ecare India Blog

Managing a medical billing company is not an easy task, as one has to face a lot of challenges besides competing with other companies in the domain. Have you ever analyzed as to where you rank in relation to your competition? If not, do it right away! Once a thorough analysis has been made, you will know whether your company is in need of expansion to be amongst the top 10 in the country. If you feel that your company is far behind in growth, then subcontract a part of medical coding and billing services to offshore vendors. It has been the secret behind the success of many of the largest medical billing companies. Use this secret formula to double your growth in 2013! Doing so will help you reap the following benefits,

Earn the Trust: Acquiring many new clients is not important, but retaining a substantial percentage of them is very important. Retaining a client means earning their goodwill and trust. To accomplish trust, medical billing companies need to work efficiently and deliver the output with exceptional quality and before the TAT expires. In reality, performing these tasks single-handedly can be challenging. However, when a part of the scope is subcontracted to an offshore medical billing company, the outsourced company can witness a substantial growth in their business while acquiring the trust of its clients.

Expand your Clientele: Now, this is in direct relation to the previous one. Once you earn the trust and goodwill of your existing clients, it becomes easy for you to acquire new ones. Guess how? Simply showcase all your achievements with your existing clients to the new ones. They will surely be impressed with your performance and will sign a contract without delay. Also, even in today’s media driven marketing world, there is nothing that is as successful as a referral from an existing client. By simply subcontracting a part of medical billing and coding services, you will not only expand your clientele, but also double your growth.

One is not Enough: Now that you have outsourced medical billing services to a offshore medical billing company, what next? Don’t stop with just one vendor, you have to use the support of two or more vendors to double your business growth. The simple logic is not to put all your eggs in one basket. It is important that you follow this idea like other medical billing companies, which have witnessed a great success in the past.

Recently, medical billing companies have been facing a tough time due to the payment reductions caused by the Patient Protection and Affordable Care Act. In addition, a new challenge – the HHS Sequestration has worsened the payment scenario. The Center for Medicare and Medicaid Services has brought into effect the sequester provision of the budget control law on April 1, 2013. According to this law, a 2% cut will be implemented on all Medicare provider payments. The impact is more since we are beginning to see that HMOs and some of the Commercial payers following suit. Let’s see how the HHS Sequestration Plan impacts the revenue cycle management of medical billing companies,

Important Features: A 2% deduction is done for all services rendered by Healthcare Facilities and Providers effective from April 1, 2013. This reduction is also applicable for Medicare Part C (Private Insurers) and Medicare Part D (Prescription Drug Plans). Wondering how these features impact the medical claims billing companies? Let’s delve into more details,

The Chain Reaction: Basically, it is the healthcare Providers and Facilities who are directly impacted by the HHS Sequestration cuts. However, medical billing companies also suffer because on a percentage of collections model, their invoice values get reduced. Providers will also likely ask for a reduced pricing to offset their loss and to balance the revenue cycle management. Therefore, a Medicare reform like the above not only affects the Provider, but also the outsourcing medical billing company, forming a chain reaction.

Solution: The best solution to reduce this financial loss and keep the revenue cycle management profitable is to outsource a part of the medical billing services to an offshore medical billing company. This way, medical billing companies can avoid overhead expenses like hiring, training and technology up-gradation, which will be comparatively greater than the outsourcing cost. While medical billing companies save a substantial amount by offshore outsourcing a part of or the entire physician billing, the 2% payment reduction will get compensated to a greater extent.

Choose Right: Choosing the right and reliable offshore medical billing company is very important. In that case, look no further than e-Care India, one of the leading offshore medical billing companies that render exceptional services while improving your cash flow.

Denials are a big problem faced by both healthcare facilities and individual physicians. Even though they take concerted efforts  on medical claims processing, claims do get denied by the payer for several reasons. Claims can be re-sent to the insurance company but only on learning the status of the denied medical claims. Till recently, physicians and healthcare practices had only the option of making calls to learn for what reason their claims got denied. However, this situation changed with recent technological enhancements in the internet and medical insurance billing domain. Now, checking the status of the denied claims is just a few clicks away! Let’s do a detailed analysis on both traditional and modern ways,

Traditional Method: As discussed earlier, physician practices and healthcare facilities made calls to insurance companies to learn the status of their rejected claims. Calls can be made only during US business hours and some of them might consume a lot of time to reach the right person in charge. However, one can still enjoy the benefits of this traditional method by disregarding the above mentioned facts. Individual physician practices and healthcare facilities get an elaborated explanation on their denied medical billing claims through the calls. It highly helps them in performing their medical claims processing perfectly next time.

