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Is Your Billing Company Registered for HBMA's Free Professional Billing Service Locator Service?

Physician owners and medical practice administrators are already signing up and may be looking for you! Today, the HBMA unveiled the free, fully automated Professional Billing Service Locator (PBSL) service, a platform that provides an efficient way for physician owners and medical practice administrators to easily find a trusted, professional medical billing partner. HBMA developed the offering to help providers with the arduous task of navigating through the thousands of medical billing companies on the market to find a the HBMA member organization that will best meet their specific needs. After registration, the PBSL will immediately identify the specialties, service details, and contact information of the most relevant and qualified medical billing companies in the region that fit a medical practice's specific profile. Finding that perfect match with the right professional billing service will help providers secure appropriate reimbursement for services delivered, achieve timely claims adjudication, and reduce claims denials to lessen days in accounts receivable. To learn more about how to register your billing company into the PBSL directory, visit Professional Billing Service Locator or call 877.640.4262.

http://www.hbma.org/blog/is-your-billing-company-registered-for-hbmas-free-professional-billing-service-locator-service

Ten No-cost Ways to Improve Patient Satisfaction

Patient satisfaction is a big deal. It boosts patient attraction and retention, and it reduces the likelihood a patient will file a malpractice lawsuit. It also saves a practice time: Happy patients do not take up physician and staff time complaining. Finally, it is beginning to affect reimbursement. Already for hospitals, and soon for all physicians accepting Medicare, patient satisfaction scores will determine bonuses and penalties.

Unfortunately, physicians do not always understand what satisfies, or even delights, patients. They tend to believe that the biggest component of patient satisfaction is quality of care.  What they miss is that patients have no way to effectively evaluate the quality of care. Instead, patients rely on proxies, and those proxies have everything to do with how the physician and staff make the patient feel — emotionally.
Here are 10 ways physicians and staff can significantly increase patient satisfaction:

 1. Use the patient's name. People love to hear their own name.

2. Use an honorific (Mr., Ms., etc.) to address a patient, particularly if you want to be addressed as "Dr. Jones."

3. Wear easy to read nametags just below your right shoulder. First name only is fine for staff. The objective is to give the patient something better to say than "Hey, you," if she needs something.

4. Make eye contact with the patient as often as is practical. This indicates you are paying attention and engaged with the patient.

5. Tell the patient what to expect. This applies to medical assistants bringing a patient back to an examining room, physicians making referrals to specialists, and check-out staff recapping the billing for visits.

6. Let the patient know what you expect of him. If you need to enter data during the visit, for instance, say, "I am entering your information, but I am listening," to indicate he should keep talking. Say, "I have to enter this information. I'll be done in just a minute," to indicate that you need silence.

7. Give written visit summaries, patient education materials, and instructions. Patients forget an incredible amount of what is said during the visit by the time they get to their car. The ability to reference a written record reassures them.

8. At the conclusion of the appointment, make eye contact with the patient and say, "Take care." This phrase resonates with patients more than, "Thank you," "Have a nice day," or "See you soon."

9. Run on time, or close to it. This may be the primary way patients evaluate the regard the practice has for them.

10. Return phone calls and fulfill requests according to your posted protocol. It is only reasonable for a patient to assume that a practice out of control in some areas is out of control in others.

Please note that I did not mention coffee and Wi-Fi in the waiting room or birthday cards for patients.  Some patients may appreciate amenities and remembrances, but none will identify them as indicating caring and concern.  Behavior, sincere and consistent, is what convinces patients that they are respected and well cared for.

Article  By Carol Stryker of Physicians Practice http://www.physicianspractice.com/blog/ten-no-cost-ways-to-improve-patient-satisfaction?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=29102013

The Unknown Impact of Health Reform on My Private Practice: An Honest Opinion From a Real Physician... "I honestly don't know."

By Melissa Young, MD, Courtesy of Physicians Practice

Patients have been asking me for the last few months, "So what do you think is going to happen to your practice with Obamacare?"  I told them what I assume most physicians are thinking, "I really don’t know. I’m apprehensive. But I guess I’ll find out."

There’s been talk about physicians being inundated with new patients because there will be an increase in demand for physicians without increasing the supply. In our case, we already have such a backlog, I don’t know what we’ll do if more patients call to make new patient appointments. I am concerned that we are going to have to close to new patients for a while if the wait for a new patient appointment gets any longer. As it is, patients are very dissatisfied with the wait. I can’t begin to imagine how primary-care physicians will handle this.

There is also the concern about increasing patient financial responsibility. That will put a greater strain on the patients, as well as on our staff who will have to collect more from patients. As many patients don’t understand when they have deductibles or how much their copays are, if their portion of the bill increases, it may become increasing difficult to get paid for services.

As a business owner and employer, there is also the question of providing health insurance to employees. We are a small enough practice that, as I understand it, I am not legally obligated to provide insurance coverage for the employees, but I have always done that anyway. I think it helps keep employees happy and instills some loyalty to the practice. Having said that, I was still obligated to print out and complete a form that I had to distribute to each employee, stating who is eligible for insurance, that we offer it, and that it is deemed affordable. They actually found it somewhat amusing that I had to inform them of something they already knew. Sigh. To think trees had to die for this paperwork.

So, what do I think will happen? Will Obamacare have a significant impact on the way our practice is run now? I honestly don’t know. But I guess I’ll find out.

Article Courtesy of: http://www.physicianspractice.com/blog/unknown-impact-health-reform-my-private-practice?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=24092013

Interview: How to Start A Medical Billing Service - Business Opportunities Weblog

Interview: How to Start A Medical Billing Service - Business Opportunities Weblog

Top 10 E-mail Etiquette Tips

Who do you and your colleagues communicate with via e-mail at your medical practice? At a minimum, it is likely you communicate with patients, vendors, and each other. Is there anyone that you exclusively (or almost exclusively) communicate with via e-mail?

