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.
Technology and medicine are often in conjunction with one another - it isn’t uncommon for the medical sphere to take advantage of technological developments to advance care in medical fields of all kinds. It may sometimes take time for certain types of technology to be used for medical purposes, but once it all gets started, the benefits and impact can be very significant. 3D printing is a technology advancing the medical field. Since being integrated into medicine, orthopedic surgeons have been able to use it for new and revolutionary ways to truly make a difference in patient’s lives. Below, we’ll walk you through the basics of how 3D printing is used in orthopedics and the benefits that it can have for both physicians and patients.
How is 3D Printing Used in Orthopedics?
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
As an orthopedic practice, your focus should be on your patients. Unfortunately, running a medical practice means juggling a million responsibilities, taking away precious time and energy away from tending to your patients. Hiring a practice management consultant can solve many of the difficulties you may be handling. A practice management consultant has the business acumen and technical prowess to do operational assessments for you, leaving you with room to plan for the future. Here are three reasons why orthopedic practice management inspires growth.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
If your healthcare practice does not have a website, then you are missing out on a huge chunk of referrals to your practice. Websites are becoming increasingly important in the healthcare industry, particularly as nearly all audiences have moved to online methods of searching for a new healthcare provider rather than a phone book. If you have a website or are looking to have a new one made, make sure to follow these six best practices for healthcare website design.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
Your orthopedic practice may very well provide the best service and care, but did you know there’s a useful way to further improve business operations? If the responsibility of running a practice is on your shoulders, you must take the necessary steps to efficiently market the business to increase exposure and profitability. Email marketing is an information distribution method that will assist your practice two-fold. This technique can influence an increase in revenue and brand awareness to current and prospective patients. This efficient spread of information is crucial to the growth of the practice. Your patients deserve to be well informed, so keep them in the know and show off how your orthopedic is truly unrivaled amongst the competition. Here are some helpful tips how email marketing can support the longevity of an orthopedic practice.Read More
The MPFS final rule was announced in the last quarter of 2017 with a concluding decision regarding proposed operational changes in radiology. The U.S. Centers for Medicare and Medicaid Services (CMS) illustrated these comparative distinctions alongside a push back of clinical decision support (CDS) until January 2020. Luckily, the ACR and other medical facilities will experience no cuts to radiology procedures. IDTFs will also benefit from the reduced cuts originally proposed by the CMS. Overall, radiology received a budget neutrality adjustment with many other positive updates and revisions that have favored practices in an unexpected turn of events.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
The Centers for Medicare & Medicaid Services (CMS) and its contractor, Acumen, LLC, is conducting a field test for eight episode-based cost measures from October 16 to November 15, 2017. This is before considering their potential use in the cost performance category of the Merit-based Incentive Payment System (MIPS) of the Quality Payment Program (QPP). During the field test, affected clinicians may access confidential feedback reports with information about their performance on these new measures, which CMS will use to contemplate measure refinements.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
In the Protecting Access to Medicare Act (PAMA) of 2014, Congress mandated that ordering providers consult appropriate use criteria (AUC) through electronic clinical decision support (CDS) mechanisms when ordering outpatient advanced imaging exams for Medicare patients. Imaging practices are running out of time to incorporate AUC into clinical workflows before the Protecting Access to Medicare Act (PAMA) requires it in 2018. The CDS mandate has a deadline set for January 1, 2018 for referring providers to begin consulting CDS when placing advanced outpatient imaging orders, and for furnishing providers to submit documentation of CDS use on Medicare claims for reimbursement.Read More
The significant growth in imaging use experienced at the beginning of the millennium has mostly leveled off and declined in recent years, according to researchers from the Department of Radiology at Thomas Jefferson University. Major cuts to reimbursement and more careful ordering of noninvasive exams are the main reasons for the decline in growth. However, according to the head researcher of the study, David Levin M.D and his fellow colleagues record levels of insured Americans and increases in preventative screening should ensure imaging utilization remains steady in the nearby future.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
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In January 2017, President Donald Trump signed an executive order against the Affordable Care Act (ACA). Implemented by former President Obama, the ACA represents the most significant regulatory overhaul of the United States health care system. The purpose of President Trump’s executive order is to minimize the economic and regulatory burdens of the ACA by repealing it and coming up with a replacement plan. Before President Trump’s replacement plan takes place in the near future, here are four things you should know about the executive order.Read More
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On October 14th, the Department of Health & Human Services (HHS) finalized and publically released the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Final Rule. The Final Rule aims to build a more patient-centered Medicare program by endorsing quality patient care while controlling mounting costs through the Merit-Based Incentive Payment System (MIPS) and incentive payments for Advanced Alternative Payment Models (APM).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.
Healthcare costs have always been a concern amongst patients in the American healthcare system. Americans who need imaging by a radiologist are not immune to these cost burdens either. Most Americans hope that the person ordering the images is aware of the cost, perhaps ensuring that each test is absolutely necessary for their care. This led a group of researchers to conduct a study recently published in the Journal of the American College of Radiology.Read More
Medicare recently made an unprecedented move in support of implementing medical device ID numbers in the billing process. This has been supported by the FDA for quite some time, but had not been formally supported by Medicare until recently. Here are the 4 things you should know about what this means:Read More
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
According to recent research in a Survey of Innovative Reimbursement Models in Spine Care1, healthcare providers who provide bundled payments can increase patient volumes from payers. These findings were published after interviews were conducted amongst 24 stakeholders across 18 organizations that perform at least 12,000 spine surgeries each year. Based on these insights, it is believed that in just 3 years, bundled payments will account for 30-45% of spine reimbursement. It was also found that a majority of revenue came from fee-for-service reimbursement accounts.Read More
In honor of the recent Independence Day holiday, why not stay in the spirit this month by celebrating your independence. At Healthcare Information Services (HIS) we believe in helping doctors secure an independent and profitable future for their practice. You may be wondering, how is that possible? The answer: A partnership with the professionals at Healthcare Information Services.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
Almost every month new updates are made in healthcare. You can keep up-to-date with the latest coding updates, thanks to Healthcare Information Services (HIS). Here are the 3 coding updates you need to know this month to prevent inaccuracies and/or inefficiencies.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...
You and your practice are ready to outsource your revenue cycle. Whether it was staff turn-over, claim denial rates, slow turn-around on reimbursements, or too much time spent on paperwork instead of patient care, we’re here to help you with the next steps.
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
It only comes around once every four years, and when it does, it can mean significant changes are on the horizon. 2016 is a presidential election year, and with this comes changes in legislation, policy, and legal process. Keeping up-to-date with healthcare news always has importance, but during a presidential election year, keeping legal issues on your radar is especially important.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.
At HIS, we primarily focus on helping our partners make more money. Whether it is through management of revenue cycle and consulting services, or coding assistance; we help ensure you’re not leaving money on the table. And we do it with an emphasis on Orthopedics and Radiology. Our dedication ensures you’re always getting the most up-to-date, relevant industry information. However, the health industry is much bigger than Orthopedics and Radiology, and changes ripple far beyond their respective industries. Therefore, keeping in step with our dedication to education, I’ve compiled these five need-to-know topics currently in healthcare news.Read More
The face of health insurance coverage in America is changing. While much of the attention has focused on individual Americans and the quality or extent of their coverage, Healthcare Information Services is concerned with highlighting the health insurance changes that impact the revenue cycle of our clients.
Medical billing and coding is undergoing a dramatic shift in the United States right now. After years of using the ICD-9 system, and two annual delays, the nation's healthcare system must now finally adopt the new ICD-10 coding system. Used around the world by most other advanced nations, the US is behind the eight ball in using this more advanced system. As a provider of orthopedic services, what orthopedic coding changes can you expect to see in 2016?
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.
Medical coders play a vital role in the daily operations of any healthcare provider. In addition to assigning codes for patient diagnosis, office visits, and procedures, coders must submit claims to insurers. As an integral part of your company's revenue stream, it is crucial these claims are accurate and timely. While all healthcare coders receive training, only certified professional coders are recognized professionally as leaders in their field. Healthcare Information Services employs only certified professional coders, ensuring that your claims and billing are processed in an expert manner.
This content was originally posted on Jan. 22, 2016 by Katherine Moody on FierceHealthPayer. Click here to see the original source.
ICD-10 has brought a lot of change and some are still feeling the effects of the shift to the new coding requirements. One of the biggest concerns ICD-10 has brought on is whether the new coding system is hurting organization’s revenue.Read More
The winter season brings on one of the busiest times of the year for healthcare organizations. High volumes of patients, procedures, and treatments are just few of the many things keeping facilities occupied. On top of swamped schedules and caring for patients, many healthcare organizations are busier than ever with the pieces involved in managing revenue.Read More
A very highly anticipated HIPAA change by the OCR is anticipated to go into effect this year, which is good news for patients and healthcare practices. It’s predicted to secure HIPAA notification rules, which will aim to keep patient healthcare information even more secure. It is up to healthcare practices to learn and regulate this system to best keep their patients’ private, personal information as safe as possible.
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 New Year is upon us, and we know what that means: change. Orthopedic billing changes will be put into effect January 1st with the new, bundled, and removed codes, along with much bigger changes. During this time, it is important to make yourself aware of these changes on the horizon, become educated on them, and learn how your practice can best adapt to them. By doing so, your business is more likely to better maintain both efficiency and profitability throughout these changes.
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 management of your practice’s revenue cycle is the foundation of your financial viability, yet physicians often don’t fully understand the very process that determines the financial health of their practice. Physicians are trained to treat patients and rarely have the financial background required for the most efficient and profitable revenue cycle management. Yet the rising cost of healthcare requires even the busiest physician and their practice to place an increased emphasis on productivity, waste reduction, and how those components of the business are impacting their operating margin or bottom line.
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
October 1st has come and gone, which means the deadline to convert to the ICD-10 coding system has passed as well. Healthcare providers and physicians around the U.S. are now using the new ICD-10 code set, which holds 69,101 diagnosis codes and 71,957 procedure codes. For some, this new code set is causing stress because the ICD-9 coding system (which held 14,315 diagnosis codes and 3,838 procedure codes) has been in use for over 30 years— and many were more than comfortable with it.
Although it is a large change in the healthcare industry, this new coding system will be of great use for outcome and data study analyses. Getting to know the system and learning to use it properly will be impactful for future medical data collection in the United States.
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.
