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 Frequently Asked Questions

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FAQ Overview

AdvancedMD and Practice Management Software

What Makes AdvancedMD Different?

AdvancedMD is a one-stop shop for your practice management needs. Like some other PM software systems, AdvancedMD gives you the opportunity to optimize your scheduling capability, manage patient care through EHR software, streamline the medical billing process, and get analytic reporting to help your practice improve. What AdvancedMD does differently, however, is take the time to build a network of support by partnering with medical billing companies directly. Read more about the benefits of using AdvancedMD here.

Coding (CPT, ICD-10)

How Do I Get Providers Excited About Prepping For ICD-10?

Let's face it: learning an entirely new set of codes is more likely to elicit groans instead of squeals. That being said, 1 October 2015 is quickly approaching, and your providers need to get on board with the change (unless Congress changes the ICD-10 transition date again)! In this blog, we discuss the psychological hurdles to the transition, and we offer 3 techniques to get reluctant physicians on the ICD-10 train.

What Are CCIs?

This stands for Correct Coding Initiative (also known as NCCI, for National). It’s a program instituted by the Center for Medicare and Medicaid Services in order to “promote national correct coding methodologies and to control improper coding leading to inappropriate payment in Part B claims” (CMS.gov). Familiarity with CCI is a good first step towards understanding why some claims get paid and others don’t.

What Are The AMA Physician Specialty Codes?

The American Medical Association maintains a list of Physician Specialty Codes. You can view and download a current version here.

What Are The CMS Physician Specialty Codes?

The Center for Medicare & Medicaid Services (CMS) maintains a list of Physician Specialty Codes for Medicare Part B carriers to enroll. You can view and download a current version here.

What Is The Difference Between ICD And CPT Codes?

ICD stands for International Classification of Diseases. As the name suggests, it’s an internationally-recognized set of codes describing medical conditions, symptoms, diagnoses, and causes of death. ICD is managed by the World Health Organization (a part of the United Nations). The US healthcare industry is transitioning to ICD-10 from ICD-9 in October 2015.
CPT stands for Current Procedural Technology, and these are codes used by medical professionals and insurance companies in the United States to describe services rendered during patient care. CPT is managed by the American Medical Association.

Where Can I Find ICD-10 Codes?

For a quick place to look up ICD-10 codes, use this website. To read about applicable codes for gastroenterology, click here. For tips to ease the ICD-10 transition, read this blog.

Where Can I Find MUE Updates?

Medically Unlikely Edits (MUEs) are revised, deleted, and added to every quarter. To see the latest updates, click here.

Electronic Health Records

How Do I Know If An EHR Is Certified For Meaningful Use?

Easy! Click here and search by product name, vendor, classification, or number. You also get an opportunity to choose which edition of EHR certification you are attesting to (2011, 2014, or a mix of both). If you're in the market for an EHR, check out the Keystone Health Partners blog to learn about comparing EHR and practice management software.

Is There A Difference Between EHRs & EMRs?

Yes, but the difference is very slight. In most cases, the terms electronic health record (EHR) and electronic medical record (EMR) are used interchangeably, and it doesn't make too much difference in context. Technically speaking, an EMR is simply a digitized copy of paper records...thinking scanning records and uploading them. An EHR lives in the digital space, most often as part of a cloud-based practice management system.

Is My EHR Obsolete?

There are as many EHR platforms as there are procedural specialties. Even if you're happy with the EHR that your practice uses, you may need to change or update it. Here are four things to check:

  1. Is it certified for Meaningful Use?
  2. What is my vendor's policy for obsolete software?
  3. Do I have to purchase expensive upgrades?
  4. Does my EHR meet compliance standards for ICD-10?
AdvancedMD is one great platform that can help your practice succeed. Click here to read more about this cloud-based solution.

What Are The Government Financial Incentives To Use EHRs?

