Tuesday, 24 January 2017

Medical billing software

3 Part Series: Medical Practice Vital Signs-Part 2

A Medical Practice is a unique business in many ways, but it is still a business and must be treated as such.  Checking the health of your practice is similar to checking the health of your patients.  In this three part series, we will look at these Vital Signs, pulse, blood pressure and temperature, to help you assess the financial well-being of your medical practice.

In Part 1, we addressed the pulse of your practice: trends in new patient statistics and physician referrals.  If you missed Part 1, please select this link: Check the Vital Signs of Your Medical Practice-Part 1

For Part 2, let’s check that Blood Pressure-  medical billing software

Are the numbers of services you bill increasing, decreasing, or staying the same?

Depending on your type of medical practice, you could expect to see one or two procedure codes billed per patient visit or for some specialties like Radiation Oncology, you may bill 10 procedure codes per visit.  In either case, reviewing reports that show month-to-month statistics can allow you to recognize anomalies in your billing patterns.  Sharp declines in a certain procedure may indicate forgotten or missed coding opportunities and therefore missed revenue.  

Many payers have time filing limits from the date of service.  They can range from 60 days to one year.  A regular review for missed charges will enable to meet those filing limits and collect on all of your rendered services.  If your report showed an unexpected procedure or an unusually high number of a certain procedure was billed, you will be able to audit the medical record(s) for appropriate documentation.  

If billing errors are discovered, you can get ahead of an insurance audit by quickly refunding any payments received for these non-provided services.  Keeping yourself in the good graces of your payers is always important.

Is your claim reimbursement in line with your contracted fees?

This type of analysis is invaluable to any medical practice.  Once you have signed on that dotted line with the payer, you are wise to ensure that you are receiving the proper reimbursement based on the agreed upon contractual rates.  

In the daily whirlwind of activity in the medical office, office staff seldom has the time to comb over the detail of every paid line item.  A monthly report that compares the payments received to the payer’s fee schedule will indicate payments that are below (as well as above) the payers contracted fees.  Payments that are below should immediately prompt a call the Provider Relations Department.  

For payments above the contracted fees, research has to be done on the accuracy of the fee schedule you are using, for instance, perhaps the payer has updated its schedule and you have not.  This type of report could also make you aware of overpayments. If those are pre-emptively refunded to the payer, it will show your practice to be following proper procedures in the eyes of the payer.

These two reports are just a small sampling of the extensive selection of practice management reporting options built into the Report Center module of Iridium Suite Medical Billing Software.

Be sure to watch for the upcoming publication of Part 3: Temperature.

Practice management software

3 Part Series: Medical Practice Vital Signs-Part 1

A Medical Practice is a unique business in many ways, but it is still a business and must be treated as such.  Checking the health of your practice is similar to checking the health of your patients.  In this three part series, we will look at these Vital Signs, pulse, blood pressure and temperature, to help you assess the financial well-being of your medical practice.

We will begin in Part 1 with the Pulse -     medical billing

How many new patients are you seeing each month?

By analyzing the trends month over month, you will be able to calculate your current growth rate and estimate the potential need for increased staffing and other infrastructure changes.  If close monitoring of your patient numbers shows a progressive decline or steep increase, it can give you the opportunity to research the reason why.  One reason could lie in the next item on our list, referrals.

Who is referring those patients to you?

With the almighty internet, physicians have been able to reach out much more easily and cost effectively to a wider range of patients.  While many people with basic medical needs may feel comfortable doctor-shopping online, there are many who have complicated issues.  These referrals generally come from colleagues and satisfied patients.  Know which providers in your area are referring patients to your office and always keep the lines of communication open in regards to those mutual patients.  

A happy, well-taken-care-of patient is the best advertising.  Many times less than stellar office staff can scare away patients who “love” their doctor, and those unpleasant episodes can make their way back to the referring colleague.  Watch for trends that would show a reduction in referrals from a particular source and take the time to reach out personally.   

These two reports are just a small sampling of the extensive selection of practice management reporting options built into the Report Center module of Iridium Suite Medical Billing Software.

Be sure to watch for the upcoming publication of Part 2:  Blood Pressure.

Iridium suite medical billing software

Five Things to Know About Sequestration

Here are the five things you should know about sequestration:

1.  What is sequestration? 

It is the mandatory 2% payment reduction in the Medicare fee-for-service (FFS) program required by the Budget Control Act of 2011.

2.  Who does it affect?  

All providers of medical services that are reimbursed under the Medicare fee-for-service (FFS) program (i.e., Part A and Part B) are subject to the 2% reduction.  This also includes those entities that bill for durable medical equipment (DME), prosthetics, orthotics, and supplies.

3.  When does it begin?  

FFS claims with dates of service or dates of discharge on or after April 1, 2013.  Payments for DME, prosthetics, orthotics and supplies will be based upon whether the date of service, the start date for rental equipment or multi-day supplies, is on or after April 1, 2013.

4.  How is the 2% calculated? 

The reduction is taken from the calculated payment amount, after the approved amount is determined and the deductible and coinsurance are applied.


A provider bills a service with an approved amount of $100.00. 

Medicare normally would pay 80 percent of the approved amount ($100.00 x 80 percent = $80.00).
The patient is responsible for the remaining 20 percent coinsurance amount of $20.00 ($100.00 - $80.00 =  $20.00).

