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Increase Patient Collections with these Simple Tips

5/19/2023

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At Priority Medical Billing, we work with our providers to maximize their revenue. One way in which we do this is help them organize their office intake and check in process to ensure they are collecting balances due from patient.

As a healthcare provider, collecting patient payments can be a challenging task, and it's easy to understand why. It's tricky to approach patients and ask for money while still providing excellent medical services. However, this is a critical aspect of your practice, as unpaid bills reduce your revenue and affect your ability to deliver quality care to your patients. Below are the top tips for healthcare providers to increase patient collections.

Communicate Clearly:
Patients will not pay their bills if they don't understand what they are paying for, or why they need to pay. Healthcare providers need to communicate with their patients clearly about their medical diagnoses and treatment procedures. Providing detailed instructions about their invoices and appointment fees can help avoid any misunderstandings that could lead to unpaid bills.

Verify Insurance Coverage: Before any medical service is rendered, verify your patient's insurance coverage. This way, you will have a clear understanding of the services that are covered and those that aren't. Knowing the limit of their insurance plan and out-of-pocket expenses will assist you in communicating a ballpark range of what they will owe for the service. It will also allow you to obtain authorization on services where it is needed. 

Use Electronic Payment Methods:
The use of electronic payment methods such as automatic credit/debit card payments or online billing makes it easier for patients to settle their bill. Patients appreciate the convenience and safety of electronic payments and this will increase your chances of getting paid.

Offer Payment Plans: Occasionally, patients may be unable to pay their bills in full or on time for various reasons. It is important to have a payment plan that will assist them in making regular payments that will eventually clear their medical bills. Offering the patient a payment plan with genuine flexibility can greatly improve their financial comfort and improve the likelihood of collecting in the long run.

Have a Clear Collection Policy: Having a well-defined collection policy that outlines the consequences and expectations can help patients understand exactly what they are expected to do if they cannot pay their bills on time. This can also help prevent any tension or misunderstanding from the patient's side and lead to amicable solutions.

Collecting payments from patients can be a daunting task for healthcare providers, but a few effective steps can make the process much smoother. Communication, verification of insurance plan coverage, electronic billing, offering payment plans, and a clear collection process will help providers collect payments efficiently while offering high-quality healthcare services.

If you are looking for a medical billing company to help you maximize revenue from not only insurance companies, but also through patient payments, contact us at billing@myprioritybilling.com or call 708-362-6080 for more information on the services we offer our providers! 

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Benefits of Neuropsychology Testing and The Importance of Accurate Coding and Billing

4/21/2023

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As a healthcare provider, offering neuropsychology testing services can be extremely beneficial for your patients who are struggling with cognitive or behavioral issues, if you know how to bill it correctly.

The coding and billing for this service is more complex than a basic visit, especially if you want to maximize revenue from testing.


Neuropsychology testing involves the evaluation of cognitive and behavioral functions such as attention, memory, language, problem-solving, and decision-making. These assessments are typically administered by a licensed neuropsychologist and can be used to diagnose conditions such as traumatic brain injury, dementia, and ADHD.

When it comes to medical billing for neuropsychology testing, there are a few key considerations to keep in mind.

First, specific codes must be used to accurately bill for these services. For one test to be completed, there could be as many as 7 different codes billed. These codes describe the length and complexity of the evaluation, as well as whether the testing was done with a computerized device, if a technician was present, and how long it took to interpret the results.

Another important consideration is the role of insurance coverage. Many insurance plans will cover some or all of the cost of neuropsychology testing, particularly if it is deemed medically necessary. When it comes to billing the testing, you have to know whether to send it to medical insurance or the behavioral health insurance. Navigating the various insurance rules and requirements can be a time-consuming process, unless you work with a medical billing team that has experience doing this type of billing.

To maximize reimbursement for neuropsychology testing services, healthcare providers may need to obtain authorization for the testing before administering it. It is also important to ensure that they have accurate documentation of the tests administered, the reasons for the testing, and the results. This documentation should be included in the patient's medical records, and may be requested by insurance companies to support the billing claim.
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Additionally, it's important to stay up-to-date on changes to billing codes and regulations, which is something a qualified billing team should be able to do for you. 

