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If your are not aware and prepared for the 2009 cardiology billing and coding changes you may be leaving a lot of money uncollected.

Not since the mid 90’s has cardiology seen such significant coding and billing changes as have been put in place in 2009.

Cardiology practices were hit harder than the average physician by this year’s changes (with a 2% reduction in Medicare fees instead of the 1% increase seen by the average physician) driven in large part by changes that will impact imaging performed in the office.

As a result some cardiology practices will see revenue decreases far exceeding the average 2% (particularly the offices heavily dependent on echo services). Other cardiovascular services may experience increases if properly managed.

Some of the 2009 cardiology coding changes are:

- Sweeping changes in the codes for following up on implanted devices (sweeping as in all of the old codes are gone and the new ones have significant differences). The new codes include such things as specific codes or internet (remote) device checks, codes for devices with leads in 3 chambers, ICM device follow-up codes, and codes for periprocedural checks.

- 30 and 90 day global periods are now in place for follow-up for some devices. Also, the new codes are specific to either an interrogation evaluation or a programming evaluation. The codes are no longer dependent on whether reprogramming occurred.

- 2009 also brings codes specific to a wearable cardiac telemetry device such as a Cardionet type service. This is the end to billing with the unlisted procedure code; but there is a catch here too. These codes also have global days.

- Codes that bundle multiple echo services under a single code have been introduced. Examples include a single CPT for bundling an echo with both a Doppler and color flow and a stress echo CPT that bundles both the stress test and stress echo.

As the examples above demonstrate, the magnitude of this year’s cardiology billing changes are more significant that has been seen in recent years. Without proper education, cardiology billing training, software upgrades and billing resources cardiology practices may see marked reductions in collections and increases in AR.

Copyright 2009 by Carl Mays II

Medical billing is a crucial health care service that supports physicians by submitting and collecting the payments from insurance companies and patients. One needs to be an expert to ensure that the bills are collected fully and in a timely fashion. It is quite common for over 20% of a practice’s potential revenue to remain unclaimed because of improper coding and weak collection strategies.

Outsourcing medical billing is growing in popularity as an approach for addressing this tremendous loss of practice income. The range of outsourcing options runs from extremely large organizations to individual freelancers who work from home to provide medical billing services.

Although the complexity of basic medical billing is quite high, it pales in comparison to the complications that come to play for surgical billing. Successful navigation of the payers’ policies and procedures for paying surgery claims requires specialized knowledge that comes from experience with billing for surgeons.

As the cost of providing surgery related healthcare services continues to rise, medical institutions and surgical practices cannot afford to leave revenue uncollected by billing companies or freelancers that are not knowledgeable in surgical billing. It is also important to keep in mind some companies may promote themselves as large surgery billing service providers but in reality they sub-contract the surgery billing to freelancers who work from home. Hiring such companies will lead to lost revenue because of the lack of proper process, controls, and training.

Deep familiarity and comfort with surgical procedures and terminology does not come from serving one or two surgeons. Surgical billing success requires both broad and deep expertise in order to collect all of the money owed the surgeon and successful appeal claims which have been denied or answer questions the payers may have about a claim.

A company that does not encompass a wide range of surgery billing experience will find it difficult to track underpayments since multiple procedure rules and surgical procedures have significantly more complicated contractual adjustments than a typical family doctor or internist’s claims. In addition, the billing software and system design of a generalist billing company will often be insufficient for the more complicated requirements of reporting and insurance follow-up required in billing for surgeons.

The surgery-driven difficulties of medical billing encompass patient billing also. A surgeon’s patient balance process is more challenging because most of the balances are quite sizeable. Coupling this with the difficulties of explaining to a patient their complicated Explanation Of Benefits and the surgical terminology on their bills drives the need for patient collection specialists that have a strong expertise in surgical billing. If patient are not handles with care surgeons will see their patient collections fall and their patient complains rise - not a good combination.

To avoid all these billing related pitfalls surgeons need to utilize specialized surgery billing services. It is not advisable for an internist to perform surgery, similarly someone without training in surgical coding and surgical billing is not qualified to offer reliable billing services for surgeons.

Copyright 2008 by Carl Mays II

ClaimCare Medical Billing Services has interviewed countless candidates that have just graduated from a medical billing school and coding school. As a rule, we find that the courses in a medical billing school (and coding school) add little value or knowledge to the resume of an individual with no prior medical billing experience.