Physician practice managers often struggle to keep up with billing and accounts receivable tasks in a timely manner. Unfortunately, most radiology practices run in constant “catch up” mode, always behind with posting payments, sending claims, and correcting denials. This leaves money on the table and out of your bank account. Instead of leaving potential reimbursement to simply float in space, perhaps it’s time to take a new approach to your radiology billing procedures.Read More
Updating, upgrading, or replacing an Electronic Health Record (EHR) system is no small task. It requires a solid understanding of all the "what-ifs" and "how-tos" necessary to effect a successful transition as well as a smooth transfer of crucial patient information.Read More
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
After postponements and countless frustrations, the time has finally come for organizations to work seriously toward getting on board with the ICD-10 conversion. While the October 1st deadline may have seemed well into the future when it was first set, now that the date is rapidly approaching it's time to settle in and turn your attention to creating as smooth a conversion process as possible. This means putting focus on your conversion team.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 Stage 1 meaningful use (MU) focused on gathering data and establishing electronic health records (EHRs), Stage 2 emphasizes exchanging patient information and coordination of care. There are many compliance requirements and penalties imposed if you do not meet them. Here are three things you need to know for sure.Read More
There are changes that will be coming in 2016 concerning the way Medicare will pay for medical services. On February 20, 2015, the Centers for Medicare and Medicaid Services (CMS) asked for public comment on its proposed changes to Medicare Advantage (MA) plans and Part D Prescription Drug Programs. The goal of the changes is to pay providers based on the quality of services they provide and not the quantity.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
CMS recently reported completion of successful end-to-end testing of new ICD-10 coding. This is sure to be a welcome announcement for any healthcare provider who works with Medicare and Medicaid, especially since the October 1st deadline for transitioning from ICD-9 to ICD-10 is rapidly approaching.Read More
The Centers for Medicare and Medicaid Services (CMS) recently issued a 301 page proposed rule for establishing Stage 3 EHR Meaningful Use (MU) requirements. If you are a practicing physician, including those in the specialties of radiology or orthopedics, the new rule applies to you.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
2015 CPT coding changes that are taking effect will mostly cause issues with billings, and denials of billings that are not coded correctly according to the new Coding Rules. In the radiology practice there are not an extraordinary number of changes, but they are important to ensure proper payments. Radiology practices must train not only their billing staff in the new coding procedures, but everyone involved in reporting procedures need to know how to document what treatments were given to ensure that proper codes are used in records and for billing.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
Most medical providers are aware that October 1, 2015, is the date they must quit using the outdated ICD-9 billing codes and begin using ICD-10 codes. The implementation date has been postponed more than once and it is not expected to be postponed again (however rumors are beginning to swirl around Congress). In order for your medical practice to maintain collections and avoid having claims denied, you already know that it is imperative for you and your staff to be ready and begin using the new codes on October 1, 2015.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
“Out of sight, out of mind” is an adage that should not apply to the upcoming ICD-10 requirements. Physicians who heaved a sigh of relief over the implementation delay should use the time wisely to get ready for the roll-out of the new coding requirements that are due to start October 1st, 2015. The fact is that the ICD-10 mandate has four times more codes than ICD-9 and many of those codes aren’t easily mapped from the old system into the new one. Some of the old codes in ICD-9 may even have multiple possibilities when recoding for ICD-10 standards. Now is the time to get a handle on how to integrate the new system so that your office will be able to breeze through the roll-out with flying colors.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
If you are a Medicare eligible provider, you are undoubtedly aware of the requirements for attesting to meaningful use (MU) of electronic health records (EHR) in your medical practice or hospital. There are consequences for failing to attest to Stage 1, and problems facing those who are now entering Stage 2 of MU.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
The implementation of the Affordable Care Act has brought about a wide range of reimbursement changes including significant modifications to both the Medicare and Medicaid programs.Read More
Radiology service providers continue to experience a rapidly-shifting professional landscape, which has led to sizable cuts in Medicare payments for advanced imaging and other diagnostic imaging procedures. Recently, the RBMA’s Payor Relations Committee (PRC) sent out an alert to RBMA members that warn of potential changes in the proposed rules that can have a potentially negative impact on digital mammography payments in 2015.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.
The Bundled Payment initiative is slowly winning health executives over. Initially it was just Centers of Medicare and Medicaid Services (CMS) “trying out” the program, but now commercial payers are starting to evaluate the options of aligning their services in readiness for bundled payment. Everyone wants to reduce costs and if it’s bundled payments that are going to get us there then that’s the way to go.Read More
Traditionally, healthcare service providers have, as much as possible, charged patients separately for each of the services and supplies provided. It is not only appropriate, but also essential, for providers to assure that they are being optimally reimbursed for the services they render. However, this has at times led to an over-utilization of services by some resulting in efforts by third-party payors and CMS to look for further reduction of reimbursement based on fee for services and evaluate alternative methods to reimburse providers for the care.Read More
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
The Medicare bundled payment initiative seems to be gaining traction among healthcare facilities and providers.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
On July 14 2014, the CMS released its Proposed Hospital Outpatient Prospective Payment System (OPPS) schedule for out-patient departments, ambulatory surgery centers (ASCs) and the Medicare Physician Fee Schedule (PFS). Hospital out-patient procedures cover services like imaging services, emergency department services and out-patient procedures and surgeries.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
As anybody involved with revenue management will attest to, revenue cycle management is a crucial element for a physician office operation. Ensuring smooth revenue management processes ensures a well-focused, effective, efficient practice.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
Rules and regulations have made the coding and billing for medical services more complex for all segments of the industry, including radiologic groups. Radiologists and radiologic groups have a need to adequately document healthcare records, correctly apply billing codes and accurately charge insurers and other third-party payers for radiological services.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
In 2014, radiology practitioners are facing a rapidly-shifting professional landscape. New technology, changes in healthcare laws, as well as the advancement of coding protocols used for reimbursement have all had an impact on the way that radiologists work and bill for their services. One of the most pressing radiology billing issues this year is the reimbursement changes to the technical component of imaging procedures, including many kinds of MRI and CT examinations.Read More
There have been numerous delays to the implementation of ICD-10. These delays have caused frustration but they have also created windows of opportunity for healthcare practices and businesses of every kind. There are several issues to consider while you readjust your ICD-10 timeline once again.Read More
Many challenges are cropping up for healthcare providers in light of trends which are currently flooding the scene. Consumer-directed healthcare, increasing patient payment amounts, pay-for-performance programs and bundled payment programs, are just a handful of developments with the potential to lead to big changes for professionals and patients alike.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
The governmental Recovery Audit (RA) program was designed to monitor Medicare payments and to identify those that were improper, either due to over payment or underpayment. Measures are taken to recoup over payments. The program is also supposed to provide for remedial actions that can be implemented in order to prevent the same medical billing management mistakes from happening again in the future.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
Healthcare professionals deal with sensitive patient information on a daily basis. Under the Federal HIPAA guidelines, it is the duty of medical professionals to keep patient information and records secure. In the modern age of technology, however, keeping electronic health records protected takes a concerted effort.
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
The vote of the U.S. Congress to push back the deadline for ICD-10 implementation to, at least October 1, 2015 may have provided some breathing room, but it doesn't change the outcome. Adherence to ICD-10 coding will still likely be required at some point.
However, with all the concerns that had been expressed regarding the upcoming ICD-10 deadline and the ramifications of its implementation, one aspect of the coding process has not received much consideration. That is the potential negative effects it could have on physicians and other care providers who count on a provider network for support and resources, not to mention a wider client base. This was addressed in a recent guest article on EMRandHIPAA.comRead More
What began in 2007 as a voluntary reporting system offering eligible medical professionals significant incentives in exchange for reporting data on quality measures relating to patients covered by Medicare benefits becomes mandatory next year. Non-participation carries a financial penalty starting in 2015. Patients with Medicare Part B and Railroad Medicare benefits are included in the Physician Quality Reporting System. The eligible incentive payment for 2014 is 0.5 percent of the total physician’s Medicare Part B Physician Fee Schedule allowed amount. If, for example, the total amount of Medicare billing for the year is $200,000, the incentive for 2014 is $1,000.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
Edited: We originally said the senate would vote today (3/28/14). The Senate will vote on Monday 3/31/14.
This has been an interesting week for the healthcare community and promises to continue to be. First off, we learned that the March 31st deadline for individuals to sign up for mandated healthcare coverage through the Health Insurance Exchanges has been extended to sometime in April. And yesterday, the House of Representatives approved a temporary Sustainable Growth Rate (SGR) fix.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
ICD-10 compliance involves more factors than just being ready for the ICD-9 to ICD-10 code switch. To ensure your practice is efficient and not losing money due to the ICD-10 compliance requirements, you need to have standards to compare to. To create this standard baseline, there are a variety of factors every healthcare organization needs to track and analyze. An example of these factors are: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 Current Procedural Terminology (CPT) coding is constantly under review and revision by the American Medical Association (AMA), The Centers for Medicare and Medicaid Services (CMS) and various other specialty medical societies. The goal is to not only keep the CPT coding up to date with new technologies and treatment procedures but also to make radiology billing, and the billing for all other medical procedures, more efficient and accurate.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
Electronic health records (EHRs) are designed to help improve the efficiency and transparency of healthcare providers, and increase communication between all parties involved in healthcare. The Centers For Medicare & Medicaid Servces, or CMS, has set deadlines for healthcare providers to show meaningful use of these EHRs, divided up into stages. On December 6, CMS extended the deadline for providers to meet the requirements for Stage 2.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
While every physician needs to familiarize themselves with the new ICD-10 codes, it's especially important for orthopedic surgeons. Over 60% of the ICD-10 codes are specific to musculoskeletal, allowing for more precision, but requiring more detailed documentation. Here at Heath Information Services, we want you to know that before you can understand how to prepare for ICD-10, you need to understand what the coding update actually entails.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
Financial woes and indecision by the government may seem far away when it comes to medical billing management; but when it comes to getting paid, your staff needs to stay current on what's happening in D.C.
The government shutdown didn't give the regulators over at the Centers for Medicare & Medicaid Services much time off, so be prepared for their final rule making on November 27, 2013 with an effective date of New Year's day 2015.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
One of the most irritating parts of the job of a radiology billing department is likely that of appealing insurance denials. Making sure that your radiology billing office is up-to-date with its CPT codes for the coming year is paramount to avoid getting a denial marked "obsolete" or "non-billable." Here is a review of code changes for 2014. Tackling these codes in numerical order, from lowest to highest, we begin with 10030, which was created to report fluid collection that is image-guided via catheter in soft tissue areas, including hematomas and abscesses.Read More
Medical care providers know all too well that they must collect as much of the fees for their services they can in order to maintain their practice and be able to continue providing high quality care. However, the collection of fees may be the most difficult part of the practice. Patient satisfaction surveys show a direct relationship between overall patient satisfaction and the medical billing services of the medical care provider.
