Billers Working With Payers: Your Pain, Their Gain

Billers Working With Payers: Your Pain, Their Gain

Billers work hard to collect the reimbursements to which clinicians are entitled and healthcare insurance providers work equally hard to delay or reduce those payments.

It requires more data, phone calls and effort on the part of billers to collect even basic amounts. In this revealing article, Nitin Chhoda examines the insurance game and how to be on the winning side.

billersInsurance companies are in business to make money. When they make reimbursements, they view it as losing money.

As a result, insurance companies have reduced the amounts they pay medical providers for services, have become inventive at delaying reimbursements, and adept at utilizing a variety of techniques to deny payments.

EMR Assistance

Reasons for rejections come in many forms and electronic medical record (EMR) software is the first step in combating short or rejected payments. The software systems transmit claims electronically, ensuring they arrive at clearinghouses promptly and provide billers with an ongoing status record of each claim submitted.

EMRs can detect potential problems that could result in a rejection, allowing billers to submit clean claims that are processed quickly. The systems aid billers in submitting the appropriate forms to the correct clearinghouse and alert billers when a claim has been accepted or rejected. EMRs provide billers with a complete system for claim management.

Learning the Ropes

The techniques used by insurance companies to deny claims or pay at lesser rates are designed to keep money in their coffers for as long as possible. Quick submissions combined with meticulous documentation are essential when submitting claims and disputing rejections.

Collecting full and timely payments is much like a cat and mouse game, but billers that learn the “rules” are able to collect reimbursements quickly and cleanly that requires a minimum of follow-up.

Winning the Insurance Game

Dealing with insurance companies isn’t for the faint of heart. Denials can be issued for legitimate reasons, such as using the wrong form, not including sufficient documentation, a clerical error or a glitch in clearinghouse software. Organization and quick attention to denials often result in a successful conclusion.

Billers must submit claims within 72 hours whenever possible. If the problem is insufficient payment, an error can be corrected and the claim resubmitted. It’s important that the payer is aware that the claim isn’t a duplicate.

Submit documentation to specify what the error was and the correction. Another beneficial tactic is to submit claims ranked by charges and don’t include documentation unless asked. The needed information is included in the claim.

If attempts to rectify the problem are met with silence or delays, make the patient an ally. Inform the client and let him/her take the battle to their insurance company for a quick resolution. billers system

Policy holders expect their insurance company to pay for appropriate expenses and not leave them holding the bag. Unhappy customers talk to others and insurance companies don’t want to lose clients.

Quick medical billing claim submissions, EMRs and enlisting the assistance of patients are legitimate means of winning the reimbursement game with insurance companies that procrastinate and underpay. In most situations, the payer holds all the cards, but billers can turn the tables and make the payer’s pain the clinician’s gain.

How Clearinghouses Can Save You Time and Money

How Clearinghouses Can Save You Time and Money

Practitioners of the medical arts are always seeking ways to reduce costs while continuing to provide the best level of patient care possible.

Three ways that practices can accomplish this is by contracting with the best payers, utilizing clearinghouses to process claims, and implementing an integrated electronic medical record (EMR) system. Nitin Chhoda examines the advantages and savings for clinicians in this informative new article.

clearinghousesMillions of reimbursement claims are transmitted digitally each day via EMR technology. They arrive at their destinations in real time and each is documented by one of several clearinghouses located throughout the nation.

Technological advances have done away with the need for postage stamps, paper claims and waiting weeks for approval or denials.

Secure Transmission

Electronic data interchange (EDI) allows practices to transmit reimbursement requests and supporting documentation to clearinghouses in a secure format that meets HIPAA requirements. It’s part of the abilities inherent in EMRs.

Billers can verify electronically that clients have met their responsibilities for any co-pays to help speed the claim along.

Destination Locations

Practitioners contract with insurance companies for payment and all submissions are sent to a specific clearinghouse where they’re scrubbed for any errors or mistakes. Clearinghouses handle a multitude of claims each day and clean claims are forwarded to the appropriate insurance company for payment. Clearinghouses and billers work together to meet the specific formatting requirements of each payer.

Clearinghouses deal with multiple medical providers and insurance companies at once, eliminating the need to bill each insurance company individually. Some charge flat fees or a fee per transaction for claims that are processed. The benefits far outweigh the costs, providing clinicians with a quick and reliable way to transmit claims, verify receipt of those claims, track their status and monitor payments.

Collecting Payments

Working with clearinghouses ensures that reimbursement claims are dealt with quickly for faster payment to physicians. Reimbursements can be electronically transferred to practice accounts in as little as 10 days.

Medical billing team and practitioners should keep in mind that even after a claim has been scrubbed at the clearinghouse it may still be rejected by the insurance company.

clearinghouses softwareIt’s the job of insurance carriers to find ways to deny claims. It’s how they make money. When a dispute arises, EDI allows practitioners to quickly discover why a claim was rejected and provide any additional documentation.

