When an E/M Code Can Be Billed with a Physical on the Same Day

Q: Can you clarify when an evaluation and management (E/M) code can be billed with a physical on the same day?

A: This is always a difficult coding scenario to unravel, but there are a couple of things to keep in mind. Current procedural terminology guidelines for preventive medicine state: “If an abnormality is encountered or a preexisting problem is addressed in the process of performing this preventive medicine evaluation and management service and if the problem/abnormality is significant enough to require additional work to perform the key components of a problem oriented E/M service, then the appropriate E/M service should also be reported.”

The guidelines continue: “An insignificant or trivial problem/abnormality that is encountered in the process of performing the preventive medicine evaluation and management service and which does not require additional work and the performance of the key components of a problem-oriented E/M service should not be reported.”
So what does this mean?

Modifier 25 guidance must be followed, as the modifier would need to be appended to the E/M code in this scenario. Medicare and other payers don’t expect that a patient, especially an older patient, wouldn’t have chronic conditions. However, if those conditions are stable and don’t need significant work to address, they would be bundled into the work for the preventive medicine code (99381-99397). Refilling medications and ordering labs for stable chronic conditions are included in the preventive visit. Per the guidelines, this isn’t considered significant additional work.
Case Study

A 34-year-old established patient comes in for her yearly physical. During the visit, the physician learns that the patient has gained an abnormal amount of weight since her last appointment. The physician discusses healthy eating habits and exercise with the patient and, with the patient being overweight with a BMI of 26, decides to watch the patient’s weight.

In this situation, the preventive visit includes reviewing the patient’s weight, anticipatory guidance and risk-factor reduction, so all of the work performed would be included in the preventive medicine code. An additional E/M code would not be supported, so the following would be billed:

99395  (Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 18-39 years)

Z00.00 (Encounter for general adult medical exam without abnormal findings)
R63.5 (Abnormal weight gain)
E66.3 (Overweight)
Z68.26 (Body mass index (BMI) 26.0-26.9, adult)

However, if a patient has an acute problem or an exacerbation of a chronic condition that does require additional work that the physician/provider wouldn’t normally perform in the course of a physical, an E/M code can be billed in addition to a preventive visit.

In order to code under this scenario, all of the elements performed as part of the physical are counted toward the preventive medicine code. Only those elements that constitute the significant additional work would count toward the E/M code level.

The key is to know when the additional workup is significant enough to warrant a separate code. You must have an illness that requires its own, separate evaluation, with a history or physical exam and medical decision-making all related to that separate problem.

An established E/M code should be billed with a preventive code.

How Coding Guidelines Define “New Patient”

The distinction between new patient and established patient is vital for correct evaluation and management (E/M) code assignment, coding compliance, and reimbursement.

CPT defines an established patient as one who “has received a professional service from the physician/qualified health care professional or another physician/qualified health care professional of the exact same specialty and sub-specialty who belongs to the same group practice, within the past three years.”

Within the context of E/M code selection, CPT defines a professional service as “those face-to-face services rendered by physicians and other qualified health care professionals who may report evaluation and management services reported by a specific CPT code(s).” The “face-to-face” nature of a professional service is important: CMS policy  confirms, “An interpretation of a diagnostic test, reading an x-ray or EKG etc., in the absence of an E/M service or other face-to-face service with the patient does not affect the designation of a new patient.” A patient is new, for instance, if the physician interpreted test results two years earlier, but had provided no face-to-face service to the patient within the previous three years.

The second requirement addresses patient status relative to other providers in a group practice. When a patient becomes established with a physician who works in group practice, the patient is established with all physicians of the same specialty/sub-specialty in the group. The AMA allows an exception for new physician’s seeing for the first time a patient established to the practice. CPT Assistant, November 2008, features the following Q&A:

Question: Can new physicians who come on board to a group practice with their own tax identification numbers charge a new evaluation and management code for patients they see?

Answer: According to CPT guidelines, a new patient is one who has received no professional services from the physician or another physician of the same specialty who belongs to the same group practice within the past three years. Also, if a physician is new to this group practice and had never seen or billed a patient previously though his tax ID number, this should be considered a new patient for the purposes of this physician billing for his evaluation and management service.

Not all payers agree with this logic: inquire with your individual payers before billing as new any patient who is established with another physician of the same specialty/sub-specialty within a group.

