When we started our medical billing business in 1994 things were very different than they are today. Electronic claim submission was just catching on. Living in a rural area in NY it was almost unheard of. Medicare and some of the larger insurance carriers were offering incentives for providers who submitted their claims electronically such as faster payments. Dot Matrix printers with multi paged forms were common and email was in its infancy.
Today technology has advanced so far since the mid 90's that if you are still doing things the way you were then you are living in the dark ages. When we purchased our first practice management system almost all were server based software. Web based probably existed, but it wasn't very popular. Many people still weren't even connected to the internet then. In fact, we used to dial in to a bulletin board for medical billers which was similar to the forums you find on the internet today. Email was pretty much a hobby. Laser printers were something only the rich owned and having a two line phone was a luxury.
Eligibility was verified the old fashioned way by picking up the phone and calling the insurance company. Many offices didn't even bother because it was too time consuming and complicated. Checking claims status was done by manually calling the insurance carrier, waiting on hold, and finally asking a person to see if the claim was received and processed. Insurance carriers didn't have websites with the options of checking patient's id numbers, eligibility and even claim status. In fact any communication done with the insurance carrier, appeals, resubmissions, adjustment requests, etc. was done by phone or mail. Many claim forms were sold as two or three part with carbon copies and had to be printed on dot matrix printers or typed. After printing the forms you tore off the perforated edges and stuffed the claims in envelopes.
Maybe you are still doing things that way but you don't have to be.
Today a whole different world of options is available. Systems available today have amazing capabilities that totally change the way not only that medical billing is done but also how the whole office operates. With technology today, new tools such as practice management systems, telephone systems, and combination photocopier, scanner, fax machine can do much of the work for you and improve your efficiency.
Telephones have changed drastically in the past few years. Most of us have the convenience of a personal cell phone. Caller ID tells us who is calling before we answer. But digital telephone service offers many advantages over using old telephone lines.
As our billing service grew, we found the five telephone lines we were using were inadequate and cumbersome. We almost needed one person just to answer phones and direct the calls to the proper person. And costs were getting out of control.
Now available are voice over internet systems which work entirely differently than old telephone lines. This is a phone system where each phone works independently of the others. Every phone has a dial tone, conferencing capability, hold capability for a second call, alerts for missed calls, do not disturb option, forwarding capability, confidential voice mail, message capability which can be sent to your email, free long distance and free fax capability from your email.
No one now wastes their time answering someone else's call and transferring it. That alone can free up much time for the person who must answer the incoming calls. Busy signals were eliminated. If the person the call was intended for is on the phone, they are alerted to another call. If they choose not to take the incoming call then it goes directly to voice mail. No need for someone to take a message and relay it. There are no long distance charges which saved us over $200 per month. Phone lines are eliminated as the calls go through the internet.
The only downside of this type of system is that if internet service is down, so are the phones. If your internet service is reliable this probably is not an issue. Even if the internet is down most people still have cell phones. If you decide to try such a phone system, you will need to purchase new phones and make sure you have enough bandwidth for your internet service.
Printers are a requirement for medical billing. Usually a printer had to be purchased and then toner had to be maintained. The printers would wear out after much use, and a new printer had to be purchase. Fax machines were usually separate and scanners were scarcely used. Replacing a printer or a fax machine was a big deal. Research had to be done to make sure it would handle the type of work it was needed for.
When our printers were no longer able to handle the work we required we looked into leasing a new combination machine as an option. At first glance it seemed pricey but we needed a solution and went with it. We were shocked at all the uses we found for this machine.
Our printers were several years old so we spent quite a bit of time and expense clearing paper jams, replacing toner and drums, replacing paper, changing forms in the drawers, and calling our repairman. We often printed on incorrect forms not realizing which forms had been placed in the drawers. Sound familiar?
