Skyline Medical Billing Management: Outsourcing vs. the cost of an employee at your Prescott medical practice

What does it cost your Prescott medical practice to have an employee handling your medical billing? It’s easy to identify wages, but what about the hidden costs? Skyline Medical Billing Management examines the cost of outsourcing to a professional medical billing service vs. hiring an employee.

The true cost of a medical billing employee is much more than just salary. Rising wages range from $13 to $15 per hour, and medical billing employees nationwide often earn $15 or more per hour. While wages are the lion’s share of the expense, there are a number of hidden costs that add up. Consider the following:

Hiring - Smaller practices generally don’t have a human resources person to handle the application and interview process, which means you are likely taking time away from your practice to find employees.

Training - Most employees are not fully productive on their first day of work and it may take weeks or months before a new person settles in at their job.

Payroll taxes - Federal law requires employers to pay FICA (Medicare and Social Security taxes) for their employees. Federal and/or state unemployment taxes are also required.

Workmen’s compensation - Under Arizona law, it is mandatory for employers to secure workers' compensation insurance for their employees.

Benefits - Health insurance and paid time off, including vacation, sick days and paid holidays are critical to attracting and keeping good employees. With all of these added incentives, a $15 per hour wage rises about 24% to nearly $20 per hour.

Office overhead - Consider the equipment needed to perform job duties: office space, desk, computer, software, technical support, office supplies, insurance, and depreciation on assets.

Skyline Medical Billing Management recommends taking a close look at the hidden costs of hiring an employee to handle your medical billing. We would like to help you manage your Prescott medical practice more efficiently and profitably, and with the confidence that you have a team of professionals working on your behalf. For more information on how we can help, or to schedule a consultation, please call us at 928-227-1167. Learn more at https://www.skylinembm.com.

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Skyline Medical Billing Management discusses balance billing for your Prescott medical practice

As a medical provider, a significant part of your business is medical billing and working with insurance companies. This is not typically considered glamorous or fun work to do, but it is necessary. One drawback of this payment model and system is that you can end up footing the remainder of a bill if the client meets their deductible and the insurance company meets their requirements. Skyline Medical Billing Management discusses balance billing for your Prescott medical practice.

Is it legal?
It may be tempting to bill your client for the remainder of a bill, but in some cases, this is illegal or could open you up to legal action for breach of contract with an insurance provider. The legality depends on state law and your agreement with insurance companies. A few situations where it is usually illegal to balance bill are when you accept Medicare, Medicaid, or you have a contract with an insurance company and bill more than the contract allows.

Under what circumstances?
However, there are circumstances where balance billing is perfectly legal. These situations typically involve out-of-network clients and procedures that are not covered by the insurance provider. If you are doing procedures that are not medically necessary, you may consider alternative billing methods such as receiving a portion of the bill prior to a procedure.

Out-of-network 

If your practice is out-of-network with the insurance company/patient’s plan, you can balance bill the patient for the FULL charged amount - not what the insurance company allows.

• Example: The doctor’s office bills a patient’s insurance $150.00 for an office visit (99204). The EOB comes in showing the insurance company allowed $102.50 toward the patient’s out-of-network deductible. Because the doctor is not contracted with the insurance company or the patient’s plan - in other words, not bound by in-network rate agreements - the doctor can balance bill the patient for the full $150.00.

Do your research
Before you decide to balance bill a client, be sure that you are up-to-date on state law and are familiar with your insurance provider contracts. Have your billing practices reviewed by an experienced attorney and medical billing expert to ensure your medical practice remains compliant. Additionally, consider that many clients will be unable to pay the remainder of their bill, and negotiating with a client may result in a more favorable outcome for your you.

If you have questions regarding balance billing or general medical billing for your Prescott practice, call Skyline Medical Billing Management at 928-227-1167 or visit us online at https://www.skylinembm.com.

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Skyline Medical Billing Management discusses the process of medical claims submission for your Prescott practice

A key to prompt insurance reimbursements is not underestimating what is necessary to move the claim from your office through the various steps until it returns to you in a timely manner and in the form of an acceptable payment. It's a mistake to regard medical billing as a clerical function or part-time job. Cash flow will either make or break your practice. Skyline Medical Billing Management recommends outsourcing this critically important facet of your Prescott medical practice to the experts.

In-House Billing
Most medical practices are probably not aware that doing your own in-house billing costs you time and money in greater delays and more errors. If you do your own billing, the claims are sent by your billing staff to Medicare or the insurance carrier for reimbursement. The entire reimbursement process can take as much as six weeks if your office is filing your own medical claims.

