CureMD has been servicing practices across the US for over twenty years now and has received numerous accolades during that time. With an easy-to-use interface and amazing customer service, CureMD’s Electronic Medical Records (EMR) software caters to 32 specialties and helps physicians and office staff efficiently manage their daily operations. The company has also been providing exemplary service to mental health professionals, making their practices substantially more organized and better coordinated; and we’re not the only ones saying this! Continue
In today’s struggling economy, physicians tend to focus more on the business side of their medical practices to ensure the sustainability of their medical practice. To improve a practice’s workflow and revenue for its survival in the long run, physicians have started shifting their focus more towards medical billing and coding. Despite this shift in the healthcare industry, many practices have gone bankrupt because of the increasing claim denial rates. It is estimated that US physicians face a loss of at least $125 billion every year because of poor medical billing. There are two main reasons why physicians face such a huge loss in practice revenue; the increasing number of billing errors made by physicians or staff members in claims and the failure of staying up-to-date with the changing rules and regulations of medical billing.
To get Ready for ICD-10 many practices have started outsourcing their medical billing tasks to billing companies, so that physicians can direct more focus towards their patients and leave the ‘dirty’ work to billing experts. However, simply handing over the billing process is not going to help medical practices reach their highest potential and squeeze maximum revenue out of the submitted claims. There are some billing companies that only assist medical practices by carrying out the implied billing tasks like code reviewing, claim preparation, claim submission and insurance follow-up. These tasks can help reduce claim denial rates of medical practices to some extent, but not assist them in turning the tide against revenue loss.
Some billing companies have taken a different approach to tackle this long term revenue loss problem. These companies offer additional services to medical practices like managing claim processing, payment and revenue generation. These added services are collectively known as Revenue Cycle Management or RCM. RCM service covers tasks like claim tracking, payment collection and also addresses denied claims, which is most likely the main cause behind 60% of missed revenue opportunity for a practice. Following are some other services offered by RCM billing companies, which makes them a better choice as compared to simple medical billing companies:
- Pursuing denied claims
Unlike other billing companies, RCM vendors keep track of both the submitted as well as denied claims. By identifying the error behind the rejection or denial of claims, these vendors can advice physicians to make the required changes before resubmitting the claim. This increases the probability of approval of future claims as well.
- Reporting and analysis
A physician needs to follow up with the billing and revenue generation process of his medical practice. RCM vendors provide timely and detailed revenue reports to the physician, informing him of the number of claims accepted or denied and the shift in the practice’s revenue generated from these claims. Regular reporting and analytics also help physicians and billers to forecast the continued growth and profit of the medical practice for the next couple of years.
- Billing follow-up
If a patient defaults on his bill, who is supposed to follow up? RCM vendors also save physicians from the trouble of tracking all patients who have yet to pay their medical bills.
In a nutshell, RCM companies have redefined the billing process of medical practices and are more suitable to handle medical billing operations as compared to simple billing companies. Moreover, not all RCM vendors charge physicians heavily for offering additional billing services, which is a plus point for small practices. In order to find a fitting RCM company for their practice, physicians must evaluate billing companies on the level of services they provide, their industry experience and use of technology.
The key behind a financially successful medical practice is the effective and efficient use of its Revenue Cycle Management (RCM) model. RCM involves all steps related to claim processing management and revenue generation. Looking at historical trends, revenue cycle management has always been a priority for physicians but the recent regulations imposed by CMS and HIPAA are making RCM unmanageable for many.
Due to this dilemma, many practices have considered outsourcing the entire RCM process to medical billing vendors, who are more equipped to handle the process.
The problem with outsourcing for many
The next question that arises, and one that puzzles many physicians, is that if outsourcing medical billing is the best solution for both small and medium practices, why are many practices (which have outsourced the service) still not generating more revenue?
Well research all points towards the RCM vendor selection process. It turns out that if a wrong vendor has been selected for the job, or a practice fails to maintain a proper relationship with its vendor, the results can be disastrous. Practices aiming to increase their revenue can go bankrupt if physicians fail to follow the appropriate guideline or steps while choosing their Medical Billing vendor.
