• (951) 757-2056
  • img


    Convenient and Secure Payment Options

    This entry was posted in Blog on
    August 14th, 2017

    Mobile and online payment options are becoming more common in healthcare, simply because they simplify the payment process, delivering a consumer-friendly patient experience. In addition, patients are growing to expect convenient payment options. The Trends in Healthcare Payments recent 2015 report found that 64% of consumers have an interest in using mobile payment systems, such as Android Pay, Apple Pay, and Samsung Pay.

    Some billing services may hesitate when it comes to mobile and online payments, simply because of misconceptions regarding security. With MPMR Medical Billing, you will not have to worry about security breaches. Our billing company is concerned that new payment options could present disruption of workflow, which can be frustrating, impractical, and time-consuming. Because of this, we use updated technologies that improve payment security, while creating an efficient, improved billing service for patients.

    Secure Payment OptionsPayment Card Industry Data Security Standards

    Apply Pay, patient portals, and digital wallets can deliver many benefits to the physician and patient. Our billing service looks to add mobile and online payment options that meet Payment Card Industry Data Security Standards (PCI DSS). These standards apply to all entities involved in the payment processing, including processors, merchants, financial institutions, and service providers. In addition, it applies to all other entities that process, store, or transmit cardholder data.

    To offer mobile and online payment options, MPMR Medical Billing will ensure that they are PCI compliant. We are aware of the PCI scope and standards, and how new payment technologies can affect the size of the organization’s PCI scope. To reduce this scope, our billing service implements payment solutions from a PCI Level 1 Service Provider. Understanding payment security allows us to bring your practice new payment technologies that are safe and secure.

    Patient Portal, Digital Wallets, and Apple Pay

    Many patients now expect convenient payment options when it comes to healthcare bills. Patient payment responsibility is rising, so it is critical that billing services offer online payment options. A patient portal in the office is visited regularly. Therefore, adding a payment solution is a must. This offers a high level of security and will reduce PCI scope. Also, as an embedded payment solution, the patient portal allows providers to collect secure payments from mobile devices and online without having the credit/debit card data pass through unsecure networks.

    Patients will appreciate the ability to pay their healthcare bills online. Billing services will also use a patient portal to offer payment plans and other ways to pay large balances. Patients may access this system at any time, and pay their bills in increments, which are saved on file. Patients will have 24/7 access to payment methods, which means the billing service has more chances to collect monies owed. With a digital wallet, the patient goes online and stores payment information for future transactions. The next time the patient logs in to the portal, they can select the payment method desired instead of re-entering all the information. The digital wallet makes online payments quicker, and also reduces the amount of effort and time making this payment.

    With Apple Pay, the consumer uses the mobile device to make payments rather than reaching their credit card. Apply Pay is extremely secure, and offers three technologies to support the payments. These include: Touch ID, The Secure Element, and Near Field Communication (NFC). In addition, each cellular phone has a secure element that is a separate chip for security. When patients put their card information into the phone, the card network sends a token to Apple, which is securely stored on the phone.

    Why Doctors Should Outsource Medical Billing

    This entry was posted in Blog on
    July 19th, 2017

    One of the main business questions faced by physicians is whether to outsource medical billing to a third-party medical billing service or do it in the office with medical billing software. Many physicians feel that outsourcing billing to a company makes the most sense because billing and coding specialists. Don’t make a decision before considering your options. Weigh the differences when assessing your practice’s needs and decide if outsourcing is best for you.


    Cost Analysis


    Costs In-House Outsourced
    Billing Dept. Costs $  118,000 $     4,000
    Software/Hardware Costs $     7,500 $        500
    Direct Claim Processing $     3,600 $  122,500
    Software/Hardware Costs $     5,500 $     2,000
    % Billings Collected        60%         70%
    Collections $1,370,900 $1,623,000
    Collections Costs $   129,100 $   127,000
    Collections (Net of Costs) $1,241,800 $1,496,000



    For many physician practices, the decision regarding in-house billing versus outsourcing boils down to one key factor – cost. To help compare costs of outsourced billing versus in-house, you should do a cost analysis. This involves:

    • Billing staff costs – With in-house billing, the calculated rate involved adding up the median salaries of two medical billing employees ($80,000), federal and state taxes ($12,000), healthcare costs ($9,000), and training costs so the employees are updated on new industry developments ($2,000). These two employees will cost the practice around $118,000 per

      year. With outsourced billers, we factor in 5 hours each week at $15.00 per hour. This adds up to around $4,000 per year in administrative costs.

