the practice’s goals change or you get closer to achieving a goal

Let’s look at some of the key KPIs for a medical practice (keep in mind that these KPIs involve establishing goals and plans for the practice’s future)

Common Practice KPIs

  • Capacity – what is a reasonable goal of appointments per day?
  • Evaluations vs. Discharges – Are you bringing in more patients than I’m discharging?
  • Conversion rate – How many referrals are being switched to active patients?
  • Active patients without future appointments – Are my patients achieving their recommended plan of care and being properly discharged?
  • Weekly frequency – Are my patients being scheduled for and attending their visits as they are prescribed?

Common Financial KPIs

  • Key expenditures such as medical supplies, wages, rent, doctor contract payments.
  • How much does it cost to acquire a new patient?
  • Are there any expenses that are much higher than they should be?
  • Are you generating as much revenue as you can? If not, why? Is it due to your pricing, your appointment mix, your medical billing, your use of site numbers, etc.?
  • Are you paying doctors and staff within industry averages? Does this match with the opinion of your practice?

Employment KPIs

  • Staff availability
  • Number of sick days used
  • Annual leave balance
  • Length of service
  • Retention rate
  • Feedback about outstanding service
  • Disciplinary actions

Customer Service KPIs

  • On time performance
  • Call tracking KPIs:
    • % phone calls answered within 3 rings
    • On hold wait times
    • Customer hang ups
  • Number of online appointment bookings. If your practice is online-focused or receives a significant number of calls and messages each day, this is an especially crucial metric to track.

What then will be some of the results of NOT having measured your practice’s performance?

  • Less than adequate staff performance
  • Lost revenue
  • Spiraling costs
  • Poor staff morale
  • Poor patient satisfaction
  • Low practice value

Okay, I’ve tracked my practice’s key performance indicators. But I’m one for real-world solutions.

How can I apply my KPI discoveries?

 Here are some practical examples on putting this information to good use:

  • Practices should be observing the total number of appointments that can be booked and comparing that to the number of unfilled appointments. From here, a practice can devise strategies on filling those open appointment slots.
  • It’s important to understand how much, on average, your practice is spending to acquire each new patient. This cost influences your profitability and measures the effectiveness of your marketing efforts.
  • Once patient acquisition cost is calculated, it’s a good idea to start calculating revenue per patient. Putting these two numbers together will tell you if your marketing was successful.
  • Keeping wait times down can help increase patient satisfaction and can help practice management determine how to staff and schedule employees.
  • Long wait times are also one of the main reasons patients will leave negative online reviews. Seeking to improve this metric can improve how your patients portray you online.
  • Ideal patient-to-staff ratios will vary from practice to practice. Keep an eye on which of your other metrics improve when this ration goes up or down.
  • By tracking active patients without future appointments, I can discover if my patients are completing their prescribed plan of care and then being discharged appropriately.
  • By tracking my conversion rate, I can discover if I’m converting a healthy percentage of my referrals into patients.
  • Increasing your visit totals can be achieved by having satisfied patients who understand their role in their health and feel engaged.
  • If you focus on hiring employees who are dedicated to making your practice an inviting and welcoming space, it’s more likely that your practice will be successful. Patients appreciate an office with little turnover and feel comfortable when they see the same faces at their appointments.

An excellent way to stay ahead of the game is to determine the specific goals for your practice and associate the appropriate KPIs for measuring these goals.  

For example, if your goal is to increase your practice by 100 visits per month, you must formulate and understand the metrics that could help you achieve that goal. These specific KPIs for this goal could include evaluations vs. discharges, weekly frequency and conversion rate.

Once you begin to implement the right Medical Key Performance Indicators (KPIs), you’ll begin to see your practice in a different light. 

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The Gravity of Ethical Medical Billing Practices

The Hypothetical Case of Dr. Michael Stevens’ Unethical Medical Billing Behavior

The case of Dr. Michael Stevens is an illustration of the worst-case scenario when unethical behavior impacts medical billing.

An anesthesiologist and owner of a pain management clinic, Dr. Stevens was obliged to relinquish his medical license when it was uncovered that his in-house medical biller was committing fraud. The biller, Edward Bailey, a family member with no experience or proficiency in medical billing, had met with a Medicare contract provider to ask for counseling on which CPT codes to use for a new treatment the practice had begun to make available. Soon, claims that had formerly been denied by payors began to come back approved.

However, when the state licensure board initiated an investigation of Dr. Stevens, they detected that the practice routinely billed the same five CPT codes for the treatment, one of which was not a standard test. Turns out that Mr. Bailey had taken it upon himself to find the grouping of CPT codes that would guarantee payment for the new treatment, whether or not those services were performed. When questioned, Dr. Stevens acknowledged that he did not review the claims that his biller submitted and that he was unacquainted with the exact CPT codes that were being billed on the claims. Dr. Stevens said he assumed that Mr. Bailey was applying the correct CPT codes as instructed by the Medicare contract provider. While Mr. Bailey pleaded guilty to healthcare fraud, the medical licensure board ultimately determined that Dr. Stevens “engaged in dishonorable, unethical or unprofessional conduct,” and he surrendered his medical license, effectively ending his medical career.

True, this is a worst-case scenario, but should serve as a cautionary tale for those medical practices that do their medical billing in-house. Truth is, it’s now easier than ever before for the appropriate government agencies to detect unethical medical practices via the use of algorithms that monitor and analyze incoming claims and payments and then flag suspicious patterns of behavior. Practices and providers who are identified through these systems can be investigated and if found to have a pattern or history of billing mistakes, may face steep fines or other penalties.

Why is ethical medical billing crucial?

