3 Keys to Being a Medical Billing Expert

3 Keys to Being a Medical Billing Expert

As a medical billing software company, EZClaim has worked and built relationships with thousands of billing experts across the country. With the aim of helping establish a standard of best practices, we have come up with 3 keys to being a medical billing expert. If you own a medical billing company or are studying to be a medical biller, then you will not want to miss these.

1. Strong Communication Skills

Medical billers must interact with a variety of individuals in their roles.

One of the most important people a medical biller must learn to communicate with is the patient. It is a biller’s job to be courteous, transparent, and offer up solutions to problems. Clearly communicating to patients their financial responsibilities will allow for the medical biller to complete the claim. It is also crucial for a medical biller to communicate well with their provider. If a patient’s claim is not complete, the biller must feel comfortable reaching out to the health care provider to find the missing pieces. Proper classification and correct billing methods is a critical component to getting paid.

2. Be Proactive

Be proactive in furthering your knowledge, the medical billing industry is continuously changing, and it benefits a biller to remain on top of the industry standards. There are billing associations you can join such as the American Medical Billers Association. Taking classes at a local community college or attending a billing school will help hone your skills. If a medical biller has gone through certification, these should be kept current. 

3. Strong Follow-Up Skills

A good medical biller understands that having a strong follow-up and watching their dates is a critical component of revenue collecting. Identifying and correcting time management issues will increase productivity. An effective medical biller will set follow-up dates to track claims and set reminders in their billing program. 

EZClaim offers many tools to assist billers with follow-up tasks. Between customized grids, follow-up reports, tasks, and reminders there’s a tool that will work for you and your workflow process.

In conclusion, a thorough knowledge of billing software, processes, and practices, is just one component to becoming an effective biller. Building strong relationships with patients, providers, and insurance companies through excellent communications and strong follow-up skills will ensure that patients stay satisfied with the medical practice and that providers are paid in a timely manner. 

 


ABOUT EZCLAIM:
As a medical billing expert, EZClaim can help the medical practice improve its revenues since it is a medical billing and scheduling software company. EZClaim provides a best-in-class product, with correspondingly exceptional service and support. Combined, EZClaim helps improve medical billing revenues. To learn more, visit EZClaim’s website, email them, or call them today at 877.650.0904.

Achieving a Stronger Denial and Appeal Management Strategy

Achieving a Stronger Denial and Appeal Management Strategy

Waystar’s newest guide investigates the state of denials and appeals in today’s healthcare landscape and explores how today’s most successful providers are redefining the core components of their denial and appeal process to grow revenue, streamline workflows and revitalize their approach to the process.

Denial and appeal management today

Like many administrative tasks further burdened by the impacts of the COVID-19 pandemic, denial and appeal management workflows dependent on manual processes are experiencing new strains on accuracy and productivity.

Last year a survey investigated how billing and administrative tasks were impacted by COVID-19, with 37% of surveyed providers reporting an increase in workloads due to issues with coding and requirements. An assessment of the general industry outlook found claim denial rates are at an all-time high, with 33% of surveyed hospital execs reporting concerns they are entering a “denials danger zone,” where rates grow to 10% or more.

Estimates put the cost of reworking denials as high as 20% of rev cycle expenses because on average they cost 4x as much to process than the initial claim. With so much strain already present on providers’ resources, many are turning to automation to ease the burden.

How automation elevates the process

Once a provider has been notified of a denied claim, steps are taken to identify whether or not it can be appealed. Many of the errors that cause denials come down to administrative issues that took place at the start of the claim lifecycle.

A recent analysis found 86% of the denials processed between July 2019 and June 2020 were avoidable. Analysis indicated that many of those issues stemmed from front-end errors related to benefit information, coverage detail, and shortcoming related to missing or invalid claim data.

While there’s a wide mix of problems that could cause a denial, with different providers experiencing a diversity of challenges depending on their location and patient population, they all face a common hurdle: the burden of manual denial management and appeal procedures put on administrative staff.

Like many other administrative processes, providers for the most part rely on a mix of manual and electronic procedures to handle denial and appeal management. But the industry’s continued reliance on manual procedures is beginning to have a negative effect.

How providers are transforming their approach to denial + appeal management

Studies have found that it costs about $118 in reworking fees to appeal a denied claim. These costs are exacerbated by the industry’s overall reliance on manual processes—a systemic issue many recognize yet fail to capitalize on. Indeed, while many providers see the promise automation can deliver on, they still face a number of considerations before pushing forward with implementing an automated solution.

And automation is a hot topic for providers for a very good reason—studies have demonstrated the US healthcare system could save as much as $16.3B by automating old or outdated processes. When it comes to denial and appeal management, the benefits are far-reaching, from improvements to productivity and a reduced strain on resources to huge boosts to claim accuracy and revenue recovery.

