P3 Healthcare Solutions

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P3Care.com sort things out with the payers and at the same time keep the communication lines open on behalf of the providers. This way the patients receive the best care and the insurance reimbursement workflow keeps on moving.

Everyone is happy.

In addition, P3Care has a strong grip over the Quality Payment Program under MACRA. The Merit-Based Incentive Payment System (MIPS) track reporting mechanism for both the specialty-specific clinicians and the primary-care physicians brings in both incentives and reputational benefits.

What is P3?

The three “Ps” stand for:




P3Care Simplifies MIPS Reporting for Specialists

Merit-Based Incentive Payment System (MIPS) is an integral part of the value-based system. In addition, CMS recognizes P3Care as a MIPS Qualified Registry vendor in back to back years of 2017 and 2018. That makes it a favorable enterprise for physicians who want to choose a registry as their MIPS submission method.

The recognition puts a bigger responsibility on our shoulders in terms of performance and meeting your expectations.

The US healthcare system revolves around a working relationship between providers, patients, payers, and medical billing services. If there are disparities at any level, at any step, there is a high probability of bottlenecks.

The government has set the course for MIPS in healthcare to go the distance and want all the clinicians to accept it. If they fail to comply with MIPS, they must be ready to face financial penalties along with putting their integrity on the line.

Heart specialists or cardiologists choose quality measures, outcome measures (or high-priority measures) from specialty-specific sets and start their journey for incentives through MIPS reporting. We take a few minutes of your time and finalize measures before submitting to CMS.

Peace of Mind for Cardiologists

What do the cardiologists say?

First, they are ready to participate in the Merit-Based Incentive Payment System (MIPS). They are actually more excited about it than the general physicians. However, more than half of the cardiologists working in the healthcare industry have reported fatigue and higher stress levels due to excessive documentation.

If IT regulations ease up, it may give them ample time to treat patients and rest as well. P3 Healthcare Solutions is here to help you report MIPS in a timely manner. Connect with us 909-245-8350 to discuss.

CMS Incentivizes Practitioners

The doctors’ job is to treat the patients, but instead, they work 10 to 20 hours a week on paperwork. That is the fact, unfortunately.

The ground reality is that CMS has allocated $20 million on the smooth transition to Merit-Based Incentive Payment System. All these initiatives are going to improve healthcare down to the grassroots level. It must do so and silence those voices screaming the phrase, ‘Americans not getting the treatments they deserve’.

To make it more difficult for cardiologists, the data coming out of the EHR system is vague and doesn’t help with the diagnosis. Often it is descriptive rather than suggesting crucial care points. P3Care brings a solution to this problem by synchronizing the medical billing service with the practice management system.

Specialty-Specific Demotivating Factor

There are no standards set for specialty-specific clinicians when it comes to MIPS quality measures. Hence, there is no way to compare the scores of specialists. The result is a low MIPS Final Score, and there may be no bonus payments at all. It is derogatory and depressing.

Quality measures outlined by the Qualified Clinical Data Registry (QCDR) reporting mechanism also have a similar story. Generally, many specialists vote in favor of QCDR.

Data Submission for Physicians and Specialists

After the month of March, CMS take around 6 months to generate detailed results on MIPS reports.

Medicare MIPS reporting on Quality measures through a registry is highly suitable because it helps to identify and list down probable errors in the report. There is no other way to identify any ambiguities because CMS directly publishes the results. We can’t afford to make mistakes. However, at the end of those evaluations, CMS gives time to practitioners to ask for a review if they are not satisfied with the MIPS final score.

MIPS Cost Measures

Cost is an additional category in MIPS 2018. It accounts for 10% of the composite performance score (CPS). As a cardiologist, you don’t need to worry about it, though. CMS directly manage this category according to your billing to Medicare.

P3Care has a plan in place for the cost category so that CMS gives you the highest ratings on it. If you’re a specialist, please follow us on LinkedIn https://www.linkedin.com/company/p3-healthcare-solutions/.  We are technologically tenable and keep a close eye on news, views, happenings, and information regarding the US healthcare industry.

When you add the inpatient and outpatient costs, the average of which is compared to the national standard set in the specialist category.  That is an overview of how the cost category is calculated. The lower the cost, the better the ratings!


Hats off to medical billing services because they exhibit crosswalking as part of their work! Crosswalking means translating from one code set to another. The billers/coders compare the old version with the new version of code sets and use only the latest codes to represent diagnostic procedures.