In general, neuropsychology testing can be an important tool for diagnosing and treating cognitive and behavioral disorders. However, accurate and effective medical billing is essential for healthcare providers who offer these services. By staying informed and organized, healthcare providers can ensure that they are providing high-quality care to their patients while also being reimbursed fairly for their services.

At Priority Medical Billing, we have been billing Neuropsychology testing for over 10 years now and we pride ourselves in maximizing revenue from these tests through working with our providers to ensure they are being billed accurately.
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If you believe you should be making more from offering neuropsychology testing or if you are not sure how to approach the billing, reach out to us at billing@myprioritybilling.com and we would love to help you out! 


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Common Mistakes in Medical Billing and How to Avoid Them

3/21/2023

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Medical billing can be a complex and confusing process, often resulting in common errors that can lead to denied claims or even accusations of fraud. These mistakes can be costly for both patients and healthcare providers, so it's important to understand the most common errors and how to avoid them.
Here are some of the most common mistakes in medical billing and how to avoid them:
  1. Coding Errors. Coding is a crucial part of the billing process, and it's easy to make a mistake when assigning diagnosis and procedure codes. Some of the most common coding errors include:
• Incorrectly reporting the wrong diagnosis code on the claim form.
• Not using the correct modifier for a procedure, which leads to confusing the insurance company.
• Billing for unnecessary procedures, leading to accusations of fraud.
To avoid coding errors, it's essential to double-check every code before submitting a claim. Make sure that you are up-to-date on the latest coding guidelines and regulations.
  1. Failure to Verify Insurance Coverage. Before a patient receives any medical service, it's essential to verify their insurance coverage. Many claims are denied due to unverified insurance coverage, leading to patients having to bear the financial burden of medical costs.
To avoid these issues, always verify a patient's insurance coverage before conducting any medical procedures or services. You can verify coverage by confirming the patient's eligibility through the insurance provider's online portal or contacting them directly.
  1. Incomplete Documentation. incomplete documentation can lead to denied claims or cause delays in the billing process. It's essential to ensure that all necessary documentation, such as medical records, lab results, and physician orders, is complete before submitting a claim.
To prevent incomplete documentation, establish a process that ensures the completeness of all documentation. This could mean double-checking records before submitting a claim or using an automated system to track documentation requests.
  1. Failure to Appeal Denied Claims. Denied claims can be frustrating, but they can also be appealed. Many healthcare providers fail to appeal denied claims, leading to lost revenue and dissatisfied patients.
To prevent this, establish a process for appealing denied claims. Understand the appeals process, and keep track of all communication with insurance providers. Also, ensure that all necessary documentation is submitted when appealing a claim.
Medical billing is a complex process that requires attention to detail and an understanding of coding, insurance coverage, and documentation requirements. By avoiding common mistakes, you can ensure timely payments and maintain positive relationships with patients and insurance providers. Stay up-to-date on the latest coding guidelines and regulations, and establish processes to ensure that all necessary documentation is complete and accurate before submitting a claim.

At Priority Medical Billing, we ensure that all of our providers stay up to date on the most current regulations to ensure that claims are processed correctly the first time. 

Contact us at Billing@myprioritybilling.com to schedule a free consultation to discuss how we can help you bring in more revenue on a monthly basis.


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Benefits of Outsourcing Your Medical Billing to Priority Medical Billing Inc.

2/15/2023

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There may be a million reasons why you decided to go into the medical field, but it's likely due to wanting to help people. What they don't tell you in medical school is how time-consuming billing insurance companies, and actually getting paid to do what you love, can be. With all the recent medical billing and coding updates, a medical billing company providing revenue cycle management services has become a necessity. Operating efficiently is now more a matter of survival than it is a good business sense. When partnering with Priority Medical Billing Inc., you get peace of mind that your medical billing needs are met with a human touch. PMB Inc. has built an extraordinary reputation on being responsive, flexible, and most of all, accountable. Like most reputable medical billing companies, we are also HIPAA compliant.

Priority Medical Billing Inc. has a team of dedicated and highly experienced medical billing professionals who are well-versed in all aspects of medical billing and collecting. The PMB team stresses quality over quantity to concentrate on providing the best services for each individual client.