As most all medical service providers know, beginning after October 1, 2015, they will be required to submit their bills to Medicare, Medicaid and other third party payers using ICD-10 codes. ICD-9 codes will become obsolete and claims for reimbursement using the obsolete codes will not be honored.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
EHRs, also known as electronic health records, offer tremendous benefits for both healthcare providers and their patients, as long as they are being used effectively. The Centers for Medicare & Medicaid Services provides incentive payments to eligible professionals that can demonstrate that they meet Meaningful Use (MU) standards for certain EHR technology. The earlier that your practice qualifies to receive EHR incentive payments, the more money you stand to earn: if you qualify to earn your first payment this year, you can still get paid as much as $39,000 through 2016, not counting the maximum $780 loss, due to the effect of sequestration on Medicare payments.Read More
As the Centers for Medicare & Medicaid Services, CMS, contemplates yet another pay cut to CT and MRI providers, the Radiology Business Management Association, RBMA, steps up to oppose them. Since 2006, there have been 12 radiology billing adjustments for imaging services with nine of those cuts directly affecting the technical component. Next year, the agency will provide new rules that affect radiology billing as part of the 2014 Medicare Hospital Outpatient Prospective Payment System, HOPPS and the 2014 Medicare Physician Fee Schedule, MPFS.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
Billing is a crucial area for an orthopedic practice that wants to maintain a steady cash-flow. Deciding whether or not your billing is handled in-house or is outsourced is a decision that needs to be assessed based on your specific practice, its resources and operating style. To choose which type of billing is best, consider the benefits and drawbacks of each option.
The advances in medical science and technology require doctors to maintain a constantly developing vocabulary. The International Classification of Diseases (ICD) has been through several permutations and has recently undergone another revision.
Coding changes for orthopedic billing happen every year. That is why people can make a career out of medical coding and billing. It seems like all you can do is roll up your sleeves and implement the changes as well as you can.
In order to keep your medical practice healthy and thriving, you must collect the full payment that is due to you for the services you provide in a timely manner. You must have procedures in place to optimize your collections to pay your overhead and keep a staff of competent and contented employees.
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.
As competition among healthcare providers increases, and insurers work to decrease costs, new emphasis is being placed on patient satisfaction. Part of the Bundled Payment program of Medicare includes a patient satisfaction survey. The Hospital Value-Based Purchasing Program also involves patient surveys that measure the overall satisfaction of the patient for in-patient medical treatment.
October 1, 2015 is the deadline put in place by the Centers for Medicare & Medicaid Services (CMS) for switching to the ICD-10 standard for medical coding. The impending switch is an issue that many healthcare practitioners need to devote some time and effort to so that they will be able to adapt to it by this deadline.
ICD-10 is the 10th version of a medical classification index produced by the World Health Organization, or WHO, to denote medical conditions and procedures. ICD-10 provides for the use of more than 69,000 codes. The United States Centers for Medicare & Medicaid Services (CMS) has imposed a deadline of late 2015 for the replacement of the ICD-9 code sets currently in use for inpatient procedures and medical diagnoses. Whether working at a large hospital or a smaller practice, there are three main things that Orthopedists today need to do to learn how to prepare for ICD-10 implementation.
EHR implementation is a subject that is weighing heavily on the minds of many healthcare professionals. Since not every doctor or medical administrator is trained effectively in the specific details of EHRs, or electronic health records, some may find it difficult to make this transition. However, the effort to make the switch should be well worth it.
As a result of reforms in the healthcare system, today’s radiologists face tremendous challenges in their day-to-day operations.
I am sure you are already very familiar with the fact that the Centers for Medicare and Medicaid Services (CMS) applies a Multiple Procedure Payment Reduction, when more than one coded procedure is performed at the same time on a given patient. Of course, the other commercial insurance carriers do the same.
Technology has changed the way business in general is transacted. It has also changed the way a medical practice is managed. You can take advantage of business intelligence and analytics to understand how your practice is functioning, where there are gaps that need to be filled and how to improve your orthopedic billing practices.
Radiologist Assistants (RAs) are changing the way that medical patients interact with the health care profession. The field of medicine has been branching out into various specialties for a long time now, and the field of radiology is not that old itself. However, the increasing public reliance on health technology such as imaging devices has resulted in an increased workload for people in this branch of medicine. The position of Radiologist Assistant was designed to answer this growing need.
Whether or not you agree with healthcare reform, it's important to know how it's going to affect you. Unfortunately, it seems like there's a lot of conflicting information out there. That's why here at Healthcare Information Services, we think it's important to lay out the facts.
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.
Physicians have long been used to working within the framework of the Stark Law. This 1989 legislation placed restrictions on the ability of doctors for self referrals, for Medicare and Medicaid patients, and to refer for advanced diagnostic imagery to institutions in which the physician had a vested financial interest. In response to criticism of the legislation, several exceptions were introduced to include, among other things, in-office ancillary services.
President Obama released his proposed 2014 budget on April 16, 2013 which may have potential impact on orthopedic in-office ancillary services and procedures.
The American Association of Orthopaedic Executives (AAOE) recently held its annual meeting in San Diego. One featured speaker was David Wold, CEO of Health Information Services, Inc. (HIS). The topic of Wold’s presentation, given on April 29, 2013, was: Enhancing the Profitability of Your Orthopedic Practice.
All medical providers are preparing to switch their billing practices from ICD-9 coding to ICD-10 as mandated by the Health Insurance Portability Accountability Act of 1996 (HIPPA). The change is to take place on after October 1, 2014.
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.
It seems like data is everywhere you look. Businesses rely on marketing data, customer demographics, accounting numbers, and in-depth analytics to make daily decisions. Experts espouse the use of business intelligence in manufacturing, health care, financial management, and other niches. What does this new reliance on data have to do with radiology billing? If you want to develop a profitable claims process, it turns out data plays a huge role.
The American Academy of Orthopedic Surgeons (AAOS) recently held its annual meeting in Chicago, Illinois from March 19 to 23, 2013. There were lectures on advances and changes in medical and surgical procedures, exhibits by pharmaceutical companies and device manufacturers as well as small group seminars. Here are three “hot” topics that emerged as being of exceptional current interest and importance to orthopedic surgeons.
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.
For 30 years, ICD-9 codes have been used throughout the medical industry. Certainly it is a painful process to convert to ICD-10, and one that has generated a great deal of resistance. But common sense dictates that a system which doesn't recognize medical discoveries and advancements made in the last 30 years needs an upgrade. Conversion will entail far more than simple code translation. In order to maximize the benefits of the richer coding system, each aspect of the medical operation must be carefully examined to ensure that it captures and uses codes that accurately describe all diagnoses and procedures.
The preliminary for the American Association of Orthopaedic Executives (AAOE) 2013 Annual Conference has been released, and it promises content specific to the many issues orthopaedic professionals face everyday at their practices. From achieving victory while navigating the tricky healthcare business to inspiring others to face an ever-changing healthcare landscape, there will be no better opportunity in 2013 to grow as an orthopaedic professional.
Effective October 1, 2014, all claims submitted to Medicare, Medicaid and private health insurers must use the new ICD-10 codes or the claims will not be processed. This change has been looming on the horizon for months. Originally, implementation was scheduled to begin in 2013, but that date was postponed in order to give medical offices more time to prepare.
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.
HealthLeaders Media reported on a recent study that was conducted, on whether or not the conversion from paper records to Electronic Health Records (EHR) is cost-effective. The study was based on data received through surveying 49 community medical practices of various sizes and specialties, in the state of Massachusetts. The survey data was then analyzed, in order to project whether physicians will experience a return on their EHR conversion investment over the next five years.
The transcription of dictated medical information is fraught with the potential for difficulties ranging from slow turn-around time to excessive cost to actual transcription errors - often associated with differences in language, dialects or accents. When selecting a transcription service here are some points to consider.
Business Analytics is one of the most powerful ways for radiologists to improve their quality of care and maximize their profit potential, but many practices have yet to make full use of the tools currently available to them. Healthcare Information Services is proud to offer the following information to help Radiologists and their partners make the most informed decisions on their Business Analytics techniques.
The following considerations for revenue cycle management can help ensure the maximum revenue stream for your radiology group.
PQRS, or the Physician Quality Reporting System, is a program run by the Centers for Medicare and Medicaid Services (CMS) that is designed to promote the reporting of useful information via a series of incentives.
ICD-10 is the 10th revision for the International Statistical Classification of Diseases and Related Health Problems and is set to replace ICD-9 on October 1, 2014 due to a one-year delay. That extra 12 months allows time to figure out how to prepare for ICD-10 and the changes that will come as a result of the update.
The Bundled Payments for Care Improvement initiative of the Centers for Medicare and Medicaid Services is a new initiative designed to determine whether or not a bundled payment approach will actually result in decreased costs. The bundled payment will be for a specific "episode of care". This is a three year trial program, which includes specific selected healthcare organizations as participants in the program. It may begin as early as April of this year, but no later than next January. The Bundled Payments initiative is courtesy of the Affordable Care Act.
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.
A common criticism of EMR (electronic medical records) use in medical practices is that it causes doctors to become less engaged and impersonal. This causes frustration for all parties - patients and physicians - because doctors didn’t sign up for computer duty and patients expect a doctor’s full attention during visits.
Professional credentialing is an important process for all medical practitioners and is essential for obtaining privileges at hospitals, ambulatory surgery centers, out-patient clinics or other healthcare entities.
Credentials are often important for any physician to stay on top of; from the entirety of revenue cycle management to explaining to patients how you're qualified to help them with a particular issue, valid credentials are referenced frequently enough that efficiency in obtaining and displaying them is an important job.
In order to stay independent from a hospital or other major medical institution, there are certain things that you'll need to do. Here are some practical tips that we recommend you follow.
General Equivalence Mapping or GEM, as it is popularly known as, is a translation tool that will help make transition from ICD-9-CD to ICD-10 a smooth and hassle-free one. It must be mentioned here that ICD-10 has a completely new structure with a novel set of diagnosis and procedure codes that promises maximum efficiency, reduced cost, lesser errors and discrepancies and better data acquisition and storage.
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.
The implementation date for compliance with ICD-10 in the United States is October 1, 2014. Unless the date is moved back, all practices must be fully ready on this date, since there is no grace period allowed.
In the early hours of January 1, 2013 the United States Senate, by a vote of 89-8 adopted legislation that prevents the majority of taxpayers from experiencing a tax increase; prevents the scheduled 26.5% SGR related cut in physician fee schedule payments for one year and delays the 2% across-the-board cut in Medicare payments until early March.
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.
The Centers for Medicare and Medicaid Services (CMS) released their 2013 Physician Fee Schedule on November 1st. For lots of medical professionals, the new fee schedule may mean overhauling many of the ways their business will be conducted. With the new plan, CMS is looking deep into several things, with an overall goal of eliminating over payments to hospitals for patient care and improving the delivery of healthcare across the board. In order to avoid a negative audit, physicians should pay close attention to the new plan and make the necessary changes ahead of time.
