The Centers for Medicare and Medicaid Services (CMS) recently implemented major changes to the Stark Law regulations, most of which are already in place. However, some health care providers may be less aware of the changes to the “special rule for productivity bonuses and profit sharing” within Stark’s group practice definition.Read More
As of March 1st, 2021, UnitedHealthcare has made several updates to their reimbursement policy for Advanced Practice Health Care Providers. The previous policy change was made on April 13th, 2020 when the word “Commercial” was added to the policy header.Read More
After some delay due to the COVID-19 pandemic, the Centers for Medicare and Medicaid Services (CMS) has released the final set of guidelines that will govern the Medicare payment system for 2021. The rule for the Medicare Physician Fee Schedule (MPFS) was proposed earlier last year, and since then, slight revisions have been made including an improvement in the conversion factor and a change to the Quality Payment Program (QPP) performance threshold.Read More
Radiologists and healthcare providers of all kinds should always prioritize their awareness of illnesses or injuries that have begun to occur more frequently, whether the instances are being described as an “outbreak” or just as a trend that is increasing over time. One such example is the recent occurrences of cases of e-cigarette or vaping product use-associated lung injury, also known as EVALI. The Centers for Disease Control and Prevention (CDC) recently released an in-depth report focused on this outbreak, its evolution, and its potential causes, which can guide radiologists moving forward as they may be faced with cases of EVALI in their own practices. Keep reading to learn more about this illness and how radiologists can best serve patients with EVALI in 2020.Read More
We are undeniably in uncertain times and uncharted territories. The medical world and the world at large has been thrown into upheaval in an attempt to weather and survive the COVID19 pandemic. Arguably, no industry has been affected more so than the medical industry; even-more the musculoskeletal specialities such as orthopedics and radiology have been virtually shut down. Elective surgeries had been canceled to free up space for COVID-19 patients.Read More
This is the latest information by the insurance companies updated August 3rd, 2020.
We will be reviewing insurance carrier information each business day and update when applicable. These policies change constantly so we have included the websites for reference.Read More
As we are sure most healthcare providers come to expect, each new year brings new changes to codes, payment policies, and processes in the healthcare industry. On November 1st, CMS announced upcoming changes to payment policies, which were detailed in its 2020 Medicare Hospital Outpatient Prospective Payment System and ASC Payment System Final Rule. The final rule included many new details on processes that healthcare providers should be aware of, and at Healthcare Information Services, we want to keep you up to date so your practice can move confidently into the new year. Below, we have provided more details on some of the main points of the final rule. Keep reading to learn more and get informed so you can be as prepared as possible to adapt to these new changes.Read More
For those who work in the healthcare industry, surprise billing is not a new concept. This practice impacts patients seeking all types of medical attention, and has been a topic of discussion among lawmakers in recent months. Attention from both the federal government and healthcare stakeholders has propelled this issue into one that might soon have a resolution, because both the House Ways & Means Committee and other significant groups in Congress have been working to find a solution. Congress has been at a stalemate for months regarding this issue, but recent proposals have sparked a new wave of negotiations and conversations by lawmakers to come to a resolution before the December 20th deadline. Keep reading to learn more about this issue and where it currently stands in Congress.Read More
We have received many inquiries on the reporting of telehealth codes due to CMS reducing the restrictions on telehealth services. As of today, these reductions are available for the diagnosis and treatment of any conditions and/or diseases retroactive to March 6, 2020. While there has been communication from some commercial insurance carriers as to their reduction in restrictions also, as of this notification, it is unknown if they will follow CMS. HIS will keep you updated if new developments change the restrictions.Read More
Those in the healthcare industry are certainly no strangers to insurance claim payments being delayed or denied. Practices facing this issue are at a great risk for losing out on revenue throughout each year, because it is estimated that around 25% of denied claims are never paid at all. If your organization’s denial rates are particularly high, this issue is one that will need to be addressed and resolved so your practice can continue to serve patients and bring in revenue. One of the most effective ways to determine how to prevent such denials is to evaluate and assess your practice’s revenue cycle. Keep reading to learn more about how to conduct this type of assessment and how Healthcare Information Services can help optimize your revenue cycle for practice success.Read More
The descriptions for intermediate and complex repairs have been clarified
including adding the description for limited and extensive undermining.
Intermediate Repair- Intermediate repair includes the repair of wounds that,
in addition to the above, require layered closure of one or more of the deeper
layers of subcutaneous tissue and superficial (non-muscle) fascia, in addition
to the skin (epidermal and dermal) closure. It includes limited undermining
(defined as a distance less than the maximum width of the defect, measured
perpendicular to the closure line, along at least one entire edge of the defect)
Single-layer closure of heavily contaminated wounds that have required
extensive cleaning or removal of particulate matter also constitutes
Complex repair- Complex repair includes the repair of wounds that in
addition to the requirements for intermediate repair, require at least one of the
following; exposure of bone, cartilage, tendon, or named neurovascular
structure; debridement of wound edges (e.g. traumatic lacerations or
avulsions); extensive undermining (defined as the distance greater than or
equal to the maximum width of the defect, measured perpendicular to the
closure line along at least one entire edge of the defect); involvement of free
margins of helical rim, vermillion border, or nostril rim; placement of
retention sutures. Necessary preparation includes creation of a limited
defect for repairs or the debridement of complicated lacerations or avulsions
Scar revision has been removed from the description of complex repair.
Per the AMA, Scar revision in which skin is excised and closure is
performed should be coded as excision of benign lesion. This code will be
considered included in most other surgical procedures.
