Category Archives: medical billing

Computerized Physician Order Entry (CPOE) system – How it improves efficiency of a Healthcare delivery system

Computerized provider order entry (CPOE) is an application that allows healthcare providers to directly enter medical orders electronically. CPOE systems can allow electronic entry of medication, laboratory, admission, radiology, referral, and procedure orders.

 

Developing and implementing CPOE is multidisciplinary effort and involves IT, clinical, business and informatics expertise with the following goals in mind:

  • Reducing the potential for human error.
  • Reducing time to care delivery.
  • Improving order accuracy.
  • Decreasing time for order confirmation and turnaround.
  • Improving clinical decision support at the point of care.
  • Making crucial information more readily available.
  • Improving communication among physicians, ancillary staff and patients.

Health delivery centers continue to strive to improve patient safety and quality of care

CPOE has tremendous benefits that impact overall efficiency of the healthcare delivery system. It enables safer, more consistent patient-centered care that is quantifiable. Time efficiency is a huge benefit of implementing CPOE across an organization. CPOE users find improved efficiency to be even more impactful than its technological advances. Specifically, with enhanced time efficiency, clinicians can communicate more effectively, provide care more accurately, and focus more of their time on patients’ needs. These benefits include:

  • Legible order entry: This allows for a decreased risk of duplicative, incorrect or erroneous orders.
  • Protocol adherence: Various kinds of checks for each order allows for a system to ensure adequate patient preparation and protocol adherence. This, in turn, ensures optimal management practices.
  • Clinical Decision Support system: Various CDS models can be added to the EHR-CPOE systems to allow useful information, including guidelines recommendations, checks, suggestions for suitable management steps based on the available information on the patient condition.
  • Medication-related checks: These include medication reconciliation that checks for duplicative medications, drug-drug interactions, allergies, medication contraindications, and renal- and weight-based dosing.

Specifically, CPOE minimizes or altogether eliminates:

  • The need to maintain physical patients’ charts.
  • Overlooked orders by nurses or unit secretaries.
  • The need for order clarification due to illegibility.
  • The need to manually reenter data, leading to transcription errors.
  • Override rates from electronic drug dispensing systems.

 

Successful CPOE implementation depends on high level of leadership involvement, widespread commitment to the project, availability of resources, access to technology, and comprehensive training and communication. When these ingredients are present to implement CPOE across the organization, it has a tremendous impact.

 

Health delivery centers continue to strive to improve patient safety and quality of care. There is also an increased focus on the efficiency of health care. The Joint Commission defined the important dimensions of performance for quality of care as “patient perspective issues; safety of the care environment; and accessibility, appropriateness, continuity, effectiveness, efficacy, efficiency, and timeliness of care.”

 

Overall, CPOE systems with CDS can improve medication safety, quality of care, compliance with guidelines and protocols, while reducing medical errors and spurious healthcare dollar spending at the same time, the cost of healthcare.

How Blockchain Can Improve Healthcare Technology

As per one definition, “Blockchain technology uses secure, encrypted authentication mechanisms to validate information from primary sources and include it in a distributed ledger, ensuring a shared source of truth for validating healthcare provider information.” Blockchain is rapidly impacting healthcare. There are several aspects of healthcare technology that can benefit from blockchain and become more streamlined, efficient, and optimized.

 

Here’s how that can happen:

  • Longitudinal healthcare records – Blockchain can enable patient records to be securely linked and be accessible across different provider organizations to improve care coordination. Blockchain has been shown to be extremely useful for recording transactions. This can be leveraged in medical records, which are riddled with inaccuracy and discrepancies. Ensuring that sensitive medical records are accurate, complete, and only available to authorized individuals makes for an inefficient system that blockchain is poised to revolutionize.

 

  • Automated health claims adjudication – By using a “smart contract” structure, blockchain can help streamline payers’ and patients’ provider payments for a more cost-efficient process.

 

  • Interoperability – Blockchain can overcome current patient data interoperability issues, as it allows efficient ways to gather the information needed to support population health initiatives. Blockchain offers the ability to share patient records across payers and providers industry-wide, reducing costs and minimizing risks. It allows patient data (clinical, demographic, billing, etc.) to be securely transferable and available to any treating physician, health system or payer within the blockchain network. It allows patients to change health insurance providers and choose physicians across various health providers, with there being no need for multiple data entry. Blockchain-powered interoperability can reduce duplicative testing, erroneous treatment, and incomplete medical data.