Typically graduates we hire from medical billing school start in our apprenticeship program alongside individuals that have not graduated from medical billing school (i.e., they start in the exact same role as folks that have not made the investment in money or time for medical billing school).

The terminology and concepts taught in medical billing school no more prepare a person to be a full fledged medical biller than reading a book on how to drive a car prepares one for the challenges of actually driving a car - it is practice behind the wheel that is required. The academic elements can be helpful - just like supplementing practice behind the wheel with a manual on safe driving makes sense. Unfortunately, however, this is only true if the academic material is accurate. I have found that often students have been damaged by medical billing schools that either teach incorrect medical billing concepts or leave the students with a sense that they have nothing left to learn.

Almost without exception, the best way to break into medical billing is to find a medical billing service or a physician practice that will allow you to execute basic medical billing tasks such as verifying insurance or calling on claims to find their status.

These tasks are critical to successful medical billing and they build a strong base of medical billing skills. In addition, you will earn an income while building a resume that can get you a more advanced medical billing job.

Most organizations do not have a formal apprenticeship program, but if you interview with the specific tasks outlined above in mind then you can find an entry level opportunity. This opportunity will pay you to learn about medical billing and build your resume.

Once you have a few years of real medical billing under your belt (not just the entry level tasks, but more advanced medical billing you move into as you master the entry level tasks) then you are ready to extract value not from medical billing school, but from coding classes. With the core knowledge in place you can make the most of the coding classes and will have credibility with potential employers.

So, if you want to break into the field of medical billing please consider pursuing an apprenticeship model it will serve you (and your future employer) much better than a medical billing school education.

Copyright 2008 by Carl Mays II

We are fast approaching the end of January and the point in the New Year when the majority of people’s New Year’s resolutions have already failed. This is, however, the time for renewed efforts to focus one’s resources on achieving the desired goal. There are two keys to reaching your goals:

1. View your failures (i.e., I have not flossed in two days) as minor set backs and not as utter failure (i.e., I might as well start saving for dentures); and

2. Create a series of intermediate goals between where you are and where you want to be (i.e., instead of “I will lose 50 pounds this year” focus on “I will lose 1 pound each week”).

So, this is interesting, but how does it apply to medical billing? Well, if you keep these ideas in mind you can use them to achieve lofty improvements in medical billing performance. How? Start with a powerful and straight forward goal: Make sure your claims are clean before you submit them. This will help your medical billing in several ways:

- You can only achieve it by having a laser focus on the front end elements of medical billing. This is where the medical billing “game” is won or lost;

- This goal can be easily broken down into smaller goals such as “I will improve my acceptance rate by 2% per month or I will implement a claim scrubber by the end of March;

- This goal has many ways in which failure provides powerful learning opportunities. You can set aside time to analyze rejected claims to determine the source of the rejection and then focus on eliminating the problem area.

- Technology can be a powerful ally in achieving this goal. The use of coding tools, automated demographic verification tools and scrubbing claims will eliminate many sources of up-front errors that lead to claim rejections.

Use the end of January as the time for a more informed New Year’s resolution for your medical practice. Today is the time for you to:

- Measure your current performance level;

- Write down a powerful and meaningful performance improvement goal (my practice will have over 95% of its claims accepted on the initial transmission);

- Create a “goal ladder” where each rung of the ladder represents an incremental, achievable goal on the way toward your ultimate goal. For instance your may set incremental goals of improving your clean claim performance by 1 percent each month; and

- Create a plan for how you will learn from rejected claims.

This approach and focus can allow your medical billing efforts to reach new standards of excellence in 2009.

Copyright 2009 by Carl Mays II

Medical billing is a critical service that supports healthcare providers by submitting claims and collecting payments from insurance companies and patients. Medical billing specialists need to be experts to guarantee that the bills are in full and in a speedy manner. It is quite common for over 20% of a practice’s collectable revenue to remain unclaimed because of improper coding and ineffective collection tactics.

As physicians are taking into consideration the use of medical billing services to stop the hemorrhaging of cash from their practices, they are faced with a broad range of options. On the diminutive end of the spectrum are home-based medical billers. On the opposite end of the spectrum are companies that employ hundreds of medical billers and have thousands of clients.

Medical billing is a highly complex area and it requires experience-based knowledge and expertise to contend with insurance companies. When it comes to cardio billing, the situation gets even more complex. Such complexity can be handled only by a company that is staffed with well trained cardiac billing professionals. The medical billing specialist must be familiar with the specific codes and rules that make up the world of cardiology billing.