The current version of the International Classification of Diseases (ICD) coding system is ICD-10-CM. Other coding standards used in the process of creating claims are Current Procedural Terminology (CPT) and the Healthcare Common Procedure Coding System (HCPCS). Thereupon, using the last released coding format requires deep insights and presence of mind. The more attentive and careful you are the more chances you get in terms of acceptance of claims.


The revision or modification in code sets occurs on a yearly basis. Medical billing experts map obsolete code sets with the updated version of code sets in a medical claim. The process links two distinct code sets, which are identical to each other.

It is important that both the code sets describe the same procedure or treatment. Ordinarily, crosswalking happens between two versions of the same code set. In other words, it is a translation between the latest version and the outdated version of ICD, CPT or HCPCS.

The Real Life Example

The practical example of crosswalking is the translation of ICD-09-CM codes into ICD-10-CM codes. As ICD-09-CM is now outdated and doesn’t represent the correct medical procedures. ICD-10-CM became the official coding structure in October 2015 onwards. The new system carries 68,000 codes roughly while ICD-9 only had 13,000 codes.

Why Crosswalk?

Sometimes, medical coders need to come back and forth between two code sets. For example, when medical billing and coding services have to check a patient’s medical history, they jump from one coding set to another to comply with the coding standard.

The updates in the coding mechanism play along nicely with the advancement in medical science and treatment cycles.

Convert ICD-09-CM into ICD-10-CM

ICD-09-CM was a numeric code set with five characters and some alphanumeric. It had one subcategory and one sub-classification.

Whereas, ICD-10-CM consists of alphanumeric codes, which are seven characters long. It has one subcategory and two sub-classifications. It also has an alpha-extension to describe the visit date and the patient’s illness. It covers more details and, therefore, describes elaborate diagnosis.

The transition between the two code sets is a bit difficult and optimally utilizes the skills of medical coders. It has higher specifications and the organization of codes. Hence, not many codes match with each other in both the coding formats.

American Medical Association (AMA) defined five types of matches in the context below:

1. Exact Matched Codes

In this type of match, codes from both formats match exactly with each other.

2. Approximately One to One Match with One Choice

Codes are not an exact match but have a close resemblance. Around 82.6% of ICD-10-CM codes can be crosswalked back to ICD-09-CM codes because of this type of match.

3. Approximately One to One Match with Multiple Choices

When codes from two different code sets match with multiple choices, it means that they are less specific. The explanation goes like this – A coder may find more than one code in one code set matching with a single code in another code set.

It is up to the coder to choose the most appropriate codes to keep medical claims as accurate as possible.

4. One to Many Matches

As the name suggests, it is a complex type of crosswalk matching. In this type, a single code in one set links to multiple codes in another code set. It means that a single code is crosswalked to a code cluster. A cluster comprises of two-four codes. It is also possible that a source code connects to more than one target cluster of codes.

It is the coder’s job to relate source code to the appropriate cluster. It requires a high level of concentration because a single missing code can cause a denial.

5. Un-Matched Codes

Sometimes, codes of two different code sets don’t match with each other. It happens while crosswalking back from ICD-10-CM to ICS-09-CM. In this scenario, coders use “NoDX” to state that no target code matches with the source code.

How Coders Can Master The Skill?

Modern medical billing can’t survive without excelling in the art of crosswalking. While we create medical claims, it is mandatory to look back in the patient’s medical history. Therefore, to make things manageable, National Center for Health Statistics invented ‘General Equivalency Mappings (GEMs)’ tool.

General Equivalency Mapping Tool

It assists in understanding the basic rules of crosswalking. For instance, you can code a specific injury or disease into a general one but never the opposite.

The tool provides a list of codes and their exact matched, possible matched, or appropriate matched codes from the other set. However, it is crucial for the coder to have medical billing and coding knowledge before using the tool.

The Way Forward in Medical Billing

Physicians’ reimbursements depend upon the accuracy of medical claims. If the claims contain errors and incorrect information, insurance companies will not pay against them until you remove those mistakes. That is exactly where P3 Healthcare Solutions comes in and gives crosswalking a new name. Follow us on LinkedIn https://www.linkedin.com/company/p3-healthcare-solutions/ for more information on coding mechanisms and changing healthcare industry.


The price transparency rules for the hospitals are set to change in 2019.

First, the healthcare professionals, patients, and amateur medical billing services are not clear about the implications of these new rules. Second, successful reporting of MIPS 2018 to the CMS is depending on them. Therefore, we will try to focus on getting some answers today.

