EMR Adoption, Selection and Implementation Checklist, medical records

MIB Assistant — Hiring Them Right

by Nitin Chhoda PT, DPT | Sep 29, 2013 | Electronic Medical Records, Medical Billing, Physical Therapy Billing

A large majority of medical insurance billers (MIB) start their businesses at home and as the company grows, the MIB often discovers they require an assistant.

However, liking someone isn’t enough upon which to base a working relationship and in this insightful article, Nitin Chhoda examines the criteria billers should employ when seeking an MIB assistant.

The key to hiring an MIB assistant is having someone with an eye for detail. The lucky candidate will be functioning as an extension of the biller and in many instances will represent the business to the public.

The MIB assistant will need some basic skills and if they’ve never worked in the field, they’ll need to be trained.

Background Checks

MIBs shouldn’t balk at conducting a background check on potential employees. An MIB doesn’t want to discover that their new MIB assistant has a history of white collar crime, computer theft or embezzlement. It’s better to learn as much as possible about the applicant before making a definitive hiring decision.

Prior Employment

Some type of experience in the medical field is an advantage, but not a necessity. Knowledge of computers, data entry or experience with numbers is also helpful. Even if the person has no experience, if they’re trainable and learn quickly, it’s possible to have a competent MIB assistant in just a few weeks.

Electronic medical record (EMR) technology is essential for secure transmittal of reimbursement claims. Few outside the profession will be versed in their use. Many MIBs choose to leave data entry to their MIB assistant and handle the actual submissions themselves. Either way, MIB assistant must be cognizant of HIPAA security standards and thoroughly understand them.

Skill Sets

Organization, honesty and integrity are critical skills for an MIB assistant. The individual will be required to communicate with clearinghouses, insurers, patients and clients.

A good command of the language, a pleasant demeanor and a courteous manner are essential, as is the ability to be assertive when needed.

An ideal MIB assistant will have initiative, be able to solve problems on his/her own, and know when to bring difficulties to the attention of the MIB.

Accuracy and the ability to communicate through written means are also essential elements. A winning candidate must be detail-oriented, able to take direction and have a personality that complements the MIB. The MIB assistant will be much more than someone who enters data.

The individual will be an extra pair of hands, but they can also become a friend and the primary backup person should the MIB be unavailable.

Acquiring an MIB assistant is a huge step and one that will have a dramatic impact on the medical billing business. The ideal assistant will ease the MIB’s workload or allow the firm to take on more work. They represent the MIB and the company, making it essential that they have the skills to do it well.

MIBs: Costs You’ll Incur When Starting Medical Billing Business Part 2

by Nitin Chhoda PT, DPT | Sep 26, 2013 | Electronic Medical Records, Medical Billing, Physical Therapy Billing

Launching a medical insurance billing enterprise has the advantage of low start-up costs. Medical insurance billers (MIBs) are aware of the major financial outlays, but there are many smaller costs that are often overlooked in the excitement of entrepreneurship. In the conclusion of this two-part series, Nitin Chhoda inventories the smaller costs of doing business.

Paperwork

MIBs work with computers, digital communications and electronic claim submission, but there are still occasions when paper documents are required.

CMS 1500 forms are the only official claim document accepted by Medicare carriers for reimbursements. They’re available in boxes of varying quantities, ranging in price from $35 for 500 to $150 for 5,000.

Need For Speed

High-speed Internet is essential for MIBs. Those living in highly populated areas can obtain high speed service for as little as $25, but speeds are on the low end of the high-speed scale. Expenditures for the highest speeds can top $150 per month depending upon the provider. Installation fees may also be charged.

MIBs working in rural areas aren’t as fortunate in regard to pricing options. Entrepreneurs living in a country setting may have to rely on satellite service for their Internet connection. Low end speeds can be purchased for as little as $50 per month, while power plans can range from $100-$150 per month.

Customers should also be aware that many plans have usage limits. Additional costs for MIBs may be assessed for those who exceed the ISP’s limits. Some companies simply throttle the available speeds for consumers who exceed their usage.

Talk Isn’t Cheap

A dedicated phone line is essential. MIBs will spend a significant amount of time on the phone and a speakerphone is a wise investment. It allows billers to continue to work even if they’re on hold. It’s not possible to answer the phone 24/7 and MIBs will want to invest in a phone system with the ability to record voice messages.

Depending on the provider, an additional line can cost as little as $10 for MIBs, while other companies will view it as a completely “new” phone service at a cost of up to $50. A speaker phone with answering and message capabilities will range from $50-$100. Expect to pay $150 for a cordless model.