E-mail is a wonderful tool, but unlike phone or face-to-face communication, the medium poses challenges when it comes to conveying the tone you are trying to imply. E-mail can also be damaging, especially when an e-mail is misunderstood. Here are 10 tips to help keep the perception of your e-mails on point.
1. Keep e-mails brief and to the point. Make your most important point first, and then provide supporting details if necessary. Paragraphs should be short and easy to read.
2. Watch your tone. Without the nonverbal cues of face-to-face conversation, your tone can get lost in the translation of an e-mail. The more to the point you can be the better. Also using words like "please" and "thank you" can go a long way. 
3. Don't assume the tone or intent of an e-mail you receive. In the same respect that you should watch your tone, never assume the intent or tone of an e-mail you receive either. It is always best to ask specifically the intent of the e-mail, as we all know what happens when you assume. 
4. Don't reply when irritated or angry. When sending and receiving e-mail, the best solution when you feel offended is simply not to be offended (pretty good general life advice too). You are likely getting worked up over something that is simply an error in the translation of the tone. If you find yourself reading an e-mail and becoming irritated, step away for a minute and calm down before replying.
5. One e-mail per subject. Even when you are e-mailing patients, it is best to send one e-mail per subject so that it is easily referenced again by the subject line. If you find yourself sending three or more e-mails, consider sending one e-mail with multiple attachments rather than including pages of text in the body of a single e-mail.
6. Use zip files when sending attachments. Also make sure that the receiving person will be able to open the file. PDF is often the best format for documents; most systems can open it.
7. Always use "if –then" options. Using "if-then" options cuts down on the back and forth of e-mailing, especially for appointment times. For example:
"Can you bring Mary in for a follow-up appointment at 3 p.m. on Wednesday? If not then please give me three additional days and time frames you could bring her in (For example, Wednesday before 10 a.m. or Friday after 1 p.m.)."
 8. Avoid typing in all small caps or all upper caps. This can make your e-mail look lazy (small caps) or like you are shouting (all upper caps). This is one of the most basic rules. However, with so many people communicating from their mobile devices, it often falls by the wayside.
9. Limit text formatting. Just because your e-mail service or program offers text formatting options doesn't mean you should use them. Avoid underlining unless it is a link. Various fonts and colors can make the e-mail difficult to read, and can often times seem unprofessional.
10. Always sign off with care. Use words such as "Thanks," "Sincerely," "Best regards," for closing e-mails. This is polite, respectful, and conveys a nice tone.
Be sure to use care and common sense when using e-mail as a tool to communicate with your colleagues, staff, and patients.

Article By Audrey "Christie" Mclaughlin, RN
http://www.physicianspractice.com/blog/top-10-e-mail-etiquette-tips-your-medical-practice?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=03092013

Three Mindsets for Growing Your Business and Sales

(An article by Ron Karr, taken from the July/August issue of HBMA Billing)

If I ask you not to think about pink elephants, what will you think about? Be honest! You're thinking about pink elephants! But why would you, when I asked you not to?

The answer is simple: the mind cannot process the negative. If you are about to go into an account hoping to not lose the sale, what do you think is going to happen? You will lose the sale. The opposite is thinking about the deal you are going to close. Thinking about what you want to achieve, instead of what you don't want to have happen, makes all the difference in the world when it comes to your success in sales. Thinking about closing the deal puts you in an entirely different mindset that allows you to have the right conversation to make it happen.

Your mindset is the difference between closing more business and losing it. We have identified three critical mindsets that top producers use to grow their business. They are:

1. Creation vs. competition
2. Openings vs. closings
3. Alliances vs. lone ranger

Creation vs. Competition

Too many sales executives go into sales calls trying to beat their competition instead of creating better results for their customers. To build a value proposition that is second to none, you must concentrate on generating better results rather than competing against the processes already employed by the client. This is what Scott Nadell, Director of Sales for a third party billing company in New York, does.

Scott called me and wanted to know how he could close more deals. It seemed as though every time he walked into a practice, the walls would go up and office managers and doctors would be rude and unwilling to listen. Scott was going in to tell them how great his system was and how he could save them time and money. He was a threat to peoples' jobs and nobody wanted to deal with him. Sound familiar?

Scott changed his approach from competing against what they are currently doing to having conversations on how partnerships with his company can produce better results. He created different mindsets that enabled his audience to want to hear what he had to say without feeling threatened.
 

Openings vs. Closings

After switching his mindset to one of creation, Scott then looked at how he presented his position when introducing himself to prospects. Instead of telling them how great he was, he provided actual statistics on how much money his company had successfully billed and collected for its clients. He positioned his company as a valued resource that helps practices increase their profits and revenues through an efficient billing and collection system.
But here is the catch! Scott did not do this in a one-sided conversation. He got the doctors and practice managers to talk first about where they wanted to take their practices and what goals they had identified for their billing systems. Once he figured out where their struggles were, he then presented his systems and results in the context of what was important to each particular practice. When the managers and doctors heard his pitch, they felt like it was fully customized to address their issues.
 

Alliances vs. Lone Rangers

Scott then decided to take the same approach when it came time to creating alliances with other parties, such as attorneys and accountants. He realized that being introduced to a new prospect by one of their trusted advisors greatly reduced the amount of time it took to gain his prospect's attention and interest. If your attorney says that you need to speak to a service provider who is going to help your business, you are going to have that conversation.

Scott always knew that this was important. What he did not realize is that you need to treat each alliance as a client. In other words, don't just ask them for referrals. Do what you do with the doctors: ask about where they are trying to take their businesses, then discuss how partnering with you can help them get there.

Today, Scott and his company are enjoying great results from operating with these three mindsets. They are closing new accounts and creating alliances with influencers in their industry who are opening a lot of doors for them.

Scott started seeing results initially in the quality of the conversations he was having, which led to more opportunities and eventually more business.

What mindsets do you operate from? For doctors to switch third party billing companies or to go to a third party biller, they need to hear a compelling reason. That only comes when you operate from the right mindset. 

Courtesy of: http://www.hbma.org/news/public-news/n_three-mindsets-for-growing-your-business-and-sales

Opportunities to Expand and Keep Your Business

By Steven Peltz, from the Jan/Feb issue of HBMA Billing

As a medical practice consultant, one the first areas of a medical practice that I evaluate is the billing department or billing company of a practice that has hired me. In my capacity as the president-elect of the National Society of Certified Healthcare Business Consultants (NSCHBC), I have had informal discussions with HBMA President Don Rodden, CHBME, about the consulting services that billing companies provide to practices, sometimes without understanding how important their role is to the practice.

I was introduced to HBMA by Government Relations Committee Chairman, Barry Reiter, CHBME. He and I have discussed the constant chaos that the healthcare delivery system is in and identified some of the opportunities that arise from that state. You may not know it, but many of you are already consulting, and if you have not set up your engagement contracts wisely, you are missing out both on revenue and having your client understand and appreciate all the value you bring to the practice. As practices merge and are acquired by hospitals, it is a good idea for your company to offer more than one line of service. Here are a few examples of what I do; you may want to consider adding these services to your company if you do not already offer them.