Below are 7 ways in which outsourcing your billing to Priority Medical Billing Inc. will benefit your practice:

1. Reduce Overhead Costs:
We don't get paid unless you do.

We provide all the billing functions of an in-house billing team without all the headaches and expenses. We cover all the expenses needed to bill and collect your payments including, but not limited to, clearinghouse fees, billing software and hardware upgrades, HIPPA and HITECH compliant firewalls, and patient billing expenses. Your only responsibility is to pay a small percentage of your total collections each month. We don't get paid unless you do!

2. Eliminate Medical Billing Headaches: 
We stay up to date on insurance changes.
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The only thing we need from you is patient information, insurance information, either a superbill, diary, or a copy of your schedule for the day. If you already have a practice management system you like to use, PMB will work with your existing billing system. If not, we have our own billing software and clearinghouse that we will use. We will create and track all claims, submit electronically, receive electronic remittances, and generate patient statements. Claims follow-up and reviews are done either monthly or as situations arise. We will give you advice and recommendations on which insurance companies are best to work with for the specific field you are in, and we will let you know which ones may be more difficult to work with. PMB will also keep you informed of insurance changes that are coming and let you know what needs to be done before the deadline.

3.Gain Control and Stay Informed:
We keep you informed on your practice flow.

You decide what type of information you need to see and how often you would like to see it and we will figure out which report will deliver that information to you best. We send standard monthly reports at the end of every month, which will give you a complete breakdown of how your practice is doing. We can easily generate various reports you may need at any time during the month upon request. PMB will also keep you informed of any problems with patient accounts (i.e. policy terminations or inaccurate insurance information). This will allow your staff to know when they need to obtain the patient's updated insurance information or collect payment at their visit.

4.Get Paid Faster and Consistently:
You get paid faster.

All billing is entered in our system and submitted within 48 hours after it is received. We submit all claims electronically unless an insurance is unable to receive electronic claims. Our electronic claims go through several audits through our clearinghouse and are rejected for incorrect information or policy terminations within 2 days. The rejected claims are then researched, corrected, and resubmitted immediately leading to no delays in payments.

5. Increased Collections:
You receive expert analysis on your practice.

Upon our clients request, we will analyze and make insurance network recommendations that will maximize reimbursement for your practice based on our 20+ years of experience.

6.Improve Patient Satisfaction:
We keep your patients informed on their statements.

When an upset patient comes into your office, you can simply direct them to us. With our friendly, personable billing staff, we can calm down any upset patients by providing detailed explanations on why they received a bill. If a non-compliant patient calls your office about a collections notice, we will handle those calls as well.

7. Personalized Attention:
We realize every provider is different. 

 We know, and understand, that every provider is different. We work with YOU to figure out the best systems needed to make your billing as efficient as possible. We can help give personalized recommendations to assist you in streamlining your work flow and communications. This will help in your office operating more efficiently, and allow you to be able to focus your time and energy on patient care.

Bottom Line:
Priority Medical Billing Inc. is your best option
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It is clear that working with PMB is the best, and most cost-efficient route to take in order to direct your attention to the area of your practice you enjoy most, treating patients. Choosing PMB as your billing service will reduce your stress, save you time, and lead to an increase in happy, satisfied patients. Just as you are a specialist providing services in your practice, we are specialists in medical billing. We make it a PRIORITY to provide only the best, individualized services to our clients and their patients.
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New Year, New Deductibles: How to Increase Your Cash Flow in 2023.

1/1/2023

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Welcome to 2019 and all the fresh deductibles that need to be met before insurance will pay. This means, for the next few months, your incoming cash flow will be based largely on how much your patients are willing to pay you. By 2020, it is expected that 95% of patients will fail to fully pay off medical bill balances based on the trend of only 68% of patients paying off their medical bills in 2016. As scary as that statistic is, it becomes even scarier when you also consider that the average out of pocket healthcare spending is expected to grow from 416 billion in 2014 to 608 billion in 2019. With these statistics in mind, also consider that according to the health care services distress research index, health-care bankruptcy filings have more than tripled in 2017. What does all this mean? It means that for the foreseeable future, patient collections will be representing a substantial part of the incoming cash flow for providers and they are incurring expenses they cannot pay for. Are you still with me? Good. Now take a deep breath and read on to see what steps you can take to ensure that you cash flow is not affected by these statistics.

3 easy steps to increasing cash flow in 2023:

1. Collect insurance information over the phone when the patient calls to schedule their initial appointment and verify patient benefits and eligibility before their visit.