Blockchain technology can potentially enable patients to more easily and securely gain access to their own medical records

  • Online patient access – Blockchain technology can potentially enable patients to more easily and securely gain access to their own medical records. Currently, patients have almost entirely no control over their own medical data. They are completely managed by healthcare institutions. This makes for an inefficient system and creates mistrust between patients and healthcare institutions.

 

  • Supply chain management – It can also enhance healthcare contract management and reduce costs by allowing through real-time contract tracking and execution.

 

  • Prescriptions – In the current system, patients have their medications prescribed and filled by hospitals and pharmacies, each with their own database, which can result in discrepancies in patient records. A prescription blockchain solves much of the problems that arise from varied systems and records and provides a trustworthy source of patient prescription records. This way, healthcare providers could have an accurate, immediate view into a patient’s medications, resulting in better, more personalized treatment.

Provider data and identity management
Identity and credential management of licensed providers is critical to the healthcare delivery system. This requires maintaining accurate, up-to-date provider database, which is expensive and prone to error. Currently, all payers and providers maintain this data individually, resulting in redundant data and expenses. Blockchain can provide a distributed database of provider credentials accessible to payers and providers made universally available. A credentialing blockchain would eliminate duplicate requests for information from original sources, reducing processing time and enabling real-time updating of records.

Clinical Context & Synopsis Generation from EHR

Clinical workload is increasing. Clinicians are seeing more patients and radiologists are having to read more scans in a day. Also, as the electronic health record system gets more sophisticated and detailed, we have access to unprecedented amounts of data. This is a scenario where doctors have more patients to see, more data to consume and better results to aim for. It’s a challenge and an opportunity.

 

EHR’s are getting smarter. They are no longer the dumping grounds for every bit of digitized patient data. It is a mineable repository of extremely valuable information shrouded in redundant noise. In the early days of EHR, it was difficult to sift through hordes of lab values and clinical/rad/path reports and have a nice summary of what’s been going on with the patient. A physician would have had to spend an inordinate amount of time to do so before every encounter. When HL7 FHIR came about, mining data from EHR became possible. It opened the floodgates for developers and informaticists to work with physicians to make EHR more user-friendly, providing itemized, relevant information as needed in a clinical workflow.

The system has to be reliable in the sense that it doesn't miss out key information from a parent source

The main concept of clinical context generation is that the care provider should have ready access to all the relevant information pertaining to the patient he/she is-bout to conduct the care of. The technology that made it possible is Natural Language Processing (NLP), which is a methodology concerned with automated interpretation and generation of human language. It depends on ontology libraries to help mine data through FHIR to create synoptic reports for real-time consumption by the physician. An example of that would be that if patient XYZ is having an MRI scan of his knee for meniscus tear surgery, a synoptic report would be created using keyword searches and text mining into the clinic notes, prior radiology reports, lab reports, prior procedure notes, etc.. The report would use NLP to create human language format and embed all the information that is ranked based on hierarchy of relevance. The radiologist would then be able to access just that report, as opposed to all the patient chart.

 

The system has to be reliable in the sense that it doesn’t miss out key information from a parent source, weights it correctly so that it makes it at the right degree of importance in the synopsis, and that it is succinct yet covering all key aspects of that patient’s history. A system has to practice through a lot of context generation exercises to be able to get to that level. A nuanced feedback approach will fine tune it to ultimately provide a highly intelligent report that greatly. improves clinical efficiency.

 

Such reporting systems can serve as historical milestones in the patient’s chart in the EHR, organizing until it becomes a diligently maintained streamlined system. User experience will play an important role in creating a system that works in the background and generates such milestones (synopses), which are easy to access, fast to process, palatable to consume and overall, eases the burden of the clinician rather than further complicate the EHR.

Medical errors – how AI can help reduce them

There is a wide range of errors that take can take place in both the clinical and the nonclinical realms of healthcare. There have been a lot of interest in applying Artificial intelligence in these areas to see if it can be leveraged to reduce medical errors. Let’s review these potential opportunities:

 

Patient identification errors:

This is because of real concern. Every day, hospitals, pharmacies and offices face discrepancies in patient identification. This becomes an even greater issue in the realm of telemedicine. Online identity theft and fake accounts have made it quite challenging for telehealth systems to accurately identify patients as they provide consults to them. AI can play a role in these settings. It can process various sources of data that contribute towards establishing patient identity, such as face recognition, retina scanning, as well as electronic user history and social media profiles, etc. Early pilot products suggest using AI in some of these settings, especially in telemedicine (along with blockchain) can significantly improve patient identification and reduce critical errors.