    • Software and hardware costs – With in-house billing, you can expect an annual cost for practice management software and hardware to be $7,500. When you use an outsourced billing company, you only pay around $500.
    • Direct claims processing costs – Clearing house fees for around 20,000 claims a year can cost you $300 per month for 3 physicians ($3,600 each year). With outsourced billing services, a percentage of the collected amount will be paid, which is around 7% for most primary care practices ($122,500).
    • Percentage of billing amount collected – With outsourced billing, you can expect a 5%-15% increase in the amount you collect. We factored in a 10% increase as an average between these numbers. Regarding in-house billing, the practice will collect 60% of what it actually bills to the payers.

    The In-House Process VS. Outsourcing

    With the in-house procedure for insurance claims processing, there are many steps to consider. The employees must enter patient information and billing codes using a software program. The superbill is used to bill services, and it is submitted to a medical billing clearinghouse. The clearinghouse will evaluate the claim for errors, for a fee, and then passes the claim on to the payer. If the claim is rejected by the payer, the staff must redo and resubmit the claim after additional information is gathered. With in-house billing, you must have an integrated electronic health records (EHR) practice management system. EHR software will populate both systems’ data fields, and diagnosis codes are used for data entry.

    The process for outsourced billing is much simpler for the office staff. The superbill is electronically sent to the medical billing service, who handles data entry and claim submission for the provider. The industry average is around 7%, which provides incentive for the biller to collect what is owed to you. Using EHR makes the billing process straightforward and easy. The EHR software eliminates much data entry, improving accuracy, efficiency, and reimbursement.

    Reasons to Outsource your Medical Billing

    Besides saving you money, there are several factors to consider regarding billing options. With outsourcing, you can expect:

    • An efficient billing system – If you are noticing drops in collections, you could have billing department issues. Outsourcing to a third-party billing company decreases time to receive payment from a payer, and lowers the number of rejected claims.
    • Tech-savvy specialists – Outsourced billing and coding professionals are tech-savvy, investing in practice management software and training. These specialists upgrade your software, handle technical issues, and deal with the computer aspect of billing.
    • Low staff turnover – In your office, you can expect medical billing staff turnover. With an outsourced company, you do not deal with this problem.

    MPMR works with practices nationwide on complete revenue cycle management. The company offers certified coders and billers along with consultants who help with operational efficiencies. Call us today for a free 30 minute phone consult!

    8 Tips for Avoiding Denials and Improving Claims Reimbursement

    This entry was posted in Blog on
    July 15th, 2017

    The worst thing for a billing specialist to see is the words “CLAIM DENIED.” When claims are denied, it leads to increased work, much frustration, and reduced practice revenue. The American Medical Association found that physician practices spend around $15,000 on phone calls, claims appeals, and investigative work related to billing. Here are 8 tips for avoiding denials and improving claims reimbursement.

    1. Automate Everything You Possibly Can

    Keeping up with different insurance policies, diagnostic codes, and billing procedures is exhausting. However, most billing software providers will automatically update codes and requirements for you. This eliminates research time, allows the billing team to spend more time double-checking claims, and improves reimbursement. Another benefit of automation is that the software system will streamline the process and flag items that should be resolved before claims are submitted. The entire billing team should be aware of how to get reimbursed, so that tracking down information is not necessary.

    1. Do More Up Front

    Before the patient sees the physician, or has a scheduled test or procedure, office staff should take charge of the situation. They must make sure forms are completed accurately, without error, and legibly. In addition. Insurance information should be verified, the patient’s demographics should be updated, and deductible, co-pays, and co-insurance amounts should be collected.

    1. Be Aware of Changes

    The healthcare industry is ever-changing. Even if you have top-notch billing software that flags for inaccuracies, the billing staff and office workers should be familiar with Medicare and other payer standards. This means subscribing to newsletters, attending conferences, and receiving training as necessary.

    1. Proper Billing Management

    For most billing companies and departments, what does not get measured does not get done. Set up policies and procedures to allow your team to check reimbursement request regularly before they are facilitated to payers. The billing staff should have a daily management system in place to allows for minimal denials and maximized reimbursements. In addition, billing management professionals should track the practice’s claim denial rate and set challenging goals for improved performance.

    1. Investigate all Causes of Denials

    The billing staff should investigate the individual causes for claim denials, and formulate a plan to prevent these issues from occurring in the future. Follow-up is necessary to lessen the impact of multiple claim denials. Thousands of dollars are not received each year when the billing staff does not follow-up and investigate causes for denied claims.