Modern Method: In recent times, most insurance companies maintain their own websites in which they update denied claims and their status. Therefore, a physician or healthcare facility registered with the particular insurance payer’s website can login to their account and view the status easily. It takes only a few minutes to check, however if the reason stated is not clear, then the physician has to take up the traditional  of calling to ascertain the exact reasons. Once the clarification is made through call, further steps in medical claims processing can be taken.

Thus, the traditional way of making calls and the modern way of checking on the web to learn the status of denied claims go hand in hand. Using both methods can help physicians and healthcare facilities get a better understanding on where they went wrong in the medical insurance billing process. For exceptional denial management, outsourcing a part of medical claims processing to an offshore company like e-Care India that does a ‘full-court press’ will be a great idea.

A common myth about Anesthesia Providers is that their work simply involves giving anesthesia to the patient undergoing surgery. In reality, they have more responsibilities like creating a customized anesthesia plan for a patient, monitoring the health status prior to and after giving anesthesia, and more. Anesthesia providers may range from Anesthesiologists, Certified Registered Nurse Anesthetists (CRNA), and Anesthesiologist Assistants. Like how treating a patient with the right anesthesia is vital, billing anesthesia services the right way is also very important. Different from the usual healthcare billing process, it has some unique requirements. The most challenging part of anesthesia medical billing is the clear documentation of records which are briefed below,

1. 1.    Pre-operative Review: In this review, the patient’s health history is thoroughly analyzed to find risk factors like cardiac complications and more. It helps anesthesiologists to tailor a custom plan for the respective patient.
2. 2.    Anesthesia Sheet: It involves the documentation of the following factors,

• Base Units: They are derived by measuring the complexity and skill set required in providing anesthesia services. More intricate procedures earn a higher number of base units.
• Time Units: The amount of time required to render anesthesia services helps derive time unit factors.
• Modifiers: Factors like patient’s physical status, co-morbid conditions, emergencies, concurrencies and more have to be taken into account in anesthesia medical billing.
• Conversion Factor: A fixed dollar amount set by the anesthesia group belonging to each state.
• Formula: (Base Units + Time Units + Modifiers) x Conversion Factor = Anesthesia Reimbursement       

1. 3.    Post-operative Review: Monitoring a patient’s health condition and rendering appropriate pain-block services after surgery is very important. Anesthesiologists are expected to document them for proper anesthesia medical billing.  

Improper Documentation: Sometimes, anesthetists fail to document their services properly or their documents might be erroneous due to their busy schedules. It may lead to claim denials or underpayment, thereby affecting the revenue cycle management. The ideal solution to overcome this situation is to outsource anesthesia medical billing to an offshore company like e-Care India.

The importance of modifiers in Coding is that they play a vital role in medical claims processing. Therefore, Healthcare Facilities and Providers must show extra care while using modifiers in the medical billing and coding process. If they fail, then there could be serious repercussions concerning reimbursement. In general, what are modifiers and why are they so important in the medical insurance billing and coding process? Let’s get into these details,

Elucidation: In simple terms, modifiers are two digit alpha, numeric or alpha-numeric codes, which shed more light on the Codes for a specific procedure or service performed by a Provider. These modifiers will be of great help to third-party payers, especially when they process medical coding & billing claims of a Provider. They contribute a great deal to the proper reimbursement for a Provider’s services.

Role: Modifiers clarify insurance payers on the following aspects,

• They explain whether the provider services had technical component or professional component or a combination of both
• They specify if more than one physician was involved in rendering a particular service or procedure
• If a service was performed in more than one location, then it is clearly indicated
• Modifiers also clarify if a service was performed completely or partially
• If an optional extra service or a bilateral service was performed, then they are coded with their respective modifier codes
• They clearly indicate if a service was performed more than once
• If mishaps occurred during the course of service, they are coded in detail

Thus, modifiers have a great responsibility in deciding the accuracy of medical billing and coding.

Impact: If the medical coding/billing staff show negligence while coding modifiers, then the respective Healthcare Facility or Provider will face a huge revenue loss. For instance, if a provider has performed bilateral services, then the billing report must be coded with Modifier 50. On failing to code properly, the provider will be underpaid. Modifiers like 26, 23 and QZ help prevent the denial of claims.

Why Outsource? Coding modifiers requires a lot of knowledge and can be performed only by highly-experienced coders. With increasing pressure on in-house Coders due to Compliance and ICD-10 migration, medical coding outsourcing would be the prudent choice!

