Many healthcare consumers are hit with surprise medical bills from physicians who outsource their billing. Risk-based auditing software solutions helps keep billing in-house and identifies compliance issues early.
(Brookfield, WI) February 22, 2018—According to recent data, as many as 22% of Americans who visit emergency departments receive surprise medical bills, even if the facility is part of their insurance network.(1) In many cases, such surprise bills result from out-of-network physicians billing for services performed at an in-network facility. Healthcare organizations often fall victim to medical billing audits as a result of compliance issues. To turn the tide and help healthcare organizations avoid costly audits, risk-based auditing software solutions such as Fi-Med Management’s REVEAL/md are being implemented in hospitals nationwide.
Out-of-network physicians billing for outstanding balances is known as balance billing. This process allows physicians to bill for outstanding balances not covered by insurance. Some facilities outsource this function, relying on individuals with no clinical experience to determine rates at which patients are charged.
In many cases, balance billing results in overpayments to physicians from commercial payers, including insurance companies and the Centers for Medicare & Medicaid Services (CMS). Regardless, outsourcing of billing practices is expected to increase by 42% through 2019.(1)
Adrian Velasquez, president, CEO and co-founder of Fi-Med Management, says, “By taking a hands-off approach to billing, physicians and healthcare organizations are exposing themselves to the risk of audits. Risk-based auditing software can help keep this process in-house by identifying billing compliance issues early, helping doctors avoid costly billing audits.”
Risk-based auditing software solutions such as REVEAL/md are being used in more facilities to manage their own billing practices and avoid outsourcing. These technologies help hospitals remain compliant and reduce the likelihood of expensive audits.
“This kind of technology really helps hospitals save money and stay on top of billing guidelines handed down by the government and insurance companies. Identifying billing compliance issues early on helps these facilities avoid audits, which can carry heavy financial penalties,” says Velasquez.
About Fi-Med (www.fimed.com)
Since 1993, Fi-Med has been working alongside healthcare providers and networks to maximize revenue and reduce risk—from catching billing errors to providing high-level safeguards against compliance risk. Fi-Med is a healthcare technology company helping to disrupt the status quo of the increasing burden of government compliance for hospitals and hospital systems. As a leader in the healthcare support and management industry, Fi-Med provides billing, receivables management, credentialing, lockbox, and other financial management and reporting services to physicians, labs and medical centers nationwide. Its strong reputation for maximizing revenue and reducing risk for hundreds of hospitals, labs, private physicians and healthcare networks is the result of the technology tools that it has created: a 360-degree understanding of healthcare compliance, chronic care management, and revenue cycle management.
REVEAL/md is the keystone product, empowering healthcare providers’ compliance departments to proactively manage physician part B audits of documentation and coding. For more information, visit www.fimed.com.
About Adrian Velasquez, President, CEO and Co-founder
Armed with an extraordinarily successful career in the business of healthcare, Adrian E. Velasquez has successfully blazed new trails, taken risks and defied the odds, and in 1993, he partnered with Christine Krause and formed Fi-Med Management, Inc. Their mission: to bring business acumen and compliance expertise to healthcare providers throughout the United States.
Prior to his work at Fi-Med, Adrian worked with healthcare providers across the country, mastering all areas of business function and management for medical organizations of all sizes. His previous experience as a system administrator and healthcare consulting from New York to California formed the foundation that he harnesses today for Fi-Med clients.
Among his accolades, Adrian won the Small Business Person of the Year Award in 2007 for the state of Wisconsin and represented Wisconsin on the national stage.
Fi-Med has been working alongside healthcare providers and networks to maximize revenue and reduce risk—from catching billing errors to providing high-level safeguards against compliance risk. Fi-Med has grown exponentially over the last 24 years, becoming trusted experts in the fields of financial healthcare management, compliance and risk assessment, and chronic care management.
- 15 things to know about hospital billing and patient payments. Becker’s Hospital CFO Report. https://www.beckershospitalreview.com/finance/15-things-to-know-about-hospital-billing-and-patient-payments.html