Inaccurate medical billing leads to several issues. Whether inadvertently or deliberately, at times billing may be performed in a flawed manner, resulting in claims rejections, unsatisfied patients or even legal liability. Moreover, inaccurate billing practices can lead to serious financial consequence for your practice. Often, it will result in your practice not receiving the full amount it is entitled to from the patient and/or the insurance company. Therefore, a higher accuracy of medical claims saves revenue.

Unfortunately, the use of inaccurate billing for the purpose of increased profits is found to be on the rise. This necessitates safeguarding patients from insurance and healthcare fraud and related issues. The first step in fighting such challenges is assuring that medical billing processes are performed ethically and in a flawless manner.

Generally speaking, there are several types of unethical medical billing practices that healthcare providers need be aware of that can result in prosecution. Since we’ve discussed such unethical practices in a previous blog, we can summarize them here as total neglect, or no services provided; worthless, unnecessary or inadequate services; and improper coding and billing.

So, what can healthcare providers do to assure they can detect and avoid unethical billing practices?

  1. Be informed
    The best advice we can provide is to arm yourself with knowledge of the healthcare laws as well as become familiar with your billing statement and CPT codes. This would help you ensure that every billing statement you generate is always accurate and free from any errors.
  2. Maintain updated and proper documentation
    Healthcare providers should always strive their best to provide the most updated and recent documentation. This would not only ensure that all information in the billing statement is correct, but it would also help medical practitioners in providing the best treatments and services. Always keep in mind, too, that this documentation remains a part of the patient’s medical record, so it’s important for the protection of your patient that it’s absolutely accurate. Inaccurate information can harm the patient and can harm the quality and accuracy of future care. It’s irresponsible, if not downright reckless, to put patient health at risk because of something like inaccurate billing.
  3. Ensure transparency
    Healthcare providers must immediately handle concerns regarding their employees’ or colleagues’ unethical billing practices. They must be transparent and facilitate interdisciplinary collaborations in making sure that the employees’ unethical behavior is dealt with accordingly. In line with this, all healthcare providers must be knowledgeable of the current mandated coding and classification system. Failure to research or state the appropriate code should be dealt with immediately.
  4. Monitor the system
    A healthcare provider must always strive to improve the accuracy of their billing process. They must ensure that both healthcare and billing professionals are aware of the ethics and standards that they must follow. The AHIMA Standards of Ethical Coding should always be followed and implemented in the workplace. This would help ensure that the expectation for making ethical decisions in the workplace and commitment to integrity during the billing process is always reflected in the employees’ work.
  5. How to achieve strong ethical behavior in your billing process
    Changes in healthcare related laws and regulations and increased legal needs make it essential for medical professionals and healthcare facilities to keep themselves regularly updated. Let’s face it, proper medical billing can be achieved only by keeping up to date with prevailing billing standards and the most recent practices. This is where professional medical billing companies come to help healthcare practices.

Conclusion

Medwave, one of the leading medical billing service providers in the industry, is equipped with a team of knowledgeable and experienced medical billing specialists. Moreover, our qualified billing professionals are provided regular training to stay abreast on the most recent changes and requirements in the medical billing process. Our medical billing solutions are efficient and timely. We ensure error-free and reliable billing that leads to proper reimbursements for your practice.

tags: Basics of Medical Billing, Ethical Medical Billing, Medical Billing, Medical Billing Ethics, medical billing fraud

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Medical Billing and Credentialing

The Reasons Why a Medical Billing Assessment is Needed

Medical Billing Assessments

Running a healthcare practice means keeping a tight ship for the sake of your patients and your reputation, as well as your financial well-being. But, let’s face it, practices are only as successful as their medical billing performance.

If you have a prosperous practice but still want to evaluate or tweak specific features of your billing practices, a medical billing assessment will be a big help.

What amounts to a medical billing assessment?

A typical assessment will include a comprehensive review that focuses on:

  • Examining your practice’s billing performance
  • Assessing its guidelines and processes
  • Gauging the technology and tools the practice employs
  • Reviewing patient care workflow

Assessments are key in offering a tool to gauging things we are doing well and things we could be doing better.

Okay, but why should you perform a medical billing assessment?

  1. You want to increase your revenues. Maybe you’ve been trying to grow your practice but haven’t been able to do so. A billing assessment will provide clues as to what’s working and what needs to change in order for your practice to grow.
  2. You want to assess your policies and procedures. Maybe your billing is not efficient in the areas of outgoing billing or in receiving payables.
  3. You want to be sure your technology is up to date. Upgrades in computer and mobile technology as well as software will make billing more proficient. But things change quickly – what was cutting edge a few years ago might already be obsolete today. You want to make sure that your tech is up to the task. It’s a fast-moving world, so it’s helpful to get an expert assessment of how current your tech really is.
  4. You want to review workflow. A medical practice is only as efficient as the employees that run it and your employees are only as efficient as the workflow they follow. A detailed assessment of your billing process will expose inefficient processes that cost your practice time and money.

Industry experts suggest that every medical practice have a billing assessment performed at least once yearly or more often such as a semiannual assessment of all providers who bill for services. Additionally, it’s a great idea to have an occasional ad-hoc assessment if you have any worries about billing patterns or your practice has a record of substandard documentation or perhaps you’ve recently added a new physician to your practice.

But how do I know if it’s time for a medical billing assessment?

Here are some tips that will indicate when it’s time to evaluate the overall financial and workflow health of your practice.

Medical Utilization Management

Is your healthcare practice growing?

Many practices experience growth and expansion; others would rather remain small but will, at times, be compelled to turn new patients away. But what if your practice has simply seen better days? Chances are it has little or nothing to do with the care you’re delivering, but more so how the patient is made to feel concerning their dealings with your practice.

If patients sense they are being marginalized because they’re having problems in resolving their insurance with your system, or they are facing unreliable billing, odds are probable the patient will simply go to another practice.

