Electronic Medical Records

Electronic Medical records are medical records that are generated by organizations such as hospitals that specialize in providing care. These records are legal and computerized. The records are a part of a stand-alone system that has record storage, retrieval and manipulation capabilities.

A recent survey done in the United States stated the fact that only a few physicians use the Electronic Medical Records Additionally, what they use is just a partial Electronic medical records system. A full records system facilitates and requires four major functions:

Electronic medical records have sensitive information thus, they must be kept unaltered. A proper secured authentication method can help in protecting the sensitive data. This can be enabled by the creator/administrator of the system. The physician can be the creator or the custodian of the record system and he/she is bound by the legislation to protect the patient’s record. The medical property that prepares these records has the sole ownership of such medical records. Some of these may include X-ray, CT, PET, MRI, Ultrasound etc. The HIPAA standards state that a patient has every right to access the information (medical records), view them and obtain the originals under the law.

The National and International standards approve the legal nature of electronic signatures and accept it. Electronic media records don’t solely depend on the capabilities of the workstation itself. There are other factors involved such as the type of system and health care settings. The dependence may be associated with mobile devices that have handwriting capabilities.

Electronic media records systems automatically monitor the medical events related to a patient. This is achieved by analyzing the patient’s data that is used for detection, prediction and prevention of any adverse effects. Other things included in the procedure are discharge/transfer orders, pharmacy orders, radiology results, laboratory results and any other necessary and critical provider notes.

Privacy is a critical concern for a patient in Electronic media records. This is so, because the records of the patient can be accessed anytime by the physician or the provider. This relates to the records generated during hospitalization, payers, providers as well as the billing data related to the patient. The Protected Health Information (PHI) in the United States is addressed by the HIPAA or the Health Insurance Portability and Accountability Act. This is applicable both locally as well as internationally. The laws on record maintenance are stringent particularly those associated with sensitive data.

A few of the standards used for Electronic medical records system today are:-

The Electronic medical records system has provided ease to the record related processes between a patient and the medical facility. Please visit http://www.healthtec-software.com/electronic-medical-records.htm for more information.

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EMR – Healthtec Software

EMR – Healthtec Software EMR or Electronic Medical record is a computerized legal medical record that is generated in an organization dealing in providing care such as hospitals. This is a part of a stand-alone system capable of storage, retrieval and manipulation of records. According to a recent survey in United States, only a few physicians use the EMR system. It is to be noted here that the EMR used by them is partial. Only a fraction of physicians have a complete EMR system that requires four functions: • Computerized order for prescriptions • Computerized order for tests • Reporting of test results • Physician notes EMR should always be kept unaltered. This can be achieved by proper authentication by the creator of the system. The creator (Physician) or the custodian of the record of the health care practice or facility is bound by legislation to be responsible for the patient’s record. These records or the physical medical records are the sole property of the medical facility that prepares it. These may include but is not limited to X-ray, CT, PET, MRI, Ultrasound etc. According to the HIPAA standards, the patient possesses every right to access the information, view the originals and obtain the original copies under the law. According to the National and International standards, electronic signatures are legal and accepted. Whenever an EMR is used to read and write a patient’s record, it doesn’t rely only on the capabilities of the workstation. The system also depends on the type of system and health care settings. This may be possible through mobile devices with handwriting capabilities as well. Many EMR systems monitor the medical events automatically. This is done by analyzing the patient’s data to predict, detect and prevent any adverse actions. Such a procedure would also include discharge/transfer orders, pharmacy orders, radiology results, laboratory results and any other necessary and critical provider notes. In the EMR system, privacy is a huge concern for a patient. The physician or the provider can access to the patient’s records during hospitalization, payers, providers as well as the billing data associated with them. The PHI or the Protected Health Information in United States is addressed by the HIPAA or the Health Insurance Portability and Accountability Act. This confers with local as well as International laws. There are stringent laws associated with the movement of such sensitive data including that of health care. A few of the standards used for EMR system today are:- • XML – Document format with interpretability • HL7 – Format for interchange between different record systems and practice management • ANSI X12 (EDI) – Transaction protocols used for transmitting virtually all the aspect of patient data. This is prominent in United States. • CEN – CONTSYS (EN 13940), Supports continuity of care • CEN – EHR (EN 13606), Standard for the communication of information • CEN – HISA (EN 12967), Standard for inter-system communication in a clinical information environment. • DICOM – Standard for communicating radiology images The EMR system has made things simpler for both physicians and patients in today’s medical field.

