Special Discount on Behavioral Health Continuing Education Courses Exclusively for AMA Customers

26. Jul, 2011 Categories: Therapy Billing Software News by admin 0 Comments

We are excited to announce a special discount exclusively for Automated Medical Assistant customers seeking Continuing Education credits in Behavioral Health. We recently partnered with BehavioralHealthCE (www.behavioralhealthce.com) to arrange a 15% discount on their online courses , which can be used on any course, at any time, for as many times as the user likes.

The online courses offered by BehavioralHealthCE are accredited by the American Psychological Association (APA) to sponsor continuing education for psychologists.  BehavioralHealthCE maintains responsibility for this program and its content. Additional accreditations and approvals can be found here.

If you’re looking to add CE credits to your credentials, be sure to take a look at BehavioralHealthCE and use discount code AMASUMMER at checkout to get your exclusive 15% discount.

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Billing and Coding Basics: An Introduction to CPT and ICD-9 Coding

14. Jul, 2011 Categories: Therapy Billing Tips by susan.carlen 0 Comments

There can be much confusion about billing and coding among clinicians. The rules and guidelines can be difficult to sort out and understand but understanding billing and coding is so vital to the bottom line of payment: if you want to get reimbursed by any third party payer, you must properly code the services you provide to your patients.

Reimbursement for provider services is based on either the provider’s contracted rate in cases where there is a managed care contract in place or the usual and customary rate for non-participating providers. The reimbursement rate is associated with the CPT code. Choosing the appropriate code is, therefore, directly connected to payment so choosing the best and most accurate code for each service ensures optimum payment.

Many variables affect CPT coding from the obvious to the more obscure. Some of these variables include where the services are provided, who provides the service, and the duration of the service. Connected to the CPT codes are Place of Service (POS) codes. Where a service is provided may change the reimbursement amount in some cases with certain carriers.

The description following each code is usually sufficient to make a code choice. However, in some cases, code description leaves too much room for interpretation. In situations where additional information is needed, the billing guidelines provided by the Centers for Medicare and Medicaid Services (CMS) can prove helpful. The following are some examples.

CPT code 90801, Psychiatric diagnostic interview examination. This description is vague. If we look at the CMS billing guidelines for this code it states, “A psychiatric diagnostic interview examination consists of elicitation of a complete medical history (to include past, family and social); psychiatric history, a complete mental status exam, establishment of a tentative diagnosis, and an evaluation of the patient’s ability and willingness to participate in the proposed treatment plan.” This is much more helpful. We can clearly see all the service components the code includes and what information should be documented in the clinical record, an important point we will discuss in more detail later.

Now, let’s look at some of the variables that affect code choice. The first and most obvious is time. Notice the above code, 90801, has no associated time limitation, though most clinicians set aside 45-60 minutes of face-to-face patient time for the initial diagnostic evaluation. Notice that the description does not mention any limitation of place of service. This means that this service can be performed in various clinical settings including the patient’s home. Another limitation often associated with CPT is who is included in the treatment service. In this service, our object of service is the individual patient. Although, the description does not specifically describe “face-to-face” as some other codes do, the term “interview” implies a one-on-one event.

The next set of codes we will review is the Individual Psychotherapy services, codes 90804-90822. Each of these codes includes a time limitation and some include a place of service limitation. When time is a stated limitation, time must be the primary consideration in code choice and time must be clearly documented in the medical record. To choose the appropriate code based on time, the minimum time element must be met in order for the code to be considered valid. For instance, a 55 minute session would be coded as 90806 as would a 74 minute session. The minimum requirements of CPT 90808 (75-80 minutes) are not met. This code is, therefore, not valid for use in this case. Document start and stop time in the record as well as total time for each service performed.

Also included in the description is where the service is performed (office or outpatient facility, partial hospital, inpatient hospital, residential care setting, etc.). A 20-30 minute individual psychotherapy service provided to a patient in an inpatient hospital or skilled nursing facility would be billed using code 90816 rather than 90804. The description for 90816 reads Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an inpatient, hospital, partial hospital or residential care setting, approximately 20 – 30 minutes face-to-face with the patient. Again, notice the specific elements of the code: Place of service, time, and to who services are being rendered are all specified.

