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medical billing services, medical billing companies, medical billing company, outsourcing medical billing services, healthcare professional, healthcare services, healthcare industry, qualified medical billing, healthcare providers, medical billing service providers, credentialing services, expert medical billing

Medical Credentialing is a Process – A Physician’s Guide

Medical Credentialing strengthens the reputation of any healthcare professional! It is a process to verify that clinicians have undergone strict scrutiny and practice to acquire the skill of medicine to provide quality healthcare services to patients.

It is also helpful for medical billing services as they can get reimbursements on time without any complications.  The purpose of this process is not just to verify a physician’s degree but to ensure that patients only get services from professionals, whose qualification, license, training, and abilities are acceptable to practice.

Why Healthcare Industry Including the Medical Billing Companies Promotes Credentialing?

Quality of care has taken a central position in the healthcare industry; every stakeholder is adopting the latest methods and technologies to achieve this goal. Where technology incorporation is inevitable, the expertise of the medical staff is equally important in order to treat patients skillfully. It also increases the revenue of medical practice. Therefore, we cannot undermine the competence of the medical staff.

Moreover, now, hospitals have a penchant for credentialing through qualified medical billing services. Nowadays, every healthcare facility including ambulatory care centers, long-term care institutions, and even urgent care clinics don’t hesitate from credentialing.

Looking into the qualifications of the healthcare professionals creates a sense of trust between patients and healthcare providers, and medical practitioners and medical billing service providers. We have seen many cases in the past when false degree holders were caught treating patents. There is no place for such negligence in today’s world, especially after the pandemic.

This article will take you to the journey of how professional credentialing services are performed. No doubt, the criteria, and function of credentialing have gone complex over time. The provider’s scope of expertise, payers’ requirements and accrediting bodies have to blame for this.

However, an expert medical billing company can solve any issue coming its way.

Here is the detailed process of credentialing.

How Credentialing Functions?

Every medical practice should hire a dedicated team or outsourcing medical billing services to ensure that the system runs effectively and the healthcare staff is qualified to perform its duties in a safe environment.

After verifying the individuals’ credentials, the practice license also comes under scrutiny for maximum performance.

  • Verify the practitioners’ clinical degree, training, and performance
  • Verify if a healthcare professional meets the criteria for working in the hospital
  • Establish ground rules for denying verification of professionals after the pre-application process
  • Establish a process to allow the rejected healthcare worker to re-apply after the initial denial
  • Have a process for rapid credentialing of emergency staff and short-term employment staff
  • Limit those healthcare workers who do not follow guidelines or their standard of healthcare is unsatisfactory

Temporary Access to Professionals outside the Practice

In cases when an outside medical or surgical specialist has to offer advice or perform surgery, there should be laws to accommodate them by the medical billing services. In the time of emergency or natural disasters, respective rules should allow practitioners outside the practice to perform their duties.

A proper code of conduct should be in place for healthcare workers who corporate for credentialing plus for those who don’t.

Sometimes, physicians from outside America have to perform a complicated operation because of their different training. In such cases, shadowing or proctoring is required by the host medical practice, and bylaws should be there to smoothen the process.

Healthcare professionals working in any capacity should also understand that practicing medicine is sensitive and privilege and cannot be taken for granted.  Therefore, there is nothing better than accompany your degree with a credentialing process.

If you want to boost your revenue and reputation, contact P3Care for professional credentialing help!

Medical billing and coding, healthcare industry, medical billing companies, healthcare organization, revenue cycle management, healthcare professionals, HIPAA Compliant, medical billing outsourcing services, medical billing services, medical practice

How Accuracy of Medical Claims Could Save Your Revenue?

Medical billing and coding is an important step in the physician’s payment model. Depending on the compiled claims by the medical billing outsourcing services, insurance companies decide if the rendered services are valid and if physicians should be reimbursed. Therefore, the accuracy of the claims and medical billing services holds a crucial place in the healthcare industry.

Medical billing and coding, healthcare industry, medical billing companies, healthcare organization, revenue cycle management, healthcare professionals, HIPAA Compliant, medical billing outsourcing services, medical billing services, medical practice

Why do Experts Stress on Accuracy of Claims?

If physicians want to get reimbursed on time, the accuracy of the claims should be maintained. The wrong documentation or manipulation of data results in denied claims, even when the physician has provided the service to the patient.

Another issue is the under coding when physicians are not paid as much as the service cost because of coding errors.  Over coding can also dent the reputation of your healthcare organization. You can be charged with fraud and can bear financial and legal complications.

The survival of the medical practice can become difficult if medical billing companies don’t pay attention to the accuracy, resulting in revenue loss.

It’s also about the reputation of the medical billing companies, the high claim’s acceptance rate they have, the more revenue they generate, and the smoother revenue cycle management process becomes.

Medical billing and coding, healthcare industry, medical billing companies, healthcare organization, revenue cycle management, healthcare professionals, HIPAA Compliant, medical billing outsourcing services, medical billing services, medical practice

Is Medical Billing and Coding Complex?

Medical billing services are a serious profession. The sensitivity of this field can be analyzed by its impact on healthcare professionals. There are several code sets and monitoring authorities, from which billers and coders can take guidance. Anyone, who is responsible for creating claims, must know about the exact diagnostic procedures, surgeries, documentation of symptoms, age, gender, pre-existing conditions, and all. Not just the claims must be accurate but also the HIPAA-compliance needs to be there to ensure the confidentiality of the information.

Staying up to date with the latest knowledge and creating claims accordingly is the skill and handling the bulk of claims at the same time is tricky. It is also a fact that leaving medical billing and coding responsibilities to in-house staff can cause financial problems.