Billers can refer to the contract terms between the clinician and the payer and initiate communications to rectify any problems.

Clearinghouses work with multiple payers and millions of claims each week, speeding reimbursements on their way to their appropriate destination, saving practitioners time and money. They assist in verifying and sorting claims, allowing clinicians to collect reimbursements quicker than ever before and are an essential element in the payment process.

Web-Based Billing and EMR – The Cutting Edge

Web-Based Billing and EMR – The Cutting Edge

Electronic medical record (EMR) systems have changed billing standards with cutting edge technology. EMR systems allow for cloud-based billing that’s quick, efficient and clinicians can receive payment in as little as 10 days.

In this insightful article, Nitin Chhoda explains how an EMR facilitates the reimbursement process.

web-based billingThe use of an EMR allows practices to conduct business in the cloud, also known as web-based billing. It eliminates the need for files full of paperwork and the space to maintain them.

With web-based billing software, claims can be filed, payments delivered and records accessed any time of the day or night for greater productivity. It’s an environmentally friendly solution.

Identifying Problems and ICD-10 Codes

Perhaps one of the biggest advantages of a web-based billing EMR is its ability to identify mistakes and potential problems. It’s a simple matter to make the appropriate corrections, ensuring clean claims that progress quickly through the system. An EMR can assist providers with up to a 91 percent payment rate the first time claims are submitted.

When a claim is questioned, an EMR makes it easy to address the problem online. The transition to ICD-10 codes can cause significant problems for practices that aren’t using an EMR. The web-based billing software system is capable of handling all the new codes with clarity and ease.

Equipment Costs and Savings

Practitioners save money and eliminate costs associated with web-based billing software, equipment and the need for upgrades. There are excellent EMR programs available for free that provide medical practices with a full service billing and management system. They keep monthly fees low, offer 24/7 customer support and online training for staff.

The vendor is responsible for all facets of the infrastructure.

Digital Delivery

Every medical practice is familiar with clearinghouses. They check claims for errors and forward them to the patient’s healthcare insurance carrier. A web-based billing EMRs transmit reimbursement claims electronically in real time and maintain an ongoing record of each claim, its details and current status in the chain of reimbursement.

An EMR is crucial for medical providers who want to work with government-sponsored healthcare insurance plans. They require claims to be submitted electronically and prefer to pay via electronic fund transfer. Submissions can be sent individually or as a batch. Real time adjudication and notice of denials or acceptance are received in moments when a web-based billing system is at hand.

Portability and New Venues

Integrated and web-based billing EMR software can be implemented on laptops and tablets. It provides practitioners with portability and the opportunity to forge trails into new venues for new revenue streams. Web-based billing software can be submitted from any location an Internet connection is available and remain in compliance with HIPAA security standards.

Other Services

Electronic medical records facilitate the payment process with cloud-based billing, but they offer a comprehensive variety of other advantages. They store information in a secure environment and allow staff to verify insurance coverage prior to treatment.

Electronic patient statements can be sent, payments made and clients can complete a variety of essential information online. Patients can be contacted by multiple methods, test results can be posted for clients and medications can be billing

Web-based billing offers clinicians the ability to receive payments quicker, opportunities to extend their circle of revenues and submit bills in real time.

The web-based billing software systems represent the future for medical practices and billing procedures. Practitioners without an EMR face a loss of efficiency, productivity and revenues.

What to Look for (and be Wary of) When Choosing Billing Software

What to Look for (and be Wary of) When Choosing Billing Software

Billing software will play a large part in the success of the billing process and getting paid. As an early implementer of medical software and an expert on electronic medical record (EMR) technology, Nitin Chhoda addresses what clinicians should seek in medical billing software.

billing softwareThe goal is to bill accurately and quickly. Ordinary billing software will work, but an EMR is recommended. It’s the new standard in medical billing software.

EMRs have functionalities ranging from submitting more clean claims to verifying patient insurance coverage. Billing software allows clinicians to collect payments quicker and provide an enhanced level of patient care.


Medical billing programs can cost from $500 to $5,000. The cost of an EMR that is integrated with billing software can reach $50,000, but the good news is that comprehensive EMR systems are available for free. Due diligence should be exercised and sufficient research conducted before purchasing any program.

Digital Delivery

While some insurance companies still require paper claims, the vast majority use digital delivery. Using billing software is fast, efficient and transmits claims to their destination in real time, allowing practitioners to get paid in as little as 10 days. It’s a requirement for government-operated insurance programs that include Medicare and Medicaid.


Today’s patients communicate in a variety of ways, from old-fashioned mail to voice messages. It’s critical for a practice’s billing software to be able to do the same. Billing programs should have the ability to contact clients by voice and text message, mail, phone and mobile device and email.

Access On the Go

Billing software places all of a patient’s information in a central location, but the programs also provide users with the ability to access client information from any location where an Internet connection is available.