Patients are expressing an increased interest in wanting to know their medical bills ahead of time. According to an Instamed survey, 88% of patients are now wanting to know their payment responsibility upfront. This is so important to them that 65% of patients expressed that they would be willing to switch providers if it meant they would be informed of their healthcare costs upfront. 75% of patients say that if they fully understood their out-of-pocket costs, their ability to pay for healthcare would be improved. Of course it is not possible to provide 100% accuracy upfront when it comes to what the patient will end up owing, but it is possible to find out exactly what their copay and deductible are, along with status of the provider being in or out of network. Insurance companies have followed this increasing need to know healthcare costs upfront by making it easy to check eligibility online. When the patient comes in for their first visit, clearly and concisely explain their financial responsibilities before they see the provider. This simple strategy will dramatically increase patient collections.

2. Educate your front desk staff on how to discuss copays with patients and reinforce the expectation of paying copays before the visit.

People enjoy routine. If the expectation to pay copays before the visit is explained from the beginning, and continually collected, the patient will be a lot less likely to get upset.  If this is not something your current patients are used to, then it is important for the front desk staff to be polite and communicate to every patient why this new policy has been set in place. Having a sign explaining this new policy will help front desk staff to feel more comfortable reinforcing it. With patient out of pocket costs rising, this is more important now than it has ever been. For convenience and ease, keeping credit cards on file for copays would help with this transition. It is a lot easier for someone to say “yes” and sign off on a charge to their card than it is for them to hand a card over. Consumers are used to paying for services up front and if the precedent is set from the beginning, going to the doctor will be no different.

3. Designate a staff member to speak with patients about outstanding balances.

Although this may be uncomfortable, with clear communication and professionalism, it can be done without conflict. Conflict and frustration will only arise when a patient does not fully understand their responsibility. Educating and training your staff to collect outstanding balances while the patient is on site is vital. Staff incentives may also help in motivating staff members to collect from patients. Keeping patient credit card on file to be charged up to a certain amount per visit may also aid in outstanding balance collections. 20% of patients say that a credit card on file would be their preferred method of payment for up to $200.00. An amount can be determined once insurance benefits are verified. Payment plans can also be agreed upon to help in consistency of payment on larger balances. Once a patient is sent to collections, according to the ACA International’s Top Collection Market Survey, it is shown that only 21.8% of the balance is actually collected and so this should be avoided at all costs, by collecting balances, copays, and deductibles up front.
 
It is becoming increasingly important to collect copays, deductibles, and outstanding balances from the patients at the time of visit. On average, more than 30% of patients walk out of a medical practice without paying anything and, once they walk out, patients are 50% less likely to pay their bills after they leave. By setting policies in place requiring copays to be collected upfront and by educating and training your staff on how to communicate with patients regarding outstanding balances, you will be able to increase your accounts receivable and ensure that your practice continues to thrive in this new year and this ever changing insurance market of increasingly high patient out of pocket costs.

 
 
References:
Biehle, Sean. “2018 Medical Billing Statistics.” MedData, 30 Oct. 2018, www.meddata.com/blog/2017/10/26/medical-billing-statistics/.
Cleargage. “How to Increase Patient Collections in Your Practice.” Cleargage, 31 May. 2018, cleargage.com/how-to-increase-patient-collections/.
Shipp, Ginny. “MGMA18 The Financial Conference.” Navicure, 2018, MGMA18.org.
Trends in Healthcare Payments. (2017). 8th ed. Philadelphia: InstaMed.
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Welcome!

10/1/2022

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Welcome to Priority Medical Billing, Inc.  We are excited to launch our new website and new overall look. Periodically check back for new updates to this blog. We will be providing all providers with the newest and most updated insurance changes and information on how to collect the most money in their practices. Happy Collecting.   :) 

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Articles of Interest

5/1/2019

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Click the Headline Below to Learn More:

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1 in 3 Americans Frustrated with Patient Billing, Collections
Healthcare consumers are unhappy with current patient billing and collection processes and they are calling for more digital, convenient options, a new survey shows.
By: Samantha McGrail


​8 Key Questions to Ask Before Hiring a Medical Billing Company.
Outsourcing your billing activities makes senjse for many medical practices, but finding the right billing service can be time consuming and hit or miss. Here are some essential questions to ask the companies you are considering.
By: Michael Sculley




