ProFast Billing News

How EMR Software Can Enable Your Clinic to Meet Meaningful Use Requirements

2012-01-12T22:30:00.000-08:00

Meaningful Use is the hottest buzzword in Health IT right now. The PCAST report (President's Council of Advisors on Science and Technology) provided this summary: Recent Federal legislation has charted a new path forward. The Health Information Technology for Economic and Clinical Health (HITECH) Act, a part of the American Recovery and Reinvestment Act (ARRA) of 2009, authorized expenditures of at least $20 billion to promote the adoption and use of EHR technologies that would ideally be connected through a national health information network. Hospitals and physicians who make "meaningful use" of interoperable EHRs can qualify for extra payments through Medicare and Medicaid.

The Medicare program enables you to qualify for $44,000 if you are meeting CMS criteria for Meaningful Use with your electronic medical records software. The Medicaid program incentives reach $63,750. The Medicaid program is easier to qualify for in the first year, but it is in the hands of the individual states to conduct this program. Also, as a provider, you will need to see at least 30% Medicaid patients to qualify for this program.

Vendors are quickly pursuing Meaningful Use certification for 3rd parties such as CCHIT. To qualify for these incentive dollars, providers must be using a Meaningful Use certified EMR product.

That's only one of many requirements that will incur workflow changes and additional possible investments. Providers and administrators are encouraged to consider Meaningful Use when beginning the EMR software selection process and EMR implementation. However, it is more important to select a product that will be supported and upgraded, and will best meet your hospital's or clinic's needs.

Following the implementation, there are many workflow considerations for a provider that hopes to meet Meaningful Use requirements. For example, patients need to be able to receive electronic copies of their records on request. Also, the providers need to be checking smoking status and completing many other requirements.

Jack Glad created EMR Software Pro. This site helps you find the best EMR Software vendor for your organization's needs! Check out EMRSoftwarePro.com.

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44K Bonus - Electronic Health Record Incentive

2011-10-23T17:59:00.000-07:00

Eligible healthcare professionals and hospitals can begin receiving incentives from CMS for meaningful use of a certified Electronic Health Records system, or EHR. Participation may start as early as 2011, but in order to make sure they receive the maximum benefit, providers must begin participation by 2012. Medicare will payout a maximum of up to $44,000 over 5 years for those providers who demonstrate meaningful use of EHR technology.

For detailed information you can visit the CMS website here.

For an easy to use, FREE EHR Solution visit here.

Please check back often for more posts and information on how to take advantage of the incentives for EHR implementation.

Modifier 33 for Preventive Services

2011-09-04T12:09:00.000-07:00

One of the most significant health care reforms involves how insurance companies are to cover preventive
services. The Patient Protection and Affordable Care Act now requires all health care insurance plans to
cover preventive services and immunizations without and cost-sharing. This means that plans cannot
require copays, coinsurance, or deductibles on office visits when these services are part of an office visit
and the primary purpose of the office visit is to receive preventive services.

In order to identify these services, providers will now append the modifier 33 to these services. There are
four instances when modifier 33 is to be used:

Services rated "A" or "B" by the US Preventive Services Task Force located at their website here.
Immunizations for routine use in children, adolescents, and adults as recommened by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention.
Preventive care and screenings for children as recommended by Bright Futures and Newborn Testing as supported by the Health Resources and Services Administration.
Preventive care and screenings provided for women in the comprehensive guidelines supported by the Health Resources and Services Administration.

Information provided from the AMA website

Procedure Codes Medical Billing

2011-09-04T09:11:00.000-07:00

Using correct procedure codes in medical billing is vital to getting your claims paid. CPT and HCPCS codes that Medicare and private insurers recognize are continually changing. Claims denials are lost money even when you resubmit a corrected denial due to extra staff hours and postage spent.

Evaluation and Management coding can be confusing as well. Correct procedure codes for billing your medical E&M's are important as well. Overcode and you run the risk of triggering an audit and being liable to reimburse the insurer. Undercode and you are losing potential revenue that you are entitled to.

Our proven team of experienced and certified coders can help you catch lost opportunities and show you areas for improvement. All at a cost that is much less than you might think! For more information on how we can help your facility or practice protect and increase its revenue, fill out the form below and a representative
will be in contact within 24 hours.

If you would prefer more information now, you may learn more by clicking here.

Influenza Q codes for Medicare billing

2011-08-27T12:39:00.000-07:00

Just a reminder now that flu season is here....Medicare no longer recognizes CPT code 90658 for the Influenza Virus vaccine. This became effective January 1, 2011. Instead, there is a set of "Q" codes depending on the brand name of vaccine you are using. They are:

Q2035 Afluria Vaccine - Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Afluria)
Q2036 Flulaval Vaccine - Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Flulaval)
Q2037 Fluvirin Vaccine - Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Fluvirin)
Q2038 Fluzone Vaccine - Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Fluzone)
Q2039 NOS (Not Otherwise Specified) Vaccine - Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Not Otherwise Specified)

You will still submit the claim using G0008 for the administration of the vaccine.

Timely Filing Rules for Medicare Have Changed

2010-05-26T20:06:00.000-07:00

Medicare fee-for-service providers take note. On March 23, 2010, the Patient Protection and Affordable Care Act (PPACA) was signed into law. One of the most significant aspects of this law amended the timely filing rules for Medicare claims.

Previously, Medicare claims had to be filed no later than December 31 of the year following 1 year of the date of service. For example, if the date of service for a Medicare claim was July 1, 2008, the claim needed to be filed by December 31 of 2009.

Under the new law, all claims for services furnished on or after January 1, 2010 must be filed within 1 calendar year after the date of service. Claims with dates of service prior to October 1, 2009 follow the rules prior to the passage of the PPACA. Claims with dates of service October 1, 2009 through December 31, 2009 must be submitted by December 31, 2010.

Time Running Out to Submit Your PECOS Updates

2010-03-01T22:14:00.000-08:00

Time is running out for all providers who refer Medicare services to update their PECOS information. You will start to receive denials for any claim with a referral on it if this is not updated. Any provider who enrolled in Medicare within the last 5 years should be okay. If more than 5 years, chances are you have never updated your information in the PECOS system.

For more information visit the CMS resource page by clicking here.

Medicare SGR Cuts Held Up in Senate, What Happens Now?

2010-03-01T22:09:00.000-08:00

You may be already aware that the Senate failed to vote on a measure to delay the Medicare 21.2% cut for physician fee schedule services. The cuts went into effect today, March 1, 2010. However, the government did act as CMS instructed its contractors to hold claims for 10 days in the hopes that this will be fixed in that time frame.

However, you may still submit all Medicare claims with dates of service prior to March 1, 2010 as those claims will not be affected.

For a good article on this matter, click here.

Profit Recovery Allows You to Collect More of Your Money

2010-01-18T20:00:00.000-08:00

Imagine collecting 41% of past due and slow pay accounts, guaranteed for as little as 5% of each outstanding account? If this was true, businesses and doctors would be able to collect a large amount of money that they were ready to "write off." Whether a business has hundreds of accounts or only a few, our Profit Recovery Service will accelerate their cash flow and virtually eliminate the need to turn accounts over to a traditional collection agency.

Traditional collection agencies can be upsetting because they give the impression to the debtor that they have been “turned in.” Businesses and Doctors love our service because we offer them professional guaranteed results that do not upset their customers like other collection methods.

Benefits of the Profit Recovery Service

Because the collection demand is intensified and applied sooner, using more powerful tools than a traditional agency can deliver, we collect more than traditional methods for much less
Recovery is also increased because every possible legal alternative is communicated to the debtor while the account is still collectable.
Security of funds will be maintained, because the business receives all payments directly.
Collection cost will be little or nothing! The cost of the system is partially or completely offset by the savings in internal expense.

For more information, visit our profit recovery service page at www.profastbilling.com.

Outsource Medical Billing: 8 Reasons Why You Should ( and 1 Why Not )

2010-01-13T21:58:00.000-08:00

1. Be a doctor again
You are a doctor, that is what you do best. All of the other duties of your practice are administration, which take time away from seeing patients if you are wrapped up in the day-to-day operations. With Medicare cuts, insurance paying less, costs rising, seeing more patients is as important as ever. Handing these functions over to an outside medical billing service can free up staff to perform other essential operations that sometimes get pushed aside. Likewise, outsourcing billing can also prevent your billing, collections, and follow up from being pushed aside as so often happens when the office gets busy.

2. Stay current with the latest updates
Healthcare billing is more complex now than even just 5 years ago. Insurance carriers are constantly changing their rules, making updates, compliance and regulatory agencies do also. And when the mandated switch to ICD-10 diagnosis coding occurs, there will be more than ever before to keep current with. The focus of a professional biller is on the pulse of healthcare billing. A good medical billing company can be a partner
to your success.

3. Reduce denials and collections
Denials can run up to 30% or more of a practice's billing. Collections can be put off until the debt is so old it is uncollectable. Even having an in-house billing person does not always resolve this. It is inevitable that other tasks will draw the attention of staff throughout the day. A medical billing specialist is dedicated to getting as much of your money for you as possible. After all, they do not get paid if you do not get paid.

4. Lower your costs
This is a result of the last reason, as well as overall it is much more cost effective to outsource your medical billing. The cost to hire, train, and employ an in-house biller can far exceed that of referring your claims filing to an outside source. Plus, the motivation to collect your money for you is often times greater. In-house staff gets paid whether your denials and unpaid claims are 35% or 2%. For an outside biller, their pay is tied to your pay. Who do you think is going to be more motivated?

5. Keep compliant without the cost
Another money saving consideration. Think about what it costs you to stay compliant with your billing function. Keeping a compliance plan in place, training, education for staff. When you outsource, the cost of compliance and a compliance officer is taken on by the billing company who in turn is able to spread their cost out over several clients.