If you have been associated with the medical transcription industry for any amount of time, you must be aware of the innumerable debates on the future, as this is one of the fastest growing sectors in the healthcare industry. Ever since healthcare reforms were announced by President Obama and $19.2 billion USD allotted for healthcare IT, medical transcription started to gain prominence. Especially with digitization influencing our life and with significant growth in the number of Baby Boomers reaching the retirement age, Bureau of Labor Statistics rightly projects excellent job opportunities and growth of the industry by almost 11% through 2018.
Tough economic times affect more than just individual workers and patients – they also affect the way doctor’s offices collect money, and in many cases, tough economic times result in slow payments after medical services are rendered. Slow collections can affect day-to-day operations for many small medical offices, though it can negatively affect even mid-size and large medical offices and hospitals. While you may not be able to collect all past-due payments overnight, there are some things you can do to gain ground on your collections.
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.
Medical transcription continues to be an important service, despite the increase in electronic health record (EHR) software's automated creation of physician reports. The Centers for Medicare and Medicaid Services (CMS) is increasingly focusing on practices for report cloning and up-coding. With that, we may see a return to increased use of transcription services. It is crucial that medical practitioners choose a transcription service that is dependable, accurate, economical and has a timely turn-around process.
Having a reliable EHR solution in place is already important, and in the coming years it will become critical for every organization involved in the healthcare business. But what constitutes a good Electronic Health Record system is still a hotly debated issue.
The complexities of healthcare reform can be overwhelming. Participating in the reform debate, while remaining focused on a quality healthcare practice, is a substantial challenge facing healthcare providers.
There is no shortage of advice for providers to improve their practice. A new consulting company, coaching service, best practices firm or related software seems to emerge every week. Healthcare professionals can often feel oversold on engaging these resources. Nevertheless, there are a few key points to accept when facing these daunting changes.
Cost reduction and improving patient care CAN be simultaneous.
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.
Radiology is inherently more specialized and has far fewer potential codes than a trauma center or primary care practice, but the added complexity of ICD-10 and its implementation still presents a number of challenges and obstacles that must be overcome.
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.
Today is the first International Day of Radiology (IDoR). It will mark the 117th anniversary of the discovery of the X-ray in 1895, and also serve to recognize the advances in patient care made by radiation therapy oncologists, radiologists and medical imaging professionals since that time.
Recent changes with CMS audits have certainly caused a good deal of attention. That’s because CMS is now using a very large magnifying glass, searching earnestly for any signs of fraud from upcoding. And Recovery Audit Contractors (RAC) audits now include office visit claims and E and M coding. Much of this increased scrutiny comes from suspicions from CMS that EHR programs have contributed to rising Medicare costs because it’s easier to charge more for services using them.
There's been a lot of talk about EHR solutions and concerns about how it's expected to completely overhaul the medical field. It is true that these systems will impact practices, especially orthopedists that face unique challenges seeing a high-volume of patients. It would be unacceptable for an EHR to slow you down resulting in lost patient volumes and revenue. If you partner with a system that understands your specialty and has a proven track record in Orthopaedics, you may see the overall benefits of implementing the right EHR in three main areas.
Whether you decided to use an electronic healthcare record (EHR) to increase revenue, provide a higher level of care, or improve reporting requirements, return on investment (ROI) is often a large concern. Purchasing a quality EHR is a considerable investment; however there are ways to increase your ROI.
EHRs, or electronic health records systems, represent an ongoing wave of change in the medical field in health offices big and small. Where offices used to have file rooms the length of the building filled with color-tabbed folders for each patient, now they are migrating to EHR databases to digitize and manage the same information. However, it's not as easy as just taking the paper information and inputting it into a computer screen. In fact, in many cases less than 30 percent of system implementations are fully successful the first time around.
An Electronic Health Record (EHR) system is an asset to your medical practice. We are living in an exciting time of transition from paper medical records to an electronic database system.
Some Medical professionals know all about bill coding, handling insurance payments and even working with government organizations to make sure their services are paid in full. But they often miss many other opportunities to cut costs and build strong returns on investments (ROI), especially in areas like EHR solutions.
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.
Dictation is an essential part of the clinical story, and there is often a lot to navigate with compliance standards. The big question is, how can you fulfill meaningful use requirements?
This article originally appeared on Auntminnie.com. Copyright 2012 Auntminnie.com - All Rights Reserved
The Medicare and Medicaid EHR (Electronic Health Record) Incentive Program gives healthcare providers financial incentives if they can demonstrate that they are "meaningfully using" their EHR systems. Now, while "meaningfully using" may sound like a potentially vague term, the Centers for Medicare and Medicaid Services have established a number of criteria and objectives for a healthcare provider to meet, in order for it to be categorized as "meaningfully using" its EHR systems.
It is natural to feel nervous about large changes to our office environment; we like the comfort of our routines. However, if your office hasn't yet switched to electronic health records, chances are the change is coming soon. If you're feeling nervous about an upcoming EHR implementation, you're in good company. But with good planning and a little guidance, making this change can be an exciting one for your office.
The time has long since passed when hand-written medical records and documentation were industry standard. Today, electronic health records continue to dominate the medical service field, and their popularity grows each day. While some medical service providers are still doing things the old way, the future of healthcare documentation will be almost completely electronic. To prepare for this shift that is already underway, having a successful EHR implementation strategy is key.
Poor management of your reven can cause an insurmountable loss of revenue and put the practice at serious risk. Physicians, assistants, administrators and staff members all contribute to the revenue cycle at some point in the process. With these seven tips, you can reinvigorate your revenue cycle and lessen the uncertainty of waiting for payments on services you’ve rendered.
The Health Information Technology for Economic and Clinical Health Act is part of the government's overall economic recovery plan. The HITECH act aims to ensure that all medical service providers move toward a system of EHR by 2014. It also requires the adoption of meaningful use standards. While EHR implementation and meaningful use can present great challenges for any healthcare provider undergoing a transition, ignoring them comes at a serious cost. Bob Chaput of Clearwater Compliance says it's time to "get serious" about following HITECH. Healthcare Information Services has the experience and knowledge to guide your company through compliance with the HITECH Act.
The following article, by Heather Linder, originally appeared on the Becker's Spine Review, and features our very own Dave Wold.
Outsourcing your billing and revenue cycle is a decision that medical service providers may have to make at one point or another. While you might be concerned about extra costs in partnering with a third-party or a perceived loss of control, when all is said and done, the advantages usually outweigh the perceived drawbacks. The key is to look for a revenue cycle management partner with experience and knowledge in the field. Through improper coding, write-off policies, etc. your practice may be losing potential revenue. A high-quality and dependable manager of your billing and revenue cycle can uncover these lost revenues, increasing profits for your company.
The implementation of an electronic health record system can seem like a daunting task. Many medical service providers imagine months of on-the-job training, during which patient volumes drop and revenues plunge. Unfortunately for some, these horror stories are true, but for most they are the extreme exception. When managed properly, EHR implementation can be a successful and relatively seamless transition that can increase your efficiency and improve patient satisfaction/outcomes. The most important decision occurs early on when you choose an EHR system. While there are many systems out there, you want to choose and EHR that is right for your practice and your specialty.
EHR implementation can end up costing medical service providers time and money when they arrive as rigid structures. In these cases, physicians and staff have to spend weeks learning an entirely new system. A high quality EHR, on the other hand, conforms to your existing workflow. With SRSsoft provided by Healthcare Information Services, you tap into a robust system that is easy to use and is flexible to the way that your and your partnering physicians practice. The workflow can be individualized to each physician and provider. There is no one workflow that works for all, so why try to force all to conform. In addition, HIS provides extensive training for your staff to ensure that the transition is truly seamless and enjoyable. The contract states in writing "unlimited training". It is this approach that has lead HIS and SRS to a 100% success rate in implementing busy high-performance physician practices.
Like a bad friend, some EHRs deliver the goods and then disappear. Fortunately, this is not the case with Healthcare Information Services. When we set your company up with SRSsoft, we stand behind our services, offer support any time to assist you in the transition. If your staff has trouble with any aspect of the EHR implementation, application or workflow, we'll be there to provide technical an emotional support.
SRS has a number Klas ranking in support and is known for its nation-wide network of satisfied users who can attest to it.
References and Experience
You can never be sure something is right until you try it, but you can trust others who have gone through an experience before you. HIS is proud of its extensive network of national references. Contact some of our clients who use SRSsoft, and we're confident they'll tell you about their seamless EHR implementation. With over 20 years of experience, HIS has developed the trust and expertise to do the job properly. Unlike other vendors, we do not just have a few handpicked references... we offer up our entire client and user list across the nation and allow you to choose who to call. Our dedication to our clients, products and service has allowed us not worry about what they will say.
What Sets HIS Apart
For any medical service provider, reimbursements are the lifeblood of its revenue stream. For radiologists, billing presents a unique set of challenges. With so many specialized procedures and medical codes to stay on top of, documentation, denials, charge capture, coding and many others can get lost in the shuffle. The best way to increase the accuracy of radiology billing is to partner with a firm that specializes in managing the revenue cycle of radiology practices. Healthcare Information Services has the experience and expertise to provide accurate and improved reimbursements through a variety of successful strategies, including employing certified coders, establishing coding and documentation education plan with physicians and a robust denial management program.
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.
Electronic health records can drive up your profits by increasing the efficiency of your workflow. Still, any medical service provider will tell you that not all EHR systems are created equal. Far from it, when implemented improperly, they can end up costing you more money than it's worth. But how do you know when to go back to the drawing board and find a new system of electronic health records?
For a long time, it seemed as if electronic health records (EHR) were an option that medical service providers could either choose or decline. It seems that today, however, we have reached the point where the market has spoken, and EHR has won.
With electronic health records (EHR) more common than ever, medical service providers have to be careful that patient records are secure. When medical data exists, not on paper but in computing clouds, there is always that risk that data can be compromised, which can have devastating consequences for patients and physicians alike. Fortunately, the best EHR systems now use advanced and enhanced security features to ensure that patient records are safer than when they were printed on paper and stored in locked filing cabinets. In particular, SRS-soft, from Healthcare Information Services, uses the most up-to-date security features available.
The financial health of a radiology practice can be assessed by the level of overall reimbursement and the status a practice's accounts receivable. It is extremely difficult to continue to provide high quality patient care if you are constantly worried about the revenue cycle and how it may impact the practice's income and profitability levels. Choosing the right revenue cycle management company is essential to a stable and profitable future of your practice.
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.
Benchmarking is critical to financial success.
