Saturday, February 23, 2008
Medical Billing - Oxygen
Before we get into the record specifications for billing oxygen claims, we're going to briefly discuss what is involved with oxygen billing and what it covers. In spite of what a lot of people think, it's more than just the oxygen itself. Oxygen billing, as a part of medical billing itself, is one of the most widely billed items.
Part of the reason for this is because of the number of smokers we have in the United States, which is where these billing specifications are meant for. Unfortunately, one man's suffering is another's prosperity. The number of smokers in this country who ultimately end up with chronic respiratory disease are the main contributors to the oxygen billing industry. It is estimated that if smoking didn't exist, at least 75% of the number of oxygen claims could be avoided. While nobody has actually proven this statistic, certainly the overall problems that have been uncovered because of smoking, do at least partially support this theory. Hopefully, the day will come when smoking is a thing of the past and these theories can be proven.
However, until that happens, oxygen billing will be big business. And as was stated up above, it is more than just billing oxygen. There are a number of pieces of equipment that go along with a patient who is on oxygen. All of these items are billable and come with quite a high price tag. And everybody wants to get a piece of the pie, from the manufacturers of the equipment itself to the doctors to the forms makers to the billers. It's no wonder that medical costs are so sky high. And of course as is true with just about everything else, where the demand is the greatest, the costs are also the greatest. In comparison to other billable items, oxygen therapy ranks up towards the top.
The actual items that are billable cover quite a range of things. There is of course the oxygen itself, which they literally bill by the liter. Every breath is costing somebody a fortune. And of course the oxygen has to be contained in something and also distributed via some means.
Probably the most common way for oxygen to be administered to a patient is through a device called a concentrator. And make no mistake about it, these things cost a pretty penny. Concentrators are made up of a number of parts, all of which can easily break down. So concentrator repairs also add to the cost of these claims. In some cases the concentrators are under warranty, but for patients who are on oxygen long term, such as patients who have serious lung diseases, these warranties are usually only good for a year. After that, any repairs have to come out of the patient's pocket.
Of course none of this even touches on the complexities of oxygen billing, which require calculations and conversions in order to bill the exact amount of oxygen the patient must get per every 30 days or so. This also is added to the cost of billing and the ultimate cost to the patient or insurance company, which ultimately leads to higher premiums.
Part of the reason for this is because of the number of smokers we have in the United States, which is where these billing specifications are meant for. Unfortunately, one man's suffering is another's prosperity. The number of smokers in this country who ultimately end up with chronic respiratory disease are the main contributors to the oxygen billing industry. It is estimated that if smoking didn't exist, at least 75% of the number of oxygen claims could be avoided. While nobody has actually proven this statistic, certainly the overall problems that have been uncovered because of smoking, do at least partially support this theory. Hopefully, the day will come when smoking is a thing of the past and these theories can be proven.
However, until that happens, oxygen billing will be big business. And as was stated up above, it is more than just billing oxygen. There are a number of pieces of equipment that go along with a patient who is on oxygen. All of these items are billable and come with quite a high price tag. And everybody wants to get a piece of the pie, from the manufacturers of the equipment itself to the doctors to the forms makers to the billers. It's no wonder that medical costs are so sky high. And of course as is true with just about everything else, where the demand is the greatest, the costs are also the greatest. In comparison to other billable items, oxygen therapy ranks up towards the top.
The actual items that are billable cover quite a range of things. There is of course the oxygen itself, which they literally bill by the liter. Every breath is costing somebody a fortune. And of course the oxygen has to be contained in something and also distributed via some means.
Probably the most common way for oxygen to be administered to a patient is through a device called a concentrator. And make no mistake about it, these things cost a pretty penny. Concentrators are made up of a number of parts, all of which can easily break down. So concentrator repairs also add to the cost of these claims. In some cases the concentrators are under warranty, but for patients who are on oxygen long term, such as patients who have serious lung diseases, these warranties are usually only good for a year. After that, any repairs have to come out of the patient's pocket.
Of course none of this even touches on the complexities of oxygen billing, which require calculations and conversions in order to bill the exact amount of oxygen the patient must get per every 30 days or so. This also is added to the cost of billing and the ultimate cost to the patient or insurance company, which ultimately leads to higher premiums.
# posted by Medical Information : 4:40 AM
Medical Billing - Hiring A Staff
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.
All in all, medical billing is harder than most people think. That is why it is important to hire a medical billing staff that can handle the job well.
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.
All in all, medical billing is harder than most people think. That is why it is important to hire a medical billing staff that can handle the job well.
# posted by Medical Information : 4:39 AM
Thursday, February 21, 2008
Medical Billing - GP0 Record Fields 22 Through 33
We're finally coming to the end of our review of the GP0 record for medical billing of claims via electronic media, using NSF 3.01 specifications. In this installment we'll be covering the last twelve fields, which is where most of the differences are between the parental nutrition CMN and the enteral nutrition CMN, which we reviewed previously when we covered the GE0 record. We pick up this installment with field number 22.
GP0 field 22, positions 78 - 92, is the amino acid name. This is the field that tells the carrier the name of the amino acid that is being administered to the patient. This field must be filled in with the actual name of the acid. No abbreviations or brand names allowed.
GP0 field 23, positions 93 - 96, is the amino acid volume. This field tells the carrier how much of the amino acid the patient is to receive per day, not per feeding, for parental nutrition therapy. This amount is transmitted in milliliters and must be exact.
GP0 field 24, positions 97 - 101, is the amino acid concentration. This field tells the carrier what the exact percentage of concentration is for the amino acid that is being given to the patient for parental nutrition therapy. In this case, a decimal is used to show a concentration that is less than a whole percentage, like 10.5%.
