10 ways to improve medical practice profitability

Transcription

1 10 ways to improve medical practice profitability How M-Scribe document specialists with coding and billing expertise can help you get there Learn how to achieve maximum reimbursement, and still avoid expensive fines that can result from inaccurate coding and billing.

2 CONTENTS Our Expertise Document Specialist... P.3 Benefits 1. Convenience... P.5 2. Effeciency... P7 3. Fast Turn-around... P.9 4. Economy... P Accurate Medical Coding... P ICD-9 to ICD-10 Conversion... P Submit Claims to Payers... P Specialty-Specific Expertise... P Advanced Technology... P One Solution for All. People Not Machines. Service Not Sales... P.17 Contact us Why M-scribe... P.18 2

3 Document Specialist with Coding and Billing Expertise The foundation of accurate medical billing is thorough and complete medical document. M-Scribe document experts with billing and coding expertise not only help create the document but also review the document integrity and complete EHR charts with relevant description of patient encounter. They also evaluate procedure and diagnosis codes generated from a medical record to ensure that the codes applied match the existing document. While one medical bill with inappropriate modifier use may result in a small overpayment, thousands of bills with the same error result in evidence of fraudulent medical billing practice. 3

4 The medical record, the codes, and the bills that follow a medical encounter equally deserve expert handling. The business of medicine is driven by accurate billing. Healthcare providers receive little to no formal training in the documentation and coding standards required by third-party payers. The healthcare industry is closely regulated to protect payers from fraudulent or abusive billing practices. The law is on the payers side. Physicians and ancillary healthcare providers need to use every tool at their disposal to protect themselves from underpayments for their services, and from expensive fines that can result from inaccurate coding and billing. Using the latest technology to directly dictate patient encounters into an Electronic Medical Record (EHR) has made documentation easier and more cost-effective for physicians. Computer-Assisted Coding software (CAC), Codefinder (from 3M) and other software has taken some of the guesswork out of the process. Despite these advances, there is no substitute for the professional knowledge and expertise that certified medical document professionals bring to the medical reimbursement process. Technology is not a panacea. A tool is only as good as the person who uses it. A physician who performs robotic-assisted procedures knows that an even greater degree of specialized training is needed for the procedure to be a success. The same principle applies after the procedure is completed. The medical record, the codes, and the bills that follow a medical encounter equally deserve expert handling. The pages to follow highlight 10 great benefits of working with documentation specialist who has coding and billing expertise to manage your day to day processes. 4

5 Benefit #1 Convenience Rather than handwritten notes or recorded dictation that needs to be transcribed, speech recognition technology enters data directly into the EHR. Advanced technologies ensure that a healthcare provider spends less time on correcting medical records and more time serving patients. Once information is spoken into the EHR, trained and credentialed medical documentation professionals review the data and its arrangement. The technology is new and it does not always recognize unique accents, regional pronunciation, or individual phraseology, even when a physician is using standardized medical language. Having a documentation professional review avoids needless errors or vagueness that a physician may not recognize and integrity of document not compromised. Behind the scenes, a document professional reviews and edits a medical record s entries, arranges the data for clarity, or asks for further specificity. Health care providers do not need to spend valuable time mastering specific software requirements or quirks. Someone who does this every day takes over that role and streamlines the process for the physician to ensure that the medical record accurately describes what occurred. 5

6 Stiff fines are paid for upcoding and providers can be sentenced to probation and/or house arrest if convicted. Do you follow the requirements of the law? One doctor who made a simple mistake. If your medical records are selected for audit review, clear records will help you to withstand scrutiny. Stiff fines are paid for upcoding and providers can be sentenced to probation and/or house arrest if convicted. An endocrinologist recently paid almost $500,000 in fines for upcoding routine blood draws to higher-paying, critical-care blood draws. A dermatologist paid almost $3,000,000 in fines for falsifying diagnosis codes for a condition covered by Medicare when the patient s actual condition was not covered. This same doctor was sentenced to two years of probation and six months house arrest. - OIG Presentation by Dr. Julie Taitsman. 6

7 Benefit #2 Efficency More patients can be seen, more procedures can be performed, and more free time can be enjoyed after normal working hours. With directly spoken medical record entry, healthcare providers can practice their profession and generate more revenue. Physicians are not paid for their time documenting patient encounters. They are paid for their professional evaluation and management of disease. Freed from the burden of checking each EHR entry for compliance to third-party payer requirements, more patients can be seen, more procedures can be performed, and more free time can be enjoyed after normal working hours. With professional documentation, coding, and billing specialists working while physicians see patients, two tasks are accomplished at the same time. A healthcare provider needs to only make a cursory review of the medical record before finalizing it. 7

