The relationships between the healthcare management and medical billers are important. It involves the whole process of physical therapy billing.
Nitin Chhoda reveals certain areas where healthcare management and medical billers should support each other for the success of the practice.
Depending on your first hand experience with medical billing, it may be completely obvious that health care management and medical billing are very closely integrated.
However, manyhealth care practice management professionals who have no experience in medical billing can cause problems for medical billers if they do not educate themselves on the relationship between the two.
Small Practice Medical Billing
In a small practice, it’s very likely that the medical billing will either be hired out to a separate company, or that it will be handled by the health care management staff.
These days it is easier to both hire out as well as accomplish medical billing jobs in-house as part of a position with other responsibilities. But this can cause a lot of problems when that single staff member starts to get overwhelmed.
Medical billing is the most important part of running a medical practice, besides actually treating patients. Health care management involves being able to detect the signs of an overwhelmed medical biller before it causes serious problems. Everyone in the office relies on the medical biller to bring in the payments that keep the practice running.
Health Care Management Indicators
There are a number of indicators which may tell health care management that the medical biller needs more support or more time to do their job correctly. Sometimes changes in workflow can bring efficiency up, but often it is more a problem of being overworked than anything else.
Health care managers who don’t realize how much time it takes to complete the medical billing in the way it should be handled are likely to overwhelm their staff unknowingly.
One way that health care management can identify a problem is by looking at rejections and denials from insurance companies.
This is a tough indicator, because the average rejection and denial rate is about 50% of claims. However, with an advanced EMR you can get more detailed information.
Why has a claim been rejected? How often are rejections and denials due to clerical error, time restriction problems, or incorrect medical coding and health care management? These are the kinds of errors that occur when the medical biller doesn’t have the time to review their work before submitting claims.
Another indicator are accounts receivable aging reports. Aging reports will tell you how long it takes for claims to be paid. It can also tell you whether or not medical billing and health care management staff is taking the time to review the accounts receivable aging reports regularly enough.
Sometimes payments are delayed or even overlooked because the claim has been sent, but was never received by the insurance company.
Sometimes the rejection or denial is sent incorrectly and the practice will have no way of knowing that this is what happened. Unless someone runs an aging report and checks with the insurance company to determine the status of the claim.
Medical billing involves a lot of duplicate work and communication. Health care management principles can ensure that this work is done correctly by giving medical billers the time to do their job.
There should always be an open communication between the medical billers and the healthcare practice management. Nitin Chhoda further explains how good communication will help to resolve any type of issues faster and more efficiently.
Medical billing professionals have plenty to worry about on a day to day basis; sometimes those bigger picture problems never get attention because there’s no time to think about anything but getting today’s work completed.
And medical billing isn’t the only profession that encounters this kind of challenge.
In most every field of work, there are people who spend time doing the work and then there are the managers who have a broader view and can make decisions for the entire practice.
Medical Billers and Management
Medical billers and health care management have to work together to find a balance between efficiency and becoming swamped. Many medical billing staff feel they have an unending set of tasks. By the time they get caught up with one thing, something else has come up and they have no time to step back and review their workflow or make things better for themselves.
On the other hand health care management may not realize that some of the most expensive problems with efficiency occur when medical billing people are overwhelmed. Health care management has the responsibility of reviewing the operations of the entire practice.
Having an Open Communication is Important
But indicators like rate of rejection or denial for insurance claims, or the accounts receivable aging reports don’t always tell enough of a story. Medical billers and health care management must work together to find solutions to the efficiency problems that exist.
When indicators are discovered, it may be time for a review of workflow and schedule pressures that the medical billing staff experience. Health care management can be a catalyst for improvements if the medical billing staff is approached in the right way.
Common Problems That Medical Billers and Health Care Management Can Solve Together
One of the most common problems that medical billing staff experience is the lack of a schedule for performing tasks. When things are just a little too busy, a medical biller may be forced to deal with whatever is most pressing at the moment.
But medical billers and health care managers should both know that the most efficient medical billing training of practices involve keeping a schedule and dealing with responsibilities in an organized way.
Rather than simply giving the medical billing staff more time, health care management should be able to talk to medical billers about what is slowing them down or inhibiting their ability to check and correct their work.
Working out times when the medical billing staff can focus on drafting claims and making it a priority to review claims can actually save medical billers in the long run.
Most mistakes lead to rejected or denied claims, which is a huge problem for the entire practice. A rejected or denied claim has to be reviewed for mistakes and then re-filed. If the medical billing staff has time to review before sending, fewer mistakes will get through and fewer re-filing will be done. This saves everyone time and therefore it will save the practice money and relieve stress.
