Medical Billing Networks and Processes - Profitable and Compliant Revenue Cycle Management in the Internet Age (Hardcover)

~ (Author), Alison Cohen (Editor), Doug Cassel (Foreword)
Key Phrases: super group, electronic medical billing software, billing transparency, Department of Justice, Wall Street, United States (more...)

Editorial Reviews

Review

A thorough, easy-to-reference guide to improving medical billing procedures and collections that will be of value to medical practices small and large.

Mathematician, inventor and CEO Lirov brings his broad range of knowledge and experience to the subject of medical billing. The company that he heads, Vericle, brings this technology to clients, but the book avoids frequent references to the enterprise and is clearly not an advertisement. Targeted toward those who are involved at any level with medical billing--including computer programmers, medical office or billing service workers, and physicians--the book addresses the problems that practices of all sizes face: how to simplify the payment process and maximize collections from clients and insurance companies. Lirov begins with an overview of the economics of health care today, comparing billing procedures and outcomes of the past with the strategies Vericle utilizes. He then explores the administrative aspects of medical offices, such as choosing the ideal billing system, computer-aided scheduling and problem tracking. The author also addresses metrics that are useful in determining efficacy of the chosen billing system--and what an office can learn from this study. Compliance with regulations including insurance claims and HIPAA is a large task for medical offices, and Lirov invited guest authors to detail their specific procedures. These authors contributed several chapters, covering topics such as physician "Super Groups," dictation versus electronic records and integration of electronic health records. Other topics of interest include outsourcing of billing and patient retention. This well-written guide contains easily referenced chapters, section headings and lists of key points, with each chapter concisely summarized and indexed. Consequently, all office workers will be able to understand the language and terminology. Further, charts and diagrams provide examples and illustrate key points.

An excellent manual for medical offices seeking to improve billing. --Kirkus Discoveries, February 5, 2009

Product Description

Is your practice profitable and compliant? Some state-managed insurance company audits have discovered up to 30% in mishandled and wrongly denied claims. This book shows private practitioners how to automate and enable such insurance claim payment audits in real time. You will discover how to:

* Improve your cash flow and reduce audit risk using Straight-Through Processing (STP) technologies
* Design and implement industrial-grade network standards for continuous billing quality improvement and compliance maintenance
* Reduce operations risk and improve your balance sheet using Software as a Service (SaaS) and outsourcing.

Understand the rules of the modern "payer-provider conflict" and learn to apply and manage winning Internet strategies, such as the "billing network effect." Gain further insight from guest chapters by Dennis Alessi, Esq., of Mandelbaum, Salsburg, Gold, Lazris & Discenza, PC; Eric Fishman, MD, of EHR Scope; Joe Kamelgard, MD, of Billing Integration, LLC; and Erum Raza, Esq, of Fox Rothschild, LLP.

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Product Details

• Hardcover: 312 pages
• Publisher: Affinity Billing, Inc; 1 edition (January 1, 2009)
• Language: English
• ISBN-10: 0979610133
• ISBN-13: 978-0979610134
• Product Dimensions: 9.1 x 6.2 x 1.1 inches
• Shipping Weight: 1.2 pounds (View shipping rates and policies)
• Average Customer Review: 4.5 out of 5 stars  See all reviews (6 customer reviews)
• Amazon.com Sales Rank: #644,976 in Books (See Bestsellers in Books)

Customer Reviews

Most Helpful Customer Reviews

2 of 2 people found the following review helpful:

5.0 out of 5 stars Medical Billing Networks and Processes - Profitable and Compliant Revenue Cycle Management in the Internet Age, February 9, 2009

By	Gregory Ribitzky "Dr.Ribitzky" - See all my reviews (REAL NAME)

Medical Billing Networks and Processes - Profitable and Compliant Revenue Cycle Management in the Internet Age- in my opinion this "how to" book is simply a must in any medical office . Before i read it- i was providing service- but did not know how to claim my money effectively and found myself loosing tens of thousands of dollars yearly. The author, Dr. Lirov showed me the way to work less and make more money.

2 of 2 people found the following review helpful:

5.0 out of 5 stars Reclaiming a vocation, December 30, 2008

By	Graham J. Prosser "'umble scribbler" (Shropshire) - See all my reviews (REAL NAME)

Modern medical practice tries to defer one certainty, death, while dealing with the other two: taxes and bad debt. With the Hippocratic oath and the IRS competing for a physician's share of mind, it's not surprising the third certainty gets less attention causing the average medical practice to work for free seventy days per year.

Having cast the relationship between providers and payers as a David and Goliath conflict and planted himself firmly in the little fella's corner, Lirov structures the book along the lines of the provider's workflow to identify how they can systematically improve their odds when dealing with payers motivated to pay less.

By combining cogent argument, case studies you can get your arms around and memorable rules of thumb Lirov applies lessons learnt years ago in the financial and telecommunication industries to demonstrate how a physician's bottom line can be improved while freeing up time for patient care and, saints alive, a personal life.

At times the proposed solutions seem too straightforward, begging the question why well-educated doctors would allow the underlying problems to beset them. Until you remember that they spent all that money educating themselves to be physicians not business managers. Lirov's lucid prescriptions can help put the onus back on that vocation.

1 of 1 people found the following review helpful:

5.0 out of 5 stars Fixing a Broken System, May 7, 2009

By	Mark Deo - See all my reviews

Medical Billing is one of those niche targeted books that demonstrates the benefit of place like Amazon.com. This is the kind of book that you would NEVER find if not for the Internet. This book is a veritable cornucopia of information and advice on how a medical practice needs to structure itself to ensure viable billing practices. This is valuable to not only the physician but also to the patient.

The author suggests that although the managed care billing system may appear to be broken, with the right disciplines we can FIX IT ourselves in many cases. In my work with medical practices and hospitals I can't tell you how often I come across physicians that have no choice but to reduce certain patient services because they just don't have the income to invest it where they would like. In the same way I have seen improper billing procedures frustrate patients so much that they literally REDUCE the number of doctor visits just to avoid the hassle of dealing with insurance and billing companies.

What I particularly liked about Yuval's book is that it can be easily understood by medical professionals, billing and insurance company representatives but also by the common person. He starts with a clear, thorough explanation of the history of the medical billing system, the advent of managed care and then gets into the nuts and bolts of billing explaining in a very down-to-earth manner, Super bills, allowable, write-offs, charge-backs, how the clearing houses work and so on. The book is loaded with graphs, captions, bullet points and images that just aid in the understanding of what can often a rather confusing topic.

Throughout the book, the author makes reference to how the system needs to change and what new variables may be on the horizon. I found this to be helpful in guiding my medical clients toward some policies and procedures that we may want to put in place regarding the new ICD codes and CPT10 system, the new FTC Red Tag privacy issues, and new HIPA regulations. The book makes a great reference tool for planning as well.

As a consultant that spends time consulting with hospital administrators, practice managers and physicians I have to say this is probably THE MOST comprehensive, easy to understand manual on medical billing that I have ever seen. I have actually purchased several copies to give to some of my clients and I suggest other medical consultants do the same.

I STRONGLY recommend this book to all medical professionals, practice managers and medical consultants. That said, if you are a patient and really want to understand the medical billing process I will say this is the ONLY book for you.

Also check out Yuval's book on practice management as well. Thanks Dr. Lirov for helping us to all take charge in fixing what is a broken system!