If you’re planning on doing medical billing and sending in claims for oxygen, you better make sure you’ve had plenty of sleep the night before. Oxygen billing is probably the most complex of all the medical billing procedures because of certain conversions and calculations that need to be done in regard to the oxygen itself. In this installment of our series on medical billing and the electronic transmission of claims using NSF 3.01 specifications, we’ll be covering the GX0 record, picking up with field number 14.

GX0 field 14, positions 125 - 127, is the oxygen flow rate. This tells the carrier how many liters per minute the patient is supposed to receive. The valid values are 001 - 999. If the patient is going to be getting less than one liter per minute than the software needs to enter 00X.

There are some notes that are important about this field, as it is one of the most important fields on this CMN.

If you’re billing for an oxygen concentrator, the concentrator being given to the patient must go along with the flow rate prescribed by the doctor. This is especially critical when billing for flows greater than 4 liters per minute and less than 1 liter per minute. Also, if you’re billing oxygen for a flow rate greater than 4 liters per minute, the date the test was performed must be filled in. Use field GX0-20 for this. Also, flows of greater than 2 liters per minute will usually require a review by the insurance companies medical staff.

GX0 field 15, positions 128 - 129, is the frequency of use. This field tells the carrier how many times per day the patient is to use the oxygen. Just a note. This field is usually only filled in if the doctor prescribed oxygen use during certain times, such as when the patient is exercising, sleeping, etc.

GX0 field 16, positions 130 - 131, is the duration of use. This field tells the carrier how long in hours the patient is to use the oxygen for each use. If the number of hours is less than 10, then the field needs to be left zero filled. So 4 hours would be transmitted as 04.

GX0 field 17, positions 132 - 134, is the arterial blood gas at 4 LPM. This field tells the carrier what the blood tests results were for arterial gas when the patient was given oxygen at a rate of 4 liters per minute.

GX0 field 18, positions 135 - 137, is the oxygen saturation at 4 LPM. This field tells the carrier what the blood test results were for oxygen saturation when the patient was given oxygen at a rate of 4 liters per minute.

GX0 field 19, positions 138 - 145, is the date the patient was tested on 4 LPM. This field tells the carrier the date that the patient was tested for the 4 LPM tests. This date can be transmitted as yyyymmdd or mmddyyyy, depending on the carrier requirements.

If you’re in the medical billing business, or plan to get into it, one of the most important things you’re going to have to do is hire a staff of billers. This may sound easy but it is far from it. In this installment, we’re going to cover some basic things that you’re going to want to look for when hiring a billing staff.

The first thing you want to look for, probably above all else is somebody who has knowledge of the industry. The reason for this is because the medical billing industry is filled with rules and regulations. Medicare regulations alone are enough to make your hair stand on end. The last thing you want is for a biller to have to look up every single regulation before sending out a bill. They need to have a solid command of the rules of the industry or productivity is going to suffer greatly.

The next thing you’re going to want is somebody who has excellent typing skills. Sad as it is, most of medical billing comes down to typing and a lot of it. The person will have to type up order pages, patient accounts and a number of other items. Plus, they will be doing this all day. It is critical that they are able to get a certain amount of claims out or the company will not be as profitable as it could be.

The next thing you want to look for in a medical billing person is somebody who is technical to some degree. The reason for this is that most billing today is done by computer and many claims are no longer printed on HCFA 1500 forms but instead sent electronically. If the person you hire is not familiar with modems and things of a technical nature, they are going to have a hard time doing their job in today’s environment.

The next think you want to look for in a medical billing person is somebody who is trustworthy. The medical billing world deals with a lot of information that is private. Your biller is going to be seeing information such as patient files that is for nobody’s eyes. They are going to have to be able to see all of these things on a daily basis and keep their mouth shut about it.

Finally, you want to find somebody with a great attention to detail. Medical billing is one of the most complex things you can do. Aside from all the regulations and forms, there are things like enteral billing and parental billing where they are going to have to understand feeding methods and conversions. For oxygen billing, they’re going to have to know how to calculate oxygen units. They will need to be able to tell when a claim just doesn’t look right. For example, if oxygen units shows some crazy amount, they are going to have to be able to recognize this.