Over the years, I have established a benchmark of what a practice's accounts receivable (A/R) should look like. It is not cast in stone and is not fail proof, but it is a simple measuring tool that I use. I take the A/R temperature of all new clients and put it on a bar graph, then compare it to my benchmarks (see page 24). I then demonstrate to the potential client that by using the graph, their money is worth less the longer it is owed to the practice. I point out that either their billing company or billing department is not meeting the standard. I also break down the front end of the billing process and identify disconnects in the data collection process, such as: poorly trained staff, lack of reconciliation, monitoring, and the final decision with respect to collections.

Reducing the lifetime of debts that your company must collect begins at the point of service. Collecting co-pays at the time of each practice visit reduces postage, cuts billing staff time, and increases cash flow. Increasing the consistency of this front end collection means training the practice's staff to train the patients. For example, the front end staff may say to the patient, "Your co-pay today is $20" and then stop and wait. A more effective script for collecting co-pays may be, "Your co-pay today is $20, and we accept cash, checks, and credit cards. How would you like to pay?" A subtle but important difference, and while it will not work 100% of the time, it will result in increased revenue. Then, tell your client that you will monitor the success of their front office staff in collecting co-pays and refresh the front staff's training a few times a year. Finally, track the front staff collections on a monthly (or less frequent, but consistent) schedule and meet with your client enough times for your client to develop trust in you as a part of the management team.

When patients call to schedule appointments, do the front desk staff members ask for enough information to check insurance eligibility and acquire authorizations, when appropriate, before the visit?

Is there a daily, weekly, or monthly close that reconciles the cash, personal checks, credit card receipts, and insurance checks with the end-of day and end-of-week computer report and the bank statement? This is a simple way to make sure all the funds go into the bank and not into someone's pocket.

Does the office manager or billing department / company supervisor produce a monthly report that compares the charges and collections of the past month with the same month last year and two months before? This will spot and identify trends before they become problems.
During the first few meetings with your client, be prepared to bring something to the discussion that demonstrates the depth and scope of your knowledge and how your expertise will add to the success of the practice. For example, each year Medicare changes their codes; you could explain which, if any, impact the practice. If it is a primary care practice, establish a referral-based report. Identify how many dollars are sent out of the practice and to what specialties. Are there ways to recapture some of those dollars? Is the PCP or the specialist asking enough questions and documenting enough to code one level higher, if appropriate? I usually tell the owners(s) that the practice needs a preventative audit at least once every year and especially after a new provider is hired. When they ask why, I give them examples of other practices that have had to write checks back to payers.

When your client brings in a new provider, do you offer to credential the provider or bring in someone who can? Do you discuss ancillary sources of revenue that other practitioners use that can also be applied to that practice?

You probably already do between 80% and 100% of the above suggestions, but does the client understand how these services impact their practice? The point is whether your client knows that you provide these services. Yes, I know that they do not want to pay more for services that they think should be included, but that is not a reason to forgo informing them of all you do. Enhancing the services that you offer discourages clients from shopping for competing providers – it is much less expensive to keep a client than it is to get a client. Also importantly, by enhancing your services, you become more appealing to potential new clients when you make sales calls and offer to analyze their operational efficiency.

As a consultant, I either know the answer to the question or where to get it. You should be no different. With the constant change in the healthcare delivery system, you need to be constantly enhancing your product and empowering your clients with more opportunities.

 Courtesy of: http://www.hbma.org/news/public-news/n_a-reminder-opportunities-to-expand-and-keep-your-business

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Section 408 Trusts – The Tax Shelter Every Business Owner Should Use - HBMA - Healthcare Billing and Management Association for 1st and 3rd Party Billers - Medical Billing, Practice Management

By Lee R. Phillips, Esq.- taken from the November/December issue of HBMA Billing.

Every small business owner should use one tax shelter every year. It may mean the difference between retiring comfortably and not retiring at all: a Section 408 trust. A Section 408 trust gives you the ability to earn money, avoid paying tax on it today, transfer it into a savings plan where it grows without a tax, invest it basically anywhere you want, and then only pay the tax when you spend the money years down the road. That is a big deal.

 

For seven years, I wrote a column every month for the Physician's Money Digest. It went out to over 300,000 physicians, and I would get many calls from doctors wanting to know how they could get a little better return on their investment. I always asked one question back: "What's the tax?"

Tax is the most important consideration in an investment. When Congress created 408 trusts in 1974, I am convinced that they did not understand the impact that taxes (or the lack thereof) have on an investment. They never envisioned the impact that 408 tax laws would have on investing. I am sure they only envisioned a little extra money that mom and dad could spend when they got old. They never saw millions of dollars in 408 trusts.

Your advisor may not understand Section 408 of the IRS Code. In fact, your advisor may not be familiar with 408 trusts at all. Ask him or her; if he or she does not know what a 408 trust is, it is time to get a new advisor, because the laws under 408 let you do many neat things - things your advisor may not have told you about.

It is good to have a 408 trust, and you should know how to use it. The way you learn how is by simply studying the law, i.e., Section 408 of the IRS Code. 408 trusts have special rules that allow these trusts to be passed on to your heirs, allowing the investments to continue to grow over their lifetime without a tax. That is a really, really big deal, but the trust has to be handled under specific protocols when you die. Very few advisors follow the protocols.

Section 408 defines something that you know as an IRA. Someone who knows the laws can make your investments sing, but if you do not understand 408 laws, you cannot make your IRA grow nearly as fast. I am not just talking about the rules of putting money in, getting a tax deduction, then taking it out when you are age 59, and the like.

I am talking about being able to have an IRA own real estate, run businesses, pay money out over your lifetime starting at any age, and do lots of other things most people do not know they can do.

Standard IRA vs. Roth IRA

One of the questions people have is whether they should contribute to a standard IRA or a Roth IRA. A standard IRA contribution will give you a tax deduction, and then you pay the tax when the investment is taken out of it.

The tax deduction is a special type of deduction. It is not just a "standard deduction." It actually lowers your Adjusted Gross Income (AGI). In fact, it is one of the few things an individual can do to lower their AGI. Always check to see what affect a standard IRA contribution will have on your annual tax return. If the deduction lowers your AGI and puts you in a lower tax bracket, by all means, use a standard IRA that year.

Is there an economic advantage to a standard IRA or a Roth IRA? The following chart runs through a little sequence and shows what would happen if you have earned $5,000 that you want to put into either a Roth IRA or a standard IRA.

Note that you do not get to invest the entire $5,000 into the Roth, because you have to tax the $5,000 before you can put any money into it. The full $5,000 goes into the standard IRA because it is a deductible dollar.

