If you are seeking medical billing education, you can find an academic program from a vocational school, trade school or college. Students who would like to work in health care administration need to acquire some form of medical billing education, as more and more employers today are seeking candidates with some degree of formal training.

Vocational schools that offer medical billing education programs vary in course specifications and duration. Typically, medical billing training lasts roughly between nine months and two years.

Though medical billing specialists are not always required to have certification, many trade schools offer certificate programs. Upon successful completion of medical billing education, students may review organizations that offer professional certification.

Common coursework that is provided in a medical billing education includes insurance and Medicare basics, acronyms and medical terminology, medical coding, collections, rejections and appeals processes, fee determination, contracts and forms, fraud and abuse, claim forms, and other relevant subject matter.

Generally, graduates of medical billing schools are qualified for employment in doctor’s offices, labs, hospitals, pharmacies, nursing homes, insurance companies, and other medical facilities. In addition, professional medical billing specialists may opt to continue their health management training, which can help the professional to stay abreast of new technologies and other relative coursework.

Steps to take to make your laboratory coding and billing system pay back more.

In today’s heightened regulatory environment, hospitals place increased emphasis on the accuracy of their charge masters. Additional controls are put in place to assure updates are reviewed and approved by chief financial officers or designees. Significant dollars are spent on consultants to assist in reviewing the charge master.

Ironically, most laboratory billing errors rarely stem from incorrect coding within the charge master. Instead, errors surface when two or more CPT codes appear on patient claims, and these coding combinations are incorrect. Historically, this was the cause of errors with unbundling of multi-channel tests and the fragmentation of reflex tests.

Given this risk, a review of laboratory billing should include an examination of those processes that map multiple CPT code combinations onto patient claims. For laboratory, this includes a review of information systems beginning with order entry and ending with claims generation.

Identify Information Systems

For many hospitals, the billing process encompasses five to seven information systems. Examples include:

* Hospital information system where order entry takes place

* General laboratory information System where hematology and chemistry orders become work in process

* Specialty laboratory systems that manage the unique needs of select services

* Microbiology

* Transfusion medicine

* Anatomic pathology

* Reference laboratory services

* Financial information systems where the charge master resides

* Claims editing systems that edit patient bills to meet specific payor requirements.

Create a list or schematic of these systems.

Determine When Orders Become Charges

Next, identify the exact point in the billing process when orders become charges. For many labs, this occurs at the time of accession when specimens are checked into the lab systems. For others, it may be at time of order. Be aware that microbiology, anatomic pathology and transfusion medicine may have different points of charge capture, so these should be addressed separately.

Look critically at your charge capture architecture. How do charges for add-on orders get captured? If an order is canceled or a specimen remains uncollected, does charging still occur? What checks and balances are in place to monitor the accuracy of charge capture?

Look For Charge Explosion Features

Examine each information system again; locate points where multiple charges may be generated from a single user transaction. This exercise frequently requires an interview with more than one system support analyst. Begin with order entry, identifying order sets or features that facilitate multiple orders with one entry. Typically, this feature is used in the emergency room as a trauma order allowing multiple radiology, cardiology and lab orders to be rapidly placed.

Continue your review with lab systems, identifying order sets, reflex test charges and other automatic charge features. Next, address the financial information system. Look for appended charge and exploded charge features.

Finally, assess the features of each system in the context of the entire process. Are any errors evident?

Re-examine Pricing

As an outcome of your informatics review, you may choose to eliminate entries within charge explosion tables, order sets, appended charges and the like. If so, we suggest examining the impact you changes may have on total charges.

Examine Claims Edits

Once charges are captured, there is another point in hospital billing processes where alterations may occur. This may be in the form of electronic claims editing software or manual transactions performed by business office staff. It is important to identify what does occur. This is typically the point where adjustments are made to multiple chemistry charges or fragmented reflex test charges.

Assess the Outcome of the Billing Process

A detailed review of information systems is not complete with a sample documentation review to validate the outcome of the billing process. Select a sample of patients having a broad array of lab services. Assemble the following documentation for each patient:

1. Copy of physician order 2. Actual test results 3. Detail patient bill 4. UB-92 claim form 5. Remittance advice

If you’ve made specific system modifications, select patients receiving targeted services to determine if new processes are working as intended. You may find that some billing issues stem from physician ordering patterns. Tests may be ordered using old test terminology rather than HCFA approved organ and disease panels. As such, order entry staff must make the translation for them.

