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.

EZClaim Gives You The Onboarding Tools To Succeed

EZClaim Gives You The Onboarding Tools To Succeed

Are you worried that training your staff in a new medical billing system will be too overwhelming? No problem. Here at EZClaim, our focus is on our customers and providing the best support possible. We understand that every customer is unique with a different set of needs and we are here to help you. The medical billing industry is constantly changing and giving you the onboarding tools you need to achieve your practice’s goals is our number one objective. 

Here are three key points that differentiate EZClaim from our competitors. 

Hands-on and Personal

Once you sign up with EZClaim you are assigned an onboarding coach. The next step in the process is a discovery call that allows your coach to get to know you and your business better. This will allow your coach to create a well-defined onboarding program tailored to your individual business’s needs and learning style.

Customer Service Focused

Our onboarding process delivers “white glove support” by treating our customers as an extended part of the EZClaim family. Keeping our customer’s needs in mind, we continually add features that are aimed to make our customer’s lives easier. 

Multiple Learning Resources Available

Here at EZClaim, we understand that not everyone learns the same way, so we offer multiple learning resources to facilitate your training process. 

With multiple training tools and resources at your disposal, we feel confident that your staff will acclimate to our software in a manner that feels comfortable to them. When it comes to medical billing, EZClaim has your back. 


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.

5 Medical Coding Challenges That Hurt Revenues

5 Medical Coding Challenges That Hurt Revenues

In the world of healthcare revenue cycle management, there are numerous scenarios that can put a stranglehold on your revenue if you’re not prepared. With the COVID-19 pandemic causing varying degrees of change in inpatient volumes and visits, and telemedicine coming further into play, physicians and their practices are having to quickly navigate the nuances of their financial well-being. A practice may be buttoned up from the time the patient walks in the door, but what happens after the visit will determine when the practice will get paid. This element of the revenue cycle starts with coding. Here are five medical coding challenges that will ruin your bottom line.

1. Coding to the Highest Specificity
Missing data on a claim relative to the patient’s diagnosis and procedure can easily cause a rise in denials once received by the payers, resulting in potentially thousands of dollars in write-offs. Medical coders are responsible for coding patients’ claims to the highest level of specificity, ensuring the appropriate CPT, ICD-10-CM, and HCPCS codes are applied based on the patient’s chart from the day’s services.

COVID-19 and telemedicine are frequently bringing on new codes and code sets, all with different variations and modifiers to make the matter even more complex. Medical coders spend a lot of time researching and learning new codes, but every year – and throughout the year – changes and updates are made. Payers don’t only want to know the diagnosis and the treatment; they want to know the cause as well. The Coronavirus Aid, Relief, and Economic Security Act passed in March of 2020 allows for an additional payment from Medicare of 20 percent for claim billed for inpatient COVID-19 patients, however, it was later indicated that a positive COVID-19 test must be stored in the patient’s medical records in order to be eligible for this payment. Being able to stay on top of codes specific to the patient’s diagnosis at treatment is more difficult than ever before.

2. Upcoding
While code specificity is important, so too is ensuring the claims do not contain codes for exaggerated procedures, or even procedures that were never performed, resulting in reimbursement for these false procedures. This seems logical enough, but upcoding can easily occur as a result of human error, misinterpretation of a physician’s notes, or lack of understanding of how to appropriately assign the thousands of ICD-10-CM codes in existence. To add to the pressure, the Office of the Inspector General issued a plan with objectives to prevent fraud and scams, and remedy misspending of COVID-19 response and recovery funds.

Much like under-coding or not providing enough data on the patient’s visit can create issues, upcoding can be a major contributor to financial loss for a practice. Questionable claims can be denied and sent back for corrections and appeals, but upcoding can have more serious ramifications outside of paper-pushing between coders and payers.

Whether it’s making sure the codes are in accordance with the care provided, understanding the code sets that apply for each procedure, or comprehension of the medical record, refraining from upcoding will help ensure a sturdy and compliant revenue stream.