When money comes out of the standard IRA, all of this money has to be taxed. Making the assumption that returns on investments are the same and that you pay a 25 percent tax on the money, you can see that the results of investing in a standard IRA and a Roth IRA are identical. The money you will spend in retirement is the same.

That is a little surprising; because you have always been told that the Roth IRA was the "end all, do all" of investing.

This chart makes one bad assumption: It assumes that the tax rates remain the same throughout the period. Tax rates change a lot. If taxes are going to be higher when you retire, you want to use a Roth IRA. If they are going to be lower, you want to use a standard IRA.

Today, tax rates are at an historic low. Believe it or not, that is true. Taxes are going to go up – way up. I am convinced more than ever that politicians do not understand taxes. Our economy will die when taxes go up, but it is safe to say that the tax rate will be higher when you retire than it is today.

If you know taxes are going up, the Roth really is neat. You may not have a Roth IRA. Many people would love to be putting money into a Roth, but they have never qualified.

If your AGI is over a certain amount (approximately $170,000) in a year, you cannot create or contribute to a Roth IRA in that year. There are many ways to lower your AGI, but you need to start today. Your options are limited at the end of the year.

Inherited IRAs

Your IRA is the most valuable investment that you can leave to your heirs. However, most kids blow their opportunity when they get an "inherited IRA." One of the most important things you can teach your kids is the financial secrets of an inherited IRA.

An IRA can be "stretched" over the lifetime of the person who inherits it. One of the most important financial concepts you can teach your children is the power of an inherited IRA. That cannot be said too many times. It is really important!

Most kids are either ignorant or just naive. As soon as they get their hands on the IRA, they think that it is "free money." They take the money out of the IRA and go to Hawaii. What they do not realize is that is the most expensive trip they will ever take by a factor of ten.

There are many rules to follow, but if you can teach your child to keep the IRA, it will produce income for them for the rest of their life. You know the miracle of compounding interest. Having the IRA growing tax-free over the next generation's life is compounding interest on steroids.
Even a moderate IRA can produce millions of dollars over the next generation's lifetime. If you can leave your IRA to a grandchild and have it grow during the 80-year life of the grandchild, the grandchild will get to spend a great deal of money. It is the best inheritance they can get, but they have to know what to do with it.

You have to teach your heirs to keep the IRAs and not cash them in. Make sure they know how to follow all of the rules so that the inherited IRA can be "stretched" over their lifetimes. The family has to file papers with the IRS and jump through some hoops, but there is no question: it is worth all that effort.

The person who inherits the IRA will have to immediately start taking out required minimum distributions based on his or her own life expectancy. The facts are, even with a conservative investment, the IRA will grow faster than when money is taken out as required minimum distributions.

Note that an IRA is a trust. It should almost never have an estate planning trust as its beneficiary. Remember to always make a "person" the beneficiary. Simply put, an inherited IRA can be a money machine for the person who inherits it. Make sure everybody understands what has to be done to make the machine work.

Section 408 Trusts – The Tax Shelter Every Business Owner Should Use - HBMA - Healthcare Billing and Management Association for 1st and 3rd Party Billers - Medical Billing, Practice Management

Follow This 3-Step Advice Before Waiving Copays

Follow This 3-Step Advice Before Waiving Copays

Tip: Get your own verification of financial hardship.

Every Physician wants to collect his due payment, even if it accumulates in small amounts through copays or deductible. Though you often hear advice pointing you away from offering discounts or waiving fees, there are times when that approach can be your best option. Our experts share three steps to properly waiving patient fees based on financial hardship.

1. Understand the Exception to the Rule

Routinely waiving deductibles and copayments can violate several federal laws and regulations, including the federal False Claims Act, anti-kickback statutes, and compliance guidelines for individual and small group physician practices. Doing so may also violate payer contracts.

In black and white: "Physicians or suppliers who routinely waive the collection of deductible or coinsurance from a beneficiary constitute a violation of the law pertaining to false claims and kickbacks," CMS says in the Medicare Claims Processing Manual, chapter 23, section 80.8.1. This applies not only to Medicare payers, but also those private carriers that base their regulations on Medicare rules.

Even though the rule is that you shouldn't offer waivers and discounts, you can make exceptions based on financial hardship-- if you follow a few guidelines.

"Waivers or discounts... should be made only on the basis of demonstrated patient financial need," says Barbara Colburn, president/CEO of B.C. & Associates Management Corp., a Wisconsin-based health care consulting/billing organization. According to Colburn, you must meet the following criteria:

1. You do not offer the waiver as part of any advertisement or solicitation
2. You do not offer waivers routinely to patients

You offer the waiver after determining, in good faith, that the individual is in financial need or after reasonable collection efforts have failed.

"In offices that i managed we always had the option of a financial hardship waiver but it was usually offered only after all the other means of collecting were exhausted such as insurance, payment plans, etc." says Marge McQuade, CMSCS, CMM, a consultant in Florida.

Note: You can offer discounts to patients with no insurance who are self-paying without proving financial hardship. Offering waivers or discounts to insured patients, including Medicare patients, "may be suspect unless they are non-routine and related to genuine hardship," Colburn says.

Pointer: "Have a financial policy in place about how you handle patients with financial hardships," advises Catherine Brink, CMM, CPC, CMSCS, owner of HealthCare Resource Management, Inc., in Spring Lake, N.J. "This is very important since it ensures you don't 'discriminate' how you handle finances with your patients."

2. Get It in Writing

Don't just take the patients word for it when it comes to financial hardship. Before you agree to debt write-off, the patient needs to be able to prove he is unable to pay.

First, document the effort you took to collect the money. "Where a physician/supplier makes a reasonable collection effort for the payment of coinsurance/deductible, failure to collect payment is not considered a reduction in the physician's/supplier's charge," CMS says in the Medicare Claims Processing Manual, chapter 23, section 80.8.1. "To be considered a reasonable collection effort, the effort to collect Medicare coinsurance/ deductible amounts must be similar to the effort made to collect comparable amounts from non-Medicare patients. It must also involve the issuance of a bill to the beneficiary or to the party responsible for the patients personal financial obligations. In addition, it may include other actions, such as subsequent billings, collection letter and telephone calls or personal contacts which constitute a genuine, rather than token, collections effort."

If you want to prove financial hardship, you'll need to ask the patient to provide you with information such as income tax returns and W-2 and 1099 forms as proof of income and essential monthly household expenditures, such as mortgage/rent, utilities, insurance, and food.

You'll then use this information to determine whether the patients earnings meet state and federal poverty guidelines. "Make sure you work within the poverty guidelines for your state," McQuade cautions.