The ideal medical billing vendor should not only have the relevant experience in Revenue Cycle Management, but should also offer a greater ROI than the cost required to outsource the process. Here are some RCM processes that practices must ensure their vendor is offering,:
Claim processing and submission is not all that is required from medical billing vendors. Billers must keep regular follow-ups on the claims that have been submitted to insurance companies for further processing. Follow up time differs for different insurance companies. Some process claims within 15 days while others take as long as 40 days. Some practices fall in bankruptcy by the time they realize that their vendors have only been submitting claims and keeping no tabs on what became of them afterwards.
- Regular reports to provider
Billing vendors should establish a strong relationship with the practice, and keep the latter updated of submitted claims through regular reporting. The reports must be shared at regular intervals (eg: every 90 or 120 days). These reports must include the percentage of accounts in receivables, as well as a breakdown of payers and providers with accounts in each category. The reports must also include a breakdown of claim denials and rejections, along with their causes.
- HIPAA considerations
The billing vendors must also keep up with the latest HIPAA regulations announced by CMS. They must also provide the practice with Risk Assessment and Measures to remain compliant with HIPAA.
There are many other RCM processes that billing vendors offer including, but not restricted to, performance guarantees, technology interfacing and address inefficiencies and shortfalls in getting fully paid on a timely basis. However, if a practice plans on outsourcing medical billing, it should be aware of billing vendors that try to trap practices by fooling them into signing misleading long term contracts. This way practices would lose a lot of revenue if they decided to end the contract early, even if the cause was poor vendor performance.
The Oscars of Health IT, as my boss likes to call it, is less than a week away. I personally believe HIMSS is more like the Golden Globes; you actually get to party while working and networking with your peers rather than being suffocated with lame jokes and an air of formality which pretty much sums up the Oscars. Anyways, I digress.
For Further Read Visit : http://blog.curemd.com/curemd-attends-himss15/#prettyPhoto
In August this year, the Department of Health and Human Services (HHS) announced that ICD-10 coding will commence on October 1, 2015, and there will be no delay as has been in the past. The announcement also states that the use of ICD-9 will continue until September 30, 2015.
Many providers, experts and healthcare groups across the country are still of the view that physicians will not be ready by this extended October 1 deadline, partly because of the existing burden of achieving other technological requirements including Meaningful Use and PQRS.
The CMS also announced three testing weeks for the tenth revision of the ICD code set. The first testing week was in November this year, however; the second and third take place on March 2-6, and June 1-5, 2015, respectively.
The CMS believes that these testing weeks will help determine if providers are able to meet “technical compliance and performance processing standards” through the implementation process. In simple terms, the testing will help check if the claims are correctly being sent out (in the new format). This step will be integral, in not only raising awareness about the new codes, but to also work on methods to fulfill their shortcomings for providers incurring issues with these new codes.
There will also be end-to-end testing, which will determine the claim submission process via the remittance advice receipt. This round of testing will be more comprehensive, and will give a more in-depth analysis for providers on the claim processing via ICD-10; and the subsequent Medicare payment process with these new codes. The months for end to end testing in 2015 are January, April, and July.
You must contact your Medicare Administrative Contractors for more information on the testing process. Your EHR vendors, medical billing company, clearinghouses and payers (insurance) must all be ready for the coding changes before your practice is, so that you can seamlessly begin the testing process as soon as your practice is ready. Get in touch with them so that you can determine if they’ll be ready for ICD-10 before time, because if they aren’t; it’s time to switch to someone who will be.
Download your own ICD-10 e-book to start your ICD-10 training or try free ICD-10 certified EHR Demo.
Running a healthcare facility, be it a hospital or small to medium sized practice; require resources and lot of effort. Sometimes the most crucial factor, the patient experience is overlooked in the medical and administrative tasks. However, physicians have to run the business side of their medical practice as well, which means maximizing profits and controlling costs.