Many medical billing companies recently have realized that their growth purely depends on outsourcing a part of medical billing services to offshore companies. If you are one among them, then you have to be choosy in selecting the offshore medical billing company. It is because of the fact that many offshore companies perform only the tasks that are assigned to them, but there is no value addition to your business. Therefore, you ought to be careful enough to choose a company that not just works as a vendor, but works more like a partner. Such an offshore medical billing company will not only get your work done efficiently, but also offer value addition to empower your business. Do you have a vendor or a partner? The answer to this question lies below,

Value Addition: An offshore vendor simply completes the task which has been assigned to it, but only a partner takes the pains to go a step ahead to analyze what betterment can be done to the process. After a thorough analysis has been made, it suggests various measures to the outsourcing medical billing company to enhance the efficiency and maintain a sustainable growth in the domain.

Exceptional Quality within TAT: Some offshore vendors hasten their work so as to deliver the output before the agreed TAT expires. In the interim, they are concerned less about the quality, than about delivery on time. Conversely, an offshore medical billing company that works like a partner will not only complete all the tasks within the contracted TAT period, but also delivers the output with 100% quality and also suggest ways to improve the process.

The Best BCP: Business Continuity Plan otherwise known as BCP is a very important factor that you need to look for in an offshore medical billing company. An ordinary vendor will not have such plans in their framework. However, when you choose a proper vendor that works like a partner, you can enjoy great benefits. Not only will it have a good BCP, but also have Disaster Recovery Centers established in various places that will operate during emergency situations.

Now, it is your choice to either have a vendor or a partner work for you. If you wish to choose a partner, then look no further than e-Care India!

The prime hassle that most medical billing companies face from their clients is undoubtedly prompt handling and managing denials. “How promptly do you handle your client’s denials?” – When this question is asked, most of the billing companies indicate that this is their biggest pain-point. It is because of the paucity of resources to work exclusively on denial management. With the current claims to be worked under severe pressure due to TAT, medical billing companies concentrate more on them, leaving the Old denials unchecked and piled up. The ideal solution to this situation would be outsourcing medical claims processing by partnering with an offshore company that offers exceptional medical billing and AR services.

Healthy Cash Flow: A recent research performed in the healthcare reimbursement domain stated that approximately 20 to 30 percent of the insurance claims are rejected every year. Consequently, physicians or healthcare facilities face a huge loss and most medical billing companies settle for less compared to what they should be able to collect. Therefore, for healthy revenue cycle management, billing companies will have to consider options such as outsourcing medical claims processing to an offshore company.  That way, the Old AR and Denials are promptly handled which makes their customers happy as well as giving a boost to the billing companies’ monthly invoicing.

Dedicated Resources: Managing denials require expert knowledge! Therefore, only dedicated resources can handle them efficiently without leaving backlogs. An offshore company deploys a dedicated team of employees who will manage denials promptly and render effective medical billing services. These experts analyze the possible denial trends and also initiate ‘global action’ that can save many claims with a simple fix. Then, they do extensive groundwork to correct ambiguous claims and avoid the chances of them getting rejected again.

Eliminate Backlogs: The offshore medical billing company’s dedicated team of resources is adept in cleaning up the backlogs that were accumulated so.  To accomplish this task, they perform a thorough root-cause analysis, decide on the right solution for fixing the particular issue, take corrective measures, submit claims and finally document the solution if the claims are accepted by the insurance agency. This way, the team can handle claims more efficiently resulting in a healthy revenue cycle management.

In recent times, the US has witnessed a substantial increase in the growth of medical billing companies. Not only that! These companies fiercely compete with one another to earn a reputation in the healthcare reimbursement domain, which is definitely an arduous task. To accomplish this goal, an US medical billing company must exceed the expectations of its clients by working exceptionally well and fortify their trust. Only when this goal is achieved can the US company expand its client base further. An US medical billing company can work ‘par excellence’ by outsourcing some of the medical billing services to an offshore company. Let’s see how:

Divide and Conquer: How can an US medical billing company earn the trust and goodwill of a client? The answer is pretty much simple! The US medical billing company has to exceed its client expectations by providing error-free output. To do this, the company must outsource a few medical billing and coding services to any offshore medical billing vendor. Thus, by dividing the work, the US company renders quality output to not only retain its existing clients but to acquire more.

Speed up the Turn Around Time: Another way to exceed client expectations is by delivering quality output even before the TAT expires. By outsourcing medical billing services to offshore medical billing vendors, an US company can focus on its core operations. In addition, subsequent services can be carried out simultaneously to save ample time and achieve a faster TAT. US companies can show these achievements to new clients and expand their clientele further.