6. Technology is expensive - and requires constant updates
The cost savings just keep adding up when you outsource your medical insurance claims. In-house billing software is expensive. And it requires constant updates which are expensive. Even if you use web-based applications, there are monthly costs associated with those as well. Pass these costs off to a billing company.

7. Payroll is one of your biggest expenses
The Society of Human Resources Management estimates that the cost of recruiting, hiring, and training a new employee is $3500. Finding qualified billers can be difficult as well. Factor in sick time, vacation time, employee turnover, benefits, taxes on employees and the costs add up.

8. Reduce employee theft
I wish I did not have to put this reason here, but you would be surprised at some of the stories I have come across. Unfortunately there are people out there who might take advantage of you. Having one person in-house handle the billing and the money could create an unwanted opportunity. Having an outside company handle your claims filing will not eliminate this threat. You will still handle the money in-house. However, an independent medical billing service creates another "check and balance". It is always a good idea to split the responsibilites that involve money between a few people. This is not always possible in-house.

So why would you not?
Sending your billing outside can feel like you are giving up control, and that is a legitimate concern. If I did not address that here then I would be doing you a disservice. After all, your claims are what keep the lights on. It can be scary trusting the most important administration function of your practice to a third party biller.

But you do not have to give up control when you outsource your billing. When hiring a billing company, ask questions, discuss expectations. Keep good communication with your consultant. Make sure they provide you with reports. A company that files claims using web-based software can give you 24/7 access in real-time to the status of your money.

Physicians are already working harder than ever, and with changes in healthcare coming down the pipe, your burdens are bound to increase. One question you may ask yourself is why have the additional burden of running a medical billing service? Many business people today live by the rule - never do anything that you can have someone else do more efficiently and at a lesser cost. Your practice is a business. Could it run more efficient? There are eight things for you to consider. Ultimately, it is your decision.

New Interim Rule on HIPAA penalties gets going

2010-01-11T09:49:00.000-08:00

by Jaun Paul

If the old HIPAA penalty rules confused you, don't expect too much from the new one; it's just a little better than the old one.

HSS issued an interim final rule with request for comments under the HITECH Act revisions on October 30, 2009. The HITECH stature requires HHS to develop new penalties for violations of health care security that occur after Feb 18, 2009. According to HHS, the rule making takes effect on Nov 30, 2009, which will consider comments until December 29 this year.

As per the proposed new rule, violations would be subject to penalty ranges that correspond to what the violator knew or didn't know: if he did not know about the violation, he would be subject to a penalty of $100 to $50,000 per violation; if a violation occurred due to reasonable cause, the penalty would be $1,000 to $50,000 per violation. The penalty would be between $10,000 and $50,000 per violation if there was willful neglect. And in case it was not corrected, the minimum penalty is $50,000 per violation.

According to Robert Markette, a partner with Gilliland & Markette LLP, one of the less clear areas of the HITECH Act was the penalties. She adds, "The way the statute was worded made it sound like the high end of the penalties was basically the same for all violations, which did not make much sense."

This can certainly be the case, but you should note that one can be penalized at the low and high ends for the exact amount of $50,000 per violation; HHS has tried to come up with a more rationale plan for civil penalties.

Markette says, "HHS should have structured it so that each tier ends at a level below the next tier, although I understand that they felt the statute tied their hands. It'll be interesting to see how penalties under these ranges play out."

Penalties are subject to an overall cap of $1.5 million for all violations of an identical provision in a year. That's about 6,000 % increase in the maximum penalty an organization or provider can pay for a HIPAA violation.

About the Author

We provide the latest developments of Compliance Law in health care according to health care security and offers advanced Learning Opportunities about HIPAA violation for healthcare executives, hospitals and physicians.

Audit Strategies For OIG Compliance

2010-01-10T12:20:00.000-08:00

By Angela S. Martin

Like any other healthcare provider, you probably have recurring nightmares about the OIG knocking at your door. But if you use certain audit strategies for OIG compliance, you can come out clean. Depending on what type of facility or physician office you work in, your audit strategies may vary. For some specialties and types of facilities, the OIG has specific concerns.

There are, however, many audit strategies for OIG compliance that all types of providers can use to their advantage.

Eye Care Services Are on the OIG's Hit List

Audit strategies for OIG compliance that some providers are using in terms of eye care services include:

Shoring up medical necessity and documentation strategies to secure claims in the event of an OIG audit;
Knowing exactly what you need with your E/M codes and how eye code requirements are entirely different;
Understanding how to keep your E/M versus eye code ratios on target; and
Nailing down reporting best practices to understand what E/M and eye codes should look like.

Secure Your OIG Compliance By Nailing Down Modifiers 25 and 59

Modifiers 25 and 59 are notoriously misused -- and the OIG is cracking down on these mistakes now more than ever. Include in your audit strategies for OIG compliance a clear understanding of how to use these two modifiers.

Instead of being afraid of using modifiers 25 and 59 -- and losing out on deserved reimbursement by failing to use them where appropriate -- you must take the time to learn the right way to append them. A quick-reference sheet can come in handy, and heed the OIG's own recommendations on how to use modifiers 25 and 59.

How to Survive an OIG Audit

One of the most important audit strategies for OIG compliance is preparation. You must understand how to handle an unannounced onsite audit and how to respond to a chart review. Comprehending the OIG Work Plan is also key to designing coding and reimbursement processes that keep your healthcare organization compliant and profitable.

If you don't already have one, you should develop an effective auditing and monitoring program for your medical practice. This internal program will not only lock in your compliance, but it can also increase your revenue and improve your quality of care. Most of all, an auditing and monitoring program will fully prepare you for an OIG audit.

One of the most important audit strategies for OIG compliance is preparation. You must understand how to handle an unannounced onsite audit and how to respond to a chart review by audit strategies for OIG compliance.

Article Source: http://EzineArticles.com/?expert=Angela_S._Martin

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Are You Updated in PECOS?

2010-01-09T10:44:00.000-08:00

Many physicians and nonphysician practitioners who are eligible to order items or services or refer Medicare beneficiaries to other Medicare providers or suppliers for services do not have current enrollment records in Medicare. A current enrollment record is one that is in the Medicare provider enrollment, chain and ownership system (PECOS) and also contains the physician/nonphysician practitioner's national provider identifier (NPI).

If you have not updated your information with Medicare since November 2003, then you are not in the PECOS system.

CMS has delayed until April 5, 2010 the implementation of this rule. Any provider not enrolled in PECOS after that date who refers or orders on behalf of Medicare beneficiaries will receive denials.

If you need to enroll or want to check to see if you are current, visit Medicare Enrollment.

Medicare Consult Codes Conversion Chart Now Available

2010-01-08T10:17:00.000-08:00

To help providers making decisions on how to file claims to Medicare for consultations, we have posted an easy to use reference chart on our website. Since Medicare has eliminated consult codes, there has been some confusion on how to bill those procedures.

For an easy guide and reference, including when you need to use a modifier and when you do not, click here.

Cost Segregation On Your Commercial Property Can Increase Cash Flow

2010-01-07T21:12:00.000-08:00

Do you own commercial property? Are you familiar with cost segregation? An engineering study could boost your bottom line and increase your cash flow.

Cost segregation is a popular, yet little known application which provides buyers of commercial property with tremendous tax advantages. How? By reclassifying components and improvements on a commercial building from real property to personal property. Why is this so powerful? Because it allows the owner to accelerate their depreciation from the typical 27.5 to 39 years to a 5, 7, or 15 year depreciation schedule. You can see the potential for reduced taxes and improved cash flow.

So what are the rules?

First, does your property qualify? If you bought, built, or remodeled the property after January 1, 1986. You must also anticipate holding the property for at least a few years.

If your property qualifies, you will need to perform a cost segregation engineering study. The best time to have a study completed is when the building is purchased or improved. However, the IRS does allow property owners to catch up on unclaimed depreciation that was not claimed from day one. In order to complete a study, your cost segregation company will probably need the following: 1) your current tax schedule 2) building cost information 3) Change orders.

Once the study is complete (it should take 4-6 weeks), your CPA will be able to complete the required forms to accelerate your depreciation.

That is it in a nutshell. Discuss cost segregation with a qualified CPA and look for a qualified company to provide the engineering study. Depending on the results, you could see thousands of dollars in tax savings.

Cost Segregation Increases Cash Flow for Commercial Property Owners

2010-01-07T07:49:00.000-08:00

Cost segregation is an IRS approved method of re-classifying, or "segregating", components of your commercial property from real property to personal property. The advantage of doing so allows you to accelerate your depreciation to as little as a 5 year schedule from the traditional 27.5 to 39 years. Why is this an advantage? By shortening the depreciation schedule on your commercial property, you can greatly reduce your current taxable income, thereby increasing cash flow.

What is required to take advantage of Cost Segregation?

Your CPA will need to file the required forms on your behalf along with a cost segregation engineering study. That is where we come in. We are an authorized agent of Cost Segregation Services, Inc, the leading provider of cost segregation engineering studies. As an authorized representative of CSSI, we can provide you with a free analysis to show you the potential savings you may gain. If you wish to proceed, we will set up the engineering study and deliver it when done to you and your CPA.

If you are a CPA, commercial banker or commercial real estate agent, contact us on how we can help your clients reduce their taxes and increase their cash flow.

Cost segregation is a great tool, but don't just take it from us. Here is an article with detailed information on what cost segregation is from The Journal of Accountancy - Click Here to Read.

Find out more by clicking cost segregation services.

RAC Contractor Updates and Information

2010-01-06T07:10:00.000-08:00

By now the Recovery Audit Contractors (RACs) have begun their reviews. In the early stages they have been primarily focusing on the Inpatient Hospital setting with some issues being reviewed for Outpatient Hospital, Durable Medical Equipment (DME) and Physician settings.