Patient Financial Experience Improving, But More Work to Be Done
Leading health systems are prioritizing patient financial experience optimization, but the organizations are not quite consumer-centric just yet, a study finds.
By: Jacqueline LaPointe


Proposed Hospital Price transparency Rule Faces Industry Criticism.
The AHA, FAH, and othetr major industry groups opposed newly proposed hospital price transparency requirements, which would mandate the disclosure of negotiated rates.
By: Jacqueline LaPointe
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​Doximity Charts the top 15 Medical Specialties embracing Telehealth.
The online professional medical network has released whats billed as the first-ever survey of specialties showing and interest in telemedicine - and those with less enthusiasm for connected health
By: Eric Wicklund

Breaking Down Different Proposals to Address Surprise Medical Billing.
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Healthcare policy makers and lawmakers are working on legislation to address surprise medical billing, leading to much industry debate.
By: Sara Heath



​Healthcare Business Office Experience Impacts Patient Collections.
Negative healthcare business office interactions result in consumers delaying patient financial responsibility payment in full, a new survey shows.
By: Jacqueline LaPointe

White House Announces New Healthcare Price Transparency Order
An Executive Order will make it easier for HHS to expand healthcare price transparency regulations to include negotiated contract rates.
By Jacqueline LaPointe



Focusing on Patient-Centricity, Experience to Drive Patient Loyalty
Driving patient loyalty is a complex task, asking organizational leaders to focus on the business priority as well as patient-centered care experiences.
By: Sara Heath
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​Strategies for Effective Cost-of-Care Conversations with Patients
Cost estimates, scripts, and cost distress screenings are top ways providers can have cost-of-care conversations that boost collections and outcomes.
By: Jacqueline LaPointe

Lawmakers Sprinting to Address Surprise Medical Bills
Congress is moving quickly to address surprise medical bills, but lawmakers cannot agree on whether setting payment rates or arbitration is the right solution
By: Jacqueline LaPointe


A Rural School District Uses Telehealth to Access Mental Health Care
Students in rural Dickinson, ND, will soon be able to use telehealth medicine to meet with a psychiatrist hundreds of miles away. The virtual care platform augments the district's available counseling resources.
By:Eric Wicklund
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Health Providers Slipping on Consumer Experience, Patient Payments 
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A new report outlined provider pitfalls when creating a positive consumer experience during patient payments Congress 
By:Sara Heath






  





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Telehealth and Telemedicine: Convenient Patient Treatment

4/9/2019

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The use of telehealth and telemedicine to treat patients is increasing at a staggering rate, due to the convenience it provides for both the provider and the patient. Almost half of all healthcare professionals plan to integrate telehealth into their practice by 2020.
 
So what is it?
Telemedicine and telehealth are considered synonymous. They are used interchangeably to essentially describe the use of electronic information and telecommunications technologies to support clinical health care, patient and professional health-related education, public health and health administration.

As for the definition that really matters, The Centers for Medicare & Medicaid Services (CMS) define it as “a two-way, real- time interactive communication between a patient and a physician or practitioner at a distant site through telecommunications equipment that includes, at a minimum, audio and visual equipment.”
 
What does this mean?
This means that patients no longer have to physically show up at an office to receive care! They can receive care from the comfort of their home. Originally telehealth services were growing at a slow rate due to Medicare’s very narrow coverage for these services. As of 2019 this is no longer the case, CMS has not only added more codes to account for a multitude of telehealth services, but they also removed the “originating site geographic requirement for telehealth services targeting treatment of substance use disorder or a co-occurring mental health disorder” While this was removed mostly to aid in combating the opioid crisis, it can realistically double the volume of individuals who receive care via telemedicine in the behavioral health field! With CMS making these changes to allow for easier patient care and coverage through telehealth, it’s only a matter of time before other insurance companies jump on board. (If they haven’t already)

Giving Telehealth some serious thought now? Here are some Pros and Cons of offering Telehealth services.
 
Pros:
  • Convenient and accessible healthcare for patients - It allows patients who live remotely, are homebound, have contagious illnesses, or simply can’t take off work to access care from virtually anywhere.
  • Healthcare cost savings - Remote analysis, monitoring services, and electronic data storage significantly reduced healthcare costs for providers, patients, and insurance companies.
  • Extended Specialist or Referring physician Access - Providers would be able to refer patients to the specialist they need, regardless of location. This also means that providers will have access to treating patients from a larger geographical area.
  • Increased patient engagement and quality of care - When patients know how to easily reach out to their physician, they are more likely to become attentive to issues they are having rather than disregarding it due to not having enough time to go in for an appointment.
 
