If you’ve been following the news, you may have heard of President Obama’s plan to digitze all of the nation’s health records by the year 2014. In fact, the President has dedicated over $19 billion of his economic stimulus package specifically to kickstarting the digital health records revolution, by offering incentives to doctors and hospitals that take patients with Medicare and Medicaid (roughly 90% already do so), and setting up regional centers with “geek squads” to help physicians, hospitals and clinics get their digital records systems running smoothly. At the moment, only 17% of American doctors have a functioning digital records system in place, and less than 2% of the nation’s hospitals use electronic records in every department.
Obviously, this move will revolutionize the American health care system, effectively bringing it into the 21st century. But not everyone is happy about the change: Detractors have argued that the shift will do little to prevent costly medical errors such as misdiagnoses, and that the cost per office to make the switch to digital could be prohibitive, even with the government incentive. There are also worries about whether digital health records can adequately safeguard patient privacy.
What does all this mean for the medical billing profession? Fortunately, the shift to electronic records is great news for billers everywhere: Since almost all of their work is done on the computer already, it would be nice to see the rest of the industry catch up!
Monday, October 26, 2009
Are You HIPAA Compliant?
Whenever you are working with sensitive medical information, you must always make sure that you are complying with the guidelines set forth by the Health Insurance Portability and Accountability Act (HIPAA). HIPAA was passed by Congress in 1996 to establish a national standard for the security of health data, in order to protect the privacy of the patient. If you work in the medical billing industry, it is absolutely vital that you comply with HIPAA and the US Department of Health and Human Services’ Privacy Rule. Failure to do so can have a number of serious consequences, including loss of accreditation, federal lawsuits, financial penalties, and even imprisonment for up to 10 years. Unfortunately, your billing career will likely be a complete loss as well. How can you avoid these violations? Always begin by making sure that any software you invest in is HIPAA compliant, complete with password protection and encryption technology, in order to safeguard patient data. If you need any additional guidance, try consulting the government’s official HIPAA website.
Medical Billing vs. Medical Coding: What’s the Difference?
Medical billing and medical coding are two terms that are frequently mentioned in the same breath. To use the two interchangeably, however, would be a mistake. What’s the difference between medical billing and medical coding?
Essentially, medical billers build the bridge that connects physicians to patients and insurance providers. In order for a doctor or other medical specialist to receive payment for anything from a standard checkup to a costly operation, certain data regarding the nature of the services provided must be entered into billing software and transmitted to the insurance provider (or, if the patient lacks insurance, directly to the patient). Billers must have a keen eye for detail in order to ensure that all of the data provided is correct. They must also be prepared to follow up on delinquent accounts or investigate unpaid claims. Additionally, medical billers frequently work from home or in an office independent of the physician who employs them.
Medical coding, in contrast, focuses primarily on assigning the correct alphanumeric codes to the specific diagnoses and treatments outlined in each patient’s file. Coding requires a more in-depth knowledge of medicine, and is more likely to involve working with the medical provider on site. While it is entirely possible to forge a successful career in billing or coding alone, you may want to consider learning both in order to broaden your horizons and expand your employment opportunities.
Essentially, medical billers build the bridge that connects physicians to patients and insurance providers. In order for a doctor or other medical specialist to receive payment for anything from a standard checkup to a costly operation, certain data regarding the nature of the services provided must be entered into billing software and transmitted to the insurance provider (or, if the patient lacks insurance, directly to the patient). Billers must have a keen eye for detail in order to ensure that all of the data provided is correct. They must also be prepared to follow up on delinquent accounts or investigate unpaid claims. Additionally, medical billers frequently work from home or in an office independent of the physician who employs them.
Medical coding, in contrast, focuses primarily on assigning the correct alphanumeric codes to the specific diagnoses and treatments outlined in each patient’s file. Coding requires a more in-depth knowledge of medicine, and is more likely to involve working with the medical provider on site. While it is entirely possible to forge a successful career in billing or coding alone, you may want to consider learning both in order to broaden your horizons and expand your employment opportunities.
Medical Billing Mistakes to Avoid
Medical billing is an extremely detail-oriented profession. One single, seemingly tiny mistake can hold up an insurance claim and prevent the physician - your client - from receiving his or her payment in a timely manner. Such mistakes aren’t always easy to correct, either; the lengthy process of reviewing, fixing and resubmitting the claim can take valuable time away from your business. In the end, you even risk losing the trust of your clients.
