Tuesday, March 18, 2008
Chiropractic Office Management and Billing Education With Shared Software and Video Knowledge Base
As chiropractic office management and billing regulations keep evolving and becoming more complex, technology takes the lead role in maintaining practice profitability and post-payments audit risk management. Practice management systems automate most clinic operation activities, starting with patient check in, SOAP note editing, insurance claim creation, and medical billing.
Unfortunately, the high level of computer skill required by the prohibitively complex chiropractic office management and medical billing solutions often hinders the doctor's ability to use such solutions correctly in a chiropractic office environment. Instead of increasing office productivity and efficiency, chiropractic billing software becomes yet an additional obstacle and profitability impediment. Its high cost and user training problems add insult to injury and frustrate even seasoned and accomplished practice owners.
Combining Wiki (shared knowledge repository on the Web) with video technology solve many of the difficult training problems of chiropractic clinic owners and office managers. Such combined solution amplifies the advantages of individual training video materials with Wiki's ability to reach every chiropractic office, share experience of real-world experts, and help practice owners and managers stay smart at their pace and on just the management and billing content they need to know. The “on-demand” nature of such combined solution enables doctors to learn from experts wherever and whenever it is most convenient to learn.
Wiki takes the concept of shared inter-article repository on the Web to the next, intra-article level, allowing multiple contributors share editing process of the same document. By localizing and focusing shared efforts to the same documents, the resulting sites achieve relevance degrees unobservable to popularity-based search engines. (Wikipedia is the most popular example of Wiki: BBC News has called Wikipedia "one of the most reliably useful sources of information around, on or off-line.")
Vericle's training Wiki now contains both introductory and advanced video training materials, starting with Initial Visit (narrative SOAP note documentation), Subsequent Visit, Advanced Coding, Workbench Management Tips, End of Day Reporting, Demographic Error Avoidance, Appointment Scheduling, Patient Check In, Front-Desk Kiosk, and Compliant Billing.
Monday, March 17, 2008
Reduce Medical Billing Time and Overhead Costs for Your Medical Practice
Owning a busy medical practice demands organization, tight schedules, and don't forget - plenty of time to care for every patient. In all the hustle and bustle, the very backbone of your financial well-being, medical billing, can get put on the back burner if you're not careful. But, don't let it get out of hand. Use the tips below to develop a steady stream of capital for your practice and keep your medical billing in check.
Organize your Medical Office
The first step to saving time and overhead costs is to get organized in the office. The office is where all patient information and billing is processed. You can't afford to lose patient or billing information. To organize your office, be sure every paper, form and bill has a designated area or file. Be sure the employees are trained properly so they'll know exactly where all paperwork belongs. This helps prevent lost paperwork, and benefits both your practice and the patient. A lost bill every now and then could result in hundreds or thousands of lost dollars each year!
Use Medical Billing Software
Another time-saver is sophisticated web-based medical billing software. This software is designed to make your medical billing easier and keep it organized. You can quickly retrieve records or past-due bills and claims when needed. You can enter information for insurance companies for quick access to process claims. Medical bills and records are stored at a secure online server instead of on your computer's hard drive. You can access the records from anywhere twenty-four hours a day, seven days a week.
EMR (Electronic Medical Records)
Some web-based medical billing software includes an EMR, or electronic medical records, feature that enables you to file medical histories on each patient, scan related images for each medical record, and even dictate information for a transcriber to access from another computer. The EMR feature works through online technology, making it easy to outsource jobs such as medical transcription, medical billing, etc.
Use a Medical Billing Service
You may choose to outsource your billing needs by using professional medical billing services. Companies that offer medical billing services usually will provide the necessary medical billing software, training and staff to get the job done - saving you many future headaches! Once you have the software in place, it's just a matter of entering information into a computer, and the medical billing company handles the rest. They keep your medical billing and claims organized, so you don't have to worry with it. You are able to concentrate on treating patients and keeping other pertinent office functions in operation.
Most medical billing companies today will provide medical billing software and training on how to work with the software to help make the process easy for you and your employees. For example, if the medical billing software is designed to be integrated with Microsoft Office, you might receive a video or materials for yourself and employees with the necessary Microsoft Office training.
Whether you choose to do your own billing with web-based medical billing software or use medical billing services, follow the tips above to create a smooth-running office and watch your profits soar!
Saturday, March 15, 2008
Translating Medical Terms And The Requirement For Translation Services
When we are injured, sick, or generally in need of medical assistance, we take it for granted that once we have reached a point of healthcare distribution, our needs will be expertly seen to. Even when the cause of distress is an emergency situation, we assume that all we need to do is to communicate the nature of our mishap and an expert will solve all our woes.