GP0 field 25, positions 102 - 105, is the amino acid weight. This field tells the carrier how much the amino acid that is given per day, weighs in grams. If the number of grams prescribed per day is greater than 100, then a narrative explanation must be given in field number 31.
GP0 field 26, positions 106 - 109, is the dextrose volume. This field tells the carrier how much dextrose is in the prescription given to the patient, per day. This field is transmitted in milliliters and must be exact.
GP0 field 27, positions 110 - 114, is the dextrose concentration. This field tells the carrier what the percentage of dextrose is, in relation to the entire solution given to the patient on a daily basis. As with field number 24, a decimal is used if not a whole percentage.
GP0 field 28, positions 115 - 118, is the lipids volume. This field tells the carrier what the volume of lipids is given to the patient on a daily basis. This field is also transmitted in milliliters and must be exact.
GP0 field 29, positions 119 - 123, is the lipids concentration. This field tells the carrier what the percentage of lipids is in relation to the whole mixture, given to the patient on a daily basis.
GP0 field 30, positions 124 - 126, is the lipids frequency. This tells the carrier how many times per week lipids are used in therapy.
GP0 field 31, positions 127 - 226, is the narrative field. This field is used to give the carrier any information that is not covered above that is required, such as explanations.
GP0 field 32, position 227, is the administration technique indicator. This field is used to tell the carrier how the parental nutrition is being administered. Valid entries are N, G, J, or O.
GP0 field 33, positions 228 - 320, is filler national and must be filled with spaces.
In our next installment of medical billing, we'll cover another in the long list of CMNs.
Michael Russell
GP0 field 22, positions 78 - 92, is the amino acid name. This is the field that tells the carrier the name of the amino acid that is being administered to the patient. This field must be filled in with the actual name of the acid. No abbreviations or brand names allowed.
GP0 field 23, positions 93 - 96, is the amino acid volume. This field tells the carrier how much of the amino acid the patient is to receive per day, not per feeding, for parental nutrition therapy. This amount is transmitted in milliliters and must be exact.
GP0 field 24, positions 97 - 101, is the amino acid concentration. This field tells the carrier what the exact percentage of concentration is for the amino acid that is being given to the patient for parental nutrition therapy. In this case, a decimal is used to show a concentration that is less than a whole percentage, like 10.5%.
GP0 field 25, positions 102 - 105, is the amino acid weight. This field tells the carrier how much the amino acid that is given per day, weighs in grams. If the number of grams prescribed per day is greater than 100, then a narrative explanation must be given in field number 31.
GP0 field 26, positions 106 - 109, is the dextrose volume. This field tells the carrier how much dextrose is in the prescription given to the patient, per day. This field is transmitted in milliliters and must be exact.
GP0 field 27, positions 110 - 114, is the dextrose concentration. This field tells the carrier what the percentage of dextrose is, in relation to the entire solution given to the patient on a daily basis. As with field number 24, a decimal is used if not a whole percentage.
GP0 field 28, positions 115 - 118, is the lipids volume. This field tells the carrier what the volume of lipids is given to the patient on a daily basis. This field is also transmitted in milliliters and must be exact.
GP0 field 29, positions 119 - 123, is the lipids concentration. This field tells the carrier what the percentage of lipids is in relation to the whole mixture, given to the patient on a daily basis.
GP0 field 30, positions 124 - 126, is the lipids frequency. This tells the carrier how many times per week lipids are used in therapy.
GP0 field 31, positions 127 - 226, is the narrative field. This field is used to give the carrier any information that is not covered above that is required, such as explanations.
GP0 field 32, position 227, is the administration technique indicator. This field is used to tell the carrier how the parental nutrition is being administered. Valid entries are N, G, J, or O.
GP0 field 33, positions 228 - 320, is filler national and must be filled with spaces.
In our next installment of medical billing, we'll cover another in the long list of CMNs.
Michael Russell
Medical Billing - EA0 Record Fields 39 Through 55
If it seems we've been covering the EA0 record for medical billing of claims for a while now, that's because this record has more info than almost all the other records in the file. We pick up with EA0 record field number 39 in this installment.
EA0 field 39, positions 209 - 241, is the lab/facility name. This is the legal name of the facility or lab where any work was done. This is a mandatory field and must be filled in or the claim will be denied.
EA0 field 40, position 242, is the documentation indicator. There are a number of fields in electronic medical billing that indicate that something is signed or on file. This particular field indicates that whatever documentation is needed to back up this claim is indeed on file. This is for legal purposes.
EA0 field 41, position 243, is the documentation type. This is a code that signifies what type of documentation is on file, be it a CMN or a PPG or whatever. This tells the payer what the documentation is.
EA0 field 42, positions 244 - 245, is the function status code. This code relates to the diagnosis of the patient and the status of same. Consult your manual for a more detailed explanation.
EA0 field 43, positions 246 - 247, is the CHAMPUS special program indicator. This is an indicator that tells the payer if this is a claim that has to do with a special program in CHAMPUS. CHAMPUS itself was explained in detail in an earlier article. Please consult previous DA1 record articles for this explanation.
EA0 field 44, position 248, is the CHAMPUS non-availability indicator. This indicator tells the payer that the claim is not allowed to receive CHAMPUS benefits.
EA0 field 45, position 249, is the supervising provider indicator. This tells the payer that the services rendered were overseen by a supervising provider in addition to the regular physician.
EA0 field 46, positions 250 - 251, is the resubmission number. This is the number of times that the claim itself has been resubmitted, if indeed that is the case. If this is the initial submission, then this field is left blank.
EA0 field 47, positions 252 - 266, is the resubmission reference number. This is an assigned number given to each resubmission.
EA0 field 48, positions 267 - 274, is the date last seen. This is the date that the patient last saw the physician.
EA0 field 49, positions 275 - 282, is the date documentation sent. This is the date that the actual physical documentation for the claim was sent to the payer.