The machine we now lease from a local business supply store has four paper drawers where we store white paper, CMS 1500 forms, Medicaid forms and we have one extra drawer. To print, simply chose the appropriate drawer and print on the correct form. The total printing costs excluding the paper are $.004 per sheet. This includes toner and upkeep on the machine.
This machine has abilities that really helped our work flow.
Any documents can be scanned and sent to an email address where you can store them for future use. Claims and eobs can be scanned and stored to avoid file cabinets stuffed with old information.
Faxes are sent to long distance numbers free of charge by scanning the document and sending it to an email where it can be forwarded on to the designated fax number through a free service.
This helped with our credentialing services as well as billing services and can now scan and email whole credentialing packets to our clients who don't have to wait for them to arrive in the mail. The credentialing packets are stored on the computer so you always have a copy without having to store a physical copy somewhere.
The internet now offers us amazing advantages that weren't possible a decade ago. Insurance carriers maintain websites for both patients and providers where providers can check eligibility, benefits, even claim status and make adjustments. These websites are great timesavers over making the traditional call to inquire.
Search engines make it much easier to research any topic. In the past we went to the library or bookstore for our research but now with the click of the mouse, we can search any subject on which we require information.
Practice Management Systems
Advances in practice management systems have been monumental in improving the way medical billing is done. Web based systems have made it possible to do things never before possible with static server based programs saving both time and money for the providers. SaaS technology (Software as a Service) has taken web based systems even farther by making them more affordable.
Web based programs offer the convenience of checking eligibility right there within the program. Some programs are capable of automatically checking the eligibility of the patients who are scheduled for the next day. When you walk in the office in the morning, you can check your software and see if any of the scheduled patients are not eligible for benefits under the insurance information you have recorded before the patient is seen.
Another big advantage of web based software is that it works in "real time". As filing requirements change, the program is updated. There is no need to wait until the next version is released as is the case with server based programs. As diagnosis codes change, programmers change these and upload the changes to the web based system. Server based software requires the purchase of new versions to handle the ever changing needs while web based software is changing as the needs arise.
Today with web based software not only claims can be sent electronically for quicker payment and less chance of denial but payments can be posted automatically. Secondary claims and patient statements are then generated by the system. Time is money so with all the time saving advantages providers find they are also saving lots of money. Web based software also saves money by eliminating the need for purchasing updated software versions and support for the software.
Claims scrubbers available in some of the best web based software catch errors that could cause claims to be denied or even whole electronic batches to crash. A claims scrubber picks up any claims it thinks has problems that will prevent payment and gives you a warning. The up front edits and claims scrubber will drastically reduce denied claims. Catching a problem claim before it is even submitted will keep the cash flow consistent and actually bring in more money. The longer an unpaid claim goes unpaid, the less chance of ever collecting on it.
Any denial for invalid diagnosis, invalid date range, invalid prefix, coverage terminated, etc. will never make it to a denial on an eob with up front edits that catch these potential problems. Stopping these problem claims up front saves resubmissions, filing adjustment forms, writing appeal letters, money, time, printing and mailing costs, calling patients for correct info, and the list goes on.
Some of the newer software is even using technology to build it's up front editing based on the input and payment information from claims by practices with the same specialty.
It has become much more common recently for insurance companies to require claims for many facilities who previously filed their claims on CMS forms to now file UB04 forms. In the past it was very difficult to find software that was capable of handling both of these forms but some web based systems are now filling these needs.
Practice management systems have come a long way in the last decade and the flexibility of web based software insures that developers will just keep coming up with great new ideas to make our lives simpler.
Where in the past web based systems were found by many to be cost prohibitive, now with SaaS technology a web based practice management system is a must! There are now affordable web based practice management systems that allow you to utilize all of the technological changes for a fraction of the cost.
Technology has changed the medical billing industry in many ways. Many of these changes have improved the way that billing can be done by streamlining the workflow, reducing initial errors, and automating many jobs that used to be done manually. Keeping up with these technological changes is important because what works well today may be antiquated next month with a newer, faster, more creative solution.
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