Medical Billing

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Three Ways to Increase Your Practice Collections

How much money is your practice losing?Increase Collections

Collections are the life-blood of your practice.  Yet, doctors in the United States lose roughly $125 billion per year due to poor billing practices.  According to an MGMA study, an average practice will recover just $15.77 for every $100 owed once a patient defaults on the amount they owe to you.

Below are some ways that can be implemented in order to maximize your collections. You will find that most are fairly easy and do not require additional resources.  They do require a concentrated effort but will prove to be financially beneficial.


  1. Make sure you have a patient portal.
  2. Remember, having a patient portal isn’t enough.  You must maximize your patient portal.
  3. Make sure you have an online bill payment option.


  1. Give patients a wide variety of options for paying their bills.  Be sure to accept cash, checks, credit cards and debit cards.
  2. Encourage patients to register a credit card to keep on file with your office and make sure they enroll in an automatic pay option for their patient balances.
  3. Encourage patients to pay past account balances and current charges at the time of service.
  4. Train all staff to firmly but gently communicate with patients about patient financial responsibility issues.
  5. Be willing to refuse service to patients who do not pay.


  1. When you transition to a billing company, you get trained specialists dedicated to medical billing.
  2. Outsourcing means you don’t have to worry about personnel issues, covering vacations or ongoing training expenses.
  3. Utilizing a billing company will afford you the benefits of state-of-the-art software, up-to-date processes and key reports in a timely fashion.
  4. Dedicated efforts, working every denial, and not accepting zero payments will result in your practice getting more money faster.

Maybe all three ways won’t work for your practice or maybe you’ve already done some and that is great.  Every way that you implement will only help to increase your practice collections.

Is Mod 59 a Magic Bullet?

Mod 59 codingWe’ve noticed an increase in the usage of modifier 59 (mod 59).  Oh we all want a magic bullet.  The code that will get every charge reimbursed the first time.   Although modifier 59 may get the claims paid it might not be the correct usage of the code.  After all there are no magic bullets.

Mod 59 does have a purpose. We asked a certified professional coder to explain when it should and shouldn’t be used.  Here is an explanation that you may find helpful.

Mod 59 is used on services that are commonly bundled and/or are not normally reported together. However, there are certain circumstances can be reported and paid separately.


Adding mod 59 indicates that a procedure or service is distinct or independent from other non-E/M services performed on the same day.  You can use modifier 59 when

  1. the procedure is performed in a different session or patient encounter;
  2. there is a different procedure or surgery;
  3. there is a different site or organ system; or
  4. a separate incision/excision and separate lesions or separate injuries not ordinarily encountered or performed on the same day by the same individual.

For billing, bill all services performed in one day on the same claim.  Add mod 59 to the subsequent procedure if the other procedures are not normally reported together and is appropriate for the clinical circumstances.


If a service is typically included in the performance of the primary procedure then the procedure is bundled and should not be reported with mod 59.  Modifier 59 should never be used when another more appropriate modifier exists to clarify the services performed and when the documentation does not support the separate and distinct status.

The Medicare National Correct Coding Initiative (NCCI) has also addressed the use of mod 59.  One function of NCCI PTP edits is to prevent payment for codes that report overlapping services except in those instances where the services are “separate and distinct.” Modifier 59 is an important NCCI-associated modifier that is often used incorrectly.  For more detailed information, click here for a copy of the related mod 59 article from the NCCI.

Patient Deductibles Can Strangle Your Cash Flow

5 Tips to Normalize your Cash Flow

At the beginning of each year, many physician practices face shortfalls in cash flow due to health plan deductibles.  Medical deductibles can play havoc with physician practices.  Health plans have consistently increased deductibles and, of course, the Affordable Care Act (ACA) plans are now in the mix.  Thus, a greater financial burden is placed on the patients for medical services and, in turn, physician practices are left to deal with the cash flow slow down.

Not so very long ago, a large portion of the medical bill was traditionally paid by commercial insurers, Medicare and other third-party payers.  But now, the landscape has changed.  Physician practices are forced to walk a fine line between providing good clinical care and limiting the burden associated with increased costs.  There are no other professions where consumers expect to receive services or goods and pay later.  But that is exactly what happens with health care.

At the beginning of each year, patients must first meet their deductibles before reimbursements will be sent to the provider.  So when you submit your bill the majority, if not all, of the allowable (what the insurance carrier would usually pay directly to you) is applied to the patient’s deductible.  Therefore, you get $0 from the insurance carrier and you must then bill the patient and wait for payment.  This can result in a delay of payment for 45-90 days.  Without excellent collection efforts from your billing team it can even result in bad debt.

What does this mean for your practice?

Let’s say Dr. Brown’s monthly collections average $100,000.00 and the total patient deductible amount for the month is $25,000.  If Dr. Brown did not collect any money from the patients at the time of service, then the projected collections for the month would be his average of $100,000 – $25,000 in patient deductibles = $75,000.  Rather than his average of $100,000 he would have only $75,000  to pay his expenses.

Ultimately, patient balances should be collected.  But how long can your practice wait for this money?  How long can you provide these interest free loans to your patients?  Below, are five practice tips to keep patient deductibles from strangling your practice.

  1. Staff members need to know what a plan covers;
  2. Verify eligibility and deductible status before every visit;
  3. Have honest conversations with patients and explain patient responsibility up-front;
  4. Collect whole or partial payments from the patient while they are in the office;
  5. Develop payment plans.