Two providers in the same practice may both classify a patient as new, if they see the patient for different reasons and the providers are of different specialties recognized by the Centers for Medicare & Medicaid Services (CMS). For a list of Medicare-recognized physician specialties, visit the CMS website. CPT guidelines specify, “When advanced practice nurses and physician assistants are working with physicians they are considered as working in the exact same specialty and exact same sub-specialties as the physician.”

For example, a general surgeon in a large multiple-specialty practice sees a patient in 2015 to remove some skin lesions. In early 2017, the same patient sees an internist—who is a member of the same multispecialty practice as the surgeon who previously treated the patient previously—for a new condition. Because the surgeon and internist (who are of different specialties) saw the patient for unrelated problems, the internist may report the initial visit using the new patient codes (e.g., 99201-99205).

If a provider is covering for another provider, a patient’s status is relative to the provider who is unavailable (not the covering provider). For example, Dr. Smith is covering for Dr. Jones, who is on a family vacation. Patients who are established with Dr. Jones would be treated as established with Dr. Smith, even if Dr. Smith has not seen the patient previously.

Finally, note that location doesn’t affect a patient’s “new” or “established” status. CPT Assistant (June 1999) explains:

Consider Dr A, who leaves his group practice in Frankfort, Illinois and joins a new group practice in Rockford, Illinois. When he provides professional services to patients in the Rockford practice, will he report these patients as new or established?

If Dr A, or another physician of the same specialty in the Rockford practice, has not provided any professional services to that patient within the past three years, then Dr A would consider the patient a new patient. However, if Dr A, or another physician of the same specialty in the Rockford practice, has provided any professional service to that patient within the past three years, the patient would then be considered an established patient to Dr A.

In other words, where the patient is seen doesn’t matter. If the provider treats a patient face-to-face service within the previous three years (in any location), that patient is established (in all locations).

Podiatry Practice Increase Revenue with Outsourced Billing Service

Podiatry billing like every other specialty billing faces its own set of challenges. Unskilled billing staff and inefficient billing practices can work havoc on the RCM process of your practice. Outsourcing the revenue cycle management of a podiatry practice to a medical billing expert can maximize claims payments and keep the practice compliant to governmental regulations. Professional medical billing services try to reach a level of efficiency when it comes to revenue cycle management of podiatry practices because of their exhaustive collection practices, incessant execution of billing tasks, and updated knowledge of prescribed documentation regulations. Here are the reasons why Podiatry Practice Increase Revenue with Outsourced Billing Service:

  • Better Understanding of Podiatry Billing Guidelines.

Centers for Medicare and Medicaid Services are very particular about the prescribed billing guidelines. The team of billing experts are well versed at podiatric procedures and related codes. This helps your podiatry practice to achieve your goal of flawless billing. Do check that the company you shortlist  has certified, professional, and experienced medical coders and billers that can keep your practice compliant with HIPAA and OIG, and in turn help you maximize payments, thus improving revenue streams. You can shortlist a company that already is dealing with podiatry practices, as this ensures that they know what they are doing.

  • Technological Aid

Podiatry medical billers and coders take help of automated technology to reach an overall efficiency of operations. They use customized templates of EHR that are specific to podiatry, as these ensure spec free use of codes native to podiatry procedures. This allows a practitioner to focus on the patient better without fretting about the billing front himself.  Billing teams also preauthorize all patient documents with the insurance providers and maintain records for them to avoid in discrepancies later.

  • Fighting Claims

Podiatry practices lose a significant portion of their annual revenue due to insurance underpayments and are often unable to estimate this loss of revenue correctly. An experienced billing partner checks all the payments received from insurers and matches them with bills filed. This brings to light underpayments, if any. The billing experts then respond to insurer’s queries about claims. They also make appeal for denied claims.  Such timely detection of underpayments also helps in timely claim filing and reimbursements. As rules and claim procedures surrounding Podiatry vary from insurer to insurer, it is a prudent step to seek the help of a podiatry medical billing company. Overtime, the expert would be able to identify the payers which usually write off your claims as underpaid or unpaid. This analysis helps the practice pay attention to the coding and documentation requirements of these insurers and chase collections regularly.

  • Dealing with The Patient

Every practice needs to realize that the overall exercises of bill collection from patients need to be improved. Outsourced Billing companies aid this by providing better customer service and putting in place an interactive interface. A more responsive approach to customer’s queries about billing and other medical practices helps in increasing the revenues in long term.

