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Are you sure your insurance companies are paying you according to your contracts? You may be surprised to know that it’s unlikely that they are. The average medical practice loses approximately five to ten percent of their collections because most insurance underpayments are never pursued or even identified.

The American Medical Association recently compiled a National Health Insurer Report Card for seven of the biggest payers in the industry — Anthem BCBS, Aetna, Coventry, Cigna, United Healthcare, Humana, and Medicare. Every single one of these payers failed to abide by their contracted payment rates to varying degrees.

The worst of the lot was United Healthcare, which failed to pay contracted rates in 38.4% of their cases. Cigna was the second-worst performer, underpaying 33.8% of their cases. Aetna followed at third place (29.2%), then Anthem BCBS (27.9%), Humana (15.8%), and then Coventry (13.3%). Even Medicare underpaid 2% of their cases.

Tracking these underpayments is tricky. If you watch many different medical practices, you’ll find the same CPTs receiving underpayments, at around the same deficiency, from the same payer, and around the same period of time. But after a month, you may find the payer playing the game with different groups of CPTs to avoid being spotted.

These under payments are not huge but they add up quickly to big dollars for a medical practice. The combination of switching the codes being underpaid from month-to-month and keeping the underpayment amount “under the radar” can make this difficult for an individual practice to spot.

Medical billing services may have difficulty finding these underpayments without comparing them with your contracted rates, as well as dealing with multiple procedure complications properly. Dealing with multiple complicated tables can be a challenge.

A medical practice or billing service must deploy and fully utilize the proper technology to systematically and effectively identify and pursue underpayments. Most billing systems do not allow effective management, identification and easy pursuit of underpayments. They typically fall short on at least one of these areas. Without the correct technology and supporting processes efforts to capture underpayments die under the complexity of the task.

Despite the complexity, however, it is worth solving this problem. Comparison of payments to allowables can increase a medical practice’s collections by 5 to 10 percent. This of course requires a strong process, powerful reporting technology and ability to track complex procedures methodically-in the end, it can however add thousands of dollars to your bottom line.

2009 copyright by Carl Mays II

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It’s hard to make sure insurance payers are issuing payments according to your contract. This is why it’s likely they’re not — it’s been found that medical practices typically lose about 5 to 10% of their revenue because of insurance underpayments.

A recent National Health Insurer Report Card compiled by the American Medical Association measured payment accuracy of seven major payers: Aetna, Anthem BCBS, Cigna, Coventry, Human, United Healthcare and Medicare. All of these payers to some degree strayed from contracted payment rate.

United Healthcare was the worst performer — it did not pay its contracted rates in 38.4% of all their cases. It was followed by Cigna, who didn’t pay the contracted rate in 33.8%, Aetna (29.2%), Anthem BCBS (27.9%), Humana (15.8%), and Coventry (13.3%). Medicare wasn’t a perfect performer either, underpaying 2% of their cases.

Tracking these underpayments is tricky. If you watch many different medical practices, you’ll find the same CPTs receiving underpayments, at around the same deficiency, from the same payer, and around the same period of time. But after a month, you may find the payer playing the game with different groups of CPTs to avoid being spotted.

On its own, an individual underpayment may not be significant enough to undermine a practice. But in the long-term, the cumulative impact of the underpayments can cost a medical practice thousands of dollars. Unscrupulous payers underpay different groups of CPTs every month, and keep the amounts underpaid small to avoid getting spotted.

It’s also hard for medical billing services to find when they don’t compare your payments to your contracted rates (as well as properly dealing with multiple procedure complexities). Properly maintaining and using more than one complex allowable table is difficult at best.

Any billing service (or stand-alone medical practice) needs to acquire and fully use industry technology to find and pursue underpayments. Most systems being used today are woefully ill-prepared to handle such cases — a good system should effectively manage, identify, and pursue these underpayments, but most systems fail in at least one of these areas. It’s a truly complex task that’s difficult to manage.

Despite the challenge, it’s still imperative to find ways to rectify the problem. Simply comparing payments to allowables can increase your monthly receivables by 5-10%. You’ll need a solid process, the latest in reporting technology, and a systematic way to track these procedures. Keep at it, and you’ll be adding thousands of dollars to your practice’s cash flow over time.

