According to a previous survey, the top three reasons for an increase in claims denials are:

1. Insufficient data analytics

2. Lack of automation in the claims/denials process

3. Lack of thorough training

What many practices don’t realize is that with a few tweaks, they can drastically reduce claim rejections and truly optimize their revenue. Let’s walk through some steps your organization can take to minimize its number of rejected claims.

Automate Insurance Ineligibility

Insurance eligibility rejections occur when the patient is ineligible for coverage for a particular treatment under their current insurance. If this is the case, you’ll likely need to reach out to the patient to either get new insurance information or directly bill the patient. We suggest that practices always take the time to verify patient eligibility before rendering services and ultimately submitting a claim. Not only does this make life easier for billers, but it also improves the patient experience by ensuring they are not met with any unexpected charges.

However, the process of verifying coverage does not need to be as manual or cumbersome as calling the patient’s insurance provider. Cloud-based medical billing software that supports real-time eligibility verification can simply and effectively eliminate rejections that may occur due to a lack of eligibility. Real-time eligibility verification helps confirm patients’ insurance coverage and benefits with just a push of a button, ensuring confirmation before services are rendered, and greatly reducing downstream claim rejections. See how EZClaim does it.

Eliminate Mistakes With Automation, Claim Scrubbing, and Training

We are all human, and mistakes are bound to happen when doing manual data entry. These types of mistakes actually do cause quite a few claim rejections. Even the best medical biller will make mistakes from time to time, as a strong denial rate for a provider submitting claims sits at 5% or less.

Luckily, there are several steps providers can take to mitigate any coding mistakes or keying errors that can cause a claim to get rejected, and put your business in the best position possible to achieve this sought-after sub-5% rejection rate.

1. Claim Scrubbing: Checks claims for coding and keying errors and discrepancies before submission, allowing providers to address any issues proactively – reducing the risk of rejections.

Claim scrubbing may not tell you every possible reason your claim was denied, but it will catch simple coding and keying mistakes that are products of human error that your billers may miss.

2. Automation: Automating aspects of the claim submission process can greatly reduce the manual labor involved in the billing process while simultaneously improving accuracy by eliminating human error. The benefits of automation can be immense, as you can often process more claims, more accurately, in less time.

3. Staff Training: Lastly, be sure to spend the time and resources necessary to train your staff on how to properly use your billing software. A well-trained team that is familiar with its software’s capabilities is less likely to make mistakes, ensuring that claims are submitted accurately and have a higher chance of acceptance. Additionally, make sure your software vendor has strong support and onboarding teams that can upskill your team and provide any assistance when needed.

Eliminate Incorrect Patient Data by Integrating with your EHR

Whether it’s the misspelling of a name or the wrong ID number, incorrect patient data is a very common reason for claim rejections. Incorrect patient data is often a product of human error, and can be effectively eliminated by taking advantage of automation and integrations.

To avoid claim rejections for incorrect patient data, look to Integrate your cloud-based medical billing software with your electronic health records system. This integration enhances data accuracy, reduces duplicate entries, and streamlines the billing process, minimizing the risk of rejection. It also serves as an additional hedge against human error in the billing process by sharing key data and information that would otherwise have to be moved over manually.

Utilizing Reports to Become Proactive Rather than Reactive

If you’re experiencing repeated rejections for the same reason over and over – this could be a systemic issue. Some common systemic issues include:

• Claims not being filed on time
• Incorrect provider information
• Incorrect demographic information
• Wrong CPT codes

Cloud-based billing software with great reporting and dashboard capabilities is an absolute must to guarantee your practice can properly track its billing performance.

Create reports to monitor and analyze claim submission and acceptance rates. Your billing software should provide detailed reports that help you identify trends, address recurring issues, and continuously improve your billing processes. Here is a list of reports we recommend:

• Aging and Denial Reports
• Payment Posting Reports
• Adjustments Reports
• Provider Productivity Reports
• Patient Balance Reports

Minimizing claim rejections is a critical part of running a successful, efficient practice or billing company. Without robust cloud-based medical billing software in your corner, your practice may struggle to submit claims and realize revenue efficiently.

Are you ready to see what a cloud-based medical billing software can do for you?

Try EZClaim free for 30 days!

Special thanks to the MMBA East Chapter for putting together this analysis of the proposed 3.36% reduction in the 2024 Medicare physician payment schedule. Visit their site here to access more valuable news and resources!

What’s the news:

The AMA is emphatically stating that the proposed 3.36% reduction in the 2024 Medicare physician payment schedule is ill-advised, posing a threat to the accessibility of high-quality physician care for the 50 million plus elderly individuals enrolled in Medicare. The AMA President emphasized that with escalating costs associated with medical practice; another year of Medicare payment cuts not only puts patient access in jeopardy but also endangers the viability of physician practices that communities rely upon. These cuts are deemed both unsustainable and morally unacceptable.