Official Guidance: The Office of the Inspector General (IOG) states, "we do not believe it is appropriate to apply inflated income guidelines that result in waivers for beneficiaries who are not in genuine financial need."

The patient and the physician should also sign a statement detailing that the practice reviewed proof of financial hardship and listing what charges the practice is waiving. You practice should keep a copy and provide a copy to the patient as well.

"The provider should keep up with legal developments related to discounts and waivers of co-payments and deductibles," Colburn explains.

Key to success: You also should only apply the determination of financial hardship to the particular visit or service you are billing for at the time, not to any future services.

3. Don't Avoid Collections If Waiver Is a No Go

If a patient applies for financial hardship but your practice deems that the patient does not meet the qualifications for a waiver, you should send a waiver denial form. But don't let that stop your collections efforts and end up in a write off. You then need to proceed with billing the patient and letting him know you expect payment.

Option: "If a patient applied for financial hardship and doesn't qualify, the next step would be to offer a payment plan for the patient, depending, of course, on the amount the patient owes and at what point you are doing the waiver (after insurance, self pay with payment plan first, etc.)," McQuade says.

"For example, ask for a credit card to keep on file that you would charge, say $50 each month," agrees Brink. "Have the patient sign this financial agreement." If the patient doesn't have a credit card, then set up a financial payment plan signed by the patient stating that he will pay by check or cash by a certain day of each month and the amount he will pay plus the date the balance will be paid in full, Brink adds.

Courtesy of: The Coding Institute: Family Practice Coding Alert

Time management: Tips to reduce stress and improve productivity

Effective time management is a primary means to a less stressful life. These practices can help you reduce your stress and reclaim your personal life.

By Mayo Clinic staff
Do you find yourself overwhelmed by the number and complexity of projects that need to be completed at work each day? As the day flies by, do you often feel as if you haven't paid enough attention to each task because other tasks keep landing on your desk, co-workers interrupt you with questions or you can't get it all organized?
You probably know that managing your time effectively will help you get more done each day. But it has important health benefits, too. By managing your time more wisely, you can minimize stress and improve your quality of life.
But how do you get back on track when organizational skills don't come naturally? To get started, choose one of these strategies, try it for two to four weeks and see if it helps. If it does, consider adding another one. If not, try a different one.

• Plan each day. Planning your day can help you accomplish more and feel more in control of your life. Write a to-do list, putting the most important tasks at the top. Keep a schedule of your daily activities to minimize conflicts and last-minute rushes.
• Prioritize your tasks. Time-consuming but relatively unimportant tasks can consume a lot of your day. Prioritizing tasks will ensure that you spend your time and energy on those that are truly important to you.
• Say no to nonessential tasks. Consider your goals and schedule before agreeing to take on additional work.
• Delegate. Take a look at your to-do list and consider what you can pass on to someone else.
• Take the time you need to do a quality job. Doing work right the first time may take more time upfront, but errors usually result in time spent making corrections, which takes more time overall.
• Break large, time-consuming tasks into smaller tasks. Work on them a few minutes at a time until you get them all done.
• Practice the 10-minute rule. Work on a dreaded task for 10 minutes each day. Once you get started, you may find you can finish it.
• Evaluate how you're spending your time. Keep a diary of everything you do for three days to determine how you're spending your time. Look for time that can be used more wisely. For example, could you take a bus or train to work and use the commute to catch up on reading? If so, you could free up some time to exercise or spend with family or friends.
• Limit distractions. Block out time on your calendar for big projects. During that time, close your door and turn off your phone, pager and email.
• Get plenty of sleep, eat a healthy diet and exercise regularly. A healthy lifestyle can improve your focus and concentration, which will help improve your efficiency so that you can complete your work in less time.
• Take a time management course. If your employer offers continuing education, take a time management class. If your workplace doesn't have one, find out if a local community college, university or community education program does.
• Take a break when needed. Too much stress can derail your attempts at getting organized. When you need a break, take one. Take a walk. Do some quick stretches at your workstation. Take a day of vacation to rest and re-energize.
• Ask for professional help
  If you're too frazzled to think about trying any of these tips, it's time to ask for help. Does your life feel totally out of control? If so, contact your employee assistance program (EAP) at your workplace for assistance, or discuss your situation with your doctor.

Courtesy of: Mayo Clinic: http://www.mayoclinic.com/health/time-management/WL00048/NSECTIONGROUP=2

 

How To Start Your Own Medical Billing Service: 5 Star Review on Amazon!

http://www.amazon.com/review/R10YDMX85DE9NJ/ref=cm_cr_dp_title?ie=UTF8&ASIN=1484928180&channel=detail-glance&nodeID=283155&store=books

Customer Review

A perfect starting point for those looking to start their own business, July 16, 2013 By lb This review is from: How to Start Your Own Medical Billing Service: Becoming Self Employed (Paperback) This book was all that I was hoping for when purchasing it. It gives a great overview on all aspects of starting your own medical billing service from home. It gives brief information on things you will need to start a business and gets into more detail on specific aspects of a medical billing business. I now have a better perspective and understanding of what I am getting myself into. The book is a perfect starting point. I am excited to get started and now I have a better outlook on the challenges that lie ahead and a better understanding of where to start.

How the New HIPAA Regulations Affect Billing Companies and Their Subcontractors as Business Associates

How the New HIPAA Regulations Affect Billing Companies and Their Subcontractors as Business Associates

Develop an Action Plan for Your Company and Subcontractors

An article by Robert A. Polisky, Esq.,  taken from the May/June issue of HBMA Billing.
       
On January 25, 2013, the Office for Civil Rights of the U.S. Department of Health & Human Services (OCR) published the anticipated final omnibus rule (the Final Rule). This rule created significant changes to the Privacy, Security, Breach Notification, and Enforcement Rules under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), many of which are required by the Health Information Technology for Economic and Clinical Health Act (HITECH Act). The Final Rule also implements changes to the Genetic Information Nondiscrimination Act of 2008.

The scope of the Final Rule is extensive, and enhances OCR's ability to enforce HIPAA. In the press release announcing the Final Rule, OCR Director Leon Rodriguez proclaimed that the Final Rule "marks the most sweeping changes to the HIPAA Privacy and Security Rules since they were first implemented" and "strengthen[s] the ability of my office to vigorously enforce the HIPAA privacy and security protections…." Individuals and entities affected by the Final Rule must comply with most of its provisions by September 23, 2013.
This article addresses key provisions of the Final Rule applicable to billing companies and their subcontractors, enforcement changes, and recommended action items needed for compliance by billing companies and their subcontractors.