Unfortunately, most people don’t have the time to travel through an intricate system like medical billing and will opt to go where they feel a practice better grasps the subtleties of appropriate billing.

What is the status of payer contracting?

Insurance plans are everchanging and evolving. Is your practice able to keep up?

Does your staff comprehend VA Medical, Medicare and Medicaid?

If your practice’s grasp of contracts is not in synch with the insurance firms you deal with and the services you deliver, then an assessment will be able pin down areas of failure and resolve them.

Is your practice up to date with Medicare?

Is your staff aware that Medicare fee schedules are revised annually? When they are, you can anticipate plenty of changes that will impact reimbursement values. Adjusted fees can add hundreds, even thousands of dollars to your reimbursement costs.

If your practice is not current on Medicare, you should think about an assessment to bring your practice up to speed.

How do you handle denial management?

Statistics indicate that 20-30 percent of claims are rejected, and 80% of such claims go unprocessed. Denied claims lower or delay revenue which can also eventually affect patients’ confidence. An assessment will assist your denial management system and present ways that can help boost revenue.

Perhaps you need to hire a medical billing company

Today’s healthcare providers must manage administrative tasks, stay current with billing regulations, and handle financial responsibilities along with the medical duties of the practice. It appears like a bit of a nerve-racking task, huh? 

Of course, it’s important to manage every facet of your practice to realize good outcomes. But don’t worry, there’s always an answer to every challenge these days. Having said that, an outsourced medical billing company can help rid of the administrative worries heaped on the shoulders of physicians with dependable solutions.

Here are five ways an outsourced medical billing company benefits healthcare practices

  1. Profit from the rewards of daily cash flow. Insurance claims are administered daily, payments are usually collected within 2-3 weeks rather than 60-90 days.
  2. Profit from peace of mind with regular daily service. At no time worry about late payments, scheduling billing staff vacations, unexpected sick days, employee turnover or pricey re-training.
  3. Profit by focus on your patients. Rid of devoting hours on the phone with insurance payer firms.
  4. Profit from guaranteed privacy and data safety with HIPAA-compliant services. A billing service will comply with document and workstation security, email, fax and data protection and document removal and destruction.
  5. Profit from easy access to robust financial and activity reports. You’ll be provided access to daily, monthly and quarterly reports that make known the work accomplished.

Conclusion

What are you waiting for? We should all know by now that the healthcare industry’s reimbursement rules and regulations aren’t going to stay put. The changes they undergo are constant; dynamic. They are always being restructured and upgraded as the system matures, forcing the need for persistent financial watchfulness by medical practices.

At Medwave, our revenue cycle management experts take care of your billing difficulties to provide a steady cash flow and enhance the turn-around time on your claims.

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COVID-19 billing

Outsourced COVID-19 Testing Billing Advantages

COVID-19 Testing Scenario

Jude Hunt, 81 years old, said she waited in line for her second PCR test a few weeks ago after her vaccinated housekeeper tested positive for COVID-19. She said she previously contracted COVID herself and received the vaccine, but added, “After the last two years, I’m not taking any chances.”

David Gallego, a medical technician at a mobile testing site, said he has witnessed the number of people stopping by for COVID tests double the past few weeks, to about 100 people a day.

More Americans are being tested for COVID – and waiting longer for results – as virus cases surge and places from offices to concert venues require people to show proof they aren’t infected. Laboratories in the U.S. processed an average of 713,000 daily tests for the virus’s genetic material as of August 2, 2021, according to the Department of Health and Human Services. That’s an increase from about half a million in early July.

It’s becoming obvious that the nation’s COVID testing infrastructure, including diagnostic labs, are racing to keep up as the highly contagious Delta variant spreads across most of the country. Workplace testing requirements and revised federal guidelines recommending that vaccinated people exposed to COVID get tested is only exacerbating the situation.

What’s more, delayed results will only hamper efforts to contain the spread of the virus and interfere with attendance at work, school or other activities that require proof of a negative test.

So, what can be done to help alleviate the logjam in testing?  It’s been recognized by numerous medical professionals that the most effective way to overcome this bottleneck in COVID testing is to engage a third-party partner that can assume responsibility for executing all aspects of the billing process.

For many labs, outsourcing laboratory billing is a method to achieve the necessary deep analysis while preserving financial, physical and personnel resources for other essential activities, such as COVID testing. A much more thorough approach than simply adding a new software system, partnering with a laboratory billing firm can have numerous benefits.

6 Advantages of Outsourced Billing for COVID-19 Testing:

  1. A cutback in operational costs and improved cash flow
    Maintaining a laboratory billing department includes the accompanying software fees, preliminary and continuing training costs and salaried, knowledgeable employees. Reducing overhead costs by outsourcing billing is an excellent way to cut expenditures and foster healthy cash flow. IOW, you’ll pay less than hiring full-time employees.
  2. Elimination of billing errors
    According to NerdWallet, almost 50 percent of Medicare claims contain some type of billing error. Medical billing for lab work is complicated and undergoes frequent changes. Moreover, to ensure labs obtain appropriate reimbursement, billers must keep up with the many and recurrent changes to current rules and regulations. Labs turn to third-party billers because they’re in the know in the subtleties of laboratory billing and constantly work to identify precise billing practices to help overcome problem areas.
  3. Automatic verification
    Incorrect verification and eligibility are the number one source of claims denials. If you presently employ in-house staff to confirm coverage, medical necessity or additional claims info, contracting out your verification services will improve accuracy and, better yet, you won’t have to expend more time and effort in keeping staff current on billing changes.
  4. Quicker processing and payment
    Instead of the weeks sometimes needed for the processing of a typical paper claim, using a medical billing service to file a mistake-free automated claim prepared by an expert biller will result in payment in just a few days.,
  5. Transparency
    Getting an accurate picture of your lab’s financial performance is demanding. With data hidden in spreadsheets and out-of-date systems, collecting information essential to optimizing operations and plan for the future is frequently arduous and time consuming. To help meet these challenges, Medwave offers cutting-edge financial and practice assessment tools, explicitly designed to give greater visibility of your operation and acquire key data and metrics for regulatory reporting.
  6. Improved performance
    Your lab merits every viable attempt to enhance proficiencies, boost revenue and grab hold of opportunities for growth. However, many lab managers just don’t possess the time, personnel or resources essential to dedicate sufficient attention to the subtleties of laboratory billing. For this reason, employing a customized billing service to help you manage your lab is an unquestionable opportunity for improved lab performance.