According to HealthIT.gov, eligible professionals can qualify for different sums “as they adopt, implement, upgrade, or demonstrate meaningful use of certified electronic health record (EHR) technology.” Amounts payable can be as much as $44,000 (Medicare EHR Incentive Program), $63,750 (Medicaid EHR Incentive Program), or possibly north of $2 million for eligible or critical access hospitals.

Medical Billing and Self-Help

What Can A Medical Billing Company Do To Help My Practice?

If you're in private practice, there's a good chance everyone has to fill multiple roles to meet both the patient care and business needs of the practice. While this can work very well, having dedicated experts for certain tasks can help efficiency in a big way. Here are five things a great medical billing company will be better at:

  • Staying on top of legislative changes
  • Knowing the ins and outs of insurance contracts
  • Understanding which diagnosis and procedure codes go together best
  • Proficiency with practice management systems
  • Compiling information from other practices to identify trends/themes

For more advantages of hiring a medical billing company, read here and here.
What Is Insurance Credentialing?

Insurance credentialing is the process by which physicians are brought into an insurance network so that claims can be covered. The process involves checking the training, expertise, licensure, and academic background of healthcare providers, among other things. Some insurance carriers also check for competence and professional conduct before a provider becomes part of their network. Keystone Health Partners can handle credentialing for single- and multi-physician practices with all insurance carriers.

What Should I Ask A Collections Agency?

If you are considering hiring a collections agency, there are some important questions to ask before you settle on one. Here are some of the most critical:

  • What is your collection philosophy?
  • How will you maintain the relationship I've built with my patients?
  • Do you do third-party collections exclusively?
  • Are you HIPAA-compliant?
  • How do you ensure compliance with other collection regulations (such as TCPA and FDCPA)?
Click here to read more about selecting the right collections agency.

What Should I Look For In My Medical Bills?

Getting a medical bill can be intimidating, whether it's from an expected procedure or an emergency. Medical debt is unique from other sorts of debt, so here are some tips to help you sort through a bill. When you get a bill, check that...

  • Names, numbers, & addresses are correct (for yourself, the medical practice, and the insurance company)
  • Medical procedures are line-itemed (do not accept a lump sum bill without an itemized list)
  • There is a clear due date for when payment must be received
  • You actually received the services that are listed
  • There are not duplicates or obviously erroneous charges
  • Did you receive an Explanation of Benefits (EOB) from your insurance company?

What Should A Medical Billing Statement Include?

Besides the typical administrative data (patient name, clinic name, address, etc), there are a few pieces of information that should be included in medical billing statements to help your patients understand what's needed of them. This in turn should help your practice collect more revenue, faster. Here are three tips to make your statements more effective.

  • Explain charges in detail.
  • Set a clear due date.
  • Allow patients to pay directly through the form.
To expand on these further, read our blog here.

Why Is Medical Debt Different Than Other Types?

Medical emergencies can happen at any time, and many medical procedures are not planned in advance. Unlike home or cash loans, a person does not typically go into medical debt knowingly. A larger lump sum may be due sooner than other sorts of debt, and medical costs can be quite significant; often the patient doesn’t necessarily choose which procedures and services they receive (especially in emergency care). These factors combine to make medical debt a unique entity. Learn how to differentiate whether your patients will be able to pay medical debt here.

For Patients and Beneficiaries

Why Do I Have To Pay My Deductible At Time Of Service?

Some hospitals and private practices are moving towards a 'pre-pay' structure, where patients pay their deductible, co-insurance, or co-payment before receiving medical services. This is driven by a few different factors:

  1. Employers and employees are selecting higher-deductible health plans, which means more financial burden is falling on patients than it did in the past
  2. Paying upfront helps the medical provider reduce costs (shortening their revenue cycle and not invoicing patients later)
  3. Saves the patient time and money by not having to mail payments back, deal with postal service, etc
If you're a healthcare provider in a private practice, check out this blog about swapping the revenue cycle.