The best way to minimize the impact of deductibles is to be proactive with patients by detailing costs and  requiring a payment of the patients’ deductible.  At first, this may seem awkward or you may feel uncomfortable asking for a payment upfront, but in today’s health care environment more assertive tactics are needed to protect your bottom line.


Extra Money Not Extra Work

Work Smarter, Not Harder

Extra Money

Extra money – everyone is always interested in how they can make extra money.  What if you were offered an extra $30,000, $50,000 or even $100,000 more per year?  And, what if you learned you could get the extra money without seeing one more patient?  Would you be interested in learning how to earn this extra money?  Well, here’s how.

When you invest in a quality medical billing company, you should expect a 10% – $25% increase in collections.  If you are talking to other billing companies and your primary decision factor is based on price, then you are undermining your practice.  Fees can vary from 2% to 10%.  So, the real question is what are you getting for the price you pay and at what cost to your practice?

You want a company that works for YOU and is committed to following up on all claims, works all denials and collects everything that is owed to you.  Follow-up work is extremely time consuming and resource intensive.  If claims aren’t being worked then you are losing money on uncollected amounts.  If you aren’t collecting every penny that is owed to you then your great deal of 2% or 3% fee just became 10% or higher.

You should also beware of hidden fess and very leery of long term contracts and lock-in contracts.  Good billing companies don’t need to trap you into staying.  Rather they expect to earn your business every day.  Make sure you know exactly what the billing company is going to do for you and all costs that are associated with the service.  Who pays the clearinghouse fees, who pays for the practice management software licenses and is there a mark-up on paper costs?  Is there an extra fee for customized reports?  Are month reports run and delivered to you automatically or do you have to request and wait or prepare the reports yourself?  What exactly do they do to help you earn extra money?

Price should not be the sole decision point.  That is not how you will make extra money.  After all the saying, “you get what you pay for” has merit.  Is it worth risking the financial viability of your practice because you ‘negotiated’ a lesser percent?  You want your billing company to want to work on your accounts and take pride in their performance.  Of course, paying a high percentage doesn’t guarantee quality work either.  You have to look at the whole picture.

Is your medical billing company a partner or a vendor?  Vendors submit claims, send patient statements and then wait for payments.  Very little effort, if any, is put into working denials, filing appeals or calling patients because that is hard work.  A good billing company earns their fee based on hard work, diligence and denial management.

Good billing services aren’t passive. They know which payers are supposed to pay in 14 days, 30 days, or 45 days or more.  If the payer is a slow payer they know why.  For all payers, they follow up accordingly.  They work denials and file appeals and they actively recommend accounts for collection.  They don’t let old AR age forever because they know this gives a false sense of what your AR is and what is truly collectable.  You shouldn’t be making business decisions based on money that will never be collected.

Based on denial patterns, they identify areas for improvement and they communicate this to you and implement their own internal controls to help drive your denials down.  Slow pay puts your practice at risk.  You are buying expertise when you partner with a good medical billing company.

At Onpoint Medical Solutions, we are interested in working with practices that want a billing partner not a billing vendor.  We are passionate about providing your practice with the comprehensive revenue cycle management services that you deserve.

  1. We have consistently increased collections by 10% – 15% for our new clients;
  2. There are no long term or lock-in contracts;
  3. We use best in KLAS practice management software with complete transparency in all that we do;
  4. All clearinghouse fees are paid for you;
  5. All reports, including month-end and customized reports are provided at no extra cost;
  6. Our pricing is customized to your practice and takes into account your specialty, insurance mix, average collections or encounters per month, and the number of providers.

Ready to start collecting more money?

Let’s talk.  We can answer your questions and prepare a customized quote.  We would welcome the opportunity to schedule a demo so we can sho you the power of what we do.

Call:  1.800.594.8043


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How to Get Paid for Incident to Billing

Employing a non-physician practitioner (NPP) e.g. physician assistant or nurse practitioner has many benefits.  It increases patient through-put, enhances the patient experience and increases a practice’s revenue.  Once the NPP is hired, we are many times asked what is “incident to” billing and when does it apply.

Simply put, incident to billing applies only to Medicare and allows the NPP to be reimbursed at 100% of eligible charges.  If incident to billing is not utilized, then the NPP will be reimbursed at 85%.  The specific requirements are detailed in Chapter 15, Section 60 of the Medicare Benefit Policy Manual.

So, what are the rules for incident to billing?  There are some basic rules and all must be met to meet the incident to rules for Medicare payment.

  1. Services must be rendered in a setting other than a hospital or skilled nursing facility. The Centers for Medicare & Medicaid Services (CMS) refers to this as non-institutional settings.
  2. A physician who is Medicare-credentialed must initiate the patient care. The NPP cannot see the patient for the first visit or if a change in the treatment plan is needed.
  3. Both the physician and the NPP must be employed by the entity that is billing for the service. If the physician is a solo practitioner, then the physician must employ the NPP.
  4. Follow-up care can be rendered by the NPP provided they are under the direct supervision of a Medicare-credentialed physician. Direct supervision requires that the physician be a part of the same group, but not necessarily the physician who performed the initial patient evaluation, be present in the same office suite and immediately available to help during the time the NPP is rendering patient care.
  5. Pursuant to the physician’s state licensure rules, they must actively participate in and manage the patient’s treatment.
  6. The service provided must be routinely provided in the office setting and are of a type considered medically appropriate to provide in the office setting. Incident to billing does not apply to services that have their own benefit category, such as diagnostic testing.
  7. Documentation should include who performed the service and who was the supervising physician.