Routine Waivers of Copays and Deductibles Amounts

Posted on October 15, 2018

While the occasional waiver of co-payment obligations is permissible, the routine waiver of co-pay and deductible amounts is not. The federal Anti-Kickback Statute (AKS) prohibits the remuneration 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 remuneration is likely to influence the beneficiary to obtain services/items from that particular person/entity.


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Qualified Medicare Beneficiary (QMB) Program

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.

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Medical Credentialing Specialists Streamline the Application Process and Prevent Errors

Posted on September 14, 2018

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 is 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.

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Moving Payment Up-Front: How to Optimize Point-of-Service Revenue Collection

Posted on August 17, 2018

“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

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Closing the Loop: Overcoming Patient Payment Obstacles for Revenue Cycle Optimization

Posted on July 13, 2018

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.

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What Is a “Good” Revenue Cycle? Evaluating the Health of Your Practice’s Finances

Posted on May 16, 2018

Two common questions we field from clients are: “So how do we know when we’re done optimizing? When do we know our revenue cycle is good to go?”

These are the billion-dollar questions. Similar to a patient with an ongoing condition asking, “When will I be cured?” the answer is always going to be, “Well, that depends on a lot of factors.” That is where we come in.

Revenue cycle optimization is not a one-size-fits-all prospect. Nor is it a process with a discrete start and end date. Think of it as a living organism, affected by any number of variables that can shift from year-to-year, week-to-week, even hour-to-hour. Revenue cycle management isn’t a “build-it-and-leave-it” task. You must shepherd this complex organism through the life of your organization and keep it as healthy as possible.

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Are You Underpaid? Adjust Your Physician Fee Schedule to Unearth New Revenue

Posted on March 15, 2018

Finding new ways to optimize your revenue stream doesn’t have to be an exercise in frustration. Looking at small tweaks to tighten up gaps can be an easy way to give your revenue numbers a boost, and it can be done whether you’re just at the beginning stages of evaluating your revenue lifecycle management or if you have a robust system in place.

Our clients are often astounded at how much loss they could prevent by a few simple checks of their physician fee schedule. We recently worked with a family medicine practice in which a few small tweaks netted several thousand dollars monthly in additional revenue that it had been losing simply by not paying close enough attention to its insurance payers’ explanation of benefits (EOB) documents. Taking a moment on a regular basis to optimize your physician fee schedule can yield previously “hidden” revenue more often than many physician practices realize.

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Why Outsource Your Healthcare Executive Search to Your Revenue Cycle Management Partner?

Posted on January 19, 2018

When we first start working with many of our clients, they assume we can only help them with their medical billing and revenue cycle management. Many don’t have any idea that we also offer healthcare executive search assistance, and that we could help them find an executive who can offer new leadership to take the practice to the next level.

We know that successful revenue cycle management starts with having the right executives with the right attitudes working on the right initiatives. When the fit is right, an executive can infuse the entire organization with the sort of leadership that breeds a culture of revenue cycle management responsibility.

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Before Acquiring a Physician Practice, Evaluate These Revenue Cycle Management Factors

Posted on November 17, 2017

We’ve been in the business of assisting clients in managing their practices for a long time, and we can’t remember a time when everything seemed so geared toward mergers and acquisitions. We hear on a weekly basis from one of our clients who is either thinking about merging, being acquired or acquiring a physician practice.

Almost $3.2 billion was spent to acquire physician groups in 2014, and the healthcare trend shows no sign of slowing down. Acquisitions help health systems diversify and stay competitive in certain service areas without needing to build a venture from scratch. Why reinvent the wheel when you can acquire a wheel and keep rolling along, right?1

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A Guide to Creating a Revenue Cycle Management Culture and a Gung Ho Team

Posted on September 15, 2017

We were recently leaving a meeting with a client’s billing manager when she said something that made us pause. “I wish the whole team here were as gung ho about revenue cycle management as you guys are,” she said.

The Americanization of the term has come to mean “enthusiastic” or “zealous.” In the original Chinese, gung ho means “work together.” If you think about it, all organizations will benefit from that attitude at all levels, especially healthcare teams in the midst of some major transformations in our industry. Following sweeping regulatory and legislative changes like the Affordable Care Act, we’re seeing huge increases in patient payer responsibility, an emphasis on data, and a seismic shift in the insurance and claims sector.1

Revenue cycle management remains one of the most important areas of focus for healthcare organizations. Creating and nurturing an organization-wide culture of revenue cycle management can foster that gung ho attitude where everyone pulls together toward the common goal of excellent patient care and healthy revenue.

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