When it comes to insurance coding, hitting your target, is the key to successful reimbursement. However, many practices are undercoding or overcoding skewing the reimbursement opportunity. Undercoding occurs when the code billed does not adequately reflect the full extent of the services performed by the physician. Undercoding means potential revenue is left on the table because you didn’t accurately code the procedure performed and missed out on reimbursement.

In an interview with Medical Economics, health policy expert, Robert A. Berenson, MD, said the administrative burdens of the new merit-based incentive payment program (MIPS) could drive many small, independent practices out of business. MIPS, which was introduced when Congress signed into law the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), combines previous quality reporting programs PQRS, Meaningful Use and the value-based modifier programs into one super-sized performance-based program. 

Group visits, also known as shared medical appointments, are an innovative way of generating a new revenue stream for your practice. Group visits allow you to grow your patient volume without having to extend your schedule or bring on additional staff. So how does it work?

With patient responsibility now more than 25 percent of the total value of the bill, practices need to develop core competencies in collecting co-pays, co-insurance and collecting deductibles upfront.

Many large groups, IPAs, and ACOs are considering taking control of the credentialing process by replacing the traditional provider enrollment (credentialing) model with delegated credentialing—earning the formal approval of payors to credential their own providers. Becoming delegated can mean decreased denials and quicker, more predictable cash flow. But preparing for delegation requires careful planning and thoughtful execution.

Managing your practice’s revenue cycle can be one of the most time-consuming and complex parts of running your business. If you are spending more time managing revenue then you are managing your patient’s health, it’s time to engage with a revenue cycle management (RCM) company. The key is finding the right revenue cycle management company for your specific needs. In this blog post, we will focus on the key questions you should ask potential RCM partners to determine the best fit for your practice.

Declining reimbursement, the increasing costs of operating a practice, time-consuming regulatory burdens, and hassles with getting paid by insurance companies and patients are putting enormous pressure on your practice's revenue cycle. Collecting every dollar and driving your revenue growth is critical to success. Any easy place to start is by maintaining a full and productive schedule. 

CMS announced last Friday an extension to the deadline for hardship exemptions from the Medicare EHR Incentive Program's meaningful-use requirements. The new deadline is July 1 adding several months from the former deadline of March 15 for eligible professionals, and April 1 for eligible hospitals and CAHs.

Historically, the purchasing and financial decisions for healthcare services were made at the “wholesale” level with arrangements between the payers, providers, and the employer; with the patient glaringly absent. With the introduction, and subsequent mass adoption, of High Deductible Health Plans (HDHP) the patient now has “skin in the game” assuming more of the financial responsibility for their healthcare needs.

In an earlier post, we reviewed the 5 things you need to know about the Merit-based Incentive Payment System (MIPS). The MACRA bill that introduced the MIPS program also provides incentives for participation in Alternative Payment Models (APM) in general and bonus payments to those in the most highly advance APMs. We detail the particulars of these incentives in this blog post.