2009 copyright by Carl Mays II

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A recent Medical Group Management Association survey showed that medical practices utilizing medical billing companies typical see improved performance across multiple dimensions. The survey focused on practices that used medical billing companies instead of in-house billing solutions.

Here are some of the interesting facts that the survey revealed:

- 73 percent saw a reduction in their AR;

- 73 percent also received higher collection rates;

- 59 percent experienced fewer lost or denied claims;

- 59 percent enjoyed significantly better reporting and practice performance insights; and

- 46 percent enjoyed better productivity among staff.

The breadth of the performance improvements uncovered by the MGMA survey (with three quarters of all practices seeing significant performance improvements) adds fact-based credibility to the notion that a well selected and qualified medical billing company provides meaningful performance improvement for medical practices.

This is not a surprise since medical billing companies have several advantages over most in-house billing solutions:

1. Medical billing companies are often better-armed to buy and use technology to submit claims properly, deal with insurance companies, and collect on personal balances.

2. A medical billing company can attract a higher caliber of billing specialists and retain these individuals.

3. Billing services have a deeper bench of employees and this provides a layer of protection for your practice by decoupling you from the risk associated with losing a key (if not the key) billing employee.

4. Billing companies are better positioned to properly utilize the technology they have.

5. Medical billing companies deal with different medical practices and professionals, which gives them a much broader view of the industry than any single in-house billing department. This lets medical billing companies see trends in the industry that can help develop even better services in the long run.

If you’d like to see the survey for yourself, check the MGMA website.

Copyright 2009 by Carl Mays II

Before making your decision regarding a medical billing service be certain to visit ClaimCare’s Website. It provides in depth information about outsourcing medical billing. Carl Mays is a national renowned expert on medical billing operations and revenue cycle management.

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It’s official — a recent study made by the Medical Group Management Association (MGMA) has shown that medical practices and facilities that use medical billing companies experience improved billing performance over those that use in-house billing systems.

The study found the following advantages in employing the services of a medical billing company.

- Almost three in four practices that use medical billing companies reduce their AR;

- 73 percent realized higher collections;

- About three in every five practices have fewer denied or lost claims;

- Three in every five also reported better practice performance insights; and

- Almost half experienced better staff productivity.

The breadth of the performance improvements uncovered by the MGMA survey (with three quarters of all practices seeing significant performance improvements) adds fact-based credibility to the notion that a well selected and qualified medical billing company provides meaningful performance improvement for medical practices.

Of course, medical billing companies do present many advantages over many in-house billing solutions.

1. Medical billing companies are more likely to be able to buy and utilize industry technology, helping practices submit claims, negotiate with insurance companies, and collect personal balances more effectively.

2. A medical billing company can attract a higher caliber of billing specialists and retain these individuals.

3. Billing services have a deeper bench of employees and this provides a layer of protection for your practice by decoupling you from the risk associated with losing a key (if not the key) billing employee.

4. Medical billing companies also utilize industry technology better and more efficiently.

5. Medical billing companies have a broader view of the medical industry as a whole because they deal with many different medical professionals at the same time. This knowledge helps them deliver better services to their clients.

A copy of the survey is available from the MGMA’s website.

Copyright 2009 by Carl Mays II

Before deciding upon a medical billing service be sure to visit ClaimCare’s Website. It provides in depth information about outsourcing medical billing. Carl Mays is a national renowned expert on medical billing operations and revenue cycle management.

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A recent Medical Group Management Association survey showed that medical practices utilizing medical billing companies typical see improved performance across multiple dimensions. The survey focused on practices that used medical billing companies instead of in-house billing solutions.

The study found the following advantages in employing the services of a medical billing company.

- Almost three in four practices that use medical billing companies reduce their AR;

- The same ratio of medical practices experienced higher collection rates;

- About three in every five practices have fewer denied or lost claims;

- 59 percent enjoyed significantly better reporting and practice performance insights; and

- 46 percent achieved higher staff productivity.

The MGMA study found that more than three out of every four practices that employ the services of a good medical billing company enjoy impressive improvements in productivity and performance. This confirms the long-held notion that utilizing a medical billing company improves a medical practice’s performance.

