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Why outsource medical credentialing specialist?

Why outsource medical credentialing specialist?

People don’t purchase basic products without all the essential documentation like warranty, quality check, etc. How do you expect patients to seek health care services from you if the medical practitioner you hire cannot justify their qualification and experience? Which is why medical credentialing is essential for every healthcare service provider.


Credentialing is the process of verifying whether or not does a medical practitioners qualification, training, and experience, malpractice history(if any), regulatory compliance record, for them to provide service in the state. It should not be confused with privileging which means the person has the permission to engage in clinical specialties. A medical doctor, doctor of osteopathy, board certification, specialty-specific practice are some of the types of doctor credentialing, which deem the medical practitioners and healthcare services fit for treating the patients.

It is essential for every medical practice to partner up with the insurance carriers and provides them a list of verified documents such as hospital affiliation, malpractice insurance certificate, degree, training certificate, board certification, the license granted by the state, enrolment application of the service provider, etc.

The paper-based credentialing is a thorough process which requires a considerable amount of calculation before the hospital can be granted affiliation. Another comparatively more efficient method of ensuring transparency in the medical provider’s credentials would be by implementing an electronic method. Not only does it streamlining the approach and whole process, but it also helps in mitigating risk, reducing cost and by continuous monitoring, it enhances the healthcare efficiency.


Medical credentialing makes a patient consider the practitioner or the healthcare service, reliable for treating their medical condition. Not obtaining a medical credential at the right time can result in massive loss of revenue. Your medical practice will no longer be eligible for reimbursement by an insurance carrier. It will also protect your medical practice form being at the receiving end of a lawsuit.


As mentioned above, the process of credentialing is intricate and takes a lot of time to yield results. Which is why we suggest you outsource these services to a medical credentialing specialist

Why, you ask?

Outsourcing a medical credentialing specialist will:

  • Help in controlling and minimising the operational cost, which would otherwise be spent in the rigorous paperwork that has a strong error possibility.
  • Mitigate denial claims since the field experts are now handling it. Also, it will eliminate administrative error and optimise your medical billing and collection. This will positively impact your revenue generation.
  • Clear the confusion, with staff now being able to concentrate better on treating patients properly and strengthening your practice.
  • Save practice’s time otherwise spent on performing repetitive, mundane processes, thereby enhancing efficiency and productivity.

Now more than ever healthcare organisations need to ensure a safe atmosphere for their patients and simultaneously make sure that the organisation does not suffer, financially. Outsourcing medical billing and coding services for credentialing can help healthcare service providers achieve these goals.

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4 Best Medical Practice that you can’t Afford to Miss

Medical billing is the most invisible engines of healthcare reimbursement. It won’t be easy to efficiently transmit critical data in the absence of medical billing. One of the biggest hurdle faced by medical practitioners is to get paid for their services. In order to be profitable, it is critical to have an efficient billing and collection system.


4 Best Medical Practice that you can’t Afford to Miss


Any organization can be profitable and achieve success by making efforts to better capture their revenue. Your billing services should take adequate steps to accommodate the health care changes. The increasing complexity of Medicare reimbursements, medical insurance claims, and other financial concerns are making billing process quite challenging.


We have compiled a list of best medical practices to collect money and increase insurance claims approval.


Increase Payment Channels

According to Centers for Medicare and Medicaid Services, the US healthcare payments market will reach $5 trillion per year by 2022. But a report released in 2014 revealed that around 30% of the money is wasted due to inefficient payment processing, administrative and billing process.


You need to recognize the digital impact on new payment channels to get maximum reimbursement. You need to introduce new tools and policies that include prompt pay discounts, staff incentive programs, minimum payment requirements and referring scripts when discussing payment process with patients.


Medical Billing Audits

A medical billing audit can reveal the strengths and weakness of your process. Two critical areas to test during the audit should be billing documentation and coding. An under the coded bill will result in revenue loss and if the process is consistent then it can cause substantial financial loss to your organization.


While over coded bills can generate additional revenue and should be returned back to the payer. In case an overcoding is discovered by the Office of Inspector General, Medicare can either impose fine or will demand the money back. You can identify and rectify these errors during the audit process.