Outsourcing Billing
If you outsource your billing, you'll find the reimbursement process can be shortened to as little as two weeks. A professional medical billing business has systems in place to simplify the process while ensuring the highest degree of patient confidentiality. Instead of sending your claims to an insurance carrier or government provider, you transmit all of your claims to your medical billing resource. Once there, your billing company will enter and double check your submitted claims for errors and batch transmit them directly to the carriers or utilize the services of a clearinghouse.

Clearinghouses
A clearinghouse will edit and convert the claim information into a standard format and forward it onto the carrier for processing. Upon receipt, the carrier typically transmits a confirmation allowing the claim to be tracked. Instead of six weeks, your office can expect reimbursement, along with an EOB, in about two weeks when using electronic claim filing.

The use of a clearinghouse means adding one more layer of scrutiny to catch the occasional coding error, providing your office with increased efficiency and expedited revenue recovery, as you experience less than 1% of your claims rejected due to coding errors. A good clearinghouse will reject a claim the same day for coding errors, so you are not waiting a week to learn about the denial. In the event a claim is denied for allegedly being submitted untimely, a simple check with the clearinghouse confirms the date the claim was submitted, and assists with filing an appeal.

Skyline Medical Billing Management wants to help your Prescott medical practice succeed, and offers ease of billing submission, the ability to instantly check the status of a claim, and reduce the time for reimbursement. If you are considering outsourcing your medical practice billing, call the medical billing experts at Skyline Medical Billing Management at 928-227-1167 for a consultation. Visit us online at https://www.skylinembm.com for more information.

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Skyline Medical Billing Management shares why you need professional medical claims follow-up for your Prescott practice

Are you finding yourself stressed over accounts receivables when you could be focusing on your medical practice? Skyline Medical Billing Management offers some reasons you need professional medical claims follow-up for your Prescott practice.

Track down claims that were never received

Claims that are lost in the mail are one of the most common causes of lengthy delays in payments to your practice. Follow-up on paper claims should be done after 10 business days have elapsed to allow time for mailing and routing to the right department. When claims are sent electronically, they are trackable and the process is more timely.

Reduce the time that accounts are overdue

With our team focused on your claims, the amount of time an account is outstanding is greatly reduced. We implement procedures to collect payments and follow up until payments are received.

Track down denied claims

Getting a head start on denied claims can help keep your bottom line healthy. A new claim request with corrections can be transmitted before you even receive the hard copy of a denial by mail.
   
Resolve issues with pending claims

When claims are pending awaiting information from the member, our professional team can follow up with the member, notifying them of the situation, and obtain the information necessary to resolve the claim.

Outsourcing claims follow-up can keep your practice funded and running smoothly while you do what matters most: caring for your patients. Trust your accounts receivables to the experts and let us use our expertise to stay on top of your claims. To find out more about how we can help your practice succeed and relieve the stress on your office staff, call Skyline Medical Billing Management today at 928-227-1167. Learn more about all of our services at https://www.skylinembm.com.

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Skyline Medical Billing Management discusses reasons acupuncture claims are denied at your Prescott practice

The traditional Chinese therapy of acupuncture has been an acceptable treatment for various maladies, the most common being pain relief. While there are insurers that cover acupuncture services, many providers are frustrated with the ongoing denials of their claims. Skyline Medical Billing Management describes some of the reasons acupuncture claims are being denied at your Prescott practice.

Checking coverage for acupuncture
What the provider needs to understand is that acupuncture coverage is all diagnosis driven. It is important that the staff, when checking coverage, determine how many visits a patient is allowed for the fiscal or calendar year, and if those visits have been used. With some insurance companies, the information on coverage is available online.

What is covered
Some insurance companies will verify that the patient has coverage for acupuncture, but only when prescribed by their physician to treat nausea resulting from chemotherapy. In other cases, coverage is limited to treatment of chronic pain that is not responding to more conservative treatment options. It is imperative that the correct question is asked: Does the insurance company cover acupuncture for pain management?

What is NOT covered
With mental health issues on the rise and people becoming more aware of the side effects of prescription drugs, alternative treatments like acupuncture are being sought. Unfortunately, stress, anxiety and anger are not considered medically necessary. In addition, allergies and coughs do not fall under a covered diagnosis code.

Limited number of diagnoses with insurance companies
There are several insurance companies, including Cigna and Aetna, that only accept a limited number of diagnoses. Blue Cross/Blue Shield and UnitedHealthcare tend to reimburse for a wider variety of diagnosis codes.