This is not a surprise since medical billing companies have several advantages over most in-house billing solutions:

1. Medical billing companies have more scale to purchase and deploy the technologies required to properly submit claims, battle with insurance companies and collect personal balances.

2. A medical billing company can attract a higher caliber of billing specialists and retain these individuals.

3. Billing services have a deeper bench of employees and this provides a layer of protection for your practice by decoupling you from the risk associated with losing a key (if not the key) billing employee.

4. Medical billing companies tend to stay on top of developing industry technology better than in-house billing departments.

5. Medical billing companies have a broader view of the medical industry as a whole because they deal with many different medical professionals at the same time. This knowledge helps them deliver better services to their clients.

A copy of the survey is available from the MGMA’s website.

Copyright 2009 by Carl Mays II

Before deciding upon a medical billing service be sure to visit ClaimCare’s Website. It provides in depth information about outsourcing medical billing. Carl Mays is a national renowned expert on medical billing operations and revenue cycle management.

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It’s official — a recent study made by the Medical Group Management Association (MGMA) has shown that medical practices and facilities that use medical billing companies experience improved billing performance over those that use in-house billing systems.

The survey found that for practices switching from in-house billing to a medical billing company:

- Almost three in four practices that use medical billing companies reduce their AR;

- 73 percent realized higher collections;

- 59 percent decreased the volume of lost/denied claims;

- Three in every five also reported better practice performance insights; and

- 46 percent enjoyed better productivity among staff.

The breadth of the performance improvements uncovered by the MGMA survey (with three quarters of all practices seeing significant performance improvements) adds fact-based credibility to the notion that a well selected and qualified medical billing company provides meaningful performance improvement for medical practices.

Some of the more obvious benefits of using a medical billing company include the following:

1. Medical billing companies have more scale to purchase and deploy the technologies required to properly submit claims, battle with insurance companies and collect personal balances.

2. A medical billing company can attract a higher caliber of billing specialists and retain these individuals.

3. Billing services keep a deep employee roster, giving medical practices the security that an in-house billing system can’t. For instance, practices using a medical billing company won’t face the risk of losing a key employee in the billing department.

4. Medical billing companies also utilize industry technology better and more efficiently.

5. Finally, medical billing companies have a broader scope than any single medical practice or facility. This allows them to see patterns across practices, specialties, states and payers that can add money to your medical practice’s bottom line.

If you’d like to see the survey for yourself, check the MGMA website.

Copyright 2009 by Carl Mays II

Before making your decision regarding a medical billing service be sure to visit ClaimCare’s Website. The site provides in depth information about outsourcing medical billing. Carl Mays is a national renowned expert on medical billing operations and revenue cycle management.

Bookmark It

It’s official — a recent study made by the Medical Group Management Association (MGMA) has shown that medical practices and facilities that use medical billing companies experience improved billing performance over those that use in-house billing systems.

The survey found that for practices switching from in-house billing to a medical billing company:

- 73 percent of practices using medical billing companies reduce their AR;

- 73 percent also received higher collection rates;

- 59 percent experienced fewer lost or denied claims;

- Three in every five also reported better practice performance insights; and

- 46 percent achieved higher staff productivity.

These and other findings offer factual evidence that the majority of medical professionals and practices that utilize well-chosen medical billing companies experience broad improvements in performance and productivity.

Some of the more obvious benefits of using a medical billing company include the following:

1. Medical billing companies are more likely to be able to buy and utilize industry technology, helping practices submit claims, negotiate with insurance companies, and collect personal balances more effectively.

2. A medical billing company can attract a higher caliber of billing specialists and retain these individuals.

3. Medical billing companies keep a deep bench of employees, so their clients don’t have to deal with the risk of losing a key billing employee from an in-house billing solution.

4. Medical billing companies also utilize industry technology better and more efficiently.

5. Medical billing companies have a broader view of the medical industry as a whole because they deal with many different medical professionals at the same time. This knowledge helps them deliver better services to their clients.

If you’d like to see the survey for yourself, check the MGMA website.

Copyright 2009 by Carl Mays II

Before making your decision regarding a medical billing service be sure to review ClaimCare’s Website. It provides in depth information about outsourcing medical billing. Carl Mays is a national renowned expert on medical billing operations and revenue cycle management.