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The Migration to Medical Record Software and Web Applications

Emergency rooms are being flooded with patients who don’t need to be there. These patients have minor maladies such as the flu, small fractures, or sinus infections.

The cost of treating these patients in the E.R. is about three times higher than it would be at an outpatient medical or urgent care clinic.

Retail outpatient clinics, such as Minute Clinic and Wal-Mart’s in-store clinics, provide a convenient way for patients to deal with minor medical problems. They like to call it healthcare on demand.

Consider Zoom Care, a retail healthcare company that operates three clinics in Oregon.

Zoom Care patients already know the length of their wait time and the price of their visit before they arrive.

This convenience is made possible by a web-based software system connected to each of Zoom Care’s clinics.

Online healthcare information is available through audio and video clips posted to the Resources area of Zoomcare’s website. This information serves a dual purpose of providing healthcare education and marketing to patients interested in changing their lifestyles.

The type of treatment available is outlined in a customer friendly “menu” also available on the website. Services include vaccinations, physical exams, strains, sprains, and fractures.

The patient leaves the office with a receipt for the exact amount of services and can ask follow up questions using an online form.

Wal-Mart’s in-store medical clinics take this a step further by storing patient health records electronically and making them available online.

In his excellent article, “the Wal-Martization Of Health Care” William Sage notes that retail clinics start with electronic record keeping. The old “primary Care”business model stores records on paper before digitizing them.

When this emphasis on electronic medical record keeping is combined with the low rental costs of a retail space, overhead costs drop dramatically. This results in lower costs for the customer.

While effective use of healthcare management software makes it possible for retail clinics to lower costs and increase convenience, the lack of innovation taking place within primary care clinics is disappointing.

A visit to the websites of the larger HMO’s revealed few features that increased patient convenience.

Unfortunately, good care does not always occur at retail clinics. Browsing a customer opinion site such as Yelp! yields good and bad stories about retail clinic care.

Many of these clinics employ nurses with advanced degrees and physician’s assistants. Most problems occur because the supervising doctor is not always onsite.

It is interesting to note that HMO clinics, such as Kaiser Permanente, also rely on a high percentage of R.N.A. nurses, student physicians, and physician’s assistants.

While retail clinics might represent a big change for community healthcare, they will not replace primary care.

It is likely that retail clinics will reduce the volume of patients who are flooding primary care facilities for minor medical issues.

It is clear that the “health Care On Demand” model, which effectively uses online interaction, transparent pricing, accessible locations, and electronic medical records, creates strong competition to HMO businesses. What isn’t clear is how good the quality of care actually is.

The self-service model of web driven client management systems is most certainly in full swing by this point, though underutilized. HMOs and even small practices can now effectively compete in this realm thanks to the increased affordability of web technology.

Emergency rooms are being flooded with patients who don’t need to be there. These patients have minor maladies such as the flu, small fractures, or sinus infections.

The cost of treating these patients in the E.R. is about three times higher than it would be at an outpatient medical or urgent care clinic.

Retail outpatient clinics, such as Minute Clinic and Wal-Mart’s in-store clinics, provide a convenient way for patients to deal with minor medical problems. They like to call it healthcare on demand.

Consider Zoom Care, a retail healthcare company that operates three clinics in Oregon.

Zoom Care patients already know the length of their wait time and the price of their visit before they arrive.

This convenience is made possible by a web-based software system connected to each of Zoom Care’s clinics.

Online healthcare information is available through audio and video clips posted to the Resources area of Zoomcare’s website. This information serves a dual purpose of providing healthcare education and marketing to patients interested in changing their lifestyles.