If you are involved in the healthcare industry, you are well aware of the prevalence of scope of practice laws, or SOPs. These laws define and specify the tasks (including procedures, actions, and processes) that healthcare providers at different levels can perform. These laws also govern the level of oversight required for specific tasks, and they vary by both state and occupation. Recently, physician assistants (PAs) have begun approaching state lawmakers and governors to seek an expanded scope of practice that would loosen supervisory and regulatory restrictions in terms of the tasks they can perform and the physician oversight needed. This has led to the consideration of New York, North Dakota, and South Carolina to expand their scope of practice laws. Below, we detail the reasons why an expansion of these laws for PAs would be beneficial to the greater medical community and its patient base.Read More
QPP stands for Quality Payment Program. The Quality Payment Program was designed to improve Medicare by helping physicians focus on the quality of care over service volume. Prior to 2015, physicians were reimbursed on a fee-for-service model. In 2015, QPP was introduced, bringing a two track value-based reimbursement system to replace the existing system.Read More
The Centers for Medicare & Medicaid Services (CMS) developed the Medicaid Integrity Strategy to combat abuse, fraud, and the waste of Medicaid dollars. The Medicaid Integrity Program was the first comprehensive Federal strategy aimed at combating the abuse of the Medicaid program. This program aims to keep Medicaid sustainable for years to come, especially with Medicaid spending increasing dramatically over the past decade.Read More
Running an orthopedic practice, or any medical practice for that matter, requires a delicate balance of business and clinical expertise. Orthopedists want to focus on providing the highest quality medical services possible, but at the end of the day, they also have a business to run. This can cause several issues within the orthopedic practice. Today, we will go over some of the most common business challenges for orthopedic practices and how to go about managing these problems.Read More
The business world experiences insurmountable changes even to the smallest detail on an everyday basis. It’s safe to say that we’re at the height of the digital age and your medical practice must follow suit in order to maximize revenue and onboard new clients in order to increase your online presence both on a local and more widespread scale. With the market rapidly evolving, you must keep up with the latest trends to improve the overall success of a business. One of the most crucial elements of digital marketing lies within the domain of search engine optimization, or more commonly known as SEO. Here are five SEO tips for you to implement into the regular operations of your medical practice’s digital agenda.Read More
When managing a medical practice, you undoubtedly have several things to worry about at any given time. Medical billing and coding is difficult to keep up with, especially with evolving laws, regulations, and medical codes. These changes make it difficult to be compliant even for the most astute practices. Unfortunately, failure to have accurate and compliant medical billing and coding can result in several negative ramifications for your practice. Here are the top three reasons it is vital to be accurate and compliant in billing and coding all of the time, and some of our tips for achieving greater accuracy and compliance.Read More
A recent article published in Clinical Spine Surgery observed payor reform opportunities for spine surgery. The article, written by Jason Scalise, MD, and David Jacofsky, MD, focuses on bundled payments, and the demands for spine surgery to implement bundled payment strategies. Spine procedures are projected to increase dramatically due to age demographics and other population factors. Substantial focus is being put on this division of musculoskeletal care to find a way to drive consistency and value. The trends and increasing pressures by government and commercial payors to drive accountability to the level of the surgeon should not be thought of as a passing phase by spine surgeons. Below are five key concepts for payor reform in spine surgery from the article.Read More
Managing a revenue cycle in the medical field is no easy task. Below are some concerns for orthopedic practices and recommendations for monitoring the health of your revenue cycle.Read More
Due to be released in early July, the CMS will likely propose a 50 percent cut to the technical component of mammography reimbursement in the 2018 Medicare Physician Fee Schedule (MPFS) proposed rule. According to industry experts, cutting down mammography reimbursements could potentially drive down access to a mammography. As a result, imaging organizations are raising questions about outdated reimbursement formulas in an effort to prevent the cuts from happening.Read More
On March 3rd, the Medicare Payment Advisory Commission (MedPAC) discussed proposed reforms to the Merit-Based Incentive Payment System (MIPS) and Advanced Alternative Payments Models (A-APMs). The purpose of this meeting was to review the issues and challenges facing the Medicare program and then making policy recommendations to Congress. Commissioners suggested different ways to help physicians’ transition from MIPS to A-APMs, and discussed their recommendations for the future.Read More
Radiology practices continue to grow, but for several years, mergers and acquisitions between practices have been a topic of discussion in radiology. Although there has not been a significant increase in blended practices, it’s a possibility that still concerns many. If your practice is facing the decision of a merger or acquisition, here’s when it might be beneficial to conjoin.Read More
As specialists in orthopedic revenue cycle management, we understand the importance of a strong and efficient revenue cycle for the health and stability of an orthopedic practice. A robust revenue cycle encourages strong cash flow, maximizes reimbursements, keeps your practice compliant, and increases efficiency and profitability.Read More
Does your practice need help ? Could it be more successful and profitable with the help of some expert practice management and consulting? Trusting someone to manage your practice and provide you with professional advice honed from 40 years of experience is not easy. Here are some best practices to ensure your practice’s needs are being met.Read More
When running a radiology practice, your number one priority is on the patients, ensuring they receive the absolute best diagnostic care. While this is of the utmost importance, it is also vital to remember you are also running a business. With a strong revenue cycle management partner, your radiology practice can remain stable and profitable for years to come – allowing you to best serve your patients. Take a look at the best practices for managing your radiology practice’s revenue cycle.Read More
Bones Society of Florida Conference in Manalapan Florida
September 16th through 18th marks the annual Bones Society Of Florida (BSOF) Conference at East Palm Beach Resort and Spa. Guests can find HIS at booth 45 within the conference all weekend long. Stop by our booth to learn more about the services HIS provides and discuss how we can help your specific orthopedic practice. As an added bonus, our table will also be giving away a gorgeous Vincent Camuto handbag.
Recently, I was asked the question “We are wondering what sets your company apart from other billing/revenue cycle companies such as Athena. We have been comparing EMRs and some have the billing side as well. We would like to know if we are comparing Apples to Apples.” I love when we are asked that question, in short it means “How does HIS compare…?”Read More
Effective May 16th, 2016 Cigna enacted a new policy for strapping. This policy will now cover strapping tape as a medical necessity, citing its importance in the initial management of an immobilized joint and restriction of movement. Strapping tape will be covered for the following:Read More
You know there are times when you need to make something fit but it just won't. Like a time when all of your information had to fit on a single page but just didn't? When this happens it's not time for a complete overhaul. Instead, some subtle tweaks are needed...
When it comes to profitability in healthcare, billing is only one part of the big picture. There are steps any radiology practice must take in order to ensure financial success. Effective revenue cycle management is key to profitability and financial health.Read More
Revenue Cycle Management (RCM) is a necessary piece of the healthcare puzzle and it remains an integral part of the success of any healthcare business. When a clinic outsources the management of their revenue cycle, they entrust an outside company to handle coding, claim submission, collections, et al. Some practices choose outsourcing RCM due to cost-benefit analyses, spacing and time issues, or convenience. Other practices retain in-house management of the revenue cycle, traditionally when they have experienced, trained coders on staff and a time-tested process already in place.
All practices are not alike and have their own nuances to their revenue cycle. Look within, and evaluate your current situation to determine whether outsourcing is right for you. Whether or not you have considered partnering with a revenue cycle management firm or not, I am sure you have heard both success and horror stories. Below, I’ve debunked four common myths about revenue cycle outsourcing.
According to a recent study by the Healthcare Information Management Systems Society, only 63% of ICD-10 coding is accurate. There were some common trends in this study as far as common mistakes people tend to make when coding. Incorrect coding costs both time and money, so take a look at these common coding errors made in ICD-10 to learn more about improving your practice’s efficiency.Read More
Healthcare coding is constantly in a state of change. Since ICD-10’s implementation, we’ve done our best to keep you informed and updated on all decisions, changes, and clarifications. Following proper coding practices increases the likelihood of prompt payment and keeps processing as efficient as possible. Below I’ve included a breakdown of changes and updates regarding comparison view x-rays, foot care, and surgical spine treatment.Read More
Now that ICD-10 is officially in full effect, radiology practices have had to fully integrate with the implementation of ICD-10. To make the conversion both swift and successful (and to avoid losing money), practices will need to implement new strategies and education. Setting up, performing, testing, and training on the new system will take some time - hopefully you've got the hang of most of it since the October 2015 switch. But what kind of impact is ICD-10 going to have on radiology billing? Good question.
One of the biggest challenges any radiology practice faces is accurate coding. The right coding procedures can make the difference between a smooth revenue cycle and quick reimbursements, and a drawn-out process that costs the clinic money and leads to delays in reimbursements. The adoption of ICD-10 codes led to changes in radiology coding. At Healthcare Information Services, our number-one priority is to assist your hospital or clinic in dealing with coding changes to maintain a healthy bottom line.
This content was originally posted on Jan. 22, 2016 by Katherine Moody on FierceHealthPayer. Click here to see the original source.
Physician billing can be complicated, especially if you work with Medicare. But even commercial companies impose a Multiple Procedure Payment Reduction, or MPPR, in some instances. And although our team of experts at Healthcare Information Services know the ins and outs of how MPPR works, we want to make sure you understand this insurance procedure, and why it occurs.