There is so much hype out there about electronic medical claims billing. If you are not sending your claims electronically yet, you are probably too embarrassed to admit it. And if you are, you are probably wondering if the method you are using is the best. What is the real truth behind electronic billing?

Many of the larger insurance companies are really pushing providers to submit their claims electronically. Some are even calling the provider’s offices and telling them that they are mandating electronic submissions by a certain date and that they will no longer accept paper claims. Others offer incentives to submit electronically, such as faster payment, or even no authorization required for services if claims are submitted electronically.

Bottom line, the real question for a provider is “is electronic billing really necessary for my practice” and “what will it require of me.”

For the first question, I think that everyone must realize that with the changes in technology electronic submission of medical claims is inevitable. Today’s society is moving towards paperless transactions in many ways.

The second question will depend upon many things such as how large, or small, your office is, how much equipment you already have and how up-to-date it is.

One of the biggest misconceptions of electronic billing is that it makes the billing in your office a lot simpler. In some ways it does, but it presents you with a whole different set of tasks that you didn’t have before. I’m not implying that it makes anything harder. Just that there are things that go along with electronic billing that you did not have to do before such as reading and acting on reports and maintaining and updating the electronic software.

When you submit a claim on paper, the claim is both received and processed, or you never hear a thing. Hopefully in the latter case, your staff will call and check status on it after 30 days. Whether your paper claim has complete and accurate information on it or not, it will be handled the same way. You will either receive payment for the claim, or an explanation of benefits showing a reason for denial.

When you submit claims electronically, it is not quite so simple. First, you will receive a report letting you know if your batch of electronic claims was accepted or rejected. If a claim has incorrect data such as an incorrect date of birth, it will be rejected before it ever reaches the insurance companies claims processing system. You will receive a report, usually within 24 - 48 hours showing all rejected claims, and the reasons for the rejections. You will also receive a report showing the claims that were accepted with no errors.

It is very helpful to receive notice so quickly that your claim had incorrect information; however, you now have to make sure your staff is able to check on this report and take the time to find and correct the needed information.

What electronic billing is actually doing is letting you know sooner that you have problems with specific claims. When you are submitting them on paper, you generally don’t find out about the problem claims until you are doing a follow-up report and calling the insurance companies. So by submitting your claims electronically, you are not eliminating all the problem claims, you are finding out about them sooner.

Once you decide to take the plunge into electronic billing, there are still choices to be made. Is the practice management system you are currently using capable of submitting claims electronically? If not, you will need to update or change your software. You will need to determine how you will submit your claims to the insurance companies. A clearing house may be the best option, or if you are a larger practice, or billing service, you may want to consider software that allows you to act as your own clearing house.

In any case, if you are not already submitting your claims electronically, it probably would be wise to start researching your options. A good place to start is by contacting your practice management system support and asking them if they recommend any method in particular. Another way is to ask your colleagues. Electronic claims submission is a big step and it should not be taken lightly.

Medical billing complexity and massive volumes of daily claims render manual claims processes incapable of protecting both the provider and the payer from underpayments, overpayments, and billing compliance violations. Straight Through Billing addresses complexity and volume processing problems by automating the majority of the claim flow and focusing the billing follow-up specialists to exceptions only. A Straight Through Billing process flags problems, routes them for follow up, and enables online correction and resubmission. Straight Through Billing methodology implements billing service transparency and focuses management on strategic process improvement opportunities.

Straight Through Billing (STB) integrates billing process within the practice management workflow, automates vast majority of transactions, focuses manual labor on exceptions, and establishes a process for continuous improvement.

First, integrated practice management and billing workflow connects patient scheduling, medical record management, and billing into a single flow. Every participant of the practice management workflow receives a unified and coherent picture of practice workload, patient and provider location, resource availability, and cash flow.

Next, transaction automation streamlines and expedites billing process by automating claim validation, payer message reconciliation, and billing workflow management:

* Automated claim validation eliminates errors downstream and reduces processing time because it flags errors before submitting the claim to payer.
* Automated claim-message reconciliation eliminates costly search for the original claim and standardizes message communication, further eliminating the need to decipher the (often cryptic) payer’s message.
* Billing workflow management drives the followup discipline required for resolution of claim denial and underpayment incidents and establishes high degree of process transparency for all billing process participants, resulting in full and timely payments.