The type of treatment available is outlined in a customer friendly “menu” also available on the website. Services include vaccinations, physical exams, strains, sprains, and fractures.

The patient leaves the office with a receipt for the exact amount of services and can ask follow up questions using an online form.

Wal-Mart’s in-store medical clinics take this a step further by storing patient health records electronically and making them available online.

In his excellent article, “the Wal-Martization Of Health Care” William Sage notes that retail clinics start with electronic record keeping. The old “primary Care”business model stores records on paper before digitizing them.

When this emphasis on electronic medical record keeping is combined with the low rental costs of a retail space, overhead costs drop dramatically. This results in lower costs for the customer.

While effective use of healthcare management software makes it possible for retail clinics to lower costs and increase convenience, the lack of innovation taking place within primary care clinics is disappointing.

A visit to the websites of the larger HMO’s revealed few features that increased patient convenience.

Unfortunately, good care does not always occur at retail clinics. Browsing a customer opinion site such as Yelp! yields good and bad stories about retail clinic care.

Many of these clinics employ nurses with advanced degrees and physician’s assistants. Most problems occur because the supervising doctor is not always onsite.

It is interesting to note that HMO clinics, such as Kaiser Permanente, also rely on a high percentage of R.N.A. nurses, student physicians, and physician’s assistants.

While retail clinics might represent a big change for community healthcare, they will not replace primary care.

It is likely that retail clinics will reduce the volume of patients who are flooding primary care facilities for minor medical issues.

It is clear that the “health Care On Demand” model, which effectively uses online interaction, transparent pricing, accessible locations, and electronic medical records, creates strong competition to HMO businesses. What isn’t clear is how good the quality of care actually is.

The self-service model of web driven client management systems is most certainly in full swing by this point, though underutilized. HMOs and even small practices can now effectively compete in this realm thanks to the increased affordability of web technology.

Tags: database, Doctor., Doctors, health care, healthcare, hmo, hospitals, Medical, medical records, Medical Software, medical websites, Nurse, nurses, Online, online records, private practice, Treatment., web service model
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Medical Billing Software- The Best Source To Obtain Modern Management Of Clinic

If you are a doctor and fails to manage different operations of your clinic then you should use medical billing software which is best for your job requirement. This is reliable and powerful software through which you can obtain modern management of clinic. Whether you have your own clinic, you have your own hospital or you are practicing in some other place, this software will always support you in the best manner. You will never get disappointed by the features of this software which is advanced and according to the needs of modern world. With the help of these useful features, you can do your everyday work better than previous.I have seen several doctors; some of few are my close friends, who were unable to keep the information of their patients.  They wanted to add information, retrieve information and analyze the medical history but they had to go through a difficult process due to which they had to lose their most of time. When I got to know that my friends were in trouble, I suggested them to use medical billing software which is very efficient to provide easy approach to the patient’s personal information. This is good software through which you can add any information and can retrieve according to your own requirements.Through this software, you can analyze well that how much patient has recovered and how many problems were there to treat. You can obtain the flexible and easy way to schedule your appointments. Patients have to face difficulty while accessing the good doctors because they don’t have appointment so far. Basically, these doctors don’t have proper tool to manage their schedule due to which several patients have to wait for the months. But if you will install medical billing software, you will easily get rid of all of your problems.You can set your schedules perfectly without any hurdle. Your patients will not get any trouble when you will have this software. In this software, you will also obtain the reminder option through which you can get an idea that which patient will come on which date. Moreover, you will get a chance to have integrated billing module in which you can save the payment information into two currencies. You will never get dissatisfied with the detailed reports and statistics through which you can get the exact cash flow and exact amount of expenses and income.You can see that now it’s very easy to maintain your life which is full of busy schedules of your patients. If you have your own clinic then you should surely purchase this software which is packed with useful and helpful features. If you have different language other than English then you can also install this software which has integrated language translator. You can set your required language with an ease and comfort and you can enjoy your life because now you have such remarkable software called medical billing software. So don’t waste your time and purchase this software which is perfect for obtaining modern management of your clinic or hospital.