A Multidiscipline Approach

Upon completion of an information systems review, you are ready to progress into other distinct billing challenges–concise physician orders, well-documented reflex test protocols and proof of medical necessity. Addressing these challenges requires the commitment of a multidisciplined task force with sponsorship from executive level management. The information system processes will continue to play an integral role, as they must be adapted to the changing needs of the organization.

MINNEAPOLIS — ProVation Medical(R), Inc. announced today that Tucson Orthopaedic Surgery Center has chosen its ProVation(R) MD procedure documentation and coding compliance software for use in both Orthopaedic and Pain Management cases.

ProVation(R) MD software for multi-specialty procedure documentation and coding compliance replaces the inefficient dictation/transcription approach and streamlines the coding and billing process. Driven by deep medical content, ProVation MD allows clinicians to quickly and completely document medical procedures and apply the appropriate CPT and ICD codes, as well as CCI edits.

Specializing in foot and ankle, hand and arthroscopic surgeries, as well as pain management, Tucson Orthopaedic Surgery Center performs more than 5,000 procedures on an annual basis. The state-of-the-art facility, with four fully equipped and staffed operating rooms, is located on the campus of Tucson Medical Center. The surgery center is jointly owned by Tucson Orthopaedic Institute and Tucson Medical Center.

“We are committed to the development of tools and refinement of techniques that allow us to deliver the best care possible to our patients,” said Stuart Katz, Administrator, Tucson Orthopaedic Surgery Center. “We have also embraced technological solutions like the ProVation software, which establishes efficient, streamlined workflows and ensures that procedure documentation is complete and coding is compliant.”

“For any medical facility, the ability to perform efficiently, code compliantly and charge accurately for specialty procedures is critical to success,” said Mark Wagner, Chief Executive Officer, ProVation Medical, Inc. “Tucson Orthopaedic Surgery Center’s selection of ProVation MD confirms that our software plays an integral role not only for hospitals and teaching facilities, but for the rapidly growing number of U.S. Ambulatory Surgery Centers.”

About Tucson Orthopaedic Surgery Center

Tucson Orthopaedic Surgery Center is a state-of-the art outpatient surgical facility located on the campus of Tucson Medical Center. With its four fully equipped and staffed operating rooms, the center performs more than 5,000 procedures on an annual basis. The medical staff is comprised of orthopaedic and spinal surgeons and a pain management specialist. The center specializes in foot and ankle, hand and arthroscopic surgeries, as well as pain management. Providing the highest quality of care along with personalized services are the center’s hallmarks.

About ProVation Medical, Inc.

ProVation Medical, Inc. (Minneapolis, MN), a leading healthcare software and services company, provides solutions that significantly enhance revenue and decrease costs per medical procedure. Hospitals and Ambulatory Surgery Centers that use ProVation Medical software (1) improve their coding accuracy resulting in a 5-25 percent improvement in reimbursement for their medical procedures, (2) eliminate transcription costs, and (3) consolidate and simplify all the major financial, clinical and administrative tasks that accompany each procedure.

3M’s advanced software tools and services are designed to capture, classify, and manage accurate healthcare data. Our revenue management solutions include a wide range of services from 3M Consulting that include chargemaster, strategic pricing, coding validation, and DRG and APC assurance services. Our outpatient software solutions include 3M[TM] APCFinder[TM] software, APC[TM] Grouper Plus software, and 3M[TM] Ambulatory Revenue Management software, which provides a single outpatient database for ambulatory reimbursement, performance management, and compliance allowing you to review outpatient data pre-bill, at-bill, and post-bill.

PFS Group improves our partners’ margins through HIPAA-compliant revenue cycle solutions and innovative technology-driven processes. Our goal is to enhance business efficiencies, reduce operating costs, and accelerate cash flow. We are committed to bringing value to our clients by exceeding their expectations.