Conclusion

Finding the appropriate medical billing company is crucial to your laboratory’s success. While a straightforward internet search will provide hundreds of billing service companies, some of them fly-by-night, determining the best among them is a significant factor to stimulating your laboratory’s revenue performance.

To this end, Medwave is your premium choice for COVID-19 billing services and stands far above other companies you might come across in your searc

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Medical Billing Software

7 Strategies to Maximize Patient Collections

Any medical provider knows how difficult it is to get paid for their services. 73 percent of healthcare providers assert that it takes 30+ days to recover their payment fully. Various issues like complicated billing procedures, changing payer fee schedules, employee attrition, government directives, lack of training and resources and high-deductible health plans complicate the payment cycle. Plus, the important communication triangle among the healthcare provider, the patient and the insurance company only aggravate the problem.

To get paid efficiently, medical providers need to establish better systems and procedures that provide lasting success. This post provides a concrete guideline for medical billing collection.

Here are 7 Medical Billing Strategies to Boost Patient Collections:

  1. Educate your Patients on Claims Processing Process
    Insurance is complex and is getting more so. That’s certainly not news to those in the profession. Physicians and their staff are now spending a lot of time on continuing education when it comes to billing. But patients could also use a bit of schooling, too. Copays, deductibles and other medical billing terminology can be a bit of a mystery to most people. Consider printing a simple flyer that explains billing basics that can apply to any insurance plan. Direct patients toward a customer service number on the back of their insurance cards for more detailed questions. Educating patients on where to get more information will also help improve patient relationships. “Patients often blame the doctor when billing problems are really between patients and their insurance provider,” says Karen Lake, healthcare consultant with the firm Pearce, Bevill, Leesburg and Moore.
  2. Have a Go-To Person for Billing
    Medical billing is complex. That’s why you need to make sure you have one person on your staff who is carefully trained and proficient in all things billing. Direct any staff and patient questions or issues to that person. Spend the time and money training your go-to person, too, as your revenue depends in large part on his/her know-how. It’s also prudent to cross-train in case your billing pro has to miss work for an extended period.
  3. Establish a Transparent Collection Process
    According to Physician Practice, 81 percent of smaller medical practices find it difficult to communicate patient payment accountability as a part of their service. Don’t be one of them! Setting up well-defined expectancies with your patients about the payment terms when they fill out the intake forms speeds up payments. Moreover, making this information freely accessible on your website, paperwork and frequently asked questions section eliminates any uncertainty. Also, describe several payment choices to your patients early on to avoid receiving payment through unsupported means. Posting your collection processes and responsibilities near the receptionist desk for easy accessibility is also a great option.
  4. Implement a Payment Policy that Requires Patient Responsibility at Check-in
    Most of the time, patients know that they will need to pay a segment of their bill out-of-pocket. As a medical practice, your goal should be to keep the patient informed again and again. You can do so by checking patient eligibility prior to each appointment and setting expectations with each patient by alerting them of the co-pays that are owed at the time of service. To make sure patients are mindful of this requirement, produce a medical office payment policy. Then, add in a patient responsibility agreement in your check-in paperwork to sign. The aim of this policy is to provide patients and your staff clear-cut procedures for collections. This can be particularly helpful for practices with less face-to-face time between patients and providers, such as radiology practices. Posting signs throughout the office letting patients know that payment must be collected upfront will help as well. You might also use your patient messaging solution to send automated appointment reminders revealing what’s due at the time of service.
  5. Accept Multiple Payment Methods / Offer Payment Plans
    You’ll also increase the probability of collecting balances at check-in by providing a variety of payment methods, including cash, credit/debit card or check. Having a handy and easy-to-use online payment tool in your patient portal will also accelerate patient payments. For larger balances, institute payment plans and train staff on how to explain these options and track them properly. Offering a more accommodating payment option will help your practice increase collections and give patients peace of mind knowing they will be able to pay for treatments they need.
  6. Look for Ways to Improve / Keep Up to Date
    To put it bluntly, the healthcare field is everchanging, and healthcare practices need to follow suit if they want to maximize efficiency and revenue. By tracking performance and keeping current on the latest healthcare regulations, practices will be able to recognize problem areas and implement new ways of addressing them. Especially keep in mind that medical billing rules are constantly being modified, and keeping up with these changes will involve continuing education and training for staff. Stay atop of any changes that might affect billing and coding protocols and seek training if necessary – this is less costly in the long run than repeatedly resubmitting claims.
  7. Know When to Outsource
    As we’ve demonstrated, medical practices must constantly worry about their patients, current trends in medicine and proper staff management. They must also stay updated with the latest rules about coding standards, insurance companies and billing regulations. With so much to keep up with, details can slip through the cracks, giving rise to rejections, denials and underpayments that cost your practice time and money. Regardless of the best attempts to employ proactive billing practices, many healthcare providers still find themselves trailing behind. This is frequently owing to the costly time and labor involved in tracking down debtors, submitting and editing claims and staying on top of current regulations – duties often heaped on top of existing duties of medical office staff. In response to the ever-increasing rules and regulations and in an effort to slash labor costs, many practices have outsourced their medical billing to third party specialists. For many, it’s an efficient way to boost revenue and re-claim control over their billing.