8 Hiring medical documentation proffesionals can improve medical practice efficiency and profitability. Time inefficiency is recognized as a major barrier to successful EHR implementation. A systematic review was performed by American Medical Informatics Association (AMIA) to examine the impact of EHRs on documentation time of physicians and nurses. The use of computerized provider order entry (CPOE) was found to be inefficient, increasing the work time from 98.1% to 328.6% of physician s time per working shift. Studies that conducted their evaluation process relatively soon after implementation of the EHR tended to demonstrate a reduction in documentation time in comparison to the increases observed with those that had a longer time period between implementation and the evaluation process. This review highlighted that a goal of decreased documentation time in an EHR project is not likely to be realized. 55% of physicians adopted EHR. 85% of physicians who have adopted an EHR reported being satisfied with their system. About three-quarters of adopters reported that using their EHR system resulted in enhanced patient care. Majority of Physicians recognized that time inefficiency is still a major issue in spite of using EHR. - Data from the 2011 Physician Workflow study 8

9 Benefit #3 Fast turn-around The benefits of having a real person dedicated to evaluate and translate medical documentation have a positive impact on cash flow, but they also have a positive impact on patien care. EHR technology has brought a number of efficiencies to the healthcare process. There is no need for a physician to wait for a lab chit to be dropped in their inbox or for a consultation report to be mailed across town. EHRs are updated by document professionals in real time when data is received and the data needed to provide effective patient care is available when it is needed. The benefits of having a real person dedicated to evaluate and translate medical documentation have a positive impact on cash flow, but they also have a positive impact on patient care. 9

10 Benefit #4 Economy Back office turnover can be a source of waste of both payroll and available clinical space. Prior to the introduction of EHR, CAC, DRT, and NLP technologies, the practice of effective medicine depended on phone lines, the U.S. Postal Service, or couriers. The increased efficiency of digital media streamlines operations. In addition, by using a centralized documentation, coding and billing service, healthcare providers do not need to employ excess administrative staff. Practice resources can be focused on delivering quality patient care while the business and compliance aspects are performed by qualified and experts. Back office turnover can be a source of waste of both payroll and available clinical space. Every medical practice has a history of working with documentation professionals, coder and billers who were not up to the task demanded of them. By employing a qualified team of medical documentation specialists who are credentialed by their respective professional associations, and who spend their entire workday doing nothing but managing health information, a medical practice reduces overhead while ensuring that documentation, codes and bills meet the highest standards required by government and commercial third-party payers. Audit risks are reduced, as is the risk of adverse findings in the case an audit is conducted. 10

11 Reduce your exposure to charges of improper billing. The Centers for Medicare and Medicaid Services (CMS) is increasing its use of Recovery Audit Contractors (RACs) to detect patterns of healthcare fraud and abuse. Commercial insurers are following suit. By having qualified health documentation professionals review and enter data, a medical practice significantly reduces its exposure to charges of improper billing. Did You Know? Roughly 87 percent of hospitals experienced RAC activity in the first quarter ended March 31, Hospitals reported 447,523 medical record requests from RACs through the first quarter of 2012 compared with 306,349 in the third quarter of Of all the denied dollars involving RACs, 96 percent were complex denials. The average dollar value of an automated denial was $521. The average dollar value of a complex denial was $5,839. RAC activity increased administrative costs for 55 percent of hospitals. About 55 percent of hospitals said they spent more than $10,000 managing the RAC process during the first quarter of Hospital RAC coordinators spent an average of 114 hours responding to RAC activity in the first quarter, the most of any hospital staff member. Roughly 59 percent of hospitals indicated they have not received any education related to avoiding payment errors from CMS or its RACs. 11

12 Benefit #5 Accurate Medical Coding Even the most advanced technology has its limits. There is no substitute for an experienced documentation professional who has made a career out of mastering the requirements of medical coding and billing. It is a necessary skill set if physicians want to comply with reimbursement regulations. The regulatory climate surrounding the healthcare industry requires informed and expert best practice when codes are assigned and submitted to third-party payers. Guidelines change on a regular basis. Human beings are required to review changes in the industry and apply them to existing documentation. Medical coding is based on what a physician enters into the patient record. Constant communication between a documentation expert and the dictating provider is essential to ensure that bills accurately reflect what was performed. Standardized medical codes are used in different ways in different situations. Diagnosis codes are reported only when a medical condition is proven in the outpatient setting, but they are reported when they are only suspected in the inpatient setting. Medical procedures are reported through overlapping sets of Common Procedural Terminology Codes (CPT or HCPCS Level I), through HCPCS Level II codes, or through ICD-9-CM Volume III codes depending on the clinical setting and circumstance. Only someone who is fluent in medical coding can produce an understandable CMS-1500 or UB-04 that justifies accurate payment. 12

13 Benefit #6 ICD-9 to ICD-10 Conversion Medical coding is as much art as it is science to the people who are trained to make sense of it. There are solid rules that govern code assignment, but there is room for interpretation based on the available documentation. The ICD-9-CM coding system is scheduled to be replaced in the U.S. by ICD-10-CM and ICD-10-PCS in ICD-10-CM will be the required standard for reported medical conditions, symptoms and diseases instead of ICD-9-CM Volumes I and II. ICD-10-PCS will replace ICD-9-CM Volume III to report inpatient procedures. The conversion from one system to the next is expected to be fairly seamless for experienced medical coders and billers. The two systems utilize similar methodology. The ICD-10 system requires a greater degree of specificity in the documentation in order to assign accurate codes. An in-practice medical biller does not have the free time to become proficient in ICD-10. Professional medical documentation specialists receive accredited training, and the transition from one system to the other will be accomplished without provider involvement on the back end. Physicians will receive updates and information on the transition as it occurs, but the transition itself will be performed by trained professionals at no additional cost. The upgrade to ICD-10-CM and ICD-10-PCS are part and parcel of the business of submitting accurate medical claims for prompt reimbursement. 13