    1. Work on Denials Each Day

    The billing company should have professionals that focus on re-working denied claims each day. This should be a standard procedure for one or more billers. When a claim is denied, it Medical Billing Companydoes not mean it is permanently denied. The billing specialist should reword, and re-work the claim, re-submit it, and attach documentation if needed.

    1. Check your Work

    Because ICD-10 codes and CPT codes are complex, and billing professionals deal with a multitude of codes and numbers, there is certainly potential for error. The smallest billing mistake cold lead to a denied claim. The billing specialists should check and re-check claims before they are submitted, looking for errors, incorrect data, and missing information.

    1. Don’t Miss Deadlines

    The billing arena is complex and difficult to maneuver. Denials are inevitable in this business. However, you can reduce denial rates by being aware of deadlines. There is no recourse if you miss a deadline, and the money is lost and gone forever. Staff must make sure all claims are submitted in a timely manner, and appeals should be sent in before deadlines. A well-managed billing team can increase the practice’s revenue significantly by managing claim denials and meeting deadlines.

    For the top medical billing specialists nationwide, MPMR offers full service revenue cycle management which also includes operations consulting. Call today for a free 30 minute phone consultation!

    Will ICD-10 Coding help Outpatient Procedures?

    This entry was posted in Blog on
    July 13th, 2017

    The International Statistical Classification of Diseases and Related Health Problems (ICD) is now on its 10th revision. There are 68,000 Clinical Modification (CM) codes, and 76,000 Procedure Coding System (PCS) codes in the ICD-10 system. The ICD-10-CM codes are to be used for inpatient and outpatient diagnoses, whereas the ICD-10-PCS codes are used only by hospitals for inpatient procedures. Additionally, coders and billers use the Current Procedural Terminology (CPT) codes for outpatient procedures.

    The Results of the 2012 MedPac Report to Congress

    In 2012, MedPac conducted a study, and issued a report on Medicare Payment Policy. In 2010, ICD-10 Consultantsthe 4,800 hospitals in the Medicare system showed a 9% growth in hospital-based outpatient business. This contrasted greatly with the inpatient volume increase of only 2.7%. Today, outpatient visits make up over 31% of total hospital reimbursement. There are around 40 million people who do not have healthcare coverage in the United States, which means outpatient procedures will be more common.

    The federal government did not change any billing requirements related to outpatient billing. However, some CPT codes used for outpatient billing are now required for noncovered entities. Based on medical necessity criteria, outpatient service reimbursements are restricted by Medicare, and if the diagnosis codes do not support this necessity, the entire claim could get denied. Hospitals and clinics should get the patient to sign an Advanced Beneficiary Notice (ABN) before the patient receives treatment or a service. This will allow the provider to bill the patient if the payer denies the claim.

    Changes with ICD-10 and Outpatient Services

    Outpatient procedures under the ICD-10 codes are not impacted directly, but there are some underlying changes required. The following factors affect ICD-10 outpatient billing:

    • Instead of having 2 sets of documentation with dual code sets, the billing company should have standardization.
    • Fewer mistakes occur given that ICD-10 procedures and diagnosis now demand more documentation.
    • Cash flow loss is avoided as most payers require and reimburse based on specific CPT codes. This includes laboratory services, interventional radiology, and diagnostic tests.
    • Use of specific codes and improved documentation will enhance data collection and be helpful for policy healthcare decisions and reforms.
    • Payers will require submission of codes for claims processing, even though ICD-10 codes may not initially be required for outpatient procedures.
    • High skill sets for the entire coding team is needed, regardless if the specialist is an inpatient or outpatient coder.Top Medical Billing Companies

    Reasons Hospitals Should Use ICD-10 for Outpatient Coding

    The federal government plans to require dual coding in hospitals. This means hospitals will need to have two types of medical billers and coders: Those who know CPT coding, and those who understand ICD-10-PCS coding. Some industry professionals are making the case to code both inpatient and outpatient procedures using ICD-10-PCS. This means that CPT coding will phase out. The two basic concepts are:

    • Standardized data for all procedures.
    • Medical coders will have more scheduling flexibility.

    While CPT codes are still being used, some healthcare payers are urging the government to change the guidelines. Healthcare payers are not the only entities with concerns. Some data collection agencies and medical registries may eventually require ICD-10-PCS codes. Outpatient coding productivity may decrease with this change, and continuing education and training will need to be budgeted. There is also concern about the increased documentation requirements associated with ICD-10-PCS.

    Medical Practice Management Resources offers nationwide medical billing, coding and operations consulting as well. MPMR works with all medical specialties along with ambulatory facilities as well. Call us now for a free 30 minute phone consult!