Check and Recheck

Before filing medical claims with insurance companies, it is wise to check and recheck since there is no room for mistakes. A slight error could easily result in denial; and, denied claims use up time to get reimbursed, eventually, leading to delayed collections. Hence, a practice needs trained people to work on their claims for a breezy cashflow. One of the ways to achieve that is to look for billing companies with EHR knowledge.

So, What Option is Left.

We suggest outsourcing to medical billing services is the best option for a seamless revenue cycle. They have dedicated staff to handle all the accounting information and tasks, which certainly, can’t be managed in-house when you have patients to take care of.

P3 Healthcare Solutions is a professional medical billing service that has years of experience in creating claims and helping hundreds of physicians in maximizing their revenue cycle. It is our way to share their administrative burden.

Visit our website for further details – https://www.p3care.com/

Medical billing, Medical billing company, healthcare system, healthcare services, Medical billing outsourcing

A healthcare System without Surprise Medical Bills is a Progressive System

Health is an important asset to human beings. Patients, physicians, medical billing companies, insurance companies, clearinghouses, all are connected in one way or another to offer quality services. Physicians are then reimbursed for their services and that’s how the process flows.

Patients are particularly free from the burden of paying for healthcare expenses by themselves when they get a healthcare plan. They just have to pay their premiums, and the rest is the work of medical billing outsourcing companies.

In recent times, the payment system in the US healthcare system has especially been under scrutiny to facilitate patients and clinicians alike.

Healthcare Costs Have Gone Up

Due to inflation and in the name of empowering patients, costs have gone up severely. Deductibles and copayments have increased, and patients can’t do anything about it as they have to maintain their monthly healthcare package in check.

Increasing expenses for care services have left patients financially vulnerable. According to an estimate, patients paid around 35% of the medical bill charges in 2019. Looking into it, this percentage is quite high as compared to the previous years.

The reason behind this is that patients have to endure surprise medical bills, and medical billing services were not to blame for this. Stats show that two-thirds of American adults, have savings less than $1000, and it is not enough to pay surprise bills sent by medical billing companies. Believe it or not, surprise medical bills are one of the causes of making families bankrupt.

All Stakeholders of Healthcare Industry will Suffer If Not Done Something to Resolve Surprise Medical Bills

A poll conducted by Kaiser Health Tracking in 2018 reflected that sixty-seven % of the Americans are somewhat worried about bearing unexpected healthcare costs for themselves or family members.

Another study showed that forty percent of the Americans who had insurance received surprise bills in 2019.

Forty-one of the Americans showed their concerns about how unexpected it was for them to see the bill going overboard.

The problem is huge. If patients are unable to pay for the rendered services, how will physicians survive? Medical billing services will not be able to get clear bills for physicians. The inability to pay bills and deductibles has increased seventeen percent from 2012 to 2016.

The US government has also noticed this issue, and there are multiple solutions into consideration.

What is the Solution?

Negative payment cycles can be reversed if taken proper actions against it.

One way to restrict the ever-increasing cost factor in the healthcare industry is to offer customized/personalized experience for patients.

The healthcare and billing process can be confusing for patients. A professional medical billing company on behalf of physicians should demonstrate each payment clearly to patients beforehand. From the appointment session to the final bill, every step should be clear to exclude the surprise element from bills.

The first strep of accurate billing services is to precisely estimate the cost of healthcare.

Medical billing outsourcing companies should break down each step for physicians to give them an idea of what patients can bear from their health plan and whatnot.

Listing payment options is also useful for patients when comes to out-of-pocket expenses.

Providers who work in efforts to improve the quality of healthcare and reduce surprise billing can enjoy a significant improvement in revenue cycle management. One can’t expect a sudden change in the healthcare industry, but a seamless billing process without surprise bills is only possible via offering tailored payment models based on the patient’s financial situation.

QPP MIPS, MIPS Quality measures, MIPS reporting services, healthcare industry

How Can Physicians Increase Patient Referrals?

Survival in the healthcare industry is getting tough day by day. The cost factor to provide value-based healthcare services is doing well in patients’ favor, but it’s also been a burden for physicians. While MIPS reporting services, MIPS Quality Measures are the parameters to show progress in terms of interoperability, cost, quality, and improvement activities.

Other than making efforts to earn incentives and bonuses and to remain protected from penalties, MIPS has been a great help. But, first physicians have to meet the criteria of checking 200 patients and bill more than $90,000 for Part B covered services.

Why Referrals are Important?

Referrals are an excellent way to keep up with the high number of patients. Word of mouth from fellow physicians and patients also helps to maintain goodwill in the industry.

It helps to grow the practice and improves the worth of your services rapidly.

How to Increase Referrals for your Practice?

Here are several suggestions upon which medical practitioners can thrive and get referrals without any problem.

  1. Connect with Fellow Physicians

Find those physicians in the industry with which you can build a give and take relationship.

For Instance, if you can refer a patient for any service to another physician, he should be able to do the same for you for your area of expertise.

  1. Increase Patient’s Engagement Level

Make processes easy and less hectic for patients. Such as a simple or automated way of patient scheduling system automatically improves patients’ engagement.

Another way is to send follow up messages to remind patients about their appointments.

These tactics can help to get referrals from patients.

  1. Have a Friendly Behavior at Work

When someone treats you with kindness, it leaves an impact on you. The same rule works for organic referrals. If a physician treats his patients with a smile, listens to them, and take time to make things easy for them, he is more likely to get referrals.

