Searching for Medical Billing Software? Key Questions to Ask

Transcription

1 Searching for Medical Billing Software? Key Questions to Ask Today s healthcare environment continues to be challenging for the physician practice. Providing quality care is not enough to ensure success; practices must also master the increasingly complex fi nancial side of the business. At least part of the answer in managing these complexities is a modern medical billing system. While most practices have some form of computerized billing, many of these systems have not kept pace with a dynamic regulatory (e.g. HIPAA) and reimbursement landscape or with the latest technologies. In addition, the rapid emergence of electronic medical records has placed added pressure on software systems to fully integrate both the clinical and fi nancial side of the practice. The search for new medical billing software can be daunting. There are many systems available, with each vendor promising an easy transition and immediate benefi ts. How do you navigate the software marketplace and fi nd the system that is right for your practice? Practice Partner, developer of the Practice Partner line of practice management and electronic medical records software, has been successfully installing these systems for over 20 years. This Forum is designed to provide a brief overview of key considerations as you plan the purchase of a new medical billing system (with specifi c examples derived from Practice Partner Medical Billing).

2 GETTING STARTED What should you be looking for? As you begin the search for a medical billing system, it is easy to get lost in a sea of features, each with their own vendor-specifi c nomenclature and unique twist. Before you begin this potentially confusing process, it is prudent to defi ne your expectations for the system. How is it going to help your practice? What benefi ts should you anticipate? While the needs of individual practices will vary according to their particular situation, this Forum lists a number of questions that are pertinent to the selection process, and provides examples of how these issues are addressed with Practice Partner software. How quickly can I enter charges? Medical billing is a transaction-intensive activity that places a premium on speed and productivity, particularly for charge entry. Some of the newer Windows-based systems, while providing an easy-to-use graphical user interface, actually have the potential to be slower, because of their reliance on a mouse instead of a keyboard. What features can a Windows system provide to help speed data entry? Here are specifi c examples: Keyboard and mouse data entry. To accommodate the keyboard-intensive activities of billing clerks, the system should offer easy keyboard data entry for the majority of essential functions. Practice Partner Medical Billing features a customizable ledger that allows 10-key data entry as well as timesaving keyboard shortcuts for many functions. Ledger design and fl exibility. All offi ces have unique posting needs. A fl exible ledger that you can customize to suit your practice will help speed posting and reduce data entry errors. Practice Partner Medical Billing uses a spreadsheet-style ledger format that was designed to allow easy customization by the practice to accommodate individual preferences. Full ledger customization, coupled with the ability to post using 10-key entry, results in fast and accurate charge posting. Automation and shortcuts for routine tasks. The system should provide shortcuts to speed the posting process and minimize keystrokes. In Practice Partner, posting charges for a routine visit involves simply entering a procedure and diagnosis code. Medical Billing automatically fi lls in the fee, place of service, and the patient s specifi c billing and insurance status. You can set up default diagnosis codes per patient, as well as default charge amounts, modifi ers, and places of service per procedure code. For commonly grouped procedure codes, Practice Partner provides the ability to group up to thirty procedure codes into a single supercode.

3 The charge screen shown below demonstrates the spreadsheet-style ledger in Practice Partner Medical Billing. This ledger design provides a practice with complete fl exibility to help suit individual posting needs. Custom formulas and fee schedules. A medical billing system that automatically populates charge information will eliminate keystrokes for billing clerks. With Practice Partner you can create your own formulas to calculate write-offs, patient co-pays, patient and insurance responsibilities, and more. These fl exible codes help reduce keystrokes and can be set by account type, insurance carrier, or specifi c to the patient. And Practice Partner also stores multiple fee schedules by provider and insurance carrier to fi t each carrier s reimbursement policies. Can the medical billing system receive charge information from an electronic medical record? The electronic superbill, also known as the electronic encounter form or EEF, automatically transfers ICD-9 and CPT codes from saved progress notes or electronic encounter forms within an EMR to the billing system. This eliminates the need for the creation, management, and redundant entry involved with paper superbills. For instance, within Practice Partner Patient Records, upon completion of the progress note, the EEF is sent directly to the billing specialist for review and posting a tremendous

4 time saver in the posting process. This also allows billing staff to focus on reviewing the completeness and accuracy of the charge information. Below is an individual electronic encounter form, displaying the procedure and diagnosis codes selected by the physician in Practice Partner Patient Records. Does the system have tools that allow me to check claims before they are sent to the payer? Complex reimbursement rules make it increasingly diffi cult to generate clean claims. Modern systems provide features (known as claims editing or claims scrubbing ) that verify charge information before a claim is sent to the payer, checking for any potential errors. By checking claims before they are sent, a practice can speed cash receipts while reducing denied claims and time spent reworking claims. For instance, Practice Partner Medical Billing checks claims against a number of edits including code validity and specifi city, CPT vs. ICD-9 medical necessity checking, Correct Coding Policy (CCP) bundling edits, and modifi er edits. If you discover a potential error, you can quickly adjust the charge information before it is saved and billed.