Stop errors before they start by keeping the following commonly made medical billing mistakes in mind:
1. Wrong patient ID number. Always begin by double-checking the patient information!
2. Incorrect or missing physician ID. Likewise, make sure the physician is correctly identified.
3. Date of procedure not accurately reported. Again, this is an easy mistake to make - but it’s also easy to avoid.
4. Rates not accurately reported. Verify that the patient has been charged the correct amount for the services rendered.
5. Incorrect bill total. Always check your math!
6. Wrong codes provided. (A background in medical coding may prove extremely useful here.)
By and large, the majority of mistakes made by experienced, educated medical billers are easy to prevent with just a bit more attention to detail. Keep your focus on your work and your eye out for these common mistakes, and your billing practice will keep its sterling reputation.
This entry was posted on Friday, February 13th, 2009 at 1:38 am and is filed under
Stop errors before they start by keeping the following commonly made medical billing mistakes in mind:
1. Wrong patient ID number. Always begin by double-checking the patient information!
2. Incorrect or missing physician ID. Likewise, make sure the physician is correctly identified.
3. Date of procedure not accurately reported. Again, this is an easy mistake to make - but it’s also easy to avoid.
4. Rates not accurately reported. Verify that the patient has been charged the correct amount for the services rendered.
5. Incorrect bill total. Always check your math!
6. Wrong codes provided. (A background in medical coding may prove extremely useful here.)
By and large, the majority of mistakes made by experienced, educated medical billers are easy to prevent with just a bit more attention to detail. Keep your focus on your work and your eye out for these common mistakes, and your billing practice will keep its sterling reputation.
This entry was posted on Friday, February 13th, 2009 at 1:38 am and is filed under
What is medical billing?
Medical billing is one of the fastest-growing and most dynamic sectors of the health care industry. But what, exactly, does a career in medical billing entail? What is medical billing?
Essentially, medical billers serve as intermediaries between physicians or other health care providers and insurance companies, be they private or government-owned. Medical billing involves collecting fees from insurance companies in order to compensate doctors for their services.
A large number of health care providers rely on professional medical billers rather than handling their billing on their own. Why? Medical billers save physicians and their practices valuable time that they can instead devote to providing better care to their patients, and their expertise ensures that the billing procedure is carried out correctly. This makes the process easier on the insurance companies, and enables doctors to receive their payments in a more timely fashion. Additionally, professional medical billers save patients the trouble of dealing with doctors, insurance providers or even collections agencies. If you’re looking for a hands-on way to make a difference in the health care industry, medical billing may be the right career path for you.
Essentially, medical billers serve as intermediaries between physicians or other health care providers and insurance companies, be they private or government-owned. Medical billing involves collecting fees from insurance companies in order to compensate doctors for their services.
A large number of health care providers rely on professional medical billers rather than handling their billing on their own. Why? Medical billers save physicians and their practices valuable time that they can instead devote to providing better care to their patients, and their expertise ensures that the billing procedure is carried out correctly. This makes the process easier on the insurance companies, and enables doctors to receive their payments in a more timely fashion. Additionally, professional medical billers save patients the trouble of dealing with doctors, insurance providers or even collections agencies. If you’re looking for a hands-on way to make a difference in the health care industry, medical billing may be the right career path for you.
Tuesday, October 20, 2009
Research health insurance options before deciding
What you should know:
A health insurance policy is a contract between an insurance company and a person or a sponsoring group, such as an employer or government agency.
Most plans have a network of providers. Generally you pay less for care if you use an in-network provider. These providers agree to receive a lower payment for care to insured patients.
Health insurance policies are usually renewable annually. The premium is the amount the policy owner pays each month for health insurance. If you have individual insurance, you pay the entire premium-which might be very high if you have a chronic health condition. If you have group insurance you often pay only a portion of the premium.
Health insurance often requires costs beyond premiums. The deductible is an amount an insured person pays for care before the carrier begins paying. The copayment is a fixed amount you pay at each visit or procedure or for each prescription before the carrier pays. Coinsurance is the percent of all covered health expenses that an insured person must pay(often 20 percent) after the deductible has been met. The insurance plan covers the balance(often 80 percent).
Insurance companies have rules that may exclude payment for certain services. They also may require an authorization, referral or second opinion before allowing coverage of services. Rules might be waived temporarily for emergency care but may require notification of the carrier within 24 to 48 hours after the emergency.
Many employers offer group health insurance as part of their employee benefits packages. Employers usually have an open enrollment period each year, when employees can sign up for coverage, change coverage or add dependents to the plan.
Group insurance has several benefits. The sponsor, such as the employer or government, usually pays a large portion of the premium. Group policies often cost less per person because they spread out the risk among a lot of people, many of whom are will. In most cases, the insurance company agrees to insure everyone in the group, regardless of their condition or health history.
The average family health insurance premiums often costs more thatn $12,000 a year. The premium and out-of-pocket costs have increased greatly over the last eight years and are expected to grow.