Whatever category you fall into, it is never too early to begin reviewing your coding and billing procedures. The RACs can review charts as far back as October 2007. If you are not sure of your coding or would like to catch mistakes and correct them now, an independent baseline audit would be a good recommendation. An experienced, certified coder can actually save you money. The sooner you can correct errors in your coding and billing, the more you save yourself in potential repayments to Medicare.

To find the latest news and updates, and the most current list of approved issues for audit in your region, click here.

Medicare Deductible for 2010

2010-01-05T06:55:00.000-08:00

A New Year means it is time for Medicare deductibles to start fresh. For 2010 and until further notice, the Part B deductible is $155.00. Patient expenses are applied toward the deductible based on incurred, rather than paid expenses, and are based on Medicare allowed amounts. Non-covered expenses do not count toward the deductible. Services not subject to the deductible cannot be used to satisfy the deductible. Generally, the date of service determines when expenses were incurred, although the order in which expenses are applied is based on when the bills are actually received. If an individual does not have Part B benefits for an entire calendar year, that person is still subject to the full deductible.

For Part A, the deductible is $1100 for the first 60 days of hospital stays. For 61-90 days, the insured pays $275 per day. For 91-150 days, $550 per day is patient portion. After 150 days, insured pays all costs.

Coding News You Can Use - Documentation Essentials

2010-01-04T06:40:00.000-08:00

By Nancy Rose

Documentation holes will cost your practice thousands of dollars in denied claims. Your top priority is getting top-notch clinical documentation for your inpatient coders. The latest coding news is that physician query and communication is now "paramount", and not just important.

To be sure your payments are on track, keep a track of up-to-the-minute coding news and see how your hospital's policies and procedures address the following physician documentation discrepancies and issues:

Documentation mistake 1: If it is clear to the physician, it will be clear to the coders.

Physicians may assume that coders can get what they need by, for example, looking at lab values or other test results. But according to national coding guidelines, coding staff cannot code from lab values, and they cannot diagnose. Coders need the narrative terms required to support key diagnoses.

Under the new MS-DRG system, the reality is that we need a lot more specific and detailed verbiage in the medical record to support correct coding.

Documentation mistake 2: Someone else will fill in the blanks for you.

Don't let physicians pass the buck when it comes to proper documentation in the medical record. Coders can't just pluck support for their codes from anyone's notes in the chart. For example, information regarding malnutrition must come from the physician (or a physician assistant or clinical nurse specialist) - not from a dietitian.

Documentation mistake 3: Physicians drag their feet when coders' queries come their way.

This is a mistake - but not necessarily the physicians'. How physicians respond to queries for more information depends in large part on how knowledgeable they are regarding the coding process - and health information managers are responsible for securing that buy-in.

Don't put your practice at risk by staying behind the updates. Get the recent coding news, or your practice's revenue will suffer.

codingnews.inhealthcare.com brings you the latest medical coding news. Check out more about 2009 CPT codes.

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Understanding Medical Claim Modifiers - The Modifier -25, -24, -51, -57, -59, -26

2010-01-03T07:59:00.000-08:00

By Pinky Mcbanon

I am writing this article again as a suggestion from many of my readers on my blog. This article is more comprehensive in a way that scenarios were cited to have a bigger look on the proper use of some of these important modifiers.

In this article, I will be describing the medical claims modifiers - Modifier -25, -24, -51, -57, -59, -26.

Modifier -25, 25: Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service:

This modifier must be appended with an E/M service. This is the modifier you will need to use with the evaluation and management service done on the same day with other procedure done by the same physician. It has to be above and beyond the usual preoperative and postoperative encounter with the procedure. In fact, by using this modifier, it doesn't have to have a different diagnosis reported. The most important thing is that, the E/M level should meet its key components or if it is selected based on time with the patient (counseling and coordination). You have to be careful in using this modifier. It must meet medical necessity. As you know, there are procedures that already includes all other care and management.

Let's describe this modifier 25:

A patient came in for her monthly follow up for her chronic back pain. At the same time, patient was complaining with severe headache. The pain doctor performed bilateral occipital block on the patient at the time of service. You will append modifier 25 for the E/M code to indicate that both services were rendered on the same day.

You don't use modifier 25 with E/M encounter that resulted to Decision for Surgery (we have another modifier for this!)

Modifier -24, 24: Unrelated evaluation and management service by the same physician during postoperative period.

As the modifier indicates, this is another modifier that you can only append with an E/M counter. It indicates that the E/M encounter is not related during the global period.

Let's describe this modifier 24:

A pain specialist performed facet nerve destruction for the patient. During the normal, postoperative global period, the patient came in to the office with severe knee pain due to fall on ice as evidenced by the patient's subjective information. The pain specialist will then report that E/M encounter with the patient by appending modifier 24 to indicate that encounter is not related during the postoperative global period.

This modifier, like modifier 25 has no restriction as with the level of E/M code as long as it meets medical necessity, all its components or are time-based.

Modifier -57, 57: Decision for Surgery:

An Evaluation and Management service resulted in the initial decision to perform surgery during the E/M encounter.

Let's describe this modifier:

An OB/GYN sees a patient who complains with severe abdominal pain. It turned out (through ultra sound, radiology and all other diagnostic testing and documentations), the patient is having an ectopic pregrancy. The OB/GYN performs the laparoscopic surgery on the same day. The E/M encounter will then be reported with modifier 57 which resulted to decision for surgery. The laparoscopic surgery should also be reported as performed on the same day without a modifier.

Modifier -50, 50: Bilateral Procedure

You will append modifier 50 for procedures that are obviously billable as bilateral (or two sides, both sides), performed on the same day, the same operative session, on identical anatomical sites, organs (arms, legs, spine).

A Facet Nerve block is unilateral (can be billed as bilateral). When using a modifier 50, make sure you only bill for one unit on the claim form since there is only 1 procedure is performed bilaterally. Though guidelines from other payers may differ. They may require you to list it twice (line 1 and line 2 on the claim form). You have to be responsible to clarify this with your payors.

You use this modifier with add-on codes too! Do not use this modifier with procedures which are already described as bilateral procedures.

Modifier -51, 51: Multiple Procedures

This modifier is used when reporting multiple procedures performed by the same physician on the same day. Do not use this modifier for "add-on" codes (see appendix D of the CPT Code book). Do not use this modifier for codes with "modifier -51 exempt" symbol (see appendix E of the CPT Code book). Do not use this modifier with an E/M code. This modifier can only be used by the same physician on the same day who performed the procedure.

Coding tip: List the highest reimbursable code (after the main procedure code) based on the fee schedule.

Modifier -59, 59: Distinct Procedural Service

Description of Modifier -59: Under certain circumstances, the physician may need to indicate that a procedure or service was distinct or independent from other services performed on the same day.

Modifier 59 is used to identify procedures/services that are not normally reported together, but are appropriate under the circumstances. This may represent a different session or patient encounter, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same physician. However, when another already established modifier is appropriate, it should be used rather than modifier 59. Only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used.

Use this modifier only if the other procedure is a separately identifiable procedure code. Procedure that is distinct and can be described as independent procedure, on separate anatomical site, lesion, injury site, different organ system, and different session. Do not use this modifier for E/M code.

Modifier -26, 26: Professional Component

This modifier is used only for the professional component (physician) of a service or a procedure. Certain procedures are a combination of both professional and technical component. By using modifier 26, it indicates that procedure being reported as professional component only.

Professional Component versus the Technical Component. By illustration, procedures rendered at a facility such as outpatient hospital or ASC, these equipments are facility-owned. The facility will then report the technical component for such service while the physician will report the professional component for the that procedure. One very good example, the physician performs Paravertebral Facet Block under Fluoroscopic guidance using CPT code 77003. The physician will report the fluoro with modifier 26 for his/her professional component. While the facility will report the the same procedure with modifier -TC for the technical component.

Modifier -LT or -RT are used to indicate a Left or Right side or anatomical site. So if the pain specialist performed Left Cervical Facet Block, you will append a modifier -LT to report this procedure.The above modifiers are used to describe your claims for the services performed on the patient for appropriate payment. Always consult your local careers and third party payors for local determination, policies and guidelines on these modifiers. Looking at the edits is also very important!

Ms. Pinky is an Independent Medical Billing, Coding and Office Management Consultant. Her focus of specialty are in: Interventional Pain Management, Orthopedics, Physiatry, Anesthesiology and Physical Therapy.

Visit her useful website on Medical Billing, Coding and Office Management at http://www.justmypassion.com/

Article Source: http://EzineArticles.com/?expert=Pinky_Mcbanon

http://EzineArticles.com/?Understanding-Medical-Claim-Modifiers---The-Modifier--25,--24,--51,--57,--59,--26&id=2210205

Selecting an EHR - CPOE

2010-01-02T07:19:00.000-08:00

By Roberta Mullin

Computerized physician/provider order entry (CPOE), is the process of computer entry of medical orders for the treatment of patients under the licensed provider's care. These orders get communicated over a network to appropriate staff or departments to be carried out. There is little argument these days that using a computer entry system reduces errors, decreases delay in order completion, and simplifies inventory and billing. And studies show additional benefits of reducing errors and costs when you combine CPOE with clinical decision support tools.

The current recommendations from the HIT Policy Committee to meet meaningful use have CPOE front and center, especially for providers. The 2011 objectives call for eligible providers to be using CPOE for 100% of their orders. Hospitals must be using at least 10% of all their orders through CPOE and by 2013 they too must be using 100% for all their orders.

So what exactly are these "orders" included in the "all" and how should they be entered?

Medication - Electronic prescriptions are now know as ePrescribing. The CPOE directly transmits prescriptions to the pharmacy. Additional features consist of drug interaction information and alerts from stored prescription history and allergies.

