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What to Look For in a Billing Company

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What to Look For in a Billing Company

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What to Look For in a Billing Company

  1. 1. Your Webinar will begin shortly What to look for in a Billing Company! Come visit us... www.curemd.com/uc14
  2. 2. Presenter Fred Melroy Director Billing Operations, CureMD
  3. 3. Good Billing Is Just Process Great Book is Check List Manifesto by Atul Gawande, MD. Good Billing is Like Good Surgery or Any Activity in Life that Requires Organization! Life and Billing is Complicated but Steps in an Organized Manner Make it Easy. Visit the Billing Office and take a look around or at the least check references. . . . .
  4. 4. Denial Management!!! Did billing have inaccurate coding? Was claim complete? Was there lack of supporting documentation? Was there an eligibility problem? One day turn around time for denials to be resubmitted. Denials logged and reviewed? Cure verifies payments for correctness using a product called “right remit” does your billing company have something similar? .......
  5. 5. The Cure Billing Process Insurance Verification Charge Entry Process Claim Submission Payment Posting Denial Management Payment verification, is your payment correct? Appeal and Collection Process. Reading and understanding reports. ........
  6. 6. The Simple Facts A billing company is just that and you are a medical practice. Reputable firms use professional management to collect all of your revenue. They hire professionally trained folks who concentrate on billing and collection (denial management). They have the latest reimbursement information from CMS and Commercial Insurance Companies. . . . .
  7. 7. More Simple Facts Operations are not interrupted by a staff person leaving as they have plenty of backup. Have the resources to hire quickly and get the right people including a CPC or two. Develop contacts at the various insurance companies. Get better priority on computer issues. Have effective relationships with EDI Carriers for data transmission and eligibility. . . . . .
  8. 8. The Dilemma EMR/EHR Patient Scheduling Claims Scrubbing Paper & Electronic Remittance Denied Claims Registration System Compliance System Claims Management Patient Demo Entry & Eligibility Verification Medical Necessity Edits Distributed environment lead towards inefficient, complex system results in increased operating cost and important of all LOST REVENUE
  9. 9. The Revenue Cycle: Critical Billing Tasks Payer Contracts Pre-visit Front desk Visit Post the Visit & Charge Entry Billing & Collection Reports & Analysis Payer Rejections Edits Patient Service and Satisfaction Compliance Provider Credentials Payer Requirement Covered Benefits Patient Appointment Registration Eligibility Pre-Auth Referrals Prior Balances Confirm Registration Copy Insurance Card Collect Payments Medical Records Documentation and Coding Charge Entry Select Payer Produce Claim/ Statements A/R Follow up Payments & Rejections Mail Claims/ Statements Cash Analysis & Reports Measure & Rewards Targets Contract Analysis
  10. 10. CureMD - Integrated All-in-One Solution Patient Scheduling Patient demo entry & Eligibility Verification Medical Necessity Edits Claims scrubbing CureMD EHR PM & RCM Paper & Electronic Remittance Denied Claims Registration & Scheduling Clean Claim & medical necessity Edits Denial Management
  11. 11. What makes us stand apart in billing? One system that ensures integrated clinical and improved communication for the complete revenue cycle management. All in one solution that works with your existing billing and financial system ensuring: HIPAA Compliance Efficiency improvement Maximum effectiveness Ensuring clean claims for denials prevention State of the art rejection and denial management Reports that make sense and Monitor activity 1. 2. 3. 4. 5. 6. . .
  12. 12. More income is lost in poor Revenue Cycle Management than you can achieve in rate increases
  13. 13. CureMD - Integrated All-in-One Solution Straight 60 % reductions in operational and administrative cost in comparison to in-house billing Staying up to date with financial health of your practice by having access to multiple financial reports (24/7) in comparison to manual in-house reporting Losing 2% of total Medicare revenue on e-prescribing and PQRS incentives Losing 17% of all claims denied for timely filing, caused by delays in the billing (Source AMA) Efficient Denial Management enables you to track denied claims and what is being or can be done to get them paid. (MGMA reports that 7%-14% of all claims are denied because of easily correctable in–office errors) . . . . .
  14. 14. It is More Than Just Time You still need to document the visit! Does you System Check Codes or Prompt Needed Items. Codes 99201-99215 should be used depending on the complexity of the visit For level 5 make sure the history meets the definition of comprehensive. A new patient is a patient who has not received any professional services (face to face) in the last three years. This time includes those you see for a different Dx. . . . . . .
  15. 15. Financial Reports CureMD’s 24/7 access to different reports helps to stay updated with your practices financial health
  16. 16. Some Numbers That Matter!
  17. 17. Thank you!! Contact Us 212.509.6200 healthit@curemd.com

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