After many years as a provider to primarily uninsured and underinsured patients, Truman Medical Centers in Kansas City, Mo., was confronting critical financial issues. With federal, state, and local sources of revenue drying up, the organization underwent physical and operational changes aimed at advancing its position in the marketplace and capturing the elusive healthcare dollar.

Truman placed a strong emphasis on managed care in the areas of contracting, operations, revenue, and most importantly, revenue recovery. The health system’s efforts were aimed at supporting its mission to provide health care to the city’s uninsured and underinsured while pursuing an evolving role as a viable partner with commercial payers in the Kansas City community.

Truman more than tripled the number of its managed care contracts over two years and soon realized that a monitoring function was needed to manage its growth effectively. To this end, Truman conceived its managed care revenue recovery program. In the early stages, Truman estimated that by improving processes and adding revenue recovery to its efforts, 10 percent of its gross managed care revenue could be returned to the organization’s bottom line.

XGear Technologies has released the newest version of its proprietary Practice Management and Billing Software, ClaimGear. Upgrades to the software were designed to further reduce the amount of time required by clients — medical billing companies, clinics and doctors’ offices — to send and receive patient and financial information to insurance companies and third party administration organizations. In addition, several new features were added to enable tracking and editing of patients’ information, claims data and scheduled/canceled appointments.

“We work closely with our clients to determine key industry needs, then adapt and enhance ClaimGear as needed to meet those needs,” said Douglas A. Kegler, President and CEO. “We are particularly excited about this release, which we spent months developing and testing, because of the way it enriches the user experience.

“One of the optimum attributes of this upgrade is the ‘point and click’ usage, which allows a great deal of editorial capacity for the updating of patient’s information, as well as a higher navigational speed — no wasted time going from screen to screen,” affirmed Kegler. “The integration of our unique system-wide notes feature means that clients can view and edit information in any screen. Each note entered into the system is stamped with the time, date and username for tracking purposes.”

Twenty years ago, Neil Notaroberto was an accomplished and well-paid computer programmer. He liked his work and he enjoyed information technology, but sitting in an office all day was, at best, not his proverbial cup of tea.

Then, through a project affiliation with the Oregon Health & Sciences University, he gained the opportunity to spend substantially more time with physicians, a career choice he had considered earlier in life, but one that lost out to computer science. One neurosurgeon in particular impressed him, and Notaroberto thought, “This guy is making a difference in the world. I need to do that.”

Today, Neil F. Notaroberto, M.D., is a solo practitioner and ophthalmologist. His EyeCare 20/20 practice enjoys two practice locations in Slidell and Harahan, La. Immediately after the Oregon experience, Notaroberto left computer programming, returned to graduate school and then proceeded through medical school. He considers himself fortunate to have had two dramatically different and rewarding careers, and the first career has dutifully provided him with a strong business foundation for his second career.

Consumer-directed health care has made it inescapable. Healthcare providers must be able to let non-ED patients know, before they receive healthcare services, their expected out-of-pocket costs for those services. Four providers offer insights into how to approach this challenge.

Question: What is more difficult than providing price transparency?

Answer: Providing meaningful price transparency.

The latest report of the HFMA-led PATIENT FRIENDLY BILLING[R] project, Consumerism in Health Care, notes that to be meaningful, pricing information must be relevant to the patient who needs it. Think about a patient who is anxious about an upcoming procedure, and worried about what it will cost and how to pay for it. The patient wants to know what the cost of the services will be out of his or her own pocket.

To give a patient an advance estimate of his or her expected financial obligations, a provider must be able to overlay the patient’s insurance benefits with his or her specific medical condition and expected treatment. Patients then could use such estimates from various providers in combination with information about each provider’s quality of care to make a meaningful interpretation of the value of care that each provider can deliver. That’s true price transparency.

Forget “creative” coding - here’s how to get it right.

Coding and billing in optometric practices has become a hot topic within the last couple of years. As someone who gives upwards of 150 lectures per year, I get to hear quite a few stories on how coding and billing is done in practices all across the country. Some of these methods are quite creative! I also get to hear a litany of complaints questioning the rejection or denial of a claim and the ensuing loss of profitability.

Enjoyable as it may be to recount these wonderful moments of creativity, it’s become clear that understanding the most common coding errors could be of value to the optometric population at large. So, I will tackle the top 10 coding errors and handle a few myths at the same time. Please keep in mind that I am using The Centers For Medicare and Medicaid Services (CMS) as the benchmark. Even though Medicare often sets the standard, there will be certain carriers that have variances to my list. So here we go, a la David Letterman…

Groups aim for faster collections, not just lower costs

Trying to decide what billing tasks to centralize in your practice?

Focus on tasks that if centralized would speed up your practice’s revenue cycle, suggests David Taylor, FACMPE, MGMA member and vice president of regional services, CoxHealth, Springfield, Mo.