KEY PROVISIONS

Business Associates and Their Subcontractors

Expanded Definition of "Business Associate"
The Final Rule expands the definition of a "business associate" to include any individual or entity that creates, receives, maintains, or transmits protected health information (PHI) on behalf of a covered entity. Companies that code, bill, and/or collect claims on behalf of a health care provider (i.e., a covered entity), are business associates under HIPAA. Notably, the Final Rule includes subcontractors that create, receive, maintain, or transmit PHI on behalf of a business associate as business associates themselves. Thus, any subcontractors that a billing company engages to assist in coding, billing, or collections, and any subcontractors that store or transmit any healthcare records on the billing company's behalf, are business associates of the billing company.

Direct Liability
As business associates, the Final Rule requires billing companies and their subcontractors to comply with the Security Rule's administrative, physical, and technical safeguard requirements as well as with the Security Rule's policies and procedures and documentation requirements. These requirements apply to business associates in the same manner as they apply to covered entities, such that billing companies and their subcontractors can be held civilly and criminally liable for violations of these requirements. Similarly, the Final Rule applies certain Privacy Rule requirements to business associates and establishes direct liability of business associates for violations of these requirements. A billing company does not need to provide a notice of privacy practices or designate a privacy official unless the covered entity designated such a responsibility in the billing company's business associate agreement.

Specifically, billing companies and their subcontractors, as business associates, have direct civil and criminal liability exposure for the following items.

1. impermissible uses and disclosures of PHI
2. failure to provide breach notification to the covered entity
3. failure to provide access to a copy of electronic PHI to either the covered entity, the individual, or the individual's designee (whichever is specified in the business associate agreement)
4. failure to disclose PHI to OCR where required by OCR to investigate or determine the business associate's compliance with HIPAA
5. failure to provide an accounting of disclosures
6. failing to enter into business associate agreements with subcontractors that create or receive PHI on the business associate's behalf
7. failure to comply with the requirements of the Security Rule

Billing companies and their subcontractors also remain contractually liable for all other Privacy Rule obligations that are included in their business associate agreements.
Business Associate Agreements
The Final Rule clarifies that a covered entity is not required to enter into a business associate agreement with a billing company's subcontractor. Rather, the billing company that engaged a subcontractor to perform a function or service involving the use or disclosure of PHI is required to enter into a business associate agreement with the subcontractor. Each business associate agreement in the business associate chain needs to be at least as restrictive as the agreement above it in the chain with respect to permissible uses and disclosures of PHI.
The Final Rule expands the requirements of a business associate agreement by obligating a business associate to comply, where applicable, with the Security Rule with regard to electronic PHI; report breaches of unsecured PHI to the covered entity; and ensure that any subcontractors that create or receive PHI on its behalf agree to the same restrictions and conditions that apply to the business associate with respect to such information.

Transition Period
The Final Rule delays compliance until September 22, 2014 for a covered entity or business associate to enter into a business associate agreement with a business associate or subcontractor if, prior to January 25, 2013, the covered entity or business associate had a business associate agreement with the business associate or subcontractor, as applicable, that complied with HIPAA prior to the Final Rule (unless the business associate agreement was modified or actively renewed between March 26, 2013 and September 23, 2013). In all other cases, covered entities and business associates will need to execute business associate agreements with their business associates and subcontractors no later than September 23, 2013.

Modification To The Breach Notification Rule

Background
Under the HITECH Act, a covered entity is required to notify affected individuals and OCR following discovery of a breach of unsecured PHI; a covered entity also needs to notify the media of a breach involving more than 500 residents of a state or jurisdiction. A business associate, in turn, is required to notify a covered entity following discovery of a breach of unsecured PHI at or by the business associate.
On August 24, 2009, OCR issued an interim final rule implementing the HITECH Act's breach notification provisions ("Breach Notification Interim Rule"). In the Breach Notification Interim Rule, a "breach" is defined as the acquisition, access, use, or disclosure of PHI in a manner not permitted under the Privacy Rule that "compromises the security or privacy" of the PHI, with certain exceptions. Moreover, under the Breach Notification Interim Rule, "compromises the security or privacy" of the PHI is defined to mean that an impermissible use or disclosure of PHI poses a significant risk of financial, reputational, or other harm to the individual (the "harm standard").
Revised Definition of "Breach"
The Final Rule significantly revises the definition of "breach" to clarify that an impermissible use or disclosure of PHI is presumed to be a breach unless the covered entity or business associate, as applicable, demonstrates that there is a low probability that the PHI has been compromised. By replacing the "harm standard" with this "low probability" standard, it is more likely under the Final Rule than under the Breach Notification Interim Rule that covered entities and business associates will determine that an impermissible use or disclosure of PHI "compromises the security or privacy" of the PHI, resulting in many required breach notifications that would not have been required previously.
Modification of Risk Assessment
Under the Final Rule, to determine whether there is a low probability that PHI has been compromised, covered entities and business associates need to conduct a risk assessment that considers at least the following factors:

• the nature and extent of the PHI involved, including the types of identifiers and the likelihood of re-identification;
• the unauthorized person who used the PHI or to whom the disclosure was made;
• whether the PHI was actually acquired or viewed; and
• the extent to which the risk to the PHI has been mitigated.

If an evaluation of the above factors, taken together, fails to demonstrate that there is a low probability that PHI has been compromised, breach notification will be required.

Right to Restrict Disclosure to a Health Plan

Under the Final Rule, health care providers, upon request from an individual, must agree to restrict disclosure of PHI about the individual to a health plan if the disclosure would be for the purpose of carrying out payment or healthcare operations, and is not otherwise required by law, or the PHI pertains solely to a healthcare item or service for which the individual, or person acting on the individual's behalf (other than the health plan), has paid the covered entity in full. To avoid payment issues, a health care provider may want to require payment in full at the time of the individual's request for a restriction. Health care providers may request assistance from billing companies to comply with this new restricted disclosure requirement.

