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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Filling Out Your Dance Card: Determining Which Revenue Cycle Management Partner Is Right For Your Practice

Posted on July 21, 2017

Just recently, a longtime partner of ours, a diagnostic services center based in the West, reported to us some truly amazing revenue numbers from last year’s third quarter. PRN is so proud to have been a part of their story from the time they were just one small location barely beginning to tweak their revenue cycle factors.

Working with a revenue cycle management partner should be more than just a decision about “outsourcing” or staying “in-house.” With PRN, those kinds of distinctions feel arbitrary — we want you to consider us as dedicated to you as any in-house department responsible for optimizing your revenue. Typically, we start working with our clients when they reach a size where in-house billing, collections, follow-ups, coding, proofing claims, accuracy audits, tracking HIPAA and other laws, and all the big and small things that make up a healthy revenue cycle, has simply become too much.

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How Your Duplicate Patient Records Problem Is Crippling Your Revenue Cycle

Posted on May 19, 2017

Jamie Hernandez, a 41-year-old former Division III soccer player, walks into a physician-owned outpatient surgical center for a knee arthroscopy. Due to an innocent keystroke error, a staff member sends the invoice for Jamie’s procedure to Jaime Hernandez, a 72-year-old retiree who had a total knee replacement at the center a couple of years ago. The error is eventually discovered, of course, when Jaime calls confused about the invoice, and a replacement invoice is quickly sent out to Jamie. By then, however, several weeks have passed, and payment is delayed.

We see scenarios like this play out at our clients’ facilities every day. Nicholas Payne comes in for an MRI in January and ankle surgery in March and ends up with two patient records, under Nicholas Payne and Nick Payne. Claire Boswell has two records, one with her birth year as 1987 and the other listing her as born in 1978. Bill Johnson is one of nine Bill Johnsons in the database, but three of the patient records belong to him, with three different addresses listed.

These things happenany organization dealing with a lot of data and customer information is bound to end up with a duplicate record problem. Many of our clients are surprised to learn that what seems like a simple administrative issue can cripple your revenue cycle if you let it get out of control. Duplicate patient records and an inaccurate master patient index (MPI) affect your bottom line in multiple ways that can all be detrimental to your organization.1

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No More Nightmares: Eliminate Duplicate Records in Your Master Patient Index for a Better Revenue Cycle

Posted on February 15, 2017

Imagine this nightmare scenario: You’ve decided to take a good look at how duplicate patient records might be wreaking havoc in your master patient index (MPI) and handicapping your revenue cycle. You’re relatively certain that a few clerical errors—like transposed dates or letters—led to a small number of duplicate records. That sort of thing happens, after all.

Instead, what you find is a veritable epidemic of patient records that may or may not be duplicates, as well as a long trail of claims denials, appeals, delayed payments, fractured demographic documentation, and already-performed services for which you cannot collect reimbursements because it’s too late to get authorization, and the error was found past the claim-filing deadline. Everywhere, of course, are signs that your staff has spent untold hours trying to fix these problems. There also is evidence of payments that never made it into your revenue cycle, or that did so only after so much rework that your organization likely paid for the privilege of receiving that payment for services rendered.

Of course, it isn’t always such a dire situation when we advise our clients to look into duplicate records issues and clean up their MPI. However, because duplicate records so directly affect revenue cycle, the process is almost always a worthwhile one and can yield hidden revenue and close the gaps on administrative issues.

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How Your Healthcare Revenue Cycle Is Affected When You Add a Specialty Pharmacy

Posted on October 14, 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

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CPT Code 99490: Increase Your Revenue by Billing for Chronic Care Management

Posted on July 15, 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.

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Four Ways to Measure an Electronic Health Record Transition’s Effect on Revenue Cycle

Posted on June 17, 2016

Gone are the days when the good ship Healthcare Practice floated on a sea of paper. Today, most of us work with electronic health record (EHR) systems to do everything from access patient information to streamline lab testing.

As of 2012, 72 percent of physician offices used EHR systems. That’s up from less than 50 percent in 2009, when the Health Information Technology for Economic and Clinical Health (HITECH) Act was passed, providing incentives from Medicare and Medicaid to organizations that made a commitment to “meaningful use” of technology and adopting EHR systems.1 Since the 2012 data, we’ve certainly noticed even more healthcare entities adopting EHR systems and upgrading from older ones to new systems.

We worked with a Nevada clinic to help it transition from paper records to an EHR, and another practice as it went from one cloud-based EHR system to another that better suited its needs. Since these were already clients of ours, we were in a position to warn them that EHR migrations often result in unplanned revenue cycle disruptions. Outbound claims can stagnate as staff undergo training and learn the new system. Everyone’s emphasis on revenue optimization can falter as multiple departments prepare for migrating from paper to EHR, or from an existing EHR to a new one.

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Now What? The Biggest Challenges of the ICD-10 Transition Could Still Lie Ahead

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.

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Mind the Gap: How the ICD-10 Transition May Have Exacerbated Your Revenue Cycle Difficulties

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.

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