Imagine though, not being able to communicate that you were in severe pain, or that you couldn't move your leg, or even the circumstances that led up to your accident. The Doctor would lack the necessary background to make a proper assessment and subsequently his diagnosis might be inaccurate.
There are ever growing numbers of UK residents who speak a language other than English in their homes and who have limited proficiency in English. In the U.S. the last reported figures for similar statistics were that out of the total population, around 45 million people's first language was not English and out of these, about 18 million had limited proficiency in English. There are no figures available for the UK, however, as can be surmised; this is leading to growing problems of communication between healthcare providers and patients.
As well as the problem outlined above, which is one of interpretation, this also extends into another dimension, that of document translation. Ever increasing volumes of patient case notes, research notes and other medical documentation are arriving from foreign medical establishments, or need to be sent to establishments abroad and this throws up a unique set of problems.
Any medical data has to be translated precisely and accurately, however, problems can easily arise when attempting to translate medical terms as there is often no direct equivalency in terms. Put in a much simpler way: language is universal but medical terms are not.
The solution to medical translations lays in the use of medical translation specialists. These firms employ dually qualified translators to cut through the confusing terminology of medical terms to reach a coherent and accurate rendering of the source text.
The medical translators in question will all have a language qualification but in addition, will all be qualified in the medical field as well; it is just as well that this is so, as most medical tracts are indecipherable to non-medical staff, even when written in English.
Thursday, March 13, 2008
Translating Medical Terms And The Requirement For Translation Services
When we are injured, sick, or generally in need of medical assistance, we take it for granted that once we have reached a point of healthcare distribution, our needs will be expertly seen to. Even when the cause of distress is an emergency situation, we assume that all we need to do is to communicate the nature of our mishap and an expert will solve all our woes.
Imagine though, not being able to communicate that you were in severe pain, or that you couldn't move your leg, or even the circumstances that led up to your accident. The Doctor would lack the necessary background to make a proper assessment and subsequently his diagnosis might be inaccurate.
There are ever growing numbers of UK residents who speak a language other than English in their homes and who have limited proficiency in English. In the U.S. the last reported figures for similar statistics were that out of the total population, around 45 million people's first language was not English and out of these, about 18 million had limited proficiency in English. There are no figures available for the UK, however, as can be surmised; this is leading to growing problems of communication between healthcare providers and patients.
As well as the problem outlined above, which is one of interpretation, this also extends into another dimension, that of document translation. Ever increasing volumes of patient case notes, research notes and other medical documentation are arriving from foreign medical establishments, or need to be sent to establishments abroad and this throws up a unique set of problems.
Any medical data has to be translated precisely and accurately, however, problems can easily arise when attempting to translate medical terms as there is often no direct equivalency in terms. Put in a much simpler way: language is universal but medical terms are not.
The solution to medical translations lays in the use of medical translation specialists. These firms employ dually qualified translators to cut through the confusing terminology of medical terms to reach a coherent and accurate rendering of the source text.
The medical translators in question will all have a language qualification but in addition, will all be qualified in the medical field as well; it is just as well that this is so, as most medical tracts are indecipherable to non-medical staff, even when written in English.
Medical Outsourcing - First Aid For Rising Health Costs
Thousands of American businesses, no matter their sector, have turned to outsourcing in recent years as a way to reduce their costs without cutting back on the services which they offer to their customers. Outsourcing non-essential parts of their operations allows them to concentrate on the essential ones, and most often, they outsource work to laborers in developing countries
Those companies choosing outsource outside of their own countries will either find a local subcontractor to supply workers, or establish a company branch in the chosen country, selecting a location with an abundance of qualified, inexpensive workers. As soon as these workers have been trained in the jobs being outsourced, the company can expect to see its labor costs reduced, and because it can hire more workers and still get a cost savings, the speed and reliability with which its work is done will improve.
Medical Transcription
Medical outsourcing is becoming more and more common, and most medical outsourcing is of medical transcription jobs. Medical transcription an IT based process of which requires transcribers, with specially designed software, to translate into digital text the voce dictated patient histories and medical treatment records they receive from medical firms. Because medical transcription must be absolutely accurate, it requires excellent listening skills.
Medical outsourcing of transcription is most often given to outsource providers in Israel, the Philippines, and India. Their location in time zones different from those of the US means that they can return the completed transcription in timeframes advantageous to US health care providers. And more importantly, Indian medical outsourcing providers can work very cheaply when compared to transcribers in the US, saving US hospitals millions, if not billions, of dollars each year.