This brings us to another element of billing known as Place of Service codes. These 2 digit codes are directly linked to the CPT codes and must match or claims will be rejected by the insurance company. To follow is a sample listing of CPT codes and associated place of services codes. You will notice that some codes can be billed in more than 1 place of service while others are unique to a specific place of service. When a CPT code can only be used in a specific place of service, this information is listed in the code description.

This is just a partial list for the purposes of the example. You will find a complete list of all place of service codes and descriptions as part of some of the resources listed at the end of this article.

The descriptions associated with the CPT codes for individual psychotherapy clearly state that these services are provided face-to-face with the patient. If the patient was not seen, this element was not met. The code cannot be used to report the service. Other psychotherapy codes may be appropriate for use. CPT codes in the range of 90846 – 90857 include services rendered to families (with and without the patient present), multiple family groups, and non-family groups. None of these codes specify time or location limitation and can be used in a variety of settings and for varying amounts of time.

Testing services represent another coding challenge. Testing is billed in hours of time. The exact description reads, “Psychological testing (includes psychodiagnostic assessment of emotionality, intellectual abilities, personality, and psychopathology, e.g. MMPI, Rorschach, WAIS) per hour of the psychologist’s or physician’s time, both face-to-face time administering tests to the patient and time interpreting these test results and preparing the report. “ You will notice that these codes include total testing time, total scoring time, and total report writing time. These three components might not be completed on the same day. The total of all hours can be billed on 1 day or as the units occur over several days. It is appropriately billed either way.

Let’s move on to coding the “why” of the patient appointment. First, let me address the obvious question: What’s the difference between DSM-IV-TR codes and ICD-9-CM codes? For the most part, DSM codes and ICD-9 are the same. The DSM was initially based on the World Health Organization’s ICD-10 coding system and then it was cross-coded to the ICD-9 diagnostic coding system used in the U. S. The major difference between DSM-IV and ICD-9 are code specificity. Most third party payers require diagnoses to be coded to highest level of specificity. ICD-9 lists diagnosis codes to the highest level of specificity whereas the DSM-IV does not. The ICD-9 is therefore the better resource for coding for claims submission and establishing medical necessity. At least until Oct 1, 2013, when ICD10 will permanently replace ICD-9. A detailed discussion about the transition to ICD-10 will be discussed in the near future.

There are some basic rules that should be followed when choosing diagnosis codes. Code why the services was rendered, the primary reason the patient was seen, as the primary diagnosis. Code any co-existing and/or contributing diagnoses second. Remember to code to the highest level of specificity. Do not code any conditions that are not relevant to the patient’s treatment. Regularly evaluate the primary code and adjust or change the code as necessary. Avoid the use of non-specific codes. These codes are identified as “NEC – not elsewhere classified” or “NOS – not otherwise specified”.

While correct coding is essential for getting paid by third party payer, documentation of the patient’s clinical record is just as important. The information in the clinical record must support medical necessity and the rationale for code choice. Specific information should be included in the record each time the patient is seen. Knowing how to properly document the clinical record will protect you if you ever get audited. In a future post, we will address the connection between coding and documentation and the importance of developing a compliance plan for audit protection.

Initial Diagnostic Interview

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Therapy Billing: Evaluating Different Options

10. Jun, 2011 Categories: Therapy Billing Service, Therapy Billing Tips by admin 0 Comments

Therapy billing is one of the most important topics of discussion and debate among therapy professionals today. It is also one of the most important aspects of healthcare in general, as a wide range of new regulatory considerations such as HIPPA are forcing all types of therapy practices to revisit their billing processes. Psychologists, psychiatrists, social workers, licensed professional counselors, physical therapists, occupational therapists, speech therapists, substance abuse counselors, massage therapists, chiropractors, dietitians, marriage and family therapists are all under increased pressure and scrutiny with regards to their billing.

Incorrect therapy billing often results in the loss of thousands of dollars each month to private practitioners. These losses can be so significant that it is not uncommon for a therapist to be reimbursed less than 40% of the actual services charges, and sometimes, not at all! Obviously those types of losses present major hurdles to sustaining a therapy practice.