  1. Be Kind to the Staff Working for You

Nurses, physician assistants (PAs), and others spend a major deal of effort and time for the well-being of patients.

Spend time with them, and make small talk to release work stress. In this way, your behavior and kindness will reflect across the board. Not only it does improve your performance but also makes an ideal working environment.

Additionally, it helps to know your staff’s relationships with others in healthcare. Through them comes the goodness for a practice. In fact, physicians can definitely deduce better results from this strategy.

  1. Embrace Technological Innovations

Adopting technology gives points for Improvement Activities (IA) in QPP MIPS. This way you get the reputation of a progressive medical practice and achieve higher MIPS points for incentives.

Medical practitioners can use the following things:

  • Make their own app if possible
  • Create a user-friendly website for their services
  • Figure a way to make the appointment scheduling process easy and automated
  • Use technology to offer support to staff and patients alike
  1. Be Informative & Unique with your Website

The website is the first portal to reach patients. Patients search online about what services they want and what doctor they need.

If you have all the information on your website, it’s easy to get referrals from others against your user-friendliness.

  1. Make Referral Process Easy

Another way to increase patient referrals is by making the referral process easy and simple.

Follow-up services after or during the appointment, thus, play a crucial role. It helps you provide quality healthcare to patients, which you can use to submit MIPS quality measures.

Moreover, if the patient has any problem giving a referral, it is easier for them to seek help from you.

Medical practices can handover a referral form during the treatment, stating the demographics, reason for referral, and other important information. It is indeed an added step for front desk staff or medical billing services can help cater to this process. The response will be quicker. But, in the long run, it will value your referral sheet.

Given above are just a few ideas to improve physicians’ worth in the industry and getting referrals. More referrals mean more patients and ultimately reimbursements and incentives to straighten up revenue cycle management.

So, get started now.

One Day in the Life of a Medical Biller

Working in a medical billing company is not at all easy. Medical billing service providers go through a roller coaster of emotions every day. Gathering bulk of data from each clinician and carefully creating medical claims requires lots of effort.

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Let’s take you through the journey of how we manage to do it all, have a look!

When medical practices hire P3 Healthcare Solutions for a complete medical billing solution, we make sure to grasp on each detail that they offer to maximize revenue as per the demands.

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Medical billing and coding agents don’t really have much time to spend on other activities.  Whenever they’re spearing some moments with colleagues, an alarm clock inside their heads gets them back to work.

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One thing is certain; medical billers and coders are so used to tough times that nothing surprises them anymore. Not even denied medical claims.

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Insurance companies have strict rules; meeting their standards is almost like climbing up the K2 Mountain.

You guys can’t even imagine the feeling when medical billing services meet up their target and submit medical claims to the payers.

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The billers and coders usually go through a session of internal crying, upon receiving the news of the denied medical claim.

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After the tiring work hours, when we listen to the good news that insurance companies have agreed to pay the full reimbursement.

We go through a phase of shock, as getting money from a private payer is certainly not a piece of cake.

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And, then, we feel like clapping and dancing to our favorite beats.

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Insurance companies when to pay the required amount to clinicians, they, upon receiving the money become extremely excited.

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As a professional medical billing company, P3Care also get satisfaction by making our clients satisfied.

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Jokes aside, medical billing services work tirelessly; and, we find our happiness in serving the healthcare industry by sharing the burden of physicians.

5 Things Every Medical Billing Company in Ontario, CA Needs to Do!

If you own a medical practice or work in a hospital, you might have hired a medical billing company for claims submission. Whether you are a reliable medical billing company in Ontario, CA or not, the discussion today is important in the general sense.

If the respective medical billing service is an established one, there’s a 100% chance that it would have overcome all the loopholes in its medical billing process. If not, you should be a little careful while hiring medical billing services.

It is observed that up to 20% of medical claims are denied due to poor medical billing practices. As a medical billing company, you surely don’t want to have a bad reputation in the healthcare industry. So, given below are a few tips that you might want to follow. It will help you work better in favor of clinicians.

  1. Focus on Training Medical Billing Staff

If your medical billing agency recruits medical billers and coders, who have little or no experience in the respective field. You should immediately do something to train your staff because it might be causing major revenue loss for physicians.

Without proper knowledge, medical coders are unable to choose correct codes for the diagnosis. It is possible that they might be using the wrong modifiers for treatments.

Medical billing services should properly train employees as per the CMS guidelines to create and submit medical claims. So, there remains no chance of error.

  1. Tighten Up Your Follow –Up Services

Medical billing services need to interact with patients and physicians simultaneously while creating medical claims. It is a lot of work. Reporting accurate diagnostic and surgical procedures along with double-checking them takes a lot of time. Moreover, they also get faxes and emails every day in bulks.

When there is so much to do, things can pile up. However, despite a busy schedule, it is compulsory to keep a check on the submitted medical claims. Know about the claims’ status that either they are in process or have been denied. It has a crucial impact on revenue cycle management. Also, the follow-up services are time-specific, meaning, you can resubmit denied claims within a specified time. Otherwise, they get lost in the piles of papers.

Thus, professional medical billing companies never look down on the follow-up services.

  1. Keep Check on the Accounts Receivable (AR)

Some of you may not consider this point significant. But, it indeed plays an important part in the revenue generation.

Patients and even insurance companies generally don’t keep a check on the payments. However, medical billing companies should verify if a bill is fully paid or not. The unpaid reimbursements can take your revenue journey down.

If a bill is unpaid, you can always go for follow up services until accounts receivable are paid.

  1. The Filing Time Plays an Important Role in Revenue Generation

There’s a time limit for submitting claims to insurance companies. If a medical billing practice exceeds that time period, the claim will not add up in the revenue.