EA0 field 50, position 283, is the homebound indicator. This tells the payer if the patient is confined to the home.
EA0 fields 51 - 54 are not supported at this time so will not be covered.
EA0 field 55, positions 311 - 320, is filler national and must be left blank.
This concludes our very long review of the EA0 record. In our next installment, we'll cover more claim data with the EA1 record.
EA0 field 39, positions 209 - 241, is the lab/facility name. This is the legal name of the facility or lab where any work was done. This is a mandatory field and must be filled in or the claim will be denied.
EA0 field 40, position 242, is the documentation indicator. There are a number of fields in electronic medical billing that indicate that something is signed or on file. This particular field indicates that whatever documentation is needed to back up this claim is indeed on file. This is for legal purposes.
EA0 field 41, position 243, is the documentation type. This is a code that signifies what type of documentation is on file, be it a CMN or a PPG or whatever. This tells the payer what the documentation is.
EA0 field 42, positions 244 - 245, is the function status code. This code relates to the diagnosis of the patient and the status of same. Consult your manual for a more detailed explanation.
EA0 field 43, positions 246 - 247, is the CHAMPUS special program indicator. This is an indicator that tells the payer if this is a claim that has to do with a special program in CHAMPUS. CHAMPUS itself was explained in detail in an earlier article. Please consult previous DA1 record articles for this explanation.
EA0 field 44, position 248, is the CHAMPUS non-availability indicator. This indicator tells the payer that the claim is not allowed to receive CHAMPUS benefits.
EA0 field 45, position 249, is the supervising provider indicator. This tells the payer that the services rendered were overseen by a supervising provider in addition to the regular physician.
EA0 field 46, positions 250 - 251, is the resubmission number. This is the number of times that the claim itself has been resubmitted, if indeed that is the case. If this is the initial submission, then this field is left blank.
EA0 field 47, positions 252 - 266, is the resubmission reference number. This is an assigned number given to each resubmission.
EA0 field 48, positions 267 - 274, is the date last seen. This is the date that the patient last saw the physician.
EA0 field 49, positions 275 - 282, is the date documentation sent. This is the date that the actual physical documentation for the claim was sent to the payer.
EA0 field 50, position 283, is the homebound indicator. This tells the payer if the patient is confined to the home.
EA0 fields 51 - 54 are not supported at this time so will not be covered.
EA0 field 55, positions 311 - 320, is filler national and must be left blank.
This concludes our very long review of the EA0 record. In our next installment, we'll cover more claim data with the EA1 record.
Wednesday, February 20, 2008
Why Outsourcing Takes Your Business to a Higher Level
Outsourcing is a term used in business and it is gaining popularity on the net as millions of web site owners discover they do not have all the tools and skills necessary to handle each and every portion of their businesses.
Unlike having to find, interview, and hire an employee - and thus incur the tax liability of a new employee - often savvy business owners turn to outside companies. Outsourcing services take on the tasks underlying a business leaving the owner more free time to pursue the front-end of his or her business.
Wikipedia states:
"Outsourcing" involves transferring or sharing management control and/or decision-making of a business function to an outside supplier, which involves a degree of two-way information exchange, coordination and trust between the outsourcer and its client."
Outsourcing, therefore, becomes an integrated part of your business. The importance is to determine what should be outsourced, why it should be outsourced, and who will provide your outsourcing services.
Business segments typically outsourced include:
* Information technology
* Human resources
* Facilities
* Real estate management
* Accounting
* Direct Online Marketing and SEO
In addition, many companies also outsource their customer support and rely on call center functions.
Using the Know How of Others
The business owner must be able to step back and make an honest evaluation of his or her talents. We are not all created equal. We all have different strengths. One surefire strength for business success that a business owner must cultivate is the ability to delegate responsibility through the use of outsourcing. That's how a well-run, profit-pulling online business accomplishes its goals.
Today's businesses - large and small - gain immense benefits by finding other companies outside their own arena who possess the technological know how to analyze, plan, and implement target objectives.
In the case of the smaller web site owner looking to gain greater footing with the hot market of search engine results, finding an outsourcing service to handle marketing (and a small portion of advertising) is one such effective strategic move.
Traditional approaches to search engine marketing have, for decades, focused primarily around a web site's meta tags, firming up web page content, and then submitting the site on a regular basis to the search engines. From a purely advertising basis, other companies will insist that just driving "targeted traffic" to a site is "enough."
While both of these methods are viable, a good outsourcing company often adds these two methods at low cost or no cost - just bonuses while the real work of marketing is underway.
Choosing the Right Outsourcing Company
As an online business owner it is easy to become frozen in place trying to keep up on all the possible, working, methods for marketing online. Even if one could find the time to read everything and devise a plan, putting that plan into action becomes cumbersome. Doing even the "smallest" of tasks can literally take hours of your week away from you. Hours better spent on web site enhancements and new products, mailing list contacts, and just being there for your web site visitors. Unless the web site owner is willing to give up some control, the grind of working the foundation of marketing too often must supercede the human approach to being there for your customers.
While we all love to do our initial digging online, pick up a phone and call or send email inquiries or submit forms for call back when choosing an outsourcing service. Make sure your questions are addressed intelligently and at a level of understanding that you feel most comfortable with. Avoid listening to pre-scripted sales pitches where all they want to do is monopolize the phone and beat you down to the point where you really don't know what they can or cannot do. Take control of the conversation, then turn that conversation into an effective two-way street of open communication. Any company not willing to do that - or vague in their explanations of how - should be moved to the bottom of your list as you locate the best outsourcing company to work with you and your website.
Finding a company that understands and weeds out fad flash-in-the-pan methods, and builds your marketing business on solid, proven methods of web site promotion should be your goal. Find that company and establish a two-way street of information and trust in order to work effectively together.