Many therapists want to concentrate on rendering the services and prefer assigning the billing task to an employee or a billing company. Being successful in private practice can hinge on having the right person with the right tools. An informed person, who knows the best billing techniques and billing secrets, can successfully perform the task of therapy billing and improve the bottom line almost immediately.

How employees using billing software score in therapy billing

Many therapists are always on the lookout for good therapy billing software. They generally select software referenced by colleagues who work in the same profession. The accuracy of therapy billing mainly depends on the person’s understanding of the concept of both the software and billing best practices. A person has to know the right codes and terminologies used in the billing software to truly enjoy all of its features.

The task of therapy billing is complex due to the nature of services, the codes used in different practices, and the many rules promulgated by the various insurance carriers. For example, some services have time-based codes, which mean that if the duration of the service changes, the rate of the service has to change accordingly. A person needs to be aware of such technicalities when preparing the bill.

Many billing tasks are automated in well designed billing software. The billing software has different forms that need to be presented for claims with insurance companies. An employee who is knowledgeable about the procedures and codes related to medical services can successfully handle the therapy billing task and expedite the often daunting task of correctly filling out insurance and other forms.

However, it is necessary that employees are aware of the limitations of the different medical insurance policies. If not, the insurance carrier will reject the claim right away. It is also the job of the employee handling therapy billing to interview the patient when he/she is admitted and make him/her aware of the financial responsibilities that need to be addressed.

Outsourcing therapy billing to third party service providers

Many therapy professionals prefer outsourcing therapy billing to a billing service provider, and with good reason. The service provider handles both billing and collections. The billing service provider also provides the right coding, which ensures that there are no losses to a therapist due to wrong codes. Besides handling the billing, the service provider also communicates with the patient and insurance provider regarding claims. Some of the benefits of these services include:

  • Accelerated payments
  • Improvement in collections
  • Practice management and financial reporting at every stage
  • Round the clock access to patient data and related financial information
  • Billing handled by professionals

With the Automated Medical Assistant, you have the same powerful tool that we use ourselves with our outsourced billing service. Regardless of how much of the billing process you wish to keep internal, this unique online therapy billing solution is affordable, powerful and proven. Register today and find out for yourself how easily you can do your own billing.

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Incorrect Billing Can Create a Huge Dent in Your Therapy Practice Profitability

14. Oct, 2010 Categories: Therapy Billing Tips by editor 0 Comments

Making sure that your receivables reach you on time is critical. Having a huge outstanding balance might look good on paper, but in reality unless you have an effective therapy billing process in place, many of these bills never get paid. In some cases they get paid so late that the administrative costs of following up exceed the payment itself.

A small mistake in your billing could also lead to rejection by the insurance companies, depriving you of hard earned money you can ill afford to lose. Sometimes it could also lead to fraud claims against you.

Correcting any loopholes in your billing system will save you thousands of dollars. It may seem very complicated but in reality just focusing on it for a little while can pay you huge dividends in the long run.

Check to see where your most common billing mistakes occur. Comparing your computerized report with a manually compiled one would tell you where the maximum rejections and denials occur. Then fixing this should be easy.

Communicate with the personnel involved in the billing about the problems. It might be a problem associated with the coding, in which case the coder could be consulted and a solution created. If it is a problem associated with a particular staff member, then evaluating his job responsibilities and correcting them, or in some cases even a reshuffling or reassigning responsibilities may be in order.

Many times billing mistakes occur due to the misunderstanding of the therapist’s instructions by the staff member involved. Confirm their understanding by asking them to repeat your instructions.

It cannot be overemphasized that denials play a key part in the overall health of your billing. Managing denials properly reflects positively on the revenues you generate in your practice. The effect of declined reimbursements by the insurance company and the cost of reclaiming them can cost your business more than just about any other expense. This can be addressed initially by adopting an error free billing process. The amount saved by adapting this process can be substantial.

One of the key factors that help to cut down on billing mistakes is training.  If the errors in your billing system have been identified and changes have been made, it is essential that it is reviewed with the staff involved. Make sure that all the changes have been documented and the staff understands it so that the same errors do not occur again.