Emphasize on Security and Data

The payment cards and bank accounts of the patient are exposed to the increase in patient payments. This has enhanced the risk of data breach. This can lead to a reputational and financial loss for a healthcare organization that results in business loss and bad publicity. Adherence to HIPAA rules and regulations is critical to enhancing security of patient’s data, during and after the claims process.


Try to achieve Interoperability

Interoperability is the ability to communicate patient health information electronically. Your billing department will have immense advantages by interoperability between systems as the exchange of information can seamlessly take place. For example, when insurance carrier asks for health history of a patient, having an access to the entire patient history can allow billers to get quickly paid.


Healthcare organizations work hard to stay on top of the latest medical research and technology to take care of the patient in the best way possible. One of the effective ways to ensure best medical billing practice os by employing the expertise of medical billing outsourcing service providers, This way organization can reduce operational cost, accelerate revenue generation and increase the efficiency of the healthcare system.

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3 Ways to Protect burnout from your team

One of the core processes of health care practitioner is Revenue Cycle Management. You need to turn around your medical practice to make revenue. Even though your patients are your first priority but maintaining flow with the changing rules and regulations can become a nightmare. This even lead to loss of revenue when claims are rejected or denied.

3 Ways to Protect burnout from your team

The odds are high that burn out will strike healthcare practitioners at some point. Recognizing the burnout sign and ways to overcome them will help your team to remain motivated and offer the patient with the best possible care.


What is Burnout?

Burnout is caused due to person’s inability to relieve the mental and physical symptoms that are related to unrelenting stress. It can affect your job performance, impersonality with patients and lack of motivation.


The symptom and degree of burnout differ from person to person. For few people, it is nothing more than the negativity of the workplace while for other can have a serious effect and no interest in ever going back to work in the same field.


Full Assessment

Knowing the symptoms, signs, and strategies to prevent job burnout can help your team provide patients the best possible care.

  • Becoming impatient or irritable with customers, co-workers or clients.
  • Becoming critical or cynical at work
  • Lacking the energy to remain consistent with productive
  • Lack of satisfaction from work achievements
  • Changes in appetite and sleeping habits
  • Feeling disillusioned about your work
  • Troubled by backaches, headaches or other physical complaints


Here are three different ways in which you can help staff succeed, stay healthy and feel personally invested.


  1. Appreciate your Staff

One way to boost the morale of your staff is by appreciating them. It is important to show appreciation for the job and take an active interest in their life. This doesn’t have to be very complicated, a simple thank you note of appreciation can go a long way.


  1. Start Taking Breaks

You need to start encouraging breaks so that they don’t overwork themselves to reach the point of burnout. This break will help them stay away from stress. Wondering where to start? You can model the behavior by initiating break yourself. Make these intervals a calming place for the team to go and ensure that everyone has a few minutes to themselves.


  1. Provide New Learning Opportunities

Your practice should encourage different educational situations and ongoing learning like seminars or classes. This allows employees to get the confidence and find out the career direction. Personal development often overlooks arena of wellness and health.


Is there any cost associated with these activities of boosting team morale. Yes, but they are worth when people’s passion for work is reinvigorated and rejuvenated. You not only need to recruit the top talent but also retain them.


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How Risk Analyzing for HIPAA Compliance can be Helpful

Health Insurance Portability and Accounting Act of 1996 is a significant health care law, which Medicare providers need to follow. This federal law is designed to allow the portability of protected health data for billing purpose. This ensures proper billing across the country.

How Risk Analyzing for HIPAA Compliance can be Helpful

HIPAA created certain measures and procedures that all the physicians and covered entities have to follow. Physicians should follow HIPAA Compliance risk analysis as these laws are formed to aid the physicians.

We have compiled crucial points to prove that conducting HIPAA compliance risk is helpful:

Technology should toe to HIPAA line

Well, this doesn’t circumscribe to your electronic record system i.e, to your EMR or EHR that has PHI and HIPAA on lock. There are several high tech electronic devices and software programs as part of clinical practice, right from wearables to telehealth platforms. They are suppose to be HIPAA- compliant. Medical coding and billing companies have started leveraging new technologies, which are developed keeping HIPAA standards in mind.

Make sure to have NPI

HIPAA requires entity that condenses healthcare service to possess unique 10 digit known as NPI- National Provider Identifier. There are two types of NPIs:

  • NPIs for organizations
  • NPIs for individual practitioners

Secure your PHI by using non technical and technical safeguards

Data storage and transmission is at high risk in every industry, which in a way means consumer identities are vulnerable to hackers. The hacking chances increase in the healthcare industry, which makes PHI storage and transmission regulation crucial.