ENFORCEMENT

Discretion
The Final Rule gives OCR discretion to use informal means to resolve HIPAA violations. However, OCR is permitted to impose a civil monetary penalty without exhausting informal resolution efforts, especially when the HIPAA violation is due to willful neglect. The Final Rule also allows OCR to coordinate with other law enforcement agencies, such as state attorneys general and the Federal Trade Commission, with respect to pursuing remedies against HIPAA violators.
Tiered Penalty Amounts
Under the HITECH Act, there are four tiers of increasing penalty amounts that correspond to the levels of culpability associated with a HIPAA violation. The minimum fines range between $100 and $50,000 per violation, and are capped at $1.5 million for all violations of the same HIPAA provision during any calendar year (see below table). The lowest category of violation covers situations where the covered entity or business associate did not know, and by exercising reasonable diligence would not have known, of the HIPAA violation. The second lowest category of violation applies to violations due to reasonable cause and not to willful neglect. The third category applies to situations where the violation was due to willful neglect and was corrected within 30 days of when the covered entity or business associate knew, or should have known, of the violation. The fourth category applies to situations where the violation was due to willful neglect and not corrected within 30 days of when the covered entity or business associate knew, or should have known, of the violation.
The Final Rule modifies the definition of "reasonable cause" to mean "an act or omission in which a covered entity or business associate knew, or by exercising reasonable diligence would have known, that the act or omission violated [HIPAA], but in which the covered entity or business associate did not act with willful neglect." The Final Rule keeps the definition of "willful neglect" as the "conscious, intentional failure, or reckless indifference to the obligation to comply" with HIPAA.
Counting Violations
In the preamble to the Final Rule, OCR states that how it counts HIPAA violations for purposes of calculating a civil monetary penalty varies depending on the circumstances surrounding the violation. OCR explains that where multiple individuals are affected by a HIPAA violation (e.g., a breach of unsecured PHI), it is anticipated that the number of identical HIPAA violations would be counted by the number of individuals affected. OCR also explained that, with respect to continuing violations (e.g., a lack of appropriate safeguards for a period of time), it is anticipated that the number of identical HIPAA violations would be counted on a per day basis (i.e., the number of days the covered entity or business associate did not have appropriate safeguards in place to protect the PHI). OCR notes that in many HIPAA breach cases, there would be an impermissible use or disclosure as well as a safeguards violation, for each of which OCR would be entitled to calculate a separate civil monetary penalty. Needless to say, the amount of civil monetary penalties that could be imposed against a billing company or one of its subcontractors for a HIPAA violation can be quite substantial.
Factors Used to Determine a Penalty
The Final Rule lists the following five factors that OCR will consider in determining the amount of a civil monetary penalty.

1. the nature and extent of the HIPAA violation, including the number of individuals affected and the duration of the violation
2. the nature and extent of the harm resulting from the violation, including physical, financial, and reputational harm, and any hindrance to an individual's ability to obtain healthcare
3. the history of prior compliance with HIPAA, including whether the current violation is the same/similar to prior indications of noncompliance by the covered entity or business associate and their attempts to correct that noncompliance
4. the financial condition of the covered entity or business associate, including any financial difficulties that could have affected compliance and whether a civil monetary penalty could jeopardize the future provision of healthcare
5. such other matters as justice may require

Agency Liability
The Final Rule makes covered entities and business associates liable for the acts of their business associate agents, regardless of whether the covered entity or business associate knew of the violation or had a compliant business associate agreement in place. According to OCR, the key factor in determining whether an agency relationship exists between a covered entity and its business associate, or between a business associate and its subcontractor, is the principal's right to control the agent's conduct in the course of performing a service on behalf of the principal. OCR observes that a business associate agent's conduct generally is within the scope of agency when its conduct occurs during the performance of the assigned work or incident to such work, regardless of whether the work was done carelessly, a mistake was made in the performance, or the business associate disregarded a covered entity's specific instruction. OCR further observes that, in contrast, a business associate agent's conduct generally is outside the scope of agency when its conduct is solely for its own benefit (or that of a third party), or it pursues a course of conduct not intended to serve any purpose of the covered entity. To protect itself, a billing company's services agreement with a subcontractor should specify that the subcontractor is engaged as an independent contractor, not as an agent, and the billing company does not have the right to control the subcontractor's performance.

RECOMMENDED ACTION ITEMS

Although billing companies and their subcontractors have until September 23, 2013 to fully comply with the Final Rule, they should begin preparing soon in light of the significant number of new or modified compliance obligations. In particular:

• Covered entities will need to revise, negotiate, and execute business associate agreements with billing companies compliant with the Final Rule by September 23, 2013 to the extent they did not have business associate agreements in place as of January 25, 2013 that were HIPAA compliant. They have until September 22, 2014 to do so to the extent they had business associate agreements in place as of January 25, 2013 that were HIPAA compliant. OCR gives a fair amount of latitude in the content of business associate agreements, so it is important for billing companies to ensure that they are not overcommitting to responsibilities or deadlines that are not required under HIPAA.
• Billing companies that use subcontractors that create, receive, maintain, or transmit PHI on their behalf will need to draft, negotiate, and execute business associate agreements with them by September 23, 2013. Billing companies will need to ensure that these business associate agreements are at least as stringent as their business associate agreements with covered entities, and enable billing companies to meet deadlines in their business associate agreements with covered entities.
• Billing companies, including subcontractors, will need to conduct a security risk assessment, implement a written HIPAA security plan, designate a security official, and create certain written HIPAA privacy policies by September 23, 2013 to the extent they have not already done so. OCR has posted guidance on compliance with the HIPAA Security Rule found at www.hhs.gov/ocr/privacy/ hipaa/administrative/securityrule that may be helpful to billing companies and their subcontractors and facilitate their compliance efforts.
• Billing companies and their subcontractors will need to perform a gap analysis to determine what HIPAA policies and procedures need to be revised to comply with the Final Rule, and then will need to revise them by September 23, 2013 based on the gap analysis.
• Billing companies and their subcontractors will need to update by September 23, 2013 their breach notification policies and any tools concerning how to conduct a risk assessment to determine whether breach notification is required.
• Healthcare providers may ask billing companies to implement by September 23, 2013 a method to flag or make a notation in the record with respect to PHI concerning an item or service paid in full by an individual – or person acting on the individual's behalf (other than a health plan) – to ensure that such information is not inadvertently sent to or made accessible to a health plan for payment or healthcare operations purposes, such as audits by the health plan.
• Billing companies and their subcontractors will need to update their HIPAA training materials and then train their workforce members (i.e., employees, volunteers, trainees, and other persons under their direct control) by September 23, 2013 to comply with HIPAA.

Given the breadth and potential penalties under the Final Rule, billing companies and their subcontractors should review their data flows (i.e., the complete lifecycle of PHI that they create, receive, maintain, or transmit) and then perform an updated risk analysis based on that review, including a risk analysis of mobile devices. Billing companies and their subcontractors will need to determine whether to encrypt these devices in light of the increasing prevalence of large penalties imposed by OCR on entities whose mobile devices, such as laptop computers and smartphones, containing unencrypted PHI have been lost or stolen. Further, covered entities and business associates should consider whether it would be cost-effective for them to purchase HIPAA liability insurance given the risk of substantial penalties for HIPAA violations.