Bookmark It

Seven to over ten percent of your practice’s revenue is being lost if your medical billing company is not systematically comparing your insurance payments to the amounts allowed in your payer contracts. Any competent medical insurance billing service should offer this feature as part of their standard service.

Medical billing services have a number of basic steps they should incorporate into their billing process. These steps should include using a claims scrubber, use of no-response calls, posting zero pays, pursuing underpayments, and using likelihood of payment scores for patient collections.

This article focuses on just one of the key elements you need from your medical billing service: pursuit of underpayments. Pursuit of underpayments starts with a critical step: comparison of EOBs to your contractual allowables (the payment your payers have agreed to make for each CPT code). You cannot count on payment posters to catch underpayments with their naked eye; the comparison must be automated and systematic. It goes without saying that if you do billing in-house the comparison still should be done.

The reason that comparison to allowables must be automated is because of the clever and systematic manner in which payers typically underpay claims. These underpayment patterns can be difficult to spot, but one of the advantages a Medical Insurance Billing Service has is that it sees payment information and patterns across many clients for many payers. This allows medical claims billing services that regularly and systematically compare payments to contractual allowables to spot patterns that a single practice might miss.

A pattern that is often seen by billing companies is one where a payer will underpay the same codes across multiple providers by the same dollar amount in month one. Then in month two, the payer will resume paying the code correctly and will begin to underpay a different code (or codes) across multiple clients.

These underpayments are not huge (5 to 10 percent) but they add up quickly to big dollars for a medical practice. The combination of switching the codes being underpaid from month-to-month and keeping the underpayment amount “under the radar” can make the underpayments difficult for an individual practice to spot.

The pattern outlined above is why it is critical that a strategy for pursuing underpayments is not based upon payment posters picking up on the underpayments. Most payment posters will notice a large underpayment, but it is too much to expect them to spot a $5 underpayment.

This single action (comparison of payments to allowables) can increase a medical practice’s collections by 5 to 10 percent. This is why you need to insure this critical step is being completed by your medical billing service.

Identifying the underpayments is the first step of the journey. Dogged pursuit of the underpaid amounts is what actually drives up your practice’s revenue. This pursuit needs to go down to even small underpayments because once a payer sees that the small underpayments are being pursued they typically taper off and contractual payments resume at the appropriate level. Much like a small child, the insurance companies are trying to see what the can get away with.

Copyright 2008 by Carl Mays II

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Is your cardiology billing department prepared for the 2009 coding changes? If not, it could cost your cardiology practice a great deal of money.

Not since the mid 90’s has cardiology seen such significant coding and billing changes as have been put in place in 2009.

Across the board the average Medicare fee increased just 1.1 percent. Cardiology in general fared worse than average, experiencing an average decrease of 2% due primarily to decreases in payments for in-office imaging.

Cardiologist that have a higher than average use of imaging services will see decreases in their Medicare fees far in excess of 2%, while other cardiologists may be able to achieve an increase in Medicare fees.

A sample of the key 2009 cardiology billing changes includes:

- Sweeping changes in the codes for following up on implanted devices (sweeping as in all of the old codes are gone and the new ones have significant differences). The new codes include such things as specific codes or internet (remote) device checks, codes for devices with leads in 3 chambers, ICM device follow-up codes, and codes for periprocedural checks.

- Global periods related to device follow-up now include global periods of 30 or 90 days. The new codes are now service specific (i.e., either an interrogation evaluation of a programming evaluation).

- The current cardiology billing changes include CPTs for wearable cardiac telemetry devices like Cardionet. These new codes include global periods. There is no more billing for such services under the unlisted procedure codes.

- The echo services are also seeing new codes. When you do an echo with a Doppler and color flow you’ll have a new code to submit that bundles these services into one code. The same is true for a new stress echo code that bundles the stress test code and stress echo into one code.

These changes are far greater than the normally “tweaking” that occurs at the beginning of each year. If you cardiology billing department is not fully aware of the changes and how to respond to these changes it could have a significant negative impact on your practice. Be sure to invest in the proper training, coding resources and billing system upgrades to be prepared for 2009 cardiology billing.

Copyright 2009 by Carl Mays II

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