5 How easy is it to send claims? With the advent of HIPAA, the era of paper claims is rapidly ending. Therefore when reviewing a medical billing system, it is essential to assess the software vendor s approach to sending electronic claims. Due to the complexity and wide variety of both commercial and government payers, most systems use a clearinghouse, which receives a batch of claims electronically (typically via the Internet) from the practice, and then directs the claims to the appropriate payer. The benefi ts of using a clearinghouse include speed (you can send a batch of claims to multiple payers with a few keystrokes) and quicker reimbursement (claims sent electronically are often paid within 14 days of receipt of the claim). The Practice Partner Clearinghouse features a secure, Web-based interface for fast claims submission and tracking with connections to over 1,000 payers nationwide, including all major commercial and government payers. HIPAA compliance. It is important to verify that a medical billing system is able to generate electronic claims fi les in the new HIPAA-compliant ANSI format. Many vendors profess to be compliant, but they are actually relying on a clearinghouse to translate the fi les. This is just one more step that can go wrong in the claims process; look for a system that produces native ANSI format fi les directly from the software. Paper claims. For payers or specifi c situations that necessitate dropping claims to paper, Practice Partner allows you to design and fi ne-tune more than 100 insurance forms including both HCFAs and UB92s. How easy is it to send patient statements? Can they be customized for specific patients? Effectively managing patient statements, due in part to their volume and their direct impact on patients and cash fl ow, is a critical part of a well-run practice. Clear and complete patient statements can help reduce patient confusion and callbacks. New medical billing systems should provide you with a number of tools to assist in this area. Some of the questions to ask a vendor: Can patient statements be customized? With Practice Partner Medical Billing, patient statement information is fully customizable. You can print statements in batches or on-the-fl y and the system allows you to print individual notes on the statement to communicate with the patient. Can the statements be sent electronically? Your practice does not need to double as a mailing service. You can eliminate the time spent printing, folding, stuffi ng, and mailing patient statements by sending patient statements electronically. Example: Practice Partner Medical Billing connects with ExpressBill to provide electronic statement services. Statements are sent to ExpressBill via modem, where they are

6 dropped to paper and mailed to patients. This service helps to reduce labor and material costs, reduce collections time, and eliminate the hassles of printing and mailing statements internally. Are past patient statements easily accessible to help answer patient questions? When your patients do call with questions regarding their bill, the system should help you answer them quickly and accurately. For instance, Practice Partner Medical Billing displays all past statements on-screen, preserving an exact snapshot of each patient bill and insurance claim for future reference. In addition, staff members can quickly view the entire ledger, with all transactions and ledger notes clearly visible. How easy is it to post payments? Like charge entry, payment posting is a transaction-intensive process. A practice management system should offer ways to make this process as effi cient as possible. Many medical billing systems offer electronic remittance advice (ERA), a powerful timesaving feature that can signifi cantly improve the speed of posting. Using ERA, the practice receives an electronic EOB that can be automatically posted to account ledgers, eliminating the need to manually post individual payments. With Practice Partner, electronic remittance enables payment posting to multiple accounts with just a few keystrokes. Billing specialists can post payments from an EOB containing multiple checks in just seconds. The HIPAA regulations also introduced a new format for electronic remittance fi les, which many payers have adopted or are in the process of adopting. A number of practice management software vendors are not yet supporting this new standard; make sure that you fi nd a vendor that accepts native HIPAAcompliant remittance advice. Using ERA with a HIPAA-compliant system such as Practice Partner ensures your compliance and long-term compatibility with your payers. In addition to ERA, the system should facilitate rapid posting of multiple payments to multiple accounts. Practice Partner also uses payment posting formulas to automatically calculate adjustments as well as patient and insurance responsibilities. Can I quickly enter new patients and accounts? Everything starts at the registration desk. The complexity of today s patient information means that registration can easily become a bottleneck, slowing down the operations of the entire practice and frustrating patients and staff. A key requirement for any system is the ability to process patient registration information quickly without compromising completeness or accuracy. There are a variety of ways that software can help make this process quick and effi cient. Here are a few key components:

7 Structure the registration process. By structuring data entry during patient and guarantor registration, your practice is able to clearly defi ne the registration process and reduce the potential for errors. For example, Practice Partner provides specialized demographic guides that help reduce registration variability and errors by allowing you to defi ne the registration screens that are required, suggested, and unnecessary. The system leads you through the required screens and information by defi ning the order of operations, prompting for data entry, and highlighting mandatory data fi elds. Minimize redundant entry. A system that prevents redundant data entry can speed the registration process and reduce entry errors. Example: Registration information in Practice Partner fl ows automatically from the guarantor to the patient to the insurance plan. There is no need to enter identical names, social security numbers or addresses the software automatically pulls the information to the appropriate registration fi eld. Allow registration and updates to occur at multiple points of entry. Because patient information is dynamic, limiting registration changes and updates to specifi c staff members may result in bottlenecks and miscommunications. Integrated systems (systems that combine medical billing, scheduling, and electronic medical records) offer the potential for broader access to registration and patient demographic information. For instance, for offi ces using Total Practice Partner (an integrated system that includes Practice Partner Medical Billing, Appointment Scheduler, and Patient Records), full registration and patient demographics are available in all three applications. From any Practice Partner application, any staff member (according to practice-defi ned privileges) can quickly add or update patients and guarantors, making all demographic information immediately available to everyone. Can the system effectively handle referrals and authorizations? An important part of patient registration is referral entry and processing. The right medical billing system can help you manage the referral process thereby improving patient service, expediting referrals, and reducing miscommunications. You will also benefi t from a reduction in billing errors and claims denials. Some of the features to look for include: Quick entry of referral information. With Practice Partner, you can quickly enter referral information during the scheduling or registration process. Because referral information is readily available, all staff members can monitor incoming, outgoing, internal, and external referrals. This information enables you to better track and manage the quality of patients from your referring sources. Storage and tracking of authorization information. Accurate and up-to-date authorization information will help ensure payment for your services. Practice Partner Medical Billing stores all pertinent information such as authorization number, referring source, from/to dates, completion dates, and authorized visits.

8 Because of the integration within Practice Partner, the system will automatically alert users of Practice Partner Appointment Scheduler if the patient exceeds their number of authorized visits. Practice Partner also allows you to record all contact with the payer regarding the authorization a very useful feature if there is a coverage dispute. The referral and authorization screen shown below stores all relevant information in one place and is accessible from Practice Partner Medical Billing, Appointment Scheduler, and Patient Records. Does the system have the ability to handle complex families? Today s medical offi ce must be able to handle an increasing number of non-nuclear families with complex relationships between the patient, the guarantor, and the insured. A medical billing system with well-designed, fl exible demographics can help reduce data entry errors and improve patient communication while still capturing the full complexity of your patients. Let s look at some of the specifi c requirements: Comprehensive patient and guarantor demographics with the ability to add custom fi elds. The system must be able to capture the unique complexities of both patients and guarantors. Example: The central demographics screen in Practice Partner clearly displays patient information with everything you need

9 to know including alternate addresses, address history, head of household, alternate IDs, addresses, phone notes, co-pay amount, primary care provider, and more. Additionally, you can create up to 100 user-defi ned fi elds to store any other patient or guarantor information that you choose. Practice Partner also allows you to store scanned or linked patient photos, insurance cards, and other images. Practice Partner s patient demographics include all relevant patient information in one central location. The patient demographics screen shown below includes information from all three Practice Partner applications and provides hundreds of separate fi elds of information. Multiple ways of locating patients and accounts. Almost by defi nition, complex families will often have varied and changing names. With an average practice having some 2,000 patients per physician, it is imperative that you have a variety of search tools to locate patients, guarantors, and insured parties. For example, Practice Partner Medical Billing provides the ability to locate a patient in over 20 different ways, including alias, chart #, alternate ID numbers, head of household, and social security number.