3. Missing or Incorrect Information
There’s a common theme to coding challenges, and that’s having the sufficient information necessary. This information typically is pulled from a patient’s chart or record of a visit, which is often completed by the attending physician. However, even when a claim is submitted, providing required information relative to the procedure to the payer is critical as well. Situations such as failure to report time-based treatments (such as anesthesia, pain management, or hydration treatments) or reporting a code without proper documentation can result in denials.

Furthermore, information in a patient’s electronic health record may also contain inaccurate information. Keystrokes and other human errors can cause these situations to flare up, and it takes a diligent, thoughtful coder to read between the lines and ensure claims have the appropriate information.

4. Timeliness of Coding
The Medical Group Management Association (MGMA) suggested in their 2018 Setting Practice Standards report that a Primary Care Physician should maintain a claim submission rate of 3.11 days after the date of service, but it is becoming increasingly difficult for practices to sustain anything close to this rate. Constant changes to code sets, an increased focus on submitting claims with sufficient and compliant information, and the requirement to code claims to the highest level of specificity, can easily delay the submission by days or weeks.

Nevertheless, delays in coding and submitting claims can cause major lags in payment and substantial loss in revenue. Insurance payers have statutes of limitations that require claims to be submitted anywhere from 120 to just 60 days after the date of service. Simply put – the more time spent coding the claim, the later it will be submitted, thus increasing the odds that the claim will be denied. Expert coders are aware of this and do everything in their power to get coded claims out the door.

5. Staffing Shortages
However, finding experts well versed in coding claims quickly, accurately and in compliance with the False Claims Act is not always an easy task. As you can imagine, the increasing need for care within the senior population is causing a rise in claim volumes, and trying to find a team of coders who know the ins and outs of complex ICD-10-CM coding can easily cause a bottleneck in the revenue cycle. Health executives expressed their struggles to find talent back in 2015, and some forecasts expect a decline in commercial payments by 2024 to further hamper a C-suite’s ability to manage labor costs. The ramifications of incorrect coding are still a key topic of discussion to this day.

The time has come for practices to begin looking outside of their organization for coding support. How is your practice planning to tackle the coding conundrum? When choosing a partner for your medical coding needs, you need to pick an expert to help your practice stay on target. TriZetto Provider Solutions, a Cognizant Company, has available highly-trained, AAPC & AHIMA certified coders with the experience of getting the details right the first time and understand the importance of coding to the medical practice.

For more information about TriZetto Provider Solutions, a partner of EZClaim, visit their website, contact them, or give them a call at 800.969.3666.


ABOUT EZCLAIM:
EZClaim is a medical billing and scheduling software company that provides a best-in-class product, with correspondingly exceptional service and support. Combined, they help improve medical billing revenues. To learn more, visit EZClaim’s website, e-mail them, or call them today at 877.650.0904.

[ Contribution of the TriZetto Provider Solutions Editorial Team ]

Doing a HIPAA Security Risk Assessment

Doing a HIPAA Security Risk Assessment

Your organization’s annual HIPAA Security Risk Assessment and Analysis are only one element of the compliance process, and whether you’re a Business Associate or Covered Entity, your organization must also “implement security updates as necessary and correct identified security deficiencies”. In other words, you must act via a Corrective Action Plan (CAP) following the required risk assessment process.

Here are a few common Corrective Action Plan steps:

  • Implement technical policies and procedures to allow access only to those persons or software programs that have been granted access rights to information systems maintained.
  • Implement procedures to regularly review records of information system activity, such as audit logs, access reports, and security incident tracking reports.
  • Conduct accurate and thorough assessments of the potential risks and vulnerabilities to the confidentiality, integrity, and availability of ePHI.
  • Develop a complete inventory of all its categories of electronic equipmentdata systems, and applications that contain or store ePHI, which will then be incorporated into its Risk Analysis, and must complete a Risk Management plan.

 

What happens if I fail to complete my Security Risk Assessment?

Failing to complete your annual Risk Assessment oftentimes means the organization will be required to complete a “robust” Corrective Action Plan (CAP) and often with at least two years of monitoring activity.

Have you ever doubted whether a small billing company or independent physician practice actually ever face penalties?