14 Benefit #7 Submit Claims to Payers By centralizing the documentation, coding and billing processes in a single off-site location, there is no need to employ a biller in-house. By centralizing the documentation, coding and billing processes in a single off-site location, there is no need to employ a biller in-house. Electronic submission has reduced claim turnaround time between submission and payment from 45 days by mail to 21 days, or quicker. Many payers now issue payments in 14 days if claims are submitted without errors. Payments are made directly to provider bank accounts via direct deposit, and remittance advices are sent instantly via electronic transmission. Instant claim submission and instant payment posting increase timely cash flow for a medical practice. Even when a remittance advice contains a denial, it is received much more quickly than before, and professional documentation specialists can submit appeals based on the medical record in real time. 14

15 Benefit #8 Specialty-specific Expertise Physicians of one specialty refer their patients to a trusted specialist of another specialty when a patient s care plan requires it. A gastroenterologist doesn t deliver babies unless an obstetrician isn t available. Medical coding and billing is not a catch-all profession. Every medical specialty deals with its own specific sets of codes and documentation requirements. A coder who has spent years reviewing and translating cardiology records cannot walk into a laboratory and begin submitting molecular diagnostic claims. The substance and basic training is the same, but the specific skill sets required for specialty practice are different. Documentation specialists know their field of expertise. They focus on the regulations, statutes and guidelines that govern medical billing and coding in their specialty. Every code set, indeed, every code, has published guidance as to how it may be used or modified for reimbursement. Interventional radiologists don t hire coders with experience in orthopedic surgery to do their billing without a break-in period. The right documentation specialist for the right job ensures that claims are submitted without worry. 15

16 Benefit #9 Advanced Technology EHRs are accessible from anywhere via smart phones such as the iphone, ipad, ipod, Android-enabled devices, or tablet PCs and e-readers. Unlike paper medical records, EHRs are accessible from anywhere via smart phones such as the iphone, ipad, ipod, Android-enabled devices, or tablet PCs and e-readers. Being on call doesn t have to mean being uncertain about a patient s history or recent test results. Real time documentation in the real world delivers better patient care. Real time review of finalized documentation ensures that the most accurate information is available anywhere, anytime. 16

17 Benefit #10 One Solution for All. People Not Machines. Service Not Sales. A physician thinks about his or her business when making business decisions, but he or she doesn t think about business when they are treating patients. Medical documentation professionals do what they do because they are trained to do what is right. Certified medical coders assign accurate codes based on available documentation because they are proud to put their training to good use. Experienced medical billers dovetail their specific knowledge regarding how to make a reimbursable claim to provide justifiable reimbursement based on the medically necessary services provided. When things are done right, appropriate payments follow. In a hospital that chooses to keep all its operations in-house, there are three or more departments dedicated to manage health information. A small medical practice may combine roles into a single desk: one person responsible for reviewing charts, coding from a superbill, posting payments, submitting appeals, and answering patient phone calls. Smart healthcare providers of every size make smart investments in technology and expertise. If they find one source that can deliver comprehensive medical documentation, comprehensive coding that conforms to established guidelines, and accurate medical bills that result in prompt and accurate payment, they subscribe to the most efficient, effective, economical, all-purpose solution. Few physicians are interested in wading through the documentation and regulatory requirements that govern medical coding and billing. They did not graduate from medical school to master the use of block 24d of a CMS-1500, or any of the other required and optional fields of a claim form. A smart physician or ancillary health care provider trusts the business side of their practice to professionals trained and experienced in navigating the healthcare reimbursement system. When these operations are centralized and streamlined, and when they are personalized, the benefits are immediately apparent. 17

18 Why M-Scribe? Call: ICD 10 Experts - currently using ICD10 certified professionals, well ahead of the 10/1/13 compliance date. Help with increased required documentation & staff comfort with ICD 10 adoption. Free EMR/EHR Coding Audits - working hard to insure compliance, we offer coding audits to our clients Seasoned Team of healthcare professionals who understand dictation and can put it on any EMR Get Paid Faster - our accurate, convenient, compliant & timely return of documents increases your revenue Spend time seeing patients, not documenting Streamline practice workflow & operations Customer Service - in-house customer support 24 hours a day, 365 days a year Paperless Option Experienced healthcare professionals are the backbone of our services. We combine the best in personnel, practices, and technology to provide quality services at very competitive rates. The most valuable asset we offer is our core team of medical professionals, who are trained and monitored closely for quality control to provide accurate and timely service. Our family of healthcare professionals include: Board-Certified Physicians Certified Medical Reimbursement Specialist (CMRS) Certified Professional Coders (CPCs) Certified Medical Transcriptionists (CMTs) 20+ years experienced, senior account management team Execution oriented customer service team Healthcare IT professionals Click Here to Request your FREE Demo today! 18