Billers can update information from multiple locations, a particularly useful feature for practitioners with more than one office and those who participate in corporate wellness programs.


Even though an integrated EMR can take the place of virtually any office system, some clinicians are enamored of their existing programs and can’t bear to part with them. Any billing software program should integrate smoothly with other systems already being used in the office.

Clean Claims

A good billing software program significantly reduces the possibility of claim errors by identifying common mistakes before the reimbursement request is sent. Clean claims can be submitted to clearinghouses that are processed quickly and efficiently for quicker payment collection.

Tech Support

A key feature of medical billing software is the ability to access tech support 24/7. A bug or glitch in the software program can mean significant losses for the practice and payment delays. Billers should be able to work with tech support any time of the day or night to fix problems.


Maintaining HIPAA compliance is serious business and billing software helps practices avoid running afoul of state and federal regulations. Patient information is confidential and billing software assists users ensure that data and submissions are transmitted securely.billing software program

Billing software runs the gamut from basic systems to those with a comprehensive array of built-in abilities. Don’t purchase the first system that’s explored.

Do take time to examine each billing software program to ensure it will grow along with the practice and can be customized to accommodate the individual needs of the clinic.

Facilitating Effective Billing and Coding with Electronic Medical Records

Facilitating Effective Billing and Coding with Electronic Medical Records

Medical billing and coding has always been a complicated procedure, but one that is necessary for physical therapists. Nitin Chhoda discusses how each code is attributed to a certain diagnosis, treatment, and etc., making the billing and coding process simplified and effective.

billing and codingThe correct analysis of billing and coding is imperative to patients’ care, and insurance agencies depend on accurate medical code billing so that medical providers can accurately reimburse the payment for their services.

The ease and availability of electronic medical records (EMRs) improves physical therapist billing and coding by eliminating the disconnection between the provider and insurance agency.

Ensures High Level of Patient Care

EMRs can help patients receive the best care possible.  Physical therapists and other providers are able to share records via EMRs, thus, receive up-to-date information.  The clarification allows providers to see the best picture yet of patient care, and enables them to make more informed decisions regarding treatment.

Employees and doctors do no longer have to deal with ineffective billing and coding. They can focus and give more attention to patient care. 

Increases Income for Practice

Healthcare management depends on quality medical billing and coding to properly invoice patients and their insurance carriers. However, this process is time-consuming and tedious. Sometimes codes are written down incorrectly or a wrong number is read due to poor handwriting.

For years, providers have reimbursement denied by insurance agencies from code errors.  EMRs lessen the chance of errors, and ease the claim submission process.

medical billing and codingBecause all billing and coding must be accompanied by proper documents, EMRs also allow for an easier physical therapy documentation system.

Some insurance agencies are overwhelmed with claims as much as the providers, and the reimbursements may be canceled, lost, or otherwise not received, and this may go unnoticed by the practice.

However, EMRs give a physical therapist the ability to track claims and monitor any discrepancies. EMRs allow a provider to accept payments electronically, thus ensuring quicker billing and coding reimbursement than the traditional check method.

Health Insurance and How It Relates to the Current Economic Outlook

Health Insurance and How It Relates to the Current Economic Outlook

The multi-tiered healthcare system in the U.S. is a slow and ponderous process, but one that’s essential for the financial stability of practices and to ease the pain and suffering of patients. Nitin Chhoda explains health insurance and its relations to our current economy.

health insurance Healthcare is a complicated and convoluted process in the U.S. that involves patients, practitioners, health insurance providers and a multitude of clearinghouses established specifically for processing, verifying and paying claims.

Due to the many facets of the industry, it can leave even insured patients with insufficient health insurance coverage or none when they need it most, while clinicians are buried in a mountain of paperwork and rejected claims.

Healthcare in the 21st Century

Healthcare was a reactive system focused on treating ailments and illnesses as they appeared.  The beginning of the 21st century saw a shift in the thinking of health insurance company executives toward preventative measures and ways for clients to avoid becoming ill or developing conditions such as diabetes and heart disease.

When the Affordable Health Care Act is fully implemented, millions of previously uninsured individuals will have access to a core group of services through health insurance policies obtained through their employment or management insurance exchange.

Health Providers

Health insurance providers are beginning to change their procedures by forcing patients to shoulder more of the cost burden and setting limitations on costs and treatments.

The result is that many clients that have health insurance are no better off than those without.

health insurance coverage

Due to these insurance practices, physical therapy management must develop and implement strategic plans to contract with the best paying providers and examine client health insurance coverage closely before beginning a treatment.

Decide Carefully

To remain solvent, clinicians will be required to make hard decisions about the patients they treat, the health insurance they accept and the providers with which they contract.

The technology embodied in an electronic medical record (EMR) system is a clinician’s best friend for verifying health insurance, providing enhanced documentation and submitting reimbursement claims.