Nitin Chhoda shares the basic fundamentals of having an effective practice management that will help increase productivity and efficiency within a practice.
Healthcare practice management is often a delicate balance between the human side of an efficiency equation and the problems or benefits related to technology.
For some practices, the introduction of the latest EMR technology is a difficult and frustrating experience.
For other practices, implementation can go smoothly and an EMR will start to improve efficiency right from the beginning. How can you determine that technology will actually benefit your practice? Good practice management will find out what the goals of the practice are before considering any new technology.
Common Reasons for Technology Improvements
Most practice management professionals know that technology is the way to greater efficiency. Communication via email is considerably more efficient than mailing a letter.
You would never consider going back to paper communication when email is an option, right? That is how most practice management professionals feel about using EMRs and practice management technology once they have implemented and adjusted to the changes.
However, at the start of the process, there will always be pushback. There are high start-up costs, and to answer the questions about whether or not EMRs are worthwhile, you will certainly need to ascertain that there are efficiency problems in the practice that an EMR can solve.
But think about investing in email. Email requires significant start-up investments, including computers, high speed internet, and software. Implementing an EMR may sound expensive, but the benefits almost always outweigh those initial costs.
What are the benefits? Most clinics find that the reduction in paper and the improved speed and quality of communication is the first thing they notice.
Additionally, for medical billing and accurate medical coding, an EMR can represent higher efficiency and better rates of accepted claims. In fact, the number one reason for implementing better technology, from a practice management perspective, is to reduce rejected or denied claims.
Ensuring That Technology Works for Staff
Of course, anyone in practice management will also want to think about how these changes will affect the staff. The idea behind technology improvements is to improve efficiency. But if the staff is not well enough prepared or if they do not find the EMR to be useful or intuitive to use, the outcome will not be improved efficiency.
Similarly, technology improvements can allow for incredible benefits for practice management reporting. Good practice management should include a reporting and review system so that you can focus on changing the things that are not working.
But if the staff doesn’t understand why they are adding more tasks to their day, they may not enter information correctly, leading to useless or even harmful report results.
Additionally, there should be an integration of staff needs and goals into the overall goals of the practice management solutions.
Effective practice management will include human resources principles into the overall strategy of improved efficiency.
Rather than assuming staff will figure it out eventually, make sure they are an integral part of the EMR or practice management technology implementation process.
Before deciding what type of physical therapy software to use in your practice, you first need to determine where your practice needs help. Nitin Chhoda shares the different healthcare practice management tools, and the ways it help to increase productivity and efficiency.
Improvements seem to be made from day to day, so should you invest now or is it too early?
Should you spend a lot of money up front for the best solution, or find something more reasonably priced and add features as you benefit from the change?
What are the risks of choosing the wrong health care practice management tool? Rather than focus on which are the best tools, first it is important to distinguish between the different kinds of health care practice management tools and what they can do for your practice.
Electronic Medical Records
At their simplest, EMRs are systems that allow you to keep detailed records of each patient without using a lot of papers and pens. There are plenty of other benefits, such as the fact that information is faster to enter, review, and communicate with others.
This can improve efficiency within the office as well as the health care practice management, and when communicating with other clinics or hospitals.
Medical Billing Software and Medical Accounting Software
For big steps toward improved efficiency, most health care practice management consulting teams will look for an integrated EMR and medical billing software solution. Medical billing software will improve the speed and accuracy of claim submissions, reviews of rejected or denied claims, and re-submittal of claims.
A well designed medical billing software system will incorporate medical coding, as well, increasing the opportunities for staff to catch their own errors before claims are sent to insurance companies.
With an incorporated system, EMRs can be shared with medical billing staff instantly. Filing and sharing of files will no longer hold up the important processes that health care practice management want the staff to focus on.
Staff may also find that their jobs become more streamlined and flexible as a result of a good EMR and medical billing system.
Staff are often thrown off balance by cancellations or re-scheduled appointments at the last minute. An improvement in scheduling can also result in improved billing and collections.
And naturally, if patient scheduling software is included in the health care practice management tool you purchase, the results can be pretty exciting. For example, if a clinician needs to be informed of a change in schedule, they can get a notification instantly.
Reminders can be set for scheduling tasks and priorities so open appointments can be filled rather than overlooked. And each patient visit can be channeled through the system via their electronic medical record, triggering the medical billing cycle, and new appointment scheduling.
There are many other perks that some EMR and health care practice management solutions provide, including radiology information systems and picture archiving systems. To determine which health care practice management tool is best for any practice, the first step should be the detection of inefficiencies that exist and goals that the practice has.
Healthcare practice management tools already exist in the market today, but you must choose wisely. Nitin Chhoda points out that the tools you selected should meet the needs and requirements of your physical therapy practice.