Furthermore, it is important to make sure that a review of your billing process is conducted frequently. This will not only ensure that your billing process is in place it will also mean that there is no stress during an audit.

As a therapy professional it is essential that you do not try to take care of the billing all by yourself. Doing too many things at the same time means that you lose focus on your core skills and that is treating and caring for your patients.  Using professional therapy billing software or even getting an outside agency to take care of your billing will ultimately save you money, time and reduce stress. We invite you to take a closer look at our flagship online therapy billing solution, the Automated Medical Assistant, which is also the cornerstone tool that we use for our outsourced billing services at Advanced Billing Solutions. In either case, contact us with any questions and we will be happy to help you find a solution to your needs.

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Why Accepting Credit Cards Can Transform Your Therapy Billing

28. Sep, 2010 Categories: Therapy Billing Software News by editor 0 Comments

By choosing a career as a therapist, you’ve stated to the world that you want to help people.  During your sessions, you shouldn’t have to worry about how you’re going to get paid and the pile of paperwork required in order to receive your fee. Accepting credit/debit cards help reduce your chances of a high-quality client turning into a financial liability who doesn’t pay his or her bill.  There are many other benefits to accepting credit cards in your practice:

1. Increase your cash flow and reduce accounts receivable – getting paid today is always better than getting paid tomorrow, and almost everyone would agree with that.  However, by not accepting credit cards, you’re choosing to get paid later by invoicing and “hoping” they will pay their bill when it’s due.  By swiping their charge card right after your session, you reduce the time it takes to get paid and reduce your accounts receivable at the same time.

2. Double or triple your sales – the reality is that the world is going paperless at an ever-increasing rate.  It’s a proven fact that people will spend more money when they’re using a credit card than when they’re paying cash for their services.  By accepting credit cards, you increase your chances of clients remaining in treatment and selling additional services.  You won’t hear “oh I don’t have money to pay for the extra long session” due to a limited quantity of paper money, and covering your off-hours crisis calls immediately will certainly help your bottom line.

3. Increased trust due to credit card logos – many people trust a business that accepts credit cards more than ones that don’t.  This might not be a factor of whether a business is reputable or not, but if a client sees that someone accepts credit cards then there’s a certain assumption that the business has gone through their bank, had their financials checked out, and is on the straight and narrow.  Your practice could be the most trustworthy business, but a lot of younger people expect credit and debit cards to be accepted and are used to carrying a card rather than cash for their payments.

4.  Less chance of a bad debt arising from accounts receivable – the fact is that some people forget or choose not to pay their bills. By accepting credit cards, you’ll reduce your risk that the person they choose not to pay is your practice.  Since you will be getting paid upon delivery of your service, you will greatly reduce (think almost 0%) chance that someone will stiff you for a bill.

Overall, accepting credit/debit cards in your therapy practice is a smart move.  The increased cash flow alone will pay for the fees that the credit card services will charge, not to mention the reduced postage and paper costs of mailing lots of invoices.  It really becomes a no-brainer when people trust you more and your receive payment at time of service.

If you don’t have the capability of accepting cards right now, we want to let you know that integrated credit card processing is now a feature of the Automated Medical Assistant online therapy billing solution. Read more about it here.

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The American Medical Association Says 20% of Medical Claims are Processed Inaccurately

04. Aug, 2010 Categories: Therapy Billing Software News by editor 0 Comments

The American Medical Association (AMA) recently released its 2010 National Health Insurer Report Card, and for therapy practices that depend on insurance payments for their livelihood it is worth a closer look. The key take away from this third installment of the annual report is that the AMA found that one in five medical claims are processed inaccurately by health insurers, which for the first time benchmarked the overall claims processing accuracy of the country’s largest health insurance providers.

Based on the AMA’s findings, the health insurance business as a whole has about an 80 percent accuracy rate for processing and paying claims. Coventry Health Care Inc. ended up on top of the seven commercial health insurers assessed by the AMA along with a national accuracy rating of 88.41 percent. Anthem Blue Cross Blue Shield completed the list with a national accuracy rating of 73.98 percent.