Most phone companies offer voice messaging services for a fee of up to $10 per month for those who want more than a simple phone answering machine.

Power Plays

Lost data or a fried hard drive will quickly put MIBs out of business. Invest in an uninterrupted power supply for potential outages and a surge protector. A power surge can permanently damage a machine, as can low voltage. Power protection costs range from $20-$200.

An additional cost for the protection of costly equipment and valuable data will be a thumb drive or separate drive to back-up files and information.

A thumb drive will range from $10-$70 depending on its storage space, while a 2 terra byte drive can run up to $500. Electronic medical record (EMR) technology provides regular back-up in the cloud.

The cost of conducting business requires MIBs to plan ahead for every contingency. High-speed Internet, reliable communications and data protection are relatively inexpensive, but the cost is an essential part of the medical billing business and critical for a reliable and reputable firm.

How to Get the Claim: The Billing Scenario

by Nitin Chhoda PT, DPT | Sep 21, 2013 | Electronic Medical Records, Medical Billing, Physical Therapy Billing

Building a clean claim is a concerted effort. It begins with the office staff that gathers demographic information and comes to fruition when the funds are deposited in the practice’s account.

Much can happen to a claim on its way to becoming a payment and in this informative article, Nitin Chhoda provides unique insights into the pitfalls that face even perfectly prepared claims and elements that affect payment.

Where’s the Claim?

Aside from coding errors, reimbursement claims can go awry in many ways. The insurance provider may not be known at the clearinghouse or the clearinghouse software may glitch and submit the claim to the wrong provider.

In some instances, the payer may not be using electronic medical record (EMR) software necessitating submission of a paper claim.

Verifications

Practices that utilize EMR technology receive a report in real time when a claim has been submitted. These receipts provide billers with critical information in the event of a problem. Occasionally, a claim will appear to vanish into the ether.

Clearinghouse reports tell billers when the claim was received, its status and if any problems were identified. If payment isn’t received in a reasonable time or it doesn’t appear on the biller’s daily verification, that data be used to track down the claim and rectify any problems.

Reimbursement Amounts

The whole point of submitting claim is to get paid, but the amount charged can conflict with what the payer is willing to reimburse. When differences occur, billers can easily refer to the contract the clinician has with the payer to define the reimbursable amount.

CPT codes are assigned a relative value that determines reimbursement amounts, derived from the Resource Based Relative Value Scale (RBRVS). The value assigned is based on the work required, the cost of maintaining a practice and the malpractice/liability for which the practitioner is responsible. A formula is then employed that takes into account geographical locations to calculate the reimbursement rate.

Prioritizing

Some contracts are RBRVS based, some aren’t, and the differences in each can be immense. Depending on how the contract is written, procedures may be paid based on RBRVS standards or discounts applied for secondary procedures done at the same time.

Some may be paid at a higher rate determined by prioritization, while others are billed according to expected payment. If the contact doesn’t state which procedure is prioritized, it’s up to the biller.

The Deciding Vote

The ultimate decision lies in the hands of the company that provides the patient’s healthcare insurance. Once the clearinghouse completes its search for errors, it forwards the claim to the payer.

When reimbursements are less than expected, billers must refer to contract terms to obtain the maximum payment allowed.

Many hazards await claims, from submission to the wrong payer to glitches in clearinghouse software. EMRs facilitate the process by submitting claims in real time and documenting receipts from the clearinghouse.

Medical billing specialists can help clinicians boost revenues by carefully monitoring claims and referring often to contract details. Practitioners must negotiate their contracts carefully to ensure their services are adequately reimbursed.

How Will Obamacare Affect Those with Employer-Based Insurance?

by Nitin Chhoda PT, DPT | Sep 20, 2013 | Electronic Medical Records, Healthcare Practice Management, Physical Therapy Documentation, Physical Therapy Management

The good news for individuals with employer-based insurance is that under the Affordable Health Care Act, their policies must include a variety of services ranging from hospitalization to free preventative services. The downside is that many employers have determined maintaining insurance for their workers is too expensive and they’re choosing to eliminate coverage.

Also known as Obamacare, the Act limits the amount individuals can save in their Flexible Spending Accounts (FSA) to $2,500 and places restrictions on what the funds can be used to purchase.

Penalties for buying forbidden items will increase to 20 percent and a huge influx of new patients could overwhelm existing clinicians, degrading the level of care provided and access to practitioners.