Even, you submit a claim within the time limit, there’s a chance that it might be rejected. Then, why take risk submitting it after time.

  1. Improve the Denial Management System

The percentage of denied medical claims is rising day by day due to strict rules of payers and governmental authorities.

Therefore, the medical billing and coding staff should be up-to-date with the latest news and criteria. Instead of ranting over denied claims, medical billing services should rectify errors and resubmit claims within time. An even better option is that the medical billing and coding process should be so transparent and precise to crash the chances of denied claims.

An experienced medical billing company straightens its billing process to maximize physicians’ revenue. P3 Healthcare Solutions is such a company that ensures high-quality medical billing for its clients.

Tell us if you think, above-mentioned tips can help a medical billing company generate more revenue at

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Attention! Medical Billing Companies are Charging More than Usual!

The Institute of Center for American Progress states that clinicians and insurance companies spend about $496 billion in the medical billing process. Either it is in the form of insurance or the cost incurred while hiring medical billing companies to create bills.

However, the alarming fact is that only about one-half of the huge money of administrative costs accounts for profitable billing. Moreover, medical practitioners and hospital staff also spend millions on providing value-driven healthcare.

Many times now, the debate is that the American healthcare industry is spending way too much on the administrative burden. Medical billing companies also suffer in this regard. They need to upgrade their systems to match the quality of administrative work.

What Should Be Done?

The high spending in healthcare with no particular outcomes has always been a concern. Thus, healthcare leaders have voiced the need for structural reforms in medical billing services.

Can We Expect to See Decrement in the Healthcare Expenditure?

As per the Recycle Intelligence, it is estimated by the governing authorities that if no major changes are done, healthcare expenditure will increase by 5.5% on annual basis with an increment of 19% in GDP.

America spends double the money on healthcare as compared to other nations, and still, it is not among the top healthcare systems of the world. Provided these facts, you can get an idea of where healthcare will be going in the coming future.

Reasons for High Expenditure on Medical Billing Companies

As mentioned above, the major reason to blame is the administrative cost. It has also influenced the physicians’ performance as they are forced to spend half of their precious time in counting numbers rather than doing their actual work. Thus, when they spend so much time on medical claims that may result in denial, how can they improve revenue cycle management?

In addition, the little revenue they generate is not solely spent on them. But, a significant portion has to be added in the accounts of medical billing services.

Different Billing Rates for Different Medical Procedures

Another reason that researchers found out is that different types of healthcare visits cost differently. For Instance, a study report of an academic health system highlights the following data set for medical billing.

  • The primary healthcare visit costs about $20.49.
  • Inpatient stay costs about $124.26.
  • Emergency department visit costs about $61.54.

Based on these facts and the revenue associated with each type of visit, emergency department visit accounts for the highest billing cost, up to 25.2% of revenue.

On the contrary, inpatient stay cost the lowest as associated with the patient’s stay in the hospital.

Time Spent on Billing Services is Huge

With administrative cost, comes increased time consumption while processing medical claims. On average, medical billing companies spend 13 minutes for primary care visits, 32 minutes for emergency department visits, and 73 minutes for a general inpatient stay.

The more time, medical billing services spend on analyzing medical claims, the more they charge physicians for their time.

Healthcare Industry Needs to Take Serious Actions!

Simple healthcare systems that have an easy reimbursement system can be a guiding light for the U.S healthcare industry.

Healthcare leaders propose that a single-payer healthcare system is a way forward towards the progressive route. However, only reducing the administrative burden will not generate favorable results for revenue cycle management.

Healthcare quality should be the focus along with setting forth reasonable rates for the medical procedures. Moreover, the centralized processing of medical claims can also reduce healthcare expenditure.

Comment if you believe these reforms will somehow show a positive influence on the US healthcare system, or, do you think the opposite?

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4 Reasons to Outsource Credentialing by a Medical Billing Company

Medical billing companies save revenue cycle management for clinicians. Without the assistance of medical billing services, we doubt the efficient running of medical practice.

The Healthcare industry is quite sensitive and responsible. Physicians are supposed to practice their skills for the ideal health status of individuals. Especially in the on-going approach of the value-based healthcare system, physicians need to modernize their treatment methods now more than ever. Hereby, medical billing companies create medical bills and handle the billing tasks to get the reimbursements. Consequently, physicians can pay attention to their actual work.

However, in addition to the billing process, a professional medical billing company also offers credentialing services for clinicians, which is a vital part of revenue generation.

What is Credentialing?

It is a process, in which hospitals, insurance companies, or healthcare authorities verify and legitimize the educational background, expertise, and qualification of a clinician. Generally, this process takes place before including a physician in the working network.

Why is Credentialing Important?

When physicians are credentialed, they get timely and rightful reimbursements from the insurance companies.

Medical credentialing is not an easy process and requires extensive focus from the start of the process to the end.

No Immature can look into clinicians’ past and derive professional outcomes. The credentialing process is legal and can result in penalties if done unethically. Hence, this responsibility should only be given to medical billing companies.

What are the Challenges that Occur During This Process?

Credentialing Takes Time

Medical billing companies and healthcare industry

Checking one’s background is a complex process. Therefore, it requires at least 60-90 days to fully credential a clinician.

Medical billing services when enlisting a physician for credentialing, are required to complete the whole process before he takes up a new patient. There is no room for error as the process involves the verification of sensitive fields such as employment history, education, medical training, licenses, and more.