What to look for in a denial + appeal management solution

Leading-class solutions offer a wide selection of tools to provide a comprehensive approach to denial and appeal management, using customized, exception-based workflows to streamline the entire process and overturn a sizable increase in denials.

The appeal toolset a solution offers should make it easier to coordinate and use the info and data necessary to automatically process appeals and recover cash that would otherwise create productivity issues or unnecessary fees.

The solution’s ability to prioritize appeals based on cash value automatically lets staff concentrate on tasks that actually demand their attention, supporting them with additional tools like automatically generated payer-specific appeal forms and robust analytics capabilities that allow you to track and measure progress and problem areas.

Keeping disruptions at a minimum is key when considering your solution as well, so consider its ability to work efficiently with your existing systems and look for a partner that can demonstrate a strong history of seamless integrations.

Wrapping it up: why denial + appeal management solutions matters

A recent Waystar survey found 76% of providers categorized denials as their biggest RCM challenge. And the wider picture of healthcare reflects an industry struggling to solve a long-standing problem with manual processes and few answers.

Implementing an automated denial and appeal management solution is quickly becoming the optimal path forward for most providers, even if many have apprehensions about committing to the switch. But as new innovations cut down on the resources and time needed to implement the tech, the time is quickly approaching where the switch will be easier, and more vital, than ever before.

Click here to find out how Waystar can help fully automate the process and help you recover more revenue while reducing the burden on staff.

Heading to AMBA in October?  Visit Waystar and EZClaim while you’re there!  Stay tuned for more event details.


ABOUT EZCLAIM:
As a medical billing expert, EZClaim can help the medical practice improve its revenues since it is a medical billing and scheduling software company. EZClaim provides a best-in-class product, with correspondingly exceptional service and support. Combined, EZClaim helps improve medical billing revenues. To learn more, visit EZClaim’s website, email them, or call them today at 877.650.0904.

[ Contribution from the marketing team at Waystar ]

Smartphone Apps and Best Practice to Reduce Risk

Smartphone Apps and Best Practice to Reduce Risk

There are many benefits to smartphones in the healthcare industry, however, there is also huge potential for HIPAA violations of patient privacy to be violated. It’s important to know what risk is associated with smartphones and other mobile devices.

CISA, or Cybersecurity and Infrastructure Security Agency, says “Mobile apps may gather information from your mobile device for legitimate purposes, but these tools may also put your privacy at risk.”

So, what are the risks associated with mobile device applications?

Apps are a convenient tool to access the news, get directions, or pick up rideshare, but these tools may also put your privacy at risk.

CISA says, when you download an app, it may ask for permission to access personal information—such as email contacts, calendar inputs, call logs, and location data—from your device. CISA goes on to say, “You should be aware that app developers will have access to this information and may share it with third parties, such as companies who develop targeted ads based on your location and interests.”

How can you avoid malicious apps and limit the information apps collect about you?

First, it’s helpful to reiterate that employee devices are for work purposes only. Therefore, applications on your workplace devices, including mobile devices must be approved by your Supervisor and must follow device guidelines set in place by your organization.

Employees must refrain from downloading, installing, and using apps such as social media platforms. Therefore, employees should refrain from posting, commenting, or sharing patient information on social media including patient names, photos, and descriptors that would identify the patient.

What steps can you take to secure data on your mobile devices?

  1. When using a public or unsecured wireless connection, avoid using apps and websites that require personal information and turn off Bluetooth.
  2. Avoid connecting your smartphone to any computer or charging station that you do not control. Charging stations are often found at transportation terminals and are not secure! Connecting a device to a computer using a USB cable can allow software running on that computer to interact with the phone.
  3. Do not leave your device unattended in public or in easily accessible areas.
  4. Ensure your device requires a password or biometric identifier to access it, so if is stolen, thieves will have limited access to its data.

If your device is stolen or misplaced, first, contact your IT administrator, supervisor, and/or designated HIPAA Security Officer immediately and notify them of the situation for immediate next steps. In general, it’s advised to, follow your organization’s Incident Response Policy immediately.

At Live Compliance, we make checking off your compliance requirements extremely simple.

    • Contact-free, accurate Security Risk Assessments are conducted remotely. All devices are thoroughly analyzed regardless of location. Conducting an accurate and thorough Security Risk Assessment is not only required but is a useful tool to expose potential vulnerabilities, including those such as Password Protection.
    • Policies and Procedures are curated to fit your organization ensuring employees are updated on all Workstation Use and Security Safeguards in the office, or out. Update in real-time.
    • Electronic, prepared document sending and signing to employees and business associates.