At AIM Healthcare, we’re revolutionizing business office operations at most major healthcare providers today. ExpressClaim[TM] is a secure proprietary network linking our provider and payer partners for the purpose of electronic claims resolution. With over 4,000 provider and payer relationships nationwide, AIM is able to customize work flow processes attacking uncollected revenue and driving clown the cost associated with the current inefficient processes. Join the revolution, today.

Dr. Greg Hinson is in the minority. He’s among the meager 13 percent of physicians in solo practice who use electronic medical records, according to a recent Commonwealth Fund survey. But Hinson is comfortable being apart from the madding crowd. He knew electronic record keeping would be the ticket to efficiencies in his practice so he traded in his hodgepodge of inadequate record-keeping techniques, said hello to an EMR geared to small and midsize practices and is engaging patients in a Web portal that puts them in the driver’s seat of their healthcare.

In August 2001, Hinson moved from a three-doctor office in rural Georgia to take over a similar size practice on Nantucket Island, Mass.–a community with a year-round population of 10,000 that quadruples the number of residents in the summer. Hinson supplemented his predecessor’s handwritten notes and paper charts with notes generated by an early, limited EMR. When the vendor phased out the EMR a couple of months after Hinson moved to Nantucket, he experimented with a mixture of handwritten notes, homemade MS Word templates, macros, checklists and dictation.

“If you opened my paper charts, you’d see notes generated in about four or five different ways,” says Hinson. “I was spending too much time documenting and way too much time hunting for paper charts. It was very confusing.”

In 2003, Hinson began searching the Internet for EMR options that would allow him to not only improve documentation, but also involve patients more in their healthcare. After seeing several vendor names pop up repeatedly on physician-driven forums like physicianonline.com and emrupdate.com, he contacted those vendors, participating in a dozen online demonstrations.

When Hinson would describe his staff size–a nurse practitioner, medical assistant and receptionist–and patient volume (approximately 45 a day), vendors would stop Hinson midsentence and say, “You can’t afford us.” The market was not friendly to small practices of fewer than 10 doctors, Hinson contends, and instead catered to medium and large physician practices of 40 to 50 docs who could justify the time and expense of customizing a product. Hinson soldiered on and after a year, narrowed his choice down to two vendors.

User Forum Helps Decision

After conducting site visits to see their software packages in action, in March 2004, Hinson chose Westborough, Mass.-based eClinicalWorks’ EMR because it met the broad needs of a family physician. Since Hinson has a special interest in childbirth, he likes that it documents pregnancy well and provides everything from health maintenance alerts to pediatric features like growth charts. The software is Internet based, easy to customize, and it was the lowest priced of all the fully integrated EMR/PM packages he considered. Plus, it didn’t require “a thousand mouse clicks to produce a cookie-cutter note that no one can read.”

Before signing the contract, however, Hinson wanted to hear more from users of the system, so he started his own Internet forum, www.ecwusers.com–without telling the vendor. “I learned users were very pleased with the company and their support,” Hinson says. “I did not hear of anyone who bought the software and gave up on it.” After a few weeks, Hinson advised eClinicalWorks of his online forum and invited them to participate. “Initially, I think they were nervous about a group of people talking on the Internet about the pros and cons of their product,” Hinson says, but eventually eClinicalWorks staff joined in the discussions. Today, the forum has more than 1,300 members and is a “form of non-urgent tech support” for users.

Bolstered by input from users, Hinson signed the contract for eClinicalWorks’ EMR in April 2004. The product is an electronic suite of front-office functions (appointment scheduling, copay collection and registration), mid-office functions (clinical documentation, lab ordering and e-prescribing) and back-office practice management (coding and billing). Most of the vendor’s clients send claims directly from the EMR to the insurance companies. Hinson, however, chose, at least for now, to email the superbill that the EMR generates to the billing company he hired four years ago.

eClinicalWeb, the ASP (application service provider) version of eClinicalWorks, provides remote access for physicians to access patient charts and other data and a secure Web portal for patients to e-mail Hinson, view lab results and schedule appointments.

Between signing the contract and implementing the software, Hinson bought a Windows server with one gigabyte of RAM, two Toshiba M200 tablet PCs for himself and his nurse practitioner and a desktop PC for the front office.