Peers Don’t Cooperate

It is obvious that physicians are always tight on their schedule. Hence, there is little possibility that peers, who can give a vote of confidence for the physician will be able to respond to inquiries on time.

To avoid this delay in the credentialing process, physicians can inform their peers prior to the process. Moreover, they can also set a time to complete this task.

No Access to the Latest Information

Physicians need to have access to up-to-date information. However, medical practitioners are so busy in their lives that they remain oblivious of the latest information. For Example,

Clinicians working in the ambulatory surgical centers (ASCs) have to reevaluate their credentials after 1-3 years. When different clinicians have a different schedule for credentialing, it becomes hard for ASCs to manage all.

Thus, no access to the information at the right time creates issues for the credentialing service providers and the confirming authorities.

Inability to be Compliant with Value-Based Healthcare

Different states have different healthcare plans and so physicians are supposed to stay true to all the state exchange and federal healthcare plans.

Another challenge that a credentialing medical billing company faces is that physicians have to treat a reasonable number of patients to handle revenue cycle management. Moreover, medical practices should implement the right healthcare strategies. Otherwise, they’ll not be able to get reimbursements for the rendered services.

Considering the difficulty, medical practitioners choose to outsource for credentialing services. There is no way that unprofessional individuals should not take responsibility for this task. After all, physicians’ revenue generation is based upon it. Thus, only, a medical billing company as P3 Healthcare Solutions can outrun all the above-mentioned challenges for credentialing and insurance enrollment and offer an efficient solution.

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Healthcare industry, medical billing company, medical billing services, healthcare system, healthcare service providers, QPP MIPS, revenue cycle management, medical practice

Providers’ Guide to Best Practices for Revenue Cycle Management

Healthcare industry doesn’t only have hospitals and large medical practices. There are some medical practices that function in only one specific medical area and consult medical billing companies for reimbursements.

P3 healthcare solutions being a medical billing company has years of experience in medical billing services. We have come across many independent or stand-alone medical practices and well-established hospitals.

How Independent Healthcare Providers Are Coping Up With Changes?

One thing we understood in all these years is that the norms of the modern healthcare industry are changing. The focus has shifted to a value-based healthcare system instead of volume-based care services.

It also leads to structural changes in the progressive healthcare industry. According to the American Medical Association (AMA), physicians having independent clinics cover less than half of the total US doctors’ population. However, this trend of owning personal medical practice was high back in the 1990s.

Reason for Reduced Rate of Independent Healthcare Practices

The declining practice of independent healthcare providers owes to many reasons.

Some observers of the healthcare industry state that independent healthcare providers are forced to join larger healthcare systems as the earned revenue is not sufficient for survival.

Why medical billing companies Can’t Support independent healthcare providers?

Independent healthcare providers don’t meet up with their cost expenditure due to inflation and price surge. The increased administrative burden of MIPS QPP increased the price of surgical hospital admissions, emergency room visits, and drugs, which has caused major problems for independent healthcare providers.

Thus, in recent years, due to low reimbursements, around 22% of the independent clinicians reduced their office support.

Impact of Low Reimbursement Rate

Low reimbursement rate from insurance companies has also damaged this industry. Even hospitals and large medical practices are not safe from the changes in the healthcare industry.

The healthcare providers when unable to cover expenses within earned money, get in-touch with huge healthcare networks. Thus, the amalgamation of large and small healthcare practices has led to low competition in the healthcare industry.

In addition, often patients don’t pay deductibles or the extra amount other than their insurance benefits to independent medical practitioners. This way, independent healthcare providers never really compete with bigger healthcare organizations.

Reservations of Solo-Medical Practitioners

One concern that the solo-healthcare services show is about the unreasonable reimbursement standards of insurance companies. Big healthcare organizations can better negotiate their demands with the increased volume of patients, which is a profit source for insurance companies.

All these issues make it impossible for small independent healthcare providers to stay in the industry. QPP MIPS has also fueled the declining trend of independent health services. Patients want access to top-quality healthcare, which a separate-working medical provider may not be able to provide. Consequently, the doctor doesn’t find a large share of incentives and bonuses.

To keep an independent medical practice, most solo-physicians function as a group outside the hospital circle. It has also helped medical billing companies to get high reimbursement for them as well as offered shared administrative responsibilities and resources over the network.

This might be the only surviving option left for independent healthcare service providers.

As large medical practices are dominating the healthcare industry, it is evident that revenue cycle management has not remained easy for solo-practitioners. However, with little adaption to change and a professional medical billing company, independent healthcare service providers can work their way up the success ladder.

Medical billing services, revenue cycle management, medical billers and coders, healthcare industry, medical billing companies, Denied Claims management, healthcare provider, medical billing company

3 Tricks by Medical Billing Services to Avoid Claim Denials

Medical billing services constantly fight with the monster of denied medical claims. Denied claims top the list of factors that restrain efficient revenue cycle management. These have been a constant threat making the efforts of medical billers and coders to go in vain.

The claim rate has cost millions of dollars to the healthcare industry. Insurance companies reject hundreds of claims each year over minor issues. Not just big established medical billing companies do this mistake, but small practices also have a huge share in it.

Having said that, denied medical claims can be recovered with little care and organized follow-up services.

How to Accelerate RCM?

Hospitals and medical billing services can manage to increase revenue by eliminating all the reasons that cause denied claims.

Medical billing companies appeal for the denied claims, but it requires a lot of time and investment. It can also lag behind the rate of creating new medical claims.

How can medical billing services manage Denied Claims?

A simple solution is to recognize areas that are causing denied medical claims. Medical billing services can never optimize revenue cycle management unless they rectify those problems.