Call us at (980) 999-1585 or visit www.LiveCompliance.com.


ABOUT EZCLAIM:
As a medical billing expert, EZClaim can help the medical practice improve its revenues since it is a medical billing and scheduling software company. EZClaim provides a best-in-class product, with correspondingly exceptional service and support. Combined, EZClaim helps improve medical billing revenues. To learn more, visit EZClaim’s website, email them, or call them today at 877.650.0904.

[ Contribution from the marketing team at Live Compliance ]

4 Steps to Designing a Superior Patient Experience

4 Steps to Designing a Superior Patient Experience

Designing a Superior Patient Experience

We live in a world of increasingly lofty consumer expectations—one where 44% of U.S. consumers will switch to a competitor following a poor customer service experience.

The medical industry is no exception to this trend.

In a study by PatientPop, 58 percent of Gen Z, Millennials, and Gen Xers, as well as 63 percent of individuals 55 and older, said that responsiveness to follow-up questions via email or phone outside of the appointment is critical or very important to overall satisfaction.

Patients want more than just excellent care from their healthcare providers. They expect easy access to medical records, convenient online scheduling and appointment reminders, prompt responsiveness, and painless ways to contact your office—24/7/365. And they’re also seeking compassionate and knowledgeable representatives who are willing to provide caring and accurate resolutions to their issues.

As a medical provider, you should not only focus on bringing in new patients but also continually strive to improve patient retention. Growth in customer retention rates by 5 percent can increase profitability anywhere from 25 to 95 percent, after all.

So how do you design an experience that increases patient satisfaction and retention? Let’s dive in.

1: Make Prompt Call Answering & Convenient Appointment Scheduling A Priority

As we mention above, patients want—and nowadays expect—your office to answer quickly as well as provide effective and swift resolutions to their health matters. But in a busy office, the staff is often focused on dealing with patients. Even front desk and administrative teams can become inundated with in-office tasks at a busy practice, leaving calls, messages, and emails unanswered.

A superior patient experience starts with prompt call answering and convenient appointment scheduling—a service that’s available to your patients whenever they need you, including weekends and holidays, and answers every call addresses delicate patient concerns with empathy, and schedules appointments quickly. If your staff is struggling to keep up with demand, consider outsourcing your phone answering and appointment scheduling. Not only will this improve patient satisfaction, but it also brings a sense of work-life balance to internal staff and allows you and your team to focus on what you do best; caring for patients.

2: Streamline and Perfect Your Patient Intake Process

The patient intake process is tedious, but it’s incredibly important to your operations, and speed and accuracy are vital. Streamlining and perfecting patient intake starts with leveraging the right software—one that makes it easy for patients to fill in their information and access their records, and provides all of the valuable data your practice needs to operate in an easy-to-navigate platform. For starters, your intake software should:

  • Be encrypted for data transfer through the internet and HIPAA compliant
  • Be intuitive and user-friendly
  • Not require special software or hardware downloads or installation for the user
  • Be portable into back-end systems

Your intake process should also be integrated with your electronic health records (EHR) software, and information should be updated and available in real-time for a smooth experience—for patients, admin staff, and providers—so that everyone is up-to-speed. Both technology and your process should remove redundancies from your workflow and streamline the intake experience.

3: Provide HIPAA-Compliant Live Chat & Text For Swift and Convenient Communication

Another great way to improve patient experience is via live chat and text, through which you and your staff can communicate with patients wherever they are, send appointment reminders, have two-way private and secure conversations, multitask as needed and be available when emergencies happen.

HIPAA-compliant chat and text messaging lets you communicate efficiently and accurately with patients and simultaneously safeguards electronically protected health information (PHI) while taking full advantage of the speed and flexibility of today’s communication technology.

Some of the many benefits of secure live chat and text in the healthcare realm include:

  • Reduced response times, including in the off-hours and on weekends or holidays
  • Ability to provide immediate recommendations for care and preliminary diagnoses
  • Ability to send follow-ups, like reminding patients to take medications, which creates better relationships between you and your patients
  • Secure PHI storage that acts as a record of past conversations, symptoms, or complaints to improve future care, diagnosis, and treatment plans

4: Leverage Technology and Software Integrations For Smarter Decision-Making

Technology and software integrations have transformed healthcare and are vital in any medical practice. Why? Because when you streamline your office functions and workflows, you improve all aspects of patient care and experience.

First, your office should be using an EHR (electronic health record) system. This system automates access to client information, helping to improve workflows and reduce incidences of errors by improving the accuracy and clarity of medical records. It should include all the key clinical data relevant to each patient’s care, including:

  • Demographics
  • Progress notes
  • Problems
  • Medications
  • Vital signs
  • Past medical history
  • Immunizations
  • Laboratory data
  • Radiology reports

Communication data collected throughout your patients’ experience with your office—such as phone conversations, appointment scheduling, and reminders, and live chat and text transcripts—should also be sent to and recorded in your EHR system.