The AMA estimates that $777.6 million in unnecessary administrative fees could be saved if the health insurance industry boosted claims processing accuracy and reliability by one percent. At the moment, the health care system spends as much as $210 billion annually on claims processing. One new analysis estimated physicians pay out the equivalent of five weeks per year on health insurer red tape. To keep up with the administrative responsibilities required by health plans, physicians divert up to 14 percent of their earnings to guarantee accurate payments from insurers.

To promote a more economical and streamlined payment system, the AMA’s National Health Insurer Report Card delivers a handy overview of how each of the nation’s seven main commercial health insurers can improve their claims processing efficiency. The methods health insurers utilize to process and pay out claims were assessed according to:

• Accuracy. Along with measuring overall claims processing accuracy and reliability, the report card looked at how accurately insurers reported the proper contract fees to physicians. Commercial health insurance providers realized significant improvements over the past three years. Contracted fees were properly reported 78 to 94 percent of the time in 2010, in contrast to 62 to 87 percent of the time in 2008. UnitedHealth showed the biggest improvement in reporting correct contract fees, while Health Care Service Corporation scored the highest. The overall performance of insurers varied substantially by state, ranging from 58.6 to 96.9 percent.

• Denials. The inconsistency found among health insurers in 2008 continued to be shown in 2010. There is wide variation in the frequency of denials by insurers, ranging between .7 to 4.5 percent. Lack of eligibility remains the most frequent cause of claim denials, signaling the need for employers and insurers to help educate patients about the limits of their insurance coverage. Physicians can help reduce denials by making sure all claims are complete and accurate.

• Timeliness. The report determined that insurers’ response time to a claim ranged between five to 13 median days. With the exception of CIGNA, all of the insurers measured last year demonstrated slight increases in the number of days needed to respond to claims.

Every effort you can make to reduce denials, rejections and delays with your billing operations will mean more money to your bottom line. And for therapy practices, your best tool to achieve this is by using The Automated Medical Assistant, the online therapy billing solution created specifically to accommodate the intricacies of therapy practice billing.

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Automated Medical Assistant Now Features Integrated Credit Card Processing for Therapy Practices

22. Jul, 2010 Categories: Therapy Billing Service, Therapy Billing Software Features, Therapy Billing Software News by editor 0 Comments

Advanced Billing Solutions, Inc. now offers state-of-the-art payment processing services powered by TransEngen for credit cards, debit cards and e-Checks – integrated into the company’s Automated Medical Assistant online practice management system. Clients no longer need to leave the AMA system to process patient payments, eliminating the need for expensive credit card terminals and dedicated phone lines. Collecting payment from patients is now easier and more cost effective.

“We’re excited about this new partnership, which brings powerful billing features to the Automated Medical Assistant and offers our clients the ability to shorten their revenue cycle and reduce patient bad debt,” said Advanced Billing Solution CEO and AMA creator Dr. Gary Traub.

In most practices today, some of the most inefficient and expensive challenges revolve around billing and collections. As more health plans shift the cost basis from the insurance company to the patient, out-of-pocket costs steadily rise, and providers continue to experience a significant and very costly increase in patient bad debt. In this economy, collecting a patient’s payment at the point-of-care and storing a payment method to assure collection in the future is more important than ever.

The credit card billing feature is offered to Automated Medical Assistant clients with no application or setup fees. Some additional features include:

  • Allows for quick and seamless implementation
  • Optimizes workflow when processing patient payments
  • Accepts all major credit and debit cards
  • Converts paper checks to ACH transactions to speed processing time
  • Automatically posts payments directly into your patient accounts
  • Frees up desk space – no separate credit card terminals or dedicated phone lines

Also featured is Patient Payment Assurance, or Card On File, which is a convenient and patient-friendly method for securing a form of payment from a patient — for processing at the time of service, after the adjudication of the insurance claim, or for repeat billings. Card on File reduces delinquent self pay and the need to send billing statements to your patients, increasing collections and saving you time and money.

