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Found articles: 41

  • Medical Billing, HIPAA Compliance, and Role Based Access Control

     HIPAA compliance requires special focus and effort as failure to comply carries significant risk of damage and penalties. A practice with multiple separate systems for patient scheduling, electronic medical records, and billing, requires multiple separate HIPAA management efforts. This article presents an integrated approach to HIPAA compliance and outlines key HIPAA terminology, principles, and requirements to help the practice owner to ensure HIPAA compliance by medical billing service and software vendors.More

  • Medical Billing Knowledge Management with Communal Documentation and Adaptive Search

     Google became a standard reference tool for almost every group of age and interest. But Google frustrates doctors looking for better understanding of medical billing complexities and modern straight through billing technologies. This article briefly explores the contradictory forces of the most popular search algorithm on the planet and outlines specialized, collaborative, and self-learning technologies to solve its limitations in the context of medical billing and compliance.More

  • Medical Billing OLAP for Lost Revenue Discovery

     Average medical practice may lose as much as 11% of its revenue due to underpayments. But underpayment recovery potential averages only 5% of revenue and involves costly appeal process. To avoid unrecoverable losses, some providers discontinue servicing patients insured by the worst performing payers.More

  • Medical Billing Process Problem Tracking

     Processes involving large volumes of complex billing transactions require effective mechanisms for problem assignment and tracking. Without such mechanisms, billing personnel cannot be held accountable for problem resolution, resulting in loss of revenue and increased compliance risk. While medical billing industry has developed specialized systems and processes for resolution of content problems, little attention has been paid to billing process problem resolution methodology.More

  • Medical Billing Transparency

     Medical billing industry has volumes of arcane terminology and payer- and time-dependent claim validity and pricing interpretation rules, facilitating massive payments of invalid or ineligible claims and denials of error-free claims. Process transparency provides its participants greater visibility of internal process activities. An increased level of access promotes teamwork, increases client satisfaction, and assists in process streamlining.More

  • Straight Through Billing Methodology for Medical Practice

     Medical billing complexity and massive volumes of daily claims render manual claims processes incapable of protecting both the provider and the payer from underpayments, overpayments, and billing compliance violations. Straight Through Billing addresses complexity and volume processing problems by automating the majority of the claim flow and focusing the billing follow-up specialists to exceptions only. A Straight Through Billing process flags problems, routes them for follow up, and enables online correction and resubmission.More

  • Medical Practice Software as a Service (SaaS)

     Software as a Service (SaaS) is the new generation of ASP model designed to reduce the exorbitant costs of specialized medical practice management software. SaaS model is available for all aspects of medical practice management, including scheduling, billing, and electronic medical records (EMR), which are mission-critical for high quality clinical service, business operations, and regulatory compliance. SaaS model extends the advantages of Application Service Provider (ASP) model, which in turn evolves from the traditional Client-Server model.More

  • Medical Billing Performance Index

     Benchmark-driven performance management helps establish objective industry standards. Medical service providers can use benchmarking to evaluate performance of their billing service and measure their improvement over time. This article presents a prototype for a rule-based chiropractic index, including its coverage definition, update cycle, volume weighting, and provided information.More

  • Medical Billing Service Selection Process

     Over four thousand vendors of medical billing services offer solutions to medical practices nationwide in response to poor in-house billing performance and increasing regulatory scrutiny of billing processes. On one hand, such a large number of outsourced billing solutions ensure continued competitiveness in terms of both service quality and pricing. On the other hand, the lack of uniform service standards and metrics among the vendors, combined with their large numbers, makes the process of vendor selection difficult and error-prone.More

  • Medical Billing Control with Computer Aided Coding

     The average practice submits half of its codes wrong, while some practices rarely exceed more than one code right out of every five codes. Inexact and inconsistent coding increases the risks of undercharging, overcharging, and post-payment audit. This article outlines evolution of coding from individualistic art towards disciplined and systematic process.More