How to Incorporate Outsourcing Into Your Business
"Prior to the contract development of any outsourcing agreement, the outsourcing company develops a request for proposal (RFP) document which highlights the major requirements and scope of the project which is to be outsourced."[1]
Through a bid-like process, or the acceptance of agreed upon stated services at given costs, the recipient company has an actual proposal of services in hand. They know what they are getting, what timeframe to expect, and projected results from this outsourced service.
By outsourcing, the owner understands what the benefits to the service(s) are, but the strategy, planning, and implementing can be safely placed into more knowledgeable and efficient hands to get the job done.
In Summary
Outsourcing is not just for the "big guy." Overall outsourcing is viewed by many organizations as a strong business tactic that ultimately is a superior economical approach to developing products and services.
Simply put, don't try to do everything yourself. You may have many fine strong points, but running your online internet business single-handedly should not be one of them. Learn when and delegating responsibility can actually make your business grow by leaps and bounds. Then find an outsourcing service you can work with - one with a complete understanding of your web site - one that is willing to go extra miles to make your business a success.
Unlike having to find, interview, and hire an employee - and thus incur the tax liability of a new employee - often savvy business owners turn to outside companies. Outsourcing services take on the tasks underlying a business leaving the owner more free time to pursue the front-end of his or her business.
Wikipedia states:
"Outsourcing" involves transferring or sharing management control and/or decision-making of a business function to an outside supplier, which involves a degree of two-way information exchange, coordination and trust between the outsourcer and its client."
Outsourcing, therefore, becomes an integrated part of your business. The importance is to determine what should be outsourced, why it should be outsourced, and who will provide your outsourcing services.
Business segments typically outsourced include:
* Information technology
* Human resources
* Facilities
* Real estate management
* Accounting
* Direct Online Marketing and SEO
In addition, many companies also outsource their customer support and rely on call center functions.
Using the Know How of Others
The business owner must be able to step back and make an honest evaluation of his or her talents. We are not all created equal. We all have different strengths. One surefire strength for business success that a business owner must cultivate is the ability to delegate responsibility through the use of outsourcing. That's how a well-run, profit-pulling online business accomplishes its goals.
Today's businesses - large and small - gain immense benefits by finding other companies outside their own arena who possess the technological know how to analyze, plan, and implement target objectives.
In the case of the smaller web site owner looking to gain greater footing with the hot market of search engine results, finding an outsourcing service to handle marketing (and a small portion of advertising) is one such effective strategic move.
Traditional approaches to search engine marketing have, for decades, focused primarily around a web site's meta tags, firming up web page content, and then submitting the site on a regular basis to the search engines. From a purely advertising basis, other companies will insist that just driving "targeted traffic" to a site is "enough."
While both of these methods are viable, a good outsourcing company often adds these two methods at low cost or no cost - just bonuses while the real work of marketing is underway.
Choosing the Right Outsourcing Company
As an online business owner it is easy to become frozen in place trying to keep up on all the possible, working, methods for marketing online. Even if one could find the time to read everything and devise a plan, putting that plan into action becomes cumbersome. Doing even the "smallest" of tasks can literally take hours of your week away from you. Hours better spent on web site enhancements and new products, mailing list contacts, and just being there for your web site visitors. Unless the web site owner is willing to give up some control, the grind of working the foundation of marketing too often must supercede the human approach to being there for your customers.
While we all love to do our initial digging online, pick up a phone and call or send email inquiries or submit forms for call back when choosing an outsourcing service. Make sure your questions are addressed intelligently and at a level of understanding that you feel most comfortable with. Avoid listening to pre-scripted sales pitches where all they want to do is monopolize the phone and beat you down to the point where you really don't know what they can or cannot do. Take control of the conversation, then turn that conversation into an effective two-way street of open communication. Any company not willing to do that - or vague in their explanations of how - should be moved to the bottom of your list as you locate the best outsourcing company to work with you and your website.
Finding a company that understands and weeds out fad flash-in-the-pan methods, and builds your marketing business on solid, proven methods of web site promotion should be your goal. Find that company and establish a two-way street of information and trust in order to work effectively together.
How to Incorporate Outsourcing Into Your Business
"Prior to the contract development of any outsourcing agreement, the outsourcing company develops a request for proposal (RFP) document which highlights the major requirements and scope of the project which is to be outsourced."[1]
Through a bid-like process, or the acceptance of agreed upon stated services at given costs, the recipient company has an actual proposal of services in hand. They know what they are getting, what timeframe to expect, and projected results from this outsourced service.
By outsourcing, the owner understands what the benefits to the service(s) are, but the strategy, planning, and implementing can be safely placed into more knowledgeable and efficient hands to get the job done.
In Summary
Outsourcing is not just for the "big guy." Overall outsourcing is viewed by many organizations as a strong business tactic that ultimately is a superior economical approach to developing products and services.
Simply put, don't try to do everything yourself. You may have many fine strong points, but running your online internet business single-handedly should not be one of them. Learn when and delegating responsibility can actually make your business grow by leaps and bounds. Then find an outsourcing service you can work with - one with a complete understanding of your web site - one that is willing to go extra miles to make your business a success.
The Hidden Costs in Offshore Outsourcing - A Case Study
One company that staunchly opposes offshore outsourcing is Hesperia, California, based Mer-Mar; oddly enough, Mer-Mar is a contract manufacturing and assembly company and is, by definition, an outsource manufacturer. With over 30 years experience specializing in circuit board assembly, Mer-Mar is an outsource provider to other businesses that do not consider circuit board assembly a core competency and/or do not wish to invest their resources in their manufacture.
The company assembles circuit boards for the medical electronics, aerospace, automotive, entertainment and leisure, and homeland security industries. Mer-Mar is an ISO-9001 certified company consisting of 50 highly skilled employees who abide by industrial quality standards. The company is a regional service provider and supplier delivering high quality manufacturing primarily in the southwest United States.