Courtesy of: http://www.hbma.org/news/public-news/n_how-the-new-hipaa-regulations-affect-billing-companies-and-their-subcontractors-as-business-associates

Billing Medicare for Non-Physician Providers

Become Fluent in the Federal Rules

An article by Richard R. Wier, Jr., Esq., taken from the May/June issue of HBMA Billing (hbma.org)
The Centers for Medicare and Medicaid Services (CMS) and federal law enforcement agencies have increased efforts to combat healthcare fraud. In order to help fund these efforts, the Patient Protection and Affordable Care Act (PPACA) has increased the Health Care Fraud and Abuse Control Program's funding by $350 million from fiscal year 2011 to fiscal year 2020. As a result of these increased efforts and funding, in October 2012, the Medicare Fraud Strike Force charged 91 individuals, including doctors, nurses, and other licensed medical professionals, for their participation in falsely billing the Medicare program, resulting in approximately $429.2 million in penalties.

According to the False Claims Act, fraudulent billing under Medicare includes, but is not limited to, billing for tests not performed, performing inappropriate or unnecessary procedures, upcoding by using more expensive billing codes when lower priced procedures were performed, and various other billing inflation practices. When billing, health care providers must remain vigilant of the ever-changing billing and coding laws and pertinent state regulations to ensure that they are not improperly submitting Medicare claims.

One billing issue that may arise is the improper billing of Non-Physician Providers (NPPs), such as physician's assistants, nurse practitioners, and clinical nurse specialists. NPPs are able to enroll and bill Medicare for services that they are licensed or certified to perform within the state. When NPPs work independently, they are recognized under Medicare for professional billing and are able to bill Medicare under their own Medicare provider numbers; however, the reimbursement by Medicare is only 85% of the Medicare Physician Fee Schedule (MPFS). The MPFS provides the billing codes and proper coding methods that are required when requesting reimbursement from Medicare for services provided. Conversely, NPPs who perform services that are incident to the physician's course of treatment, which are known as "incident-to services," can bill Medicare for the services provided by the NPP under the physician's Medicare provider number, and the health care provider would receive 100% reimbursement from Medicare under the MPFS. In order for NPPs to bill incident-to services, Medicare requires that the physician perform an initial visit with the patient in order to establish the physician-patient relationship. After the initial visit, the physician does not need to be involved in each patient visit, but must actively participate in the management of the course of treatment for the patient. Although not required by Medicare, some carriers require that the physician meet with the patient every third visit or when a new symptom or medical issue arises.

When determining whether to bill for services provided by the NPP independently or incident-to the physician's services, health care providers must verify the scope of practice for the NPP, the place of service, and physician supervision over the NPP. There are a variety of resources available for guidance, including Title 42 of the Code of Federal Regulations (CFR); coding and billing under the Medicare Physician Fee Schedules (MPFS), as previously mentioned; and state laws and regulations. The CFR is a federal law that provides minimal standards necessary for billing under Medicare. Health care providers must keep in mind, however, that it is imperative to look at state law first because it may be more stringent than the federal law. State law will specify the scope of practice, certification and licensing, and level of supervision required for each type of NPP, and these factors determine whether the NPP can bill incident-to services under the physician's Medicare provider number, which will result in 100% reimbursement under the Medicare Physician Fee Schedule for services performed. Therefore, the health care provider who employs NPPs must fully review state laws in order to ensure that proper billing is submitted to Medicare for reimbursement.

The most important state law regulation to consider when billing incident-to services is the level of supervision required by a physician when an NPP treats a patient. Some state laws allow NPPs to bill under the physician's Medicare provider number when conducting incident-to services that relate to the physician's course of treatment without requiring the physician to be physically present during the meeting. The incident-to services must be part of the physician's course of diagnosis or treatment of an injury or illness, and the physician must supervise the services provided to the patient by the NPP. State law will define "supervision" as it is to be applied to Medicare billing. For instance, some states do not require the supervisory physician to be present in the room, nor does the physician have to provide any care during a patient visit. However, a physician in a supervisory role must still be "present on the premises" and immediately available to assist the NPP in providing services if necessary. State law can also define the specific meaning of "present on the premises." Similarly, the location where the services are provided will affect the way in which billing is submitted to Medicare, because incident-to services performed by an NPP in a hospital are directly paid to the hospital, and hospitals are reimbursed differently under Medicare. With these factors in mind, it is imperative for the health care providers who employ NPPs to verify state law for regulations regarding the location, scope of practice, and level of supervision required for an NPP when billing Medicare – especially since these laws are constantly changing.

Preparing your clients practices' for the government's increased scrutiny of fraudulent billing and overpayments are crucial. Therefore, it is important to meet with your legal counsel to identify risks and discuss preventive measures to ensure your doctors are in compliance with state and federal laws and regulations.

Courtesy of HBMA
Billing Medicare for Non-Physician Providers - HBMA - Healthcare Billing and Management Association for 1st and 3rd Party Billers - Medical Billing, Practice Management

What is a superbill?

What is a superbill? Also known as a charge slip or patient encounter. A superbill is an itemized form consisting of CPT, HCPC and ICD-9-CM/ICD-10-CM codes. This form is completed by a provider to communicate services rendered to his biller.

 

The patient name, date of birth, medical record number, demographic information and insurance information is commonly found at the top of a superbill.
When the patient arrives at their physician's office the receptionist prints a superbill. The physician will complete the superbill during and/or after seeing the patient and completing the chart notes. The superbill then goes to the medical biller to enter into the billing software and send a claim electronically or by paper to the patients insurance company.
Electronic Medical Records (EMR) programs will have a superbill template on the screen the physician uses, often on a tablet. The physician simply chooses the diagnosis/diagnoses and service(s) rendered by touching his screen. The information is then sent electronically to the medical biller. Then it is reviewed and converted onto a claim form for electronic or paper claim billing to the insurance company.
By: Gina Thatcher of Smart Billing Solutions www.smartbillingsolutions.net

HBMA request for information program! Join for recommendations to physicians

HBMA 2013 Fall Conference Attendee Registration - HBMA - Healthcare Billing and Management Association for 1st and 3rd Party Billers - Medical Billing, Practice Management

HBMA 2013 Fall Conference Attendee Registration - HBMA - Healthcare Billing and Management Association for 1st and 3rd Party Billers - Medical Billing, Practice Management