Laboratory - Bidirectional transmission allows providers to order labs through the CPOE and receive results back. The results can be received directly into patient records.

Procedure - Tracking and storing history of patient procedures.

Diagnostic Imaging - A work in progress feature that is being debated on how providers should have access to images as well as reports. Currently this IT feature is described as primitive at best with links that open web viewers. Look for picture archiving and communication systems (PACS) to take control of this debate. Here is an interesting article.

Immunization - A CPOE should store patient history of immunization, alert on needed immunization, and have a reporting interface to state registries.

Referral - Providers refer patients to another doctor or specialist for examination and possible treatment for something that is either out of his specialty or something he wants another opinion on. Referring specialist information would be stored in the computer system.

These will be key features to evaluate when selecting an EHR. Although the 2011 requirement does not include electronic interfaces to receiving entities, systems that have any of the capabilities now have a head start. Take time to review these features and be sure to see a demo on how these work in a system. Users say that your staff spends most of their time in these functions.

Roberta Mullin
HITECH Answers
http://www.HITECHAnswers.com

HITECH Answers' mission is to provide independent information on the impact of the HITECH Act of 2009 and Health Information Technology to health care providers and organizations. Much of the information we provide on this site is free while our more in-depth content from industry experts and consultants is through a paid subscription. For more information, visit http://www.HITECHAnswers.com

Article Source: http://EzineArticles.com/?expert=Roberta_Mullin
http://EzineArticles.com/?Selecting-an-EHR---CPOE&id=3256523

E-Prescribing Changes for 2010

2010-01-01T08:46:00.000-08:00

Reporting for E-Prescribing is changing effective January 1, 2010. The current codes in use G8443, G8445, and G8446 are being deleted. They are being replaced with one code, G8553. If a medical provider prescribes at least one medication electronically, G8553 will be reported. If no prescriptions are electronically prescribed, then nothing is reported.

Also for 2010, a physician will only have to electronically prescribe 25 times per year in order to qualify for the e-prescribe bonus. The reporting code G8553 must always be reported with a unique face-to-face patient encounter to qualify towards the 25 times minimum. Faxed prescriptions do not count either.

Making the Transition to the E-Prescribing Era

2009-12-31T21:01:00.000-08:00

By Jaun Paul

Payers and health plans have pushed for new incentives for electronic prescription in 2009. For example, in January, Medicare paid doctors a bonus if they exchanged their prescription pads over to e-prescribing. Various private health plans have also offered extra payments along with free equipment.

Free software is available thanks to technology companies. These are given away to encourage doctors to go electronic. Free software normally provides what you paid for it. For example, there is little or no support when you sign up for free solutions.

What the stats say: According to Web sources, the number of physicians prescribing medicines electronically has more than doubled in the past year to about 70,000 (about 12 percent of all office-based doctors). The increase is owing to the incentives introduced at the start of the year. Try not to fall in the 88 percent bracket still holding out in 2010 while throwing out two percent of your Medicare income and possibly other bonuses from private payers.

So have you applied electronic prescription processes? If not you could be missing out on a two percent Medicare bonus. Here's what you can do to ensure an easy transition.

Before you get going, it is essential that you ask yourself if you want to practice e-prescribing using a stand-alone system or one that is part of an electronic health records (EHR).

Pros and cons:

Standalone systems are the least expensive and the fastest to implement. But EHRs have additional features that aid in managing a medical practice over the long run.
Standalones will enable the practice to be up in time for 2010 to optimize the bonus.
Standalone systems may have the capability to interface with a PM or EHR system.
The practice can then convert from a standalone system to an integrated system when an EHR is implemented.

But the good news is you do not have to have an EMR (electronic medical record) system to e-prescribe. You can find standalone e-prescription systems such as online options that come much cheaper than a full-blown EMR.

Provides the latest news of Healthcare IT training and offers advanced Learning Opportunities about e-prescribing, ARRA funds for healthcare executives, hospitals and physicians.

Article Source: http://EzineArticles.com/?expert=Jaun_Paul

http://EzineArticles.com/?Making-the-Transition-to-the-E-Prescribing-Era&id=3470500

Impact of the Switch to ICD-10 on Your Practice

2009-12-28T14:59:00.001-08:00

You've probably heard by now that the required switch to using ICD-10 has been delayed by a few years until October 2013. You can breathe a little easier for now, but have you begun to consider how your office will implement the changes? And what do these changes mean to you anyway?

A little background...as you know, insurance companies do not pay for "tension headaches" and "15 minute office visits for an established patient" - insurance companies pay for medical diagnosis codes like 307.81 and procedure CPT codes such as 99213. Diagnosis codes, CPT and HCPCS codes all describe patient complaints, illness, procedures and supplies for a submitted claim. The ICD-9 codes currently in use were adopted in the 1960s by the U.S. Since then there have been many advances in healthcare. Under the current coding system, the room to expand is limited. By adding codes under the new system, there will be room to expand and be more specific in reporting.

How much so? Think there are a lot of codes now? Try 68,000 diagnoses codes, up from 13,000 now. For procedure codes (CPT) we go from 3000 codes now to 87,000 codes! What's more, ICD-9 codes will go from up to 5 digits (ex. 307.81) to up to 7.

The deadline for implementation is 2013, which is still in the future. According to a recent article in the Wall Street Journal: "CMS says it expects implementation of the new system initially will boost by as much as 10% the number of claims returned because of coding errors. But a study by the Blue Cross and Blue Shield Association of insurers predicts billing errors are likely to rise between 10% and 25% in the first year."

If you currently do your billing in-house and file using on-site software, the switch to ICD-10 could be a large expense for updates to your software as well. What's more, by January 1, 2012 all physicians must begin using the new version of HIPAA transaction standards known as 5010 in order to file claims. This is due to the fact that the current 4010 version does not accommodate ICD-10 codes. Even if you believe you can put off updates to switching to ICD-10, you should at the very least start considering what it will take to update to the 5010 transaction standards.

It may be a good time to consider either a switch to outsourcing your billing to pass the cost off to a billing company, or at least consider an internet based billing program. The advantages with internet based electronic claims filing is that the updates are built in to the platform at no cost to you other than your regular fee of using the service. This could potentially save you thousands upfront as well as over the long run. The whole purpose of the switch to ICD-10 is to accommodate the annual updates in technology and procedures. You can be sure that any in-house software you use for claims filing will require annual updates that can represent cost to you as well.

You can see why it will be more important then ever to have a coder educated on the new codes as a part of your practice. Implementation of the new system will be costly, so when the time comes, out-sourcing your coding could be a cost-saving solution.

House Passes Medicare Physician Payment Reform Act

2009-12-28T09:40:00.000-08:00

A major cause for concern for many medical providers who accept Medicare patients was the looming 21% budget cuts to be in force as of January 1, 2010. On November 19, 2009, the House voted in favor of repealing the scheduled fee reduction 243-183. Instead, the House plan favors a replacing the sustainable growth rate formula with a new system designed to end the cycle of increasingly larger annual fee cuts that Congress must keep erasing with short-term patches.

However, the Senate must still pass the bill before it can be signed into law by the President. A similar plan in October was rejected by the Senate. Some Washington observers remain hopeful that the Senate will pass this bill before the end of the year, although some see a temporary solution being passed, as in previous years.

For more information, visit here.

Why Medical Providers Outsource Their Billing

2009-12-20T20:50:00.000-08:00

Profast Billing Solutions now offers a free dvd titled "Why Medical Providers Outsource Their Billing." You will find many answers to questions you might have about the benefits of having an outside company handle your billing function. For more information, or to order your copy, click here

Sign up for our New Newsletter

2009-12-17T19:33:00.000-08:00

We have made some updates to our newsletter and hope you'll sign up. Receive information by email about changes and updates in areas of interest concerning the health insurance industry. You will also find information about ways to increase revenue and cash-flow for your practice. It's free, it's easy. Click here to sign up!

New Cash Crunch To Cash Flow Webinar Available Online Now

2009-12-17T09:38:00.000-08:00

Profast Billing Solutions has just made available on our website a webinar titled "How Medical Providers Can Get More Money Faster Into Their Medical Practice." This is a recorded webinar from one of the monthly webinars hosted by Patrick Phillips. Mr. Phillips is the founder of American Business Systems, the nation's largest network of independent medical reimbursement specialists, and author of the book "Cash Crunch to Cash Flow. It is a 30 minute webinar that you will find very informative, covering how to plug the hidden leaks in your medical practice that cause cash-flow problems.

We made this available to all of our visitors to fit their schedule. Please feel free to contact us with any questions. At the end of the webinar their is an offer for a free book "Cash Crunch to Cash Flow." If you are interested in this offer, please go to our contact page and send us an email requesting your no obligation complimentary copy. There will be no charge and shipping and handling is free. Please make sure to include where you would like the book mailed to in your email.

To listen to the webinar, click here.

What To Look For in a Medical Billing Service

2009-12-11T14:37:00.000-08:00

If you are a medical provider considering outsourcing your billing, there are a few things you should consider. Choosing a medical billing service can be hard to do because it may seem like you are relinquishing control over the most important aspect of your practice. Here are a few tips to help you make the right decision.

Communication and transparency are the key to any successful relationship between a physician and their billing service. Make sure the medical billing company you are considering has a policy of communication that is satisfactory to you. Some questions to consider: what type of reports
do they run and how often are they provided? How often do they work insurance denials? Establish your preferred method of contact, whether by phone, email, etc. How does the medical billing service file their claims? Do they run software on their computer or use an internet based service?

Make sure the physician billing service does not make any changes to ICD-9, CPT, or HCPS codes without your consent. A billing service can be instrumental in finding errors in your coding and help you make the correct changes, but they should not do so unless consulting with you first. This prevents any liability issues down the road. Ask the billing service if they provide any physician education or feedback on insurance billing issues. Some may charge for this information, but most may be happy to provide it as part of the service.

