FOR BILLER

What should I expect from an ideal billing software?

A billing software should streamline and automate the entire revenue cycle process for private practice owners from start to finish.

Here are some important components of the revenue cycle management process.

1)The ideal billing software simplifies all aspects of the claim process; this process starts with claim creation. Once a claim is generated, it should be scrubbed for the presence or absence of all modifiers and analyze all components of the claim in order to minimize claims denials.

2) The software should then transmit the claim to a clearinghouse

3) Once the payer gets the claim, they will return an EOB or an ERA.

EOB – explanation of benefits which provides more information about the benefits of the patient and how much will be paid by the insurance company

ERA – electronic remittance advice is a digital version of an EOB

The billing software should be able to take the ERA and apply it to the patient record with one click. This is called ‘auto-posting’ and will save your office time.

4) It should also be able to generate a clear, easy-to-read patient statement, if necessary. You should also be able to track the claim cycle throughout its acceptance process.

What is the difference between a biller and billing software?

Learn the difference between a ‘biller’ and a ‘billing software’.

A biller is the person who makes sure that the provider gets paid, based on the work they performed. The biller makes sure that the clinician gets paid for services rendered and collects receivables.

A biller can only be as good as the billing software he or she uses. A biller can become far more efficient if he or she is using In Touch Biller Pro.

A billing software (like In Touch Biller Pro) can make a biller more productive and efficient in the following ways:

Integrated scheduling and online eligibility verification, saves the biller the trouble of having to call insurance companies to verify eligibility.

ERAs that come back from the insurance companies can automatically be posted to the patient record with one click.

Automatically keep track of allowable amounts and check if you are getting paid less than your allowable amount.

Complete integration with the billing software and the clearing house and makes it easier for a biller to maximize billing for a clinician and gets the clinician paid more, faster with less denials.

What is the difference between an ERA and an EOB?

An EOB is an explanation of benefits that come to you from an insurance company. When a claim is sent to the insurance company, the payer sends back information about that claim in a paper format which is called the EOB.

An ERA is a digital version of an EOB and comes back much faster than an EOB.

Since an ERA is faster, the billing cycle is shortened and the clinician gets paid faster.

In Touch EMR can take an ERA and automatically apply to it the patient record with the click of a button. This is called ‘auto posting’.

There is no need to manually copy the EOB or the ERA to the patient record. This saves time and effort on the part of the biller.

In Touch EMR will enroll your paper payers to electronic payers so you can take advantage of ERAs. You can now start to auto-post ERAs and get paid faster.

How can we become more efficient at claims and billing?

There are three key elements to billing efficiently:

1) an integrated system for scheduling, documentation and billing

>>some data might get lost in the process if these components are not integrated seamlessly

2) the ability of the biller to edit the claim before it gets submitted

>>billers can optimize the claim and ensure first pass claim acceptance

3) it is important to have a reporting function that would allow the clinician to see how the practice is doing

>>accounts receivable can be broken down to different information/filters to allow for better viewing of information

How does 'Depth of Diagnosis' affect our insurance reimbursements?

Different line items can be found on a claim form. Each line should have it’s own individual CPT code.

It is important for each ICD code to have a specific CPT code linked to them in order to ensure depth of diagnosis. This essentially is you explaining to the insurance company that you are performing the following procedures because of the related diagnosis.

This will maximize your billing and reduce claim denials.

What should I look for in billing reports in my software?

Billing drives your practice in terms of cash flow. It should be simple, streamlined and efficient.

There are different kinds of billing reports that can give the clinician a financial overview of how his/her practice is doing.

Reports should be fully customized to suit the needs of the clinician and of the practice.

They should have the capability to break down the accounts receivable into different metrices such as by patient, by payer, by provider, by location, by ICD and CPT codes.

These reports keep you informed on how much you are getting paid and how much of your money is out there waiting to be collected.

These reports allows the practice owner to review their business. They can then change the way they are doing things to attain business goals.

The level of sophistication of the billing reports in In Touch EMR are directly related to how successful you are as a practice owner.

How can I make things easier for my biller?

The biller is an important person in your practice. It is important that they have a simple, efficient yet powerful biling software.

In Touch Biller Pro saves the biller the time and the effort of having to manually enter information from paper or one system to another.

In Touch Biller Pro is completely integrated with the clearing house.

The information in the billing software communicates directly to the clearinghouse.

As soon as an ERA comes back from the insurance companies, it is seen in the billing software where the biller can review it and can be automatically posted to the patient’s account. No need for manual entry.

It frees up the biller so he or she can do more important tasks of making sure money keeps coming in and following up with patients using streamlined patient statements which can be automatically batched.

