Most consumers don't realize it, but this common practice, known as balance billing, often is illegal. When doctors or hospitals think an insurer has reimbursed too little, state and federal laws generally bar the medical providers from pressuring patients to pay the difference. Instead, doctors and hospitals should be wrangling directly with insurers...

Balance billing most frequently occurs when medical providers participating in a managed-care network believe the plan's insurer is imposing too deep a discount on medical bills or is taking too long to pay. California, New Jersey, and 45 other states ban in-network providers from billing insured patients beyond co-payments or co-insurance required by the plan. Similarly, federal law prohibits providers from billing Medicare patients for unpaid balances.

These laws require medical providers to seek payment only from the insurer for services covered by the plan. Many states also shield insured patients from balance billing by out-of-network hospitals and doctors in emergencies, since patients usually don't control who treats them in those situations. (Bans on balance billing generally don't apply when a patient gets an elective procedure, such as cosmetic surgery, or seeks out-of-network, non-emergency service without a referral.)

Source:   http://www.businessweek.com/magazine/content/08_36/b4098040915634.htm

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Excerpt:   MTBC, the unique revenue cycle and practice management company, has executed automated real-time adjudication (RTA) of claims for patients with United Healthcare insurance.  MTBC believes it is the first U.S. billing company to achieve this breakthrough with any insurer.

RTA provides an immediate adjudication of insurance claims and allows a physician practice to determine and collect the full payable amount – not just the patient co-payment.  RTA has not been widely used because of technology hurdles and repetitive manual submission that is time-consuming and error prone.  MTBC is now rolling out its automated RTA process to its clients and is actively developing and testing the interface and communications channels for other insurers and 3rd party vendors that offer RTA implementation.

"This advance demonstrates that we're a nimble technology company that acts quickly on the issues reshaping the entire healthcare industry," said David Rosenblum, president of MTBC. "We are committed to maximizing and accelerating our clients' collections, and RTA is one step in achieving that."

In its continual campaign to reduce costs through process improvements, MTBC already performs all inclusive billing at only 4 percent of collections, a rate typically 25 percent - 50 percent less than that of most medical billing services.

Source:   http://www.reuters.com/article/pressRelease/idUS211546+30-Jul-2008+PRN20080730

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Excerpt:   Electronic medical records promise to be the gateway to the future of health care, but as convenient and helpful as they may be, adoption among doctors is happening at a slow rate.

Steep upfront costs associated with digital medical charts and privacy concerns are making doctors reluctant to embrace digital record keeping.

According to a recent survey published in the New England Journal of Medicine, only 4% of U.S. physicians providing direct patient care said they had a full EMR system and only 13% had a basic system…

“It’s a return on investment issue. Physicians, when they implement an EMR, might also integrate a billing system and when they do that they may document what they’re doing for the patient better and generate other billing items,” he said. “When the clinical documentation, transcription, billing, and charts are all integrated and a patient can go online to request appointments and prescription refills, this creates a lot of savings for front and back end offices of practices.”

Source:   http://www.foxbusiness.com/story/electronic-medical-records/