The following is an article originally published by radiologymu.org. Copyright © 2010-2012 | All Rights Reserved
Electronic health records, are quickly becoming a standard part of orthopedic practices. As an efficient and quick system, an EHR allows doctors to transfer patient medical records without hassle or delay. Still, there are barriers to EHR implementation that keep some service providers from adopting. Some providers worry, for instance, that EHR means having to learn a completely new computer system, leading to delays and decreased revenues. Healthcare Information Services helps you overcome these barriers with an EHR system that is easy to learn and efficient to use. HIS is the only reseller in the nation of SRS High Performance EHR.
According to HHS.gov, the top barriers to EHR implementation include (1):
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.
What is Meaningful Use?
At the end of 2011 radiologymu.orghttps://www.radiologymu.org/ launched the Radiology Meaningful Use Practice Analyzer, a unique application intended for all U.S. radiologists hoping to understand, and potentially participate in, the CMS EHR Incentive Programs. This online application guides radiology professionals through the complex process of analyzing their practice for Meaningful Use.
Radiologymu.org took a look at 6 months worth of research results and put together an article that:
Implementing electronic health records is one of the most important decisions you can make as a healthcare provider. EHRs can simplifying your paperwork and reduce your workload, helping you spend more time with your patients! But here's an important factor to consider... not all EHRs are created equal. No matter what medical services you offer, getting a system that is government-certified has numerous advantages, including increased access to government subsidies and grants, robust functionality, speed, enhanced data analysis, and claims rates.
With electronic health records quickly becoming a necessity for orthopedic practices, finding EHR solutions that work for you and your patients is of paramount concern. While there are a variety of EHR options to choose from, too many are narrowly focused, not taking into account the multiple needs of orthopedists. Only the SRSsoft EHR delivers all-in-one service designed specifically for orthopedic practices. Healthcare Information Services is the only reseller in America of SRSsoft, and with more orthopedists successfully using SRS more than any other system in the U.S., SRS is the best all-in-one solution for your practice.
One of the reasons why SRS-EHR is the most popular choice among orthopedists is the unified desktop, an innovation that can save your practice time and money. The unified desktop integrates your EHR, practice management, PACS, patient portal and transcription into one easy place. Instead of shuttling between a variety of applications, doctors using SRS-EHR have all their patient data integrated on one screen. With all the information you need right at your fingertips at once, your doctors will be less likely to make costly errors, and will spend less time at their computers and more time seeing patients.
The main reason SRS is adopted by so many orthopedists, is because SRS does not slow you down. SRS offers productivity increasing solutions helping physicians attest to meaningful use and increase their workflow efficiencies. The bottom line is that SRS-EHR is a productivity based system that allows orthopedists to worry about their patients, instead of worrying about operating the system.
Part of being an all-in-one solution is offering other services that compliment EHR solutions. In particular, SRS-EHR is optimized for easy integration with medical transcription. With the revolutionary SRS Snippets program, orthopedists can dictate small amounts of patient information without having to repeat large blocks of text that occur frequently. Physicians save time, and patients win out by having cleaner medical records and more time spent with their orthopedists.
For all-in-one EHR solutions that orthopedists need, SRS, delivered by Healthcare Information Services, is your number one choice. We make sure all of your relevant information is integrated in one place, making your job easier, and your practice more efficient.
As you decide whether investing in an electronic health record (EHR) system is right for your medical practice, you've likely learned that there are several key features to look for. But have you determined what things you should try to avoid when deciding on a system?
In the fast moving, constantly changing medical field, electronic health records (EHR) are quickly becoming a necessity for the modern practice. An EHR system helps makes storing patient data simple, billing a breeze, and improving patient care a definite. However, if you have already implemented an EHR you may find that what you've purchased isn't meeting your practice's needs. There are several things you can look for to determine if your EHR is failing:
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:
With the electronic health records becoming more and more the industry norm, the focus for many healthcare providers has shifted to achieving meaningful use. Fulfilling meaningful use requirements is key to your business. In addition to ensuring that your EHR is being managed soundly and ethically, meaningful use helps you qualify for government incentive programs. While achieving meaningful use benchmarks can be a challenge, having solid customer support from your electronic health records management team can go a long way to getting you there. Here are just some of the many ways in which customer support is important when it comes to meaningful use.
Too often, healthcare providers are left to navigate EHR systems immediately after they are implemented. While doctors and staff members are skilled professionals, they don't always have the time to learn a new system on their own, with patients to see and other matters to attend to. A good partner will take the time to show your staff exactly how to use the EHR system. Healthcare Information Services makes training a priority. With your physicians and staff comfortable with the system, they'll be less likely to make mistakes that can compromise meaningful use requirements.
Keeping on Top of Updates
If you could just memorize meaningful use requirements as they stand today, attesting and qualifying for the incentives for your practice would be much more manageable. Unfortunately, government standards can change and are often updated. In addition, meaningful use is being rolled out in three stages, with the final stage set for 2015. Customer support can help you keep track of these updates and changes before they get out of hand. Let HIS worry about new rules and regulations. Our customer service will keep you informed on what you need to do to achieve meaningful use, allowing you to focus on providing quality care to your patients.
General Advice on Meaningful Use
One of the benefits of partnering with an experienced and dedicated EHR vendor is the wealth of expertise and experience they bring to the table. HIS handles EHR management for a large population of Orthopedic practices, meaning that our trusted team knows how to help you achieve meaningful use requirements. Our customer support workers are happy to advise you on things you can do as an organization to meet core set and menu set measures. Our experience makes us a trusted source for information on all aspects of meaningful use, and we're happy to help our clients.
Outsourcing your medical billing management is an important decision for any healthcare provider that shouldn't be taken lightly. As a major source of revenue for your company, you can't afford to put your medical billing into the wrong hands. If you are a physician considering getting some extra help to manage the business side of your practice, you would be wise to ask a few questions of any prospective billing service. When you do eventually find the right one, you'll see your claims success rate jump, and you'll have more time to meet with your patients.
Does the company have a proven track record?
A revenue cycle and medical billing management service is only as good as its track record. Look for a company with experience in the field and that has a high success rate for claims and appeals. Don't be afraid to ask for references. Handing over your billing should not be done lightly, and you want to make sure you make the right decision. Healthcare Information Services has been managing billing for more than 30 years. We have excellent claims rates, and we always appeal claims that are denied. With a team of dedicated professionals, we ensure that you are getting the maximum revenue you are entitled to.
Does the company employ certified professional medical coders?
Any medical billing management service that does not employ certified professional coders should be a red flag. Certified medical coders are recognized by a professional body as being experts in their field. They have rigorous training and maintain up to date knowledge of industry norms to ensure that all of your claims are filed accurately and on time. HIS employs only certified professional coders. Our team has a clean-clames rate of 98 percent, so you can be sure that we're doing everything possible to get you the reimbursements you deserve.
Does the company maintain open communication?
When it comes to revenue cycle and medical billing management, communication is one of those intangibles that is difficult to evaluate until after you have signed a contract. Nonetheless, it is an important consideration. The last thing you want is a company doing your billing that is unreachable at crucial times. At HIS, we understand the importance of open communication. We provide support for our systems and services whenever you need it, and we are committed to being available whenever you have important inquiries. Your revenue cycle and bottom-line is our top priority, and we value the trust you put in us.
Meaningful use is everywhere, and it’s hard to navigate all of the rules and regulations on your own. HIS is committed to helping you better understand meaningful use for radiology, that’s why, when we came across this great resource by Merge Healthcare Incorporated and Center for Diagnostic Imaging, we had to share!
This how-to guide was created to help radiologists comply with the HITECH Act.
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.
Collections are the lifeblood of a healthcare provider's revenue stream. Without a proper system for collections in place, you'd be amazed at how quickly your profits can dry up. One of the challenges when it comes to healthcare billing is that service providers have to take care of the paperwork on both ends, dealing with patient payments and insurance claims. With so many balls in the air at the same time, things can fall through the cracks, potentially costing your company millions in lost revenue. Take control of your healthcare billing and make the process as efficient as possible.
If you are a healthcare provider that still has not adopted electronic health records (EHR), now is the time. With technological advances, we are reaching a tipping point where companies need to modernize or get left behind. Healthcare Information Services offers EHR solutions that increase efficiency, maximize revenues and improve patient outcomes. Here are seven ways your company will benefit immediately from EHR:
Orthopedic practices live and die by their revenue cycle management. When bad management occurs, money is lost and it is only a matter of time before the business' survival at stake. With so many complex procedures going on in an orthopedic practice, it is crucial to take control of your revenue cycle management.
Orthopedic practices come with their own set of challenges and because orthopedic doctors and surgeons deal with complex problems, billing can be more of a headache than usual. To take control of your billing, it is necessary to begin tracking your payments carefully, appealing denied claims, and updating your billing procedures to make them modern and efficient.
Orthopedic practices are difficult to run successfully and smoothly. With physicians performing complex and expensive procedures, costs can spiral out of control in a hurry. Therefore, it can be tempting to keep your revenue cycle management in house. But, when you stop and do the math, contracting out the management of your revenue cycle will actually save you more money.
A quality EHR is a great way for orthopedics to manage their practice. The software enables orthopedics to access practice specific forms, as well as data such as lab reports. This makes the software ideal as it can improve efficiency.
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. With factors such as coding expertise, training and the currency of knowledge affecting every aspect of the switchover, you can't afford to take a risk that your practice will not be ready. The best way to prepare for ICD-10 is to partner with an expert in healthcare information services, which can make the transition a smooth one without affecting your bottom line.
The most significant impact that the ICD-10 transition will have is on medical coding. Medical coders without the proper knowledge are much more likely to make errors in claims submission, leading to automatic denied claims. When you rely on the coders employed by Healthcare Information Services, you can be sure that they have the expertise and experience to maintain a high level of quality in coding during and after the transition. Our coders are all certified, meaning they are officially recognized as experts in their field.
Even if you hire the best medical coders in the world, ICD-10 will still affect your own staff in a variety of ways. Even the smallest error in paperwork can affect your claims rate, potentially costing healthcare providers millions in lost revenues. The best way to ensure ICD-10 compliance is to train your staff well before the transition takes place. Healthcare Information Services offers the very best in staff training. We run workshops to get your staff up to speed on ICD-10 compliance.
Currency of Knowledge
While Healthcare Information Services medical coders are certified, they also take pride in staying up to date with knowledge in their field. HIS employs an AHIMA I-CD 10 Certified trainer and has over 65 Certified coders on staff. So far, this has proven to be a model of success, with a 98 percent claims rate across the board. We make sure that our medical coders are the best in the business, requiring that they each maintain a 95 percent success rate. With the ICD-10 transition looming, our team of medical coders are already on top of things and ready to meet new challenges.
The ICD-10 transition will be difficult, but is manageable if you take steps with HIS now. Feel free to contact us or leave a comment below.
Though healthcare legislation and reform can be hard to keep up with, it is very important, as it directly effects HIS’ client’s bottom line. Following, are some important facts, and timelines of two legislative issues currently in progress.