What should I expect from my biller?

The biller is the most important person in the clinic other than the clinician.

In Touch Biller Pro, the biller does not have to do the following tasks (most of which are extremely time consuming):

1) Manually entering ICD and CPT codes from the notes of the clinician to the billing software

2) Manually entering the ERAs from insurance companies to the patient’s account after review

3) Make do with inefficient and ineffective reports that do not help the clinician.

In Touch Biller Pro allows the biller to:

1) create sophisticated reports that can be drilled down according to data needed. These reports can help the clinician analyze financial data in aid of decision making

2) biller can do depth of diagnosis to maximize billing and revenue

3) take the notes of the clinician and use it to create a claim automatically

4) take the ERA from the insurance companies, review it and post it automatically to the patient record

5) allow the biller to generate a patient statement as needed

Can claim submissions be automated

Claim submission can be automated to some extent.

When a claim is generated for a particular visit, often times it is the biller who adds the modifiers to the ICD and CPT codes.

An ideal billing software should be able to scrub the claim like what the biller does.

In Touch EMR has the sophistication to do online verification and to pull all data from the insurance company and create a patient record. This minimizes user error when entering claim data.

Once a clinician documents, a claim is then generated automatically and In Touch Biller Pro will scrub it for you.

After the biller reviews it, he or she can then submit it to the insurance companies.

How can patient pay-online options increase my cashflow?

Patients tend to pay their other bills before their patient statement bills from clinicians.

Therefore it is very important to make it easy for them to pay their patient bills.

You should ideally give them the option to pay by cash, check or credit card.

The patient can also be given the option to split the payment into recurring payments.

Allowing the patient to pay online will make it easier for the patient to settle their bills on time.

If the patient is seldom online, you can take their card information and set it up with a merchant account.

These options are available in the billing component of In Touch EMR.

What is the 'ideal architecture' of a patient statement?

The patient is the last payer of the revenue cycle of a clinic and in some cases, the most difficult payer to work with.

It has been found out that patients are more likely to pay off their utilities bills quicker than their healthcare bills.

An ideal patient statement should from a billing software should be:

1) One page to make it simpler and easier to understand for the patient and also reduce printing and mailing costs

2) Detailed, providing the following information in a clear and legible way:

  • treatment rendered and CPT codes billed

  • how much you billed and the amount of money insurance company paid

  • the amount adjusted, what they have paid so far as co-pay

  • what the balance of their payable is

An ideal billing software should also allow the posting of payments to the patient’s statement so it will reflect the amount they have paid so far. Generating patient statements should be easy for you to do in office or to send out to a printer for a nominal fee.

How do I increase cash flow and minimize accounts receivable?

A common problem with private practice is the account receivable. Three things that a clinician can do to shorten the revenue cycle process of the practice:

1) submit claims as quickly as possible

In Touch Biller Pro automatically batches all claims and sends them out to insurance companies on the same day. This means no more manual batching and uploading of claims.

The efficiency in the billing process is extremely important as it allows you to shorten the revenue cycle to get paid more, faster.

2) the billing software should tell you what stage the claim is at in real time, as well as track the claim at all times throughout its life cycle

3) the billing software should also automatically post ERAs, cutting down on manual data entry.

In Touch EMR has all these capabilities and can mean huge savings in as it makes the job of the biller simpler by cutting down the billing process.

What are the three KEY elements of claim submission?

When a biller is submitting a claim, there are three things that are very important:

1) Is there automation between the clinician’s method of documentation and the billing software? The documentation of the clinician should automatically be carried over to the billing software without the need to manually enter the data.

2) Can the biller edit the claim data before submission? The biller should have the capability to check and maximize claims before it gets sent out.

3) Can the biller have the claims scrubbed automatically by the billing software? This capability allows the biller to submit the claims faster.

In Touch EMR can do all these for your biller, to ensure a faster billing process.

How do I get patients to actually pay and settle their statements?

The patient is usually the last payer and the hardest payer at that.

It is important to make it easy for patients to pay their bills by providing multiple payment methods and modes of payment.

Patients would like to pay online so it is important to have an online payment facility.

Automatic patient reminders can be done in In Touch Biller Pro.

What do I need to know about the Therapy Cap & KX modifier?

It is almost impossible to keep track of a therapy cap real time.

You can find the therapy cap information on the internet, but it is not real time.

You can turn on the KX modifier in In Touch EMR in case the patient has reached the $1,900 therapy cap.

How do I make it easy for patients to pay their statements?

It is sometimes difficult to get patients to pay off their balance. For them, paying off healthcare bill is their last priority.

