Probably no other aspect of your practice raises as many questions, concerns and frustrations as the billing process. Should you stay in-house or outsource? Submit claims yourself or use a clearing house? Are you getting paid what you deserve? And what to do about all those denials?

Can we reduce our "busy work?"

Many front-office staffs are faced with the tedious challenge of retyping the same patient data over and over – first into the scheduling software, then into the documentation software, then into the billing software, etc. AppointmentsPRO reduces your data entry through built-in capabilities with leading billing systems from companies like BMS Reimbursement, MDeverywhere, PTOS, DBC and TurboPT, Vernon F. Glaser & Associates and Innovative Healthcare Services (as well as with documentation systems like ReDoc and MediNotes).

Once you enter a patient’s demographic data into one of these billing systems, that information is immediately available to AppointmentsPRO so that you can select that new patient and schedule an appointment. This makes certain billing systems much more attractive for practices currently using AppointmentsPRO.

Can we accelerate our cash flow?

Some companies offer billing submission services that can speed the time it takes to get your claim processed and paid. For instance, AppointmentsPRO shares demographic data with Vernon F. Glaser & Associates, a company that offers in-house billing and practice management systems for a wide range of medical specialties. Using Glaser’s system, practitioners are equipped with wireless tablet PCs to fully document each patient encounter. The practice then uses the systems billing software to code and bill each case. That data is then transmitted to Glaser & Associates, which submits the claims to each insurance provider electronically in a standardized format for faster approval. An added benefit of this approach is that the submission system electronically reviews all of the coding to ensure accuracy and compliance with each carrier’s rules.

Are we getting paid what we deserve?

As a recent article in Health Management Technology put it, "If you’re not coding, you’re not billing." These days, it’s a full-time job simply to keep up with the ever-changing rules and acceptance standards of the insurance industry, much less do the actual billing and submission. No two insurance carriers accept the same set of codes, and the range of codes that any one carrier accepts varies almost daily. Even the codes themselves are evolving: ICD-9 codes are revised each year; CPT codes are updated four times a year.

That’s why – in most cases -- it takes a a full-fledged billing service to identify everything from a patient encounter that should be coded, understand the nuances of every insurance company’s unique acceptance standards and submit each claim in the way that generates the most revenue for the practice.

The boost in revenue a billing service can deliver is often tremendous. "There are some practices losing as much as 24% of their potential collections because they use incorrect codes, lower-paying codes and make other preventable billing mistakes," says John Wallace, PT, OCS, the Vice President of Client Services at BMS Reimbursement Services, Inc., a billing and collections service for the rehab industry. "It’s pretty rare that we can’t increase a practice’s revenue significantly."

Coding for rehab is particularly complex, according to James C. Hall, CPA, General Manager at Rehab Management Services. "Rehab is the most complicated field to code for, short of oncology," he says. "Take the time to find a company that specializes in the type of work you do. Then give them a few EOBs and let them explain what they can do for you."

By putting your own codes into AppointmentsPRO, you give a billing service the data they need to fully analyze your cases and come up with the best solutions for your needs.

Are we in the business of healthcare or billing?

"Most people who outsource their billing realize it’s not their expertise or passion," says Hall. "They also realize that it’s expensive, with thousands in startup costs to acquire the necessary hardware and software, followed by monthly staff expenses."

For these people, AppointmentsPRO features an extensive integration with several billing services that provides a literally hands-free billing solution. Your practitioners simply log the details of each patient encounter in AppointmentsPRO, then the system transmits that data to the billing service automatically, where the case is reviewed, the coding is revised as necessary, the claim is submitted and any denials are immediately revised and resubmitted.

Details of each claim are updated daily and available online, so a practice can maintain control over the entire process without getting mired in the actual billing details. Current participating companies include BMS (rehab), MDeverywhere (general medical billing, focusing on practices in NY, NJ and CT) and Innovative Healthcare Services (general medical). You can find out more about this integration by calling SpectraSoft at 1-800-889-0450 ext.1.

Conclusion

Whether you choose to handle your billing in-house, outsource it, or something in between, AppointmentsPRO offers compatibilities that can enhance your solution. Let us know how you’re doing and if this article was helpful by emailing PMN at newsletter@ssoft.com.