October 1st, 2015 marked the official transition of the long anticipated ICD-10 coding guidelines going into effect. While there was no “transition period”, medical practitioners were told well in advance that they would have to completely make the change to ICD-10 by the first of October 2015. Hospitals and medical practices all over the United States have been preparing for the huge medical coding change to go into effect. This has included hiring teams to come in and train the staff, hiring a team to take over the management of your revenue cycle, or spending a significant amount of time dedicated to learning the new guideline on their own. Now that ICD-10 has been in full swing for a full quarter, let’s see the effects it is having on practices and hospitals in the United States.Read More
Radiology is a high-volume specialty, and as you can image accurate coding is critical. If you think about the massive number of medical records and documents your radiology staff have to read and interpret, you understand why they want billing processes and reports that are quick and to the point. An experienced radiology coder understands the critical pieces of documentation needed to assign procedure codes to ensure physicians and their practice make as most money as they can. That's why we have billing experts, right? Better radiology billing knowledge = better bottom lines.Read More
As with every New Year, change is coming. Over the years, radiology billing has experienced a number of changes, specifically in regards to coding. This year is no different, as there are new codes to learn and more codes to bundle. We’ve put together an overview of the changes from 2015 to 2016 to help your healthcare practice prepare for what’s coming next.
The Healthcare Information and Management Systems Society and Workgroup for Electron in Data Interchange recently released a report on ICD-10’s national pilot program. The results within this report found that only 63% of submitted ICD-10 codes were complete and precise. Although this finding occurred prior to the ICD-10 coding system being enforced on October 2015, it was still able to collect relevant errors and mistakes to avoid while moving forward with this system.Read More
The billing process in the revenue cycle is one of the most important functions for orthopedic practices today. With proper billing, revenue will continue to come in with minimal delays minimizing stress and cash flow issues. When it comes to orthopedic billing, practices need to keep several important things in mind if they want to bill as effectively as possible and minimize the chance of claim denials. Here's five orthopedic billing guidelines at the top of our list...
Since the conversion from ICD-9 to ICD-10 in October 2015, there have been many questions regarding the switch. At HIS, we understand the stress and confusion this change may cause for healthcare providers and their staff. ICD-10 is much more complex than previous coding systems in effect for the last 30 years. Though change can at times be uncomfortable, it can also be good. ICD-10 allows for much more detailed diagnoses and its set rules about coding is far more suitable for the twenty first century.Read More
Every year the amount of bills sent to collections increases. This is hurting healthcare practices’ pocketbooks, increasing patient debt, and damaging patient credit scores. Because collection agencies are paid by healthcare providers to collect money from patients, healthcare institutions are paying to be paid. This is neither beneficial or a good use of your practice's revenue.Read More
The evolution of the healthcare industry and adaption to ICD-10 is making for many changes, stresses, and distractions for healthcare professionals. In addition to this and daily care for patients, some medical workers are also lending a hand with administrative tasks like helping with bills, paperwork, and claims. It may seem like a good system, but utilizing workers who are not specialized specifically in healthcare billing and administration can actually cause an organization time and money.Read More
In the business of healthcare, revenue cycle management covers all of the processes that encompass with collection and measurement of revenue to you and your practice. This should include registration, eligibility verification, coding and claim preparation, claims submission and processing, insurance collections, rejections, denailas, appeals, patient responibility collections,payments posting, financial analysis and reporting, financial projections, and all other relevant tasks for revenue generation and colleciton. In other words, it should help you monitor your claims and payments throughout the life cycle of your practice. The revenue cycle begins when a patient first schedules an appointment and ends well beyond the collection and posting for all payments for that encounter.
Medical practices, including radiologists and orthopedic surgeons, are facing numerous challenges in 2015 as the entire healthcare industry debates the benefits of volume-based care versus value-based care. The current volume-based reimbursement model has faced controversy over the idea that doctors may be over-treating patients as a way to generate additional income or in an attempt to keep up with lowered reimbursements. This has created an ethical and financial dilemma for practices who want to be reimbursed at a rate that can keep their doors open, but without over-treating patients or increasing the volume of patients to unmanageable levels. The move from the volume-based to a value-based model is supposed to be a step toward resolving these concerns, but it also raises six critical issues when comparing the two models.Read More
Physicians, hospitals and small medical practices are in a race to make sure they are in compliance with ICD-10 codes by October 1st, 2015. Switching their systems over has proven to be a bit more complex than anticipated. The reasons are that ICD-9 codes may have multiple mappings to much more specific ICD-10 codes or no mapping at all. The complexity of each system switch-over is different depending on the medical specialty, the codes normally used to provide services, and the type of office itself. Many providers are turning to special tools to help them make the switch, but in the end the usage of such tools will have to be customized to their particular practice.Read More
Beginning October 1, 2015, the medical community will be required to switch from the ICD-9 coding system to ICD-10. This change brings with it many tasks and responsibilities on the part of physicians and their staff. Even so, there are apparently, many orthopedic practices and other medical practices that have taken little to no action to prepare.Read More
While not the first time Medicare funding has undergone revision, (and likely not the last), the "Doc Fix" bill seeks to fix a long term problem with the system. This bipartisan effort is focused on establishing more realistic funding and for Medicare, affecting both patient care and physician reimbursement. This bill is considered a long-term fix, and not the more commonly used patch method to secure funding.Read More
In 2012, Centers for Medicare and Medicaid Services (CMS) published a rule that would require providers to report and refund any overpayments within 60 days from the date the overpayment was found. As an orthopedic provider, you have probably received some of these notices from Medicare. However, due to the amount of comments and extensive discussion around the issue, CMS has delayed its final ruling on the 60-Day Overpayment policy. Of particular concern has been the provision that this requirement could include audits going back as much as ten years. So what does this mean for your office? Read on.Read More
By now, you and your staff are probably quite familiar with the concepts and regulations of "meaningful use" (MU) of electronic health record (EHR) technology which has to be demonstrated in order for hospitals and eligible providers (EPs) to receive the incentive payments from the Centers for Medicare and Medicaid Services (CMS). You are probably also fully aware that there are specific criteria that has to be met and "attested" to in order to document that "meaningful use" has been achieved.Read More
Payment variances may have many causes, but they typically land in two major categories. The first category is when a payer has updated their payment system to account for issues like a new contract fee schedule. The second major category of occurrence that can cause payment variances is when a payer has made changes to their payment system, but the configuration wasn’t successfully applied. Since both of these situations tend to happen at the start of a new contract year, that’s the time to pay attention to issues that crop up by analyzing your payment variances before they get out-of-hand.Read More
Correct documentation is crucial for physician billing to Medicare. Over the past few years, The Department of Health and Human services has been strongly focused on correcting and minimizing healthcare fraud. Currently, evaluation and management (E/M) services are under high scrutiny, especially CPT code 99233. What does this mean for your practice, and how can you protect your assets? We’ve compiled a list of three ways to prepare for random CMS audits of 99233.Read More
Medical residents who are preparing to graduate this June and who wish to be classified as an interpreting physician according to the MQSA need to be aware of requirements changes that went into effect last year. The ABR made changes to their certification process which led the FDA to come out with guidelines to accommodate those ABR changes. This confusing process, and attendant requirements, are explained below.Read More
Orthopedic providers may be subject to a reimbursement penalty on all claims submitted to Medicare for 2015. If you are an eligible professional (EP) that participates in the Physician Quality Reporting System (PQRS) or a group practice participating in the Group Practice Reporting Option (GPRO), then you’re in danger of receiving a negative payment adjustment (penalty) of 1.5% on all covered services rendered this year. The 1.5% is to be deducted from the normal Medicare Physician Fee Schedule (MPFS) for services provided. Keep reading to find out if your practice will be affected by the adjustment.Read More
The 2015 CPT coding changes will affect many different venues of healthcare with new and combined coding as well as removed codes. CPT 2015 code changes include: 134 revised, 143 deleted, 264 new as well as changes in guidelines. For orthopedic practices the new coding is already in effect, and needs to be adhered to immediately to ensure proper billing and payments.Read More
Released in September of 2013, Epocrates' 8th Annual Future Physicians of America Survey asked more than 1,000 U.S. medical students to share their opinions about healthcare reform, their career goals, evolving technology and other hot button topics. The survey found that today's medical students are overwhelmingly planning to join group practices or hospitals instead of starting solo or partnership practices.Read More
Like many other physician practices, you may be undecided whether or not to outsource your billing and Revenue Cycle Management (RCM) functions. You may have already outsourced payroll and transcription, but when it comes to billing, you might think twice and say, “Won’t that be a mistake?”Read More
Summary of 2015 Medicare Physician Fee Schedule (MPFS) Final Rule
On October 31st, 2014 CMS released final ruling on the 2015 Medicare Physician Fee Schedule (MPFS). This is a summary of that final rule.Read More
As the use of electronic medical records (EMRs), now electronic health records (EHRs), becomes more prevalent, users are beginning to really understand their ultimate value and critical use. One of the most illuminating ways EHR data is helping out the healthcare industry is in their aid with decision making.Read More
In today’s competitive healthcare environment, radiologic service providers must operate under increasing requirements and constraints as they face decreasing resources and reimbursements. Consequently, they must continuously demonstrate values to their clients and look for ways to continually make improvements. Service providers must go beyond simply managing operations and measure upgrades in their processes as it relates to productivity, efficiency, quality, and safety.Read More
Over the past several years, orthopedic revenue cycle management has been impacted by the number of
changes taking place throughout the healthcare industry. Not only have government programs such as Medicare and Medicaid reduced physician reimbursement, but third-party payers have also implemented negotiated fee-for-service contracts. These changes have a negative impact and tend to result in less than 100% reimbursement for charges accrued.
