Category Archives: medical billing

Clinical Context & Synopsis Generation from EHR

The 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. Let’s review how the Clinical Context & Synopsis Generation from EHR is done.

 

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 the hierarchy of relevance. The radiologist would then be able to access just that report, as opposed to all the patient chart. This is how the Clinical Context & Synopsis Generation from EHR is processed.

 

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. And you can process the Clinical Context & Synopsis Generation from EHR.

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. Let’s take a look at why is accurate medical billing important.

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. So, it’s important that you have complete knowledge of how to prevent common medical billing errors.

 

Continuous updates in the health care industry require fast-paced changes and the adoption of modern technology. However, these changes also add to 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.  And that way you can prevent common medical billing errors

 

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 the 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. You can Avoid These Costly Errors In Medical Billing using a few tricks.

 

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 too 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. And it is one of the ways to Avoid These Costly Errors In Medical Billing.

 

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.

Avoid These Costly Errors In Medical Billing

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. That is how you can Avoid These Costly Errors In Medical Billing.

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 medical billing errors can easily wipe out profit :

 

  • 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 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. And it will create medical billing errors that will wipe out profit.

 

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. And that is how medical billing error that will wipe out profit.

 

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. And it is one of the main  Medical Billing Errors That Will Wipe Out Profit.

These are just extra headaches that pile pressure 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.

Why Using a Medical Billing Company Will Produce Additional Profit?

Using a Medical Billing Company

Using a reliable and proven medical billing company can quickly and efficiently turn a medical practice into a profitable business. At the same time, the benefits can extend to the patients’ too increasing confidence and provide reassurance. With technology improving considerably, this is now being considered a must-do operation by many US medical practices.

 

What exactly is medical billing?

 

Medical billing is an interaction between the healthcare provider and the insurance company. This can be a time consuming and complex procedure. It’s easy to make mistakes as many medical practices have experienced first-hand. Any small changes that have not been noted or any tiny errors can be costly and hold up a claim. This can result in frustrated patients and lead to long delays trying to solve these issues which will impact other areas of service. The reputation of the healthcare service is at stake and this is why so many healthcare providers look to outsource medical billing these days.

Eliminate mistakes

 

By using a trusted medical billing company, you take the pressure off the practice. A good medical billing company will know exactly what they are doing as this is their sole business. This is a complex industry, and these are professionals in their field of expertise. Mistakes can be expensive, and by ensuring you have professional systems in place and backed by professional, well-trained people, this eliminates the stress on a day to day basis.

 

A medical billing company will also be on top of any legislative changes in a way that a medical practice might not. Again, this is an area that can be very expensive if any new changes are not adhered to. By eliminating these potential risks, you allow the practice to concentrate on what it does best which is patient care. Improved cash flow and reduced overheads allow growth and higher profits.

 

A proven medical billing company will already have a good understanding as to the long-term medical benefits achievable by any medical practice and will know how to implement them in a very efficient manner. This long-term plan will encompass growth and a fine-tuned approach to where it matters the most. A good medical billing company can accelerate productivity and increase profits which benefits the whole practice. It does this by reducing overall running costs and creates a tight efficient business blueprint which the practice can come to rely on. There will be customized options instead of generic data which can save in-house medical staff a great deal of time searching other resources. You gain easy system API, Regular updates and fast turnaround times and all this leads to an efficient service.

 

What should a medical center look for in a medical billing company and what are the advantages?

 

  • Ways to increase patient confidence
  • Ways in which to reduce overall running costs
  • To be able to detect where cash flow can be increased
  • To improve overall efficiency
  • To accelerate productivity
  • To have a vision of the long-term benefits to the company

 

A serious advantage to any business is an increase in cash flow as this can absorb unexpected shortfall problems and act as a buffer when sudden demands are called for. By outsourcing to a reliable medical billing company, you eliminate training needs but gain valuable expertise, speed, and efficiency at a whole new level.