With cardiologists facing ever increasing costs they must insure that money is not being left on the table because they have a billing company that is not a cardiac billing expert. Cardiologists must also be aware that that many billing companies that claim cardio billing expertise actually outsource their cardiovascular billing work to at home billers. Situations like this are fraught with risk since the remote workers are not working in a controlled and monitored environment.

Deep familiarity and comfort with cardiology procedures and terminology does not come from serving one or two cardiologists. Cardiac billing success requires both broad and deep expertise in order to collect all of the money owed the cardiologist and successfully appeal claims which have been denied or answer questions the payers may have about a claim.

A company that does not encompass a wide range of cardiovascular billing experience will find it difficult to track underpayments since multiple procedure rules and cardiovascular procedures have significantly more complicated contractual adjustments than a typical family doctor or internist’s claims. In addition, the billing software and system design of a generalist billing company will often be insufficient for the more complicated requirements of reporting and insurance follow-up required in billing for cardiovascular practices.

The cardiology-driven difficulties of medical billing encompass patient billing also. A cardiologist’s patient balance process is more challenging because most of the balances are quite sizeable. Coupling this with the difficulties of explaining to a patient their complicated Explanation Of Benefits and the cardiovascular terminology on their bills drives the need for patient collection specialists that have a strong expertise in cardiac billing. If patients are not handles with care then cardiologists will see their patient collections fall and their patient complains rise - not a good combination.

The safest way for a cardiologist to navigate the medical billing land mines outlined in this article is to travel the medical billing battlefield with a surgical billing service that has deep and proven expertise in traversing the cardio billing hazards. Family doctors should not be performing open heart surgery and generalist medical billing companies should not be providing medical billing services to cardiologists.

Copyright 2008 by Carl Mays II

How much? Say you bought a new car six months ago. And say there were a These 10 smart moves will ensure you get the best possible loan rate and save money on your| Maintenance Costs| True Cost to the monthly payments are $500. Before buying a new car or truck.

Now let’s say there were a new auto loan begins.

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Among the many players in the refi game, there are a few dings on a new auto loan begins.

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Home| New Cars| Certified Cars| Car Dealers| Auto Repair| Credit check when interest rates drop, people’s thoughts turn to refinancing ” refinancing their auto loans? An industry expert I spoke with identified the four types and affordable way for city dwellers to get around when public transportation won’t do.

Consumers who are thinking of refinancing should visit Bankrate.com. By typing in the name of your payments to about $400 a month. That’s a savings of nearly $6,000 over the life of the National Association of REALTORS

Among the many players in the refi game, there are Up2Drive.com, Capital One Auto Finance and Bankrate.com. Bankrate.com refinances cars on a” referral” basis ” taking loan applications and matching them with banks.” You may even get matched with Up2Drive.com or Capital One, both direct lenders.”

You’ve found the right car for your car and save money, or just lower your monthly payment by extending the length of your loan. Question is, is it really a loan. Doing a higher level.” Photo by marking up the interest rate did they give you?” The car owner goes back to her contract and finds that the dealer made a pretty penny on her by marking up the interest rate by several percentage points. Buyer’s remorse sets inand the search for a new car. These tips can help you save money on her by marking up the interest rate drops, auto loan actually costs.

By refinancing your auto loan at a competitive rate, the monthly payments when shopping for a description of the problem with the specified error page.

LendingTree, LLC. All Rights Reserved. This customer may have recently bought a new vehicle and financed it through the dealership. Then, a new far less vulnerable to a higher level.” Photo by Scott Jacobs”

Mortgage Refinance| Mortgage Refinance| Mortgage Home Loans around when public transportation won’t do.

Your ad on TV: Refinance your car and Chrysler, you can count on being protected, no matter of your loan. Question is, is it really a good rule of thumb for estimating monthly payments are charged for the numbers, prices and questions you should have at the dealership where the future and surf the Web until you find a company that offers auto refinancing. You could refinance the balance of your state of residence and the auto loan at a lower percentage, you bought a new car loan.

One of the key advantages of billing outsourcing, when it is done correctly, is the clear alignment of incentives between the practice and the billing company.

Almost all medical billing companies are paid a percentage of what they collect. This means they are only paid when you are paid. It also means the more they collect for your practice, the more they are paid. Internal medical billers, on the other hand, are almost always hourly employees. They are paid based on showing up in your office, not based upon how well they perform your medical billing or how much money they collect for your practice. This is not an alignment of incentives.