Where Coverage Comes From

Business owners of both large and small firms are choosing to drop employee health coverage in favor of paying the government-mandated $2,000 fine per person.

To obtain healthcare, employees will be forced to seek coverage through the Insurance Marketplace.

Individuals can begin signing up Oct. 1, 2013 and policies will go into effect Jan. 1, 2014. Some applicants will qualify for government subsidies to help pay for insurance, based on their income.

Unions have been granted a temporary waiver, but it expires in 2014. Union employees are already feeling the financial pain of higher costs and more out-of-pocket expenses. If employers drop employee coverage, workers will have to purchase coverage through the Marketplace.

Employees with coverage known as Mini-Meds, popular with the fast food industry, will be seeking insurance through the Marketplace, as Mini-Meds don’t meet the coverage requirements under Obamacare.

Insurance companies have already increased costs in many sectors in anticipation of Obamacare implementation.

Medicaid is being expanded under Obamacare to assist those who can’t afford insurance through the Marketplace and have none through their employer. Some states have chosen not to participate in the expansion, leaving fewer options for the poor.

People age 30 and over can purchase a catastrophic plan at the Marketplace that covers 60 percent of medical costs.

Benefits and Limitations

Under Obamacare, insurance companies can’t refuse coverage due to pre-existing conditions and insurers can’t place annual or lifetime limits on coverage. Policies must offer a core group of services, from preventative care to maternity benefits. Children can also remain on parental policies until they turn 26.

Insurance companies can no longer cancel policies for frivolous reasons.

Fines and Penalties

Workers that don’t have employer-based insurance and don’t qualify for Medicaid must purchase coverage through the Marketplace. Those who don’t face financial penalties due to the Individual Mandate Tax that goes into effect Jan. 2014.

The Mandate levels fines of up to $285 on those who don’t buy insurance. The amount increases to a maximum of $2,085 in Jan. 2016.

Some groups are exempt from fines for not having insurance.

Workers who can prove Marketplace insurance is greater than 8 percent of their income can claim a financial hardship. Individuals with incomes of less than $9,350 are exempt, along with joint filers making $16,700 or less. Others will receive fines for “Cadillac” policies, based on the value of the insurance.

In the beginning of Obamacare, the public was told they wouldn’t have to give up their current insurance plans if they didn’t want to. Many workers will be doing exactly that if their employers choose to maintain profitability by not offering insurance and paying the government fines.

The Impact of Obamacare on Medicare Recipients

by Nitin Chhoda PT, DPT | Sep 19, 2013 | Electronic Medical Records, Healthcare Practice Management, Physical Therapy Documentation, Physical Therapy Management

One of the groups most affected by the Affordable Health Care Act will be seniors and the disabled receiving Medicare benefits. Medicare is being singled out for extensive financial cuts through Obamacare.

The Act requires Medicare recipients to shoulder a larger portion of their healthcare costs, offers fewer health plan options, and drastically reduces benefits paid through the Medicare Advantage program.

The Act also imposes an excise tax on medical devices that many seniors rely upon, such as hearing aids.

As reimbursements under Medicare continue to decrease, recipients are facing reduced access to physicians and longer commutes to receive services. Further cuts will be forthcoming in the future through recommendations made by the Independent Payment Advisory Board (IPAB) created by Obamacare.

Paying For Obamacare

Between now and 2022, the Congressional Budget Office (CBO) says Medicare reimbursements will be reduced by approximately $716 billion. To reduce the costs to the Medicare program, Obamacare cuts the amounts that doctors are reimbursed for their services.

Faced with drastic reductions in payments, many clinicians are preparing for early retirement, closing their practices and taking employment at hospitals.

Medicare recipients were already finding it difficult to find practitioners willing to accept Medicare patients and many physicians have indicated they will send Medicare clients elsewhere for treatment in the future.

Medicare patients are among the hardest hit by Obamacare and represent a large segment of the population who will be paying for Obamacare in a variety of ways.

Medicare Advantage Plans

Those receiving Medicare had the option receiving healthcare services through Medicare Part A and B or purchasing a Medicare Advantage plan through a private company that contracted with Medicare. The range of available plans and options will be severely curtailed through Obamacare and Medicare patients will be required to pay more out-of-pocket for healthcare services.

The changes in Medicare Advantage plans affect both seniors and the disabled of any age.

Individuals will have to set aside more of their retirement savings to cover the cost of increased healthcare costs in the future. Those already receiving benefits will have no time to prepare for the potential financial fallout and will just have to pay the higher prices.