Other Medical Outsourcing
Medical outsourcing, however, is not limited to transcription services. Billing, claims processing, and coding, as well as remote medical and medical help desk services are all outsourced, to the tune of two hundred billion a year when the global numbers are totaled. As the cost of healthcare continues to soar, healthcare facilities and related industries like laboratories have simply turned to medical outsourcing in poorer countries and in the process saved as much as seventy percent their associated expenses.
Medical outsourcing, in fact, has grown to include the clinical trials associated with bringing new drugs to market. The problem with this is that many countries to whom the drug companies have turned in order to save research costs do not have the same government oversight of such trials as the ES and European countries do. While the pharmaceutical companies slash their expenses, many people have questions about the safety of the drugs which result from these trials.
Medical Outsourcing - First Aid For Rising Health Costs
Those companies choosing outsource outside of their own countries will either find a local subcontractor to supply workers, or establish a company branch in the chosen country, selecting a location with an abundance of qualified, inexpensive workers. As soon as these workers have been trained in the jobs being outsourced, the company can expect to see its labor costs reduced, and because it can hire more workers and still get a cost savings, the speed and reliability with which its work is done will improve.
Medical Transcription
Medical outsourcing is becoming more and more common, and most medical outsourcing is of medical transcription jobs. Medical transcription an IT based process of which requires transcribers, with specially designed software, to translate into digital text the voce dictated patient histories and medical treatment records they receive from medical firms. Because medical transcription must be absolutely accurate, it requires excellent listening skills.
Medical outsourcing of transcription is most often given to outsource providers in Israel, the Philippines, and India. Their location in time zones different from those of the US means that they can return the completed transcription in timeframes advantageous to US health care providers. And more importantly, Indian medical outsourcing providers can work very cheaply when compared to transcribers in the US, saving US hospitals millions, if not billions, of dollars each year.
Other Medical Outsourcing
Medical outsourcing, however, is not limited to transcription services. Billing, claims processing, and coding, as well as remote medical and medical help desk services are all outsourced, to the tune of two hundred billion a year when the global numbers are totaled. As the cost of healthcare continues to soar, healthcare facilities and related industries like laboratories have simply turned to medical outsourcing in poorer countries and in the process saved as much as seventy percent their associated expenses.
Medical outsourcing, in fact, has grown to include the clinical trials associated with bringing new drugs to market. The problem with this is that many countries to whom the drug companies have turned in order to save research costs do not have the same government oversight of such trials as the ES and European countries do. While the pharmaceutical companies slash their expenses, many people have questions about the safety of the drugs which result from these trials.
Medical Outsourcing - First Aid For Rising Health Costs
Those companies choosing outsource outside of their own countries will either find a local subcontractor to supply workers, or establish a company branch in the chosen country, selecting a location with an abundance of qualified, inexpensive workers. As soon as these workers have been trained in the jobs being outsourced, the company can expect to see its labor costs reduced, and because it can hire more workers and still get a cost savings, the speed and reliability with which its work is done will improve.
Medical Transcription
Medical outsourcing is becoming more and more common, and most medical outsourcing is of medical transcription jobs. Medical transcription an IT based process of which requires transcribers, with specially designed software, to translate into digital text the voce dictated patient histories and medical treatment records they receive from medical firms. Because medical transcription must be absolutely accurate, it requires excellent listening skills.
Medical outsourcing of transcription is most often given to outsource providers in Israel, the Philippines, and India. Their location in time zones different from those of the US means that they can return the completed transcription in timeframes advantageous to US health care providers. And more importantly, Indian medical outsourcing providers can work very cheaply when compared to transcribers in the US, saving US hospitals millions, if not billions, of dollars each year.
Other Medical Outsourcing
Medical outsourcing, however, is not limited to transcription services. Billing, claims processing, and coding, as well as remote medical and medical help desk services are all outsourced, to the tune of two hundred billion a year when the global numbers are totaled. As the cost of healthcare continues to soar, healthcare facilities and related industries like laboratories have simply turned to medical outsourcing in poorer countries and in the process saved as much as seventy percent their associated expenses.
Medical outsourcing, in fact, has grown to include the clinical trials associated with bringing new drugs to market. The problem with this is that many countries to whom the drug companies have turned in order to save research costs do not have the same government oversight of such trials as the ES and European countries do. While the pharmaceutical companies slash their expenses, many people have questions about the safety of the drugs which result from these trials.