“Centralizing billing and business operations can produce savings through economies of scale, but if you’re not improving how quickly you collect money, you aren’t getting any savings in the long run,” Taylor says.

Medical claims generated by the hospitalowned system’s 55 offices average 45 days in accounts receivable (A/R). Reducing days in A/R speeds up cash flow, which ultimately improves the group’s financial position and is more beneficial than just spending less on billing, he says.

The 150-physician medical group, which serves 18 southwestern Missouri counties, uses a networked practice management system. Employees at the clinics can enter new charges, schedule appointments and update patient demographics in a central database. The system allows them to answer patients’ billing questions quickly or spot and attempt to collect outstanding balances or payments due at time of service.

At Loma Linda University Medical Center, new EDI tools have allowed the business office to streamline information processing procedures and accelerate account receivable days.

Staff at the business office of Loma Linda University Medical Center, a teaching university located 70 miles east of Los Angeles, have continually sought ways to more efficiently process the volume of information inundating our office.

Responsible for the billing of services at one of the busiest medical centers in California, the Loma Linda business office submits 22,000 to 25,000 claims each month, including Medicare, MediCal and commercial carriers. Of this number, as much as 25 percent of all claims are for Medicare reimbursable services.

Loma Linda University Medical Center, licensed for 797 beds, is the only state-designated Level 1 regional trauma center for the four inland counties of Southern California. Its 72-bed neonatal intensive care unit is one of the largest in the world. The medical center is home to the Proton Treatment Center, the only such hospital-based facility in the world for the treatment of cancer. The hospital is also designated by Medicare as a heart and kidney transplant center.

“The Complete Insurance Guide” is imparted in a 3-CD PowerPoint presentation accompanied by a well-formatted workbook. The high-quality, tabbed, printed material is organized in an easily accessible three-ring binder, excellent for daily office use.

The guide offers effective communication strategies for dealing with insurance carriers, and provides information to assist in developing or upgrading your current tracking systems. Here’s how: Chapter 1: Introduction; Chapter 2: Treatment Plans; Chapter 3: Treatment Protocols; Chapter 4: Verification; Chapter 5: Letters of Medical Necessity; Chapter 6: Collections; Chapter 7: Billing; Chapter 8: Coding; Chapter 9: Diagnosis; Chapter 10: Phases of Rehabilitation; Chapter 11: S.O.A.P. Notes; Chapter 12: Office Compliance.

Chapter 12 goes beyond insurance and billing information. It supplies office compliance materials such as details on the Health Insurance Portability & Accountability Act (HIPAA), and how we can best handle information regarding patient records and security regulations. Chapter 12 also ventures into practice management, and includes forms and an employee manual. You’ll be able to hone your office procedures with forms such as Performance Review; Management/Supervisory/Professional Staff Feedback; Supervisor’s/ Manager’s Assessment of Employee; Rating Instructions; Employee Effectiveness; Interpersonal Skills; How Well Employee Leads and Manages People; Previous Employment Verification and Reference Form; Alleged Harasser Interview Form; Leave of Absence/Disability Coordination Agreement; Exit Certification Form; and Employee Termination Form. The guide also furnishes Treatment and Care letters, allowing your staff to succinctly notify insurance carriers of the patient’s course of treatment.

The Medicare payment error rate is 9.3 percent for FY04, CMS recently announced, up from 5.8 percent in FY03, due in part to nonresponses from providers when errors were being resolved by contractors for insufficient documentation. CMS will attempt to reduce this rate by:

* Encouraging the American Medical Association (the owner of the physician coding system) to improve clinical examples and other documentation guidelines for correctly coding evaluation and management services

* Developing new data analysis procedures to identify payment aberrancies and using that information to stop improper payments before they occur

* Encouraging Medicare contractors to educate providers about documentation rules

* Encouraging Medicare contractors to educate providers about documentation rules

In 1993 about 6 billion medical claims were processed, burying physicians and health care providers under a deluge of paperwork This forced many medical professionals to outsource their billings and collections to companies capable of wading through numerous insurance codes and government regulations. Electronic medical billing services has proved to be a viable business opportunity for companies with experience in accounting, provider billing and computer systems.

Electronic medical billing services read patient claim forms, inputs the data according to complex coding systems and then submits the forms via computer to major clearinghouses. The clearinghouses then bill the patients or the insurance companies, who, in turn, pay the physicians.

Armed with 14 years, experience in hospital medical billings and a $5,000 investment, Vanessa Best began Precision Health Care Consultants in Jamaica Estates, New York, in 1995. A physician at the hospital where she was employed was leaving for private practice and Best persuaded him to retain her medical billing services - for $1,200 a month. Best’s business now earns $38,000 annually. In addition, she was recently employed as a consultant to help launch the medical billing division of the Fidelity Group, a $8.5 million African American-owned insurance, benefits and medical management company in Great Neck, New York.