Third, focusing manual labor to exceptions requires timely exception identification, routing to followup personnel, online error correction, and rigorous followup tracking. Again, process transparency, as implemented in vericle-like systems, enables tracking exception followup.

Finally, a process for continuous improvement requires continuous observability of every process attribute and a modification methodology for both automated claim processing and manual exception followup tracking.

STB implements billing transparency by design because billing transparency is an integral attribute of every component of STB process.

Straight Through Billing Architecture

Straight Through Billing systems architecture mirrors the architecture of general Straight Through Processing (STP) systems developed for the financial services industry. Such systems require effective workflow management, knowledge base validation system, connectivity to all process participants, including on-line data reconciliation, and tracking of problem resolution. Therefore, a typical vericle-like STB system has a three-tier architecture:

* Back-end processing engine designed for high-volume transaction processing environment
* Middle-tier uses Java Servlet technology
* Front-end is an HTML-JavaScript zero-footprint client

An STB system (e.g., Vericle) following the methodology outlined above implements rich functionality, which allows automated

* Computer aided preferential patient scheduling
* Integrated electronic medical records
* On-line computer aided coding
* Real-time claim validation and patient eligibility testing
* Electronic claim submission
* Payment posting, reconciliation, and verification of meeting contractual obligations
* Monitoring of audit risk and billing compliance
* Tracking of denial appeal process

Quantitative STB Management

STB methodology allows for quantitative management as the likelihood of failure of the entire process can be estimated as the product of such items for each individual workflow steps. A vericle-like STB system tracks the percent of clean claims (claims paid without any manual intervention in full and within the allocated timeframe) and focuses the management on those process aspects that yield the greatest potential improvement. Thus STB methodology focuses on exceptions both at tactical and strategic management levels.

Medical billing services are companies that take the pain of collecting money out of the doctor’s office. A good service will maximize a doctor’s receivables, while keeping their cash flow consistent. The key is choosing the right medical billing service.

A great service will submit insurance claims timely (preferably electronically), track the payments, follow up on unpaid claims and deal with all denials. They will not let any claim go unpaid.

Representatives of the service will attend insurance company seminars, advise the doctor of changes in their field and provide them with regular financial reports. They should not only handle the billing needs, but should act as consultants for the doctor, advising of fee structure, coding practices, and other ways to improve the office.

An obvious way a doctor can save money by outsourcing his billing is in the savings he will generate thru payroll, equipment, software support, updates, postage, forms, etc.

Outsourcing medical billing produces more than cash savings. A good service can maximize what the doctor actually brings in by collecting more money than an in-house staff can. In most offices, the in-house staff does not have the time, or the knowledge to handle the problem claims and the doctor ends up not getting reimbursed anything for those services.

By outsourcing, a doctor is hiring a professional. Medical billing services have the expertise to submit claims accurately, collect on all claims, even those that have been denied by the insurance carrier. This helps the doctor’s patients by avoiding billing the patient for a claim that should have been paid by the insurance carrier.

A doctor should avoid choosing the wrong service by carefully checking references. A doctor should call several other doctors who might be using a particular medical billing service.

When a doctor interviews a potential service, what is his overall impression of the people who will be handling his income? During the interview, he should pay attention to how they answer his questions. Are they confident in their answers? Are they correct in their answers? Does what they offer make sense?

Like many other fields, there are good and bad billing services. But medical billing services can be a great resource for a doctor if they are careful to choose the right one.

When you decide to opt for Web-based medical billing software you will find many great benefits. These include but are not limited to, reduced install and maintenance costs, security from natural disasters, anytime access.

Anytime Access

A major benefit of a Web-based medical billing solution is that you can access the information anytime. Whether you are at home, or in the office, you only need an Internet connection and you will be able to access all the information you need. Late at night or early in the morning or during the day you will be able to access the information for your practice.