Many people are denied health insurance or can't afford it. Many spouses and kids lose insurance coverage after a divorce. People often lose their health insurance when they lose their jobs. The cost of continuing a temporary policy(COBRA benefits) without the help of an employer can be exorbitant.
People without insurance often resort to extremely expensive emergency room care. Others do without needed care.
Many health insurance reform advocates want changes in the U.S. health insurance system including
(1) Ending discrimination against people with pre-existing conditions
(2)Preventing insurance carriers from dropping coverage on very sick people.
(3)Stabilizing and protecting Medicare and making needed prescription medication a covered benefits all year long.
(4)Preventing annual or lifetime limits on insurance coverage that cause many families to go bankrupt.
(5)Increasing access to preventive services to find health problems early when they are less costly and easier to treat.
What you should do
Choose your health plan and care providers wisely. Check their ratings, credentials, accreditations and reputation.
Before choosing a plan, find out if it will cover your needs and the costs. Make sure pre-existng conditions and the providers you need are covered.
Follow the rules of your plan. Know what your plan covers.
Be sure your providers get the required authorizations or referrals. Ask providers to make the required notifications to the carrier after an emergency.
Take charge of your health. Be involved in decisions about your care. Keep careful records of referrals, approvals, names of phone contacts and explanations of benefits.
Know your rights. In a true medical emergency, you have the right to be treated in a hospital, regardless of whether you have insurance.
source: Family Health...Take Charge provided by Memphis Common Table
healthymemphis.org
A health insurance policy is a contract between an insurance company and a person or a sponsoring group, such as an employer or government agency.
Most plans have a network of providers. Generally you pay less for care if you use an in-network provider. These providers agree to receive a lower payment for care to insured patients.
Health insurance policies are usually renewable annually. The premium is the amount the policy owner pays each month for health insurance. If you have individual insurance, you pay the entire premium-which might be very high if you have a chronic health condition. If you have group insurance you often pay only a portion of the premium.
Health insurance often requires costs beyond premiums. The deductible is an amount an insured person pays for care before the carrier begins paying. The copayment is a fixed amount you pay at each visit or procedure or for each prescription before the carrier pays. Coinsurance is the percent of all covered health expenses that an insured person must pay(often 20 percent) after the deductible has been met. The insurance plan covers the balance(often 80 percent).
Insurance companies have rules that may exclude payment for certain services. They also may require an authorization, referral or second opinion before allowing coverage of services. Rules might be waived temporarily for emergency care but may require notification of the carrier within 24 to 48 hours after the emergency.
Many employers offer group health insurance as part of their employee benefits packages. Employers usually have an open enrollment period each year, when employees can sign up for coverage, change coverage or add dependents to the plan.
Group insurance has several benefits. The sponsor, such as the employer or government, usually pays a large portion of the premium. Group policies often cost less per person because they spread out the risk among a lot of people, many of whom are will. In most cases, the insurance company agrees to insure everyone in the group, regardless of their condition or health history.
The average family health insurance premiums often costs more thatn $12,000 a year. The premium and out-of-pocket costs have increased greatly over the last eight years and are expected to grow.
Many people are denied health insurance or can't afford it. Many spouses and kids lose insurance coverage after a divorce. People often lose their health insurance when they lose their jobs. The cost of continuing a temporary policy(COBRA benefits) without the help of an employer can be exorbitant.
People without insurance often resort to extremely expensive emergency room care. Others do without needed care.
Many health insurance reform advocates want changes in the U.S. health insurance system including
(1) Ending discrimination against people with pre-existing conditions
(2)Preventing insurance carriers from dropping coverage on very sick people.
(3)Stabilizing and protecting Medicare and making needed prescription medication a covered benefits all year long.
(4)Preventing annual or lifetime limits on insurance coverage that cause many families to go bankrupt.
(5)Increasing access to preventive services to find health problems early when they are less costly and easier to treat.
What you should do
Choose your health plan and care providers wisely. Check their ratings, credentials, accreditations and reputation.
Before choosing a plan, find out if it will cover your needs and the costs. Make sure pre-existng conditions and the providers you need are covered.
Follow the rules of your plan. Know what your plan covers.
Be sure your providers get the required authorizations or referrals. Ask providers to make the required notifications to the carrier after an emergency.
Take charge of your health. Be involved in decisions about your care. Keep careful records of referrals, approvals, names of phone contacts and explanations of benefits.
Know your rights. In a true medical emergency, you have the right to be treated in a hospital, regardless of whether you have insurance.
source: Family Health...Take Charge provided by Memphis Common Table
healthymemphis.org
Saturday, October 17, 2009
How much does an HSA cost?
An HSA is not something you purchase; it’s a savings account into which you can deposit money on a tax-preferred basis. The only product you purchase with an HSA is a High Deductible Health Plan, an inexpensive plan that will cover you should your medical expenses exceed the funds you have in your HSA. However, HSA trustees often will charge fees for their services.
