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The Impact of COVID-19 Pandemic on Medical Billing

The COVID-19 pandemic has had a massive impact on all aspects of daily life, safety, and financial and emotional well being. The impact of COVID-19 on medical billing is significant as well as you must now adjust to new billing and payment tracking updates while striving to continue to provide stellar service to your patients.

The COVID-19 Pandemic has created the following medical billing challenges:

  • new tracking and billing updates
  • lack of resources strains healthcare practice
  • an increase in the number of denied claims
  • states are taking action to protect against surprise medical billing
  • revenue cycle impacts
Health Insurance Claim Form

Medical Billing Claim Denial VS. Claim Rejection

What is the difference between denied claims and rejected claims?

Denied claims are claims that were received and processed by the payer and deemed unpayable.

A rejected claim is a claim that contains errors found before the claim was processed.

The medical biller’s goal is to make sure the provider is reimbursed for their services. Unfortunately, errors – both human and electronic – are inevitable. Running a successful and profitable medical practice requires reducing as many of these errors as possible. When an insurance company denies a claim, they keep a record of that claim in their system. If a claim is rejected, however, they don’t keep a copy of the claim in their system.

These errors can be as simple as a transposed digit from the patient’s insurance ID number. A rejected claim can be re-submitted once the errors have been corrected; since it was never entered into their system.



Medical Billing Tips To Maximize Your Revenue

According to a 2019 Healthcare & Business Technology report concerning medical billing, nearly $125 billion in medical revenue is not collected by medical offices each year. Many aspects of healthcare reform and the failure to stay up to date on billing rules and regulations in addition to billing errors can cause revenue losses for healthcare providers.

Here are several steps your healthcare practice can take to be more proactive in your medical billing procedures:

  1. Establish a Clear Collections Process
  2. Properly Manage Claims
  3. Reduce Coding Errors
  4. Promptly Handle Denied/Rejected Claims
  5. Constantly Look for Ways to Improve
  6. Know When to Outsource
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How to Protect Your Medical Practice From Cyber Attacks

If you pay even the slightest attention to the news you know that medical practices have become a huge target for criminal computer hackers. You also probably know about the potential negative impact that a data breach could have on your medical practice, including loss of money, time, and most importantly loss of trust that patients have placed in you and your organization.

  • 71% of data breaches happen to business with less than 100 employees.
  • 60% of small business go out of business after a data breach.
  • Ransomware is a real threat to medical practices.
  • Employees are your weakest link. 95% of data breaches are caused by employee mistakes.
  • Data breaches can lead to an Office of Civil Rights investigation for HIPAA compliance.

One common method of attack is to install ransomware. Once a medical practice’s system has been compromised, all of the patient files are held hostage until ransom is paid. These attacks often happen because an employee clicks on a sketchy email. But there are other often nebulous ways that criminal computer hackers can enter your systems.

Here are 10 tips to protect your medical practice from a cyber attack.

  1. Make sure the entire staff is properly trained on healthcare security protocols.
  2. Use secure passwords.
  3. Don’t delay software updates.
  4. Control access to protected patient data.
  5. Perform regular data backups.
  6. Deter insider threats.
  7. Encrypt data.
  8. Maintain a layered defense system.
  9. Make sure you have the best cybersecurity software and hardware.
  10. Assess the risk and have a contingency plan.

Make sure the entire staff is properly trained on healthcare security protocols.

The weakest cyber security link in your medical practice is the user. Training is mission critical. If you can’t supply this yourself, make sure you bring in a consultant who can provide training on the latest security protocols.

Use secure passwords.

Password best practices include:

  • Use strong passwords.
  • Make the password at least 8 characters long and include numbers, capital letters and symbols.
  • Don’t use words that are in the dictionary.
  • The strongest passwords are a passphrase. Use a phrase like “I went to elementary school in New York City in 1972” and then use the first initial of each word to create your passphrase “Iw2EMSiNYC1n1972#”.
  • Change passwords every 60 to 90 days.
  • Don’t post your password in plain sight or in a file labeled “passwords” on your computer.
  • Consider using a password manager.
  • Consider using multi-factor authentication.

Don’t delay software updates.

We all understand that software updates are annoying since they require computers to be offline for a bit. However, neglecting to get the latest version of your outdated software leaves you and your devices much more vulnerable to attack. This is especially true of your websites. Hackers take advantage of those who don’t update software when updates are available.

Control access to patient data.

Minimize the amount of access that an employee or contractor has to patient data. Make sure that individuals only have access to what is needed to perform their job function.

Perform regular backups.

Backing up data will protect your medical practice from data loss due to damaged servers or ransomware. Automated backups should encrypt and copy data offsite. Make sure that data backups are routinely tested to ensure you can recover the data.

Deter insider threats to your medical practice’s cyber security.

Insider threats are a leading cause of HIPAA data breaches. Insider threats include employees or contractors that access patient information without authorization. To deter insider threats, follow these best practices:

  • Minimize the amount of access employees and contractors have to patient data.
  • Periodically review the level of access for each employee and contractor.
  • Ensure that there is system auditing in place.
  • Periodically review system audit logs.
  • Make sure your staff knows that system auditing is in place as this will minimize insider threats.

Encrypt data.

The best way to protect sensitive patient information is to use encryption. Many medical practices don’t realize how much patient information is on mobile devices. Sensitive patient information could be in emails, spreadsheets, documents, PDF files and scanned images.

Create a layered defense system.

If you have layered security protocols in place, even if an attacker breaks through one layer they still won’t be able to access the protected data and your medical practice might be able to identify a full cyber attack before it’s complete. A layered cyber security defense system would include:

  • Strong passwords
  • Updated software
  • Remote backups
  • Physical security – locked doors, security guards, surveillance equipment
  • Antivirus software
  • Robust firewall

Make sure you have the best cyber security software and hardware.

Make sure to use software from companies that prioritize cyber security in their software. Also invest in a next-generation firewall to protect all data and your systems and deploy the latest in anti-malware detection.

Assess the risk and have a contingency plan

A security risk assessment (SRA) is a critical step to understanding the risk to your practice and patient information. Not only is it required under the HIPAA Security Rule, but it has the following benefits:

  • An SRA will inventory patient information, identify how you are currently protecting the data, and make recommendations on how to lower risk.
  • An SRA will help you understand the risk of phishing scams and ransomware, the dangers of lost mobile devices, and the risks of insider threats.
  • An SRA provides documentation you need as evidence that you have considered all of the risks.
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When does it make sense to outsource your medical credentialing services?

While there have been all kinds of advancements and efficiencies in patient care in the medical field, the barriers to running a successful medical practice have increased dramatically.

Every medical practice is constantly faced by a near continuous onslaught of challenges that limit its ability to serve the medical needs of its patients. 

Provider credentialing is one of the most important steps to building a successful medical practice. A healthcare provider must become affiliated with insurance providers in order to accept a third party reimbursement.

Increased Efficiency

Reduced Labor Costs

Eliminate or Reduce Risk of Turnover