 

Diagnostic errors:

A lot of research is emerging that shows AI transforming the face of diagnostic medicine. In the realm of pathology and radiology, AI is fueling computer-aided diagnosis and it is propelling the radiogenomics revolution. In the conventional sense, human-based interpretation is being matched by AI/ML driven interpretation, and in some cases exceeded by the latter. This helps in reducing human-based diagnostic errors by automating the process of segmentation, lesion detection, image analysis and interpretation.

 There is a very high incidence of errors in medical reporting

Procedural errors:

AI can streamline the protocoling and other workflow-related processes that can help reduce procedure-related errors in medical practice. This includes issues such as laterality checks, protocol selection, radiation doses, pharmaceutical agent selection, procedure type selection, etc. AI can help in ensuring several quality control checks as well that can also help in reducing procedural errors.

 

Medical reporting errors:

There is a very high incidence of errors in medical reporting. Radiology and pathology reports can have many errors that can lead to significant issues in medical management. AI-driven bots/systems can streamline the dictation and reporting process so that manual errors are reduced. Feature selection based reporting system, as opposed to completely free text reporting may be useful in terms of reducing errors and when aided by AI, it can be leveraged to generate semiautomate reports to an extent that they limit the scope of making errors and detects them when they occur

 

Coding & Billing errors:

Similarly, clerical errors such as incorrect coding and indication mismatches leading to billing discrepancy is another drain on the resources. AI can automate the process of coding and billing in a way that no or very limited human involvement is needed while ensuring accurate coding so that no claims are denied and all billing is seamlessly processed. There are a few solutions in the market that are leveraging this technology and it is beginning to show promising results.

Don’t Understand Medical Billing? You Might Lose Your License.

What’s the most important thing they don’t teach you at medical school? And yes there is a lot they don’t teach at medical school but arguably the most important point in your future practice is medical billing. Medical billing is incredibly confusing and the new ICD-10 has somewhere in the region of 70 000 billing codes. Remembering and understanding all of this are imperative to get the right fee for your service. This is often where medical billing services come in. The argument for medical billing services has probably been made to you a hundred times over, yes they improve revenue and cash flow and mean you get to spend more time with your patients, but you might not have thought about how the billing service industry protects you from fraud charges.

The easiest way to ensure a safe and accurate medical bill is provided to ensurers is to call in the professionals.

Yes, that’s right, medical billing services could actually save you from costly fraud charges that might leave you and your practice in tatters. But why exactly is this? Well, having a poor understanding of the procedures you are performing or incorrectly entering billing codes can have dire consequences, as Dr. Joseph Pober recently found out.

 

If you recall the name Dr. Pober that’s because he became famous for helping out a trump supported who was injured in a brawl. But now the New York Post is reporting he finds himself in trouble over incorrect billing. The Board for Professional Medical Conduct is set to hold a hearing about Dr. Pober that will decide whether or not Dr. Pober has his medical license revoked. Dr. Pober is currently the defendant in a fraud charge after he allegedly falsely represented a number of skin graft procedures he did. These “deviated from medically accepted standards” according to the state.

 

Clearly, a medical billing service would not have this kind of issue. Their service provides the correct billing codes for insurers as they are experts in medical billing who understand the process and intricacies of the American system. If a practitioner is left to their own devices with medical billing, incorrect charges can be levied on insurers. As we have seen in the tragic case of Dr. Pober, this may lead to the loss of a doctor’s license.

 

Therefore the easiest way to ensure a safe and accurate medical bill is provided to insurers is to call in the professionals.

Why is Accurate Medical Billing Important?

Changing regulations and stricter standards for medical billing and coding have made billing a bigger challenge than before. Medical practices seek improved billing solutions not only to get reimbursed fairly for the services rendered but also to be able to deliver the best patient care.

Need for accurate medical billing

Inaccurate medical coding and billing can cause various problems. It can result in claim denial and rejection, unhappy patients or even legal issues.

 

This makes it necessary to ensure that medical coding and billing processes are performed accurately and flawlessly.

 

HIPAA, ACA and other healthcare laws have been designed to protect patients by ensuring uniform standards and appropriate methods being followed by physicians and practices. This calls for eliminating the practice of inflating costs or inaccurate coding.