Well, keep in mind, a Business Associate is a ‘person’ or ‘entity’. This means that there is no billing company too small to have to comply with the Federal HIPAA regulations. Again, if you have not completed an accurate and thorough security risk assessment prior to that, you could also be penalized under ‘willful neglect’. This category alone is $50,000 per violation!

It is important for you to understand that every complaint or potential breach must be investigated by HHS/OCR. If you, a billing company, or another vendor suspects a breach, you must inform the covered entity (your client) and have a breach risk assessment completed to determine key factors and take action.

 

An EZClaim partner, Live Compliance, will help you to make checking off your compliance requirements extremely simple. They provide:

  • Completely online, our role-based courses make training easy for remote or in-office employees.
  • 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.
  • Complete set of HIPAA Policies and procedures built directly into your portal. Includes actionability, change management documentation, and Incident Response Policy to assist with your Corrective Action Planning. Easily share policies with staff with one click.
  • Built directly into your portal, easily monitor where your workforce may be vulnerable with our Dark Web Breach Searches. Easily expose breach sources with ongoing searching of active employee email or domain ensuring continued awareness of potential breach exposure. Weekly automatic email notifications if new breaches are discovered.
  • Short, informative, privacy awareness videos covering technical, administrative, and physical safeguards with topics such as ransomware, phishing, the Dark Web, password protection, and more. All delivered monthly with no logins required, they empower your workforce to make conscious decisions when it comes to your organization’s privacy and security.

 

So, don’t risk your company’s future, especially when Live Compliance is offering a FREE Organization Assessment to help determine your company’s status. For more information, visit their website, e-mail them, or give them a call at 980.999.1585.


ABOUT EZCLAIM:
EZClaim is a medical billing and scheduling software company that provides a best-in-class product, with correspondingly exceptional service and support. Combined, they help improve medical billing revenues. To learn more, visit EZClaim’s website, e-mail them, or call them today at 877.650.0904.

[ Contribution by Jim Johnson with Live Compliance ]

Insights from a Medical Billing Expert

Insights from a Medical Billing Expert

In this interview with a medical billing expert and co-owner of Elite Billing Resolutions, Vicky Greenwood, we talk about dealing with the challenges in owning a billing company, some important skills that every medical biller needs, and the value of choosing the right medical billing software. In our time speaking with Vicky, we focused on topics that will aid, contribute, and help grow the skills of the medical billing community. We at EZClaim believe in highlighting the best practices in the industry and sharing those with the larger community. We encourage you to consider these insights, and then let us know what topics you would like to learn more about.

 

EZCLAIM: When did you get into medical billing?
VICKY: “I started in 1994, and at the time we were working on a dinosaur of a system called, “Signature.” We would have to wait overnight to process the entire day’s work. Then we would return in the morning to see if there were any errors in the batch or denials in the claims, which meant being accurate in entering information was essential. Outside of that, we kept all our paperwork in filing cabinets, and they needed to be sorted and organized by date. If a date was off in the filing system it could take the better part of a day to find a patient’s claim. The difference between then and now is night and day. I am definitely thankful for technology.”

EZCLAIM: Why did you start Elite Medical Billing?
VICKY: “We started Elite Medical Billing because we wanted to be able to directly impact our medical practices with the services we provided, and we wanted the freedom to enjoy doing it for our clients. I also knew that I was experienced in the field, was competent at my job, and enjoyed doing what needed to be done to get practices paid. Once I honed those skills and knew we could do it. We hired a lawyer and an accountant, then formed our company.” 

EZCLAIM: What are challenges in starting a company?
VICKY: “First, you have to understand the value of time management and delegation. You don’t want to bite off more than you can chew. It is good to know when you need to ask for help. Next, you want to find good staff. I look for people who have the right attitude about the job first and have the characteristics to be proactive and work hard. Then, I look for experience in the field, learning if they had hands-on experience with claims, denials, and coordination of benefits is part of that. At the end of the day, my staff are my [company], and fortunately, most of my staff have been with me from the beginning.”