Exceptional AR Management: One main challenge that many US billing companies face and their clients fear for is managing the Accounts Receivables. Recovering the amounts due from the Payers can be a very tricky challenge. The prudent decision would be outsourcing AR services, including insurance follow up, denial management, claims status checks, patient follow up, credit balance audits and old accounts receivable clean-up to an offshore medical billing company. The US medical billing company can utilize cost arbitrage of off-shoring to medical billing company in India to have more resources working the AR. Delivering them with great quality can surely increase the ranking of an US company. This in turn lays a firm foundation for client expansion.

One of the key areas that healthcare revenue cycle management companies need to focus is information security. Due to the sensitive nature of information that the RCM companies deal with, it is mandatory to maintain a secure work environment; but the ‘road to perfect security’ does not end just with that! Whenever technology blossoms with new innovations facilitating businesses and common people around the globe, the flip side is the possible exploitation of that technology for illegal activities. The U.S. healthcare industry is under constant threat of this unwritten ‘law of technology’!

In U.S., we keep hearing about patient data (PHI – Patient Health Information) leaks and loss due to data piracy attempts, ignorance and carelessness leading to compromise of patient information security and loss amounting to billions of dollars. Many revenue cycle management companies have now started to take-up certifications that can give them the processes that would significantly reduce such incidents and also to take immediate corrective measures should such an event occur.

Can certifications help in bridging the gap in data security?

This has been a question for ever, for almost every business; let alone the revenue cycle management companies. Getting a certification is not everything, but eases the concerns of data security. Adhering to policies and certifications are like traveling on a bridge that has already been laid for you; easier than building your own. Experts have already thought well and put forth as policies; but, once you are certified, you are not done with it; you need to keep following the policies, to reach the destination.

Let’s talk about policies that help in enhancing the healthcare security:

HIPAA:

The Health Insurance Portability and Accountability Act (HIPAA) was enacted by the U.S. government in 1996 with the view to establish “national framework for security standards and protection of confidentiality with regard to health care data and information”.

Moreover, it states that HIPAA assists in three prime segments: ‘Administrative Simplification’, ‘Security’ and ‘Privacy’ for PHI. Being in the industry, the healthcare revenue cycle management companies need to follow the nationalized policies in order to keep pace with industry standards and achieve enhanced operational efficiency. If it is an offshore medical billing company, it becomes essential for you to follow the guidelines of HIPAA to ensure safety of patient information and satisfy the security demands of your U.S. billing partner.

ISO 27001:

The ISO 27001 helps in attaining best-in-class Information Security Management System (ISMS). It insists on management standards for information security and is risk-based, helping in effective decision making. ISO 27001 allows you to set your goals for information security management specific to your business and in assessing your growth periodically and attaining augmented and measurable business results. ISO 27001 has many policies in common with HIPAA and covers the most sensitive areas of concern.

Following these policies can satisfy the security needs of your revenue cycle management company,  and it is important to focus on continuous improvement after getting certified. You can refer to the related article on our Blog – ‘Securing patient data’.

In this fast-paced world, several business organizations compete with one another – not just make profits and grow – but to earn the goodwill and trust of their clients as well. In that list, US based medical billing companies are no exception! The demands and deadlines set by the clients are high and so are their expectations. Working in a normal and steady phase will not help in satisfying their needs. One has to work exponentially harder without compromising on the quality to meet such tight deadlines, which is definitely a herculean task. That’s where the idea of business office extension comes in. A US based medical billing and coding company can extend its business office to an offshore company in which a team of dedicated professionals will work solely for the US company. The advantages are many and they are as follows:

No Additional Investment: By outsourcing a few medical billing processes to an offshore medical billing company, the US based organization can save costs on getting additional resources. Recruiting new people and training them in the intended field will call for more investment. In addition, the US based medical billing company also has to invest on the technology and infrastructure to carry out the process. All these things put together will cost a small fortune for the billing company. Therefore, extending the business office to an offshore billing company would be the more prudent choice.

Additional Office Space: The US outsourced medical billing company will not have any necessity to extend its office space in the event of outsourcing a few services to an offshore medical billing vendor. The cost for space extension is saved as are the overhead expenses.

Handle Risks: Sometimes, a US based medical billing and coding company may face a shortage of employees or any a cyclical business volumes. In such cases, the offshore team can handle the variance in work volumes efficiently without any discrepancies in the output.

Work 21/5: One of the major advantages of outsourcing medical billing processes to an offshore company located in a country like India is that employees can work in multiple shifts for up to 21 hours a day to get the work done faster than anticipated. Therefore, the core company can deliver the processed output to its client as promised or even before the TAT deadline. That’s the best way to maintain a healthy healthcare revenue cycle management and earn the goodwill of a client, isn’t it?