As an end service provider, Mer-Mar does not outsource offshore. The company’s leadership also has a fundamental philosophy that views offshore outsourcing as impractical for their customers, which are in industries with high quality standards and just-in-time delivery requirements. While some of its larger competitors have commenced offshore outsourcing of various services, Mer-Mar has resisted.
Mer-Mar’s customers rely upon the quality of the products, history of dedicated customer service, and dependability of receiving orders when promised. Mer-Mar is also frequently asked to quickly complete orders for customers within a matter of days. In order to be flexible and responsive to its customers’ requests and to provide adequate support, Mer-Mar is required to remain close to its customers and its suppliers to keep its supply chain accessible and lead times brief. Each of these characteristics is perceived to be vital to Mer-Mar’s success and would be compromised if Mer-Mar were to outsource its manufacturing operations offshore.
Despite Mer-Mar’s favorable reputation, several customers have recently outsourced their circuit board assembly operations offshore. As with other industries, the attraction to offshore outsourcing is the promised cost savings. However, Mer-Mar cautions that many companies fail to recognize the increased soft costs frequently associated with offshore outsourcing.
These soft costs include additional personnel to monitor operations in foreign factories; time and money associated with shipping and customs inspections; costs to rework faulty products; the lack of easily accessible spares, and the challenges of working in a foreign country including communication challenges, low-skilled workforce, unfamiliar laws and regulations, and infrastructure constraints. Mer-Mar believes these additional soft costs frequently exceed the promised hard cost savings that initially lure the company offshore.
Mer-Mar agrees that some lower-level technology or lower-end priced products may be outsourced offshore, highly complex assembly, and/or products for which price is not a major obstacle, often remains in the United States. But, customers that rely on high quality, advanced technology, and skilled labor will need to keep their assembly manufacturers close to home.
For example, customers requiring circuit board assemblies for critical care medical equipment may not be comfortable with the risk level that offshore outsourcing firms represent. Instead, they may depend on local contract manufacturers such as Mer-Mar to do the job. Mer-Mar’s focus is on those customers in specific industries where the need for reliability, accessibility, and repeatability outweigh the cost advantages of going offshore.
Management at Mer-Mar does acknowledge that it makes sense for high volume consumer goods, such as low-level electronics including toys and video games, to be outsourced offshore. In these cases, the cost savings are frequently realized, despite the rework and failure rates of these types of products. The also believe it is acceptable to offshore outsource services when the talent cannot be found domestically. In these situations, a company has no other alternative but to outsource.
Yet, offshore outsourcing is not an option for Mer-Mar. However, due to Mer-Mar’s niche market positioning and reputation for excellence in assembling highly technological and advanced circuit boards, customers continue to rely upon them for these services. With its plant located in the lower-cost, high desert community of Hesperia, and its focus on quality, reliability, and offering service to its customers, Mer-Mar continues to maintain its competitive edge.
Dr. Joe Greco is Director for the Center for the Study of Emerging Markets (CSEM) located in Fullerton, California. As part of the College of Business and Economics at California State University, Fullerton, CSEM was established to promote the flow of global information and technology between the academic and business communities. In particular, CSEM studies offshore outsourcing and it economic and cultural impact on US based emerging markets.
The company assembles circuit boards for the medical electronics, aerospace, automotive, entertainment and leisure, and homeland security industries. Mer-Mar is an ISO-9001 certified company consisting of 50 highly skilled employees who abide by industrial quality standards. The company is a regional service provider and supplier delivering high quality manufacturing primarily in the southwest United States.
As an end service provider, Mer-Mar does not outsource offshore. The company’s leadership also has a fundamental philosophy that views offshore outsourcing as impractical for their customers, which are in industries with high quality standards and just-in-time delivery requirements. While some of its larger competitors have commenced offshore outsourcing of various services, Mer-Mar has resisted.
Mer-Mar’s customers rely upon the quality of the products, history of dedicated customer service, and dependability of receiving orders when promised. Mer-Mar is also frequently asked to quickly complete orders for customers within a matter of days. In order to be flexible and responsive to its customers’ requests and to provide adequate support, Mer-Mar is required to remain close to its customers and its suppliers to keep its supply chain accessible and lead times brief. Each of these characteristics is perceived to be vital to Mer-Mar’s success and would be compromised if Mer-Mar were to outsource its manufacturing operations offshore.
Despite Mer-Mar’s favorable reputation, several customers have recently outsourced their circuit board assembly operations offshore. As with other industries, the attraction to offshore outsourcing is the promised cost savings. However, Mer-Mar cautions that many companies fail to recognize the increased soft costs frequently associated with offshore outsourcing.
These soft costs include additional personnel to monitor operations in foreign factories; time and money associated with shipping and customs inspections; costs to rework faulty products; the lack of easily accessible spares, and the challenges of working in a foreign country including communication challenges, low-skilled workforce, unfamiliar laws and regulations, and infrastructure constraints. Mer-Mar believes these additional soft costs frequently exceed the promised hard cost savings that initially lure the company offshore.
Mer-Mar agrees that some lower-level technology or lower-end priced products may be outsourced offshore, highly complex assembly, and/or products for which price is not a major obstacle, often remains in the United States. But, customers that rely on high quality, advanced technology, and skilled labor will need to keep their assembly manufacturers close to home.
For example, customers requiring circuit board assemblies for critical care medical equipment may not be comfortable with the risk level that offshore outsourcing firms represent. Instead, they may depend on local contract manufacturers such as Mer-Mar to do the job. Mer-Mar’s focus is on those customers in specific industries where the need for reliability, accessibility, and repeatability outweigh the cost advantages of going offshore.