Role of Medical Coding and Billing Companies

Changes in health care-related laws and regulations have made it essential for medical practices and to follow the best medical coding and billing practices. Since this may pose a challenge since you are running a busy practice, many physicians have outsourced their billing to a professional medical coding and billing service. These companies have a large number of trained billing professionals who stay updated with prevailing standards and best practices. Outsourcing your billing ensures accurate coding and billing, timely reimbursements, increased revenue while you can focus all your attention on patient care.

 

To learn more or to take advantage of the top specialty medical billing services, such as behavioral health billing services, call Emerald Health LLC in Massachusetts at 855-650-9906 Today.

Prevent Common Medical Billing Errors

The payment for medical services rendered is directly affected by the accuracy of medical coding and billing. Hence, physicians and medical practices can’t afford to have erroneous or delayed billing. It can seriously impact their bottom line.

 

Continuous updates in the health care industry require fast-paced changes and adoption of modern technology. However, these changes also add the likelihood of errors. This is why many healthcare practices have outsourced their medical coding and billing tasks to reputed medical billing companies. These companies have the required capabilities, such as trained staff and regularly updated software and technology.

 

Errors in medical billing not only impact your bottom line but also the patients. Errors can make patients face financial issues or being pushed to pay for services they didn’t receive. This can cause patient dissatisfaction which doesn’t bode well for any medical practice.

Common Billing Errors

 

  • Treatment and diagnosis code mismatch
  • Not justifying medical necessity
  • Entering wrong data
  • Duplicate billing
  • Careless use of balance billing
  • Failure to verify insurance coverage
  • Undercoding / upcoding
  • Unbundling services

Prevent Medical Billing Errors

Errors mean claim denials and rejections. Correcting claims and resubmitting them can take a lot of time and negatively impact a practice’s cash flow. Hence, it makes sense to prevent these errors in the first place. Verifying patient information, checking that diagnosis and treatment codes match, proper insurance verification and hiring a medical billing company with the right expertise can help you avoid billing errors.

 

To learn more or to take advantage of the top medical billing services offered by one of the best medical billing companies in Massachusetts, call Emerald Health LLC in Massachusetts at 855-650-9906 Today.

Medical Billing – Isn’t It Time to Avoid These Costly Errors?

As much as your medical center will strive to offer the best patient care, you still must consider it as a business. There are so many elements that can be costly in terms of time and financials and so, it is important that if you are going to avoid making errors within your practice, you have the best staff, the best technology, and processes too. If we look at medical billing and coding, we know that it is, of course, one of the most crucial elements of the medical industry and yet, for so many medical practices, there can be an extraordinary number of costly errors.

 

Many of your health expenses are paid as a result of health insurance and this is why those who are involved in the medical billing processes must be at the top of their game. Too much is at stake for errors to be made. Mistakes can build up too.

 

Accuracy is all-important.

 

Legislation changes constantly but do you have time to keep your finger on the pulse of medical billing? As a healthcare provider, it’s your responsibility to ensure that you and your employees are well-informed and that you meet and uphold the changes in medical standards. Of course, this is not always as easy as it sounds, in fact, at times, it can create longer hours and much more work.

 

After a busy day treating and reassuring your patients, the last thing you may want to deal with is changes to billing legislation. Therefore, it makes sense to have a professional company that you can delegate all billing errors to and who will keep up with important changes. As these people are trained to a high level and, their training is ongoing so to avoid costly mistakes, they have all the capabilities to take this chore off your hands. Plus, they are far more accurate than most people could be. This saves you time and money.

 

What happens when billing is inaccurate?

 

Even with the best of intentions, it is so easy for errors to be made. Unfortunately, the simplest of errors can turn into the most complex of problems to resolve. Ultimately, it leads to your patients potentially being put under financial hardship. It is no surprise when they feel frustrated and unhappy as a result. Of course, mistakes can be made but, if your patient is already under duress and worried about their health, this is just one more problem to deal with it at a time when physically or emotionally, they may not be capable of dealing with it.

 

There are many common errors all of which take time to resolve.

 

  • Wrong data entered
  • Duplicate billing request
  • Insurance coverage unverified
  • Upcoding
  • Undercoding etc.

 

Solutions

 

Why add extra administrative issues to an already busy day? Doesn’t it make absolute sense for this highly-important role to be given to companies who do it so well and who will take the pressure away from you and your team? Ultimately, fewer errors will equate to less stress and enable you to focus on patient care and so, outsourcing medical billing is undoubtedly the way forward.