Services of expert billers in specialty Podiatry billing can help a practice overcome billing challenges easily.

 

Pros and Cons of Medicare for Independent Practices

These days, there’s no shortage of payers in the healthcare marketplace, and many physicians choose to contract with those that pay the highest rates. This strategy means that Medicare—a payer that often pays the lowest rates—falls to the bottom of the priority list, and many physicians simply choose not to participate.

In some ways, this makes sense—especially when a practice is already at optimal capacity. Why would a physician want to do the same amount work for less reimbursement? But is it the right approach when trying to expand the practice? We talked to Frank Cohen, director of analytics at Doctors Management, LLC in Spring Hill, Florida, to hear some pros and cons as it comes to Medicare’s impact on medical practices.

Pro – Faster Payments and Less Hassle with Medicare

“The truth is that Medicare doesn’t pay the best, but the hassle factor is the least, and it pays the fastest,” says Cohen. “Medicare is also totally transparent with its fee schedule, so you can plan ahead.”

Pro – Build Patient Volume

Accepting Medicare patients essentially allows physicians to grow their patient volume while establishing a predictable cashflow. “Practices can build volume on the front-end because there’s no shortage of Medicare patients out there,” he adds.

This is especially true for new practices. A recent study by the Kaiser Family Foundation found that younger physicians are more likely to accept new Medicare patients as they build their patient caseloads.

Pro – Lower Denial Rates

Even though Medicare often pays less than commercial payers, Cohen says the denial rate is also often much lower, meaning physicians recoup much of what they bill without needing to waste precious time and administrative resources on appeals and resubmissions.

With private payers, reimbursement amounts may be higher, but denials occur much more frequently. “You’ve got to fight them to get your money. Sometimes it’s just not worth it,” he adds. This game of ‘bait and switch’ makes it difficult for practices to grow. The turnaround time for payments also tends to be longer with private payers, making cashflow problematic—particularly when a practice is trying to expand, he adds.

Con – Lower Reimbursement

Still, there are cons to participating with Medicare. Reimbursement amounts are one of the biggest cons with Medicare paying an average of 20% less than most private payers, says Cohen.

Another challenge is that physicians receive a financial penalty when they don’t satisfy requirements outlined in the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015, although participating physicians can also receive incentives. “You face the problem of being in a contract with a government agency that can come back and audit you at any time and take all of your money back,” says Cohen. “That’s a real problem.”

(To learn more about MACRA program requirements, see the Independent Practice Guide to the MACRA Quality Payment Program.)

Practices that have been in business for a while can perform a financial analysis to determine the average cost per relative value unit (RVU) before deciding whether to participate with Medicare, says Cohen. If the per-RVU costs are less than what Medicare pays per RVU (i.e., $30-$32), the practice profits every time a Medicare patient receives services. That profit might be nominal, but at least it’s money coming in the door, he adds.

And remember that accepting Medicare certainly isn’t the only way to grow a practice. Cohen says physicians should also explore other options, such as contracting with additional private payers or even transitioning to concierge medicine.

“It’s a business decision,” says Cohen. “You can only lose money for so long, and then you’re out of business.”

6 Tips to Get Paid by Medicare

Accepting Medicare is one of many ways in which physicians can expand their practices. That’s because even despite often having a lower fee schedule, Medicare tends to pay consistently and promptly, making it easier for practices to grow.

However, choosing to accept Medicare isn’t a ‘one and done’ decision. Instead, it requires a thoughtful approach to ensure that practices are paid appropriately, maintain adequate cash flow, and safeguard revenue so auditors don’t try to eventually recoup that money.

Frank Cohen, director of analytics at Doctors Management, LLC in Spring Hill, Florida, provides these six tips for practices that are new to Medicare:

1. Hire a nurse practitioner or physician assistant

The cost-to-revenue ratio is significantly lower when non-physician practitioners (NPP) treat Medicare patients, says Cohen. This means it’s ultimately more profitable when NPPs see these patients. This strategy also allows physicians to fill their schedules with patients whose insurance pays more per relative value unit. This allows the practice to accept and treat Medicare patients without having to drain all of the physician’s time and resources.

2. Be strategic when scheduling patients

For example, set aside a certain number of daily slots for patients with Medicare, Medicaid, and private insurance. Because Medicare often pays the lowest, consider setting strict limitations for the number of Medicare patients seen in a single day or week, says Cohen. Balancing the schedule in this way creates a cashflow equilibrium.