10 Practice Partner also helps you easily locate patients and accompanying guarantors with different last names. Other options include the sounds like search, which locates patients and guarantors based on the sound of their name, rather than solely based on spelling. Easy methods of linking patient, guarantors, and insurance plans. With increasingly complex family and fi nancial relationships, it is essential that your practice management system provides the tools and design to link patients, guarantors, and insurance plans. Example: Practice Partner Medical Billing creates accounts that provide a broad umbrella to link guarantors, patients, and insurance plans. This approach helps you track the relationships between the clinical and fi nancial parties and allows the convenient set up of family-style billing. Additionally, Practice Partner allows for instances in which the guarantor and patient have different last names, addresses, insurance plans, etc. For complex billing scenarios, you can also attach patients to multiple accounts. Can the software handle rapidly changing insurance plans and benefits? Does it provide tools to ensure my patients are eligible for services? Today s patients frequently change insurance plans and benefi ts. Effectively managing this information on a day-to-day basis is essential to both the success (i.e. reducing denied claims) and productivity of the offi ce. Some of the characteristics to consider include: Comprehensive storage of insurance information, with the ability to activate and inactivate plans on-the-fl y. There should be no practical limit to the number of plans that you can associate with an account. Example: With Practice Partner Medical Billing, you can store up to 999 insurance plans per account. These plans are easily activated and inactivated on-the-fl y without the need to ever fully delete insurance information. Within Practice Partner, patients can have as many as four active insurance plans and you can quickly change the billing order with a few keystrokes. Practice Partner also supports crossover billing, which helps reduce turnaround time on claims sent to secondary plans. Easy to update information with minimal redundant entry. For example, if you discover that the address of an insurance plan has changed, you should only have to change the address once. With Practice Partner, this change automatically updates the insurance address for all patients. Online eligibility checking. Many newer medical billing systems offer electronic eligibility, which allows you to send electronic queries to payers to determine if patients are eligible for services. Some payers also provide information regarding the patient s co-pay, deductible status, and coverage. Typically, offi ces perform eligibility checking in a batch for the next day(s) of patient appointments or on-the-fl y during patient check-in. Practice Partner Medical Billing provides HIPAA-compliant electronic eligibility

11 checking with a growing number of payers, helping you cut down on time spent on the phone, and eliminating lost revenue from claims for patients who are no longer covered by their payer. Ability to handle cases (e.g. worker s compensation scenarios). Authorizations involving a payer outside the patient s normal insurance plans should never require creating dummy patients or deleting other insurance plans. These workarounds only cause confusion. The Cases feature in Practice Partner makes it easy to manage these situations throughout the billing and scheduling process without affecting the account s normal insurance information. Example: During charge posting, Practice Partner will prompt the billing specialist to apply the charge to the active case and the corresponding payer, helping to ensure that claims are sent to the correct place. Does the system have tools to manage the collections process? A practice management system should offer specialized tools and features to manage collections. These collections features are essential: Ability to assign collections accounts. It is critical that you are able to assign accounts to collections both individually and in batches. Practice Partner Medical Billing will automatically fl ag results from the Delinquent Accounts Report or Open Insurance Claims Report as collections accounts. These accounts can be automatically assigned to staff members for follow up. In addition, Practice Partner users can fl ag an individual account for collections as necessary. Easy-to-use collection workfl ow tools. Once you assign an account to collections, staff members need a logical, user-friendly method to prioritize and work the collections accounts. The collections tools in Practice Partner Medical Billing include work-lists with fi lters, priorities, categories, and account information. Practice Partner also records all individual contacts with the insurance company or guarantor, providing an accurate log of activity on an account. Collection letters and notices. Timely and comprehensive collections letters and notices can reduce accounts receivable by effectively communicating with patients and payers. Medical Billing tracks patient and insurance payments and automatically generates delinquent patient account letters and notices to carriers. To create mailings, you can build custom letters to use with Medical Billing s mail merge capability. Collect at the door. As you know, collecting at the time of service is the best way to ensure payment. Medical Billing s estimation of benefi ts features automatically calculate what the patient owes at the time of visit. You can redefi ne the formulas for benefi t calculations as necessary. Practice Partner tracks both insurance benefi ts paid and the deductible accumulation for each patient.