As if these changes aren’t enough, certain provisions contained within HIPAA have also made claims data submission more stringent. Consequently, many practices are looking for ways to improve their revenue cycle processes.
Insurance verification and pre-certification are two issues in orthopedic practices that can affect reimbursements. Implementing strategic changes in the business processes related to these areas can enhance the bottom line of any practice.
Verification at your practice
The staff that you have assigned to verify your patient's benefits plays a critical role in your practices reimbursement rate. Verification may be the most effective method to lowering denials from the payer as they are the ones making decisions that will determine whether you will be paid appropriately for services rendered-- if paid at all. These employees’ must focus not only on obtaining benefit information before a patient arrives for an appointment, but must ensure that the benefit information they obtain is accurate and correct.
The best practices for ensuring that the verification process at your practice works to the optimal level includes the following elements:
Well-trained staff can get the bulk of this information by simply looking at the insurance ID number, group, or plan on the patient’s insurance card. Make sure that new employees or individuals promoted to the verification staff have the proper training on the appropriate processes.
Pre-certification or pre-authorization has always been a thorn in the side of physicians and their billing staff. According to a study published in the Journal of the American Board of Family Medicine, it is estimated that the cost for prior authorization activities, per full-time equivalent physician to be between $2,161 and $3,430 a year. Many insurance carriers are now requiring pre-authorization for more procedures and services than ever before. In addition, many insurers have made it a policy to disallow retroactive authorizations.
The process of obtaining prior authorization can be challenging and time-consuming. However, getting proper pre-authorization on the front-end before rendering services increases the likelihood of prompt payment and decreases write-offs on the back-end.
If your practice has more than one location, consider creating greater efficiencies by centralizing the responsibility for obtaining pre-certification. You can also seek blanket approval from insurance carriers for a “plan-of-care” for specific conditions and treatment protocols, which minimizes or eliminates the need to call every time for authorization.
The degree to which you effectively manage your revenue cycle will determine the level of success your practice will have. With reimbursements from private insurance carriers and the government on the decline, conduct an evaluation of how you manage your processes, especially as it relates to verification and pre-certification procedures.
After you conduct the assessment, you should have a better understanding of the underlying issues affecting your bottom line. You will now be prepared to take the necessary steps to remove the impediments and improve your revenue cycle processes.
As the healthcare industry continues to grow in terms of capacity and complexity, there is one thing that clinics and private practices have in-common; the need for an efficient revenue stream. For many healthcare administrators this presents a bit of a dilemma since, to provide quality care and secure a reliable revenue cycle, they must wear two very different hats.Read More
The increasing competition in private practices puts a significant burden on your shoulders. You’re no longer just required to deliver excellent results but you also want to cut on costs by increasing efficiency to maximize resources.Read More
According to a recent report, the trend for hospital physician employment may not be as beneficial to hospitals and physicians as some previously thought. Although there may be some advantages for physician groups to be owned by a hospital, by and larger there are numerous of reasons such an arrangement may not be the best one.Read More
In order to maintain a healthy revenue stream, it is key that your practice has a well-balanced mix of payers. If your revenue stream seems to be sagging it could be that your payer mix has shifted in a negative direction. That is, you may have seen patients with coverage from lower, poor, or slow payers. Here are some things you can do to address that situation.Read More
A recently released study from the Office of the Inspector General (OIG) of the US Department of Health and Human Services focused on improper Medicare payments for evaluation and management (E/M) services. E/M services include visits to non-physician and physician practitioners that aim to manage and assess a patient's health. In 2010 Medicare paid $32.3 billion for all E/M services which made up almost 30% of all Part B payments for the year.Read More
When it comes to collecting payments for orthopedic services rendered, time is the enemy. As time passes, the likelihood for reimbursement decreases. What can a practice do to ensure the collection of payments?Read More
Orthopedic practices often suffer from revenue stream issues stemming from a number of different causes. The reimbursement process is complicated enough without holding it back due to issues within a practice, and yet there are common concerns which plague orthopedic practices if not carefully monitored. One of these issues is the credentialing process for providers.Read More
A healthy revenue stream is the lifeblood of any healthcare practice, but with so many variables in play, maintaining a steady flow of incoming revenue can be a challenge. It's situations like this which call for investigation into the practice's revenue cycle management.
On January 30th, the Centers for Medicare and Medicaid Services (CMS) released financial figures which showed savings of approximately $380 million. These savings, according to HHS secretary Kathleen Sebelius, could be directly attributed to various Accountable Care Act and Bundled Payment initiatives.
The Bundled Payments for Care Improvements (BPCI) initiative of the Centers for Medicare and Medicaid (CMS) seeks to improve the quality of care - the outcome - while limiting the cost of the services provided for a particular episode of care for specific patients. The approach is not unlike that taken by CMS in the mid-1980’s with the implementation of the Inpatient Prospective Payment System (IPPS) based on particular discharge Diagnosis Related Groups (DRGs). That saw the change from a “time and materials” type of reimbursement for inpatient care to hospitals, to a “flat fee” basis for a particular discharge diagnosis. This caused the change of various hospital departments, like radiology, physical therapy, rehabilitation and occupational therapy, lab, etc., from being “revenue centers” to being designated as “cost centers”. Hospitals were no longer reimbursed based on the amount of services provided to inpatients, but strictly on the discharge diagnosis. The DRG-based IPPS reimbursement program only applied to inpatient reimbursements to hospitals. The reimbursement to physician providers and for hospital outpatient services were still based on the volume of services provided.