Finally, the right software can help you make better patient and business decisions. For instance, maybe you want to know the percentage of patient calls versus the percentage of calls from hospitals that come into your office. Or, maybe you want to know which hospitals call you the most or you want to know the main reasons patients call so you can use that information to improve patient care and education.

How The Highest-Performing Medical Practices Prioritize Patient Experience

Medical practices that provide a superior service experience are available to their patients 24/7, have a streamlined and accurate intake process, are tech-forward, and have omnichannel communication options that empower patients to reach out any time and from anywhere. But most medical practices don’t do it all on their own. The highest-performing medical providers leverage an outside service provider like Nexa to improve client satisfaction, increase retention and grow their revenue. Learn more about how Nexa can help your medical practice level up by visiting nexa.com/medical.


ABOUT EZCLAIM:
As a medical billing expert, EZClaim can help the medical practice improve its revenues since it is a medical billing and scheduling software company. EZClaim provides a best-in-class product, with correspondingly exceptional service and support. Combined, EZClaim helps improve medical billing revenues. To learn more, visit EZClaim’s website, email them, or call them today at 877.650.0904.

[ Contribution from the marketing team at Nexa ]

Healthcare Loses Billions Due to Over-Reliance on Manual Tasks

Healthcare Loses Billions Due to Over-Reliance on Manual Tasks

We already know the trend toward automation in healthcare continues to grow each year. As technology continuously improves and the financial bar to entry lowers, the opportunities for healthcare providers and health plans to enhance operational processes grow as well. But even with the radical progress and the easier-to-use-than-ever healthcare operations software, many organizations fail to implement the solutions. It may be a lack of organizational enthusiasm or a simple need for more skilled internal technological expertise.

And while this is likely common knowledge at your organization, the amount of money wasted each year – driven by the absence of process automation – may not. Billions of dollars that could otherwise be spent on improving patient care and satisfaction, on building and rolling out new service lines, and generally improving healthcare operations are wasted every year. Billions.

The most recent CAQH Index reports $372 billion is spent yearly on administrative tasks throughout the US healthcare system. Of that amount, $39 billion of those administrative transactions are specifically tracked by the CAQH Index. “Of the $39 billion, the industry can save $16.3 billion, or 42 percent of existing annual spend, by transitioning to fully electronic transactions,” according to CAQH.

$16 billion in savings.

The current opportunity for savings driven by automated, electronic transactions within the healthcare industry is tremendous. That’s not to say the healthcare industry is doing nothing. CAQH found that healthcare organizations already save $122 billion annually thanks to process automation.

Even with the apparent success of automation, however, CAQH found the utilization, adoption, and growth of fully-automated processes year-over-year was stagnant or modest at best:

      • Eligibility and benefit verification remained steady at 84%
      • Prior authorizations increased to 21% from 13%
      • Claim status inquiry grew slightly to 72% from 70%
      • Claim payment automation increased marginally to 71% to 70%

With the small and slow shift to the use of automated transaction processes in the healthcare industry, there’s a decided advantage–in time and money–to not automating many, if not all, backend operations. Doing so allows staff to focus on strategic initiatives, like building out new programs or service lines, rather than plodding through everyday tasks better tackled through repeatable processes supported by technology.

“The industry continues to make progress towards a more automated administrative workflow as transaction volume increases, new business needs and technology emerge, and health insurance benefit and payment models evolve,” CAQH explains in the report. Nevertheless, as mentioned earlier, the “progress” remains slow, like a river choked with debris.

Ironically, even as automated solutions become more abundant and easier to use, CAQH reports healthcare providers to perform more manual tasks today than in the past. With today’s technology-rich environment, there’s little reason for healthcare providers to input any type of care-related documentation by hand. That time can and should be better spent improving the healthcare experience for patients and their families.

It’s far past time to clear the detritus from the river. With the advantage of today’s technology, it’s easier to make the change when each of us plays a part in the cleanup.

Contact a TriZetto Provider Solutions representative today to learn more about automation-enabled technologies that can help drive efficiencies and increase revenue.


ABOUT EZCLAIM:
As a medical billing expert, EZClaim can help the medical practice improve its revenues since it is a medical billing and scheduling software company. EZClaim provides a best-in-class product, with correspondingly exceptional service and support. Combined, EZClaim helps improve medical billing revenues. To learn more, visit EZClaim’s website, email them, or call them today at 877.650.0904.

[ Contribution from the marketing team at TriZetto ]