One of the fastest growing payers in the physician community right now is patients themselves. The rise of consumer-driven health plans, the Affordable Care Act, and the like have led to a move away from comprehensive, low or no-deductible health coverage to plans that offer more freedom and less monthly cost, but ultimately more financial burden on patients when it comes time to actually use them. This arrangement makes financial sense for many patients but can be difficult for their providers.
We have talked about the reasons for claims denials before. Let’s now talk about their impact.
Medical credentialing is a simple process, at least on paper. You send information about a provider’s qualifications – work history, education, certifications, licensure, and so on – to a payer for review and verification. After they go through a thorough vetting process, the payer confirms the provider and begins reimbursing him or her for services rendered.
The joy and pain of change and growth.
Think back to your early career mentors and how you learned pearls of wisdom, work ethic, and life lessons from them. Now, think about what you learned of their career’s foibles, successes, and frustrations. I have marveled at the study of how to manage a fulfilling professional life. How can I minimize health and emotional pitfalls while "keeping it fresh".
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.