Reduced Install and Maintenance costs

Another benefit of the software being Web-based is that there are much lower installation costs. You will see this benefit right up front as it will be the first step that you go through. Another benefit is the reduced maintenance cost. Many server based technologies need to be upgraded and constantly monitored. This can sometimes lead to unexpected costs to help maintain your current system. With Web-based technologies these maintenance costs are much, much, much lower.

Accidents unfortunately happen

As much as we like to think that accidents never happen to us, there is a chance that they just may. Many people use insurance to cover them incase of these major accidents. But many people do not think about what is going to happen to their information in an accident. With Web-based electronic medical billing software there is greater satisfaction in knowing that if an accident where to go through a horrific accident, you would be not lose all of your records. If there were a fire, earthquake, flood and your servers were hit, you would lose all of your client information. But if you had a Web-based software solution, even though your office may be damaged, your records wouldn’t be. You would be able to be up and running in almost no time.

Don’t you just ‘love’ those Internet ads for medical transcription training that say, ‘Earn up to $40,000 per year as a medical transcriptionist. Enroll Now!!’ To all medical transcription newbies: This is bunk. Disregard these ads as overblown hype.

The job outlook is very good for medical transcription and will continue to be so due to our aging population, commonly referred to as the graying of America. Many are drawn to medical transcription due to the fact that many medical transcriptionists can and do work at home, thanks to the advancement of technology.

With regard to starting salaries, a realistic income for a medical transcriptionist right out of school may range from $25,000 to $30,000, depending on the area of the country and other prior skills that the candidate possesses. For instance, a person who is a good word processor, has excellent command of English and grammar, has a fast and accurate typing speed, and who learns computer software programs quickly might be able to command a salary closer to $30,000 when first starting out as a medical transcriptionist.

A medical transcriptionist who has been in the field for a few years and who has established him/herself will make the kind of money (and more) specified in the Internet ads, but a medical transcriptionist who is seeking an entry-level position directly from school will not. Period. End of story.

In order to standardize and make all medical records available to hospital staff, colleagues and officials many health care institutions are computerizing their records and switching to an electronic medical records system. However, these systems are not universally accepted and the advantages and disadvantages are under debate by the medical community.

The idea behind electronic health records is to have a computer-based history of a patient’s clinical and administrative details. This will include every document made by each doctor that was ever involved with the patient’s medical history.

The big benefit of this computerization is that it is easy for a new doctor to pull a patient’s history, even from one hospital to another. On the flipside is the ever-present possibility of invasion of privacy.

Different care providers in the medical community may have different protocols in treating some conditions, and these differences may not be able to reflect in a shared medical record.

The issue with all computerized systems is security. Software developers in the EMR industry are taking steps to improve security by adding features like username and password requirements. However, for the determined and experienced computer hacker, breaking a username and password combination is not too hard to do.

The newest security features to be added to computer systems are biometric identifiers. It almost sounds like science fiction, but it is becoming more and more common to use things like fingerprints, eye scans and voice prints in security systems.

The dream of the paperless work environment is a definite benefit of having an electronic medical records system. Administrative staff are freed up from spending time managing files and having to make copies of records and so on. The drawback is that now the doctors need some kind of portable device to access record when consulting with patients.

A benefit of electronic systems is data accuracy. In a well designed software system, many data entry fields will be checked for valid entries. With information being entered in a standardized way, the software can also be programmed to alert doctors about certain conditions for a patient, like allergies to drugs, drug interactions or medication errors. This kind of sophisticated software makes it possible for the pharmacy, doctor and nurse to interact in a whole new way.

The debate about electronic medical record system may continue, but it is an almost inevitable fact of life for the future of the medical community.

Electronic medical records, or EMRs, are being touted as the way of the future for physicians keeping patient records. They would cut down on the amount of paper used and storage space required for traditional hard-copy records. The government is even sponsoring a pilot project that would give higher Medicare payments to doctors that converted to an EMR system.

As good as it sounds, getting physicians to change to electronic medical records is slow going. Two of the biggest reasons that physicians are resisting the change to EMR software are workflow disruption and the cost of training on a new system.