This can be eliminated by discovering the risk of unlawful access to electronic PHI in the organization. Access all the security measures such as technical, administrative and physician safeguards. Be ready to address the loopholes in the organization’s security program.

HIPAA compliance Risk analysis will result in:

  • Greater security and privacy of patients
  • Cost reduction in the PHI and health plan through standardization
  • Health plan will have constant processing as electronic formats and values will be uniform throughout the health industry
  • Data interpretation through set codes and standardized transactions
  • Easy accessibility of new option for submitting referrals and authorization for transmission of different referrals using uniform formats.

The perfect way to ensure that office is HIPAA complaint is make patient privacy an integral part of your practice.Practice the above discussed way to breeze your internal audit and even if OCR shows up, you don’t have to take the stress.

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Top 6 reasons behind claim Denials

Are you experiencing numerous claim denials? Medical healthcare can increase the chances of higher reimbursement by knowing the reason behind denied claim and taking necessary steps to prevent these errors.


Let’ see the top 6 reasons behind claim denials:

Duplicate Claims

Medical practices and hospitals plays huge part in generating duplicate claims that results in largest percentage of claim denials. The front office hits resubmit by not hearing back from insurance that resets the clock again to the time to pay a claim. A duplicate claim either delays or denies the claim processing.


Missing or Incorrect CPT Modifiers

CPT modifiers indicate procedure or service that gets altered by specific situation but doesn’t get change in code or definition. These modifiers strives to allow special consideration to make payment. Filling correct CPT modifiers becomes crucial to get claims paid in the right amount.

A missing or incorrect modifier will result in losing thousands of dollars or an overpayment services. Missing or incorrect CPT modifiers are most common reasons behind denied claims.


Lack of Information

Lack of information are most prevalent mistakes in claim processing. Basic information such as name and DOB are the most common mistakes. Physician are just leaving money on the table by not examining and resubmitting claims.


Expired Eligibility

Many healthcare practices verify coverage prior to avoid any issues. The most common claim denials involves verifying patient’s health insurance coverage.

Many cases practices check the eligibility while making appointment but the coverage can be dropped between the actual visit and appointment period. This makes it important to perform the eligibility check again.

You can avoid another claim denial by verifying when procedures are not covered by insurer. Real time verification can avoid the problem of claim denials.


Expired Time Limit

The exceeding time limit can cause hole in the physician pocket. This reason causing to claim denial can be easily avoided. Mostly physicians gives larger claims their priority, which means small money claims are neglected or put on backburner. This result in small claim denials and eventually adding up to a lot of money.

Billed Amount is Incorrect

The claim amount can be missing or incorrect causing claim denial. In order to make sure that the billed amount is correct, all the charges should be included on every line without any decimal point. The billed charges should be numeric and without any space.


We all have observed that medical claims are hassle and result in financial difficulties. The above discussed reasons show that many of these mistakes can be easily avoided. These mistakes can result in not getting reimbursed properly. Many healthcare industries are hiring medical coding and billing industry to avoid these mistakes.

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Conclusion on ‘Why Outsource Medical Coding and Billing?’


Do you know what poor Revenue Cycle Management in health care business means?

Harsh effect on the patient doctor relationship which leads to major downfall of business.

Reputation of the company might go on stake.

Unnecessary headaches and overheads.

Outsource Medical Transcription is one solution. Liberate yourself from the burdens of billing, follow ups, claim submissions and other overheads and rather focus entirely on your practice and patients for a successful long run office. After the recent alterations in the healthcare act, it has got even tougher to keep up with medical billing and coding. Abiding by the rules and regulations and at the same time keeping up the competition is not at all easy for untrained people. For this reason you can’t rely on your internal staff and must consider outsource medical transcription.


What are the advantages? Ask me one and I will be happy telling you plenty. Read on to know more:

  • Cut down mammoth investments:

Buying equipments for the billing and coding process was never a good idea. Reasons being; one they are expensive and two the technology keeps on changing. Outsource medical billing and coding can afford the latest of the technology because they distribute the cost in their number of clients but being a small firm, it is not always feasible to update the equipments. Old technology means slow process and superior chances of error. Then the expenditure doesn’t end there, the annual maintenance cost goes pretty high.