Once you have settled on goals for the practice, you can start to explore your options for health care practice management tools.
Many of these tools will offer basic EMR and EHR systems, but there are also features to consider for the future, or that might make sense to implement right now to reach your goals.
No matter which health care practice management solution you select, remember to set your goals first. The wrong system may not improve efficiency as expected and can cause problems instead of offer solutions.
The final decision should also be determined by the size of the practice, your specific needs, and the flexibility of the system as balanced by your budget; if you don’t have the finances to purchase an all-encompassing, health care practice management system, find one that can be expanded upon with other features as you feel ready.
Top 10 Most Popular Health Care Practice Management Tools
While popularity isn’t necessarily the best measure of a good health care practice management tool, companies that have done more installations are going to have worked out more bugs and inefficiencies. You can at least count on them to have evolved to suit their clients. Below is a list of the top ten companies and their market share as of 2011. Data may change in the near future.
Epic Systems (8.7%)
Siemens Healthcare (8.4%)
Healthcare Management Systems (7.3%)
Self-developed systems (5.8%)
Eclipsys, now part of Allscripts (3.9%)
The first three in the list above account for over 50% of market share, but that may be because they are used in large hospitals; for that reason it makes sense to review the experiences of practices of a similar size to yours, that have actually installed a health care practice management system you are considering.
Meditech is generally used in large applications of health care practice management, such as in hospitals and medical facilities that see hundreds of patients and have specialists of all kinds on staff. The program is considered very stable and consistent, but users do have some trouble with the interface. The majority of applications are used for medical accounting and lab documentation, but less by physicians and clinicians.
Cerner also ranks fairly low with users for functionality and is used by large hospitals and clinics. But there are quite a large portion of users who find Cerner to be quite useful.
It may be that for the right practice, this is the right health care practice management solution.
Amazing Charts, SOAPware, and e-MDs Chart also rank highly with small practices, although Amazing Charts ranks fairly low for functionality.
Praxis EMR is also highest ranked for satisfaction with support and training, which may be the most important ranking.
For small practices, with between one and five physicians, there are other options which rank very highly with practices that currently use the system. The top user ranked health care practice management consulting tool for small practices is Praxis EMR.
Nitin Chhoda emphasizes that a physical therapy practice should be aware of all the regulations and laws that are connected within the practice. Not everyone can be an expert, but assigning a dedicated staff member to focus on regulations, laws and the changes that are made will be helpful to your practice.
For a large hospital or clinic to keep a lawyer on staff is not uncommon, and in many ways it makes sense to always have a legal specialist available to answer questions about the rights of the hospital and their patients.
However, for a small practice it is much harder to justify having legal representation on staff. There are many horror stories of legal problems causing bankruptcy for a medical practice.
Health care practice management should include some basics about the dangers of making legal decisions for which the outcome is unclear. However, because of the focus on patient lawsuits, health care practice management teams often forget to think about regulatory legal blunders.
Understanding HIPAA regulations is one of the most important jobs of health care practice management. While mistakes in following HIPAA regulations can be damaging, they are also some of the easiest mistakes to avoid, if the health care practice management team is aware of common mistakes that are made.
The most common problems that health care practice management run into focus around liability for fraud, mishandling overpayments, violations of privacy, and not responding to Medicare inquiries. Third-party payer audits and certificate-of-need process should also be comfortable topics for health care practice management consulting professionals.
HIPAA violations can be avoided if at least one member of the health care practice management within your practice understands HIPAA thoroughly. It may seem like a very big and ominous law, so expecting everyone to know everything will be challenging.
But at least one person should be or become a HIPAA specialist so the practice has someone to ask before procedures and standards are set that will violate HIPAA regulations.
Legal blunders relating to contracts are also very common. Naturally, health care practice management professionals are on high alert about any contracts, especially with staff, physicians, and clinicians.
You can also run into trouble with non-compete clauses if you work with physicians who are providing services for more than one practice, especially in-office ancillary services.
To avoid legal problems, it is best to negotiate all contracts in full, taking the time to review all aspects that may introduce conflicts within the practice.
At the first sign of a problem, make sure that communication is open and honest so that changes can be made before a problem becomes a legal issue.
The HITECH Act will also pose a lot of risk for health care practice management, as the punishments for not following HIPAA regulations are more severe as a result of the HITECH Act.
Additionally, funding through the HITECH Act is expected to increased oversight so that infractions are more likely to be discovered.
Regulatory oversight can be the least of your worries if you have focused on improving your knowledge of the regulations.
Managing a health care practice can include complex facets, and being aware of risks to the practice should be a high priority. The best way to avoid a risk is to understand what constitutes risky behavior.