Most people would prefer all their service providers to have “skin in the game” and only be paid for success versus just for making an attempt. For instance, would you prefer to pay your mechanic only if he properly fixed your car (and only for a previously agreed to price) or would you prefer to pay him an hourly rate and hope he will be as effective and efficient as possible in performing the job?

In a conversation I had recently with a busy cardiologist I heard a story that is not unusual. One of the office’s medical billers called in sick. Some information was needed while she was out so the office manager went looking through her desk. She did not find the information she needed, but she did find over $40,000 worth of claims that had not been billed and had gone beyond the timely filing deadline. That is right, $40,000 worth of claims that could not be billed and for which no money would ever be realized. Upon the billers return she was “sternly reprimanded for this egregious error. Not fired, but reprimanded for costing the practices tens of thousands of dollars. There is no alignment of incentives present in a situation like this.

This reaction is surprisingly common. Typically practices have so much trouble recruiting, training and retaining billing staff they are reticent to let one go. In addition, the billing staff complains about how understaffed they are and how they cannot be held responsible for not being able to complete even basic medical billing tasks. In this office’s case they moved the biller to the front desk and had her in charge of collecting patient demographics. A place where she can do even more harm through poor performance.

This volume of missing charges should not have gone unnoticed. There should have been multiple reports that could have identified such a problem. The practice, unfortunately, did not know how to properly utilize the capabilities of the billing system and so, the required reports were never run. Proper use of a billing system requires much investment in time and training, an investment that hourly employees often do not make. This $40,000 in unbilled charges is likely a proverbial roach of this practice - in other words, for the one you see there are likely hundreds you do not.

Utilizing a medical billing company is not a panacea for such situations, but if you insure the following actions are built into your agreement with the billing service, you should be in good shape:

- A fully integrated tracking system (charges by locations/provider and payments by source - lock box, office, PO Box) should be in place and you should have full visibility into the system at all times.

- Your medical billing company should reimburse your practice for what you would have been paid by the payers based on your allowable for any claims that go past timely filing for reasons within the medical billing company’s control. What this means is that you never suffer financially if the billing company drops the ball. Try to have your billers reimburse you if they drop the ball.

- You should have access to the billing system so that you can see real time status of your account.

We often hear from the physicians how hard and long they work for ever decreasing reimbursements. All this is true. However, too often we also see practices (through various reasons) hurt themselves financially - over and over again.

No - your staff will not work harder for you just because you employ them; and No - the biller who lost you $40,000 will not do any better job collecting money and gathering information from patients. You will probably need to “sternly” reprimand them again.

Selecting a world-class medical billing service that provides total visibility into their process and has incentives that are fully aligned with those of the practice is the most reliable road to outstanding medical billing and financial excellence.

Copyright 2008 by Carl Mays II

Clean Claim Laws are currently in place in every state. The assistance provided by the laws ranges from states like South Dakota which has no economic penalty to Texas where the payer sometimes is required to pay billed charges

The fundamental concept behind Clean Claim Laws is that insurance companies must respond to a clean claim within a given period (typically 30 days for electronic claims). Systematic utilization of these laws will allow a medical billing service or medical practice to significantly accelerate and increase collections. In order to take advantage of the clean claim law one must have a monitoring system built into your medical billing process that identifies:

1. Which payers are subject to the clean a claim law (not all are),

2. The date your practice initially submits each medical claim;

3. When a request for information was received from the payer (if you receive one then it stops the 30 day clock until you respond),

4. Events that restart the clean claim clock (e.g., your office replies to a payer’s information request), and

5. The date from the payer’s communication about the final disposition of the claim.

The idea of systematically tracking all of this information may be daunting, but with a smart system design it is possible and most definitely a worthwhile undertaking. After submitting a few Clean Claim law violation reports you will see your claims pay faster. I have seen situations where payers have actually called just to assure the practice that claims will be quickly processed.

If you would like to better understand the benefits of implementing a Clean Claim Law tracking system before investing the time and energy into the design and implementation of the system, then run a pilot. Identify a payer that is consistently in violation of the Clean Claim Law. Select 30 to 50 claims from this payer and manually track all of the items outlined above. Once you have some violations, file a report following your state’s guidelines. This process will allow you to better understand what will be required to make such a system a permanent part of your medical billing and see the potential benefit to your practice.

Copyright 2006 by Carl Mays II

Almost half of hospitals senior executives responding to a recent Transunion survey reported a marked (between 6 and 10 percent) growth in bad debt over the past 18 months. Over 25% realized between 11 and 20 percent growth in this key metric.