How can I get a Health Savings Account?
Consumers can sign up for HSAs with banks, credit unions, insurance companies and other approved companies. Your employer may also set up a plan for employees as well.
What Is a “High Deductible Health Plan” (HDHP)?
You must have an HDHP if you want to open an HSA. Sometimes referred to as a “catastrophic” health insurance plan, an HDHP is an inexpensive health insurance plan that generally doesn’t pay for the first several thousand dollars of health care expenses (i.e., your “deductible”) but will generally cover you after that. Of course, your HSA is available to help you pay for the expenses your plan does not cover.
For 2008, in order to qualify to open an HSA, your HDHP minimum deductible must be at least $1,100 (self-only coverage) or $2,200 (family coverage). The annual out-of-pocket (including deductibles and co-pays) for 2008 cannot exceed $5,600 (self-only coverage) or $11,200 (family coverage). HDHPs can have first dollar coverage (no deductible) for preventive care and apply higher out-of-pocket limits (and copays & coinsurance) for non-network services.
For 2008, in order to qualify to open an HSA, your HDHP minimum deductible must be at least $1,100 (self-only coverage) or $2,200 (family coverage). The annual out-of-pocket (including deductibles and co-pays) for 2008 cannot exceed $5,600 (self-only coverage) or $11,200 (family coverage). HDHPs can have first dollar coverage (no deductible) for preventive care and apply higher out-of-pocket limits (and copays & coinsurance) for non-network services.
What is a Health Savings Account (HSA)
Health Savings Account is an alternative to traditional health insurance; it is a savings product that offers a different way for consumers to pay for their health care. HSAs enable you to pay for current health expenses and save for future qualified medical and retiree health expenses on a tax-free basis.
You must be covered by a High Deductible Health Plan (HDHP) to be able to take advantage of HSAs. An HDHP generally costs less than what traditional health care coverage costs, so the money that you save on insurance can therefore be put into the Health Savings Account.
You own and you control the money in your HSA. Decisions on how to spend the money are made by you without relying on a third party or a health insurer. You will also decide what types of investments to make with the money in the account in order to make it grow.
^
You must be covered by a High Deductible Health Plan (HDHP) to be able to take advantage of HSAs. An HDHP generally costs less than what traditional health care coverage costs, so the money that you save on insurance can therefore be put into the Health Savings Account.
You own and you control the money in your HSA. Decisions on how to spend the money are made by you without relying on a third party or a health insurer. You will also decide what types of investments to make with the money in the account in order to make it grow.
^
Friday, October 16, 2009
DISASTER RECOVERY PLAN
I posted steps to set up a disaster recovery plan can my bookkeeping blog:
at www.verythoroughbookkeeping.blogspot.com
at www.verythoroughbookkeeping.blogspot.com
Tuesday, October 13, 2009
Prometheus Payment
Overview of PROMETHEUS Payment®:
PROMETHEUS Payment® (Provider payment Reform for Outcomes Margins Evidence Transparency Hassle-reduction Excellence Understandability and Sustainability) is a new provider payment model which offers a different approach to payment to include all providers treating a patient for specified conditions. The primary purpose of PROMETHEUS Payment® is to offer a sustainable payment model that will improve quality for patients, lower administrative burden for providers and plans, pay fairly, and provide useable, transparent information to propel improvement while facilitating choice where it can be exercised. PROMETHEUS Payment® begins with good clinical practice guidelines (CPGs) which should be brought to bear when treating a patient with a specific clinical condition. For more information on the PROMETHEUS Payment® program, please visit www.prometheuspayment.org.
PROMETHEUS Payment® (Provider payment Reform for Outcomes Margins Evidence Transparency Hassle-reduction Excellence Understandability and Sustainability) is a new provider payment model which offers a different approach to payment to include all providers treating a patient for specified conditions. The primary purpose of PROMETHEUS Payment® is to offer a sustainable payment model that will improve quality for patients, lower administrative burden for providers and plans, pay fairly, and provide useable, transparent information to propel improvement while facilitating choice where it can be exercised. PROMETHEUS Payment® begins with good clinical practice guidelines (CPGs) which should be brought to bear when treating a patient with a specific clinical condition. For more information on the PROMETHEUS Payment® program, please visit www.prometheuspayment.org.
Monday, October 5, 2009
2 white papers on Payment Reform by Health Care Financial Management Association.
I found this 2 white papers very educational and helpful in understanding what
is happening in payment reform in today's health care reform climate.
Health Care Reform
A call to Action
Health Care Payment Reform: from Principles to Action.
is happening in payment reform in today's health care reform climate.
Health Care Reform
A call to Action
Health Care Payment Reform: from Principles to Action.
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