Posted on November 27, 2018
Are you satisfied with your collections from your patients? Would your practice benefit from more revenue from your patients? With more patients having higher co-pays and deductible amounts, it is imperative that providers find effective ways to collect amounts that are assigned to patients. The increase in this revenue is crucial to your practice’s vitality.
Posted on October 15, 2018
While the occasional waiver of copayment obligations is permissible, the routine waiver of copay and deductible amounts is not. The federal Anti-Kickback Statute (AKS) prohibits the renumeration to a beneficiary of a federal and state health plans by any person or entity if the person or entity knows (or should know) that the renumeration is likely to influence the beneficiary to obtain services/items from that particular person/entity.
Posted on October 8, 2018
Qualified Medicare Beneficiaries (QMBs) are dual-eligible beneficiaries with low income (at or below $12,000); they are individuals who have Medicare and are also enrolled with Medicaid, and get help with their Medicare premiums and cost-sharing. Medicare providers may not charge QMBs for Medicare cost-sharing for any Part A and B covered items and services. This applies to all original Medicare and Medicare Advantage providers and suppliers. The providers and suppliers may bill State Medicaid agencies for Medicare cost-sharing amounts. Most states do limit their payments of Medicare deductibles, co-insurance, and co-pays for QMBs. Nevertheless, QMBs have no legal liability to pay Medicare/Medicare Advantage providers their cost-sharing amounts. Therefore, all original and Medicare Advantage providers, even those who don’t accept Medicaid, are not allowed to balance bill QMBs.
Posted on May 18, 2016
We sometimes use a pie analogy when working with clients on all the different aspects of revenue cycle management. It helps our clients train their staff if they understand the different steps and how everything must work together and be timed correctly to get a good result. This holds true whether we’re talking about a delicious, made-from-scratch pie or a healthy revenue cycle. When it came to working with providers on October 2015’s ICD-10 implementation, we once again found ourselves breaking out the pie analogy.
Posted on May 13, 2016
In our years in the medical billing industry, we’ve seen how credentialing can become a major problem area for our clients. We have one client whose new physician started seeing patients before being credentialed and approved by the payers — his services ended up being free — it was bad news all around. The practice lost money and the physician lost production compensation.
Practitioners sometimes get (understandably) overwhelmed by the credentialing process, or find out after completing their initial submission that their approval just isn’t coming as fast as they need. To avoid a protracted approval process or a denial, it’s important to understand the complexity of submitting a successful credentialing application, and consider letting a credentialing professional handle the job — it will save you time and money, and let you keep taking care of the patients who need you instead of worrying about reimbursement.
Posted on May 11, 2016
Working with so many healthcare organizations on facets of revenue cycle management like billing and practice management over the years, we know industry trends can have huge impacts on our clients. From regulatory changes to new technology advancements, changes in the industry affect how our clients do business.
Acquiring or launching a specialty pharmacy practice is one trend we’ve been keeping our eyes on recently. It has grown in popularity due to soaring drug prices. Has your practice thought about how acquiring or building a pharmacy practice might impact your revenue cycle in the short and long term?
Benefits of Acquiring or Launching a Specialty Pharmacy
The trend of pharmacy growth didn’t come about in a vacuum — like most healthcare trends, it grew to fill a gap.
In 2014, the United States spent $124.1 billion on specialty drugs, up from $98.1 billion in 2013. Despite an average growth for pharmaceuticals of 20 percent a year, hospitals fill their own prescriptions less than 20 percent of the time, and clinics and outpatient services are often comparable. This highlights a sizeable gap where practices who might need specialty drugs for patients or procedures are putting a significant portion of their revenue at the mercy of a third party that is not bound by payer contracts or rates.1
Posted on May 5, 2016
Over the past several months, we’ve come to some realizations we hadn’t previously about the recent ICD-10 transition: Many healthcare organizations who used the grace period leading up to ICD-10’s official arrival to prepare were blindsided by the little ways ICD-10 immediately impacted what they thought were small areas of their revenue cycle.1
By any measurement, and in any context, going from 13,000 of something to 68,000 of something is a big jump. When we’re talking about codes used to drive the payments and reimbursements of one of our country’s most crucial and complex industries — healthcare — it’s easy to see why the ICD-10 transition is considered one of the most important changes in the field in a generation. For the most part, it looks like the big-picture transition has gone very smoothly for almost all healthcare entities and payers — everyone is mostly using the right codes and not seeing a drastic rise in rejected claims or other issues.
Posted on May 4, 2016
“Would you consider bringing your car in for an extensive repair job that takes highly skilled mechanics several hours, and then drive your car away without paying?”
Of course not. None of us would. We have heard this and similar analogies from our clients and colleagues when lamenting all the revenue hits the practices are taking due to patient payment-related bad debt. The healthcare industry spends more than $400 billion annually on payments, billing, claims processing, revenue cycle management, bad debt, and collections. As patients’ out-of-pocket expenses continue to balloon, and high-deductible health plans (HDHP) become increasingly common, healthcare organizations must find a method of collecting more from patients.1
Posted on April 28, 2016
Some professions are impossible to contain inside working hours. Teachers work more hours than the school day or school year would suggest, for instance. And we know well that physicians also work far more hours than is revealed by hours billed or patients seen. One of the common refrains we hear from clients who rely heavily on physician practices or physician procedures for their revenue is that physicians spend a great deal of time on patient care activities that can’t be billed because they aren’t direct interactions with patients. For example, if a physician spends an hour every few weeks calling a patient’s cardiologist to ensure they are coordinating care, many practices believe that’s an hour of time that can’t be billed.
Now, however, they could bill for it. And so can your organization. As part of an effort to encourage more emphasis on patient outcomes, the Centers for Medicare and Medicaid Services last year began allowing Medicare payments under the Medicare Physician Fee Schedule (PFS) for the American Medical Association’s Current Procedural Terminology (CPT) code 99490, which covers face-to-face care coordination services for Medicare beneficiaries with multiple chronic conditions.
Posted on April 26, 2016
For our clients who are staring down huge amounts of bad debt related to services their patients haven’t paid for, the trend toward much higher patient payment responsibility can mean a hot-and-cold relationship with patients.
It’s possible this stems from a disconnect on both sides of the equation: Many patients don’t understand that they are now responsible for paying for more of their healthcare services, and some practices have not yet optimized their processes to make patient payment easy and efficient.
The world has shifted for many of our clients and healthcare organizations of all type and sizes. According to the Medical Group Management Association’s (MGMA) research in 2010, $1 in every $4 of payments comes from patients, and that trend has only continued and intensified since then.1
The patient wields unprecedented power and responsibility in the new healthcare terrain, and many healthcare organizations aren’t doing enough to facilitate better patient relationships and smoother patient payments, which is directly impacting revenue.