The Patient Protection and Affordable Care Act, along with modifications made by the Healthcare Education Affordability Reconciliation Act (collectively, the "Healthcare Reform Law") was signed into law on March 23, 2010. One of the more controversial provisions of this legislation was establishing the Independent Payment Advisory Board or IPAB.
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.
ICD-10 will create serious headaches for healthcare providers. Tens of thousands of new codes means that your company will not only have to change its diagnostic procedures, but will have to manage the errors that result from such a huge shift. ICD-10 will affect all areas of the industry, including billing, claims submission, staff training, and resource management. Implementing your company's compliance with ICD-10 can be best accomplished by hiring an outside service provider to manage it for you. Healthcare Information Services can guide your company through the complexities of ICD-10 implementation, making the transition as smooth as possible.
The coming implementation of ICD-10 looms large over the healthcare industry. With changes coming, healthcare providers need to be up to date when it come to filing claims. With the potential for your company's resources to be eaten up with managing the switchover, it makes sense to hire an expert coding team to manage your claims and billing. Choosing a coding team wisely requires that you consider certification, accuracy of knowledge and a track record of doing timely and successful work. Healthcare Information Services employs only the top coders in the industry to manage your transition to ICD-10 successfully.
While medical coders don't need to be certified to practice legally, you should always check to make sure they have have proper certification. Certified coders have had to pass exams in coding, anatomy and medical terminology, ensuring that they are the best at what they do. With ICD-10 coming, there is no reason to take a risk by hiring a team of non-certified coders. HIS' coders are all certified and take pride in doing their job to the highest standard of quality. When you assemble a team of certified coders, you can rest assured that they have the training and knowledge to file claims accurately and on time, potentially saving your company millions.
Being designated an expert is one thing, but coders also need to maintain relevance in their field. When you assemble your coding team, you should make sure that they have intimate knowledge of ICD-9, HCPCS and CPT coding books, as well as ICD-10. Having a team of medical coders who are familiar with the ins and outs of these standards, ensures that your claims will be processed properly and will be more likely to be approved. The medical coders employed by Healthcare Information Services are always up to date on the important knowledge in the field, including ICD-10.
Timely and Accurate Work
The only way you can really know if a team of medical coders does good work is by looking at their track record. The best medical coders have a history of filing claims on time and accurately for the best results possible. When you hire coders from HIS, you know that their team has a 98 percent claims rate, much higher than the industry average. Our expert team will deliver claims cleanly, ensuring fast payment and higher revenues for healthcare providers.
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.
With the upcoming transition from ICD-9 to ICD-10, many healthcare providers are in a panic. With the number of procedure and diagnosis codes to increase substantially, there are many areas that providers need to upgrade to ensure compliance, including reimbursement processes, capturing codes and call volumes. The recently announced deadline delay for ICD-10 compliance will help, no doubt, but there are still many challenges facing the healthcare industry. The experts agree that there are a few key steps that healthcare providers need to take to ensure they are meeting the requirements for ICD-10.
One of the most involved aspects of any healthcare provider is their billing services. Changes that are coming with ICD-10 will require an overhaul of the ways that companies do their billing. While many companies still choose to do their billing themselves, experts recommend that you hire a healthcare revenue cycle management company, such as HIS, with certification in ICD-10. With ICD-10 on the horizon, now is the perfect time to make the switch. HIS can manage your billing with greater accuracy. We help your revenue cycle by making your collections faster and more successful, reducing your administrative costs and allowing you to focus on providing quality care. We also offer the best in billing management by monitoring all aspects of your payments to ensure that you are getting your maximum payouts.
Claim Submission and Denial Management
The biggest bureaucratic headache that healthcare providers endure involves submitting insurance claims and managing denials. ICD-10 will only make this more complicated. Hiring HIS is a smart way to have these cumbersome tasks taken care of for you. A good management provider will have the expertise and knowledge to adapt to the new reimbursement processes without hassle. With the tens of thousands of new codes, HIS is your best option for dealing with claims submissions and handling claims denials successfully.
With over 65,000 new codes about to hit us, your employees need to be well-versed in ICD-10 compliance to avoid headaches down the road. Partnering with a healthcare expert, in coding and billing, to train your staff can ensure error-free coding. This will save you time and money. Healthcare Information Services specializes in training staff to comply with ICD-10 codes.
Let us know us know how we can help you make your transition to ICD-10 as seamless as possible.
While many healthcare providers have been quick to adopt an EHR, some physicians have been more reluctant. Here are 10 important ways that an EHR will benefit physicians.
1) Accurate data capture: Handwritten notes cannot accurately capture patient information because of illegible writing. EHR solutions allow doctors to enter data as accurately as possible, ensuring no mistakes.
2) Safer prescriptions: Another consequence of handwritten notes is the potential for errors in prescriptions. When a note is entered electronically, there is little chance of a pharmacist misreading it.
3) Ease of reporting: Writing a patient report using handwritten notes can be time-consuming. EHR solutions allow physicians to generate reports automatically. Information is collected seamlessly, allowing for quick and comprehensive reports.
4) Transferability of files: When a patient moves, their medical records should travel with them. Instead of causing delays, electronic records can be sent immediately and at virtually no cost, leading to faster care and better patient outcomes.
5) More time spent with patients: Handwritten notes must be cataloged and retrieved using an old-fashioned filing system. This can take time and lead to errors. Physicians who use EHR never have this problem, leading to more time spent treating patients.
6) Automated workflow: EHR solutions also save physicians time in other ways. An EHR can provide a seamless file for tracking all patient procedures. In addition, an EHR can give alerts when a patient has an upcoming test, ensuring that physicians are up to date on all aspects of their patients' care.
7) Increased revenue: Payroll is a major expenditure for most practices. An EHR allows physicians to spend less on human resources, leading to increased revenues. With an EHR that maximizes efficiency, staff are not needed for overtime filing. Staff can be reallocated to where they are most needed.
8) Integrated office technologies: An EHR allows physicians to use a single system for patient records and all other digital equipment. The result is a smooth workflow that is easy to use.
9) Work from home: Because an EHR allows doctors to access files from anywhere, physicians can maximize their efficiency by reviewing patient records at home or on vacation. All you need is an internet connection.
10) Increased patient satisfaction: Patients who have more face time with doctors, who receive quality care and accurate assessments are happy patients. An EHR allows doctors to answer patients' questions immediately and accurately.
EHR solutions benefit physicians in a variety of ways. Contact HIS for more information on adopting electronic records.
As a healthcare professional, chances are good that the least satisfactory and, perhaps, most frustrating part of your job, is the billing and collection process. At Healthcare Information Services (HIS), Revenue Cycle Management is what we do best and, in successfully partnering with private physicians, hospitals and clinics over the past twenty plus years, we have been able to help them boost both profitability and cash flow through the implementation of our services. We do what we do best so that you can concentrate on what you do best, patient care and treatment.
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 optimization of Electronic Health Records is imperative to fully maximize on all its possible benefits. EHRs take a lot of time and research to implement, but the results are well worth it. Orthopedic practices should follow these steps in order to take full advantage of their EHR system:
Processing an insurance claim is rarely as simple as it may appear. In an ideal world, the claim's reimbursement arrives swiftly and without any processing roadblocks. However, anyone in the medical billing field understands that careful attention needs to be paid to each claim and careful follow up performed in order to maintain a high clean claim rate.
In an EHR case study with SRSsoft, one of the country's busiest orthopedic practices found that selecting SRS as their EHR system resulted in a quick implementation, high payback in a timely manner and a manageable learning curve for physicians and staff members. The group found that SRS allowed their group to grow considerably in terms of patients and physicians while maintaining cost.
The client had over 60 manual chart processes that SRS condensed into 7 groups, which included:
Revenue cycle management is critical for any orthopedic practice. It is how cash flow is generated, which it is the lifeblood of your practice.
As a leading healthcare revenue cycle management provider, Healthcare Information Services (HIS) is dedicated to helping you make a smooth transition from the ICD-9 coding system and the ICD-10 system.
This daunting shift is due to be complete by October, 2013. Important decisions and challenges face healthcare professionals during this time frame. Will you hire someone to do your billing or will you do it yourself? An increasing number of healthcare organizations now hire out this process to ensure competent and accurate work, which statistics show can very often result in significantly better reliability.
Yet some practices do not wish to outsource the management of their revenue cycle to an outside party. If you are such a practice, how can and will you best implement ICD-10 without losing quality or expertise... and in the end dollars? ICD-10, along with containing tens-of-thousands of new codes will create new complexities with claim submission and successful management of denials. Physicians must be prepared for the changes that come with ICD-10 and how it can significantly affect your reimbursements and bottom-line.
At HIS, we can work with your staff to ensure that your coding is error-free. By starting now, your staff will be trained and your transition, complete with time for you and your staff to establish and adjust to a new, ICD-10 compliant solution for your company.
Many medical practices looking to get the most out of their revenue cycle outsource their billing needs to medical billing companies. There are a number of reasons that outsourced billing can be the right choice for a practice: more and faster successful collections, a reduction in administrative costs and headaches, and the ability to focus exclusively on patient care. When choosing the right outsourced billing provider, you have a significant array of options, so it's important to consider reliability, control, and value.
One of the most frustrating occurrences any practice can experience is facing a denied insurance claim. While it may appear that, that is the end of the process most don’t realize that they have the option of filing an appeal.
It can be easy to get lost in the sea of electronic health record (EHR) information available to physicians and practices. Everywhere you turn there's a new "expert" ready to be a source for you as you investigate the available EHR options. But how do you know what is accurate and what information is not to be trusted?
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.
In healthcare there is so much to be concerned with all the time; finding the time to maximize time seems counterproductive. But you waste minutes and hours every week, month, or year doing things wrong. Follow these 10 steps and you’ll be that much closer to maximizing your healthcare revenue cycle management.
Having an accurate way to monitor and maintain your healthcare revenue cycle management is vital to the success of your medical practice. No practice will survive if there isn't a healthy stream of revenue to support operations and high quality patient care. Although many practices may try to turn around their own revenue cycle, having HIS as your partner can provide peace of mind to your practice and boost your revenue.
There are several highly beneficial advantages your medical practice can realize with an effectively focused EHR solution. The ability to generate increased revenue as well as deliver more efficient medical services to patients is directly correlated to the selection of the correct EHR vendor and software application. In fact, for a physician practice that uses a productivity-focused EHR system, the practice can realize a conservative gain of at least 10 percent in revenue growth. This means real dollars to the tune of $1 million in billable hours, or more a year, if a physician has a mid-sized practice of 7 – 12 doctors.
As we’ve mentioned in a previous blog post, beginning on October 1, 2013, the US Department of Health and Human Services will issue a mandate requiring all healthcare providers discontinue use of the ICD-9 medical codes and adopt ICD-10 diagnosis and in patient hospital procedure codes.
