The 1996 Health Insurance Portability and Accountability Act (HIPAA) established national privacy and security standards for electronic health care transactions, including a national identifier for providers, health plans and employers. Accordingly, by May 23, 2117, healthcare providers and all health plans and clearinghouses must change both their processes and information systems to implement HIPAA’s National Provider Identifier (NPI) regulations.
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Poor health care provider’s data quality affects virtually every aspect of health care payer’s enterprise, diluting profits and member goodwill. Successful transition to NPI impacts eligibility and authorization processing, provider enrollment, contracts and directories, claims adjudication and payment, referrals, and reporting and presents a unique opportunity for added automation, improved data accuracy, lower fraud and abuse, and streamlined operations.
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However, until recently, the use of Excel for medical billing analysis has been limited because of the difficulty to produce effective ad hoc reports and inability to export data into Excel. Vericle lifts the limitation with its integrated medical billing reporting and a 2-step Excel export capability.
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Mistaken payments add up to an estimated $211 billion, exceeding 11% of national healthcare costs. A payment scrutiny program to avoid mistaken payments can be as successful a profit-building strategy for insurance companies as raising premiums or adding members. However, avoiding mistaken payments is hard because of the volume of claims, the disparate and disconnected sources of relevant information, the resource-intensive manual processes needed to identify and investigate recovery opportunities, and regulatory requirements for timely payments. A full-scale implementation of payment scrutiny strategy requires sophisticated processes to handle prepayment claim review and post-payment audits and uses advanced fraud detection technology similar to those used in credit card fraud detection.
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The pharmacy Industry has entered the “enterprise era” of electronic technologies for clinical development. Virtually all their clinical trials use electronic data capture (EDC). As Electronic medical records (EMR) become more prevalent in offices, Clinics and hospitals; clinical sites and sponsors work towards integrating the collection of Clinical trials and EMR data.
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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. Computer aided coding with integrated superbill completes the transformation of coding from individualistic art towards disciplined and systematic process.
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A new industry of high-technology medical billing has mushroomed under the auspices of its promise to streamline the collections process and leave doctors with more time to care for their patients. Though many high-quality services and systems exist, an overwhelming variety of options and attractive (yet unsubstantiated) performance claims from some providers have charmed busy doctors into making poor strategic decisions for their practices. Collaborative billing knowledge base improves medical practice profitability and compliance.
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August Billing Performance Index (BPI) underperformed July value by 8.7%, replacing six participants in the list of top ten performers and dropping the index from 15 down to 16.3. This article reports a third iteration of a prototype for a rule-based chiropractic billing index, including its coverage definition, update cycle, volume weighting, and provided information.
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Dr. Ben Lerner, founder of Teach The World About Chiropractic and author of “One Minute Wellness,” discovered a convenient way to educate thousands of chiropractors about coding compliance and audit risk reduction. “Compliance maintenance requires special skills and military discipline,” says Dr. Lerner. “Webinars are ideal for audit risk management instruction because they deliver urgently needed education but require minimal investment in terms of time and cost.”
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In our world where data is power, large companies put a high priority on their data back-up and data storage. Unfortunately, this kind of data storage is typically very expensive and impractical for the small home PC user…
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- April 2007 (75)