For more information on healthcare IT, follow us here – https://www.linkedin.com/company/p3-healthcare-solutions/

How to ensure price transparency?

That is the question!

Which format is valid?

That’s another question…

The sooner we answer these questions and others like them, the quicker we will move towards a solution. CMS answers the frequently asked questions (FAQs) to clear the fuss. The details include –

  • Hospitals that are subject to new requirements

  • The items and services in the form of a list to go public

  • Definition of machine-readability

What Does The Rule Say?

CMS finalized the rule for Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital Prospective Payment System (LTCH PPS) in August 2018. It made compulsory for healthcare providers to publicize the charges list of all the medical procedures. Another new requirement is to update the list annually and it should be in a machine-readable format by the following year.

The new rule is a blessing as it comes with many advantages.

Bridge the Gap between Clinicians and the Patients

All the advancements in the price transparency rules are to empower the patients and uplift the quality of the US healthcare industry. Price transparency means definite pricing for rendered services and medical equipment. It leads to better healthcare since anyone can see the progress through the glass. Furthermore, it is a direct step towards a constructive relationship between healthcare providers and patients.

A momentous question rises in this regard…

Can it help you score high in MIPS?

Yes, it can! It improves the chances of interoperability (health information exchange) and cost-reduction with reasonable use of resources. MIPS quality measures play a significant role in reaching a higher score against the services you offer.

The physicians get to focus on their actual work i.e. give more time to their patients. Thus, the quality of services improves and you score higher at the same time. No more stress of penalties or negative payment adjustments!

CMS’ Official Announcement about the Charges of Services

CMS clarified the final rule of IPPS/LTCH PPS for the 2015 fiscal year (FY) and made the statement public. It gives a peek into the standardized charges for hospitals, medical equipment, and services. Moreover, it is a compulsory act to publicize the list via internet in 2019.

However, hospitals have the liberty to make the list public in their desired format as long as it represents correct information.

The format with the Provision of Machine-Readability

The new amendment in IPPS/LTCH PPS for 2019 FY rule also requires the online public list to be machine-readable. By machine-readable, it means the availability of data in a format that the computers can understand. As per the CMS explanation, the format should be a digital accessible document. For example, an XML or CSV format!

PDF is a famous format but it doesn’t satisfy the healthcare price transparency requirement. Files in this format are not easy to import or read into the computer system. Thus, NO PDF format which is the restriction according to this rule.

Care Quality Information and their Respective Fee

CMS cleared away any doubts related to the implementation of these rules. It doesn’t limit hospitals to post quality information or additional charges about price transparency data. The federal government is, in fact, stepping in to fill out any gaps. It encourages hospitals to adopt the patient-friendly communication model regarding hospital charges.

It will empower patients with the freedom of choice. They can estimate potential expenses against the medical treatments. It is like price estimation for the best HD TV available on the market. When we make the prices visible on the official website, it gives room to research well before rendering services.

Finally yet importantly, it is a milestone in the healthcare industry as the patients will be able to compare charges for the same procedure in different hospitals and facilities.

The Requirements of the Federal Government

CMS, like a responsible monitoring authority, briefed about the new rule according to federal authority requirements.

CMS stands shoulder to shoulder with the federal government in the price transparency initiatives. If the hospitals or practices join hands with the state on this initiative, they are still not exempt from fulfilling the requirements of the final rule of IPPS/ LTCH PPS. Thus, the hospitals need to follow each provision by the book without any weak links.

Although these changes are for the betterment of the healthcare industry, in the JAMA Internal Medicine study, we see that only 21% of the hospitals are capable enough to provide complete information on service expenditures.

If you are underprepared or have no clues to go about it, consult the highly trained and skillful HIT consultants at P3 Healthcare Solutions to improve your financial cycles.

Shaping the Healthcare Industry!

CMS busts the bubble of unnecessary worries caused by the new price transparency law. If you have any queries that you can’t find the answer to in the article, we hope you get in touch with us directly at 909-245-8350. We will set you in the right direction. The new rule enables medical practices to plan transparent and consistent ways of healthcare solutions.


The medical billing services operations in the USA have dramatically changed over time. The billing staff and the insurance companies wrestle with each other around payments of the physicians. Payment process has become complex with the never-ending workload on medical billing outsourcing companies. To make things worse, the rate of claim denials has jumped up along with the denial write-offs.