In a comprehensive 120-page comment letter (available in PDF format) submitted to the Centers for Medicare & Medicaid Services (CMS) regarding the Medicare physician payment schedule, the AMA pointed out that physicians are confronted with a threefold challenge as impending pay reductions loom on various fronts. The proposed 3.36% decrease can be attributed to two factors. Firstly, a 1.25% reduction arises from a temporary legislative update, and secondly, there is a negative budget-neutrality adjustment associated with the introduction of a CMS-developed office visit add-on code.

Why it’s important:

Even prior to the onset of rampant inflation and the epidemic, physicians were grappling with an unsustainable trajectory. When adjusted for inflation, Medicare physician payment has effectively declined by 26% from 2001 to 2023, and this is before factoring in additional inflation and recent cuts. Moreover, in 2023, physicians experienced a 2% reduction in pay. Unlike other providers, physicians lack an automatic increase to offset inflation.

Furthermore, the AMA has received reports indicating that a greater number of physicians and group practices may face penalties under the Medicare Merit-based Incentive Payment System (MIPS) in 2024, based on the recently released feedback for the 2022 performance period. These penalties could lead to reductions in Medicare payment of up to 9%. Notably, MIPS were largely on hold during the 2020 and 2021 performance periods due to the COVID-19 public health emergency. The AMA expresses significant concerns that this could unfairly penalize physician practices, particularly smaller, independent, and rural practices, due to a lack of awareness about the expiration of automatic COVID-19 flexibilities.

Recently, CMS released performance feedback and final scores for MIPS for the 2022 performance year. These scores will determine whether a physician receives a positive, neutral, or negative payment adjustment on Medicare services provided in 2024. Physicians can access this information on the Quality Payment Program website using their HCQIS Access Role and Profile (HARP) credentials. For those who believe there was an error in the calculation of their MIPS final score, CMS offers a targeted review process, with requests to be submitted by Oct. 9.

Furthermore, reductions in physician payment rates will significantly hinder access to care for Medicare patients. The Medicare Trustees have explicitly cautioned that access to physicians for Medicare patients could be seriously compromised in the long term if payment rates do not adjust. Delays in care, particularly among underserved populations with limited access to healthcare, are linked to poorer health outcomes and inequitable healthcare delivery.

AMA President emphasizes, “Policymakers have a responsibility to rectify the Medicare system and prevent these consequences. As physicians, we owe our patients our utmost efforts to ensure that healthcare access is not curtailed. Together with our allies in organized medicine, we are committed to ensuring that both CMS and Congress hear this perspective.”

Momentum is growing for reform. In March, the Medicare Payment Advisory Commission, for the first time, recommended a physician payment update tied to the Medicare Economic Index—the government’s gauge of inflation in medical practice costs. Additionally, in April, a bipartisan group of House members introduced a bill advocating for annual inflation updates to the Medicare pay schedule based on the Medicare Economic Index.

In July, a bipartisan group of 101 House members signed a letter urging urgent action to address challenges in the healthcare system, which has been exacerbated by the pandemic and physician burnout. The letter highlights the problematic Medicare payment system, noting that physician practices are struggling to remain open amidst surging inflation and escalating costs.

The American Medical Association (AMA) has emphasized the urgency of reforming Medicare physician payment as a top advocacy and legislative priority. To provide physician advocates and policymakers with a comprehensive understanding of the intricate landscape surrounding Medicare physician payment reform, the AMA’s Medicare Basics series offers a detailed and accessible overview of crucial components within the payment system, highlighting the need for reform.
In its extensive comment letter, the AMA addressed various areas, including:

• Valuation of specific codes.
• Practice-expense data.
• Evaluation-and-management (E/M) add-on code.
• Appropriate Use Criteria for Advanced Diagnostic Imaging Program.
• Supervision of residents in teaching settings.
• Telehealth and remote monitoring.
• Medicare Shared Savings Program accountable care organizations.
• Diabetes screening.
• Billing for split or shared visits.

For more information on the significance of reforming Medicare payment and to stay updated on other advocacy priorities actively pursued by the AMA, visit AMA Advocacy in Action.

Access to high-quality revenue cycle reports can make all the difference for practices and billing companies looking to optimize their processes. Without a proper understanding of performance, how can you possibly improve and grow your business? Today, we take a look at five critical revenue cycle reports every business doing billing should use to drive informed decision-making.

Aging and or Denial Reports

What are Aging and Denial Reports?

Aging reports provide a breakdown of outstanding accounts receivable by the number of days a claim has been outstanding (e.g., 30 days, 60 days, 90 days, etc.). Your aging report should also include the status of your claims, including denial analysis, which enables you to understand the reason any of your claims have been denied by insurance companies. Think of your aging report as your “home base.” This report succinctly tells you where in the process your claims are, and what action (if any) you need to take next.