Who posts payments? Some physicians may choose to keep this portion of their practice management in-house. In the beginning there will be a gradual overlap as you transition posting payments from your books to the billing company's. Some patient balances may not match due to the information provided to your billing service. For example, maybe a patient as a credit on your books but the medical billing company you are using is not informed of this, creating two different balances. The more information you can provide up front, the closer your books will match.

One easy way to feel a sense of retaining control as well as being able to manage transition issues is to use a medical billing service that files claims through an internet based practice management system. Those that do use an internet based system are more transparent as they can provide 24/7 access to you from anywhere you have a computer.

Try to find a service that bills on a contingency fee. Some states may prohibit this, but it is the preferred method of billing. A set dollar amount per claim may make it easier to judge your cost each month. However a contingency fee, or percentage of the paid claim, offers distinct advantages. One, you only pay when you are paid. Two, there is more incentive for the billing service to work collections and denials. Three, it helps you control costs, especially since insurance allowables on some procedures can be very low.

Finally, try to find a physican billing service that is a partner in your success. Are they able to help you identify areas of opportunities in your practice to increase revenue? Correct errors? Prepare you and inform you of notable changes in insurance billing policies? A good medical billing company is one that acts like a consultant and not just a medical biller.

How Does the Rac Review Process Work?

2009-12-06T18:07:00.000-08:00

If you are a Medicare fee for service provider, you may have heard of the RACs by now. A RAC is a Recovery Audit Contractor, authorized by Medicare to audit any and all fee for service providers for improper payments. There are four RACs, each responsible for a region of the country. They are separate from your local Medicare carrier, so do not confuse a RAC audit with an audit from your local carrier. They are two separate entities. If you receive a letter from a RAC notifying you that you are being audited, it will be on their letterhead, not your local carrier's.

RACs review Medicare claims filed by providers on a post-payment basis. There is a three year look back period, so they cannot review anyclaims older than October 2007. The Centers for Medicare and Medicaid Services authorize which issues the RACs are allowed to audit, and these approved issues are required to be posted to the RACs website as public knowledge. So at any time, a provider may check their region's RAC website and see if any services they provide have been approved for audit.

The auditors use the same Medicare polices as carriers, FIs and MACs. They are subject to all NCDs, LCDs, and CMS Manuals. Each RecoveryAudit Contractor is also required to employ a staff consisting of nurses, therapists, certified coders, and a physician CMD.

There are two types of review: Automated, in which no medical record will be needed from you. The RAC reviews these claims by an automatedcomputer algorithm. You should be able to identify at which point you have been audited by the automated process. A remittance advice will be issued with the remark code N432: Adjustment based on Recovery Audit. Your local carrier recoups the overpayment by offset on future claims payments unless you submit a check or a valid appeal.

The second type of review is complex. This is where you will be contacted with a request to send in medical records for the claims under review. There is a limit to the number of files that the contractor can request every 45 days.

This is a brief summary of the process. More information can be found here.

Why Doctors Should Outsource

2009-12-03T15:27:00.000-08:00

Outsourcing can seem like a touchy subject and you might even feel like it is a cost. But when you step back and take a look at what it costs your practice to run all of the operations yourself, that can be a cost as well, even though it may be hard to put a dollar value to it.

Billing is the most important aspect of any practice. Yet sometimes billing becomes an afterthought. Scheduling patients, pulling charts, answering phones...you get the picture. Everything that happens on a day to day basis can cause paperwork to be pushed to the side to be taken care of later. This can be a cost to you when this happens with your billing. Timely filing rules with insurance carriers, the cost of floating money that could be in your bank account, that is a cost. A professional medical billing company is a specialist whose sole responsibility is keeping your cashflow positive.

Think about the technology cost aspects of billing as well. With the ever changing nature of medical billing, there can be a significant cost to your practice as well. Software purchases and updates, compliance systems...these can add up. When you outsource your billing, you pass the cost of technology off to the billing company who is able to spread their cost across several practices.

How about everyone's favorite task? Following up on insurance denials. In many practices that I speak with, this is one of the last things to get attention. It is time consuming, it can be frustrating and confusing, and as a result denials can slip through the cracks. It is not uncommon these days for a practice to have 30% or more of their claims denied. A lot of that just gets written off. Why? Insurance carriers are constantly changing rules. Visit Medicare's website...ever try to find why your claim denied by searching the CMS website for that one specific nugget of information? If you could put a dollar value to the cost to your practice just for denials and all of the follow up involved, what do you think that would be worth?

A professional medical billing company does all of that work for you. Better yet, a billing company that works on a contingency basis ( charging a percentage of monies collected ) has more of an incentive to collect your money than an office staffer paid by the hour.

Many physicians code their own charts as well. This can be very time-consuming, preventing you from scheduling and seeing more patients. Errors can occur as well, even if you use software. Coding programs don't always get updated resulting in incorrect coding of claims. As of October 2013, healthcare providers will be required to be using ICD-10 codes. How much more time consuming will that be when diagnosis codes go from around 17,000 to 150,000? Outsourcing coding may seem like a cost, but there is a dollar value to the work you do as well. What pays you more? Doing work that someone making $10, $15, $20 per hour can do ( coding ) or seeing patients?

For more information on why it benefits doctors to outsource systems that can be done at a lower cost by others, read this article from BC Advantage, "Why Doctors Should Outsource Their Billing."

CMS releases latest CLIA waived tests

2009-12-01T19:02:00.000-08:00

The Centers for Medicare & Medicaid Services has the latest list of tests approved by the FDA as waived tests under CLIA. The CMS provides an updated list of waived tests every quarter to Medicare contractors.

For the newest list, click here.

How Medical Providers Can Get More Money, Faster, Into Their Practices

2009-12-01T18:56:00.000-08:00

This 30 minute live presentation can help you get the cash flow in your practice where it needs to be.

Patrick Phillips, author of the new book, "Cash Crunch to Cash Flow," will show you why you are pocketing much less than you could be, even with your current patient base.

He will discuss how to plug the hidden leaks that are draining profits from your practice.

And, if you are an office manager or in charge of the receivables, you will have your eyes opened. Spend LESS time on the cash flow and yet see it increase two to three times what it is right now for the practice.

Seats are limited, so reserve one now. You will be able to listen on your computer, or over the phone, and will see the presentation live on your computer screen.

Click here to register

Note this will last about 30 minutes and starts at 1:00 pm CENTRAL time, so adjust for your time zone:

11:00 am Pacific
12 Noon Mountain
1:00 pm Central
2:00 pm Eastern

MEDICARE ELIMINATES CONSULTATION CODES

2009-11-28T08:45:00.000-08:00

The CMS has released its final 2010 Physicians Fee Schedule. One of the most significant changes was the elimination of payment for consult codes as of January 1, 2010.

This does not mean you can no longer bill for Medicare consult codes, it just means that you will have to bill these services differently than you do now. Here are the facts regarding this new ruling and the potential impact on your practice.

1. Consultation codes 99241-99245 (outpatient/office) and 99251-99255 (inpatient) have been eliminated effective January 1, 2010. Telehealth consultation G-codes (G0425-G0427) will not be eliminated.
2. Starting January 1, 2010, CPT codes for new (99201-99205) or established (99211-99215) patients should be used to replace consultations in the office/outpatient setting.
3. Starting January 1, 2010, CPT codes in the inpatient hospital setting (99221-99223) should be used to replace inpatient consultation codes (99251-99255), and for nursing facility consultations use codes (99304-99306).
4. To distinguish the difference between the admitting physician of record from the consultants for initial hospital inpatient and nursing facility admissions, CMS will develop a modifier. Currently, modifier "AI" is for principal physician of record – however Medicare has not finalized the modifier to be used for consultations.
5. Medicare states that its changes are budget neutral. RVUs for all E/M codes have been increased in an attempt to offset the fees lost from the elimination of consultation codes. The increase in E/M payments is approximately 6% for outpatient/office codes and 2% for inpatient codes above 2009 levels.

An important note regarding commercial or private insurance. No information has been released by other third party payers regarding payment for consultation codes as of yet. However, if a patient has Medicare as a secondary payer, a decision will need to be made by the physician as to how you will report the consultation. Any consultation claim filed with a commercial insurer such as Blue Cross or Aetna who is primary using the eliminated consultation codes when Medicare is secondary would result in a denial for the secondary claim by Medicare. In those instances where Medicare is secondary, you may want to consider using the new guidelines as stated above for reporting consultation codes.

One more note. If you have not updated your enrollment information with Medicare since November 2003, you must do so by April 5, 2010. Although enrolled in Medicare, many physicians who are eligible to refer Medicare beneficiaries to other Medicare providers or suppliers for services do not have current enrollment records in Medicare. A current enrollment record is one that is in the Medicare provider enrollment, chain and ownership system (PECOS) and also contains the physician's national provider identifier (NPI).

If you need to update your enrollment information, you may do so here: Medicare Provider/Supplier Enrollment.

How to Get Paid for Administering the H1N1 Vaccine

2009-11-25T07:58:00.000-08:00

Now that we are full in to flu season, you may have begun administering the H1N1 Vaccine. CMS has created an HCPCS code specifically for reporting the administration of this vaccine. Providers are instructed to bill using code G9141. Payment is the same as that for seasonal flu vaccine. CMS also has a code for the drug itself, G9142, however since this is not a payable code, it is not required to be included with your claim submission.

Private insurers are not required to use the G code, but many will accept it. Others may have different guidelines. Many private insurers ask that providers use the standard CPT code for the administration of H1N1 vaccine. According to the American Medical Association's website, CPT 90470 (H1N1 immunization administration (intramuscular, intranasal) has been created for the administration of H1N1. To indicate the vaccine itself, you should include CPT code 90663, even though this is not a payable code.