Among the benefits of outsourced medical billing include:

  • Dedicated specialists: Medical billing companies have a committed staff of billing experts whose only job is to ensure that claims are filed properly and denied claims are resubmitted accurately.
  • Quick submissions: Well-trained staff can submit claims more rapidly and with better awareness to detail.
  • Better focus on patients: Once they’ve gotten rid of the time spent on billing and staffing matters, doctors and nurses can better focus on their patients.
  • Up-to-date standards: Medical billing companies are obliged to stay current with the existing regulations.

Give the professionals at Medwave a call to find out how we can help!

Tags: Basics of Medical Billing, Collection Process, Medical Billing, medical billing strategies, medical billing strategy, outsourced medical billing, Patient Collections

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Healthcare Practice Revenue Affected by Medical Billing Issues

Let’s say a patient comes in and gives you his or her Medicare card. The front desk carefully records the information and billing submits the charge to Medicare. But the claim is rejected, maybe even from the clearinghouse.

The problem? The patient thinks he’s simply on Medicare, but his plan is actually with Blue Cross, United Health Care or another Medicare Advantage plan.

This is but one example of a billing error

As a healthcare provider or medical facility, you want to provide the best possible medical solutions, determining the right diagnosis and treatment plan for your patients. But, you also must manage the costs of running your health facility.

However, are you aware that medical billing issues can impact your practice revenue?

Running a cost-effective, efficient medical practice demands a consistent and reliable revenue stream. Unfortunately, that’s going to be difficult to achieve if your billing efforts aren’t optimized for success. Whether they result in delayed payments, denials, patient complaints, or even lost productivity, medical billing blunders hurt your practice. Eliminating such errors is critical to your bottom line, so it’s essential to think about the most common medical billing mistakes and put strategies in place to prevent them from impacting the management of your revenue stream.

The most common medical billing mistakes include:

Wrong patient ID number or patient information

The medical billing process begins with the front office gathering patient information, which is the foundation for billing and collecting. Taking the time upfront to assure all ID numbers are accurate will mean a decrease in such issues in the future. 

Leaving off even one of the requisite fields in a bill can bring about a denial. It’s actually quite easy to double-check to make sure you’ve provided all the required information before submitting the claim. What’s trickier is making sure all the data in those fields is correct. It’s easy to misspell a name or transpose numbers, especially during busy times at the front desk.

Kenneth Hertz, FACMPE, principal consultant at MGMA Health Care Consulting Group, suggests having a separate space for taking insurance information, if possible. A separate room is ideal, but if you don’t have the space for that, at least try to arrange a cubicle or quiet corner to keep distractions to a minimum during this detail-oriented process.

Incomplete claim information

A sole entry or unchecked box on a claim can be all it takes to bring about a claim denial. Even the most basic fields like gender, date of birth and time of the accident or medical emergency are frequently left blank.

At a minimum, make sure a second set of eyes offers a cursory review of each paper or electronic claim the office files to help assure the necessary fields are completed. If you’re only working e-claims, check that your software system flags users to check missing fields and input all required info before allowing them to be submitted.

Entering the wrong diagnostic code

A number of patient billing errors take place because a staff member entered the wrong diagnostic code onto the bill. This becomes more common on bills that total $10,000 or more. Did you know that, according to credit agency Equifax, those bills often come with errors totaling more than $1300?

Many of these mistakes are straightforward – a diagnostic code for an exam of both limbs when only one was examined, or a typo that results in a different and more expensive diagnostic code than the one that was prescribed.

The problem is that these errors can result in insurance companies disallowing the claim, harming your practice’s revenue stream and making it more difficult for the patient to get the care they need.

Sending claims to the wrong insurance company

Sending the claim to the incorrect insurance provider is one of the simplest medical billing errors you can avoid.

This might sound like a no-brainer, but it’s actually an easy mistake to make.

Remember our example at the beginning of this article where the patient presented the wrong card and your office ended up billing Medicare rather than the Medicare Advantage company?

This typically occurs when you don’t have a copy of the patient’s insurance card on record. It’s imperative to have a copy of both the front and back of the card so you can verify and choose the correct insurance company. Always ask the patient if there are any changes to their insurance, too.

Lack of specifics

Insurance carriers often deny claims for not being coded to the highest level of specificity or being “truncated” (needlessly or inaccurately shortened). As a trained coder understands, each diagnosis must be coded to the utmost highest level for that code, meaning the maximum number of digits for the specific code.

If your staff are not highly acquainted with coding, they could be making this kind of error regularly without even recognizing it. Education is vital. Teach your billers what truncated codes look like so they can amend them before filing.

What are some of the outcomes of errors on your medical practice?

  • Lost time – Billing errors will require a number of corrections and/or amendments, leading to a huge waste of time.
  • Cash flow – Whether payments are late or rejected, they will slow down your cash flow.
  • Added personnel – If rejected claims become substantial enough, new claims don’t get processed and the practice is forced to bring on extra personnel to deal with the backlog.
  • Angry patients – Billing errors will aggravate your patients, eroding trust, damaging patient satisfaction and hurting patient retention.
  • Audits and alarms – With audits, billing errors can be considered as acts of fraud and pave the way for an investigative audit. If the practice is found to be at fault, it can result in legal charges of fraud being leveled. This can result in fines, loss of privileges or added legal expenses to deal with the outcomes.

Eliminate medical billing errors with Medwave

The best way to stay clear of plain mistakes is to work with well-trained professionals. One possibility is to outsource your medical billing, which is proven to help medical practices maximize revenue by lowering claim denial rates.