Cons:
  • Technical Training and Equipment - In order to effectively implement telehealth in your practice, your staff needs to be trained correctly in order to ensure maximum return on investment. If this is done properly, the cost of implementing it will be minimal. This can also lead to a decrease in staff.
  • Medical Record Access - On demand telehealth services, where patients can be connected to a random telehealth provider, is only great if there is an effective EHR system in place for providers to access all of the patient’s records.
  • Fewer In-Patient Consultations - In some instances, it is best to treat someone in person.
  • Internet Connections - The real time audio and visual requirement means that there will have to be a strong internet connection to communicate effectively.
  • Policy and Regulation Rules - Healthcare laws, reimbursement policies, and privacy regulations have struggled to keep up with the increasing demand of telemedicine services. The change in Medicare has been a huge step in the right direction.​

The list of ‘cons’ related to telehealth can easily be avoided if telehealth is executed properly, which is why so many providers are beginning to integrate this into their practice.
 
To be very clear, telehealth is NOT something any provider can do simply by downloading a platform like skype.
There are specific platforms that need to be used in order to properly treat patients via telehealth, AND you need to become accredited to do so through ATA-CHQI. These telehealth platforms used to be costly for private practices, but that is no longer the case. More affordable solutions for individual practitioners are becoming available to purchase, and large enterprise telehealth services run by payers and health systems are offering options that bring the telehealth capabilities into the hands of all the affiliated individual practitioners.
 
As patients begin to realize how much easier it is to be treated via telehealth, it will only be a matter of time before they are specifically seeking providers that offer these services. Early adopters/providers will have the ability to completely redefine their revenue stream as telehealth gains popularity among patients.
 
Interested in learning more about telehealth?
Start by clicking here to visit the American Telemedicine Association and learn how to become an accredited telehealth provider! I also recommend checking out the links below for more information.

Stay tuned for next months blog where we will continue to provide more information on telehealth or contact us today at billing@myprioritybilling.com for more information!
 
References:
McLaughlin, George. “Telemedicine and Remote Patient Monitoring Trends 2019.” Redox, Redox, 27 Feb. 2019, www.redoxengine.com/blog/telemedicine-remote-patient-monitoring-demand-2019/.

Bennett, Jay Holder. “Integrating Telehealth into Existing Practice.” American Well, American Well, 27 Sept. 2018, www.americanwell.com/integrating-telehealth-into-existing-practice/.
 
“Telemedicine Benefits and Disadvantages, Telemedicine Pros and Cons.” Revisit, EVisit, 25 May 2018, evisit.com/resources/10-pros-and-cons-of-telemedicine/.
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4 Simple Steps to Increasing Patient Payments

3/4/2019

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As we head our way into March, the effects of high patient deductibles and copays are more noticeable now than ever. Incoming cash flow from insurance companies is at the yearly low and, since collecting from patients is often the hardest thing to do, overall cash flow is likely down as well. If this is the case for you, you MUST begin to collect money from patients BEFORE their visit. The health and success of your practice depends on it!

With patient healthcare responsibility being at an all-time high, most patients are experiencing some degree of financial difficulty during this time of the year. We understand that as providers, all you want to do is help people. We also understand that this may make it extremely hard to ask for payment from patients who say they don’t have the money. Unfortunately, you have no other choice but to collect or only see patients who are willing to pay. In this evolving healthcare industry, you are being forced to adapt. In the long run, the consequences of not adapting could be fatal to your practice.


1. Create a payment policy that is clearly written and easy to understand. Do NOT make exceptions to this policy.

Why?
  • By setting a precedent to collect up front, patients will know exactly what is expected of them every time they come in for a visit. It is well known that in order to receive a service, you need to pay at the time the service is provided. The healthcare industry should be no different. In order for this policy to be effective in your office, it absolutely has to be enforced by your or your office staff. As soon as exceptions are made, the whole point of the policy is defeated.
How do you Implement this?
  • Ask us for a sample payment policy document and adjust it to fit your practice.
  • Train your front desk staff on the proper way to ask patients for payment (ie: Do not ask “Do you plan on paying today?” Instead ask “How do you plan on paying for this today?”)
  • Use appointment reminders as outstanding balance reminders. Inform patients of their balance and make it very clear that the balance will have to be paid PRIOR to the patient seeing the provider.
  • Do not hesitate to ask a patient to reschedule their appointment if they do not have a means to pay or if they refuse to pay. Remember, your time is too valuable to offer services for free. 
By reinforcing a strict "payment at the time of service" policy, you are creating clear communication with your patients on what is expected of them, if they want to use your services. If they aren't willing to pay at the time of service, they were more than likely never going to pay anyways.