You can make this process easier for everyone by:

1) Giving them multiple payment options

  • the more options they have, the easier it will be for them to pay off their bill

  • give them the option to pay in small recurring payments

2) Informing the patient that any balance should be paid within 60 days and if unpaid after that period, it will go to a collection agency

  • give the client a courtesy call reminding them of their balance

  • if account is still unpaid, then forward to collection agency

In Touch Biller Pro utilizes mechanisms that can gently remind patients to settle their balance, and make it easier for you to collect your outstanding balances.

What are the pros and cons of Automated vs Manual patient follow up?

In a standard practice workflow, a lot of effort goes into reminding patients about their appointments.

Front desk staff can save time and effort as patient appointments can be automated within Touch EMR.

The patient will get a call that will allow him/her to choose their options: confirm, cancel or reschedule.

This automation combined with a manual reminder/call should slash your cancellation rate.

How do I minimize the problem of missing / incomplete charges?

One of the big mistakes in practices is missing charges or not charging patients because of incomplete documentation.

The payment cycle will become longer if there is delay in documentation.

The faster the documentation is completed, the faster the charges are entered and sent off to insurance companies, the shorter the revenue cycle will be.

In Touch EMR will help you get paid faster as it streamlines the entire practice workflow.

In Touch EMR provides you with a summary at the end of the day for patients seen vs charges sent out.

Missing charges should be at zero at the end of the day- if not, at the end of the week.

What should I look for in a billing service or billing company?

It makes sense for clinicians with small practices to have an in-house biller rather than a billing company.

Here are some attributes of a good biller:

1) flexible in using a billing software

2) provide reports and are highly familiar with analyzing reports

3) have experience in the field you are in, whether it be physical therapy or otherwise.

In Touch EMR makes things easier for you and your biller, but your biller should still be efficient and competent.

What are the types of reports that I should expect my billing company to give me?

In Touch Biller Pro has the capability to produce different types of customized, thorough reports. You can view your A/R:

1) by ICD codes – which codes got paid the most from insurance companies

2) by payer – which payers are paying you the most amount of money

3) by provider – which providers are generating the most income for your clinic

4) by referring clinicians – which physicians are driving your revenue most

5) by patients’ outstanding balance and co-pay

In Touch Biller Pro has the capability to produce different types of reports.

Having sophisticated reports in your billing software can help greatly in assessing the productivity and financial standing of the practice.

What are the key distinctions between a billing software and a billing service?

In an ideal workflow, claims created in the EMR should go directly into the billing software.

The billing company or service will now manage the claim to get it submitted and paid fully by the insurance companies and patient, if applicable.

In Touch Biller Pro simplifies and automates a lot of the things done by the billing company.

There is no need for the billing company to manually enter data from your EMR to the billing software.

In Touch EMR and In Touch Biller Pro are completely integrated that data from one flows to the other seamlessly.

Are you making these mistakes with your billing service?

Here are common mistakes that your billing service should not be making:

1) Spending too much time in posting of ERAs. In Touch EMR automatically posts ERAs to the patient records, so there is no need to manually enter information

2) Manually batching claims and sending to insurance companies, wasting time. In Touch EMR automatically batches claims and sends them out at end of day

3) Manually scrubbing the claims before they get submitted. In Touch EMR has built in scrubs that complies with standards in the industry

4) They do not have the capability to generate reports that drill down to specific data. In Touch Biller Pro has a built in reporting mechanism that can assist in decision making.

Are you making these mistakes with your billing software?

Common mistakes with a billing software include:

1) no online patient eligibility verification

2) inability to create a patient record automatically

3) manually creating batches of claims

4) manually posting the ERAs from clearing house to patient records

5) does not automatically bill secondary payers

In Touch EMR can correct all these mistakes, which saves a lot of time for the front desk, clinician and billers to shorten revenue cycle and make the work easier and more efficient.

What are the common myths about the Medicare 8 Minute Rule?

The Medicare 8 minute rule is now being implemented by other insurance companies as well.

You must total the number of units in a treatment session to determine the maximum number of units you can bill for.

You need to bill on the total number of minutes and RVU. This only applies to timed services.

In Touch EMR automatically calculates the number of units applicable to Medicare 8 minute rule.

What are the common myths about modifier 59

Modifier 59 is part of the CCI edits to make sure to bill codes that are mutually exclusive.

It tells Medicare that there is a documented reason why you are billing those codes together.

In Touch Biller Pro automatically checks for modifier 59 and applies it as documented.

Common Myths About the KX Modifier

It is difficult to accurately track the Medicare cap of a patient. It can be tracked within your system only. You can track it on the Medicare website.

In Touch Biller Pro allows you to turn on the KX modifier option so you can be as close as you can get to a patient’s cap.