As a well-trained and practiced medical billing and coding partner, Medwave has been helping healthcare practices upgrade their billing practices throughout the Pittsburgh region and beyond. We’ve been successful with a diversity of practices which have allowed us to put the most reliable systems and policies in place to help boost their overall clean claims and improve their revenue cycle management.

To learn more about how our billing and coding specialists will work with you and your staff to reduce medical errors and boost your insurance reimbursements, contact our team today for a free consultation.

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Original Article: https://medwave.io/2021/07/medical-billing-issues-affecting-healthcare-provider-revenue

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Patient Flow Increases Revenues

No longer can healthcare practices rely on the single appointment and waiting room process. Managers of healthcare practices of all types and sizes increasingly recognize that effective patient flow is key to increasing revenue and improving efficiency for the practice as well as providing a positive experience for the patient.

As the business manager of a fast-growing orthopedics group explained, “We have to get this right.”

In most person’s increasingly busy lives, the experience of going to the doctor or treatment center isn’t simply making an appointment and waiting to see a provider anymore. Attention needs to be paid to how patients can move seamlessly from check-in to clinical practice areas to check-out, so that providers can operate efficiently and maximize time with patients.

Before proceeding, let’s all agree on the definition of patient flow.

Patient flow represents every touch point during the patient visit experience, from arrival to departure. It encompasses everything from patients arriving at the facility to checking out at the reception desk. When patient flow strategies work, patients move from check-in to check-out in a way that maintains the quality of care, improves patient experience and enhances medical practice revenue.

Here are some guidelines which outline good patient flow

  1. Clearly define patient destinations
    Patients should never need to think about where they are supposed to be. Signage is the key. It may be as simple as lobby or parking lot signs directing patients to the correct floor or door. It may be signs within a practice clearly distinguishing check-in from check-out, or segregating patients by type of service needed. One great way to figure out if you’ve got any confusing spots is to ask a few friends (preferably those who may have trouble – the elderly, families with lots of kids, etc.) who have never been to your practice to give it a try. If they have trouble navigating, you know where you may need some more signage. Make sure to record what happens during the visit and any observations and impressions along the way.
  2. Keep the patient informed
    When patients are left alone in a waiting room for an extended period, they are sure to get restless and build up frustration. Keep your receptionist up to date on your schedule so they will be able to relay information to patients. If your schedule gets backed up early in the day, inform afternoon patients by text or phone that their appointment will be delayed. If someone is able to leave work 15 minutes later because they know their appointment will be delayed by that amount of time, your waiting room will not be as crowded, and the patient is much less likely to become frustrated.
  3. Plan visits
    One effective planning approach is for medical providers and support staff to review their schedules in order to identify how to make the day run more smoothly. Too often, staff will realize that they are missing crucial test results or required documentation after a patient has already arrived. To prevent cancelling the appointment during the visit, determine if all the necessary information is available in patient charts the day before and reschedule if necessary. An electronic health record (HRE) can help by providing real time updates of lab and imaging results.
  4. Improve practice layout
    The layout of your medical practice can have an enormous effect on patient flow. Whether you’re starting a new medical practice (from scratch) or considering a remodel, make a patient-friendly layout a priority. For example, consider the strategic user of exam rooms. Know how many exam rooms are needed. For many, it’s two or three. Plan accordingly, then consider “swing” exam rooms – extra rooms allocated among several practitioners to absorb patients at times of high demand. These may be used to enable a patient to see a doctor on schedule, when another patient with a complex visit would otherwise cause a back-up in the schedule.
    From the exam room patients should be able to head directly to a separate exit when finished.
  5. Invest in mobile technology
    Consider incorporating tablets into your patient experience. Rather than having patients fill out paperwork at reception, hand them a tablet where they can review their medical history and make changes. Most of your patient population is likely to be speedier on a tablet than a person with a pen and paper. You can also equip nurses and physicians with tablets for note taking and other tasks.
  6. Parking is part of patient flow
    Yes, parking is part of patient flow and can dramatically affect both patient satisfaction and revenue. One primary care practice took the extraordinary step of borrowing money to build a parking garage. In their small town, street parking was limited, and their parking lot could not accommodate all the traffic. Because patients could not find parking spaces, many were late for their appointments. Others gave up and became no-shows. Both practice revenue and patient satisfaction suffered. In many suburban locations, the problem is not as severe, but still chronic. Patients cannot find spaces or must squeeze into overly small parking spaces. Another parking issue is an appropriate drop-off area. Can a family member pull into a covered space to drop off an elderly family member or patient on crutches? If so, you have enhanced patient flow and experience. Whenever you’re considering a new facility or improvement to an existing one, consider parking carefully. You can be sure your patients do.
  7. Don’t forget your supply path
    What about movement of supplies? Your medical supplies should contribute to a smooth flow of patients and doctors. There are a variety of options that would work for your supply flow. You can use a single, central storage area. Or you could put supplies in each individual room or even use carts that move from location to another. It doesn’t matter what you choose, the key is to make sure that supplies never slow down the flow and efficiency or your office.
  8. Reduce missed appointments
    No-shows and late cancels can cost your practice thousands of dollars. And the truth is – there’s only so much you can do when patients need to take time off work, find a babysitter or drive through traffic to get to their appointment. While little things like adding a cancellation policy with a fee can help, offering patients a way to do virtual visits from their home can be really effective. If patients don’t need to brave traffic or take time off to see you, they’re much less likely to skip an appointment.

Patient Flow — Conclusion

If your medical practice takes time to execute the strategies discussed, in addition to others not mentioned here, you’ll be responsive to patients’ expectations, while remaining current with the changing dynamics of the healthcare market.

By putting the patient first and anticipating their overall needs, practices can create a solid stream of new and returning patients which can lead to increased practice revenue.