EZCLAIM: Why did you choose EZClaim?
VICKY: “We had a client who needed software and, being a smaller company, we needed cost-effective software with strong tech support. When we searched on Google for “easy to use medical billing software,” we found EZClaim. We were won over by the first phone call. Since then, we have been reminded of how great a decision that we made. The simplicity by which you can enter the information, process new patients, and ‘claim them’ within minutes is invaluable. That combined with the great customer service—that answers our questions most often on the first call with detailed answers—and video tutorial support is why we will continue to use and promote the software.”

EZCLAIM: Are you a member of AMBA and MMBA?
VICKY: “We joined the MMBA and AMBA in 2016 to help us certify our billing company. That process and the training, testing, and materials were amazing pieces of helping us get established and grow. In addition, the expos, webinars, and online support offer an abundance of information. Of course, the annual expos are both informative and a great work trip for team building and fun. We make it annually to the MMBA, but our next big goal is to go to the AMBA in Las Vegas!”

EZCLAIM: Have some final thoughts to offer fellow medical billers and business owners?
VICKY: “As a medical biller and owner, you have to be willing to talk with physicians. You need to show them the vouchers and documentation of your work. And it is important to communicate how they bill and how they can be sure to properly classify to get paid. You need to review what they have done in the past and how they can improve in the future by training staff.”

“You can also add value by making them the good guy and yourself the bad guy when dealing with patients and getting paid. We allow patients to call us directly, we answer the questions, and tell them how much they have to pay—then we forward the call to the office. Remember, at the end of the day, you have to show them the money. They work hard and they deserve to get paid.”


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.

HIPAA Items To Focus On NOW!

HIPAA Items To Focus On NOW!

There are a few HIPAA items to focus on RIGHT NOWbefore the end of 2020!

The U.S. Department of Health and Human Services (HHS) has designated the “Health Insurance Portability and Accountability Act” (HIPAA) as the national standard for protecting the privacy and security of health information (in 1996). This led to the Health Information Technology for Economic and Clinical Health Act (HITECH), which has a provision in it for audits, and the HHS Office for Civil Rights is responsible for carrying out HIPAA audits, and responding to complaints and breaches. Ignoring them is not an option!

A Risk Assessment IS NOT Enough
A risk assessment is only one element of the compliance process. You must also “implement security updates as necessary and correct identified security deficiencies.” In other words, you must act via a Corrective Action Plan (CAP) and follow the required risk assessment process.

Dark Web
It is no secret that the “Dark Web” is a scary place to lose your information. So, what if it did happen and affected your entire company? Identity thieves get anywhere from $1-$1,000 for medical records, for each instance! So, how can you protect yourself and/or your organization?

Well, data breaches are becoming more common—sometimes which are out of your control—so carefully monitoring where you store and enter your passwords can be extremely beneficial to help minimize the risk of a hack and keeping personal or patient information protected.

One solution for this is the automatic Dark Web monitoring built into the portal of one of EZClaim’s partners, Live Compliance. Their solution helps keep an ‘eye’ on employees whose information was involved in a breach, and suggests next steps to take where the breach was found. Then, it allows your to conduct an accurate and thorough Security Risk Assessment. This is not only required, but is a useful tool to expose potential vulnerabilities, including those that involve password protection.

So, what can I do to ensure this doesn’t happen to me or my organization? Well, Live Compliance makes checking off your compliance requirements extremely simple by providing:

● Reliable and effective compliance
● Completely online, our role-based courses make training easy for remote or in-office employees
● Contact-free, accurate Security Risk Assessments are conducted remotely. All devices are thoroughly analyzed regardless of location.
● 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. It is updated in real time.
● An electronic document is sent to employees and business associates

So, don’t risk your company’s future, especially when Live Compliance offers a FREE Organization Assessment to help determine your company’s status.

For additional details, call them at 980.999.1585, e-mail them, or visit their website at LiveCompliance.com

[ Article provided by Jim Johnson of Live Compliance ].


ABOUT EZCLAIM:
EZClaim is a medical billing and scheduling software company that provides a best-in-class product, with correspondingly exceptional service and support. Combined, they help improve medical billing revenues. To learn more, visit EZClaim’s website, e-mail them, or call a representative today at 877.650.0904.