The bundled payment program is an attempt to expand the DRG reimbursement concept and extend it to a whole “episode of care” as opposed to a particular “length of stay” as a hospital inpatient. As structured by the CMS, the bundled payment program has four different models for implementation.Read More
If you are a practicing physician in this market, you may wonder why you are working long hours and seeing as many patients as you can, yet the amount of money you are collecting seems to be decreasing. You cannot identify the problem and it seems as though your billing system is working. Bills are going out and collections are coming in but something is just not right.Read More
HIS was challenged and accepted the ALS Ice Bucket Challenge:
HIS is a tight-knit group and often act as a family. On Friday August 29th, 2014, we honored one of HIS' family members and the memory of her husband who died from ALS.
More than twenty people participated in the ALS Ice Bucket Challenge and together raised close to $1500 for ALS research. See the video below or you can also see the video here.
Keeping with the spirit of the challenge, Dave Wold CEO of HIS challenged the Administrators from Illinois Bone & Joint Institute. With this, they are now on the clock.
Eliminating claim denials is a crucial aspect to revenue cycle management. Successful healthcare providers have streamlined operations and made the revenue cycle more efficient. They understand that every step counts when it comes to securing reimbursements and obtaining revenues for their services. An operation that lacks efficiency, the necessary staff skill set or effective processes in place can have unnecessary insurance denials which can have a costly impact on your bottom line.Read More
2014 has certainly had the medical profession dealing with major changes in every facet of healthcare. From procedure documentation and coding, to billing and coding policy changes, and even the collection of patient balances; just about every aspect of the physician practice has been affected by changes in policy and regulations. The Affordable Care Act (ACA) has made the already confusing and oft times, costly and time consuming recovery of the patient insurance copay and deductible portion of medical claim even more frustrating.Read More
PHI may be referred to as "personal health information" or "patient health information", and both of these acronyms are technically true, as the information in question is personal to the patient. However, according to the HIPAA Privacy Rule, PHI is short for "protected health information". According to the HIPAA website, this information includes: “patient names, addresses, and all information pertaining to the patients’ health and payment records". It can also extend to financial information, SSN numbers, and even photos of patients.
Keeping this information private and secure is essential in order to avoid negative repercussions for the patient (should their personal, medical and/or financial information fall into the wrong hands) and to avoid civil and criminal penalties which could be incurred if a practice fails to comply with HIPAA Rules.Read More
The latest delay in ICD-10 implementation has caused both frustration and relief for people in the healthcare field. Now that the official date for implementation is October 1, 2015, here’s what you can expect to see happening during this interim period.
The primary purpose behind the several delays has been to give healthcare practices more opportunity to prepare for the transition. A great number of companies have taken advantage of this most recent delay to go far beyond mere readiness. Instead, they are investing more time in training their staff in the new codes.
This is not a question of simply learning a few new codes. ICD-9 already had 17,000 codes and five positions. ICD-10 will contain 69,000 codes and seven positions. Even people already well-versed in coding practices need a considerable amount of preparation to learn the new codes and their various permutations.Read More
Market forces and the implementation of the Patient Protection and Affordable Care Act have combined to transition radiologists and other healthcare service providers from a traditional fee-for-service payment model to other types of payment agreements, including medical shared risk reimbursement. Radiologists and other stakeholders must put into practice strategies that will enable them to balance potential revenues and profit with the financial risk.Read More
Using the practices referenced above can go a long way toward ensuring that any practice's radiology billing process will become more streamlined and efficient, thus allowing for greater success for the healthcare provider in question
Accurate and efficient radiology billing can prove tricky, especially with so many factors influencing the final outcome. Still, maintaining a healthy revenue stream is possible for any healthcare provider so long as the practice adheres to a handful of best practices. Many of them are fairly common sense but, if ignored, can prove detrimental in the long-term.Read More
Increasingly, the healthcare industry has been shifting toward patient cost-sharing, which includes high deductibles, co-pays, and coinsurance. Consequently, collecting from patients has taken on a higher level of importance than in the past. According to ACA International, 29 percent of adults have medical debt. Many of these people have problems paying their medical bills.Read More
A study conducted by Dr. Eugene Schneller, Professor of Supply Chain Management at Arizona State University: ‘The Value of Group Purchasing 2009: Meeting the Needs for Strategic Savings’, reports that group purchasing saves the healthcare industry $36 billion annually. For decades, hospitals have used the advantages of group purchasing to leverage their combined purchasing power to receive significant discounts and realize tremendous efficiencies and savings.Read More
With the increasing adoption and implementation of the Patient Protection and Affordable Care Act and its various components, the financial reimbursement picture is drastically changing. We now have an increased emphasis on value-based reimbursement, risk sharing and bundled payments instead of just volume-based reimbursement. In addition, there is now an increase in the patient portion of reimbursement that needs to be taken into account.Read More
Consider contracting the healthcare revenue cycle management functions to a third party such as Healthcare Information Services. This will allow you and your staff to focus your efforts on other core areas, such as recruiting, providing new services, and improving other areas of you practice.
For physicians and other healthcare providers, the healthcare revenue cycle management (RCM) function for patients can be an administrative nightmare. To help your practice do a better job of collecting on patient accounts, you must place a priority on educating patients and helping them understand the insurer’s payment policies, as well as their own billing and payment responsibilities.Read More
The Affordable Care Act has generated more interest in healthcare legislation than any other single piece of legislation to have been enacted in decades. For the healthcare industry, the flurry means more sources to use in our exploration of this and similar topics that we’ve followed throughout our careers.Read More
As a healthcare professional, your focus and strength should be on your patients and their treatment plans rather than on managing your office financials. In looking at how you handle medical billing, you may be tempted to stay with what you have in place rather than spend the time to make a change. But in today’s volatile economy, you should pay attention to the signs that it’s time to take that leap. Here are five signs that you should outsource your medical billing.Read More
The process of switching over to ICD-10 has caused a lot of stress in healthcare circles even before many companies begin to make the change. While the repeated delays in the mandate to convert record-keeping processes bring a relief to some, they also cause more confusion. These delays have generated a number of myths that need to be dispelled so that coders and billers can get on with the real work involved in moving on to ICD-10.Read More
Due to incentives offered to physicians by Centers for Medicare and Medicaid Services (CMS) for using electronic health records (EHR), physicians have been experimenting with different ways to do this that are both efficient and cost-effective.Read More
When President Obama signed H.R. 4302 into law, it pushed back the compliance date for ICD-10 by at least one year. The 10th revision of the International Statistical Classification of Diseases and Related Health Problems introduces a significant change to the coding system. That has some practitioners scrambling to accommodate the over 67,000 coding options in ICD-10. The extra year offered by H.R. 4302 buys them time to complete the transition, but at what cost?Read More
According to a recent survey, less than 10% of physician practices are ready for the upcoming transition to International Classification of Diseases, 10th Edition (ICD-10), up from less than 5% a half year prior. Will you be ready for the 2015 changeover deadline or will this be HealthCare.gov all over again?Read More
The new ICD-10 medical billing codes that go into effect next year, are totally replacing the current ICD-9 codes. The majority of these new codes will be helpful in narrowing down the location, type and severity of the injury. The treatment provided will also be more carefully documented.Read More
Being ICD-10 ready within your organization is great, but it is not the only thing you need to worry about. It's imperative that your vendors are also ICD-10 ready. While more than likely, your EHR vendors are prepared with the new codes, it is important that you know that your billing company, clearing houses, and insurance carriers, among other vendors, are also ready.Read More