Given below are three easy ways to avoid denied medical claims.

Verify Insurance Benefits

One of the major reasons for denied medical claims is the problems in the patient’s benefits. Moreover, there are also some other reasons such as, deductibles, copayments, and secondary insurances that shake up the claim’s status.

To avoid all these issues, medical billing services need to verify the patients’ demographics along with the credentialing status of the physician. Also, checking all the information given by the insurance panel is mandatory.

Verify If Healthcare Provider is among the Insurance Network

Sometimes, the healthcare providers’ are not in the network of the insurance company. It can be a problem causing revenue leakage.

In addition, clinicians don’t know about the variance of the reimbursement rates in the insurance plan. There can be many factors that affect the variance.

For Example,

  • Location of the healthcare provider
  • Number of medical claims
  • Medical expertise

Medical billing services should check the insurance payers’ contract with the physician. These contracts specify under what rules and guidelines, the insurance company will pay. Coverage policies, referrals, pre-authorizations are also included in the contract, clearly stating the benefit plans to the patients.

The insurance payers’ contracts are legal documents but are negotiable. For maximizing the revenue cycle management, healthcare providers should efficiently explain their expertise to the insurance companies.

Keep Track of Accounts Receivable

A healthcare facility can’t run smoothly when they have pending accounts receivable. Keep track of the claims if they are paid or not. Follow-up services play a crucial role in revenue cycle management.

If a claim is not being paid within 60 days, medical billing services should directly get in touch with the insurance company. It helps in determining the status of the processed claim, or the claim will end up as a denied claim. Moreover, it also helps in reducing the rate of wear-out medical claims.

If the claim has been paid, record its date, if rejected, go for the appeal process.

The responsibility of medical billing services is huge. Denied medical claims disturb revenue management of not only physicians but also the medical billing companies. To decline the rate of medical claims denial, above-mentioned tricks reduce administrative errors. Consequently, investments and efforts are not wasted unnecessarily.

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Updates in Stark Law: What It Means for QPP MIPS?

CMS (Centers for Medicare and Medicaid Services) has revamped the Stark Law for healthcare service providers.

The upgraded law will have an impact on the volume and quality of healthcare services. Especially, QPP MIPS eligible clinicians can take notes and design strategies to improve patient satisfaction.

For those of you, who do not know about the Stark Law, here is its definition!

What is Stark Law?

This law prohibits physicians from self-referral, particularly in a situation, when a physician has a financial relationship with a patient and refers to another entity for the provision of designated health services (DHS).

The new laws will also influence the QPP MIPS quality score via a transparent referral process. Without a doubt, it is a great step towards an altogether progressive healthcare system.

Proposed Changes

  • CMS proposed changes that allow exceptions for/among certain physicians.
  • The final proposed rule also applies exceptions in some cases when a physician receives reimbursement for items or services from another clinician.
  • CMS also proposed flexibilities for the funds or donations extended to the cybersecurity technology and services.
  • Moreover, the existing exceptions for the EHR (Electronic Healthcare Records) data, products, and services are also modified.
  • The update in the Stark Law is expected to be effective from next year January 19, 2021.

The Stark Law, since its provision in 1989 was the same, and there were no updates since then. CMS says that these modifications are significant and will change the referral scenario in the healthcare industry.

Conclusion

The new changes strive to encourage clinicians to adopt quality-based healthcare practices as specified by the QPP MIPS without fearing Stark Law violations.

The exceptions are introduced to facilitate the reimbursement process and to improve coordination among different stakeholders in a legitimate manner.

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CMS Plans to Expand RSNAT All Across America

CMS (The Center for Medicare & Medicaid Services) works for quality care and optimized performance in the healthcare industry. The healthcare industry leaders are focusing on every aspect and taking measures step-by-step to simplify operations.

Apart from announcing advancements in medical billing services and other healthcare operations, they also consider aspects of non-emergent care.

Recently, CMS announced to expand Medicare Prior Authorization Model for Repetitive, Scheduled Non-Emergent Ambulance Transport (RSNAT) across all America.

According to CMS, before the expansion process, RSNAT Prior Authorization Model will test the need for prior authorization of services.

What will be the outcome if outsourcing medical billing services seek approval before the service is rendered or before they send the due claim to the payer? Will it save cash for Medicare while trying to achieve quality healthcare for repetitive, scheduled non-emergency ambulance transportation?

Let’s find out.

CMS implemented this model in several states of America

An Overview

Such as New Jersey, Pennsylvania, South Carolina, North Carolina, Virginia, West Virginia, Maryland, Delaware, and the District of Columbia during different years to test out its implications.

The results were quite astonishing and encouraging to say the least. The quality of care and easy access to essential services were maintained as expected. Statistics show that Medicare Prior Authorization Model for Repetitive, Scheduled Non-Emergent Ambulance Transport saved around $650 million over four years.

The Need to Implement a New Model

Medical billing services used to face problems related to improper/inconsistent Medicare payments for non-emergent ambulance transports. There was a much-needed room for a new payment model that promotes cost efficiency and counters risks related to payments.

And, CMS wants to ensure proactive measures that minimize fraudulent activities.

Is the New Model Successful?

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The first evaluation report of this program came under analysis in 2018 and based on that, CMS is hopeful to expand it nationwide to curb down Medicare Spending. The recently released second evaluation report also highlighted that the use of RSNAT is reduced by 63% and its respective spending is reduced by 72% overall. (The report results were concerning the end-stage renal disease and/or severe pressure ulcers during the first four years of the model.) However, it supported the previous assumption that it is safe to implement this program everywhere. There was also no evidence against this system that reflected poor healthcare quality.

