Have You Heard? We’ve Gone Paperless!

One of the most frequent questions asked by prospective clients is, “How do you receive the charges?” HIPAA compliance is always on the forefront of everyone’s mind, and third-party medical billing requires transmission of protected health information. Email does not meet HIPAA security standards, so the most common method of charge transmissions were fax and courier service.

Seeking to create a more convenient means of transmission for our clients, In Charge Office Solutions has launched a new program this week. We have developed a software program exclusively for our clients that makes uploading charges to our server quick, easy, and secure.

How Does it Work?  keyboard

Clients simply:

  •  Scan their own superbill or use our fillable PDF
  •  Drop the file into a specified folder and double click on the “In Charge Office” icon.
  • The program pulls all files from the folder, encrypts the information, and uploads them directly to our server.

Clients receive immediate confirmation that their files have been received for posting/billing. The program and our server exceed HIPAA privacy and security standards.

Our hope is that this program increases efficiency, cuts down on paper usage, and gives peace of mind that your information is secure.

Sequestration: Have you Felt the Effects?

What does sequestration mean for you and your practice? Most significantly, this means a 2% reduction in Medicare reimbursement for all services provided on or after April 1, 2013. This means that instead of Medicare payment at 80% of the allowed amount, they pay at 78% of the allowed amount. The patient is still responsible for 20%, and the provider of service has to adjust the 2%.

What Does This Look Like?

Prior to
Sequestration
After
Sequestration
Allowed Amount $161.61 $161.61
Medicare Payment $129.29 $126.70
Patient Payment $32.32 $32.32
Provider Paid $161.61 $159.02

 

The difference of $2.59 is not reimbursable by supplemental insurance, and the patient may not be billed for it. This is a “contractual obligation” and is shown on your Remittance Advices from Medicare with adjustment code “CO-223.”

What Does this Mean?

Declining revenue for Medicare providers will affect not only the provider, but their employees and patients as well. Reduction in Medicare fee schedule has become standard, however the additional 2% reduction on top of the usual reductions will become unsustainable for many providers.

The American Medical Association is projecting a loss of up to 766,000 jobs in the healthcare industry due to sequestration, (source: AMA: Sequestration Cuts Cause Real Pain for Medicare Patients, Physicians) and there is no near end in sight to the 2% fee schedule reduction.  Due to the further decline in fee schedule, it is more important than ever to ensure each claim is billed accurately for the highest reimbursement allowable, to keep on top of Accounts Receivable, and to keep communication open with patients on any out-of-pocket expenses.

Patient Billing: A Fine Line

The cost of healthcare for the patient is rising, yet reimbursement for medical professionals is declining. The growth of high-deductible/high coinsurance plans leaves the patient responsible for more and more of their care, even when insured. It is no surprise that medical bills are the biggest cause of US bankruptcies, with many people unable to pay thousands of dollars for an unexpected illness or injury.

If a patient is surprised when they see their bill in the mail, feeling uninformed and overwhelmed by the amount makes it less likely they will pay their portion. Many offices try to mitigate this by adjusting the balance, but this only leads to decreased revenue and essentially, services provided that do not cover the cost of practicing. The converse of this is hard-line collections, and in the medical community, doctor/patient relationship suffers.

Because of this trend, patients are rightfully inquiring what their out-of-pocket expense will be prior to a procedure or service. This information is often difficult and time consuming for a medical office to predict, as it depends on an individual’s specific insurance plan and benefits.

When an office contracts with In Charge Office Solutions, we estimate patient out-of-pocket expense for procedures at the time we confirm their benefit for it. Our clients are then given a “Procedure Authorization and Payment Estimate” form detailing:

  • The patient’s covered benefit.
  • Authorization number, should one be required.
  • The contracted fee schedule amount for the procedure.
  • Estimate of what the insurance plan with pay and what the patient’s responsibility will be, based on the patient’s available benefit information.

A well informed patient PRIOR to the procedure allows for pre-payment, or payment arrangement discussion to begin.