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In the land of medical billing, we get so caught up in the day-to-day operations of getting the bills out, we completely forget about checking to see if our software system is operating the way it should. Needless to say, as problems become noticeable, it is usually because of neglect in keeping an eye on things. In this review, we'll go over some basic system reports that you should be running just to make sure that your software is performing the way it should.

The first report that you should be running is an error report. All software packages track any kind of errors that occur during processing. This could be any kind of processing from submitting claims, to printing forms to running other reports. This error report should be run on a daily basis. The number of errors that occur should be minimal to say the least. If you find a gradual increase in the number of daily errors, this could be an indication that there are problems with the software. The most common of these are corrupted databases. If you suspect this, run a utility to check the integrity of your various databases.

The next report you should run is what is called a failed request report. This usually has to be run on the server unless the software package itself has this capability. Most high end DME software packages do produce a limited failed request report. But if you really want to get a full blown report with all the details that you're going to need. The usual cause of failed request is a bad network connection. If this is what you suspect, have your network administrator run diagnostics on the network. Also have him check all the wiring and network cards in all the computers. Usually the failed requests will come from one particular computer which narrows down your search for the culprit.

You're also probably going to want to run a report on network activity and system resources. For the most part, unless you have a massive billing department, the activity on the server should be minimal. Memory usage shouldn't even register a blip. However, if you find that there are spikes in memory usage, you might want to look at the times of the day that this is occurring. Find out from the billing department when their heaviest periods are as far as billing and other activities. See if there is a correlation between the two.

Finally, you're going to want to run a report to see the rate at which your databases are increasing in size. If you are a large medical billing company, your databases are going to grow at an alarming rate. While your server capacity may be in the gigabytes, it doesn't take long before you find that your medical billing software is hogging up 50% of your disk space. Once you see this happening, you're going to need to make plans to either add another drive or upgrade the one you have.

Medical billing is more than just sending out bills. If your system isn't functioning properly, you could be out of business before you even know what happened.

Everybody has their own point of view on every subject. In this world, our point of view, at least in our minds, is the right one. Well, that is no different in the world of medical billing. The patients think they should be paid for the claims, the medical billing companies want the patients to get paid for their claims so they can make their money and certainly the doctors want the patients to get paid for their claims or they'll go to another doctor. But what about the insurance carriers? It seems that they are the last people who want to pay claims. Well, this is for a very good reason. While everybody else is getting paid, the insurance carriers are paying out.

Sure, these carriers also get a monthly premium from somewhere, whether it be from us poor workers if they are a government agency or from the patients themselves if they are a private insurance company. But the truth is, especially with government run agencies, the money coming in is far less than the money going out. That is why the United States Medicare and Medicaid programs are in such trouble and in danger of going broke. Medical costs are skyrocketing because doctors are charging more and more for services, but the common worker doesn't make enough to put into the fund to make up for these increases.

As for private insurance companies, they have an even bigger problem. Whereas the government agencies can work at a loss because they're non-profit, the private insurance companies have to show a profit to their stockholders. Otherwise, the company goes out of business. This makes it so that they are even more reluctant to pay out claims. This however, is a real catch 22. See, the people they are paying the claims to are the people who are providing them with their income in the form of insurance premiums. So if they're not being paid, they're going to take their business elsewhere. Talk about a no win situation for a private insurance company. That's why so many of them have gone out of business over the last 30 years. Even the big giant Prudential has had its problems.

Because of these concerns, the insurance carriers have to be very careful about paying out claims. They have to research each one carefully to make sure the claim itself is legit. This will ultimately slow up the process, which is what medical billing companies and patients end up complaining about. But the truth is, there are a lot of bogus claims out there and if these insurance carriers paid out on all of them, they'd be broke sooner than you can say "I've fallen and I can't get up". So it is understandable that these insurance carriers run their businesses the way they do.

The point of this article is to give these carriers a little slack if you're a patient or a medical billing company. Remember, without them, you wouldn't have a job and would have to pay for your medical bills out of your own pocket.

In this installment of medical billing and DME software, we're going to cover a brief overview of lookup tables, which is probably the heart and soul of the whole DME system. Without lookup tables, the whole operation of the system, including the medical billing itself, would be extremely difficult.

A medical biller has a hard enough job as it is. When billing a medical claim, there is an enormous amount of information that has to be sent to the insurance carrier, including patient information, item information, insurance information and so on. If you read the series on DME NSF 3.01 record specifications, then you already know that hundreds of fields of information are transmitted to the insurance carrier. If the medical biller had to enter all this information by hand, the billing of one claim would literally take hours. To speed up this process, lookup tables are used.

A lookup table is essentially a self contained database that has information pertaining to that area of billing, whether it be patient, item or carrier related. The reason that many tables are used is because of the amount of information that is contained in each table. If they were all combined into one table, the lookup process itself would be slowed to a crawl because of all the records the lookup would have to go through. As it is, with very large billing agencies, these lookup procedures can take several minutes depending on how large the network is and its capabilities to handle the load.

Each lookup table is indexed, usually in several ways. By doing this, a medical biller can lookup patient information in a number of ways. For example, if the biller doesn't know the patient's ID number, they can look it up by the patient's last name. Some lookup tables allow you to do a broad search via city and state. For item lookup tables, if the biller doesn't have the sku number, they can look up the item by description. Of course, with many of the same items in the system, this method can be time consuming.

The main point of a lookup table is that for each table, there is a large amount of information that is tied to it. So by looking up a patient, the biller is pulling all the information associated with that patient, such as name, address, phone, date of birth and a number of other things. In the process, all these items are automatically pulled to the various forms that need to be filled out. So what would normally take maybe 5 to 10 minutes to fill out, can literally be done in seconds. Obviously, this is a real time saver for medical billing agencies and greatly reduces costs, which are high enough as it is.

Quite simply, without lookup tables, DME software would be pretty much worthless, as the bulk of the operation would be the manual input of hundreds of pieces of information, which would totally defeat the purpose of having the software, to speed up operations.

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.