CMS has made clear that across the board accountability, lesser loopholes for frauds, simplified solutions, and expanses in check will make a progressive healthcare system. Moreover, with the new plan, medical billing services, physicians, and patients, all will be benefitted in one way or another.

CMS administrator, Seema Verma says that although medical billing experts complain about the complexity of prior authorization. But, with a proper plan of action and accurate deployment of the model, Medicare can ensure that its requirements are met even before the start of the service.

One more advantage of this system is that billing experts on behalf of physicians don’t have to indulge in extra administrative work afterward.

Henceforth, the program will continue to run in the currents states although they were expected to end this year. But, the success of the new model of non-emergency ambulance transportation changed the whole view.

CMS will release new guidelines regarding the expansion in every state. The model will remain the same as the existing model.

It is expected that medical billing outsourcing companies will find this new model accommodating with respect to maintaining cost.

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An Insight into QPP MIPS Payment Adjustments in 2020

CMS states that up to ninety-eight percent of the eligible clinicians are expected to receive positive payments in 2020 for the year MIPS 2018. The rate is five percent higher than the previous year.

In the upcoming year, the trend of incentives and reimbursements is going to increase as the quality reporting is supposed to improve via MIPS Value Pathways (MVPs). MVPs will be operational from next year.

MVPs – A Chance to Succeed for Everyone

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In order to translate practice’s expertise in the true sense, we must adopt MVPs. Small medical practices and medical facilities in rural areas irrespective of their operational size can earn rewards for their rendered services. Seeing the numerous benefits of the MIPS program, rural medical facilities are participating more and more each year.  Statistics show that there was a rise of four percent in QPP MIPS participation from 2017 to 2018.

The Report Card for MIPS 2018

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CMS has published the results for MIPS 2018 participation. 889,995 eligible clinicians have reportedly received positive payment adjustment, and 872,148 of them have received neutral payment adjustment.

Seema Verma, CMS administrator is quite happy with the results as it depicts the higher number of physicians opting for quality healthcare delivery systems. The quality outcomes also credit the vision of empowered and cost-effective healthcare industry.

Despite the administrative burden, more and more participants succeed in the QPP MIPS. It is due to the lower performance thresholds, which ultimately reflect on payment adjustment. Moreover, CMS doesn’t want to jump up the positive payment adjustment, as it has to be balanced with the negative payment adjustments.

MIPS Future Holds Higher-Performance Thresholds

CMS has planned to make higher thresholds for exceptional performance to reduce the reward distribution. They are working on a strategy to reward physicians who continuously invest in the quality of healthcare and interoperability, and help patients in many manners. This can be seen in the gradual increase in the performance bar for penalties and bonuses.

Seema Verma also hints on supporting clinicians via reducing the burden and providing opportunities for meaningful services. The No-cost Small, Underserved and Rural Support initiative tends to lend a hand with technical assistance for smooth and optimized performance in the healthcare sector.

This program also creates awareness about the quality care and payment model along with helping eligible clinicians with participation in MIPS.

With the research and taking into account what physicians bring to the table, the future reporting criteria is estimated to only include a framework that flows without stressing physicians unnecessarily.

CMS also wants participants’ feedback on the MVPs’ developments. They are looking forward to advancements that help them drive value to the healthcare industry in terms of payment models, lower administrative burden, and cost-effective patient outcomes.

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CMS announces QPP MIPS reporting Relaxations for 2020

The last few months have been tough for the healthcare industry. All stakeholders were trying desperately to assist each other and save resources for COVID-19 response.  Of course, meanwhile, CMS also took necessary measures to unburden some of the clinicians’ load.

Where physicians have already burned out with COVID -19 cases, the administrative burden of QPP MIPS 2020 was additional pressure. The dynamics have changed. The contact points that were easily accessible before are now operational via online mediums.

Thus, eligible clinicians and MIPS Qualified Registries can take benefit from it and serve effortlessly to the patients.

At first, CMS requested clinicians to impede elective medical procedures. In simple terms, it means to delay diagnostic procedures or treatments that don’t qualify for emergency conditions.

However, the process of offering flexibilities continues for the QPP MIPS. At first, CMS asked healthcare professionals to delay elective medical procedures and treatments, but with things starting to get back to normal, the Trump administration reopens all medical practices.

Telehealth was another option that was promoted to continue the services along with COVID response. QPP MIPS 2020 is also going to reward physicians who adopted telehealth and practiced it to accommodate patients from every corner. It not only accounts for improvement activities but for promoting interoperability.  It is a great opportunity for scoring high and target incentives.

The following are the relaxation areas that MIPS eligible clinicians can enjoy.

Relaxations for the QPP MIPS 2020

CMS states that the eligible clinicians who are significantly impacted by the public health emergency can apply for Extreme and Uncontrollable Circumstances to reweight any of the four or all MIPS performance categories.

However, they are required to submit a solid explanation for the impact on their medical practice.

A COVID-19 clinical Improvement Activity under MIPS is also introduced by the CMS.  Eligible clinicians can obtain outcomes via:

  • Participating in a COVID-19 clinical trial Improvement Activity and submit data into a data platform
  • Participating in the healthcare of COVID-19 infectees and submit patients’ data to Clinical Data Registry for research

As physicians are busy battling against coronavirus pandemic, CMS has decided to not use data reflecting from January 1st to June 30th, 2020 for the Medicare Quality Reporting and value-based purchased programs. These measures are taken to give advantage to eligible physicians to some extent as to minimize the administrative burden incurred during data collection and management. A lot of time and investment can be saved, henceforth.