Automated Medical Assistant™ (AMA) is the premier solution for online therapy billing software, therapy practice management software and medical scheduling software. The software is the flagship product of Advanced Billing Solutions, Inc., a health care technology company that provides affordable, user friendly medical billing/practice management software, as well as billing and practice management services for therapy practices.

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Why You Should Move Your Therapy Practice to Electronic Claims Filing

02. Jul, 2010 Categories: Therapy Billing Software Features by editor 0 Comments

Therapy practices are increasingly embracing electronic claim filing and realizing significant benefits. These benefits include large costs savings, a reduction in filing errors, less staff time, and improved turnaround time for payments.

At a time when therapy practices are being challenged to realize cost efficiencies to remain competitive, moving to electronic claims is an excellent financial decision. But how do you make this transition?

The Automated Medical Assistant™ is the premier online solution for therapy billing, practice management and scheduling. The system can automatically send your insurance claims to the insurance company. In fact, the system can even electronically handle your paper claims too. The built in clearinghouse knows which insurers accept electronic claims. For those that don’t, a paper claim is printed and mailed for you. The clearinghouse “scrubs” the claims and catches most errors that cause a denial.

The system is comprehensive and incredibly affordable. It makes it is extremely easy for your therapy practice to make the transition to electronic claims. The Automated Medical Assistant is the only tool you will need. Give us a call today (1-800-815-BILL), or sign up on our web site: www.automatedmedicalassistant.com. Get started today!

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The Automated Medical Assistant and Your iPhone

10. May, 2010 Categories: Therapy Billing Software Features by editor 0 Comments

With the Automated Medical Assistant, your patient information is available 24/7 from any internet connection. You can enter appointments, post payments, send electronic claims, view your patient’s electronic chart, view or print reports, view graphs to analyze your practice, or anything else you want from anywhere, at any time, from any browser! This means that you can work from home, on the train, at Border’s, from your iPhone, or anywhere else that you have access to the internet!

We’ve made sure that you can use AMA with your favorite handheld device, whether it’s a Blackberry, iPhone, iPad, Android or any other leading brand of smartphone. Check out some of the screenshots for yourself:

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Should I Outsource My Therapy Billing to a Billing Service Provider?

28. Apr, 2010 Categories: Therapy Billing Service by editor 0 Comments

The Automated Medical Assistant is an online therapy billing software product that makes in-house billing more productive, profitable and efficient. But did you know that we offer therapy billing services as well? You’ll be pleased to know that our secret billing weapon is the very same online software tool that we sell here for an incredibly low monthly cost.

The therapy billing service from Advanced Billing Solutions, Inc. handles much of the difficult work associated with the billing process. We follow up on rejected claims, pursue and collect on unpaid accounts, and even send invoices directly to patients. The convenience of handing these headaches over to a resource who can give them their full attention is the main reason that providers choose to outsource.

We charge just 5-8% of what is actually collected, depending on the particulars of your practice. And because all the work is done with the Automated Medical Assistant, you have 24/7 access to your data, reports, graphs, and all the features of AMA. You can use this service for as long as you want, or cancel when you are ready to take over. All your data will be in the system so you can seamlessly pick up where we left off.

Besides costs, there are other factors where a provider should consider outsourcing their billing.

  • Inefficient billing process – Outsourcing to a third-party billing service will decrease the number of rejected claims and improve the time it takes to receive payments.
  • High staff turnover – High turnover in a provider’s billing department is damaging and leads to a slowdown or even stoppage in the processing of claims. With an outsourced option, claims processing moves forward like clockwork.
  • New providers – Outsourcing your billing from the start can give you relief from the day-to-day challenges of launching a new therapy practice, without the additional burden of hiring, training and managing employees (typically one of your biggest start-up costs).
  • Different priorities – Many therapists are not strong on the business side of running a practice, and their motivation lies in helping patients rather than pushing paperwork.

In sum, our therapy billing service takes the stress out of having to deal with the constant changes and complexity of insurance regulations.  By allowing us to take over your billing, you eliminate the need to deal with difficult insurance carriers, and the many administrative headaches in managing the billing and collections process. We can increase your collections, decrease your costs, and improve your bottom line, while you focus on doing what you were trained to do: help patients get well.

Contact us today for a quote.

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