Tags: doctor software, hospital software, medical billing, Medical Software
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Medical billing software An Ultimate Solution For All Medicare

Technology is improving day by day and making high strides to make people astonished of inventions of modern world. These inventions have made our life quite easier. We can use them for our ease and comfort. A software market is also serving these purposes. Doing big calculations and keeping record of a huge number of clients may be a hectic job without the help of computers and softwares. Medical billing software is also one of these helping tools, which have made life of many doctors very easy.Medical billing software is an ultimate way out for proper, timely, efficient, steadfast and up to date management of your hospital or clinic practices. It is a complete solution offering you a huge range of features for your medical transactions.The major feature of this software is its ability to keep electronic medical records. It serves you to save each and every single bit of information and data about your patients. It helps you schedule your appointments and lots of other features making it the best option for your medical practice.Medical billing software is ultimate software for all kinds and sizes of hospitals, clinics and medical care organizations. It also helps you manage activities in more than one office. It offers different security levels providing you options for the access rights and data available to different members of your team. Medical billing software is compatible with your Windows PC. Therefore, you don’t need to install any special kind of hardware for its installation. You can run it on any standard Windows PC.The most important feature of this software is the appointment scheduling. Patients are always worried about the correct and precise scheduling of their appointments. The software enables you to create a complete appointment where you can enter date, time and all the required info about the patient. You can also create new accounts for the patients visiting you for the first time. Different states of diagnosis and examination are shown differently in different colors and styles. The software also gives you reminder option. It helps you remind of meetings, appointments, orders etc. it also serves to leave notifications for your staff.The software saves all the data about your patients and generates electronic medical records for each patient. It saves their name, address, contact numbers, picture, examination status, disease, services required and reports etc. As these are electronic records, you have complete control over editing, searching, managing these records. The software makes you quite efficient without handling huge bundles of papers. Patients’ data can be searched very easily and efficiently. You can save all the data based on different criteria as well.Detailed reports and statistics are generated for each patient by this software. It allows you to configure the layout and presentation of these reports according to your own choice.Every organization has its own set of services and products. Therefore, every hospital can classify its services by giving names, category, charges, time etc.

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How Electronic Medical Records Provide Useful Results While Using Medical Billing Software?

Electronic medical records plays very important role in medical billing software. This is a feature which is the need of every doctor while dealing with their patients. Instead of using papers, you should use this facility through which you can maintain loads of patient’s medical history. You will not get any problem while searching out the required information because with the help of medical billing software, you can obtain what you want. Through this software, you can improve the efficiency of your work and enhance the documentation quality just by using EMR properly.  You don’t need to worry about the security of your documents because in medical billing software, it is fully protected.You can easily add the personal information of your patient that what is his/her name, address, age, sex etc. You can also save information on how many examinations are being done by you and your patient and when you have taken these exams. You put entire information in electronic medical records and can retrieve them whenever you yearn for. There is no difficulty in searching the specific patient’s medical history. You can search each patient by first or last name or with the examination date or with doctor name etc. While having these records in the medical billing software, you can save chunks of money and can maintain them according to your own requirement. Administration of hospital or clinic can easily control the workability of this software which has outstanding EMR feature through which a good documentation on medical information of each patient can be prepared. This software is becoming popular day by day just because of these features which enhance the functionality of this software more. With the help of EMR, you can never go through a major loss because predefined email system is there through which you can obtain information whenever you miss any. It’s very difficult to control the paper work which can also be misplaced by any of your staff member. When you go for manual system to store your patient’s medical information, you have to face several disadvantages which force you to think on better option. You know it very well that patient’s record goes in the store room where several of other records are also being placed. Whenever you will ask your staff member to search around the particular medical history, you have to wait for the hours because it’s difficult to seek out the medical information of specific patient from so many records. But with the good use of medical billing software, you can have the chance to save these hours. You can retrieve the information any time you want from EMR and in this process; you just have to wait for few seconds. You can get an idea that how easy it would be to work with this software which lightens up your burden in a very well way. Purchase this software which is better than your manual processes and which cut your costs and boost up your revenues to a desirable level.