3. File clean claims every time

“Do it right on the front end so you’re not subject to an audit three years down the road,” says Cohen. “Clean claims are the secret to not only making—but keeping—money in this industry.”

Filing clean claims may require physicians to hire a certified medical coder. They’ll also need to budget for that individual’s ongoing continuing education. If the physician can’t afford a certified coder, then it’s best to outsource the coding function to a reputable company, says Cohen.

(Here’s a checklist to help you decide on your medical billing needs: Is Outsourcing Your Medical Billing the Right Choice?)

4. Establish a compliance plan—and follow it

The Office of Inspector General (OIG) provides guidance for individual and small group physician practices to help them conduct internal monitoring, implement practice standards, develop corrective action and more. Following a documented compliance plan helps physicians stay on track, and it mitigates risk for denials and recoupments, says Cohen.

5. Work with your practice management vendor

Because Medicare’s National Coverage Determinations, Local Coverage Determinations, and National Correct Coding Initiative edits are completely transparent, physicians are most successful when they work with their practice management vendors to ensure that this information is loaded on the front end. This enables practices to validate claims prior to submission. Many systems also offer coding checks that validate procedural codes and modifiers.

It’s difficult to implement this same type of checks and balances with private payers, says Cohen. “The problem with private payers is that there’s still a lot of black box editing that goes on,” he says, adding that he recently had to look 22 pages deep into a payer’s website to find its payment policy.

6. Hire an external auditor annually

Under these self-disclosure and payback policies, the government and private payers are expecting physicians to hire an external auditor, says Cohen. External auditors can easily identify billing and compliance risk that could be potentially catastrophic when left unaddressed, he adds.

Choosing to accept Medicare can help physicians grow their practices, but only when implementing a strategic approach to stay profitable. This includes careful consideration of staffing, scheduling, billing and auditing.

The Deer story.. Must read

 

In a forest, a pregnant deer is about to give birth. She finds a remote grass field near a strong-flowing river.

This seems a safe place. Suddenly labour pains begin.

At the same moment, dark clouds gather around above & lightning starts a forest fire.

She looks to her left & sees a hunter with his bow extended pointing at her.

To her right, she spots a hungry lion approaching her.

 

What can the pregnant deer do?

She is in labour!

What will happen?

Will the deer survive?

Will she give birth to a fawn?

Will the fawn survive?

Or will everything be burnt by the forest fire?

Will she perish to the hunters’ arrow?

Will she die a horrible death at the hands of the hungry lion approaching her?

 

She is constrained by the fire on the one side & the flowing river on the other & boxed in by her natural predators.

What does she do?

She focuses on giving birth to a new life.

 

The sequence of events that follows are:

– Lightning strikes & blinds the hunter.

– He releases the arrow which zips past the deer & strikes the hungry lion.

– It starts to rain heavily, & the forest fire is slowly doused by the rain.

– The deer gives birth to a healthy fawn.

 

In our life / business too, there are moments of choice when we are confronted on αll sides with negative thoughts and possibilities.

Some thoughts are so powerful that they overcome us & overwhelm us.

Maybe we can learn from the deer.

The priority of the deer, in that given moment, was simply to give birth to a baby.

The rest was not in her hands & any action or reaction that changed her focus would have likely resulted in death or disaster.

 

Ask yourself,

Where is your focus?

Focus should always remain on faith and hope

Top 10 Reasons to Train for a Medical Billing and Coding Career

Medical billing and coding can be a demanding career. To succeed, you must be precise, you must be able to meet deadlines, and you must have enough medical knowledge to accurately identify a wide array of conditions, procedures and outcomes. Becoming a medical insurance biller and coder requires special training and you must regularly update your knowledge for as long as you practice your profession. Your performance can not only determine if a patient receives the proper course of treatment, but it can also expedite or delay payments that can total in the tens of thousands of dollars.

It’s a lot to think about.

But as demanding as medical billing and coding is, there are many compelling reasons to pursue it as your career. Here are 10 of them:

1. There’s a demand for trained professionals. Health care is one of America’s healthiest industries (no pun intended), accounting for 17.9 percent of our Gross Domestic Product (GDP)…and growing. As for medical billing and coding professionals in particular, the U.S. Department of Labor expects jobs openings to increase 21 percent between 2010 and 2020, a rate it describes as “faster than average.”