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Original Article @ https://medwave.io/2021/07/efficient-patient-flow-increases-revenues

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Healthcare Practices Save Money with Higher Accuracy of Medical Claims

Reimbursement for medical practices has been impacted by numerous trends and healthcare industry changes over the past five to ten years. Medicare and Medicaid are constantly cutting physician reimbursement, third-party payers (UnitedHealth, BCBS, Humana, Anthem, Aetna, Cigna, etc.) have bargained for fee-for-service contracts with healthcare providers, often bringing about reimbursements at less than 100 percent of charges. Moreover, the Administrative Simplification requirements of the Health Insurance Portability and Accountability Act (HIPPA) have stiffened claims data submission requirements.

Add to this the government’s emphasis on healthcare fraud and abuse and compliance have all increased the significance of accurate billing. Because of such concerns, medical practices are being forced to upgrade their revenue cycle management processes.

What do we mean by Revenue Cycle Management?

The Healthcare Financial Management Association defines the revenue cycle as “all administrative and clinical functions that contribute to the capture, management and collection of patient service revenue.” Basically, then, the revenue cycle is everything that happens from the moment a patient account is created (at intake, whether that’s a doctor’s office, outpatient clinic, tertiary care center or other site) through payment for the particular treatment, surgery or care package. It may take weeks to months for a medical practice to get reimbursement due to submission of the claim depending on the nature of the patient’s illness to diagnosis, treatment and selection of medical codes, as well as dealing with claim denials.

For the revenue cycle to work most effectively, it must be predictable. That means its processes must be executed correctly, which is no small task. An early error can derail the process at multiple points along the way, causing errors in billing, slow payment, and other negative actions. Getting things back on track can be time-consuming and costly.

How Bad is it?

Failure to remain current on medical billing rules and regulations, in addition to billing errors, results in U.S. healthcare providers leaving roughly $125 billion in uncollected revenue each year! Specialists like radiologists face even bigger challenges due to the intricacy of their procedures and special billing requirements.

Truth is, medical billing is the backbone of healthcare revenue cycle management, but many providers experience significant challenges with efficiently and accurately billing patients and payers for services they perform.

The medical billing process can be a pain point for some providers because it involves an array of healthcare stakeholders and each step to getting paid relies on the previous interaction. Healthcare organizations must communicate across departments and payers, as well as ensure that crucial information is properly captured in each step of the process.

A Thankless Job?

Let’s face it, managing the medical billing and coding for your practice may seem a thankless job, but the importance of accuracy to the entire revenue cycle cannot be overstated. Depending on the compiled claims by the healthcare administrative team, insurance companies decide if the services provided to the patients are medically essential and valid.

Following up to ensure that claims are fully paid, and any errors corrected takes time and a very detailed mind. Moreover, medical billing codes change on a regular basis, adding complexity to the overall process. Anyone responsible for filing and submitting claims must stay up to date with the real-time changes in this field. Subsequently, medical billers should make sure that they compile accurate data during the documentation process. Any single mistake during this procedure can lead to a significant loss of revenue and cause disputes with insurance payers. As a result, it may also impact your business reputation among the payer’s community in a negative way.

That’s why qualified medical billing specialists should have in-depth knowledge about the exact diagnostic procedures, surgeries, documentation of symptoms, age, gender, pre-existing conditions and so forth. They should not only be able to file claims but also deal with the patient’s confidential data in compliance with the HIPAA regulations.

Are you experiencing Revenue Loss?

It’s a fact: Incorrect coding is often responsible for the greatest lost revenue in a practice, causing certain claims to be completely denied and others to be only partially paid.

Unfortunately, many healthcare payers are deploying inexperienced claim examiners that will often err at a significantly high rate. Often, their training falls short of what is necessary to ensure accurate and efficient payments, and many will continue making the same costly, repetitive payment errors once they become “experienced.” So reports Paul Adams, Director, and Deanna Hodges, Manager, Health Care Consulting Group of Moss Adams, a Seattle-based consulting firm in a recent article in Washington Healthcare News.

Without an effective billing process in place, your practice is at risk for:

  • Incorrect coding of claims
  • Poor management of account collections
  • Significant loss of revenue that makes your practice less profitable, jeopardizing your ability to stay competitive and attract top talent

If you’re falling behind in these areas, there’s a good chance you've fallen victim to revenue loss.

Look to an Experienced Medical Billing Company

Outsourcing the coding and billing to a reputable medical billing company just might be the best way to ensure a seamless revenue cycle. Medical billing companies with dedicated personnel can efficiently manage the coding and billing-related tasks that typically cannot be handled in-house due to cost and time constraints to look after patients.

Medwave has years of experience in credentialing and medical billing and has helped numerous healthcare providers in improving their revenue cycle. When you work with a professional billing organization, you can be assured that your credentialing, coding and / or billing is completed to the highest standards of quality. This provides a crucial component of a strong, medical revenue stream. Find the right solutions for a complete suite of healthcare revenue cycle management.

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Outsourcing Toxicology Billing Maximizes Profit

As a supplier of toxicology testing, you’re well aware that medical billing for toxicology laboratory work is highly complex and undergoes frequent and often unpredictable changes. Further muddying the waters, lab testing work is an area of attention and scrutiny by agents for the Office of Inspector General and the U.S. Department of Justice. In order to make sure your lab receives proper reimbursements for toxicology billing and doesn’t draw the attention of these regulators, you need to keep up with frequent guideline changes, both from government-sponsored and commercial payors, and be mindful on how to apply the existing rules.

Nationwide, toxicology labs have turned to well-informed, medical billing companies. Those who fully understand the nuances of toxicology billing. Those who’ll work hand-in-hand with your lab to pinpoint the proper billing guidelines and surmount any likely problem areas.