Tags: doctor software, hospital software, medical billing, Medical Software
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How to Evaluate Medical Practice Management Software

Whether you are opening a new practice, taking over one that is established, or trying to grow your practice, you need to have control of financials, workflow and staff performance. Understanding the value of automating practice management processes is one thing, and perhaps you’ve already computerized some of your office processes, but has it gone as smoothly as you had hoped? Are you ready to manage more of your office processes electronically? Evaluating and implementing software can seem like a daunting task but it doesn’t have to be. Here’s what you should expect when you choose a practice management software solution.

Today’s applications can run on a single desktop PC or over a network. Look for software with a user-friendly interface that’s as familiar as a patient ledger card, with logical online menus. The best products will offer on-screen tutorials, which can go a long way to help your staff learn the basics and develop proficiency on their own, at their own pace. Start with a software solution that ensures your patient database will be compatible with other ‘off-the-shelf’ tools you may use to customize reports and forms.

You should be able to integrate Practice Management software with most billing applications and Electronic Medical Records (EMR) systems. Having the ability to combine clinical patient records with labs, data, prescription writing and other functions means you can streamline and automate front- and back-office processes in your practice. Tasks can then be performed with less steps and greater accuracy

Continue reading How To Evaluate Medical Practice Management Software >>

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Starting a Medical Billing Company

Starting a Medical Billing Company

The need for medical billing services is in great demand. Healthcare providers need to obtain payments from insurance companies and patients. With the growing demand of healthcare services, the demand for such billing services has also increased. More and more providers are outsourcing their billing to professionals in the medical billing industry. Most providers have no experience in medical billing, which results in claim denials, reduction in cash flow, and a financial strain on the office.

Unfortunately, entering into the field is easy, but being successful is hard work. Unless you have experience in the medical billing field, you will need training in order to properly code claims, and bill insurance companies. Many companies offer “training” to assist you in your medical billing profession. Before deciding on your training, be sure to check the company out with the local Better Business Bureau and medical billing associations. Obtaining certification as a professional medical billing coder will assist in making your business more successful.

Another important aspect in your medical billing company is selecting the right software to assist you in managing your business. Select a software solution that provides a cost effective billing system that will help you market and grow your business. The system should support multiple clients, and provide complete security to allow your client access to their data.

The software vendor should support the scheduling, registration and charge entry while you concentrate on the billing and collections. This will provide you a competitive edge, so that you can offer your clients a complete solution from scheduling to collections and collections.

The software should support electronic claim submission. Most insurance companies give priority to electronic claims. Claims received online are paid in 10 to 14 days, as opposed to paper claims, which are set on the back burner for at least 25 days.

Finding a software that is available as an ASP (i.e. hosted solution) will reduce your IT costs and reduce your technology concerns, allowing you to focus on your business!

Another important business decision will be what type of provider(s) you will target and how you will reach your target market. At this point you should consider how you would structure the fees for your services.

There are options on how you can bill your clients for your services. These include a per claim fee, a volume discount, a percentage of billed charges, a percentage of collected charges, along with possible incentives (SLA’s) as you become more successful in your business.

As you are considering how to charge for your services, you should do research on specific restrictions some payers have with fees charged. For example, Medicaid does not allow physicians to pay a percentage for billing services. So, if you plan to bill Medicaid, you will need to charge a fee per transaction.

You are now ready to establish your client base. It is important to analyze the multiple types of providers in your area, along with your coding/billing knowledge, to help you identify the market you will target.

Stay tuned for the next article to assist on identifying your target market, establishing contacts and growing your business.

pdmsoftware.com

Tags: Clinic Billing, medical billing, Medical Collections, Medical Software, Physician Billing
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ROI Analysis for Full Cycle Web Based Practice Management Software Solution

ROI Analysis for Full Cycle Web Based Practice Management Software Solution

Executive Summary

Within this document, you will see detailed financial analysis and real world scenarios that will demonstrate the exponential cost savings that can be achieved with a full cycle practice management software.