2. The field is secure. With America’s population aging, the demand for medical services and support personnel is only going to increase. Even if the U.S. went to a Canadian-style single-payer health care system, there would still be a need for specialists to handle the biggest thing the private and public sectors have in common: paperwork.

3. You can train quickly. Yes, you need specialized training, but if you have a high school diploma or its equivalent, you can usually earn your medical billing and coding diploma in one year or less.

4. It’s a health care position with no patient contact. An a medical billing and coding specialist, you can enjoy all the benefits of working in the health care industry without having to expose yourself to germs, bodily fluids or the other “ick” factors often associated with actual patient contact.

5. You will work in a professional environment. You will likely work in a physician’s office, clinic, hospital or similar environment alongside highly educated professionals. Or you may work for an insurance company in an organized corporate atmosphere.

6. You may be able to work from home. Like medical transcription, medical billing and coding is a specialty that can also be performed from the convenience and comfort of your own home. A medical billing career is a great career for young parents or others who’d prefer to avoid the hassle and expense associated with daily commuting.

7. You may be able to work part-time. Many medical billing and coding specialists work only half days, or on evenings and weekends. Again, if you’re looking for flexibility, medical billing and coding can be a great choice.

8. Pay is competitive. Compensation will naturally depend on where you live, local market conditions, whether you work full- or part-time, and your level of experience. Nationally, the average starting rate is about $10.70 per hour, but it can be as high as $12.12 per hour in states like California and New York.

9. There’s room for growth. With time and experience, your income can more than double. Nationally, top-tier medical billing and coding specialists average more than $56,000 per year, and more than $58,000 in higher-wage states.

10. Your skill set is transportable. Are you a displaced worker or changing careers? The skills you acquire in medical insurance biller and coder can allow you to transition smoothly to other industries that rely on detailed documentation, such as insurance, banking and home lending.

If these benefits sound good to you, then medical billing and coding is a field you should explore further. With the right training, you could be out of school and ready to go to work by this time next year. So what are you waiting for?

[1] Source: http://data.worldbank.org/indicator/SH.XPD.TOTL.ZS

[2] Source: http://www.onetonline.org/link/summary/29-2071.00

[3] Source: http://ije.oxfordjournals.org/content/31/4/776.full

[4] Source: http://www.careerinfonet.org/occ_rep.asp?optstatus=011000000&soccode=292071&id=1&nodeid=2&stfips=36&search=Go

Techli – Huge Demands for Medical Coders

Minnesota’s burgeoning healthcare tech scene sparks huge demand for coders

Minnesota is well-known for its robust healthcare tech scene, and now the demand for coders has reached such a high level that the University of Minnesota has launched a coding boot camp.

Last year, 98 health technology startups in Minnesota raised $420.28 million, according to an article by Modern Healthcare.

A simple job search on Indeed for “medical coding specialist” in Minnesota displays some 450 positions ready to be filled while ZipRecruiter lists over 2,000 available slots for “medical coder.”

Companies that are looking for coders include Twin Cities OrthopedicsHealth Partners, and Fairview among many others, but more on that later.

In order to meet the overwhelming demand for tech talent in Minnesota, including its burgeoning healthcare sector, the University of Minnesota is launching a coding boot camp.

Although the boot camp is not aimed specifically at healthcare tech, that’s where you will find the highest demand as evidenced by recruitment within the industry.

With demand for skilled web developers at an all-time high, University of Minnesota’s College of Continuing Education will launch a 24-week Coding Boot Camp in November 2017.

“Students who complete the program will have the skills they need to develop dynamic end-to-end web applications—and to make a great impression on prospective employers,” the university website reads.

The University of Minnesota Coding Boot Camp is offered in collaboration with Trilogy Education Services, a Continuing Education Program Manager (CEPM) that creates and manages skills-based training programs that combine market-driven technical instruction with a deep emphasis on career coaching and employer networking.

minnesota healthcare

Dan Sommer, CEO and Founder at Trilogy Education Services

“Today, more than ever before, knowing how to code is a form a literacy just like the ability to read and write, said Dan Sommer, Founder and CEO of Trilogy Education Services.

“Forward-thinking continuing education programs recognize their essential role in helping train a job-ready workforce with technical skills, and the University of Minnesota College of Continuing Education is at the forefront of this movement.”