With the support of these billing service providers who maintain industry insight and in-depth experience in the field of toxicology lab billing, you can realize a healthier bottom line.

Here are some of the reasons that warrant outsourcing toxicology billing services, which maximize revenue collection.

9 Reasons to Outsource Toxicology Billing

  1. Reduces administrative strain
    No doubt, the overall success of the laboratory business is greatly dependent on a capable administrative and healthcare staff. By retaining a dependable billing company, you get the support of well-trained lab billers. By carrying out modern revenue cycle management solutions, they help boost business profitability.
  2. Increases efficiency
    Experienced teams streamline the billing process quickly and efficiently. Outsourced toxicology billing experts are responsible for administrative tasks such as coding, billing, and medical claims submission. They don’t carry extra administrative duties on their shoulders. This allows them to focus on boosting the efficiency of the entire lab revenue cycle. 
  3. Provides timely reimbursements
    Timely reimbursements are key to meeting the expenses of your healthcare facility. It’s been documented that when a healthcare provider administers the billing process in-house, they face a number of issues. For example (in terms of retention), when an in-house biller leaves your practice, you’re forced to either put added responsibility on the existing staff, with little knowledge of billing. Or, you have to spend a substantial sum of time and money hiring and training a new employee. During times like this, medical claims are left unattended and late payments occur. By outsourcing your toxicology billing, such concerns are eliminated.  Moreover, medical billing companies have in-depth knowledge of the latest reforms in the healthcare industry. This enables them to submit medical claims according to industry standards, allowing you to take in hard-earned revenue without waiting for months or some cases, years.
  4. Minimizes rejections, faster payment
    Professional billers submit medical claims without informational errors. This in turn reduces claim denials and rejections. With less errors, outsourcing gets your claims paid sooner. You’ll receive maximum payments in the shortest time possible. One more benefit – in addition to ensuring orderly submission of claims, pro billers provide persistent follow-up. They put fourth the effort to follow up on all denied claims.
  5. Offers know-how about insurance specifics
    Does your in-house staff or current billing service precisely understand which payors need which codes for toxicology billing? If a toxicology billing service has no idea what we’re talking about, you know who (the lab) will pay the price.
  6. Maintains regulatory compliance
    When you hire a HIPAA compliant billing group, you needn’t worry since such groups follow the HIPAA guidelines to protect confidential health information and your practice stays clear of accidental fraud, which happens a lot more frequently than most healthcare providers think. For instance, certified medical billers ensure the accurate translation of patients’ diagnosis and lab services into standard codes. In the long run, this saves your lab practice from potential healthcare fraud such as up-coding, undercoding, etc. Moreover, outsourced billing experts deliver consistent analytical reports that keep healthcare providers well informed of the status of their payments and overall revenue cycle management.
  7. Increases control
    Even when you outsource to toxicology billing experts, you’ll still need to understand the processing status of your medical claims. Unfortunately, many practitioners falsely believe that outsourcing to a medical billing company means handing over total control. It’s quite the opposite. Fact is, a quality, outsourced biller delivers reliable analytical reports that keep you well informed. Moreover, experienced billers reduce errors and identify payer reimbursement problems before they become bigger headaches.
  8. Provides security
    Patient privacy is absolutely critical to your practice, not only because you maintain a business, but your clients entrust you with their confidential information. Plus, you need to conform to federal and state privacy laws, such as the aforementioned HIPAA guidelines. You need a reliable, trustworthy provider of lab billing services, one that takes security to heart as much as you do.
  9. Attracts more patients
    Finally, by outsourcing toxicology billing services, you don’t have to worry about the hectic, complex paperwork. You’ll be free to spend more time with patients. Your concentration on offering quality care will result in long-term relationships with patients. When you effectively fulfill the needs of your patients, your lab practice acquires a good reputation, increases client retention, and ultimately attracts / conquests more patients.

Take action now

As we’ve described above, toxicology lab billing is a complex and dynamic process that undergoes frequent and unpredictable changes. Take action now, outsource your toxicology billing to optimize your revenue collection and generation.

Medwave is a renowned healthcare billing service provider, offering the best solutions for your laboratory practice growth and financial stability. Contact us today to speak with someone on how we can be an affordable asset to you and your toxicology lab’s future.

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SuperCompanies

Top Medical Billing Companies 2021 by SuperbCompanies

We are excited to announce that Medwave Billing & Credentialing has been named one of the top Medical Billing Companies 2021 by SuperbCompanies. With more than 20 years of experience, we have accumulated many accomplishments, and each award is special for us. A huge team of experts works hard to provide our customers with the best medical billing services, and it is always an honor for us to be recognized for our efforts.

About Medwave Billing & Credentialing

Medwave is one of the leaders in providing comprehensive medical billing services to behavioral (mental) health providers and both genetic testing and toxicology labs. Our indeed first-class medical billing helps companies to increase their income. Medwave offers efficient and effective solutions for medical practitioners that are hard-pressed for time and resources to take over the billing and related administrative functions of the medical institution.

Medical Practices served by Medwave:

  • Behavioral Health
  • Genetic Testing Labs
  • Toxicology Labs
  • Allergy Testing
  • Durable Medical Equipment (DME)
  • Family Practice
  • Physical Therapy
  • Internal Medicine
  • etc.,

About SuperbCompanies

SuperbCompanies is an independent market research and analytic platform. The SuperbCompanies team pays special attention to the process of ranking companies in each of the presented categories. SuperbCompanies performs a detailed analysis of companies in each area, taking into account the most important criteria from company experience to customer feedback, which makes it possible to compile a list of the top companies that provide the best services in the field of their activity.

To be among the best companies that provide medical billing services is a great honor for us. We are grateful to SuperbCompanies for this award and promise to hold the bar high, provide top-notch services, keep growing and getting better.