Why Aging and Denial Reports Matter:

These reports help identify overdue claims and allow the billing department to prioritize follow-up efforts for unpaid or underpaid claims. 

Once you have an understanding of why your claims are being denied, you can identify which steps to take to improve claim accuracy and reimbursement rates. Addressing the root causes of denials can significantly improve claim accuracy and reimbursement rates.

Payment Posting Reports

What are Payment Posting Reports?

These reports detail the payments received from insurance companies and patients. Payment posting reports provide insights into the accuracy of payments and identify discrepancies that may require correction, which helps reconcile payments with claims.

Why Payment Posting Reports Matter:

Accurate payment posting is essential for proper revenue recognition. Your payment posting report ensures your payment collection function is performing as it should, and your business is on the path to growth.

Adjustments Reports: 

What are Adjustment Reports?

Adjustment reports enable your business to track any changes or adjustments made to financial transactions or accounts. 

Why Adjustment Reports Matter?

Businesses use adjustment reports to track any changes made to charges using standard and customizable codes to help insure accuracy, transparency, compliance and accountability in financial reporting.

Provider Productivity Reports: 

What are Provider Productivity Reports?

These reports assess the performance of individual healthcare providers, such as physicians or nurse practitioners. Provider productivity reports often include metrics like the number of patient encounters, charges, collections, and productivity per provider. 

Why Provider Productivity Reports Matter:

Monitoring provider productivity can help identify areas for improvement and optimize revenue generation for your business. This report is particularly useful for practices, enabling them to measure their overall operational effectiveness and evaluate productivity in several critical areas.

Patient Balance Reports: 

What are Patient Balance Reports?

Patient balance reports enable you to dive deep into individual patient balances, isolating patient balances from insurance.

Why Patient Balance Reports Matter: 

Patient balance reports enable your business to maximize patient payment collection by highlighting patient balances and excluding insurance. Using this information, businesses can determine where their collection efforts are best focused.

Custom Reports are Critical! 

Remember, most reports generally include the same data, but present it through different lenses depending on what you are trying to analyze. Top-rated medical billing software offers customizable reports with different details and supporting information. You should be able to set custom criteria and sort by month, by week, or by individual.

While these five reports are typically considered essential for medical billing and revenue cycle management, the specific reports you need may vary based on your business’s size, specialty, 

and unique billing processes. If you are looking to get more out of your medical billing reporting, look no further than EZClaim. Our affordable, easy-to-use medical billing software enables your business to customize its revenue cycle reports to meet its particular needs, ensuring you have all the data you need to make informed decisions. We are your partner in medical billing success, from claims processing to compliance. Schedule a call today to learn more about EZClaim!

Rapid advancements in artificial intelligence (AI) and machine learning have ignited a profound debate within the healthcare industry: Will AI replace medical coders? This question is not just an academic curiosity, but a topic of increasing relevance as technology continues to transform the way medical data is managed and processed. Medical coders play a vital role in ensuring the accurate classification of healthcare procedures and diagnoses for billing, research, and patient care. However, AI-driven coding systems are making significant strides in automating these tasks, raising critical questions about the future of this profession and the potential benefits and challenges AI integration may bring to the healthcare ecosystem. Let’s take a more in-depth look at the abilities and limitations of AI, and assess its future impact.

Why Use AI in Medical Billing?

As we digest the question of “Will AI replace medical coders?” we need to start with why organizations would even look to use AI in place of their billers and coders.

The answer here is relatively simple: the potential for AI to process more claims, faster. Undeniably, AI can comb through data and spit back results faster than a human can, oftentimes without the manual errors that human touch comes with.

An organization called TECHealth released a fascinating analysis of what AI can accomplish in the medical billing world in which they found that AI was able to parse through more than 80% of their claims with either limited or zero human interaction.

If AI was able to completely handle the medical billing/coding process, practices and outsourced billers could potentially realize increased revenue, fewer claim denials, and a more frictionless claim submission process. Practice staff would also have much more time freed up to focus on patient experience and running the practice. The combination of AI and robust medical billing software would likely fuel tremendous efficiency for practices and billers alike

AI’s Limitations in the Billing/Coding Space

Although AI has the potential to make a meaningful impact in the medical billing world, it is not without its shortcomings.

This is especially evident in more complex realms like surgical billing. Medical coding requires a high degree of expertise and specialized knowledge in medical terminology, anatomy, and physiology, as well as a knowledge of the latest coding guidelines and regulations. Beyond this knowledge, interpretation is often necessary, which is where AI can run into trouble.

AI is excellent at parsing through data and handling simple claims, but there are serious doubts as to its ability to capture the full complexity of a patient’s condition and code appropriately for more complex claims.