A study report reflects upon the years from 2011-2017. During these years the volume of denied claims increased by 79% for an average hospital. It means that there were fewer timely reimbursements that put financial pressures on healthcare professionals in general and not only the physicians.

The constant tug of war between hospitals and insurance setups for the rightful payments is not a good omen for the industry. Therefore, we have to do something to bring stability, reliability and keep the trust factor alive amongst the Americans for concerns with the US healthcare industry.

For starters, we need efficient AR management as an immediate solution to this problem. If we pursue better accounts receivable, the pressure on the revenue stream reduces automatically.

Poor Denial Management – A Major Cause of Failed Cash Recovery   

Generally, AR specialists within medical billing services manage accounts receivable (AR) to the best of their abilities. However, sometimes they don’t pay enough attention to the aged medical claims. According to an estimate, around 65% of the denied claims remain incorrect with mistakes and never see the light of an insurance company. That indicates how follow-up services have failed to deliver to the revenue cycle management process.

Over-aged medical claims typically of above 300 days are on their way to a write-off. It is one of the alarming reasons behind decreased reimbursement rates in the industry.

A Setback to Revenue Cycle Management

The decrement of profit margins, the increment of denial volume, and the restricted capacity of medical billing services do not add value to accounts receivable (AR).  Hospitals are to take direct steps towards minimizing these problems. Billing staff should be capable of professional follow-up services for those claims unattended for 90 days or more.

AR management instructs the whole team to re-analyze denied claims. However, claims which reach beyond AR-threshold age have to face write-offs.  A recent research study shows that 30% of the hospital facilities have accounts receivable of around $10 – $50 million. It is more surprising that 6% of physicians have pending payments of more than $50 million. Imagine the amount of money they can recover if denied claims go through resubmissions within the specified period.

There are many other reasons for the setback in physician revenue, however; not having proper follow-up services tops the list.

Gear Up to New Revenue Opportunities

Despite all the problems, it is a good sign that stakeholders of the industry have started to realize the problem. There is a gradual shift towards a better healthcare system by overcoming the AR issues. Billing companies acutely check the claims for errors and do rigorous follow up after old age claims.

Hospital staff, on the other hand, gets to focus on the patient and the procedures at hand. There is no need for them to worry about the creation, submission or resubmission of medical claims. They depend on medical billing outsourcing for the finances involved in their practice.

What Is Your Role As A Medical Billing Outsourcing Company?

A mature medical billing outsourcing company helps in a number of ways contributing positively to your goals as a healthcare professional. They not only increase your revenue as a whole but also decrease AR against your TIN. Furthermore, you are safe in terms of collections at the end of a proactive billing session.

Three Functions of a Billing Company

  • It establishes a systematic approach to AR management for 100% claim resolution.
  • It optimizes claim-processing methods to minimize errors
  • It evaluates performances to check the transparency of the revenue cycle

Those efforts if done sincerely increase cash flow, reduce bad debt reserves, and fewer claims end up on the write-off destination.

Pursuance of a Zero-Tolerance Strategy against Write off Claims

Medical billing services should fill the cracks leading to write-offs. There’s a need to follow-up claims after every 30 or 90 days as a company policy. Going forward, if nothing happens, they can launch their ‘final effort teams’ upfront for uncollected claims.

Through the final-effort payment collectors, hospitals make sure to collect payments and deal with unverified payments in accounts receivable.

Search for the Root Cause of Denied Claims

Hospital personnel don’t have the time to determine the underlying reasons for unpaid claims. Billing companies can use system automation to find those reasons. It can help segment the denied claims according to the type or size of the error. This way, the precautionary measure can lead up to higher claim acceptance rates in the future.

What about Pending Payments?

Achieving a reasonable rate of cash recovery serves to provide efficient revenue cycle management. By implying a strong accounts receivable strategy, hospitals can get their due amount on time without any write-offs.

If you face the same problem of not getting what you deserve for rendered services, consult a professional healthcare IT firm as early as possible. You may experience a positive increase in your payment structure, thus speeding up the revenue cycle.

Follow us on LinkedIn – https://www.linkedin.com/company/p3-healthcare-solutions/ for professional medical billing services, expand your opportunities with fewer write-offs, and add more juice to your payments.


The auspicious Thanksgiving Day is just around the corner. It is a day to celebrate the blessings, family union, and prosperity. The true meaning of Thanksgiving is when everybody sits around the table, eats, laughs and feels special around each other.