Full Cycle Practice Management Software will:

· More efficiently utilize your schedule by using Resource Scheduling

· Set-up scheduling rules based on your practice needs (by caregiver, room, equipment, procedure)

· Maintain Caregiver Profiles

· Maintain Payer Contract Fee Schedules

· Set-up billing rules specific to your claim forms and payer contract requirements

· Automatically track your collection efforts and all follow-up

· Complete revenue reporting for financial reporting to stakeholders

Traditional Practice Management Software

Managing a practice should not include adjusting your practice rules to fit your software. The software should adjust to fit your rules. We will look at various aspects of a practice management software.

Scheduling

With a typical manual appointment book system, your employees invest much time in maintaining the “book”. Appointment rules are not built in the appointment book. Instead, your appointments may be based on the person speaking with your patient. If you are no longer using the “book” but instead using an appointment book software system, your appointment scheduling software may not maintain all appointment rules. Both of these types of systems hinders your ability to successfully manage all employees time (appointment scheduler, caregiver, front desk personnel) and provide quality patient care.

Let’s take a look at a real world scenario. Patient A phones your office to schedule a follow-up to a wound care visit. Using “book scheduling” (either manual or software) your appointment scheduler must remember the rules for this type of visit. Unfortunately, Patient A is scheduled for a 15 minute appointment, but in reality the appointment includes time not only with the caregiver but also with a wound care personnel. Patient A’s appointment lasts 30 minutes. By the time Patient G is seen (assuming alphabetical patients) all appointments are 30-45 minutes behind schedule.

How much does this cost your practice? Let’s assume Patient G has time constraints and was assured at time of scheduling he would be out of the office within 45 minutes. Patient G is now 45 minutes past his schedule time, and hasn’t even seen the caregiver. Patient G may either leave your office (unseen) or complain loud enough in your waiting room for patients behind him to leave. If Patient G’s visit charge would have been $100, that revenue has just left your door. Let alone if other patients behind him leave as well.

If this is happens in your office, it does not happen only once. So, you must multiply that number by 3, 5, 10, times as often as this scenario happens within your practice.

Result – A single patient leaving your office due improper appointment scheduling 3 times a month can cost your practice $3600 ($300 x 12 = $3600) per year. This cost is in addition to the employee labor costs involved to maintain your book schedule.

If you feel these projections are not accurate, you are probably correct. The costs are probably higher. The average charge is probably higher than $100. And, the frequency can be realistically higher than 36 lost appointments per year.

Investing in Resource Scheduling Software

With Resource Scheduling, appointment, caregiver, equipment, modality rules will be set up for your practice. The system will manage the rules, and appointment slots will be provided based on these rules. Ongoing labor costs will be minimized, as your employees are not learning the rules for each appointment type. With PiMS you will receive unlimited rules capability, ability to define preferences, block scheduling, the ability to define multiple resources for an appointment, plus much more. With Resource Scheduling, your practice can efficiently schedule appointments based upon your practice rules, and reduce its financial loses while improving patient care.

A typical Resource Scheduling software costs, for single location practice, less than $1,000 to install. With the above scenario, you should experience a return on your investment within 3 months.

Lost Appointment Costs – $300 per month (3 patients @ $100 charge per patient)

Labor Costs – Let’s assume an average of 1 hour per patient @ $25 per hour (appointment scheduler, caregiver, front desk personnel)

Estimated Lost Appointment Cost Total – $375 per month

With this analysis, you can see how investing in a Resource Scheduling software will provide a quick return on investment for your practice.

Billing

Billing errors can cost your organization thousands of dollars. This section analyzes manual billing pitfalls, costs to your organization, and proven ways to recover lost revenue.

Most billing errors can be eliminated prior to the submission of your claim. Managing these errors with little labor (i.e. people) intervention increases your overall profit. Relying on simple billing/claims software and/or personnel to remember specific billing requirements will result in an increase of denials and delayed cash. Instead, invest in billing software that has the capability of building your specific billing rules into the system. The system should allow for multiple claim forms. Your users should be able to view claim forms online, and reformat the claim online if necessary. The system should have the ability to automatically submit clean claims to the Payer, without human intervention. And most importantly, the system should contain your Payer specific rules for billing.