It's no secret that some patients get upset at long wait times in healthcare offices, but a recent survey from Software Advice put numbers to the patient experience problem. According to the survey, 97 percent of patients report being frustrated with wait times, even though 45 percent of respondents said they waited less than fifteen minutes to see a doctor.Read More
The expected coding changes coming with the ICD-10 implementation of next year are having a big impact on all physician billing practices. In the mean time there are changes to the Current Procedural Terminology (CPT) codes effective as of January 1 that orthopedic practices should be aware of. If you are just catching up on all this now, here are a handful of key areas in which the most important changes have occurred.Read More
With the development and expansion of electronic technology comes additional ways to save time, and to incorporate more productive input into the time we utilize. It is the same in the world of medicine as it is in the world of logistics, manufacturing or even marketing. However, in medicine, sometimes the use of standard computer technology can compete with or hinder the achievement of the intended goal.Read More
It's a simple fact that the only way to maintain a practice is to be compensated for procedures. Unfortunately, according to a recent study presented at the Radiological Society of North America's annual conference in Chicago, over a quarter of ED radiological services were completely uncompensated from 2009 to 2012. This study wasn't looking at isolated events: it covered 40 states and examined radiology billing claims for 2,935 practitioners (approximately 8% of radiologists in the United States).Read More
Accurate coding for completed medical procedures impacts reimbursements from insurers. In an attempt to reduce errors and improve the level of documentation on completed procedures, healthcare providers must switch to an updated coding process, moving from ICD-9 to ICD-10. Learning how to prepare for ICD-10 can be a challenge. Many providers have fallen behind schedule for the recommended timeline, and according to a survey conducted by Workgroup for Electronic Data Interchange, four out of five providers will not be in a position to begin testing the new coding process by the new year. At Healthcare Information Services, we help providers get back on track and implement the highest accuracy standards for billing and coding.Read More
As the 2015 deadline approaches, the necessity for immediacy in preparation for the transition from ICD-9 to ICD-10 is crucial. The ICD-10 coding impacts every step along the patient treatment process from the initial encounter with the examining physician to the billing department submitting requisitions for reimbursement of services. However, the billing department will face the greatest challenge in claim submissions if the coding is not properly structured. Orthopedics, in particular, will be hard-pressed to receive correct reimbursement with incorrect coding. Over 60% of the ICD-10 pertains specifically to Orthopedics and Musculoskeletal (MSK).Read More
Radiologists need to become more involved with their patients; partnering with their patients is absolutely necessary to foster the kind of relationship required for optimal patient care. That was the basic message delivered by Radiological Society of North America president Dr. Sarah Donaldson to the RSNA 2013 attendees. On December 1, 2013, in Chicago, President Dr. Donaldson, current professor at Stanford University School of Medicine in Stanford California, former nurse, research assistant and high school cheerleader, delivered an impassioned plea to radiologists to recognize the importance of getting more up close and personal with their patients.Read More
We at Healthcare Information Services (HIS) would like our clients to be aware of the new Managed Care/Commercial Insurance Contract Evaluation Guidelines, published by the American College of Radiology (ACR) and the Radiology Business Management Association (RBMA), and how they may affect you. These guidelines are intended to make it easier for all sides to evaluate and negotiate managed care contracts involving radiology or radiation oncology. The guidelines contain definitions and strategies for negotiating and implementing managed care contracts.Read More
The Radiological Society of North American (RSNA) began their Image Share Project in 2009 to give people more control of their own medical records. It used to be that medical images were taken, processed and sent to the patient's doctor of record. It was a simple one-step process. Now however, we live in an era where people want the freedom to have their images looked at, and treatment given by the specialist of their choosing. This means the images must be shuttled from one office to another. The RSNA Image Share project improves the patient experience by giving them control of where their images are sent.Read More
The Radiological Society of North America is geared up to host the RSNA 2013 annual meeting in Chicago, Illinois. It will be held at the beautiful McCormick place in Chicago from December 1st to the 6th. This year's program promises to be an extraordinary gathering with a host of special lecturers. This will be the 99th Scientific Assembly and Annual Meeting, so attendance is expected to be very high. Registration is now open and you are encouraged to register early for this prestigious event.Read More
Medical care providers all know that beginning in 2015, claims for reimbursement must use ICD-10 billing codes. Claims using the old ICD-9 codes for any services provided after the change takes place will be rejected.Read More
To prepare for Stage 2 Meaningful Use (MU), you first need to have met the Stage 1 core and menu structure criteria. For the remainder of this article it will be assumed you have already met the Stage 1 requirements.Read More
Edit: ICD-10 implementation has been delayed until after Oct. 1, 2015
There are just 300 working days left until October 1, 2014. That date should ring a bell because it is the day that the tenth edition of the International Classification for Disease (ICD-10) will be put into effect. If that seems like plenty of time you are probably far behind in your preparations. Anyone who has already begun the transition can tell you that the work load is significant. If you want to catch up or stay on track with your transition from ICD-9 to ICD-10, take a few tips from the people who are already learning how to prepare for ICD-10.
With more and more orthopedic procedures being done on an outpatient basis, proper coding of those procedures is one of the most important elements for today’s ambulatory surgery centers (ASCs) to consider. This is especially true in light of the projected changes in procedure coding resulting from implementation of ICD-10. Ambulatory surgery centers have certain procedures that they need to understand how to code, so that they can keep their operations running smoothly and get reimbursed for the work done there. There are several things to remember to provide the best possible physician billing process.
1) Familiarize Your Practice With New Coding ProtocolsRead More
With the impending switch to ICD-10, orthopedic practices must begin preparing to convert their ICD-9 codes over to ICD-10 if they want to keep their operation running smoothly and profitably with steady management of both patients and data. The Centers for Medicare & Medicaid Services has provided some helpful online resources for medical practitioners looking to ease the transition to this new coding system, including timelines, checklists, and implementation guides. To help convert your most commonly used codes from ICD-9 to ICD-10, there are several important steps to take.
Here at Healthcare Information Services, we want to make sure that your radiology billing is ready for 2013. Because of the Health Insurance Portability and Accountability Act, the valid medical code set has to be used based on when the service was provided. This means that you needed to update your billing systems by January 1st, in order to keep billing nightmares from happening.
The US Dept. of Health and Human Services has directed the supplanting of the ICD-9-CM code sets, those currently utilized by physicians, medical billers and coders to report healthcare procedures and diagnoses, with ICD-10 codes. Implementation is to be effected after October 1, 2014. Its implementation will impact and completely change the current coding system. It will necessitate a huge amount of effort to implement, and it isn't going to go away. Individual and organizational health providers need to get on board with training if they expect to get paid for their services after October 1, 2014.
Making sure you get paid on insurance claims is a daunting task for any orthopedic office. There are multiple reasons why claims get denied by insurance companies. Many of them are easy fixes for office personnel, while others require time and attention or expert and detailed review by a certified professional coder. The following are three top steps in avoiding billing claim denials.
The Coding Corner highlights the most up-to-date medical coding tips, information, and legislation. HIS has over 60 Certified coders, who are experts in ensuring proper coding to guarantee compliance and maximize reimbursement.
By: Trudie Galan, CPC, Sr. Mgr. Coding Education, Healthcare Information Services, LLC.
At the end of January it became apparent in the Radiology Industry that Medicare had changed its reimbursement policy for the Breast Biopsy Clip Placement Procedure (19295). Radiology Groups across the country began receiving denials for this procedure. When the final 2013 Medicare Fee Schedule was posted at the end of January, Medicare had changed the classification of this code to a Supply Code--no longer allowing Physician reimbursement.