Smooth Implementation

Implementation in May was “pretty easy,” says Hinson. Staff in his practice had scanned paper charts into digital files even before he chose a vendor and eClinicalWorks migrated the rest of the data from the billing company to build a new database. Three days before training began, eClinicalWorks remotely accessed the computers in Hinson’s office and installed the software. Hinson chose to license the EMR and have it installed, but it can also be hosted from a data center.

MINNEAPOLIS — Cardiology joins ProVation Multi-specialty platform including Gastroenterology, Pulmonology, Orthopedics, Pain Management and Urology

ProVation Medical announced today the official release of its ProVation MD Cardiology software for clinical documentation and coding compliance. ProVation MD for Cardiology is a multi-caregiver documentation and coding system that produces complete, billing-ready, diagram-enhanced procedure notes and coding reports. The software is available for Cath Lab, Echocardiography and Nuclear Medicine modalities.

Already in use by more than 4,000 clinicians at 250 medical facilities across the country in specialties including Gastroenterology, Pulmonology, Orthopedics, Pain Management and Urology, ProVation MD software allows clinicians to create and finalize procedure notes in minutes - complete with the appropriate ICD and CPT codes with CCI edits for proper reimbursement, compliance and faster payment.

“As with our other specialty products, ProVation MD Cardiology was designed by our in-house team of physicians and coders. Features and functionality were based on research and feedback from Cardiology experts across the country,” said Arvind Subramanian, Chief Operating Officer, ProVation Medical. “The result is software that mimics the natural preferences and workflows of Cardiologists, nurses and technologists.”

The software’s innovative Anticipatory Interface feature(R), (a series of cascading menus that acts as the cornerstone of each specialty offering), is a direct result of this development process. For ProVation MD Cardiology, the Anticipatory Interface is accompanied by DocuDiagrams(TM), a dynamic graphical diagram system that drives bi-directional documentation and coding.

The company will exhibit the software at the American College of Cardiology (ACC) 2005 Annual Meeting, Booth #723, March 6 - 8 in Orlando, FL.

About ProVation Medical, Inc.

ProVation Medical, Inc. (Minneapolis, MN), a leading healthcare software and services company, provides solutions that significantly enhance revenue and decrease costs per medical procedure. Hospitals and Ambulatory Surgery Centers that use ProVation Medical software (1) improve their coding accuracy resulting in a 5-25 percent improvement in reimbursement for their medical procedures, (2) eliminate transcription costs, and (3) consolidate and simplify all the major financial, clinical and administrative tasks that accompany each procedure.

3M Health Information Systems has acknowledged that the U.S. Department of Defense (DoD) Military Health System, one of the nation’s largest health care providers, has selected 3M to provide a fully integrated system of software products and consulting services for medical records coding, compliance and data analysis as part of their TRICARE Patient Accounting System. Following an initial performance period at a multi-site demonstration, it is the goal of the DoD Military Health System to deploy 3M Health Information Systems products and services at more than 100 military hospitals and associated medical and dental clinics worldwide.

Under the agreement, the DoD Military Health System will implement 3M’s industry-leading coding and reimbursement product suite, integrated with comprehensive data analysis and reporting modules of the 3M Health Data Management System. 3M will support DoD goals to improve the accuracy of clinical information, help ensure correct billing, reduce the risk for noncompliance, trend clinical performance, target education efforts and improve revenue generation. 3M will team with Planned Systems International Inc. (PSI), based in Columbia, Md., to meet the objectives of the program. 3M also will be working with Park City Solutions of Midway, Utah, the prime systems integrator for the coding and compliance project.

3M will provide the DoD Military Health System with data analysis and reporting tools for every step in the care process, including applications for coding, grouping and editing; reimbursement calculations; patient data abstracting; care management evaluation; and medical necessity review. As part of the overall implementation, 3M also will provide process improvement and training services for DoD coding and billing operations. Products included in the agreement are the 3M Coding and Reimbursement System, 3M Physician Coding and Reimbursement System, 3M Coding Reference Software, 3M All Patient Refined DRG (APR-DRG) Software, 3M Audit Expert Inpatient and Outpatient Software, as well as 3M Health Record Management Software and the 3M Care Management System.