2. Give multiple payment options including: Venmo, Chase Quickpay, Check, Cash, Credit Cards, and the option to pay online at home (ask us about this service).

Why?
  • Patients want to go digital- 65% want to be able to pay healthcare bills online according to the 8th annual instamed healthcare report.
  • Using hard earned money to pay for bills is hard enough. Make it as easy as possible by allowing for a variety of payment options that will allow the process to be automated.
How do you implement this?
  • Create a sign you can put up at the front desk listing all the methods of payments that are accepted. This will help eliminate the excuse of “forgetting their checkbook at home.” because you will have other methods of paying as an option.
  • Find a credit card processing system that has an online portal that patients can log into at home to pay. BillFlash has this and we provide a url on every patient statement that gives patients the choice to pay at home online, it also allows us to set up digital payment plans.
  • Stay up to date with the times and create a Venmo and Zelis (chase quickpay) account as another way to accept cash payments
By accepting a variety of payment methods, you are showing patients that you are willing to work with them to make paying for services as easy as possible.

3. Offer automatic patient payment options by keeping credit card information on file.

Why?
  • It is a lot easier to collect from patients when the patient doesn’t have to physically hand over their credit card or money to the provider. Saying “yes, you may run my card on file.” Makes the whole process a lot easier.
  • Sometimes, patients are truly unable to pay upfront for a service, yet are unable to wait until they have the full amount. This is when a payment plan would come into use. You can enforce the “payment due upfront policy” by accepting a portion of the payment upfront and putting their card on file to charge the remaining balance at a later date.
How do you implement this?
  • You need to find a credit card processing system that allows for cards to be saved on file. We recommend BIllFlash to our providers as it communicates with our system to update patient balances when statements are sent out. They also allow for cards to be kept on file for automatic payment, approval only payment, and for setting up automatic payment plans.
  • This is the easiest to implement! When patients say they cannot afford to pay the full balance upfront, you are able to provide them with a solution that will allow them to still receive services! If they aren’t grateful for this and refuse to keep their card on file, they were likely never going to pay anyways.
By offering automatic payment plans or by keeping a card on file, you are being sympathetic to the needs of the patient, without your practice cash flow suffering.

​4. Consider offering a small discounted rate on a large outstanding balance if it is paid in full upfront.

Why?
  • If you do not currently have a strict patient payment policy, this may mean that you have patients with extremely large balances. In order to move forward with the new policy, it may benefit to offer a slight discount for patients who are able to pay a large amount up front.
How do you implement this?
  • This is another easy one. You simply offer this option to patients with a large balance. It shows the patients that you care enough to do your best to help them pay off their larger balances. Everyone loves a good deal.
By implementing the first 3 steps, you may one day find that you no longer need to implement step 4.

At Priority Medical Billing Inc., our providers success is our success. This means we are always willing do everything in our power to help in increasing cash flow for every one of our providers. Are you feeling overwhelmed on how to begin implementing these practices? We are here to help! We offer step by step procedures to help our providers slowly begin to implement these new methods of collecting payment. We offer sample office policies, information on BillFlash, and sample scripts (that will help teach your front desk staff how to handle patients who are unwilling to pay). If you are one of our providers and would like to hear more, contact us for more information.

If you are not one of our providers, but are interested in becoming one, reach out to us at sales@myprioritybilling.com to get more information!
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Discounting Deductibles and Copays. Is it Legal?

2/4/2019

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The short answer? No. The long answer? No, but of course there are always exceptions. As a provider you can protect yourself, and your relationship with the patient, by fully understanding why this is NOT okay to do.

