The measures set forth in the Health Insurance Portability and Accountability Act (HIPAA), specifically the Privacy Rule and its 2013 Final Omnibus Rule update, are an omnipresent concern in most physician practices. Its goal of security and protecting patient Protected Health Information (PHI) is both noble and necessary, but, for smaller practices in particular, ensuring compliance with those measures in order to achieve this goal is an arduous process, one with dire consequences should it fail.

Nothing throws a wrench in your revenue cycle quite like a growing list of denials. For your office, denials mean less money in the door, more work for your staff, and less consistency in your monthly AR.

The good news if you are struggling with claims denials is that the most frequent causes for those denials are surprisingly easy to correct. Here are the top five most common reasons for claims denials according to Healthcare Finance, along with what you can do to fix them.

The much-anticipated proposed rule for quality reporting in 2018 has been released by CMS. This proposal aims to grant clinicians greater flexibility to promote participation in the Quality Payment Program (QPP). The following details are regarding the MIPS year 2 reporting.

The most noteworthy pieces of the proposal include:

Low Volume Threshold for the Reporting Year 2018

• Clinicians or groups who bill $90,000 or less Medicare Part B OR 
• Clinicians or groups who provide care for 200 or fewer Medicare Part B beneficiaries

Is your practice still doing manual eligibility verification? Do you know how much time and money it is costing you?

According to an MGMA analysis, the average practice spends approximately 12.64 minutes manually verifying a single patient’s insurance eligibility. To put this in perspective: if you were to manually check eligibility for every patient you see in a day, and you see 40 patients, you’d have to spend 8.4 hours just checking eligibility. That’s a full day’s work for one of your employees!

With both reimbursement requirements and the solutions to manage them growing more complex, many practices may laugh at the notion of “streamlined” workflows in the office when it comes to their revenue cycle. Technology is supposed to help solve problems, after all, not add layers of technology that create more.

As the healthcare industry moves away from fee-for-service and towards pay-for-value, the number of government, insurance, and third-party programs looking to incentivize clinical quality is only going to increase. If you are a practice manager or owner, you will want to be particularly familiar with three of these programs in 2017. 

The practice of medicine is changing at an unforeseen pace.  With fee-for-service reimbursements declining, practices need to make sure they are maximizing productivity, collecting all they are entitled to, and making the important shift toward value-based care. So how does a practice know if they are doing their best?  How do they identify areas that need improvement?

The regular collection of data allows a practice to assess whether the correct processes are being performed and desired results are being achieved. If you can’t measure it, you can’t manage it.

As we generally do with proposed regulations that impact EHR developers and their customers, the Electronic Health Record Association (EHRA) carefully reviewed and collectively commented on CMS’s proposed rule on the Hospital Outpatient Prospective Payment Systems (HOPPS) and EHR Incentive Program on September 1. Our comments, submitted on September 1 and available here, are based on the collective experiences of more than 30 EHRA member companies who service the vast majority of hospitals and ambulatory care providers using EHRs across the United States.

The Department of Health and Human Services wants to improve your medical bills. So much so that they have launched a nationwide challenge called “A Bill You Can Understand,” to help create a clearer, less complex, and more understandable medical bill that improves the patient financial experience. 

Telehealth Services

Telemedicine is changing the way we experience healthcare. It allows patients to consult medical professionals via technology for a range of illnesses or follow-up care from the comfort of their home. While telemedicine has existed for more than a decade now, recent advancements in technology have seen it re-emerge as a tremendous force.