As with any new system there is a learning curve, and healthcare providers are concerned about the impact the new coding system will have to healthcare revenue cycle management. The changeover represents one of the most significant changeovers in the history of information management and technology: according to IT experts, the size of the system upgrades required should easily surpass those required for 1999-2000 Y2K changeover (healthleadersmedia.com, 2012).
Reimbursement will be directly affected if providers are not prepared for the change. With this in mind, we’ve decided to present a complimentary webinar, to help educate the Orthopedic Industry.
Join HIS's Senior Director of Coding Compliance and Education, Lynn Anderanin, CPC, CPC-I, COSC, AHIMA ICD-10-CM Certified Trainer, for a review of the musculoskeletal section of ICD-10 to understand the differences in ICD-10 for Orthopedics, and the impact it has on documentation, coding, and your reimbursement.
As you consider investing in an electronic health records (EHR) system there are several key features you should look for during your research. Since an EHR solutions system can increase your practice's productivity, boost overall reimbursement levels, and improve patient care the decision of which EHR system to select is crucial. As you investigate and evaluate EHR systems you should ensure that the one you choose is:
Designed for both speed and increased productivity: Your practice likely has the goal of seeing more patients, and in turn creating more revenue, as one of its primary business goals. Choosing the right EHR solutions system can help meet this goal by providing quick and easy access to patient and practice records and streamlining workflow to increase productivity.
Adaptable to your practice's workflow: No two medical practices are alike and their EHR needs are likely very different as well. The EHR solutions system that you choose for your practice must be able to adapt to your unique needs and requirements. The system should be easily customizable to meet your data, design, and functional needs and should also allow you control over how each component of the EHR is implemented.
Comprised of various functionalities: Even though your practice is unique, there are standard components that you want to make sure are included in the EHR system you choose. These components are helpful to practice management, patient care, and communication; including electronic prescription ordering, comprehensive patient data files, medical chart access and reporting, lab management, inventory and order management, and patient accessibility.
Certified as a complete EHR: Since the Federal Government now provides incentives to practices and physicians that have converted to using an EHR solutions system, you want to ensure that the system you choose falls within the required guidelines. A system that is government certified as a complete EHR will help your practice qualify for the Medicare and Medicaid EHR incentives.
Choosing the right EHR system can help evolve your practice by providing high quality patient care within a more efficient system. This is beneficial to patients, providers, and the practice's productivity!
The Health Insurance Portability and Accountability Act (HIPAA) was enacted to ensure that personal information regarding your health is kept private. This means, if I go to the doctor, the information the doctor uncovers through his investigation can’t be shared with others, allowing me to rest at ease and substantially reducing the likelihood that I avoid the doctor for fear of information about my health status being released.
While HIPAA has been in effect since 1996, changes are continually being made to this law. The most recent change is the HIPAA 5010, which took effect January 1, 2012. This modification to the existing legislation dealt specifically with healthcare revenue cycle management. This 5010 modification specifically stipulated that healthcare professionals must use electronic billing services.
These changes impact everyone from the doctors themselves to the patients who will experience changes in the ways in which they are billed. Because there can be financial penalties for failure to comply with this legislation, understanding the new requirements is vital for healthcare providers.
This 5010 upgrade was an enhancement upon the 4010 version of this legislation, which also dealt with digital processing of medical billing. A number of factors lead to this modification. The major motivating force behind this legislation change was the continued need for high-quality, low-cost healthcare. This legislation was also implemented to ensure that information could be simultaneously kept private but still relatively easily exchanged between medical offices to ensure that doctors were operating from a place of knowledge.
The hope of champions of this legislation was that streamlining this payment process and using electronic billing and payment methods would also save some cash as processing these payments manually is very labor intensive and, by connection, costly. Though this transition may be a difficult one, particularly for those who deal directly with healthcare revenue cycle management, once complete the efforts will likely payoff in the form of better, and more affordable, care for patients.
Photo courtesy of Michal Marcol
People are driven by many things; passion, emotion, empathy, obligation; and on and on it goes. For business the bottom line is the bottom line. Dollars and cents rule the day.
So it goes for EHR (Electronic Health Record) companies. Just like the dot-com bubble burst; so too will this abundance of EHR’s. The reason is simple; the marketplace is flooded. Doctors are also unhappy with many of these smaller providers as they were rushed through government compliance; many physicians simply sat down with whatever EHR provider was there once the music stopped.
The main aspects of a quality EHR solutions boil down to three things; speed, productivity and usability.
Speed: Speed is determined by screen responsiveness, amount of clicks required to get to patient information, and increased speed from page to page. In medicine, seconds count; you can't be burdened down by slow response times. You need to be working with an EHR who has streamlined workflow, enhanced speed, and acute customer loyalty.
Productivity: Productivity is about making the most of every second of every day. The repetitive nature of medicine means that there's a lot of the same things being done day-in and day-out. But what does all that add up to? If every time a prescription is generated takes an extra 5 seconds; what does that add up to at the end of the year? How about 30 seconds? You want to be working with an EHR solutions provider who is sensitive to these seconds and allows for maximum productivity to be achieved.
Usability: Usability is not just defined by speed and productivity but also by the EHR incentives portion of the American Recovery and Reinvestment Act - also known as the Economic Stimulus Plan. Physicians have known for some time that the seconds are ticking down on these EHR solutions benefits. Participation in this program is provides incentives now but once the benefits are gone, they're gone. And then the incentives turn into penalties for non-compliance.
EHR software technology is the future. And while some physicians have procrastinated about taking advantage of upgrading their systems, the benefits are abundantly clear. As a user you want to be working with EHR solutions which make sense for your practice; EHR solutions which are set apart from everyone else. One such system which fills all these parameters is our SRS Soft EHR.Feel free to contact us or leave a comment below.
Photo courtesy of digitalart
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 efficiency of your practice's healthcare revenue cycle management is directly related to the quality of your medical billing process. Claims that are submitted timely and free of errors result in quick payment or reimbursement for services, and provide a steady stream of revenue for your practice. But the challenge to achieving high efficiency medical billing lies in its complexity; coding procedures change frequently, physician's documentation can make correct code identification difficult, and when problems develop too often offices lack the resources to resubmit claims or appeal a denial, resulting in significant loss of income.
For the practice to run efficiently, your billing and coding team must possess the expertise to submit clean claims, complete with proper coding and accurate documentation, aggressively mange and reconcile denials as well as the resources to collect on outstanding A/R. Any breakdown in the system translates into a slowdown in your healthcare revenue cycle management process which has a ripple effect on the rest of your practice and causes cash flow problems. The key to a financially healthy practice is a revenue stream that is consistent and robust. It is extremely difficult to provide quality healthcare when you are struggling to pay your bills.
The solution is to have a consummate medical billing team for your practice. Healthcare Information Services, LLC (HIS) is a leading company in healthcare revenue cycle management, combining hands on industry experience with unparalleled technical expertise. HIS' certified coders use state of the art software for claims scrubbing and internal quality control procedures to quickly improve the efficiency of your practice by providing the highest quality billing and collections, giving you peace of mind and enabling you to focus on treating your patients. HIS also partners with a third party clearinghouse, which performs a final review and makes any further edits, also providing feedback to HIS on the quality of the claims submissions, enabling us to monitor our clean claims rates with accurate, specific benchmarks.
Finally, HIS certified coders perform an Auditing and Compliance program to make sure that all billable charges are captured to maximize your practice's revenue.
Expert billing translates into increased efficiency for your practice. HIS will work with you to develop the optimal solution for improving your healthcare revenue cycle management by working closely with your organization to design an approach that meets the unique needs of your busy practice, eliminates common issues that plague the typical practice, and provides long term potential for growth.
Beginning on October 1, 2013, the US Department of Health and Human Services will issue a mandate requiring all healthcare providers discontinue use of the ICD-9 medical codes and adopt ICD-10 diagnosis and in patient hospital procedure codes. As with any new system there is a learning curve, and healthcare providers are concerned about the impact the new coding system will have to healthcare revenue cycle management. The changeover represents one of the most significant changeovers in the history of information management and technology: according to IT experts, the size of the system upgrades required should easily surpass those required for 1999-2000 Y2K changeover (healthleadersmedia.com, 2012).
This article was first featured in Becker's Orthopedic, Spine, and Pain Management and was written by Laura Miller.
Today's healthcare news is ripe with medical service consolidation. With the changes to healthcare legislation, more small orthopedic practices are choosing whether to become employed by hospitals or merge with neighboring practices to form bigger groups.
"There is so much fear and uncertainty right now related to healthcare reform," says Dave Wold, CEO of Health Information Services, who played a critical role in eight successful mergers to grow Illinois Bone & Joint Institute. "You see physicians wondering if the complexity of running their medical practice might be too much. Others want to remain independent and they emphasize coming together with other groups for strength in numbers. Fifteen physicians have more influence when dealing with hospitals and payors than four or five."
Mr. Wold and Wayne J. Miller, Esq., a healthcare transaction and regulatory attorney and founding partner of Compliance Law Group in Los Angeles, Calif., discuss 10 things every orthopedic group should know for a successful merger.
According to the most recent data released from PricewaterhouseCooper's Health Research Institute, approximately one half of the $2.2 trillion dollars spent annually on healthcare, roughly $1.2 trillion dollars, is wasted. The participants in the study were doctors, nurses, hospital groups, and patient advocacy groups; with 16 areas in the industry analyzed for waste.
The healthcare revenue cycle management process figured prominently as a metric where waste is a common occurrence: inefficiencies cost physician's practices "billions of dollars annually", according to Susan Pisano, spokeswoman for America's Heath Insurance Plans. Lack of standardization of forms, inefficiencies in claims processing, lengthy 'pre-certification" protocols for higher-priced processes such as MRI's, and general lack of understanding of medical technology are the driving factors behind slow payment/reimbursement and/or denied claims. Problems in any one of these areas slows your revenue cycle; requiring your busy practice to reallocate resources to solve the issue. If your practice struggles with a combination of issues the cost to your practice is potentially debilitating.
The solution is to enter into a joint partnership with an organization that specializes in understanding, managing and improving busy physician practices' healthcare revenue cycle management. As a doctor, you are dedicated to treating your patients and do not have the training or time to manage the billing, workflow, and monthly cycle of your business.
Healthcare Information Services, LLC. (HIS) is a leader in healthcare informatics and has an staff of experts that specialize in streamlining your workflow, tightening your billing and claims, and identifying areas of your practice where money can be saved and/or income can be generated. HIS certified medical coders have a 98 percent clean claims rate as opposed to in-house billing teams that are typically between 70-80 percent; high clean claims rates translate into quick payment for services. HIS' Auditing and Compliance programs are designed to identify and correct errors in billing along with capturing all billable hours timely. The result is that you save money for your practice by eliminating waste, reducing errors, and speeding up your revenue cycle.