However, due to the sequestration reduction, 2 percent of the $80.00 calculated payment amount is not paid,       resulting in a payment of $78.40 instead of $80.00 ($80.00 x 2 percent = $1.60).

Billing Note:  The 2% reduction will be noted on the explanation of payment as Claim Adjustment   
Reason Code 223.  (CARC 223 is defined as adjustment code for mandated federal, state or local law/regulation that is not already covered by another code and is mandated before a new code can be created.)
5.  Where do I get more information? 

The Importance of Autism Awareness

The current accepted medical terminology for Autism is Autism Spectrum Disorder (ASD).  The use of “Spectrum” accurately describes the wide range of symptoms, levels of impairment or disabilities and their varying degree of severity.  As some children can be only mildly impaired by their symptoms, others can suffer from severe disability. 

In March 2012, the Centers for Disease Control and Prevention issued their ADDM autism prevalence report. The report concluded that the ASD affects 1 in every 88 children born in the United States, with a slightly higher rate for males, almost 1 in 54.  

With occurrence rates that high, almost everyone knows someone impacted by ASD.  Therefore, it is important we all educate ourselves about this common and complex issue.

What are the symptoms of ASD?

As mentioned before symptomology and severity can vary widely from one child to the next. 

Generally accepted indicators can include:
  • Lack of or delay in spoken language
  • Repetitive use of language and/or motor mannerisms (e.g., hand-flapping, twirling objects)
  • Little or no eye contact
  • Lack of interest in peer relationships
  • Lack of spontaneous or make-believe play

Persistent fixation on parts of objects

Parents, family members or others in close connection with the child should bring any concerns about the potential for ASD in the child to the attention of their health care provider immediately.  

Early intervention can reduce or prevent the more severe disabilities associated with ASD and may also improve your child's IQ, language, and everyday functional skills, also called adaptive behavior.

How is ASD diagnosed?

Whether it is the result of an evaluation specifically initiated by a parent or a routine developmental screening during well-child checkups with a health care provider, children who show some developmental problems are referred for additional evaluation. 

Initial Screening

A well-child checkup should include a developmental screening test, with specific ASD screening at 18 and 24 months as recommended by the American Academy of Pediatrics. A parent’s own experiences and concerns about the child's development are a very important part in the screening process.  Notes about the child's development, even family videos, photos, and baby albums help to document behavioral timelines and developmental milestones are all useful to the health care provider in the evaluation of the child.  

The initial screening instruments used by the doctor for toddlers or preschoolers may consist of: 

Checklist of Autism in Toddlers (CHAT)
Modified Checklist for Autism in Toddlers (M-CHAT)
Screening Tool for Autism in Two-Year-Olds (STAT)
Social Communication Questionnaire (SCQ)
Communication and Symbolic Behavior Scales (CSBS).

To screen for mild ASD or Asperger syndrome in older children, the doctor may rely on different screening instruments, such as:

Autism Spectrum Screening Questionnaire (ASSQ)
Australian Scale for Asperger's Syndrome (ASAS)
Childhood Asperger Syndrome Test (CAST).

Comprehensive Diagnostic Evaluation

The next step in diagnosing ASD involves a thorough evaluation to rule out other causes or conditions that could be responsible for the symptoms.  This stage utilizes a team of health care professionals that encompasses a wide range of specialties: psychology, neurology, psychiatry, speech therapy.  

The evaluation at a minimum should include the assessment of cognitive and language levels, and age-appropriate skills needed to complete daily activities independently.  Due to complexity in nature of ASD and the possibility of other accompanying illnesses more comprehensive testing may be appropriate:  hearing testing, screening for lead poisoning, brain imaging, genetic testing, and in-depth memory, problem-solving, and language testing.

Some helpful resources on ASD screening include the Center for Disease Control and Prevention's General Developmental Screening tools and ASD Specific Screening tools on their website.

How is ASD treated?

Once a child is diagnosed as having ASD, discussions begin on treatment options.  As varied and individual as each child, so are the options. 

Nonmedical interventions include behavioral and educational approaches as well as focuses on sensory response and communication.

Applied Behavior Analysis (ABA) is a treatment plan that includes verbal behavior and pivotal response training interventions centered around shaping and reinforcing new behaviors, such as learning to speak and play, and reducing undesirable ones.

Developmental, Individual Difference, Relationship-based (DIR)/Floortime Model aims to build healthy and meaningful relationships and abilities by following the natural emotions and interests of the child.

TEACCH (Treatment and Education of Autistic and related Communication handicapped Children) emphasizes adapting the child’s physical environment and using visual cues.

Interpersonal Synchrony targets social development and imitation skills, and focuses on teaching children how to establish and maintain engagement with others.

Medical interventions, in children ages 5 to 16 who have ASD, with medications such as 
antipsychotics, antidepressants, and stimulants have been known to help reduce symptoms such as irritability which can often translate into aggression, self-harming acts, or temper tantrums.

Biomedical treatments include modifications in diet such as the gluten-free/casein-free diet, addressing food sensitivities, addition of vitamins and minerals supplements, immune system regulations and others.  

Here are several links expanding on the topic of ASD awareness:








No comments:

Post a Comment

Popular Posts