“For more than 15 years, 3M Health Information Systems has partnered with the DoD Military Health System to provide software products that enhance the delivery of patient care to military personnel and their families,” says James Burgess, division vice president of 3M Health Information Systems Division. “[This] announcement represents an important strategic alliance for us. We look forward to helping the DoD meet the complex challenges of patient care with advanced technology for measuring performance, influencing outcomes, and managing resources across all military healthcare facilities.”

The scope of the agreement includes full integration of the 3M coding and reimbursement product suite and 3M Health Data Management System with both the Department of Defense Military Health System Composite Health Care System I (CHSC I) and Composite Health Care System II (CHCS II) the global computer-based patient record (CPR) system presently being developed within the DoD Military Health System. CHCS II has been developed using core software components of 3M Care Innovation, a suite of expert applications that form the foundation of a computer-based patient record. The DoD enterprise license agreement for 3M Care Innovation software was awarded in September 1999.

The DoD Military Health System is one of the largest enterprise health care providers in the United States. The contract covers all DoD Military Health System entities whose mission is to provide health care services and support to members of the Armed Forces, their family members and others entitled to DoD health care–from worldwide theater of operations to the continental United States.

PSI is the prime system integrator for the DoD Military Health System Third Party Outpatient Collection System (TPOCS). Founded in 1988, PSI is an IT solutions and services company. With a staff of over 210 quality IT professionals, PSI core competencies include information systems development and integration, communication and network systems, healthcare informatics, information assurance, and e-commerce solutions, supporting key customers in the public and private market sectors. PSI’s major clients include the U.S. Navy; DoD Health Affairs; Defense Finance and Accounting Service; the Department of Agriculture; the National Science Foundation; State of Maryland; and commercial customers, including Unisys and IBM.

Park City Solutions of Midway, Utah, is the prime systems integrator for the coding and compliance project for the TRICARE Patient Accounting System. Park City Solutions is a leading technology and professional services firm that advances health care performance through its people, process and technology. By delivering a broad range of Web solutions, and providing clinical best practices and IT consulting services, Park City Solutions assists its health care and governmental clients to better manage the quality and cost of care.

When are carriers instructed to update their coding system to reflect changes made in the Current Procedural Terminology (CPT)?

Answer: I know, you just got familiar with the old codes and now they went ahead and changed some of them on you. Unfortunately, every new year equals more changes in the coding system. So I guess this probably means you’ll be spending some of your free time researching the changes that will affect you.

HCFA has granted a 90-day grace period to allow you adequate time to make these changes. You may bill a 2000 code for a 2001 date of service until March 31, 2001. This will give you some time to research the new codes to see which changes you may want to make to your superbill and computer system, and to train your billing staff.

During this grace period, HCFA will pay all deleted codes using the applicable 2001 payment methodology. On or after April 1, if you bill a 2000 HCPCS code for a 2001 date of service, HCFA will deny the claim. Don’t use a 2001 HCPCS code to bill for a service performed in 2000.
HCFA has granted a 90-day grace period to allow you adequate time to make these changes. You may bill a 2000 code for a 2001 date of service until March 31, 2001. This will give you some time to research the new codes to see which changes you may want to make to your superbill and computer system, and to train your billing staff.

During this grace period, HCFA will pay all deleted codes using the applicable 2001 payment methodology. On or after April 1, if you bill a 2000 HCPCS code for a 2001 date of service, HCFA will deny the claim. Don’t use a 2001 HCPCS code to bill for a service performed in 2000.

Physicians don’t always have an opportunity to fully document every patient risk factor when updating medical charts. Even when they do, errors can be made when these risk factors are later entered into hospital databases by administrative staff. While the underreporting of patient risk factors may not always directly affect a patient’s medical care, it can have a serious, negative effect on hospital rankings created by industry groups such as the Joint Commission on

Accreditation of Healthcare Organizations and the National Committee for Quality Assurance.
Hospitals that underreport patient risk factors will have lower predictions for patient mortality. Even if their success rates are equal to other hospitals, their rankings will be lower because their actual patient outcomes were worse than what should have been expected from the reported risk factors.