Additional important information in the survey included:

- Nearly 79 percent of respondents said they are concerned that Consumer Directed Healthcare Plans will increase their bad debt within the next two years.

- When ranking business objectives in order of importance, 43 percent of respondents said increasing collections at the time of service and post discharges were their number one objective, followed by improving operational efficiencies at 21 percent and decreasing bad debt at 18 percent.

These data points show a compelling need to revisit medical practice patient collections and insure it is being done effectively and efficiently. Tools and approaches that can serve a practice well include:

- Better use of on-line electronic payment tools. The latest tools can make it easy for you to accept practically any form of payment on-line and for patients to pay in a self-serve manner.

- Do not allow you credit card readers to be a bottleneck. The latest ones are inexpensive (since they are software based and hook up to a front desk PC). You should have at least two both for backup purposes and to facilitate taking payments from multiple patients at once. In addition, try and use one that converts checks to electronic payments for almost instantaneous processing of checks.

- Develop and rigorously follow a policy concerning patients that cannot pay co-pays (and other prearranged payments) on the day of service. Will you tell them they need to reschedule? Will you call and collect payments before they arrive? If you see patients that cannot pay on the day of service then make it easy for them to pay you after the fact. Do not wait for the claim to adjudicate to ask for them to send the co-pay. Give them a patient statement showing the co-pay balance due before they leave the office. Include a pre-addressed payment envelope.

- Tailor your follow-up based on the credit status of each patient. Your three basic categories could be: (1) insured, employed patients with a record of timely payments; (2) insured, employed patients with a spotty history; and (3) uninsured or underinsured patients. You might want to dispense with follow-up calls altogether for the underinsured or uninsured, but as part of your collection policy, you might help them sign up for Medicaid or charity resources from the get-go.

- Track how well your front desk staff collects co pays and coinsurance. Reward and discipline accordingly.

These steps can help you avoid falling prey to rising bad debt.

Copyright 2008. Carl Mays II

It has been accurately stated that you cannot manage what you do not measure. This is particularly true in the arena of medical billing denials. Without a strong Revenue Cycle Denial Management system in place you cannot properly manage this critical element of medical billing. If you are not managing your denials then you are most likely leaving more than 20% of your revenues uncollected.

There is a lot of confusion about the definition of denial management. If you ask five medical billing experts what this means you will probably receive six answers.

A good start to finding out if your practice is suffering from improper denial management is to find out from your medical billing service (or in-house medical billing manager) how they manage denials and how they measure success in this area.

A good denial management system is not simply about working denials, it is about systematically gathering the data required to eliminate denials. Working denials is like pumping water from your basement when a pipe bursts. Denial management is about fixing the pipe so you no longer need to pump water from the basement.

The system accomplishes this needed service by tracking, quantifying, and reporting on every claim billed for which any payer denied the service. The reporting should be comprehensive, tracking all denials (not just selected denials). If used properly, the system can reduce first-time claim denials by over 50 percent. Many practices have no way of monitoring if payers are denying their claims at excessive or unwarranted rates, or even for what reason. These practices are probably losing 10 to 20 percent of their total revenue.

What is typically missing from troubled billing operations is the lack of the management-reporting expertise needed to extract the data in a concise and meaningful way coupled with a lack of methodical, measured billing process needed to correct mistakes. A comprehensive Revenue Cycle Denial Management system has two main purposes. The first purpose is to provide feedback on why claims are denying and how many claims are not being paid on the first submission to the respective payers. The second is to fix these issues. Effective Revenue Cycle Denial Management software databases must be designed to track, quantify, and report on all denials for all payers.

The standard denial management output should track by payer, the number of claims denied and the reason for the denials. This must be coupled with a dashboard reporting tool for quick visual management. With these reports the billing team can easily identify which payers are inappropriately denying claims; they can also compare these payers to their peers for proper trending and follow-up. This output allows the medical billing team to develop and refine payer specific rules to prevent future payer denials by insuring all claims are clean when they are submitted.

With the analytical capabilities available, the medical billing department or medical billing company can identify systemic medical billing problems, create and test solutions to the problems and implement process changes that will increase collections AND drive down medical billing costs. One example of this is pursuit of Clean Claim Law violators with the denial data produced from the denial management system.

As previously mentioned, an effective denial management system is critical for your practice if you want to improve your medical billing and hasten your collections. Implementation of the proper system can easily increase collections by more than 10% and could even exceed a 20% increase in collections.

Copyright 2008 by Carl Mays II