Tuesday, March 11, 2008
Common Questions to Ask When Choosing a Medical Transcription Company
Outsourcing of medical transcription services has experienced a steady growth in the last few years as hospitals and clinics come to a greater realization of outsourcing's strategic benefits. Combined with an increased shortage of medical transcriptionists as well as the emergence of increased technical capabilities, hospitals who are deciding to outsource are seeing many overall financial and customer service advantages.
With the increased ease of entry for new transcription companies into the marketplace, many different factors will determine how each will fit within an organization. How does the medical transcription company measure quality? Do they understand the impact they have on patient safety? How do they price? How do they reconcile invoices? Can they deliver the document on the timing physicians require? What processes do they have in place to meet the security requirements for protected health information? Do they have a platform in place to accommodate speech recognition technologies? These are some of the important questions to ask while making a decision that will affect an organization's overall profitability, and below are the answers that will help you when determining what company meets your needs and helps you achieve your goals without sacrificing important factors like quality, turnaround times and customer service.
How do the Medical Transcription Service Organizations (MTSOs) differ?
The outsourced medical transcription industry is fragmented and companies vary from small, locally owned operations to large international companies. MTSOs are different based upon technology, scalability, quality approach and focus, customer service processes, executive involvement and the ability to respond to and resolve issues. As your organization is thinking about partnering with an MTSO, you will want to carefully consider organizational goals and objectives and match them to the MTSO that best meets your company's needs.
What will it cost?
You can avoid surprises by thoroughly understanding the cost and units for billing at the offset. There are two standard ways to price transcription - Visual Black Character (VBC) and standard price per line. MTSOs have appeared to move more toward VBC in the last few years, as the benefits to the business have been growing. MTSOs choose to utilize VBC pricing as it gives their customers a greater ability to audit and verify their costs. In order to determine which cost/pricing strategy works better for your organization, it should give any prospective MTSOs a package that includes the company's existing reports that may help to set the future cost standard.
How does the MTSO guard protected health information?
Whether your MTSO keeps work within the United States or sends it offshore, it is important to determine how sensitive health information will be protected and whether the company has already established processes for handling health information. How is the work audited and how are these people trained to ensure they comply with all security standards? How are quality checks performed and have any others experienced security issues? If it is an offshore home-based model, are vendors required to sign a business associate agreement?
How are MTs assigned to my work?
Try to find out how MTs are assigned work. Does the MTSO have specialists for certain work types, or is there a general pool of MTs to perform various transcription specialties? Would the account have dedicated MTs assigned specifically to certain work types, or will they differ on a regular basis? Dedicated MTs will be able to become more familiar with individual physicians, their speaking patterns and the types of reports they perform, thus eliminating language barriers and transcription errors.
What type of support structure do they provide?
What is the overall structure of their customer service process? Will your company be able to reach its personal representative at any time, or will it be directed to a general 800 number? When it does call in, whom does the call go to and how quickly? Is the IT staff educated to help with varying technical issues and are they easily accessible and timely in their response?
What type of tools/technology do they provide?
The transcription industry is in the midst of an overhaul of its technology capabilities. Staying on top of these trends and learning to differentiate between each company's capabilities will ensure that the right company is chosen to meet personal business needs. Look closely at the capabilities available to distribute, track and capture inbound dictation and outbound reports. Find out if that technology will work for the physicians at your company and where they will be able to access that information. If the MTSO is utilizing a third-party for this technology, will it affect the timeliness of resolving issues? Also, if your organization changes its scope of work, does the MTSO have the appropriate technology in place for speech recognition and electronic health records should the need arise?
How do they ensure quality?
The need for quality work continues to far surpass other transcription needs. What is the quality assurance process? How quickly will the MTSO resolve quality issues, and if the work is unacceptable and fails to meets requirements within the service agreement what processes are in place to receive timely compensation? Is the MTSO currently analyzing their quality structure and taking steps to ensure all MTs are thoroughly trained and their suppliers are regularly audited? How are MTs held accountable? What training takes place? Are MTs organized in narrow work pools by specialty?
How are bills reconciled?
Some companies are focused on pricing transparency, which will allow the organization to be continually aware of any and all charges it will be responsible for. Some companies have a system in place that allows reports to be run in real time, thus allowing their customers to reconcile bills at any time. Find out how the process works and how you will be charged.
How difficult will the MTSO processes be to implement?
Ask how easily the MTSO technology will be to integrate into the organization. Is there an implementation team? How is service maintained once the technology implementation is complete?