12 Does the system include reports to monitor and analyze the financial health of the practice? Can I easily create customized reports? An essential characteristic of any practice management system is the ability to accurately report on the performance of the practice, from a variety of perspectives. Standard reports. Systems typically offer a series of standard reports that are built directly into the system. Review these reports, and verify that you can set your own reporting criteria without the need for programming or complicated user intervention. For example, in just one step, Practice Partner Medical Billing provides the option to report on individual practices, as well as the option to roll-up the report to include the entire organization. Other report features to look for include using report results to generate mail merge fi les for letters or cards, producing Microsoft Excel fi les, and running reports in defi ned batches. Practice Partner features the Insurance Payment Comparative Report, which allows you to compare payments for individual procedure codes by payer providing you with negotiating power for future payer contracts. Several provider reports allow you to compensate providers based on true productivity by tracking payments and adjustments on their visits. The HMO Report helps compare fees received for capitated patients with what would have been received in a fee-for-service scenario. Other standard reports in Practice Partner Medical Billing include: Accounts Receivable Provider Activity Aging Delinquent Accounts Account/Patient Information Aged Insurance Receivables Analysis of Services Open Insurance Claims Practice Analysis Insurance Payment Comparative Practice Trends HMO/Managed Care Report Referring Sources Encounter Form Tracking Audit Reports Monthly/Daily Activity Patient Recall Report Carrier Analysis Expected Payment Analysis

13 The standard reports in Medical Billing allow you to quickly set criteria to fi ne-tune your reports. You choose what data to include and how to organize it. You can also use these report results to generate letters and Excel fi les. Sample reporting screens from Practice Partner s Accounts Receivable Aging Report (one of Practice Partner s 25 standard reports) are shown below. Custom reporting. More sophisticated reporting requires the ability to design custom reports. Practice Partner Medical Billing provides a built-in query tool that allows reporting on virtually all data in the system, including user-defi ned fi elds. These reports are easy to create, modify on-the-fl y, and save for later use. A fi nal important question: Can you access all of the data that you need? A fully ODBC (open database connectivity) compliant system makes it possible to access all data in the software using any reporting or query tool. Practice Partner s ODBC capabilities allow the use of third-party reporting packages such as VSVIEW, Microsoft Excel, or Crystal Reports.

14 Is the system integrated with electronic medical records? What integration features does it offer? The continued adoption of electronic medical records is changing the way that the marketplace evaluates medical billing systems. A modern medical billing system works with an EMR to bring together all of your practice s clinical and fi nancial information. A practice management system is most effective when it exchanges information with an EMR to create software for managing all aspects of your practice. If you are considering purchasing an integrated software package that includes electronic medical records, medical billing, and appointment scheduling, there are a number of factors to keep in mind. Many software vendors tout their integrated software, but are actually offering disparate applications with simple interfaces connecting them. These integrated packages are just as ineffi cient as purchasing systems from three different vendors. To truly enjoy the benefi ts and effi ciencies of integration, you need a system that is truly integrated, not loosely connected. The most important integration feature is the sharing of a single patient database. Why is this important? A shared database means that you only have to enter data once whether in the electronic medical record, scheduling, or medical billing application. Once that data is entered, everyone accesses the same up-to-date information in all three applications. This eliminates redundant data entry and prevents miscommunication by providing all appointment scheduling, medical billing, and electronic medical records users with access to the same up-to-date information. There are many other important features found in truly integrated systems. Some of the integration features provided by Total Practice Partner, a fully integrated system that includes Practice Partner Medical Billing, Appointment Scheduling, and Patient Records, are listed below: Using an automatic electronic encounter form to send patient charge information from the progress note directly over to billing clerk for verifi cation and posting Switching back and forth between charts, schedules, and the ledger with minimal keystrokes Using the same lookup screen to fi nd patient data Viewing billing information and health maintenance information while scheduling patients Fully integrated messaging between the scheduling, billing, and EMR users Confi guring pop-up fl ags to appear on screens in any of the applications Automatically alerting the scheduling staff if a patient is about to exceed their number of authorized visits

15 In addition to these specifi c features, purchasing a fully integrated system has a number of other benefi ts. Setup and installation are generally easier, you only have to work with one technical support staff, and installing updates is a much simpler process.

16 SUMMARY Many medical billing systems are quickly becoming outdated as today s healthcare landscape becomes increasingly complex and competitive. Finding the right practice management system for your practice can mean the difference between fi nancial success and failure. If you are deliberate about your search, and do your homework, you can fi nd a system that will provide healthier fi nancial results, a satisfi ed staff, and improved overall offi ce effi ciency. For more information: Microwize Technology, Inc. 1 Kalisa Way, #104 Paramus, NJ