As of March 1st, 2021, UnitedHealthcare has made several updates to their reimbursement policy for Advanced Practice Health Care Providers. The previous policy change was made on April 13th, 2020 when the word “Commercial” was added to the policy header.Read More
After some delay due to the COVID-19 pandemic, the Centers for Medicare and Medicaid Services (CMS) has released the final set of guidelines that will govern the Medicare payment system for 2021. The rule for the Medicare Physician Fee Schedule (MPFS) was proposed earlier last year, and since then, slight revisions have been made including an improvement in the conversion factor and a change to the Quality Payment Program (QPP) performance threshold.Read More
Radiologists and healthcare providers of all kinds should always prioritize their awareness of illnesses or injuries that have begun to occur more frequently, whether the instances are being described as an “outbreak” or just as a trend that is increasing over time. One such example is the recent occurrences of cases of e-cigarette or vaping product use-associated lung injury, also known as EVALI. The Centers for Disease Control and Prevention (CDC) recently released an in-depth report focused on this outbreak, its evolution, and its potential causes, which can guide radiologists moving forward as they may be faced with cases of EVALI in their own practices. Keep reading to learn more about this illness and how radiologists can best serve patients with EVALI in 2020.Read More
We are undeniably in uncertain times and uncharted territories. The medical world and the world at large has been thrown into upheaval in an attempt to weather and survive the COVID19 pandemic. Arguably, no industry has been affected more so than the medical industry; even-more the musculoskeletal specialities such as orthopedics and radiology have been virtually shut down. Elective surgeries had been canceled to free up space for COVID-19 patients.Read More
This is the latest information by the insurance companies updated August 3rd, 2020.
We will be reviewing insurance carrier information each business day and update when applicable. These policies change constantly so we have included the websites for reference.Read More
As we are sure most healthcare providers come to expect, each new year brings new changes to codes, payment policies, and processes in the healthcare industry. On November 1st, CMS announced upcoming changes to payment policies, which were detailed in its 2020 Medicare Hospital Outpatient Prospective Payment System and ASC Payment System Final Rule. The final rule included many new details on processes that healthcare providers should be aware of, and at Healthcare Information Services, we want to keep you up to date so your practice can move confidently into the new year. Below, we have provided more details on some of the main points of the final rule. Keep reading to learn more and get informed so you can be as prepared as possible to adapt to these new changes.Read More
For those who work in the healthcare industry, surprise billing is not a new concept. This practice impacts patients seeking all types of medical attention, and has been a topic of discussion among lawmakers in recent months. Attention from both the federal government and healthcare stakeholders has propelled this issue into one that might soon have a resolution, because both the House Ways & Means Committee and other significant groups in Congress have been working to find a solution. Congress has been at a stalemate for months regarding this issue, but recent proposals have sparked a new wave of negotiations and conversations by lawmakers to come to a resolution before the December 20th deadline. Keep reading to learn more about this issue and where it currently stands in Congress.Read More
We have received many inquiries on the reporting of telehealth codes due to CMS reducing the restrictions on telehealth services. As of today, these reductions are available for the diagnosis and treatment of any conditions and/or diseases retroactive to March 6, 2020. While there has been communication from some commercial insurance carriers as to their reduction in restrictions also, as of this notification, it is unknown if they will follow CMS. HIS will keep you updated if new developments change the restrictions.Read More
Those in the healthcare industry are certainly no strangers to insurance claim payments being delayed or denied. Practices facing this issue are at a great risk for losing out on revenue throughout each year, because it is estimated that around 25% of denied claims are never paid at all. If your organization’s denial rates are particularly high, this issue is one that will need to be addressed and resolved so your practice can continue to serve patients and bring in revenue. One of the most effective ways to determine how to prevent such denials is to evaluate and assess your practice’s revenue cycle. Keep reading to learn more about how to conduct this type of assessment and how Healthcare Information Services can help optimize your revenue cycle for practice success.Read More
The descriptions for intermediate and complex repairs have been clarified
including adding the description for limited and extensive undermining.
Intermediate Repair- Intermediate repair includes the repair of wounds that,
in addition to the above, require layered closure of one or more of the deeper
layers of subcutaneous tissue and superficial (non-muscle) fascia, in addition
to the skin (epidermal and dermal) closure. It includes limited undermining
(defined as a distance less than the maximum width of the defect, measured
perpendicular to the closure line, along at least one entire edge of the defect)
Single-layer closure of heavily contaminated wounds that have required
extensive cleaning or removal of particulate matter also constitutes
Complex repair- Complex repair includes the repair of wounds that in
addition to the requirements for intermediate repair, require at least one of the
following; exposure of bone, cartilage, tendon, or named neurovascular
structure; debridement of wound edges (e.g. traumatic lacerations or
avulsions); extensive undermining (defined as the distance greater than or
equal to the maximum width of the defect, measured perpendicular to the
closure line along at least one entire edge of the defect); involvement of free
margins of helical rim, vermillion border, or nostril rim; placement of
retention sutures. Necessary preparation includes creation of a limited
defect for repairs or the debridement of complicated lacerations or avulsions
Scar revision has been removed from the description of complex repair.
Per the AMA, Scar revision in which skin is excised and closure is
performed should be coded as excision of benign lesion. This code will be
considered included in most other surgical procedures.
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