For many, it’s not just about the money, although the financial investment in EMR software can be substantial. It’s about behavior modification. People like to do things the way they’ve always done them, without significant disruption. However, in order to make things better for customers, you have to sometimes find a better way of doing things.

This is where the customization of EMR software comes in. Rather than having to adapt to EMR software, you can make the software adapt to you. Finding EMR software that allows extensive customization will help make the transition to electronic medical records as smooth as possible.

Breaking old habits

The idea of learning something new isn’t always a pleasant one, especially if you’ve grown accustomed to a certain way of doing things. This is especially true in offices with multiple doctors, where each physician has a different way of working, and trying to compromise is only slightly harder than pulling teeth without anesthetic.

Customization in EMR software can make it easier to adopt the new system. You can customize the software to work the way that you’re used to working. That way, the time spent on learning the new software is significantly reduced, which enables a smooth transition to a new way of record-keeping. The more familiar a software is to users, the less time they’ll have to spend learning it.

Why you need multiple customizations in EMR software

You’ve already been asked to change the way you’ve always done things, so it’s not too much to ask that your software grows and changes with you as you find new, more efficient ways of doing things. EMR software that allows for multiple customizations not only makes it easier for multi-doctor clinics to adopt, but it also enables you to continue to change the configuration as you learn what works and what doesn’t.

If you’re part of a multi-doctor clinic, look for EMR software that allows multiple customizations. That way, each doctor can continue keeping records the way he’s most accustomed to, which will help ease your clinic’s transition to using electronic medical records.

Not all EMR software allows this kind of customization. Some will charge you each time you need to customize the software, where others won’t allow for customization at all. Rather than the software fitting into the flow of your practice, you have to disrupt everybody’s rhythm to accommodate the software.

For a quick and painless transition to electronic medical records, make sure you find EMR software that offers all the customization options that you need. Whether you’re a solo practitioner or just one of many doctors in a health clinic, customization in an EMR software will allow you to get your practice running just the way it was in a matter of weeks, rather than months.

Medicine is one, in fact the only, profession where the owner / consultant is treated as god. This is one stream where the customer (patient) never bargains or settles down for something cheaper. All seek the best and it is justified too. A small slip or ignorance could lead to immense irrevocable human losses. Nevertheless, than if so much is at stake, complete precision in all matters is must. Minor recordings, fillings, case histories and other necessary document if not handled with caution, could result in the least desired. However, it must be noted that even practitioners are human and are prone to human errors. Even they need assistance, which can be perfectly imparted by the latest medical practice software.

Medical Practice Software: Advantages Medical practice software is a gift to human kind. Programmed for enabling accurate recordings and precise transactions, this software ensures complete diligence. Medical practice software has been designed in consonance with the profession’s needs. The variety of offerings can be a handy tool for all purposes at all levels i.e. from physicians to nurses to medical representatives to administrative in-charges can manage them with ease.

The accountability of the medical practice software can be gauged by its compliance with the Health Insurance Portability and Accountability Act (HIPAA), which acts as a yardstick for products and offerings in this field.

Medical practice software is easily available in market and can be purchased both online and directly. There are various brands available and each have an overlapping set of features to offer. The best combination to select depends entirely upon your organization’s field of practice, level of operability, size and the specific defined requirements. In this context, beware of the glossy terms and / or offerings, which are completely irrelevant. Any such temptation could be complete monetary loss at the end of the day.

As mentioned the software is loaded with various functions of which the basic ones are summarized below:

• Appointments and Scheduling: a complete diary of your patient’s appointments along with the physician’s availability. This is a definite requirement to avoid any last minute chaos. You certainly would not like to go mad at busy hours, so do include this feature in your requirement package.
• Summarizing all records or rather reporting: This could be monthly weekly or daily, however a careful inspection on regular basis is must for future planning and reducing the scope of error. All these facilities are enabled by this feature.
• Automated billing makes the job easier: Who wants to act like a clerk when sitting at such a reputed position? Automated billing not only reduces the scope of error but also increases the transparency in such matters.
• Internal communication tool coupled with the complete security requirements.

The listed and many more features enabled by medical practice software can certainly take off the burden from your shoulders and can act as the most error prone personal assistant you could ever find.