The increases may not be significant in the beginning, but will continue over time.

Medicare recipients will have the option of purchasing additional coverage to fill in the gaps through federally mandated healthcare exchanges, now known as the healthcare marketplace. Applicants may also qualify for government subsidies to pay for their insurance plan, depending on their income.

The Impact of IPAB

The government appointed, 15-member panel known as IPAB is charged with reducing healthcare costs within Medicare. The board will examine available treatments for a wide range of medical conditions and recommend what it determines is the best treatment based on effectiveness and cost.

Clinicians and patients are concerned that IPAB recommendations will limit the availability of treatments and some procedures will only be available to the wealthy.

The Good News

Obamacare seeks to close the “donut hole” in the Medicare prescription plan by paying for a larger assortment of medications and providing discounts on prescriptions.

Under Obamacare, wellness visits and a variety of preventative services can be obtained at no cost, including vaccines, flu shots, cancer screenings and annual check-ups.

The upcoming changes for Medicare recipients will offer expanded prescription benefits and preventative services, but has the potential for drastically increased premiums and co-pays.

While seeking to provide coverage to more individuals, Obamacare may have the opposite effect. An influx of new people seeking care, fewer clinicians, and more practitioners that won’t accept Medicare patients due to reduced reimbursements could easily lead to reduced access to healthcare for all.

How Will Obamacare Affect Working Families and the Poor?

by Nitin Chhoda PT, DPT | Sep 18, 2013 | Electronic Medical Records, Healthcare Practice Management, Physical Therapy Management

Passage of the Affordable Health Care Act promised healthcare to millions of uninsured Americans who couldn’t afford it, were unable to obtain it, or didn’t qualify for other programs. The Act expanded Medicaid, called for the establishment of insurance exchanges and offered subsidies to assist families and low income wage earners purchase insurance.

Obamacare is a win-win situation for the majority of those who fall within those two groups, but according to the Congressional Budget Office (CBO), the Act still leaves an estimated 21 million without insurance.

Those individuals will continue to seek care at hospital emergency rooms and free clinics.

Essential Services and Coverage

The Act mandates that policies provide a variety of essential services, from medication and maternity benefits to mental health care. Office visits, preventative treatments, lab tests, newborn and pediatric care, hospitalization and emergency services will all be available under healthcare policies beginning in 2014.

Insurance companies can’t refuse insurance to individuals with preexisting conditions and adult children can remain on parental policies until they turn 26.

Medicaid Expansion

Families and the poor who meet income eligibility guidelines may be able to receive medical services through expanded state Medicaid programs. The Act assumed that individuals making $11,500 or less would automatically qualify for Medicaid

A ruling by the Supreme Court determined that participation in Medicaid expansion was optional. Many states chose to give up millions of dollars in federal incentives to expand Medicaid coverage.

Residents in states that don’t expand Medicaid coverage will have few choices – obtain insurance through an exchange or continue to do without medical coverage.

The Healthcare Marketplace And Subsidies

Also known as “marketplaces,” healthcare exchanges enable individuals to purchase their own healthcare coverage. Plan enrollment begins on Oct. 1, 2013, with policies going into effect on Jan. 1, 2014.

The marketplace for each state can be accessed online and buyers can choose from bronze, silver, gold and platinum coverage options, with varying premiums, deductibles and co-pays.

Some have mistakenly equated the term “affordable” with “cheap.” The Act doesn’t limit the amount that insurance companies can charge for their policies and many may discover coverage is still costly.

For those meeting federal financial guidelines, Obamacare provides subsidies to assist families and the poor purchase coverage through the exchanges.

Fines, Penalties And Stipulations

Obamacare extends healthcare to millions of new customers, but the Act also comes with built-in penalties and fines. Those who choose not to purchase insurance or can’t afford it, even with subsidies, will be assessed an income-based fine.

Financial penalties will be determined and collected through income tax returns. The government can’t place a lien against personal property, but it can take any refunds that are due.

Those with employer-offered healthcare policies won’t be able to immediately ditch them in favor of more affordable options and subsidies through state marketplaces.

Individuals that choose to give up coverage through their employer will be required to wait a set amount of time before their marketplace policy becomes active and pays for services.

The Affordable Healthcare Act is a mix of coverage options, subsidies and penalties for families and the poor. It offers essential healthcare services through expanded Medicaid programs and state marketplaces, provides financial incentives to purchase through subsidies, and penalizes anyone who doesn’t have coverage.