Accurate documentation of each patient encounter is the foundation for all healthcare providers' businesses and partnerships. Medical transcriptions serve as reference for diagnosis, treatment, continuity of care, and billing activity between healthcare providers.
The following considerations for revenue cycle management can help ensure the maximum revenue stream for your radiology group.
Medical Transcription, is the system in which information given by a physician or other medical professional is converted into text and stored either electronically or as a hard copy in a patient's paper file. This offers many advantages for most medical practices, which are covered briefly below.
Medical transcription services offer a wide variety of benefits to any practice, but as with any program, they have certain problems that you should be on the lookout for. Here are some of the most common problems, along with solutions that you may wish to implement.
Self-Pay patients present a certain risk for payment that must be taken into account by any practice who will be accepting them. However, following certain guidelines can increase the rate of collection for services rendered.
With the upcoming switch to ICD-10, major changes are being made to the way things are being done. To help smooth out the transition, here are the most important differences between ICD-9-CM and ICD-10-CM that you need to know.
As owners, managers and administrators in the medical field you have to know your business in-and-out if you want to be successful, and one area of particular importance is communicating with your patients. This is true not only in regard to their medical conditions, but also in explaining and collecting payments on their bills.
ICD-10 is not required for entities and organizations that are not covered by HIPAA, including worker's compensation programs. However, not adopting ICD-10 and requiring a different billing method can be expected to impose significant hardships, so many worker's compensations are voluntarily making the switch.
General Equivalence Mappings or GEM as it is popularly called comes into use if you are looking to translate lists of codes, coded data or code tables while converting a system or any other application containing ICD-9-CM. GEM is developed as an essential tool to assist conversions of ICD-9-CM (International Classification of Diseases, 9th Edition, Clinical Modification) to ICD-10 (International Classification of Diseases, 10th Edition) and vice-versa.
ICD-10 (International Classifications of Diseases) Coding and Reporting guidelines are provided by National Center for Health Statistics (NCHS) and Centers for Medicare and Medicaid Services (CMS) - agencies within the Department of Health and Human Services (HHS) of US Federal Government. The guidelines are aimed to be used as a guide for the official version of ICD-10-CM (Clinical Modification) to classify reasons for visits and diagnoses in health care settings and ICD-10-PCS (Procedure Coding System) which relates to in-patient hospitals only.
In less than two years the WHO's new International Classification of Diseases (10th edition) will be implemented by the Centers for Medicare and Medicaid Services (CMS), rendering the previous ICD-9 code sets obsolete. It will also, therefore, render all medical practices that have not adopted and implemented the ICD-10 code sets outdated. This will have a serious negative impact on the speed and efficacy of information sharing and processing, and also on the revenue cycle management of a practice.
Medical practice costs have risen over 50% in the last decade, far outstripping the Consumer Price Index and Medicare payment rates (ama-assn.org.) More specifically, orthopedic practices are facing declines in patient numbers, reimbursements, and elective surgeries (according to beckersorthopedicandspine.com). Physicians are looking for ways to avoid making the difficult choice between reducing their practice costs and maintaining practice efficiencies and service. Your office might be able to cut costs from various places in your practice, from overhead costs to revenue cycle management.
EHR implementation is less a choice of "if" than of "when" and "how." With patient records steadily moving online, it is imperative that medical service providers stay ahead of the curve and implement electronic health records on their own terms. While EHR implementation will usually help your bottom line, the transition can be time-consuming if not managed properly.
Here are five tips for ensuring a smooth and successful transition to EHR:
1) Choosing a Partner
There are many providers of EHR out there, and it can be difficult to find the one that is right for you. All things being equal, it is best to choose a provider that has a long history of experience, a successful track record and a network of enthusiastic references. Healthcare Information Services has all three. With more than twenty years of experience, HIS is dedicated to helping you ensure a seamless EHR implementation.
So much of an EHR's successful implementation depends on the system it is made up of. A good EHR system will adapt to a medical service provider's existing workflow and network, rather than the other way around. In a seamless EHR implementation, staff and doctors should have no trouble learning a new system if it is optimized to fit software that they already know. SRSsoft is one of the most adaptable systems out there.
3) Hardware and Features
There are choices when it comes to EHR. Part of ensuring a seamless implementation is partnering with a provider that can help you choose the software and features that are right for your practice. Find software like SRSsoft from HIS that is quick, accessible and that uses state of the art security features can make for a seamless EHR implementation. Look for features such as cloud connectivity and automated prescriptions to help with the transition.
Even though a good EHR is easy to learn, training can always help make the implementation a smooth one. Look for a company that provides staff training along with its EHR services, as HIS does. Keep your staff up-to-date and well-versed in the system's ins and outs.
5) Bundled Services
One way to make EHR implementation seamless is to bundle your EHR with other services, saving you money in the process. HIS offers revenue cycle management along with its EHR. If you've already been thinking about outsourcing your revenue cycle management, pairing with with EHR is the perfect way to make both transitions smoothly.
MONTVALE, NJ – June 7, 2012 –SRS, the leader in productivity-enhancing EHR technology and services for high-performance physicians, today announced that Western Kentucky Orthopaedic & Neurosurgical Associates (WKONA) has selected the SRS EHR for its 11 physicians across 5 locations. WKONA provides quality orthopaedic and neurological care to the south-central region of Kentucky.
Healthcare Information Services is proud to provide SRSsoft EHR technology to a wide variety of medical practices. By partnering with HIS, these healthcare professionals have ensured they have access to a robust and functional system that maximizes time spent with patients and increases their efficiencies and workflow.
Maintaining your medical billing management internally may seem to be a good choice for your practice, many providers feel keeping billing "in house" allows them more control over both coding and billing. However, numerous other practices have discovered the benefits of outsourcing their medical billing management to a team of professional coders and billing experts. There are three factors that signal it may be time to consider outsourcing your medical billing management:
Although it's more than a year away and the timing of any delay is not yet set in stone, the mandatory switch for healthcare providers from ICD-9 to ICD-10 will have a lasting impact. As one of the largest changes to ever hit the industry, healthcare providers need to be ready for this huge industry shift. With errors in coding and denied claims already a major burden on many companies providing healthcare, the switch to ICD-10 will only exacerbate the situation.
Managing your EHR implementation is a decision that will affect you medical practice for years to come. Opting for a discount EHR can save you money up-front, but patient records are too important to trust to a company without a proven track record. The smart choice is to select a quality EHR. Unlike discount EHRs, quality EHRs offer systems that adapt to your workflow and that will save you money in the long run.
Electronic health records (EHR) are quickly becoming a necessity for healthcare providers. In addition to making it easier to capture and store patient data, an EHR makes information transferable between institutions, key for sharing medical data when a patient moves or sees multiple specialists. Like any system, however, some EHRs are prone to breakdown if it is implemented improperly. If you find that your doctors are spending more time entering data in a computer than seeing patients, it may be time to look for alternative EHR solutions. Look out for these warning signs that your EHR is failing.
1. Difficult to Use: One sure sign of a failing EHR is when doctors have extreme difficultly entering and retrieving patient information. In muddled and overly complex systems, physicians end up spending inordinate amounts of time trying to figure out the system. The result is less contact time spent with patients, and overall decline in quality of care. HIS offers SRSsoft: an EHR solution that is easy for anyone to use. It prioritizes speed and usability without compromising quality, allowing doctors to get away from the computer and back to their patients.