It is all about accuracy and efficiency. HIS will work with your practice to achieve an optimal level of both in your healthcare revenue cycle management, providing you with confidence that your have the tools you need to ensure the long term viability of your practice.
Feel free to contact us or leave a comment below.
Medical practice management consulting firms are trained to work with all healthcare providers as well as physicians in medical specialty fields like orthopaedics and radiology; with the objectives of improved productivity and increased profit. Consultants study the business side of the practice, evaluating the workflow and implementing policies and procedures that create consistency, efficiency and a work environment that enables the physician to concentrate on providing high quality healthcare.
A medical practice management consultant will establish benchmarks to track specific areas of the practice. The importance of benchmarking is that it sets performance standards for the physician and staff, and identifies areas of strength and areas of opportunity, providing valuable feedback in the form of empirical data such as statistics, evaluations, and performance ratings. It is imperative that the medical practice management consulting firm you hire have in-depth knowledge of how to benchmark and be able to communicate to your practice specifically the targeted metrics, how they plan to collect the information, interpret the results, and work with you to make improvements based on the results.
A practice management consulting firm will objectively evaluate your practice's financials to determine if you need to reduce expenditures and/or trim waste. They will also assess your workflow for the practice's overall productivity, and make recommendations based on their findings. Because budget reductions coupled with a mandate for increased productivity can be a difficult objective to achieve, these types of assessments are often better conducted by an impartial source, especially in offices where a close knit, family atmosphere prevails as the work environment.
The solution is a collaborative partnership with an industry leading organization whose goal is to work with your busy orthopaedic or radiology practice to improve its profitability and increase productivity, resulting in a strengthened workflow. Healthcare Information Services, LLC (HIS) offers practice management consulting to work with busy physicians to identify areas of opportunity for improvement within their practice, create actionable initiatives, implement the suggested changes, and create increased value to their patients. HIS believes in formulating strategies that are unique to your practice, and will work with your practice to ensure they are communicated to your staff clearly and concisely.
As a physician, you are trained to provide medical care for your patients. HIS' medical practice management consulting team is dedicated to facilitating that goal by developing a business plan tailor made for the unique needs of your practice.
Adopting an EMR/EHR system for your busy Orthopedic practice can provide numerous benefits, but thorough preparation is the key to maximizing benefits and gaining widespread acceptance of EMR/EHR implementation. Based on initial feedback received and disseminated by the New England Journal of Medicine, Medical Group Management Association (MGMA), Blue Cross, and other respected sources, the benefits of the traditional EMR/EHR have been mixed at best.
From the New England Journal of Medicine: "We have observed the EHR become a powerful vehicle for perpetuating erroneous information, leading to diagnostic errors that gain momentum when passed on electronically", and a government funded NE Journal of Medicine study reported only 4% of physicians reported having an extensive, fully functional EMR/EHR system.
MGMA reports: "...medical practices using EHR reported a decrease in physician productivity of up to 15% usually lasting a year or more".
A 2008 Blue Cross of Massachusetts concluded that based on its findings, there is no positive ROI for EMR/EHR implementation.
Evidence suggests that traditional "point and click" EMR/EHRs aren't meeting expectations, let alone exceeding them. They are proving cumbersome,difficult to navigate, and have been accused of depersonalizing the doctor/patient relationship. Doctors report a steep learning curve that causes a perceived negative impact to quality of patient care, causing them to quickly revert to the old methods of handwritten dictation and exam notes. Once this happens, ROI from an EHR implementation dissipates, and the system becomes little more than a document management system.
The key to success is the right system and a collaborative partnership with the right health information technology company to assist with implementation. Healthcare Information Services, LLC. (HIS) is the industry leader in healthcare informatics. HIS is the nation's only certified reseller of SRSsoft, the preeminent productivity-enhancing EHR solution developed for high-performance physicians.
SRS is not a traditional "'point and click" EHR; its capabilities create an integrated system with robust functionality that improves your practice's productivity. SRS has a 100% adoption rate attributed to ease of use, quick implementation, expedited training programs for doctors and office staff along with practice management and claims management applications that adapt to individual physician preferences, improving physician task management. HIS is dedicated to ensuring your practice group is well prepared and confident with their EMR/EHR implementation.
An EHR implementation is an exciting step forward into the future of the healthcare industry. A partnership with HIS ensures you are well prepared.
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.
When President Obama revealed his dream for a national EMR/EHR system in his 2008 inaugural address, our nation's healthcare providers were given notice that current industry paradigms were under scrutiny, and that change was in the wind. The paper-based medical records and documentation processes that are the current standard are slow, unwieldy, and speak to the past of healthcare, not to the future. The future of healthcare documentation lies in an EHR implementation.
Records entered electronically into an EHR system are instantly available to all healthcare providers involved, from physicians to hospitals. A computerized patient order entry (CPOE) means prescriptions will arrive at the pharmacy the instant the physician writes the order, and will be waiting for the patient when they arrive to pick it up. EHR implementation also increases safety; the system will check for contraindications electronically at the time the order is written.
As a physician, you rely on science and empirical evidence to make decisions on how to treat your patients. With the right EHR solution, you gain access to a limitless supply of medical information, research, data, and history, enabling you to broaden your scope of knowledge and improve patient outcomes with better diagnoses and lowered costs due to increased efficiency. Your documentation practices should support your decision making process by combining speed with accuracy in a user friendly platform.
Not all EHR software are created equal; many over-promise and under deliver, resulting in a drop in your practice's productivity due to poor performance of the system. Medical documentation should be easy to enter, access, and manage; the key is a collaborative partnership with the right company. Healthcare Information Services, LLC (HIS) combines technological expertise and real-world industry experience. HIS is the nation's only certified reseller of SRSsoft, the healthcare industry leader in EHR based solutions. SRS has a 100% adoption rate; proving that it is the EHR software of choice for physician groups around the country.
Notes, orders and prescriptions written by hand or created through a "point and click" system slow you down and have increased potential for error. HIS will work with your practice to develop an EHR software that allows fast, easy documentation entry by the physician or healthcare provider at the point of service, rather than having the information imported into the EHR by support staff at a later date. Your practice will reap the benefits of lower costs, greater efficiency and higher quality healthcare for your patients.
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.
EHR implementation has the potential to affect a transformational change to your practice. Workflow is streamlined, errors and inefficiencies are greatly reduced, and increased revenue is generated when an integrated approach is utilized that combines the humanity of the healthcare industry with the power of technology. The key to success is to establish a partnership with an organization having a reputation as an industry leader. Healthcare Information Services, LLC has the ability to work with your practice to ensure that your EHR implementation provides you the maximum return on your investment.
HIS technology experts begin by identifying the right hardware for your practice's requirements. Hardware is the foundation of your system, and putting the right hardware in place means state of the art security, speed, and accessibility for your practice's system, allowing you to share information with other healthcare professionals, payers and providers without worrying about HIPAA violations, viruses and system security breaches due to hacking.
Most importantly, your IT infrastructure must be compatible with your EHR hardware. HIS utilizes networking experts who will partner with you to achieve the optimal results from your EHR implementation. HIS project managers will work directly with your physicians to discover the unique needs and challenges of your practice, selecting the optimal hardware for your business. Too much or too little hardware is problematic; too much and you lose revenue due to under-utilization. Too little hardware and you run the risk of system failure due to overload, resulting in problems ranging from loss of service to breach of security.
The right hardware ensures that your EHR implementation has the foundation it requires to meet (and hopefully) exceed the needs and expectations of your practice.
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.
In his 2008 inaugural address, President Obama introduced his mandate for a nationwide EHR system by 2014. Although significant progress has been made towards the accomplishment of that goal, barriers still exist that challenge EMR/EHR implementation; overcoming these areas of resistance is critical for successful implementation and management of EMR/EHR's.
Physician and staff resistance to change:
Mark Twain once said, "It isn't the progress I mind, it's the change I don't like". Change is the great constant in both our personal and professional lives. While healthcare professionals recognize the value EMR/EHR implementation brings to their industry, widespread adoption of a new system poses a potential challenge. EMR/EHR systems impact increasingly large, heterogeneous workforces and more areas of the organization, requiring leaders to acquire change management skills to assist their team with EMR/EHR implementation. Leadership that recognizes the potential psychological impact of a new information system to its workforce and practices strong change management skills will find this barrier to implementation lower than organizations that fail to account for this phenomenon.
Physicians' concern about the integrity of EHR Implementation: Although the HIPAA privacy rule was enacted in 2003, concerns regarding electronic medical record confidentiality persist today. Prior to HIPAA setting a national standard for accessing and handling medical information, state law prevailed, and their laws varied. With HIPAA, states may now only adopt laws increasing privacy, but may not fall below the national minimum standard. Although healthcare providers, Plans, and health care clearinghouses are subject to HIPAA laws anytime they transmit health information electronically, there are many entities to whom the data may be made available. Some of these entities include but are not limited to:
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.
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.
Many physicians' practices today are actively working to develop ways to increase revenues, reduce expenditures, and decrease errors in billing. One strategy is to develop a partnership with a company that specializes in healthcare Revenue and Practice Management, and has a dedicated team for medical billing services.
Administrative duties such as coding and billing are extremely complicated; with billing errors and discrepancies representing a significant area of opportunity for improvement in many practices. Coding, claims submission, and medical billing error resolution are time consuming and costly in terms of both labor expended and lost revenue. Medical coding accuracy requires strong analytical skills to determine the right ICD-9 or CPT code for timely reimbursement for services. Furthermore, claims submission is time sensitive: many private payers have a 60 day window for submission, and Medicare has a 120 day limit for disputation of a denied claim. Finally, many offices don't have the time or resources to resubmit denied claims, which means thousands of dollars in lost revenue for your practice when your staff does not resubmit denied claims or appeal the denial.
HIS medical billing services employs certified medical coders who are trained to review the physician's medical documentation to determine the correct coding for the procedure or treatments performed, resulting in clean claims. The typical physician office's in-house billing department has a clean claims rate between 70-80%: HIS' clean claims rate is 98%. Claims are scrubbed regularly with state of the art software to ensure they are clean prior to submitting them for reimbursement, and HIS partners with a third party clearinghouse that performs further edits (when necessary), also providing ongoing, immediate feedback on the quality of submitted claims.
What does all this mean to your practice? HIS's medical billing services team speeds up your cash flow by reducing error in the claims process. Clean claims mean faster reimbursements, improved consistency and increased cashflow month over month, which improves your revenue cycle, thus giving you a competitive advantage over offices that don't have our resources at their disposal. The end result is a healthy, thriving practice with great potential for long term stability.