How call hospitals and other healthcare providers improve the accuracy of their reported patient risk factors? Text mining software can play a key role in helping analysts automatically deduce predicted patient risk factors by examining ICD-9 codes in patient billing data.

Patient Risk Factors

The standard procedure used by insurance providers, industry watchdog groups and professional societies to examine hospital quality and cost-effectiveness has been to compare risk-adjusted estimated length of stay, healthcare costs, mortality rates or complication rates against the actual values of these rates.

The Department of Obstetrics & Gynecology and Women’s Health at Montefiore Medical Center (MMC) in New York was seeing red. Its accounts receivables were growing at twice the pace of revenue. MMC managers recognized that improving financial performance was paramount.

Organizations historically have invested more dollars and time in managing back-end, instead of front-end, revenue-cycle operations. Yet front-end operational improvement often makes a more dramatic bottom-line impact.
MMC managers, with the assistance of consultants and the support of MMC senior leadership and the chairman of the department, focused on the billing cycle. They reasoned that by supporting and training front-end staff to collect the right information as patients registered, back-office employees would chase fewer rejected claims and amass larger payments.

In 2000, the department’s revenue growth–5 percent in the prior three years–was outpaced by its A/R growth of 30 percent. With a total A/R of $15 million, $5.8 million was in the collection-agency category, while 35 percent of rejected claims were attributable to causes correctable at the front end. MMC could increase collections by $1.2 million without cost cutting or billing increases.

MMC managers set out to retool billing processes. Two years later, the department’s gross collection rate had increased to 42 percent, collections had increased 58 percent, while charges had risen only 11 percent. More than $5 million of the $7.4 million increase in income was due to collection-rate improvement. In addition, active A/R, days outstanding, and bad-debt write-offs dropped by 50 percent. This initiative required a Herculean effort to turn the billing process on end by training and retraining support staff and involving physicians in data collection at a level rarely experienced before. The department implemented change across the board: in the collection process for patient demographic and insurance information; verification of eligibility and referrals; approach to obtaining precertifications for procedures and surgeries; registration; use of waivers and consent forms when applicable; copayment collection procedures; financial plans for self-pay patients; capture of all relevant information on encounter forms; and coding and charge entry.

The department’s success was driven by operations, not data. Financial improvement required front-line overhaul, using myriad strategies.

Appoint one leader. The department had expertise in revenue analysis and reporting. However, no one was accountable for revenue cycle performance. MMC created the position of billing director to implement a “quality-in/quality-out” philosophy, by coordinating all inputs, people, and processes throughout the revenue cycle.

The billing director implemented rapid, effective, sustainable change by setting and enforcing clear performance goals and by combining performance goals with a coordinated plan of improvement, supported with the right tools and people. Perhaps most important, a single leader was able to develop a unifying organizationwide strategy that motivated all, including physicians.

Standardize procedures. Care delivery in the department was complex. More than 50 subspecialists provided services in six divisions over 31 locations. Multiple payers, a challenging payer mix with a high percentage of indigent patients, and high turnover among the support staff further complicated efforts to effect streamlined, efficient, and consistently high performing, front-end revenue-cycle operations.

This diversity, combined with growth, spawned substantial variation in revenue-cycle processes. Several site and division staff and managers had developed systems that worked in their location for their specialty. However, the lack of standard procedures resulted in potential lost revenue, significant duplication of effort, and no uniform understanding of how individual performance affected the bottom line. Standardization was needed to solve these problems.

First, managers restructured workflow processes, particularly preclaim tasks, to shift focus from appealing claims and fixing errors to preventing errors. Managers implemented preregistration, eligibility, and referral checking to collect as much of this information as possible before patient visits. Automated scheduling was used for most services, thereby providing a better trail for services performed and helping improve data capture and editing, as less rekeying of information helped minimize errors.

Next, as much as possible, managers created and standardized appropriate policies and procedures. For instance, MMC did not have a well-enforced, up-to-date uniform policy for handling cash. Instead, staff in different offices used different approaches for accepting patient copayments, issuing receipts, and creating daily deposits. The copayment process was standardized: like cashiers in a supermarket, every staff member had a cash drawer and had to “proof out” to a supervisor with end-of-day deposits.