For example, some Payers have different billing requirements for the same procedure code. Your system should have the ability to generate a claim specific to the applicable Payer.. If your system does not have the capability of managing these types of rules, you are relying on personnel to catch the requirement up front and edit the claim prior to submission. Or, the claim will be submitted to the Payer and then denied for missing information.

Let’s examine the cost of both processes (manual versus system built rules). If you are relying on a manual or simple billing/claims system, your process will typically be as follows. A claim is generated and reviewed by your office staff. The Payer requirement states the specific procedure code must be submitted with a letter of medical necessity. Your office staff must remember this requirement (in addition to the other multitudes of billing requirements Payers create). The charge is $500. The claim is mailed to the Payer without the LMN. Twenty days later a denial is received from the Payer, stating the claim is not eligible for payment due to missing information. At this point, your staff will either remember what the missing information is, or more than likely contact the Payer for explanation. Your staff will then retrieve the LMN and resubmit the claim to the Payer with the LMN attached.

How does this cost your organization? Let’s assume the initial charge is $500. Begin subtracting the personnel cost to review the claim up front, review the denial, contact the Payer, correct the claim, resubmit to the Payer, and then follow-up with the Payer regarding payment. On average, this would entail approximately 2 hours of personnel costs. Plus, the $500 receivable has been delayed at least thirty days, resulting in a lower margin to your organization.

Investing in billing software that allows you to build in Payer specific rules will increase your margin almost immediately.

Medical Billing Software

Investing in a Medical Billing software, will decrease your billing denials. Medical billing software should provide flexible billing cycles, the capability to build in rules for Payer specific billing requirements, flexible claim formatting, missing element tracking, online reformatting, and a multitude of other user friendly functions to assist your personnel in billing.

How will this benefit your organization? In the above example, your $500 profit is reduced by 8-10% for personnel costs. That is then reduced by another 5% due to the delay in collection of the receivable. Conservatively, your margin is reduced by 15%. Multiply that by the number of instances this is currently occurring in your practice. You can see how quickly your margin erodes, and cash flow is delayed.

The cost of a typical medical billing software is probably dependent on the size of your practice and number of concurrent users. For a small practice, the cost could be less than $2,500 to install. Taking the above example into our analysis, your return on investment would be seen very quickly.

In addition to the features mentioned above, the software should provide your organization with Revenue Management reporting, an on-line patient financial folder, automatic charge posting, and much more!

Collections

Healthcare practices that do not invest in efficient billing and collection processes may find themselves in a cash crisis without resources to meet financial obligations. Your collection practices must be communicated, and adhered to, by all individuals within your practice. From communicating the patient responsibility, collecting this responsibility at time of visit, and thorough follow through until the account is paid in full should be one of your organization goals throughout time.

Understanding where you are today, and deciding on your organization’s goal for the future should be the first step in developing your collection processes. So, first calculate your current days sales outstanding (the average time it takes to collect your receivables). To do this, divide your net sales by the number of days in the period (I recommend monthly to effectively manage your cash flow). For example, if your sales for month is $75,000, divide that by 30, which equals 2500.

Next, take the above number and divide it into your accounts receivable trade balance. For example, if you have $165,000 in total receivables, divide 2500 into that number, which equals 66 days. Therefore your days sales outstanding is 66 days. Once you calculate this number, you can effectively set reasonable goals and processes for your staff.

Payer collections will probably be the vast majority of your collection efforts. Therefore, it is imperative processes are in place that dictates your organization’s follow up procedures. Your practice management system is the key to successful and timely collections of your accounts receivable. Timely follow-up on outstanding claims, denied claims, claims paid incorrectly, and delayed claims is a must.

Review your Payer contracts. What are the terms of payment? Does your state have legislation that dictates payment guidelines? Build your collection processes around these guidelines. For example, if Payer A contract terms is 30 days, you should be following up with the payer on day 31. Then, you should follow-up every 10-14 days from that point, until the claim is paid in full. Let’s examine how not following these types of processes can cost your practice.

