Monthly Archives: October 2023

Titus Schleyer, DMD, PhD, Director of the Center for Biomedical Informatics at the Regenstrief Institute in Indianapolis, Indiana, offers valuable insight for those contemplating signing a new EHR system vendor agreement:

“Transitioning to a new system represents a substantial investment, and it can significantly impact the viability of your practice when you’re allocating hundreds of thousands of dollars every few years for a new system. So, exercising caution and meticulous preparation are paramount for a successful transition.”

Before you take the leap, it’s crucial to conduct your due diligence. To ensure that you’re making the right decision, incorporate the following essential inquiries into your discussions with potential EHR system vendors:

1. Data Migration: The process of migrating data from your current EHR to a new system is a monumental undertaking. As Daniel’s experience underscores, manually inputting data for an entire week to ensure accuracy can lead to temporary practice disruptions. To avoid such complications, pay close attention to data migration in the EHR system vendor agreement by seeking answers to the following questions:
   • What is the estimated timeframe for completing data migration, and is it possible to migrate data incrementally?
   • How does the system ensure the accuracy of the data migration into the new vendor system?
   • Does the vendor possess the capability to integrate data from various sources, such as the billing system, LIS, RIS, PACS, and medical devices? If these details are not explicitly stated in the agreement, it is advisable to seek clarification directly from the vendor.
2. Billing Process: The billing system serves as the lifeblood of any practice. Disruptions or disorganization in this area can jeopardize your entire operation. Therefore, it’s imperative to confirm that the following aspects are well-delineated in the agreement:
   • Billing capabilities
   • Training procedures
   • Data integration Software training and data integration are pivotal for effectively utilizing a new vendor system in your practice. If these elements are not adequately provided, you may need to enlist the assistance of an external software consultant to ensure the seamless integration of the new EHR system with the medical billing system, incurring additional expenses for your practice.
   Exercise caution! Thoroughly review your vendor system agreement because some vendors may automatically assume responsibility for managing your organization’s billing system after your transition to their service. If you prefer a different provider to handle this, it is essential to promptly communicate your preferences to the vendor and amend the agreement accordingly.

To expedite the medical credentialing process, consider implementing the following steps:

1. Expand Your References (Preferably to Five): Hospitals and healthcare systems often mandate three professional references when evaluating a medical practitioner’s credentials. However, the credentialing specialist responsible for validating these references won’t waste time chasing unresponsive contacts. Listing only three references, especially if one is difficult to reach, can lead to prolonged processing times. By providing five references, you give the credentialing specialist more options to consider, which ultimately accelerates the process.
2. Keep Your Documentation Current Ensure that the following documents are kept up to date:
   • Council for Affordable Quality HealthCare (CAQH)
   • Drug Enforcement Authority (DEA)
   • CLIA Certification
   • Any other ancillary services requiring proof of accreditation
   • IRS Letter Confirming Established Tax ID Number
   • Articles of Corporation (LLC, PA, INC., etc.)
   • License
   • Malpractice Insurance If any of these documents require annual renewal, ensure that the documents provided by your physician are still valid.
3. Initiate the Credentialing Process Early: While the medical credentialing process typically takes 50 to 90 days from the initial application receipt, it could extend to 120 days based on the quality of the application and other factors. Thus, it’s wise to submit your forms early, especially at the beginning of the year. The sooner you begin, the sooner your physician can start working in your practice.
4. Familiarize Yourself with State Credentialing Requirements: Understanding your state’s specific medical credentialing prerequisites is crucial, particularly if you’re establishing a practice in a new location. This includes being aware of any additional fees that may be mandated by:
   • Medicare
   • Medicaid
   • Tricare or V.A.
   • Durable Medical Equipment Regional Carrier (DMERC) Stay informed about your state’s current requirements to facilitate a faster medical credentialing process.

Closing Thoughts on the Credentialing Process:

In some cases, outsourcing the medical credentialing process to a third-party provider can be a wise choice. These companies have established relationships with payers, making them well-versed in common mistakes and errors that can impede the credentialing process.

Accurate and timely submission of medical bills and insurance claims is of utmost importance for healthcare organizations to effectively manage their revenue cycle. Any coding errors or processing issues in claims and bills can prove costly, resulting in claim denials or rejections. Outsourcing medical coding and billing responsibilities to professional companies presents an ideal solution for medical practices and healthcare providers. These companies efficiently oversee every aspect of the billing, coding, and processing procedures, ensuring the submission of error-free bills and claims within stipulated deadlines. Experienced medical billing companies offer a range of services, including:

Coding:

Reputable firms perform medical coding tasks with precision and clarity. They handle medical coding audits, CPT coding, DRG/ICD-9-CM coding validations, and other related coding procedures with exceptional accuracy to maximize reimbursement.

Providers of professional medical billing services dedicate their expertise to various aspects, including the collection of monthly invoices, the computation of self-accounting totals, facilitating fund transfers, and more, all aimed at optimizing revenue for healthcare practices. The primary focus areas encompass:

1. Charge Entry
2. Cash Posting
3. Reconciliation

Accounts Receivable Management: Medical billing firms offer top-notch solutions for managing accounts receivable, assisting medical facilities in resolving credit and collection challenges. These firms deliver expert assistance in:

1. Insurance Collections
2. Patient Collections
3. Follow-up and Collections on Accounts Receivable

Audit and Compliance: Most companies conduct audits on the charges entered by their billing teams to assess the accuracy of data entry and ensure compliance with billing regulations. Additionally, they verify the precision of claims in accordance with carrier requirements.