For more information, visit the AMA website.

Medicare RAC Audit is Coming - Are You Ready?

2009-05-01T14:55:00.000-07:00

So you got the notice the Medicare RAC is coming to your practice. No big deal? Think again. The Medicare audit of all beneficiaries of Medicare payments (i.e. - those who file claims with Medicare) is here to stay and if your practice is out of compliance, it could end up costing you thousands of dollars. It's not all gloom and doom, however.

Follow a few simple steps to help get your practice prepared.

First, a little about the RAC. In 2005 Congress authorized the Recovery Audit Contractor (RAC) program to do a demonstration in California, New York, Florida and 3 other states. The purpose - to discover areas of fraud and waste and recover overpayments made by Medicare due to improper coding and compliance with Medicare guidelines. The result - over $900 million in overpayments recovered and returned to the Medicare Trust Fund. With the success, Congress authorized the RAC program to be rolled out to all 50 states and Puerto Rico no later than January 1, 2010.

Don't expect it to go away either ... this program is to be permanently in place.

Anyone who files claims with Medicare, physicians, hospitals, home health agencies and durable medical equipment providers are all affected. What does this all mean to you? If you fall into one of the above categories, expect a notice soon from the contractor in charge of the audit in your region. Don't expect them to tell you what they are looking for, however. That is left up to you. The RACs are compensated on a contingency basis based on the amount of overpayments that they find. You think they are going to be aggressive? You betcha! The penalties for overpayments? At the very least, overpayments will have to be returned. And Medicare isn't going to send you an invoice and wait for the money...they will just take a portion of your current and future claims payments until the overpayment is paid in full. In extreme cases, Medicare may suspend a practices claims privileges all together.

Protect yourself by following a few easy procedures.

First, consider conducting an internal assessment of submitted claims to make sure they follow Medicare guidelines. Either you, your staff, or a third-party auditor can do this. However, a qualified third-party auditor may be the best option as this allows for someone outside your practice to give you a second opinion. If you do choose to do it yourself, look for claims that have been denied in the past and and review the RAC's website.

Consider having a certified coder review a sample of your files and help you identify any pattern of inconsistent or improper coding. Again, a third-party audit service is an excellent option. A qualified auditor should have certified coders on staff, preferably with government auditing experience as well.

Comply with Medicare's request for medical records in a timely manner. Failure to do so may cost you the right to appeal any decisions by the RAC that you disagree with.

Finally, implement corrective actions to ensure compliance with Medicare guidelines prior to the RAC visit to your office. The sooner you do this, the less money you will cost yourself when the RAC finally gets around to you. If you choose to use a third-party auditor to assist you, they should provide you with a report on areas for improvement as well as consult with you on other areas of compliance as well.

With the right preparation and implementation of processes, you don't have to fear the RAC. Besides, some good may come out of your audit. During the same demonstration in the above mentioned states, $38 million in underpayments to providers was made. You may find areas where you have been underpayed, so it isn't all bad news.

For detailed information about the RAC you can visit the official Medicare website at http://www.cms.hhs.gov/RAC

Profast Billing Solutions offers a random 50 chart audit for providers, hospitals, home health agencies, durable medical equipment providers. Let us help you identify any errors in coding, documentation and billing. We also provide educational webinars for providers and staff. Learn more at profastbilling.com

Medicare RAC Audit Preparation By Profast Billing Identifies And Corrects Errors, Saving Thousands

2009-02-27T17:08:00.000-08:00

Profast Billing Solutions announced the launch of a new service for physicians, home health agencies, hospitals and durable medical equipment providers in preparation for the upcoming Medicare audit by the RACs.

"The RAC audits are a big issue right now in the medical community," said Jeff Roh, co-owner of Profast Billing Solutions. "Anyone who files claims with Medicare probably has at least a little bit of concern about what the RACs might find when they audit their practice. The RACs are compensated to find errors, so you can be sure they will be aggressive. Even a little technicality could end up costing a physician thousands of dollars. That's where we can help."

A detailed, comprehensive base-line audit in advance of the RAC is intended to assist the provider identify and correct errors in the current billing and coding, and to make recommendations for areas of improvement. By catching errors well in advance, a practice can save thousands of dollars in Medicare overpayments.

Profast Billing will do an audit of a random sample of patient files. Audits are done by certified coders who have extensive experience in coding as well as government audits. The company has a page set up on their website with details of how the process works and what is needed, along with Frequently Asked Questions and contacts.

"The cost of doing a review independent of the Medicare RACs is minimal when you consider that not knowing what the audit contractors are going to find could cost you thousands," Jeff Roh said. "What's more, around 15% of the providers out there may find that they are being underpaid by Medicare due to improper coding. Believe it or not, Medicare is not only looking to recover money, but to pay back underpayments as well."

Profast Billing Solutions is a medical practice management company specializing in improving the cash-flow of medical practices. You can learn more about the Medicare audit at profastbilling.com

What are Physicians saying about the Medicare RAC audits?

2009-02-20T17:53:00.000-08:00

There is a lot of talk out there on blogs and article posts by physicians regarding the Medicare RAC audits that will be starting in full force soon. Is the RAC audit a big deal? You bet! The majority of physicians may have a good handle on their billing and coding, and the vast majority of physicians do not commit fraud. They may think they are safe from the CMS RAC audit...but think again.

All would be good and well if they were just looking for instances of fraud, abuse, or sloppy coding. But keep in mind, they are compensated to find errors, and even a small technicality may wind up costing you thousands of dollars. Medicare states that you can challenge the RACs findings, but if you've ever dealth with the appeals process, you know how that can be.

For a good opinion and more information, you can go to the article "When Fraud isn't Fraudulent" here.

A good way to protect yourself and potentially save your practice thousands of dollars is to catch any errors well in advance of the RAC audit. An independent third-party review by a qualified company is an excellent choice. For more information, click here.

How Medical Providers Can Get More Money, Faster, Into Their Practice

2009-02-18T15:22:00.000-08:00

Join us for a Webinar on March 6

Space is limited.
Reserve your Webinar seat now at:
https://www2.gotomeeting.com/register/255352187

This 30 minute live presentation can help you get the cash flow in your practice where it needs to be.

Patrick Phillips, author of the new book, "Cash Crunch to Cash Flow," will show you why you are pocketing much less than you could be, even with your current patient base.

He will discuss how to plug the hidden leaks that are draining profits from your practice.

And, if you are an office manager or in charge of the receivables, you will have your eyes opened. Spend LESS time on the cash flow and yet see it increase two to three times what it is right now for the practice.

Seats are limited, so reserve one now. You will be able to listen on your computer, or over the phone, and will see the presentation live on your computer screen.

Note this is at 1:00 pm CENTRAL time, so adjust for your time zone:

11:00 am Pacific
12:00 noon Mountain
1:00 pm Central
2:00 pm Eastern

Title:		How Medical Providers Can Get More Money, Faster, Into Their Practice

Date:		Friday, March 6, 2009

Time:		1:00 PM - 1:30 PM CST

After registering you will receive a confirmation email containing information about joining the Webinar.

System Requirements
PC-based attendees
Required: Windows® 2000, XP Home, XP Pro, 2003 Server, Vista

Macintosh®-based attendees
Required: Mac OS® X 10.4 (Tiger®) or newer

Medicare Audit is Coming to Your Practice: Are You Ready?

2009-02-18T15:17:00.000-08:00

So you got the notice...the Medicare RAC is coming to your practice. No big deal? Think again. The Medicare audit
of all beneficiaries of Medicare payments ( i.e. - those who file claims with Medicare ) is here to stay and if your
practice is out of compliance, it could end up costing you thousands of dollars. It's not all gloom and doom, however.
Follow a few simple steps to help get your practice prepared.

First, a little about the RAC. In 2005 Congress authorized the Recovery Audit Contractor (RAC) program to do a demonstration
in California, New York, Florida and 3 other states. The purpose - to discover areas of fraud and waste and recover overpayments made by Medicare
due to improper coding and compliance with Medicare guidelines. The result - over $900 million in overpayments recovered and returned
to the Medicare Trust Fund. With the success, Congress authorized the RAC program to be rolled out to all 50 states and Puerto Rico
no later than January 1, 2010.

Don't expect it to go away either...this program is to be permantely in place.

Anyone who files claims with Medicare, physicians, hospitals, home health agencies and durable medical equipment providers are all affected. What does this
all mean to you? If you fall into one of the above categories, expect a notice soon from the contractor in charge of the audit in your region. Don't expect
them to tell you what they are looking for, however. That is left up to you. The RACs are compensated on a contingency basis based on the amount of
overpayments that they find. You think they are going to be aggressive? You betcha! The penalties for overpayments? At the very least, overpayments
will have to be returned. And Medicare isn't going to send you an invoice and wait for the money...they will just take a portion of your current and future
claims payments until the overpayment is paid in full. In extreme cases, Medicare may suspend a practices claims privileges all together.

Protect yourself by following a few easy procedures.

First, consider conducting an internal assessment of submitted claims to make sure they follow Medicare guidelines. Either you, your staff, or a third-party
auditor can do this. However, a qualified third-party auditor may be the best option as this allows for someone outside your practice to give you a second
opinion. If you do choose to do it yourself, look for claims that have been denied in the past and and review the RAC's website.

Consider having a certified coder review a sample of your files and help you identify any pattern of inconsistent or improper coding. Again, a third-party audit
service is an excellent option. A qualified auditor should have certified coders on staff, preferably with governemt auditing experience as well.

Comply with Medicare's request for medical records in a timely manner. Failure to do so may cost you the right to appeal any decisions by the RAC that you disagree with.