Assume your payer contracts all dictate 30 days payment of a clean claim. The first step you perform is to calculate your current days sales outstanding (i.e. DSO). Once you do the calculation, you find your average DSO is 66 days. In this example, you are financing your current expenses by services you performed 66 days ago. This is not an effective means for managing cash flow and becoming profitable. And, you are allowing your payer to delay payment for services you performed.

Ensure your Payers are abiding by the contract guidelines. You must be able to access their payment style and their ability to process your claims according to your contract. Once payer payment issues are discovered, they must be presented to Management, to assist in contract negotiations and improvements. How does this impact your practice?

If your payer contract stipulates 30 day payment upon receipt of a clean claim, and paid at 80% of billed charges, your staff must be able to determine if payment was made correctly. If the payer is paying your claims at 75% and you are writing off the remaining 5%, you are losing revenue.

Patient collections are an important part of your collection process as well. From the appointment each patient must understand his financial responsibility. That responsibility must be collected at time of service. If the amount is not collected, your collection processes must include how and when to collect any remaining patient responsibility.

Investing in a practice management system that will provide the tools to analyze your current state is crucial in the streamlining of your collection efforts. Your software should accommodate the multiple payer contract payment requirements, and the processes you have developed to collect any outstanding receivable. The more you can automate, the less likelihood of delayed collections. These processes must include both payer and patient collection efforts.

Collections Software

Your collection software should allow you to manage your collection process by user-defined guidelines. The software should provide user activities, worklists, and letters to guide your staff in the collection of your receivables.

Creating automatic collection letters is a must. The letters should be as specific or generic as you wish (from small balances to a more rapid letter sequence for higher balances). Your users should have access to unlimited worklists, with multiple assignments based on your criteria. Supervisors should be able to view employees worklist any time on-line. In addition, the software should provides productivity reports to help you analyze what your collectors are doing.

Another important aspect is the software should provide account financial responsibility by both third party and patient. This eliminates staff confusion and allows the staff to follow-up more efficiently with the third party and patient.

How can investing collection save you money? In the above example, if your payer contract stipulates a 30 day payment, and your average DSO is 66, your are financing your operations out by 2 months. Investing in a software that will provide you both tools and resources to define your current state and automate your collection process will decrease your DSO.

For a small practice, the cost could be less than $2,500 to install. Taking the above example into our analysis, your return on investment would be seen very quickly. Investing in PiMS Medical Collectoins will be paramount in increasing cash flow.

Revenue Reporting

In addition to scheduling, billing, and collections, your software must provide you the tools to accurately analyze your financial picture. These tools should be in the format of reports. These reports must have meaning to your organization. Understanding where your practice is today, and how you can improve will provide Management the necessary information to make important strategic decisions.

The software must provide a thorough selection of real time reports that will assist in you accurate financial analysis of your practice. With PiMS reporting, you will be able to view aging reports (by financial party), revenue reports, productivity reports, plus many more. These reports are real-time, online, and retrievable at your discretion.

Performing routine financial analysis will quickly provide to you not only the items mentioned above, but will also quickly provide you the return on investment you have seen.

In summary, investing in a full cycle practice management system will quickly provide effective processes, streamlining of the A/R process, decreasing labor costs, and most importantly increasing employee productivity and your organization’s profitability.

Tags: Clinic Software, Healthcare Billing, medical billing, Medical Software, Practice Management, Scheduling Software
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The 6 Things You Need to Know Before Buying Medical Office Software

Medical Office Software can often make or break your clinical practice, and it is crucial that you know what you are getting when you make the investment of bringing a new software system into your office. Your software needs to be much more than just “office” software for your medical practice. It needs to be medical billing software, electronic medical records software, medical history software, and medical case management software. Your medical office software needs to be able to help you manage your entire practice and the health of your patient base to be effective.

Conversion from a manual system to an automated one can be costly, and so is converting from one software to another. So be sure that you ask, at least, the following questions before investing in a new medical office software system.

Tags: Medical Management Software, Medical Office Software, Medical Software
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