2. Incompatibility:A common complaint about EHR is that physicians have to learn an entirely new system, leading to decreased productivity during implementation and less time for seeing patients. If your doctors are still having trouble learning an EHR system even weeks after implementation, you should look for other EHR solutions. The EHR solutions offered by Healthcare Information Services is compatible with your existing workflow system. Instead of having to learn an entirely new system, our technology adapts to your standards, making implementation an easy transition.
3. Customer Support: No matter how easy a system is to use, healthcare providers will always need ongoing support from their EHR provider. One sure sign of a failing EHR is if your vendor becomes less and less available to address your questions and concerns. If you find yourself speaking to voicemail more than a person on the phone, you need to look for a new EHR solution. With Healthcare Information Services, support is always available. Whether you have a pressing concern or a more general question, staff is available to chat with you one-on-one to come up with a solution. With HIS we're not a separate EHR team, we're your partner in quality healthcare.
A good EHR system should start saving you time and money almost immediately after implementation. When you start to detect warning signs that the system is failing, look to HIS for top-performing and top-rated SRS-EHR.
The Coding Corner is a bi-monthly feature, which highlights the most up-to-date medical coding tips, information, and legislation. HIS has over 60 Certified coders, who are experts in ensuring proper coding to guarantee compliance and maximize reimbursement. Following is a coding tip that we sent to our clients.
Ensuring that your practice's medical billing and claim processing is handled quickly and efficiently is vital to your practice's success and ability to provide high quality patient care.
There is a significant difference between certified and non-certified medical coders. While there are no legal requirements for certification to be a medical coder, certified medical coders possess credentials that identify them as experts in their field. In addition to passing rigorous exams for medical coding, a certified coder has passed exams in gross anatomy and medical terminology, giving them critical knowledge and proficiency important for reading and interpreting patient charts correctly.
With a complicated, frequently changing coding system, medical billing services teams are constantly challenged to stay current. The healthcare industry, ergo, medical billing and coding, is dynamic due to advances in technology, surgical procedures, treatment protocols and changes in how payers reimburse physicians and hospitals. The medical billing services company with whom you partner must have proven processes for identifying, tracking and reporting variances and abberations in billing patterns. It is not sufficient to rely on software and technology to correctly code and bill for services: a combination of certified medical billing coders, a rigorous compliance system, well designed software and excellent analytics is required.
Optimization of your selected EHR system is key to healthy ROI and maximizing its potential benefits; however, it can take months for practices to develop a good, working knowledge of all the functions of their EHR system. Best outcomes for EHR implementation occur when medical practices adopt a goal of integrating the EHR into their entire operation, and view EHR implementation as a journey, not a destination.
Preparation is key: Do not select an EHR system without careful planning. Technological changes nonwithstanding, there will be process changes also, and if you select a poorly designed system or do not provide sufficient training and support, low adoption rates by your staff and providers may result, causing reduced productivity and dissatisfaction.
Review your present workflow: Analyze your existing paperwork process, eliminate inefficiencies and incorporate best practices into your redesigned workflow for integration into your EHR implementation.
Select the system with the right amount of capacity for your practice. Too much or too little capacity increases the potential for inefficiency, resulting in loss of revenue. Additionally, Access and "up time" are two critical factors to consider in your selection process. Also consider where you would like your practice to be in the future. Look for a system that can scale with you.
Involve your staff: Engaging the people who will be using the system day to day is just good common sense. Soliciting their inputs and incorporating their needs into the EHR selection will improve the "buy-in" from your staff, but will also provide a blueprint that will facilitate EHR implementation.
Don't implement alone: The initial impressions of your staff and providers is critical to the EHR systems's acceptance and successful adoption. Partner with an EHR company and utilize their training programs to plan and implement your EHR system.
Be patient: Even the most well designed, user friendly, efficient EHR will have an adjustment period. Together, with the company from whom you purchased your EHR system or the consultants hired to guide your practice through EHR implementation, continue to provide support and encouragement.
Acquisition, implementation, and integration of an EHR system can be one of the best decisions you can make for the future of your practice. The key points to remember are: preparation, partnership, and patience.
Strong revenue cycle management is integral to a financially healthy physician practice, and a medical billing services team plays a prominent role in the process. Accurate billing and coding will increase a practice's cash flow by improving the payment process. Hiring a medical billing service can be a great decision for your practice, resulting in increased revenue due to improved quality of claims, however, not all medical billing services are created equal. HIS (Healthcare Information Services, LLC) a leading provider of healthcare management solutions, suggests asking the following seven questions before hiring a medical billing services team:
1) Are Your coders certified? Medical coding is complicated, requiring extensive training and keen analytic skills to determine the right code for the treatment. HIS medical coders are certified and stay abreast of changes that occur due to new technology, advancements in medical treatment, and changes to treatment protocols.
2) How are your coders preparing for ICD-10 implementation? With implementation less than two years away, the time to prepare is now. Is your company conducting beta testing to determine what kind of training will be necessary as the launch date approaches?
3) What is your clean claims rate? Clean claims translate into fast payment. The typical clean claims rate for in-house medical billing teams is somewhere between 70-80%.
4) Do you offer a guarantee for your medical billing services? Only a company with a high level of confidence guarantees that they will boost your revenue.
5) What type of benchmarking do you perform? Do you track percentage of A/R outstanding, and what intervals do you measure? These benchmarks help determine of your practice is meeting the benchmarks established by groups like the Medical Group Management Association (MGMA).
6) What kind of follow up methods do you utilize to ensure that I am realizing maximum benefits from my relationship with you medical billing services team? Will your medical billing services team communicate via email, telephone, one-to-one (or any method of my choosing) to ensure that the program is working well for my practice?
7) What collection methods do you use to increase physician practice revenue? With the rising levels of patient deductibles and co-pays, payment up from can significantly increase your revenue.
Affirmative, knowledgeable, and proactive answers to these questions sets your practice up to achieve your goals from your physician billing service; stronger revenue, improved billing consistency, and stability to your practice's financials.
Feel free to contact us or leave a comment below.
What is the impct that ICD-10 will have on Healthcare Revenu Cycle Management?
Wrong codes used due to outdated reference material – The codes change and the staff needs to be up-to-date with those changes. Sending coders to seminars or having them attend web-seminars, as well as running internal check-ups and purchasing sufficient supporting material for the staff, can prevent lost or delayed revenue that can be lost due to coding errors.
Photo courtesy of 123rf.com
Although medical procedures, operations and diagnosis all have officially titled names, there’s a matching resource code attached to it. This code represents the procedure for paperwork and medical billing services. Coding condenses the necessary information placed on a billing statement, as most medical terms and operations have a rather long technical name. For individuals in charge of inputting the coding into a computer databank, it is essential to match the correct code with the corresponding term. There are thousands of different codes though, so regardless of how familiar the staff is with coding, having several available resource options on hand is wise, to prevent possible errors from entering a medical billing services record system.
The Coding Corner is a bi-monthly feature, which highlights the most up-to-date medical coding tips, information, and legislation. HIS has over 60 Certified coders, who are experts in ensuring proper coding to guarantee compliance and maximize reimbursement. Following is a coding tip that we sent to our clients.
The Coding Corner is a bi-monthly feature, which highlights the most up-to-date medical coding tips, information, and legislation. HIS has over 60 Certified coders, who are experts in ensuring proper coding to guarantee compliance and maximize reimbursement. Following is a coding tip that we sent to our clients.