Management at Mer-Mar does acknowledge that it makes sense for high volume consumer goods, such as low-level electronics including toys and video games, to be outsourced offshore. In these cases, the cost savings are frequently realized, despite the rework and failure rates of these types of products. The also believe it is acceptable to offshore outsource services when the talent cannot be found domestically. In these situations, a company has no other alternative but to outsource.
Yet, offshore outsourcing is not an option for Mer-Mar. However, due to Mer-Mar’s niche market positioning and reputation for excellence in assembling highly technological and advanced circuit boards, customers continue to rely upon them for these services. With its plant located in the lower-cost, high desert community of Hesperia, and its focus on quality, reliability, and offering service to its customers, Mer-Mar continues to maintain its competitive edge.
Dr. Joe Greco is Director for the Center for the Study of Emerging Markets (CSEM) located in Fullerton, California. As part of the College of Business and Economics at California State University, Fullerton, CSEM was established to promote the flow of global information and technology between the academic and business communities. In particular, CSEM studies offshore outsourcing and it economic and cultural impact on US based emerging markets.
Tuesday, February 19, 2008
Medical Billing - Allowable Tables
In the world of medical billing, nothing is more dreaded by billing companies than allowable tables. There are numerous reasons for this. In this particular installment on medical billing, we're going to cover the main reasons why allowable tables are such a pain the backside.
Before we do that, it would probably be a good idea to explain what an allowable table is for those who are not familiar with them. Allowable tables usually refer to Medicare billing, though there are other government carriers that also have allowable tables. An allowable table, as applied to Medicare, is a table of prices for each item that can be billed to Medicare. In other words, let's say a patient needs a wheelchair. If wheelchairs can be billed to Medicare, they will have a table entry for how much Medicare will pay for that wheelchair, whether it be to purchase it or rent it on a monthly basis. Sounds simple enough and it is. The problem is what this actually means to the medical billing company.
The first problem this presents is actually getting the allowable tables from Medicare. The reason this is important is because a medical billing agency has to know how much they are permitted to bill for each item. If they overbill for the item and actually expect to get paid that much, it is going to come as a big shock to them when their payment is considerably less than what they expected. So a medical billing company must get these tables setup in their system. To do this, they have to get them from Medicare. Guess what? It's not a free service. They have to pay for it and it's not cheap.
Then there is the matter of actually loading these allowable tables into their system. This has to be done just so or nothing is going to bill correctly. This is a common problem with an allowable table update. Sometimes the files are corrupt, sometimes the software has a bug in it and on and on. Agencies hate when it comes time to have to do an allowable table update, which is usually done four times a year, every quarter.
The bigger problem is when a company bills for a certain item that costs them a certain amount of money and they are hoping to get a certain return on that item. For example. Let's say a company is selling a wheelchair to a patient for $350. The wheelchair costs the company $250 and they hope to make $100 profit on the sale. Medicare has the allowable set to $350 so all is well. Then, the next quarter update comes out and Medicare lowers the allowable for that wheelchair to $300. The agency now can only bill for $300 and can only make $50 on each sale. This cuts their profit margin in half. This is more common than you know and it drives medical billing companies crazy.
The sad part is, there is nothing that can be done about this. Medicare will allow what it will allow and that is the end of it. The company has no other choice but to absorb the loss. Yes, allowable tables are a real pain in the backside.
Before we do that, it would probably be a good idea to explain what an allowable table is for those who are not familiar with them. Allowable tables usually refer to Medicare billing, though there are other government carriers that also have allowable tables. An allowable table, as applied to Medicare, is a table of prices for each item that can be billed to Medicare. In other words, let's say a patient needs a wheelchair. If wheelchairs can be billed to Medicare, they will have a table entry for how much Medicare will pay for that wheelchair, whether it be to purchase it or rent it on a monthly basis. Sounds simple enough and it is. The problem is what this actually means to the medical billing company.
The first problem this presents is actually getting the allowable tables from Medicare. The reason this is important is because a medical billing agency has to know how much they are permitted to bill for each item. If they overbill for the item and actually expect to get paid that much, it is going to come as a big shock to them when their payment is considerably less than what they expected. So a medical billing company must get these tables setup in their system. To do this, they have to get them from Medicare. Guess what? It's not a free service. They have to pay for it and it's not cheap.
Then there is the matter of actually loading these allowable tables into their system. This has to be done just so or nothing is going to bill correctly. This is a common problem with an allowable table update. Sometimes the files are corrupt, sometimes the software has a bug in it and on and on. Agencies hate when it comes time to have to do an allowable table update, which is usually done four times a year, every quarter.
The bigger problem is when a company bills for a certain item that costs them a certain amount of money and they are hoping to get a certain return on that item. For example. Let's say a company is selling a wheelchair to a patient for $350. The wheelchair costs the company $250 and they hope to make $100 profit on the sale. Medicare has the allowable set to $350 so all is well. Then, the next quarter update comes out and Medicare lowers the allowable for that wheelchair to $300. The agency now can only bill for $300 and can only make $50 on each sale. This cuts their profit margin in half. This is more common than you know and it drives medical billing companies crazy.
The sad part is, there is nothing that can be done about this. Medicare will allow what it will allow and that is the end of it. The company has no other choice but to absorb the loss. Yes, allowable tables are a real pain in the backside.
# posted by Medical Information : 2:01 AM
Medical Billing - Choosing A Billing Method
If you're a medical billing company, your main point of operation is doing just that, sending out bills for services rendered to the various patients that you represent. And while this may seem like a simple decision to make, deciding what method of billing you're going to use is sometimes not as easy as some people would think. In this installment, we're going to discuss your various choices and what factors are involved in making your decision.
First of all, one thing a company has to understand when it comes to billing is that it's not simply a matter of what method you use to send the bill itself. After that part is done, the next part involves posting the money that is paid to you by the insurance carrier itself. How you get paid and how you post those payments, unfortunately has a lot to do with how you bill in the first place. So payment issues must be kept in mind when making your decision.