Let’s first look at the financial health of most Americans.
  • According to a 2017 Market Watch report, nearly half of American households live paycheck to paycheck. What makes this even more interesting is that only 1 in 5 people who claim to be struggling financially actually fall below the poverty line. My point? It’s a hard fact to face, but a majority of people are struggling with money because they simply don’t know how to manage it. If providers were to give discounts to half of their patients that claim they are financially struggling, because they live paycheck to paycheck, then we wouldn’t have many providers in business. If the business reasons are not enough to convince you to collect deductibles and copays, lets go over the legal side of it.

Every healthcare provider wants their practice to be successful, but this is also a field of work where the main priority is helping people. This leaves the healthcare provider with a hard choice when a patient asks for a discount due to financial hardship. It is easy to view giving a discount as a harmless and selfless act, and this is how most providers look at it. Unfortunately, discounting copays and deductibles is considered breaking the federal and, in many cases, the state law as well.

In order to understand this better, lets look at the insurance company’s point of view
  • Any patient with insurance has already legally agreed to their copay and deductible benefits, which means they MUST pay both or they are breaking their agreement with their insurance.
  • Any provider who is in network has also contractually agreed to accept the in-network benefits for that insurance, which includes billing the patient for deductibles and copays.

With these facts in mind, lets put this into play using simple math.
  • If a provider charges $100.00 for their service and the patient has a $20.00 copay, the insurance will pay $80.00 and the patient will be responsible for the $20.00 copay. If the provider chooses to waive this copay, the insurance can easily consider this fraud since the provider is technically choosing to only charge $80.00, even though they billed the insurance for $100.00.

Why is this fraud?
  • Because if the provider had only billed $80.00 to the insurance, the insurance would have only paid $60.00 and would have left the patient to pay the $20.00 copay. In the insurance’s eyes, the provider is technically lying about their service fee to receive a greater benefit. If the insurance finds out about this, it is legal for them to request this amount back, reprocess all the claims for the provider, and drop the in-network contract due to non-compliance. The same scenario applies to deductibles.

Waiving copays and deductibles is especially unlawful when it is a routine adjustment taken at every visit.

As stated by OIG Guidance Special Fraud Alert released on December 19th 1994, “Routine waiver of deductibles and copayments by charge-based providers, practitioners or suppliers is unlawful because it results in (1) false claims, (2) violations of the anti-kickback statute, and (3) excessive utilization of items and services paid for by medicare.”

So what can you do when a patient can TRULY not afford to pay their bills?
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The truth is, financial hardship can be real and if this is fully documented to support the financial hardship of the patient, you will be in a much safer position as a provider should the insurance company find out.

Below are some things you can do to ensure proper documentation according to Liles Parker PLLC Attorneys & Counselors at Law:
  • Documentation is KEY. Document everything in this process.
  • Develop a policy and procedure for determining patient financial hardship and stick to it.
  • This policy and procedure should include FULL documentation of financial hardship, along with a waiver.
  • These waivers with full documentation should be updated annually and include the most recent federal poverty level guidelines.
 
Not only will this policy of providing financial hardship help keep you safe as a provider, it will also allow you to see the truth behind if the patient is struggling financially or if they are simply bad at managing finances.

At Priority Medical Billing Inc. we understand that it can be hard to gather all the information needed to create a waiver that includes all the documentation needed. In order to make this easier for our providers, we are providing sample waivers with the most recent poverty guidelines to any of our providers who may be interested.

E-mail us at billing@myprioritybilling.com to obtain a sample waiver!

Legal Disclaimer: The information contained in this site is provided for informational purposes only, and should not be construed as legal advice on any subject matter. You should not act or refrain from acting on the basis of any content included in this site without seeking legal or other professional advice.

Resources:
Ambury, T. (July 2017). Legal Compliance: One More Reason to Collect Patient Deductibles and Copays. Retrieved from https://www.webpt.com/blog/post/legal-compliance-one-more-reason-to-collect-patient-deductibles-and-copays
Debt.com, LLC. (January 2019). Personal Finance Statistics. Retrieved from https://www.debt.com/statistics/
Kocher, H. (April 2015). Discounts and Waivers—When are They Permissible or Likely Illegal? [Power Point Slides]. Retrieved from www.lileparker.com
Redmond, M. (June 2018). Is Your Doctor Breaking the Law? The truth about waiving co-pays revealed. Retrieved from https://www.medicalbillingstudycourse.com/tips/truth-about-waiving-copays/
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