Posted on July 30, 2019
“Great things in business are never done by one person, they’re done by a team of people.” Steve Jobs
What is teamwork?
The business dictionary defines teamwork as a process of working collaboratively with a group of people in order to achieve a goal. Teamwork is essential to accomplishing the objectives and goals of an organization. And the ability to perform both as an individual and as an effective teammate is the key to professional growth and success.
Posted on June 26, 2019
Are your vendors also your business partners?
While having customers/clients is vital to your business or practice, vendor partner relationships play an important role in efficiency and how smoothly your company or practice operates. Therefore, having the right vendor partners can make it easier for you to succeed and grow your business or practice.
A vendor provides products and/or services to businesses/practices. A vendor partnership goes beyond the scope of just their products and services. When a partnership exists between your business/practice and the vendor, there is a cooperative effort to succeed together. Vendor partners want you to succeed. They do not just sell you a product and then walk away. They continue to be responsive to your needs even after the sale. It means that your phone calls and emails are returned in a timely manner. Good vendor partners understand that communication is key to a successful relationship. Vendor partners also respects your time, which means that scheduled meetings are on time and the necessary individuals are present on conference calls. Your vendor partner should be experts in their field and can help you resolve any issues you run into.
Posted on May 31, 2019
What is pre-authorization and why is it important?
Pre-authorization is the insurance company’s permission that is given to the provider to perform a service. If permission is not obtained, the provider will not properly get paid for the service. The prior approval process allows the insurance company to (1) verify that the patient’s account has enough benefit dollars for the insurance company to pay the provider for that upcoming service; (2) ensure that the particular service is an eligible service under the patient’s insurance plan; (3) determine if the procedure is medically necessary.
Posted on May 2, 2019
What is a clean claim?
A clean claim is a claim that was accurately processed and paid the first time it was submitted to the insurance payer; it is the ultimate goal in medical billing.
Why do you want clean claims?
When a claim is rejected, it delays your payment, inflates your accounts receivable, and increase your operational costs because the whole claim cycle must begin again. Your staff or billing company will have to identify/review the denials and perform any necessary corrections, in order to resubmit these claims to the payers. Thus, it is in your best interest to ensure that you have a high percentage of clean claims.
Posted on April 1, 2019
Do you provide a Compliance Hotline to your employees, vendors, patients and their families? One of the seven elements of an effective compliance plan is the development of effective lines of communication. As a provider, your staff, patients, and family members of your patients need to feel that they have the freedom, as well as the obligation, to report compliance issues, such as potential improper coding or billing practices, vendor misconduct, harassment, bullying, or other improper conduct. Offering a compliance hotline gives the complainant the ability to report the issues anonymously, a solution for those who are in fear of retaliation.
Posted on March 12, 2019
Diagnostic tests paid under the Medicare Physician Fee Schedule (MPFS) for the physician office and the Outpatient Prospective Payment System (OPPS) for hospital outpatient departments are regulated by the Centers for Medicare & Medicaid Services (CMS) by way of its supervision rules. A supervising physician provides oversight of the medical (technical) components of the facility. Duties include overseeing quality assurance, testing of equipment, development of protocols for the studies, creating policies and procedures that guide the medical operations of the organization, as well as the oversight of the healthcare staff. The objective is to ensure study quality and patient safety.
Posted on February 26, 2019
As a healthcare provider, do you have a compliance plan in place? Healthcare providers and business associates are required by law to have a compliance program. And as a part of the program, we are mandated to have a compliance plan. Unfortunately, there is not a “one-size- fits-all” template that providers are able to adopt. Each organization is different, with different operational environments and ways of doing things. Due to this uniqueness, it makes sense that each compliance plan would differ from one to another.
While the process of creating a compliance program can be daunting, having one is advantageous. First, it is a proactive way to ensure that you are meeting the statutory and regulatory requirements. Second, it shows the government your good faith effort to comply with the law should you ever become the subject of an investigation. Along with that, should you ever become convicted for violations of any of these statutes and/or regulations, having a compliance plan is favorably considered at sentencing.
Posted on February 1, 2019
Are you submitting your charges correctly and accurately to Medicare and other insurance carriers? It is imperative that providers code their services correctly and appropriately to prevent violations of the False Claims Act (FCA). You are violating the FCA when you knowingly submit a false claim to the government or cause another to submit a false claim to the government or knowingly make a false record or statement to get a false claim paid by the government. Here are some illegal methods that you should avoid when submitting your charges.
Posted on January 16, 2019
How does Medicare define fraud? It is when you knowingly submit or cause to be submitted false claims or making misrepresentations of facts to obtain a payment from the federal government, which you are not entitled to. It is also when you knowingly solicit, receive, offer, and/or paying remuneration to induce or reward referrals for items or services that are reimbursable by federal healthcare programs. Furthermore, it is when you are making prohibited referrals for certain designated services.
Posted on January 3, 2019
Form CMS-R-131 or Advance Beneficiary Notice (ABN) is a written notice that is given to Medicare beneficiaries when item(s) or service(s) is/are expected to not get paid for certain reasons, such as lack of medical necessity. Providers (including independent laboratories, physicians, practitioners and suppliers) are required to give a beneficiary this notice when payment is expected to be denied by Medicare.