For example. If you're going to send paper claims, meaning that you are sending a HCFA form, then you automatically make it so that you can't be paid via batch billing methods. Batch billing is when the insurance carrier, supported by the software itself, sends you a file, which you usually download from their site, that contains all your payments. Once you download this file and run it through the batch billing system, the payments will automatically be posted to the patient accounts. However, in order to use this system, you have to batch bill, which means you have to bill electronically.
This is where we run into a cost effectiveness problem. Electronic billing is more costly than paper billing if you don't have a lot of patients to bill. In other words, if you're a small billing company, the cost of an electronic billing system will probably eat into your profits more than what it is worth to use. So the first thing you have to do is a cost analysis of what your electronic package will cost as compared to what kind of revenue you'll be bringing in. Most medical billing companies don't know how to do this and end up having to bring financial analysts in to compute this. That too costs money.
You also have to figure in the cost of the forms you're going to need. If you're doing a lot of DME billing, which is billing of durable medical equipment, a lot of this equipment is going to require more than just a HCFA form. You're also going to need a printed CMN or Certificate Of Medical Necessity form. This is going to add to the cost of your billing expenses.
Another thing to consider when choosing a billing method is the experience of your billing staff. If none of your staff has ever done electronic billing, even if it is cost effective, you may not want to use it because of all the problems you may run into because of inexperience.
When in doubt, it is best to consult with the software company itself. They will be able to give you a pretty good idea of the best medical billing method for you to use.
First of all, one thing a company has to understand when it comes to billing is that it's not simply a matter of what method you use to send the bill itself. After that part is done, the next part involves posting the money that is paid to you by the insurance carrier itself. How you get paid and how you post those payments, unfortunately has a lot to do with how you bill in the first place. So payment issues must be kept in mind when making your decision.
For example. If you're going to send paper claims, meaning that you are sending a HCFA form, then you automatically make it so that you can't be paid via batch billing methods. Batch billing is when the insurance carrier, supported by the software itself, sends you a file, which you usually download from their site, that contains all your payments. Once you download this file and run it through the batch billing system, the payments will automatically be posted to the patient accounts. However, in order to use this system, you have to batch bill, which means you have to bill electronically.
This is where we run into a cost effectiveness problem. Electronic billing is more costly than paper billing if you don't have a lot of patients to bill. In other words, if you're a small billing company, the cost of an electronic billing system will probably eat into your profits more than what it is worth to use. So the first thing you have to do is a cost analysis of what your electronic package will cost as compared to what kind of revenue you'll be bringing in. Most medical billing companies don't know how to do this and end up having to bring financial analysts in to compute this. That too costs money.
You also have to figure in the cost of the forms you're going to need. If you're doing a lot of DME billing, which is billing of durable medical equipment, a lot of this equipment is going to require more than just a HCFA form. You're also going to need a printed CMN or Certificate Of Medical Necessity form. This is going to add to the cost of your billing expenses.
Another thing to consider when choosing a billing method is the experience of your billing staff. If none of your staff has ever done electronic billing, even if it is cost effective, you may not want to use it because of all the problems you may run into because of inexperience.
When in doubt, it is best to consult with the software company itself. They will be able to give you a pretty good idea of the best medical billing method for you to use.
# posted by Medical Information : 2:00 AM
Monday, February 18, 2008
Medical Billing - Allowable Tables
In the world of medical billing, nothing is more dreaded by billing companies than allowable tables. There are numerous reasons for this. In this particular installment on medical billing, we're going to cover the main reasons why allowable tables are such a pain the backside.
Before we do that, it would probably be a good idea to explain what an allowable table is for those who are not familiar with them. Allowable tables usually refer to Medicare billing, though there are other government carriers that also have allowable tables. An allowable table, as applied to Medicare, is a table of prices for each item that can be billed to Medicare. In other words, let's say a patient needs a wheelchair. If wheelchairs can be billed to Medicare, they will have a table entry for how much Medicare will pay for that wheelchair, whether it be to purchase it or rent it on a monthly basis. Sounds simple enough and it is. The problem is what this actually means to the medical billing company.
The first problem this presents is actually getting the allowable tables from Medicare. The reason this is important is because a medical billing agency has to know how much they are permitted to bill for each item. If they overbill for the item and actually expect to get paid that much, it is going to come as a big shock to them when their payment is considerably less than what they expected. So a medical billing company must get these tables setup in their system. To do this, they have to get them from Medicare. Guess what? It's not a free service. They have to pay for it and it's not cheap.
Then there is the matter of actually loading these allowable tables into their system. This has to be done just so or nothing is going to bill correctly. This is a common problem with an allowable table update. Sometimes the files are corrupt, sometimes the software has a bug in it and on and on. Agencies hate when it comes time to have to do an allowable table update, which is usually done four times a year, every quarter.
The bigger problem is when a company bills for a certain item that costs them a certain amount of money and they are hoping to get a certain return on that item. For example. Let's say a company is selling a wheelchair to a patient for $350. The wheelchair costs the company $250 and they hope to make $100 profit on the sale. Medicare has the allowable set to $350 so all is well. Then, the next quarter update comes out and Medicare lowers the allowable for that wheelchair to $300. The agency now can only bill for $300 and can only make $50 on each sale. This cuts their profit margin in half. This is more common than you know and it drives medical billing companies crazy.
The sad part is, there is nothing that can be done about this. Medicare will allow what it will allow and that is the end of it. The company has no other choice but to absorb the loss. Yes, allowable tables are a real pain in the backside.