The Christian meaning of Thanksgiving amplifies when we come back home from far-flung places of work or study. The day brings joy, love, festivity, and a long weekend for kids and adults together. Thanksgiving facts for kids are that they get to enjoy food and the company of other kids. They run around the house with pets chasing them, embrace the warmth of the family members and experience blissful harmony.

When all of this is true, Thanksgiving also gives us some hidden messages on how to improve our lives in general. P3Care connects with the clinicians to improve their finances, but in this article, we try to uncover those hidden messages to gain more out of work than just the Benjamins.

1. Importance of Well-Being

It is not a hidden fact Thanksgiving brings people together under one roof and under one table. Who doesn’t know about the world-famous Thanksgiving Turkey meal, a must have on every dinner table. While sitting and eating together fills the air with the love, care, and respect for each other, we should not confine the spirit only to this day and try to stretch it over to the next Thanksgiving.

When we give ample time to our friends and family, we must have at least one dinner with our coworkers as well. They are an extended part of the family and give us the pleasure of celebrating our professional lives.

It fuels the passion that the work colleagues are not only committed to work but also to the well-being of each other. By doing this, it will open a new chapter in the lives of patients as well because it is going to generate positive vibes when hospital staff have each other’s back on important occasions.

2. Exchange Gifts and Strengthen Relationships

When we give gifts to each other, it develops a mutual feeling of love and trust. It can go a long way when we practice the same sense of gratitude with the patients and other hospital staff. It is not necessary that you have to give away expensive gifts. A gift can be as small as a keychain!

A present brings objectivity to something that is only emotional. It is an expression of your respect for another person. A smile or a simple gesture of a nod brings courage to the table and gives them the confidence they may be lacking in that very moment. It matters when you take a fellow nurse out on their birthday or anniversary.

The world recently went through a kindness day. It is time to expand our kindness circles one person at a time.

3. Cultivate a Sense of Gratitude

Being grateful for blessings instead of being thankless for the things we don’t have is the need of the hour. Moreover, Thanksgiving is a day to forget about worries, losses, anxieties and focus only on the positive things in our lives.

Gratitude attracts bigger opportunities. When we are thankful, we express satisfaction aloud which gives way to happiness and success to sneak in. Share the same feelings at your workplace. Be grateful for your life as it is going to bring more happy moments.

Healthcare needs you to be responsible and often short of time. Since lives are at stake, you are willing to give maximum time to it. On this day, you need to give yourself a pat on the back for your commitment to work and for caring for the people around you.

4. Don’t Compare Yourself with Your Peers

Thanksgiving is an occasion when everybody feels happy and proud of themselves. We don’t judge each other for having less or more. We just indulge in festivities and learn our way forward. It is best we don’t compare our lives with the lives of others.

Each one of us is as important as the person sitting next to us. We must respect our own unique identity and presence in this world. Everyone is valuable just the way they are.

In addition, just like we don’t take the family for granted, we should not take the coworkers for granted. To think of them as our extension is the way to go. The bond that develops afterward is going to be strong and irrevocable. Therefore, convert this day to something magical for the times to come.

The Lesson

All these tips are for anyone reading this article, but most importantly, it is for the people in the healthcare industry.

Big Sales Coming Your Way! Thanksgiving & Black Friday SALE!

Thanksgiving is not just about eating a Turkey but making the best use of Black Friday sales and going out on a shopping spree. Thanksgiving Day sales 2018 is a big event and most of us wait for it throughout the year. The Black Friday bells start ringing loudly the moment we talk about sales! It is a day on which you can shop expensive items at customer-friendly rates.

People get amazing discounts on household items, clothes, electronics and much more. Some of the popular shopping havens include Amazon Black Friday sales 2018, Macy’s Black Friday deals, JCPenney Black Friday sale, Staples Black Friday sale, Cyber Monday, Best Buy after Thanksgiving sale, Toys r us, Chevrolet, GMC, Buick, and Honda.

Attention Physicians! P3 Healthcare Solutions Has a Surprise for you!

When it is the month of generosity and open hearts, why would P3Care stay behind?

P3Care brings a 10% discount on MIPS/Meaningful Use final (pending) payments for the valued clients. All you have to do is pay by the end of November 2018 to avail this offer. Usually, the payments aren’t due until the first quarter of 2019. Come forward and talk to your healthcare IT consultant for an immediate reduction in those payments, no later than November 30th.

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Copyright by P3 Care Healthcare Solution 2018. All rights reserved.

Copyright by P3 Care Healthcare Solution 2018. All rights reserved.

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