EHRs have become quite a common phenomenon in the American healthcare industry. In 2015, 78% of office-based physicians use an EHR system while 59% want to switch their current EHR provider. Moving forward in 2016, CureMD, eClinicalWorks, and Practice Fusion are the top three EHR vendors. CureMD offers one of the most comprehensive cloud platforms as an EHR vendor with continuous support and problem resolution. eClinicalWorks has the second highest market share in the American market at 10.2% as it provides solutions to practices of multiple sizes. Practice Fusion specifically caters to smaller practices and is MU, ICD-10, and PQRS compliant. Read more
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
For providers looking to select the ideal Oncology Electronic Health Record (EHR) for their practice, and for those seeking replacement for an underperforming system, here are features your new system must possess.
- An evidence-based regimen library
You need Oncology specific templates which should be sequenced based on disease classifications and treatment categories. Your system should also have to ability to create specific protocols to deal with disease-complications and for catering to patient specific needs.
- Chemo management, preparation and ordering
Another feature your specialty specific EHR must possess is this by which orders are electronically delivered, and the drug volume is automatically calculated through a ratio analysis system. The system should be intelligent enough to make a distinction between dosage vials to find out the resultant amount of wastage, in addition to the generation of billing codes and for documentation
- Support for Clinical Operations
The feature known as ‘Clinical Decision Support’ makes certain that patient dosages are automatically updated when particular factors change. The feature should also keep tabs on lab work to make certain that Chemo-plans are updated in correspondence with Renal and Hepatic conditions.
- Integrated Charge Capture
If your system has this feature, you will be able to collect all data needed for billing via Chemo-documentation.
- Auto-complete Progress Notes
This will help convert words into detailed notes. You can also add other images and attachments alongside these notes, in addition to faxing and emailing them to the referring providers.
- A Patient Portal Service
Using this feature, you will be able to enhance patient care and satisfaction by allowing them to securely request refills and appointments, receive test results, and access educational material online.
Keep the above-mentioned features in mind when selecting an EHR for your practice. Download this free Oncology EHR Whitepaper for more help in the vendor selection process.
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.
For a specialist that deals with mental disorders on a daily basis using methods such as psychoanalysis, psychotherapy, prescribing drugs and other treatment techniques; the structured documentation of your clinical encounters is much more important than most other specialties.
Electronic Health Record (EHR) systems not only make this process more secure, but also do so in a very organized and accessibility-enhancing manner.
There must be numerous different customizable psychiatry templates for anxiety and depression, paranoia, substance abuse, etc. Relevant templates will aide providers in effectively documenting different processes. Additionally, there must also be point-and-click SOAP note templates for the specialty which will help you (or the person tasked with entering the information onto the system) during (or after) the visit.
You must also inquire if your system has interface with a Practice Management System and if it is compatible with a Patient Portal. The vendor must have a functioning patient portal used by patients or their guardians. Psychiatrists must upload educational information in addition to accepting or rejecting prescription refills on these portals.
Additionally, a Cloud-based system would also boost functionality as it would allow providers to access this information from other non-clinic locations via laptops, Smartphones and tablets.
In addition to E&M coding assistance, the highest coding level that should be billed should also be automatically determined by the system to maximum reimbursements.
The provision for scheduling, including recurrent appointments, is very important in this specialty to determine when you’re free; and not waste any time when you could be earning more money. Moreover, there must also be e-Prescribing with different pharmacies to enhance patient convenience.
Furthermore, a report building feature must also be present in this system so that you can group all patients with certain diagnosis or medication requirements, making life a lot simpler in the process.
There are numerous other features that help psychiatrists gauge if their Psychiatry EHR is up to the mark; the key, here is to always stay educated and willing to improve your shortcomings so that you always stay ahead of your competition.