About Heartland Information Services
Heartland Information Services specializes in high-quality, full-service medical transcription providing financial and service advantages that helps its clients reach or exceed goals. Heartland provides unparalleled efficiency, reliability and management capabilities while interfacing with virtually any health information system and software. Heartland's corporate headquarters is located in Toledo, Ohio, with work centers in Bangalore, Chennai, Mumbai, Pune and Delhi, India. Heartland Information Services can help you answer these questions.
Visit http://www.heartlandis.com or call 866-277-3199 to find out more about Heartland's quality transcription work and how they can help your organization reach its financial and business goals.
Medical Transcription - Physician Dictation Services
Medical Transcription involves the transformation to text variant of taped SOAP notes. The recording of SOAP notes is done by medical practices but the process of transcriptioning is left to the professionals as that operation can take away all the time and resources of a medical center.
On the face of it, all it seems to need is a word processing software and a dictation recording player. Still, a truly professed medical transcription service will go further than that. It will be instrumental in effective management of amount of SOAP notes that are supplied by the medical offices, along with ably tracking and storing it.
A medical transcription project has to be executed as per the succeeding steps. Foremost, accept recording tapes from the medical practice, transcribe the first SOAP notes duplicate, save it and do the aforesaid task for the whole batch of SOAP notes recordings. Now, crosscheck the transcripts for errors and transport transcript back to the medical practice.
A point to note is that medical transcription itself is of myriad types distinguished by the specialty of medicine as well as the variety of reports transcribed. We have host of MT types like Radiology reports transcription, Cardiology reports transcription, H&P reports transcription, Surgery notes transcription, Lab reports Transcription etc.
As can be seen plainly, medical transcription occupation can be done from homes too. This means that those who have family constraints of staying at home as well as pressing business needs, can surely opt for the activity of medical transcription.
Outsourcing of Medical Transcription Duties
One of the largest growing sectors of the medical field is that of medical transcriptionists. Hospitals, clinics and doctors offices require the doctors’ words to be put into writing for patients’ files and other documentation purposes. In addition, a most hospitals require it to be in digital format. Hence, the need has arisen for people to translate doctors’ oral reports into digital documents.
Although employed secretaries often do this job, it is quickly becoming big as an area for outsourcing. When outsourcing, the transcription can actually be done more quickly than it can in-house. This is because the outsourcing firm or individual devotes full time to the assignment, while a secretary is constantly interrupted with phone calls and other duties.
In a time of growing interest in home-based businesses, these two needs have merged. Many people make a good living from their home computer typing up medical transcripts. It’s a job that pays well. However, this isn’t an easy job. Specialized training and experience are required. If you have it, you’re in demand. Recent years have shown an increase in demand for medical transcriptionists, but a smaller supply. Therefore, it’s a ripe field for the entrepreneur.
As a outsourcing medical transcriptionist, you would be providing services to medical facilities of all types who outsource this activity. You don’t even have to live in close proximity, as long as you have a reliable computer and Internet connection. They will send you an audio file and you type it up, making sure each word is clear and spelled correctly. It is crucial that it be accurate, as this will serve as the doctor’s documentation.
Many American and foreign companies alike are getting on board and offering medical transcription services. In the U.S., it’s usually existing medical companies that offer these services to other medical facilities. Asian companies are the target of many other American health care institutions for outsourcing their transcription needs.
As an industry, it is growing particularly quickly in India and the Philippines, where labor costs are significantly cheaper. Some estimate it is the 4th largest outsourcing industry in India. It’s gaining ground in the Philippines, where it is one of the government’s top 10 priority growth sectors. It is particularly suited to this field because of the Filipino high literacy rate, proficiency in English and medical training. The population of both countries has always been adept at information technology.
Research shows that the U.S. spent $2.3 billion in 2004 for medical transcription outsourcing services. That number is expected to grow to $4.2 billion in 2008. Worldwide, the U.S. Department of Labor has projected the demand for medical transcriptionists to reach $20 billion.
The demand is there, at least for now. If you’ve always dreamed of your own business and are willing to be trained, go to the Internet and do a search on “medical transcription training”. Research several different courses and choose which one suits you and your present circumstances. You’ll be your own boss making a decent income all from home in no time!
Tuesday, February 26, 2008
Medical Billing - Software System Reports
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.
Medical Billing - Insurance Carrier Perspective
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.
Monday, February 25, 2008
Medical Billing - DME Software Lookup Tables
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.
Medical Billing - Allowable Tables
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.
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