Advance Beneficiary Notice of non-coverage (ABN)
If you are contracted with the insurance company and you know the services will not be covered by the patient’s insurance, it is in your best interest to have the patient sign an advance beneficiary notice of non-coverage (ABN). An ABN is a waiver of liability that providers are required to give a patient for services provided that may not be covered or considered medically necessary. The ABN needs to be signed before the services are rendered.

As simple as it is to bill acupuncture, it can be very frustrating if you don’t have a good understanding on the ins and outs of covered codes. For more information on how we can assist you in your Prescott practice, call the billing experts at Skyline Medical Billing Management today at 928-227-1167. For more information, visit us at https://www.skylinembm.com.

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Prescott Medical Billing
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Skyline Medical Billing Management discusses the importance of medical billing accuracy at your Prescott practice

Are billing errors hurting your Prescott medical practice? Skyline Medical Billing Management discusses the kinds of problems that errors in medical billing can cause and the steps that medical practices can take to develop their billing department's accuracy.

It's a fact that billing is an essential part of any medical practice, no matter how patients are paying, whether through insurance or out of pocket. And with most medical care being as expensive as it is, it's becoming increasingly more difficult for patients to meet their obligations. According to recent statistics more than half of all patients owe in excess of a $1,000 to their medical providers. So you can see how vitally important it is not to complicate matters through billing errors.


Most patient billing errors can be simple, honest mistakes...

• Incorrect diagnostic code
• Typos
• Transposed numbers

…but the consequences can be complicated and serious. Medical billing errors can result in denied insurance claims depriving the practice of vital income. They can result in a patient disputing the charge, thus delaying payment with the same troublesome outcome: depriving the practice of vital income. Far more serious are patients failing to get the care they need because their claims were incorrectly submitted and treatment denied.

Medical billing errors are far more common than most people realize. It is said that approximately 80 percent of all medical bills have billing errors. That is a staggering number. Even the very simplest errors involving patient's name, address, personal identifiers, account numbers and insurance carrier information all fall under the umbrella of billing errors. Poor or incomplete documentation also contributes to an indefensible number of medical billing errors.

Because medical billing is such a vital part of medical practices, it’s imperative that bills are submitted promptly and accurately. Remember, accuracy is a critically important part of billing. Don't leave a vital part of your medical practice to part-timers or those not thoroughly trained in medical billing.

Medical billing mistakes are seriously hurting the healthcare industry. Don't let them hurt your practice. Let the experts at Skyline Medical Billing Management handle the medical billing demands in your Prescott medical practice. For more information on how we can help you, call us today at 928-227-1167 or visit us online at https://www.skylinembm.com.

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Skyline Medical Billing Management discusses patient collections for your Prescott medical practice

With ever-rising healthcare costs, the healthcare industry at large has been compelled to engage in even more assertive collection practices in order to safeguard the livelihood of health-related businesses, especially those dependent on patient payments. Skyline Medical Billing Management understands that patient co-pays, deductibles and coinsurance payments are dollars that your Prescott medical practice cannot afford to lose through inadequate billing and collection practices.

Skyline Medical Billing Management offers these guidelines:

What you should do:

• Be up front. The best time to tell a patient about your payment policy is when they are scheduling their appointment. Prior notice prepares patients to pay when they arrive at the office.

• Be repetitive. Documentation, signage, pamphlets and easy-to-see notices where they check-in, check-out, and enter into patient-only areas are part of reminding and encouraging your patients to be prepared to meet their responsibility.

• Motivate. It is more cost effective to motivate patients through discounts for timely payments than it is to pay outside collection costs or sustain complete losses.    

• Offer payment plans. Out-of-pocket expenses can sometimes genuinely be outside of your patients' immediate ability to pay. A no- or low-interest payment plan could be the difference between getting fully paid in a reasonable amount of time versus only getting partially paid, or worse.   

What you should not do:

• Ignore the problem. Of course, unless it's an emergency, do not allow patients to continue to accrue bills when previous bills remain unpaid.

• Prematurely assign accounts to third-party collection agencies. Put the 'good practices' into place first and only send accounts to collection agencies when all else fails. Collection agencies are not known for their compassion, and your practice's reputation could suffer as a result.

• Ignore delinquencies. When the patient arrives for a new visit, that is the time to remind them of their outstanding bill and your expectation of them to pay it.

As uncomfortable as it may be for some, collecting the patient's portion of a bill has to be done and is as vital to your office as collecting from insurance companies. For more information on how we can assist you in your practice, call the billing and collecting experts at Skyline Medical Billing Management today at 928-227-1167. For more information, visit us at https://www.skylinembm.com.

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