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Guide to the Latest Medical Billing Codes for COVID-19 Test

The constant threat of coronavirus has led the panel of AMA – The American Medical Association to introduce CPT (Current Procedural Terminology) codes for medical billing services.

As the number of infected cases in the USA increased, the need for a separate code for COVID-19 testing emerged. The president of AMA, Patrice A. Harris, MD, MA, announced a unique code to report for laboratory testing of the coronavirus. This information was released on March 13, 2020, in order to translate the advantages of tracking, allocating, and optimizing resources.

What’s New for Medical Billing Services Regarding Corona Test Coding?

The coronavirus code belongs to a new category I of CPT codes.  The details are as follows.

  1. 87635 infectious agent detection by nucleic acid (DNA or RNA)
  2. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), for the examination technique

The codes are now available to use to report on behalf of physicians by the medical billing companies. This code also has short and medium descriptors, which can be accessed on the official AMA website – https://www.ama-assn.org/practice-management/cpt/cpt-releases-new-coronavirus-covid-19-code-description-testing

Coronavirus around the Globe

The situation of the novel coronavirus is serious. President Trump has declared a national emergency in the USA, and the only way to stay safe is by maintaining the social distance.

The Healthcare industry, in almost every country, is under pressure to combat the seriousness of coronavirus pandemic. The number one step for managing this catastrophe is by dealing with hundreds and even thousands of diagnostics procedures, and this code will help deal with the billing matters.

Rick A. Bright, Ph.D., director of Biomedical Advanced Research and Development Authority (BARDA) at HHS stressed the need of increasing the capacity of testing kits to identify and separate infected individuals as early as possible.

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There have been delays reported in terms of accessing the diagnostic procedures of COVID-19. The delays and shortage in facilities may affect the frontline fighters (physicians), and ultimately potential patients.

According to AMA, the newly released code is a progressive step towards optimal coronavirus diagnostic services. All along, the physician or medical billing company is required to use the Healthcare Common Procedure Coding System (HCPCS) codes to document public encounters with the health payment programs as Medicare.

The Centers for Medicare and Medicaid Services (CMS) also stated to create two new HCPCS codes to support the coronavirus diagnostic procedure.

The first code released in February (U0001) is for SARS-CoV-2 diagnostic tests performed specifically for CDC testing laboratories.

The second billing code (U0002) released this month will extend medical billing services for coronavirus lab tests, allowing to bill for non-CDC laboratory tests for SARS-CoV-2/2019-nCoV, (novel coronavirus or COVID-19).

QPP MIPS requests everyone to stay strong and be mindful of others around you. Spend this difficult time to connect with yourself and be creative while staying home.  You never know who carries the virus therefore, use hand sanitizers, clean your space, wear gloves, and face mask before going out and keep a safe distance from everyone.

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Jackie Chan: 1 Million Yuan for Whoever Finds the Cure

Famous movie star Jackie Chan who needs no introduction has promised an amount of 1 million yuan for developing a vaccine for coronavirus. Since the virus is still very much around, especially around the city of Wuhan, it is a call to researchers, inventors, scientists, pharmacists, chemists, and biologists to come up with a remedy. A miracle vaccine!

Somehow finding its way to the Chinese population, the virus has taken hundreds of lives in a matter of days. Unable to find a solution until now, it has spread like wildfire in over 25 countries. According to the veteran actor, he feels for his fellow men and women and anyone who has succumbed to the deadly coronavirus.

No less than a million yuan is quite an incentive for the thinking brains out there to work their magic and invent an antidote. It is not about the money for Jackie Chan or the people he is calling on for a solution.

We are confident that it will happen anytime soon because that is what we want. Not only does human suffering is painful to see but it puts the responsibility on us to unite on this very cause. The cause is to find relief against coronavirus once and for all.

Jackie Chan’s stance

“Science and technology are key to overcoming the virus, and I believe many people have the same thought like me and hope that an antidote can be developed as soon as possible”, the actor declared.

He continued, “I have a ‘naive’ idea now. No matter which individual or organization develops the antidote, I want to thank them with 1 million yuan”.

He stressed the fact that he doesn’t want people to suffer from the virus when they should be enjoying life. And it is not about the money but the people.

Back at home during the medical masks and protective gear emergency, the actor was among the people who donated generously. It goes to show this guy is exactly how he looks like; a person with a heart of gold.

Kicks and nunchakus for coronavirus

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World Health Organization (WHO) has declared it a global health emergency. Whether coronavirus likes it or not, it has to face the likes of Jackie Chan and the world of martial arts knows that if he sets his mind to something, he is unstoppable. Get ready to face round-house kicks because the attack mode is on which will not stop until it is defeated.

Background

The origin of this virus is still unknown; however, the Chinese city of Wuhan, located in the province of Hubei is under attack since December 2019. The area has been discussed so many times in the past that most of us have memorized it by now. However, it is of utmost concern to come up with a remedy.

All the efforts are being done to create a vaccine that neutralizes it in the system of an infected person. Most probably, the ideas will form into a permanent solution any day now.

Peace to the world

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As of now, 780 people have died of this virus in China and a large number of people (over 37,000) are infected from it both in and out of the country. God bless the people as we hope to God to shower His peace and blessings from eternal heavens and wipe this menace of the face of the earth.

Conclusion

P3Care medical billing service supports any research efforts being done around the world against coronavirus. We may fail once; we may fail twice, but if we continue to look for a vaccine, ultimately, we will have one. The healthcare industry in the US is as concerned as anyone else. US government organizations such as the CDC have reassured the Chinese government that they are always ready to help.