Before we do that, it would probably be a good idea to explain what an allowable table is for those who are not familiar with them. Allowable tables usually refer to Medicare billing, though there are other government carriers that also have allowable tables. An allowable table, as applied to Medicare, is a table of prices for each item that can be billed to Medicare. In other words, let's say a patient needs a wheelchair. If wheelchairs can be billed to Medicare, they will have a table entry for how much Medicare will pay for that wheelchair, whether it be to purchase it or rent it on a monthly basis. Sounds simple enough and it is. The problem is what this actually means to the medical billing company.
The first problem this presents is actually getting the allowable tables from Medicare. The reason this is important is because a medical billing agency has to know how much they are permitted to bill for each item. If they overbill for the item and actually expect to get paid that much, it is going to come as a big shock to them when their payment is considerably less than what they expected. So a medical billing company must get these tables setup in their system. To do this, they have to get them from Medicare. Guess what? It's not a free service. They have to pay for it and it's not cheap.
Then there is the matter of actually loading these allowable tables into their system. This has to be done just so or nothing is going to bill correctly. This is a common problem with an allowable table update. Sometimes the files are corrupt, sometimes the software has a bug in it and on and on. Agencies hate when it comes time to have to do an allowable table update, which is usually done four times a year, every quarter.
The bigger problem is when a company bills for a certain item that costs them a certain amount of money and they are hoping to get a certain return on that item. For example. Let's say a company is selling a wheelchair to a patient for $350. The wheelchair costs the company $250 and they hope to make $100 profit on the sale. Medicare has the allowable set to $350 so all is well. Then, the next quarter update comes out and Medicare lowers the allowable for that wheelchair to $300. The agency now can only bill for $300 and can only make $50 on each sale. This cuts their profit margin in half. This is more common than you know and it drives medical billing companies crazy.
The sad part is, there is nothing that can be done about this. Medicare will allow what it will allow and that is the end of it. The company has no other choice but to absorb the loss. Yes, allowable tables are a real pain in the backside.
# posted by Medical Information : 1:37 AM
Medical Billing - Choosing A Billing Method
If you're a medical billing company, your main point of operation is doing just that, sending out bills for services rendered to the various patients that you represent. And while this may seem like a simple decision to make, deciding what method of billing you're going to use is sometimes not as easy as some people would think. In this installment, we're going to discuss your various choices and what factors are involved in making your decision.
First of all, one thing a company has to understand when it comes to billing is that it's not simply a matter of what method you use to send the bill itself. After that part is done, the next part involves posting the money that is paid to you by the insurance carrier itself. How you get paid and how you post those payments, unfortunately has a lot to do with how you bill in the first place. So payment issues must be kept in mind when making your decision.
For example. If you're going to send paper claims, meaning that you are sending a HCFA form, then you automatically make it so that you can't be paid via batch billing methods. Batch billing is when the insurance carrier, supported by the software itself, sends you a file, which you usually download from their site, that contains all your payments. Once you download this file and run it through the batch billing system, the payments will automatically be posted to the patient accounts. However, in order to use this system, you have to batch bill, which means you have to bill electronically.
This is where we run into a cost effectiveness problem. Electronic billing is more costly than paper billing if you don't have a lot of patients to bill. In other words, if you're a small billing company, the cost of an electronic billing system will probably eat into your profits more than what it is worth to use. So the first thing you have to do is a cost analysis of what your electronic package will cost as compared to what kind of revenue you'll be bringing in. Most medical billing companies don't know how to do this and end up having to bring financial analysts in to compute this. That too costs money.
You also have to figure in the cost of the forms you're going to need. If you're doing a lot of DME billing, which is billing of durable medical equipment, a lot of this equipment is going to require more than just a HCFA form. You're also going to need a printed CMN or Certificate Of Medical Necessity form. This is going to add to the cost of your billing expenses.
Another thing to consider when choosing a billing method is the experience of your billing staff. If none of your staff has ever done electronic billing, even if it is cost effective, you may not want to use it because of all the problems you may run into because of inexperience.
When in doubt, it is best to consult with the software company itself. They will be able to give you a pretty good idea of the best medical billing method for you to use.
First of all, one thing a company has to understand when it comes to billing is that it's not simply a matter of what method you use to send the bill itself. After that part is done, the next part involves posting the money that is paid to you by the insurance carrier itself. How you get paid and how you post those payments, unfortunately has a lot to do with how you bill in the first place. So payment issues must be kept in mind when making your decision.
For example. If you're going to send paper claims, meaning that you are sending a HCFA form, then you automatically make it so that you can't be paid via batch billing methods. Batch billing is when the insurance carrier, supported by the software itself, sends you a file, which you usually download from their site, that contains all your payments. Once you download this file and run it through the batch billing system, the payments will automatically be posted to the patient accounts. However, in order to use this system, you have to batch bill, which means you have to bill electronically.
This is where we run into a cost effectiveness problem. Electronic billing is more costly than paper billing if you don't have a lot of patients to bill. In other words, if you're a small billing company, the cost of an electronic billing system will probably eat into your profits more than what it is worth to use. So the first thing you have to do is a cost analysis of what your electronic package will cost as compared to what kind of revenue you'll be bringing in. Most medical billing companies don't know how to do this and end up having to bring financial analysts in to compute this. That too costs money.
You also have to figure in the cost of the forms you're going to need. If you're doing a lot of DME billing, which is billing of durable medical equipment, a lot of this equipment is going to require more than just a HCFA form. You're also going to need a printed CMN or Certificate Of Medical Necessity form. This is going to add to the cost of your billing expenses.
Another thing to consider when choosing a billing method is the experience of your billing staff. If none of your staff has ever done electronic billing, even if it is cost effective, you may not want to use it because of all the problems you may run into because of inexperience.
When in doubt, it is best to consult with the software company itself. They will be able to give you a pretty good idea of the best medical billing method for you to use.
# posted by Medical Information : 1:36 AM
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