In any business, customer satisfaction is of utmost importance. Similarly, Patient Satisfaction is important for the success of a medical practice – every point of interaction between the patient and practice’s staff is crucial, as it will determine the patient experience and satisfaction. A patient satisfied with the service of medical and administrative staff of practice will return and spread good word about it. Therefore, it is necessary to make your patients happy so that they return to your practice for quality medical care.
Interaction with the front desk staff
This is the first point of patient interaction with the practice that will create an impact on their experience during other steps of their visit. The front desk staff should be trained in operating the Electronic Health Records (EHR) system to avoid errors that will require a call back to the patient to get accurate details. This carelessness will irritate the patients, making them reconsider their choice of physician.
Another point of interaction is at the check-out time. At the time of checkout front desk staff should clearly explain the patient’s, the amount they need to pay for the services. This amount can be an estimate based on deductibles received from patient’s with similar diagnosis and treatment.
Experience in the exam room
When patients enter the exam room, they place their trust in the physician to help them with their medical issue. They expect the physician to listen to them attentively, examine and diagnose with undivided concentration and sincerity. The uninterested tone of the physician and rush to end the consultation – so that the physician could squeeze in more patients – will not make leave a good impression on the minds of the patients.
Sometimes patients can be difficult to treat. If you dismiss the complaints of your patient by calling them irrational, then you are just losing your customers. Instead, listen to them carefully and try to explain them in a polite and sympathetic manner.
Physicians are the face of their practice. The decision to return to the practice in future rests heavily on the shoulders of the patients. If patients are not satisfied in the exam room, then there is likelihood that they will not ask for another appointment.
Leaving the patient unattended
The patient sits in the hallway for hours, waiting for his/her turn to see the physician, only to realize that the administrative staff has forgotten about them. That’s the worst way to deal with a customer. The patient has been quietly suffering in pain, while there is no one to attend to him/her. This creates a negative perception of the practice. The front desk staff and nurses can play a role to deal with the patient while physician is busy with other patient.
The front desk staff using the Electronic Health Records (EHR) should carefully schedule appointments, such that they don’t overlap with each other and patients don’t have to wait for hours. In case, patients are late for their appointment, then they can be asked to wait. Meanwhile, nurses can attend to the patient to help them with pain.
Like any business, it is imperative for physicians to retain their patients to generate revenue for their practices. Therefore, physicians should provide their customers – patients – with finest service.
In recent times, our country’s health IT industry has witnessed a complete transformation with the introduction of strict regulatory laws, the progress of technology and the vision of providing quality, cost-effective care.
Electronic Medical Record (EMR) systems have exponentially improved during this time to an extent whereby they have become almost a necessity for any practice looking to survive in the extremely competitive healthcare industry.
The HITECH Act of 2009 and similar developments have resulted in massive increases in the number of EMR vendors, making the market for these products extremely competitive. Technological innovation due to the growing number of EMR Vendors resulted in the quest for comprehensive solutions.
Although EMRs contained the clinical and medical treatment data of patients at one practice, there was an industry-wide need for more comprehensive “health” records, and the option of more portability of this data. That is how Electronic Health Record (EHR) systems surfaced. By definition they provide a broader and more comprehensive view of patient data (that would exceed the standard clinical information gathered at a hospital or clinic).
Moreover, they would are interoperable, meaning that relevant data can move across practices, labs, patients and other stakeholders that could help provide better, faster and more accurate care.
Here are some of the most beneficial features of EHRs:
- Accurate medical, social history and family records of patients on a single, easily accessible source can help physicians make more accurate decisions with the lesser chance medical errors
- Cloud-based EHRs can be lifesaving; for example, relevant patient records can be transferred across practices and states to deal with emergent situations, or to speed up the care delivery process in day-to-day processes.
- Patients will not have to visit the practice to receive lab and test results, as they can be delivered to them electronically via portals in these systems. Patients can also interact with, and receive educational material from doctors online.
- Integrated with medical billing software, they can significantly boost the efficiency of the payment process
There are various other benefits of these systems all of which are aimed towards making the care process cheaper, more efficient and of better quality.