While the University of Minnesota Coding Boot Camp will help train students to do code across industries, the healthcare sector is where big companies and startups alike are looking to hire.

Startups in Minnesota’s healthcare tech sector are receiving serious funding, including $14 million raised by Minneapolis-based Gravie last month.

Other leading healthcare startups in Minnesota that are looking for tech workers include Bright Health, who are looking for data scientists, and SherpaHealth, which was created by Element Consulting based on the need to “leverage clinical data to recognize patient risk factors and enable patient interventions with clinicians,” is looking for “Technology Solutions Integration and Migration” positions.

With big funding coming in for startups in Minnesota’s healthcare tech sector, the demand for coders is rising tremendously.

According to Modern Healthcare, “In Minnesota, about 439,300 people are employed in the healthcare industry.”

The University of Minnesota’s Coding Boot Camp is one of way of educating home-grown students to meet that demand, but it still won’t be enough to fill all the thousands positions currently available in healthcare, from well-established corporations to up-and-coming startups that are producing great work everyday in the Land of 10,000 Lakes.

What is Medicare new program MACRA talks about

MACRA :

The above abbreviation stands for Medicare Access and Chip Re-Authorization Act.

Medicare keeping in mind to reduce the rising cost in delivering healthcare and in the interest of keeping patient most healthier, introduced some quality payment programmes.  By asking the top providers in the country to join this drive, has made the providers life easier, patient healthier and the rising costs reduced.  As we all are aware Medicare was paying the providers through a method namely “FFS – Fee for service”.  This service actually depends on the sustainable growth rate formula created for fixing the prices for the services provided.  Each year, the congress used to pass a bill which affected the providers remuneration to greater extent as these were based on volume and not the quality of services provided.

Quality payment programme has provided 2 ways to track the quality measures to the providers:

  1. MIPS (Merit based Incentive payment systems)
  2. APMs- Advanced Alternative payment models.

MIPS – When providers participate in MIPS they will be entitled to earn a performance based incentive.  They have laid certain criteria for certain providers, as for MIPS is concerned.  The providers must also be 1. Physician, 2. Physician assistant, 3. Nurse practitioner, 4. Clinical Nurse specialist or 5. CRNA’s.  If they are ready to participate, they have to submit the data on the quality measures undertaken, electronically, for the period Jan 1 2017 – Dec 31 2017 by March 31, 2018.  If they do not participate, then they are entitled for a negative payment retraction of 4% by Jan  1, 2019.

Not only this, Medicare has provided 3 options to choose for those providers who wish to participate for MIPS.  They could 1. select to submit a few quality measures data, 2. Partial year submission 3. Full year submission.

APM’s – When providers participate in Advanced Alternative Payment Model system, they will be entitled to earn the incentive based on the quality measures provided on the APM”s.  The participating providers should submit the data on the quality measures undertaken, electronically, for the period Jan 1 2017 – Dec 31 2017 by March 31 2018.  Through this programme, the providers are entitled for a 5% incentive.  If not, they are entitled for a negative payment adjustments by 2019.

If the providers participate in these quality measures and are successful, they could reach higher heights in terms of remuneration, patient satisfaction and in return, more business expansions can happen.  If not, their negative retraction will be higher…

How do physicians choose an outsourced medical billing provider?

The best way to choose a medical billing service is to understanding the needs of your practice. After that check the accuracy and the amount of time they take for claims filing and the collection percentage.

Accuracy, timeliness and collection percentage.

Accuracy – How accurate are the claims that are going out. Do they go to the right insurance company? Do they contain all of the information necessary for payment? Do the payments go to the right lock box or bank account? Who is responsible for errors? What kinds of reports are available? Often known as slicing and dicing, what kind of accurate reporting can the vendor supply that can help the practice with productivity, planning, forecasting, etc.

Timeliness – How quickly does the information provided by the practice get turned around? What is the process for handling claims denied for timely filing? This is usually a negotiation to determine who is at fault when this happens. Making sure these terms are fair to the client as well as the vendor is key here. How soon are reports available for the practice? (Daily, weekly, hourly) How quick is the response to questions, issues, requests. How available is the vendor?

Collection percentage – Who does claim follow up? Who works denials? Percentage of clean claims that go out? How much is collected on the billed dollar? How much work does the practice do to resolve the AR and how much is taken care of by the billing company?

These are common concerns when shopping for a billing company.

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