  • The process has to be like anything like water:

The medical coding regulations keep on changing and the only solution is to learn them as soon as possible. Why I compared it with water because just like water fits itself in every vassal shape, billers must do the same. Why this is considered tough because one has to deliver quantity along with the quality. You think wrong if you are thinking that you can manage both this and medical practice at once effectively.

  • Save money on unnecessary hiring:

In house medical transcription not only requires trained professionals but also time and heavy budget. Even after this you are not done with the responsibilities; then why not hire a billing company instead? Save the bulky hiring and operating costs without giving up on the quality work.

  • Even more control:

It is a myth flowing that outsourcing is not safe and you lose control over your billing procedure. Let me assure you that one thing that all what you lose is just the headache of billing. Usually the procedure is web based and you can access data anytime and from anywhere. The latest equipments help you keeping your transactions and viewing risk free. Plus the systems are easy to use with customization options added.

  • Give ease to HR and management team:

As the logic suggests you might have to hire a different team of human resource management for transcription since the present one is for patient handling and they both are entirely different work jobs. If you outsource medical billing your business will run smoothly with the existing team. Any business excels only when the employs are happy working and are not always loaded with work. One reason why outsource billing service providers are getting more popular than before is because all the process is so well organized that they are practically able to deliver results on time; which is comparatively very hard when doing in-house. Not all but many would pledge and assure performance guarantee.

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Hopes Drown As ICD-10 Gets Postponed

ICD-10 change was expected to be the biggest break through in the Healthcare industry but when it was at the brink of creating history, Obama decided to Delay it, again!
ICD-10, which was supposed to be implemented in October this year has been delayed. Health care professionals seem to be more annoyed than disappointed with the spread of this news. After its unexpected delay, only pleas can be heard all around. None had anticipated that such a heart-breaking news is coming their way.

While most health care providers had already geared up to meet the demands of ICD-10, are left devastated now. This delay have become law of the land, so whether you are willing or not you will have to abide by it. Though it will be implemented after almost a year, but many faces have dropped with sadness. To say the least, it has caused real big troubles in the health care environment.

Feeling gutted is one thing, many will have to undergo financial losses as well. The valuable money that people must have invested in preparing for the ICD-10 codes, might go in vain. Definitely a hefty part of their earnings would have gone in making technological upgrades, improving programs and so on. So yes, the side effects of poisoning this code are more than one can imagine.

Investments made by stakeholders in order to update health care delivery, have incurred a great loss too. Providers had devoted their sincere and dedicated efforts in making the required changes to modify their work flow and clinical documentation. On the sad note this delay has resulted in wasting their precious time and efforts.

While some had already prepared themselves for ICD-10 and others were on the finish line to meet the demands of the codes, so at this stage postponing it has made things deleterious for all.

We cannot deny that fact that many will get more time to prepare but on the other side it poses a question that what about those who have heavily dedicated their money in the transition? Unfortunately, none seems to be accountable for their loss.

It is not going to be a cakewalk for providers when it comes to maintaining the technology for as long as a period of one year. It is going to take a lot of patient to wait for another 365 days, since number is indeed big. Entities will have to sit down with their team members and calmly think about how to cope up with the additional labor cost along with maintaining the technology.

Providers can sense betrayal from CMS, though in the past it has made the best efforts to uphold the reinforcement of the October 1, 2014 deadline. Without any doubts implementing ICD-10 in October 2015 is going to create various hassles.

It is hard to say whether these additional twelve months are going to do any good or not but looking at the present situation it only seems to be making matters worse.

It is shattering to know that the conversion procedure if going to be dragged for this long. Those providers who were in high spirits to welcome ICD-10, their momentum might just drop down in the meantime.

You need a strong mind to deal with the delay of ICD-10 and bear the losses. Health care professionals are left with no other choice than waiting until next the year.

Medphine, has decided to take advantage of this delay. Instead of dropping all the plans and wait for the 2015 deadline to come closer, it is wiser to keep up the preparations. The strategy is to offer webinars and implementation sessions to health care providers once in a month. Regular updates will be provided to all the members who have subscribed to our newsletters, so they can learn with creative info-graphics and free webinars.

So, if you are not a part of it, get enrolled now.

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