Medical Billing Specialists – Optimize A List of Questions Before Hiring

 Optimize A List of Questions Before Hiring

As a medical professional with a busy medical practice, you will want to ensure that all your administrative processes work smoothly so that you can focus on the areas of the business most important to you – that of patient care. In the same way that you would interview potential new members of staff, it’s wise to compile a list of targeted questions so to ask any medical billing specialists before hiring. This way, you are more assured of a good fit and as it is an important decision, it will give you peace of mind by doing so.  In many ways, medical billing specialists become an important part of your team even if are not actively employed onsite.

Hiring the right company can make a big difference to your financials as it can ensure that your cash flow is interrupted. This is an important element for all business but it also ensures a healthy bottom line. Each part of a medical centers processes are important but if billing errors are made, this is a costly drain on time and only causes delays before payments are made.

Therefore, you may have many questions but, as a starting point, consider the following:

What qualifications do you have?

Before you sign on the dotted line, it’s a good idea to ask to see company references. If you know someone else who uses the company, this may naturally give you peace of mind, but otherwise, review the website for feedback or, ask for references. Most businesses will not mind.  You also need to consider whether they have an in-depth knowledge of medical codes and that their qualifications are up to date. As legislation changes frequently, it’s important to know that they are proficient. If you specialize in a specific field of expertise, you may wish to check whether they can provide you with the service you need.

What does the service cost?

Understandably this is an important consideration and you need to know whether they charge for a percentage of the charges which have been collected or if it will be a flat rate. You also need to check whether there are any additional fees to be taken into consideration. This may include data conversion, initiation or termination. Find out what is included in the service. If you opt for a cheaper service, you may find that the service is by no means comprehensive. So, less is not always more.

Find out more about how your account will be managed

Check for any frequency of reports and also, what data will be included. You may wish some reports to be customized. Consider their HIPAA compliance plan and whether your patient data is safe. In addition, who will be managing the account? Having a contact name and number should any problems arise is extremely important. It may be a big consideration for you to outsource this aspect of your business to any medical billing specialists so it is understandable that you want to be satisfied that the service will exceed expectations. Also, who do you contact if this person is not available or out of the office?

It’s also worth checking out the company’s website to ascertain the full complement of services available and this will help you to gain the right service for you.

7 Surefire Medical Billing Errors That Will Wipe Out Profit

 7 Surefire Medical Billing Errors That Will Wipe Out Profit

There’s no doubt about it, medical billing errors can easily wipe out profit and put a medical practice under severe pressure. It can be costly to your patients too. Miscommunication is common and even more so now with legislation changes that happen all the time. Human error will always occur from time to time but when it damages your business, it needs to be kept to a minimum.

 

 Here are 7 common mistakes:

 

  • Separate billing on charges that should be added together.
  • Duplicate billing. This often occurs when more than one person is involved in the procedure and both send bills out, believing it to be their responsibility.
  • Forms being filled in the wrong. This can be costly to both the patient and the company. Often insurance companies will not pay out if the information is not correct.
  • Upcoding, this is illegal but does happen. A medicine that has been prescribed is billed as a more expensive one and this inflates the bill. This practice would quickly damage any business through a legal process and quickly create a lack of trust from patients.
  • Balance billing mistakes, when an insurance company negotiates a price with a medical billing company, it is important that the practice and the patient are aware of the exact costs covered. This is an area that should be as transparent as possible.
  • Incorrect patient information. This happens very easily when there are several people involved in a patient’s care. Even misspelling the name of a patient can be sufficient for an insurance company to withhold on a claim.
  • Matching treatment to costs. Sounds a bit obvious but, this error is surprisingly common. A patient may have had changes to their medical treatment but these changes, have not been listed on forms. This can again cause delays before insurance companies will settle.

 

Errors in medical billing costs practices across America a staggering $125 billion a year. Even a small mistake will cause an insurance company to refuse to pay and as a result, this means having to resubmit forms and this is costly in both time and money.

 

This can be avoided to a certain extent if health care workers who operate within the admin side of the business are kept up-to-date with the latest company procedures. This is also true of the legislation that is constantly being brought in through a series of changes. It is very important for staff to be aware of them.

These are just extra headaches which pile pressures onto medical health practices. This alone is the reason why many practices swap over to an outsourced company to handle their medical billing. By doing this they, of course, take off the pressure and the costs are often paid for by an increase in profits and staff being able to do what they do best which is, of course, treating more patients. This results in higher confidence levels which are reflected right through the company. There are of course many arguments for and against outsourcing and so, it’s important that you consider what is right for your medical practice. In the main, most people see outsourcing medical billing as the way forward now