Finally, implement corrective actions to ensure compliance with Medicare guidelines prior to the RAC visit to your office. The sooner you do this, the less money you
will cost yourself when the RAC finally gets around to you. If you choose to use a third-party auditor to assist you, they should provide you with a report on areas
for improvement as well as consult with you on other areas of compliance as well.

With the right preparation and implementation of processes, you don't have to fear the RAC. Besides, some good may come out of your audit. During the same demonstration
in the above mentioned states, $38 million in underpayments to providers was made. You may find areas where you have been underpayed, so it isn't all bad news.

For detailed information about the RAC you can visit the official Medicare website at www.cms.hhs.gov/RAC.

To learn more about our independent base line audit to prepare you for the RAC, go here.

How Physicians Can Get More Money, Faster, Into Their Practice

2009-01-27T14:56:00.000-08:00

Join us for a Webinar on February 6

Space is limited.
Reserve your Webinar seat now at:
https://www2.gotomeeting.com/register/943600501

This one hour presentation could be the best one hour you will spend in order to get the cash flow in your practice where it needs to be.

Patrick Phillips, author of the new book, "Cash Crunch to Cash Flow", will show you why you are pocketing much less than you could be, even with your current patient base.

He will discuss how to plug the hidden leaks that are draining profits from your practice.

And, if you are an office manager or in charge of the receivables, you will have your eyes opened. Spend LESS time on the cash flow and yet see it increase two to three times what it is right now for the practice.

Seats are limited, so reserve one now. You will be able to listen on your computer, or over the phone, and will see the presentation live on your computer screen.

Note this is at 1:00 pm CENTRAL time, so adjust for your time zone:

11:00 am Pacific
12:00 noon Mountain
1:00 pm Central
2:00 pm Eastern

Title:		How Physicians Can Get More Money, Faster, Into Their Practice

Date:		Friday, February 6, 2009

Time:		1:00 PM - 2:00 PM CST

After registering you will receive a confirmation email containing information about joining the Webinar.

System Requirements
PC-based attendees
Required: Windows® 2000, XP Home, XP Pro, 2003 Server, Vista

Macintosh®-based attendees
Required: Mac OS® X 10.4 (Tiger®) or newer

How Physicians Can Get More Money, Faster, Into Their Practice

2009-01-22T14:57:00.000-08:00

Join us for a Webinar on February 6

Space is limited.
Reserve your Webinar seat now at:
https://www2.gotomeeting.com/register/943600501

Title:		How Physicians Can Get More Money, Faster, Into Their Practice

Date:		Friday, February 6, 2009

Time:		1:00 PM - 2:00 PM CST

After registering you will receive a confirmation email containing information about joining the Webinar.

System Requirements
PC-based attendees
Required: Windows® 2000, XP Home, XP Pro, 2003 Server, Vista

Macintosh®-based attendees
Required: Mac OS® X 10.4 (Tiger®) or newer

How to Get More Money, Faster, Into Your Medical Practice

2009-01-05T19:31:00.000-08:00

Join us for a Webinar on January 14

Space is limited.
Reserve your Webinar seat now at:
https://www2.gotomeeting.com/register/636822565

This one hour presentation could be the best one hour you will spend in order to get the cash flow in your practice where it needs to be.

Patrick Phillips, author of the new book, "Cash Crunch to Cash Flow", will show you why you are pocketing much less than you could be, even with your current patient base.

He will discuss how to plug the hidden leaks that are draining profits from your practice.

And, if you are an office manager or in charge of the receivables, you will have your eyes opened. Spend LESS time on the cash flow and yet see it increase two to three times what it is right now for the practice.

Seats are limited, so reserve one now. You will be able to listen on your computer, or over the phone, and will see the presentation live on your computer screen.

Note: this is at 1:00 PM CENTRAL time, so adjust for your time zone:

11:00 am Pacific
12:00 noon Mountain
1:00 pm Central
2:00 pm Eastern

Title:		How to Get More Money, Faster, Into Your Medical Practice

Date:		Wednesday, January 14, 2009

Time:		1:00 PM - 2:00 PM CST

After registering you will receive a confirmation email containing information about joining the Webinar.

System Requirements
PC-based attendees
Required: Windows® 2000, XP Home, XP Pro, 2003 Server, Vista

Macintosh®-based attendees
Required: Mac OS® X 10.4 (Tiger®) or newer

Patient Payment Plan/Pre-Authorized Checking FAQ

2008-12-29T21:14:00.000-08:00

Doctors and business owners are always looking for ways to
increase their cash-flow and collect more of their
receivables. We've talked a little about how we can help
you achieve that with the Patient Payment Plan and
Pre-Authorized Checking.

Here are a few of the common questions we hear, and some
answers.

1. What kinds of companies will Pre-Authorized Checking
work for?

The answer is simple, if a business takes payments PAC will
work for them. Whether it is automating their recurring
monthly payments, helping to collect slow pay accounts, or
offering an in-house payment plan to potential customers
PAC is the unique low cost tool that any business can use
to increase profits.

2. Can this program work for me if the amount billed to the
customer is different each month?

Our PAC system works well in situations in which the amount
owed by customers varies from month to month. The only
difference in the program is that the business would need
to send out a monthly statement to their customers with
varying payments to let them know the amount to be drafted
so they could make a note in their checkbook register.

3. How do you collect from me?

We use the same technology to collect from businesses using
PAC that they use to collect from their customers. ProFast
Billing Solutions simply creates a bank draft from the
business' account for the amount of the combined service
fees for a given month.

Here is an example to make this absolutely clear.
Say that a business has 50 customers on the Pre-Authorized
Checking service. The monthly invoice to each of these
customers is $50 each to keep the math easy. 50 customers
at $50 each would be a grand total of $2,500 collected each
month using PAC. The agreed upon service fee for each of
these drafts was $2.00, again keeping the math easy. This
would mean that the service fees would total 50 customers
times $2, or $100 each month. In this scenario, ProFast
Billing Solutions would hand the business a stack of 50
checks that totaled $2,500 each month. The next day, we
would produce a draft, pre-authorized by the business, for
the amount of the service fees totaling $100. The business'
net would be $2,400 each month.

4. How is my customer informed that the check has been
submitted and cleared their account?

A customer's check is noted in their monthly bank
statement. The check will be numbered as "000" or will not
be numbered at all. This prevents a conflict with their
checkbook numbering system. The on-line bank account
statement will refer to this transaction as a
"Pre-authorized Check." The customer can then balance their
checkbook as usual.

5. What is the agreement between you, me, and my
customers?

ProFast Billing Solutions prints pre-authorized checks on
behalf of your customers. Any contractual or cancellation
clauses in the agreement will be settled upon prior to
initiating your service. We will go over typical
arrangements and make suggestions on a course of action
depending on the individual needs of each business.

6. Do you have access to my customer's or my bank account?

Our system does not have the ability to electronically
access any bank account information. It is a proprietary
software that was developed to store information and print
checks only.

7. What about paperwork? Is it complicated and
time-consuming?

NO, it could not be simpler. First of all, we will provide
you with professionally designed literature that describes
the Patient Payment Plan™ to your patients and lets them
know exactly how it works. Then we provide you with
application forms in electronic format so that you can
easily print copies for your patients. The patient fills
out this easy, one page form with all of the pertinent
information about themself and their banking information.
The last step is to attach a check made out to "ProFast
Billing Solutions" for the one time setup fee. The
application form and check are then sent to our office.
There is nothing more to it than that.

8. Will my patients actually consent to having their
accounts drafted every month… and paying the service
charge?

YES. Think about it. If a patient has a bill of $500 to pay
out of pocket, you can now offer them the ability to make
smaller monthly payments instead of paying in one lump sum.
You can choose the amount of the payments, but let us say
for this example that you decide to have the patient pay
$50 a month for 10 months. That is $500 dollars, right? To
keep the math easy let us add a 5% service charge to their
$50 payment. The patient now has to pay $2.50 for the
service fee to use the service that month, bringing their
total monthly payment to $52.50. Do you think that for an
extra $2.50 a month the patient is going to turn you down?
Generally the answer is no. In essence, you have just
extended them credit at an extremely low 5% interest,
without a credit check or additional hassles. Try finding a
credit card that is so generous! And remember, the important
thing here is that the money will be automatically drafted
out of their account every month, which virtually assures
you of payment.

Hope that answered some of your questions. Feel free to
call us at 888-889-5073 or visit us at www.profastbilling.com.
.

Top 10 Reasons to Use Pre-Authorized Checking

2008-12-23T20:41:00.000-08:00

Now that you know what PAC or Pre-Authorized Checking is,
you may wonder how you can use it to your advantage. Here
is a list of ways you can use it to your benefit.

10. Increase Customer Retention!
Industry statistics support the claim that clients on an
auto-pay type system remain faithful customers in excess of
90% of the time.

9. In-house Collection
Pre-Authorized Checking (PAC) can be the perfect answer to
the "age-old" excuse -"The check's in the mail." All you
need to process a pre-authorized check is written consent
and their checking account information. Now consumers can
afford a service by dividing the total amount over a
payment term, allowing them to purchase products or
services they otherwise could not afford.

8. Reduce Billing and Invoicing Costs
Each and every draft produced by PAC will save your company
money. Studies show that the average business spends $10 per
account, per month to bill their customers. With PAC there
are no-ongoing fees to the business owner. By reducing
invoicing, mailing, bookkeeping and all other associated
billing expenses PAC can directly add to a business' bottom
line.

7. Convert NSF Checks into New Payments
If a business receives any NSF checks, they can contact the
customer and with their consent reissue the payment. The
business can even obtain customer consent to include the
bad check fee in the new draft.

6. Mail Order, COD and Telephone Sales
With our system businesses can close those telephone sales
immediately by drafting their customer's checking account.
Much like a credit card order, they get the sale now, but
without the payment delays, rejects and merchant card fees
associated with taking credit card payments.

