Category: Billing Service

ALERT: Watch Your Net Revenue Carefully – CMS Changes are Draining Profitability for DME Businesses

September 21, 2016 Posted on Categories AR Review, Billing Service, CMS, DME

On July 1, 2016, the changes that CMS implemented to the durable medical equipment and prosthetics, orthotics and supplies (DMEPOS) went into full (100%) effect.

The impact of these fee changes on DME businesses cannot be overstated. While DME businesses are putting in just as much work to serve just as many patients, they are seeing their reimbursement rates drop by up to 50% overnight.

As a business owner, this is the time to look very closely at your business expenses to make sure you have minimized them. Without business process cost reductions, you will very likely end 2016 with a loss, even if it appears that your revenue is increasing.

Now is the time to pay careful attention not just to your gross revenues, but your net revenues based on reimbursement. That is where you will see the significance of CMS’s recent changes.

In an effort to support the DME industry, Bonafide is offering complimentary A/R reviews and advice to support each and every DME operator in maximizing their reimbursement rates this year and beyond to avoid the crippling effects of these fee changes.

Contact the team at Bonafide today to discuss our proven solution in securing years of future business success for your business.

End Denied Claims through Correct Practice Management Systems

March 28, 2016 Posted on Categories Billing Service, Practice Management Software

By Michelle Tohill


Maintaining a healthy business practice that profits while at the same time keeps your patients physically healthy can be a difficult task. Because keeping people well requires immediate attention in most cases, your staff may become preoccupied and busy. Businesses can only thrive if overhead, costs, and profits are sustained.

It is necessary to collect maximum reimbursements in order to continue providing exceptional healthcare to your patients. To ensure high cash flow and ongoing profits, practices must have consistent, high levels of reimbursement. Without it, your business will be impacted in multiple ways. You may have to cut or underpay employees which results in poor service. Under-reimbursed practices can create high levels of stress that can be extremely detrimental to the entire business.

One way to guarantee your business remains in the black is to minimize claims denials. An American Medical Association study attempted to estimate how much reworked claims can cost a practice. The results showed that medical offices waste about $14,600 each year on rectifying denied claims through appeals, phone calls, and troubleshooting.

Most practices are already aware of the hindrances that come with successfully submitting claims from their billing department.

Here is some advice on how to avoid losing $14,600 each year:


Regular Updates:

It is essential for employees to stay updated on any insurance policy changes that could affect patient’s coverage. Your billing department must be attentive for insurance policies regarding diagnostic codes and procedures. Signing up for insurance company emails and newsletters can be beneficial for staying informed. Having good practice management systems in place can also be helpful. These software systems should automatically update new changes on a regular basis in order to guarantee you have all the information for gaining reimbursements.



All denied claims should be investigated to determine why exactly it was denied. One of the most basic reasons claims are rejected is due to the code referenced being incomplete, invalid, or not matching the treatment stated by the physician. As mentioned before, many of these problems can easily be avoided through regular updates. These small coding mistakes can cost your practice thousands of dollars. Other causes for denied claims include timing issues, pre-authorization/authorization mistakes, and authorization period discrepancies. These problems are usually due to the patient not having the correct referral, failing to pay on time, or losing their insurance coverage. Having a practice management system in place can make investigations into denied claims much easier. Leaving denied claims as denied can cost you millions in profit.


Always Recheck Your Work:

Proof-checking your work can be monotonous and prolonging, but rechecking your claims can prevent potential errors. Spending time on this initiative can save time in the future and prevent substantial money loss. Allow your billing department enough time to double check claims or make sure your practice management system notifies you of errors.


Billing Comprehension:

Management should fully understand your practice’s billing process. This means being able to follow billing statuses and reports and relating them to the health of your company. Acquiring great technology and providing effective communication are important in achieving this goal.

These four tips can considerably assist practices in reducing or eliminating denied claims. As a result, you begin to receive the maximum reimbursement for your work.

How to Reduce ICD-10 Denials

October 16, 2015 Posted on Categories Billing Service, ICD-10

by Michelle Tohill

As you well know, ICD-10 went into effect Oct. 1. Many of you are already submitting claims using the new coding system. In the next few weeks, you’ll find out how well you’re doing based on the number of successful reimbursements compared to rejections.

Avoid costly delays and irritation by following these five steps to reduce ICD-10 claim denials:film Despicable Me 3

1. Review/work claim rejections daily
With the new standards, it’s important to review and work your rejections on a  daily basis. This is good practice regardless of the situation, but with so much change in the system, it is more important than ever to stay on top of your claims.

2. Documentation is essential
Now is the time to make sure that your documentation is completely buttoned up so that you can justify every claim and also quickly correct any errors that you make that result in claim rejection.

3. Education & knowledge on ICD-10 medical billing standards
Hopefully you have good billing software and a billing team that is helping through this transition, but even the best systems and software can’t beat taking the time to really learn the new ICD-10 coding system to reduce errors and eliminate rejections.

4. Avoid using the “Unspecified” ICD-10 codes
This is a red flag, and will likely result in claim denial. If you absolutely must code with an “unspecified” code, provide needed detail associated with the ICD-10 and documentation aiding in meeting medical necessity.

5. Become familiar with the LCD guidelines
Local coverage determination (LCD) guidelines vary from region to region, making it critical that your medical billing software and billing team are familiar with which region applies to the specific care being claimed. Not following LCD guidelines will result in unequivocal claim denial.

Most of these tips are things I recommended before Oct. 1, but now they are even more important. At Bonafide, our software-only customers have the benefit of utilizing our updated software. Of course, our billing customers have the added benefit of our expert team of billers. Let us know if you need some help reducing your medical billing claims!


Michelle Tohill is Director of Revenue Cycle Management of Bonafide Management Systems and oversees all billing programs and processes. Her specialty is conducting AR audits to expose inefficient billing practices that fail to fully reimburse physicians for their work. She conducts AR audits and provides Bonafide customers with training and consulting on how to improve every aspect of billing and practice management to maximize revenue.

How is ICD-10 Going to Affect You Oct. 1?

September 23, 2015 Posted on Categories Billing Service, Cash Flow, ICD-10

by Michelle Tohill

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Oct. 1 is right around the corner, and we still don’t know exactly how ICD-10 is going to impact healthcare businesses. In fact, there is still some slight question about whether the CDC is going to pull back at the last minute due to readiness concerns.

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Here are some things you should know for your business in preparation for Oct. 1:

>> You must use ICD-9 codes up through Sept. 30; beginning Oct. 1, you must use ICD-10 codes.

>> If you don’t use the correct ICD-10 codes, you will not get reimbursed.

>> It may take time for your partners and providers to get on board, so even if you are ICD-10 ready, your cashflow may still be impacted due to their inability to provide the correct billing information.

 streaming The Lost City of Z movie

While it’s hard to say EXACTLY what will happen on Oct. 1, we do know that there will likely be a great deal of confusion and an overall slow-down in the medical billing and reimbursement industry for at least the first 90 days following ICD-10 implementation.

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If you haven’t already, make sure your billers or billing service is fully ICD-10 ready, and prepare a cushion in your bank account to allow for significant cashflow slow-downs.

 streaming The Lost City of Z movie

Michelle Tohill is Director of Revenue Cycle Management of Bonafide Management Systems and oversees all billing programs and processes. Her specialty is conducting AR audits to expose inefficient billing practices that fail to fully reimburse physicians for their work. She conducts AR audits and provides Bonafide customers with training and consulting on how to improve every aspect of billing and practice management to maximize revenue.

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