Additionally, AI is only as good as the information that it is fed/has access to. Before it is implemented on a large scale, the AI used for billing and coding will need to be provided with extremely detailed, nuanced coding information to create an accurate, effective prediction model. This needs to be done by a human with extreme proficiency in billing and coding. Without the best information entering the system, the information that comes out will not be adequate, which creates a considerable risk for those involved in the medical billing process.

There is also the issue of compliance. Who would be responsible for overcoding in a situation where AI gets something wrong? Practices will likely want to have a human check over AI-processed information to prevent liability and insulate themselves from potential errors. There is the issue of HIPAA compliance as well. There needs to be more standardized regulations and protocols for the exchange of information and security for AI to be widely adopted in the medical billing space.

It is also possible that high start-up costs may limit the adoption of AI in the billing world. It is very risky for practices to invest heavily in AI without certainty that it will be efficient and accurate enough to justify the investment. AI will need to demonstrate its financial viability as a solution before being widely adopted.

What Will AI’s Impact Be?

Pending advancement in AI’s ability to interpret information, we see AI as having the potential to take over easier parts of the billing process, but not without human intervention. Whether it’s using AI to process a claim and have a human check it for accuracy, or vice versa, AI is very likely to become a common tool for improving the accuracy and efficiency of the medical billing process. Organizations likely do not want to risk AI making mistakes on a large scale, making human oversight necessary until full confidence in this technology is established. Expect AI to integrate with your medical billing software sooner rather than later.

So, will AI replace medical coders? The answer is no (for now). In the short term, we see AI assisting billers and coders and making their lives easier, not completely taking over the space and eliminating jobs. Of course, this has the potential to change as technology continues to develop.

_________

If you have questions about AI and the role it will play in the medical billing industry in the future, we’d love to speak with you. As leaders in the medical billing space, it is our mission to help businesses optimize their operations and get the most out of the billing process.

In the medical billing world, accurate and efficient billing processes not only ensure a steady revenue stream, but also foster trust between providers and patients. As healthcare regulations become increasingly complex and reimbursement models continue to evolve, the need for robust medical billing reporting has never been more critical.

However, despite the advancements in healthcare technology, many medical practices and billers find themselves grappling with subpar medical billing reporting that fails to meet their needs. These shortcomings can lead to revenue leakage, operational inefficiencies, and a loss of valuable insights for informed decision-making. In this blog, we dive into some of the reasons why your medical billing reporting may not be getting the job done.

1. Inaccurate or Incomplete data: One of the most significant issues in medical billing reporting is the presence of inaccurate or incomplete data. This can lead to incorrect claim submissions, denials, and payment delays, negatively impacting the revenue cycle. Your medical billing reporting should be trustworthy and reliable, in addition to being timely. The value of real-time reporting cannot be overstated. Delayed reporting can result in missed opportunities for addressing claim denials or underpayments promptly, leading to potential revenue loss. Your business should have no tolerance for inaccurate reporting.

2. Lack of Standardization: Medical billing involves various codes, regulations, and guidelines, such as CPT (Current Procedural Terminology) codes, ICD-10 codes, and payer-specific rules. The lack of standardization across different systems can lead to confusion and errors in reporting. The last thing your business needs is avoidable mistakes in its reporting. No standardization makes your business far more prone to these errors.

3. Lack of Customization: A major shortcoming of most medical billing software is the lack of an ability to personalize reports, and create them from scratch. Your business is unique, and you likely want to create unique reports and use data in different ways. Your software should not hold you back in this regard.

Customization is one of EZClaim’s strongest functionalities. Our robust medical billing software enables you to customize reports, create reports from scratch, and leverage tools like grid customization to create the exact report you need.

4. Failure to Track Claim Status: Many billing systems lack proper mechanisms to track the status of claims effectively. This can lead to a lack of visibility into the progress of claims and hinder the identification of potential issues. If your business is in the dark as to the status of its claims, it makes it incredibly difficult to project results and accurately forecast performance.

5. Limited Insights: Inadequate reporting tools and analytics can impede the ability to gain actionable insights from billing data. Bad data means bad insights. If your medical billing reporting is ineffective, you will not be able to use your data to draw actionable conclusions that will make your billing process more efficient. Without accurate insights into performance, it is incredibly difficult to improve your billing process.

6. Insufficient Integration: Integration between your EHR and billing software is critical for seamless data flow. Poor integration can lead to data discrepancies and duplicate entries. Ensure your billing system integrates with your EHR to ensure there isn’t any disconnect in your processes.

Is your business getting the most out of its medical billing reporting? If the answer is no, we’d love to speak with you! EZClaim is the solution of choice for practices and outsourced billers alike thanks to our easy-to-use interface and comprehensive billing features. Our mission is to make the medical billing process as simple as possible for your business. If you are interested in learning more, we encourage you to schedule a free consultation with our team!