5. Installment Plans and Recurring Billings
Our "silent payment" concept helps prevent account
delinquency. Customers will appreciate the convenience of
automatic payments and business owners love getting their
money on time, every time. Now there is no more forgetting,
ignoring, or worrying about past due accounts or service
interruptions.

4. The Ultimate Fund-Raising Tool
Members and donors can simply draft their checking accounts
instead of having to remember to mail a promised donation.
This helps organizations get all the fund-raising dollars
they have been promised, and because it costs less than
taking a credit card, more money makes it to the cause it
was intended to help. PAC is great for non-profit partner
donors, building programs and telethons of all types.

3. Improve Customer Service
Many customers will appreciate the convenience of PAC
account payments because they can easily have a payment put
on hold and reissued the next month. This allows business
owners to continue collecting their funds without angering
a long time client who may be having a tough financial
month.

2. It Is a Win-Win Situation
The PAC solution benefits both business owners and their
customers. Businesses cannot afford the opportunity cost of
forgone business growth, or the possibility that their
clients who desire the convenience of auto-pay would find
another provider who offers this service.

1. Get Your Money Faster
The PAC solution puts the business owner in control of
their payments. They decide when they get paid. PAC checks
can be produced for immediate sales and implemented
effortlessly on all recurring invoicing services, products,
or payment plans.

The Bottom line: ProFast Billing Solutions can dramatically
improve the cash flow operations of your business!

Collect More of Your Money with Payment Plans

2008-12-21T06:56:00.000-08:00

The Problem: Collecting Money From Patients

Even with insurance claims a significant portion of a doctor's income comes directly from their patients. The problem is that many of these patients do not have the money to pay for treatment right away. This immediately forces doctors to either extend credit to patients or refuse to treat them. By extending credit the doctor takes the personal risk that the patient will never pay, which added up over time can total tens of thousands of dollars in potential profits each year. By turning new clients away they slow the growth of their practices and deny the potential revenue boost. It is a no-win situation for most doctors: either turn away business and lose money, or accept business that they know there is a good chance they will not get paid and lose money.

The Solution: The Patient Payment Plan

Finally, there is a solution to this problem. The Patient Payment Plan (PPP) is revolutionizing the way doctors across the country collect money from their patients. It allows them to collect a significantly higher portion of the money that they have already earned, in most cases 98% of that money. All of this can be done without alienating or harassing patients, and without burdensome overhead expenses. In fact, the PPP has no ongoing expense or cost to the doctor. Now patients have the ability to make affordable monthly payments without the need to apply for credit or go through a lengthy approval process. These payments are then automatically taken out of their bank account each month until their bill is paid.

This service isn't just for doctors.

Even with the best intentions, some customers will have difficulty making payments to a business on time. Whether it is because customers cannot afford a large payment, they simply forget to make it, or any other number of excuses the bottom line is this: when a business does not get paid on time it can cause major problems. Poor cash flow is cited as the number one reason why new businesses fail. At this point a business owner has two choices, they can continue to spend a small fortune using traditional methods attempting to collect what their customers owe them, or they can switch over to one of the fastest growing methods for receiving payments today. It is called Pre-Authorized Checking (PAC) and now any business owner can start using it immediately to increase their company's bottom line.

Here Is How It Works:

PAC ensures that your payments are received on time each month, every month. A customer simply completes the release form to sign up for the program. This form is then forward along with other completed forms to ProFast Billing Solutions. Our processing center prints the pre-authorized checks for the agreed upon amounts and delivers them to the business on the scheduled date(s). Owners simply take the pre-authorized checks to their banks and deposit them like any normal check. Depending on the volume of accounts, ProFast Billing Solutions can even deposit the checks for a business. With PAC there is no computer access into a customer's checking account like a traditional ACH. Their check is simply re-created on the agreed-upon day each month for deposit into the business owner's bank account. Their pre-authorized check is noted on their monthly bank statement like any other check. This non-threatening approach makes signing up customers on PAC very easy. Because you will be in control of the checks being deposited, there is no chance for the bank to make a mistake on your customer's account. This flexibility allows you to even hold a check for a few days if necessary for your customer without any problems or fees.

Visit www.profastbilling.com for more info.

Frequently Asked Questions Regarding Outsourcing Medical Claims

2008-12-20T14:18:00.000-08:00

Maybe you have considered outsourcing your medical claims before, maybe not. But either way, I'm sure you may have some questions. So here are a few of the more common ones we get to hopefully answer any that you may have.

Will my claims really get paid faster?
Most definitely. Electronic claims are always processed before paper claims, and because of the electronic tracking methods in place, the insurance companies cannot claim they never received your claims. With our exclusive next generation technology your claims can settle with money in your account in as little as 7 days!

Will I be able to know at all times what claims have beenfiled?
You will be given a detailed verification report that will show what claims have been transmitted and when

Will I have to have expensive equipment and software?
No. In fact, you do not have to have any equipment or software at all. With our specialized software your office can out-source all of your data entry of new patients, posting of charges and payments, and statement.

Will my patient charts ever have to leave my office?
Absolutely not! If there is any information your billing specialist needs, they would contact your office manager and request it by either fax or phone. Only information that is pertinent to filing the claim is necessary. All patient information is kept in the strictest of confidence and is only used for billing purposes.

So what exactly does the billing specialist need from ouroffice to file the claims electronically?
We will need a copy of the super bill for services performed, a copy of the patient registration form, and a copy of the insurance card front and back. If ProFast Billing Solutions is going to perform full accounting of payments as well, then we will need a copy of the EOB so we can properly post payments.

I do not have a formal superbill. Can one be designed formy needs?
Yes. ProFast Billing Solutions can even put the form on two part NCR paper so your office will not have to make copies of them. The same can be done for a patient registration form.
What happens if the claim is rejected or paid wrong?Your billing specialist will challenge any and all rejections and will do prompt follow up on any problems

What are the liabilities involved in using an outsideservice?
At ProFast Billing Solutions we take every precaution to ensure the quality and security of handling your billing needs. Our software and systems meet or exceed all the guidelines stipulated in HIPAA. All data is backed up on a daily basis and is stored off site in multiple remote data centers; a backup can also be provided to your office upon request. These data centers use the latest in security and hacker prevention to keep your data completely safe.

How will the information needed to file a claim get from myoffice to my billing specialist?
Because each office's needs vary, our billing specialists can work with you on an arranged time to pick up the necessary data to file the claims.

What would my office staff be responsible for?
Your office staff will be able to continually concentrate on increasing patient care and follow up on the status of all the patients who come through your practice. With this kind of care, your patients will become great word of mouth referral sources for you.

Electronic Medical Claims Filing

2008-12-19T21:37:00.000-08:00

The Problem: Insurance Companies Hate To Pay What They Owe

As you probably know, the whole process of filing insurance claims is cumbersome, time consuming and energy-draining. The insurance companies have made it as difficult as possible to get paid. Obviously they have a vested interest in paying out as little money as they possibly can. One of the best ways they hang on to their money a little longer is by creating an extremely difficult set of hoops that doctors have to jump through to file and collect their insurance claims.

The results of this frustrating process are startling: On average 32% of all claims are rejected, 5 to 15% are lost in the shuffle and never collected, and the average time it takes the doctors to collect their money is 60 to 90 days. It can be even longer for Medicaid claims.

In addition, aside from stretching the time it takes to receive payment, this process also presents one with another major problem: it takes a tremendous amount of employee and overhead cost for one to manage the entire claims filing process. In fact, the New England Journal of Medicine states that a typical doctor's overhead and billing expenses account for 43.7% of his/her gross income.

The Solution: Electronic Medical Claims Filing

Electronic medical claims filing now comes into play. Instead of relying on staff to laboriously file claims and then endlessly follow-up on them through the approval and collection process, now a physician can outsource the entire process to a medical billing professional. ProFast Billing Solutions can also lower the time it takes to receive payment from an industry average of 90 days to as little as 7 days. We are trained professionals who are equipped with proprietary, state-of-the-art software that allows us to electronically file claims for you. The benefits to your practice are enormous. For more on the benefits of outsourcing your medical claims, visit www.profastbilling.com.

Benefits of Using Claims Filing Service vs. Doing Your Claims Yourself

2008-12-18T15:36:00.000-08:00

Being in business and making money whether you are a doctor, entrepreneur or what have you is all about leverage. Leveraging your time and resources to help your business thrive and grow and assure you will be in business for a long time to come.

One of the best ways to do this is outsourcing. This is simply the act of paying someone else to do tasks for you that take time from you doing what you do best - being a doctor. The majority of the time it is cheaper too, in terms of what it costs you to do it yourself.

Here are a few ways it actually saves you money and allows you to spend more time on your practice:

No more dealing with the red tape of insurance companies, Medicare, Medicaid, etc.
No more wasted time in supervising the processing of claims.
No more problems with office software and hardware support and service
Greater income from increased efficiency of claims collections
Cost savings
Increased office space
A professional at your disposal who can help you stay current with the latest changes

These are just a few ways it benefits you to look into hiring a professional service to handle your claims. For more information and a free analysis, give us a call at 888-889-5073 or email at info@profastbilling.com.

New Services Added - Equipment Financing and Merchant

2008-12-16T17:59:00.000-08:00

We are pleased to announce that we have recently added two new services that we are able to offer. Through partnerships we are now able to offer equipment financing for new or used equipment as well as merchant account services.

Please take a moment to check out those two pages for more information. You can find a link to them under "services for doctors" or "services for businesses".

Welcome

2008-12-14T11:27:00.001-08:00

Welcome to ProFast Billing's blog for news & resources. Here you will find information and the latest news from major insurance carriers, resources and information regarding our services. Please bookmark, subscribe to our feed or come back often!