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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 services, Professional healthcare, Healthcare professional, HIPAA, Healthcare services, Medical Billing Company

Telemedicine Emerges as Cure Outlet Amid the COVID-19 Outbreak

Got allergies? You can still see a healthcare professional if you are at home during the coronavirus outbreak.

U.S. health officials, clinics, hospitals, and insurance companies are insisting on people to try telemedicine for minor health problems such as ear infections, rashes, and earaches and skip the doctor’s office.

It is also a way to get screened for COVID-19 if you think you have the symptoms.

The Goal: Prevent it from spreading, especially to the elderly, the infants, and to those who are most vulnerable with existing health conditions.

Instead of waiting for the doctor for days, virtual care has long been a solution for the Americans; it is just that they have been slow at adopting it. Now is the time to embrace and make use of it in our best interest.

Let’s take a closer look at how Telemedicine functions.

What is Telemedicine?

Medical billing services, Professional healthcare, Healthcare professional, HIPAA, Healthcare services

Telemedicine is a means to connect with a healthcare professional via smartphone, tablet or computer. That is all you need to hop on this train. Sometimes, we use words like telehealth and virtual visits to describe it.

Ordinarily, it connects you with a provider like a doctor or a therapist remotely over a secure line. As a matter of fact, the patient makes use of an app to connect with them.

Sometimes telemedicine portals use a version that involves texts only for patients who may not speak or see each other.

Telemedicine often serves as a tool to diagnose and treat a new health problem, but it is also used to see a long-term diabetic or chronically ill patient. It is more than going for a prescription refill, although doctors can write prescriptions, if needed, after a virtual visit. That involves antibiotics, anti-allergies, or dietary supplements.

Where Can I Get Telemedicine?

Providers such as individual practices and hospitals are rich outlets of telemedicine. Providers are urging the patients to see them using telehealth channels during the outbreak. Search by calling your local hospital or simply put a query in Google to search for the best telehealth companies.

The federal government is committed to helping people with Medicare, i.e. citizens aged 65 and above as well as the younger slot who qualify due to disability through telemedicine. This trickles down to the state level where local governments are urged to expand telemedicine access to help people with Medicaid, i.e. people with low incomes.

Until now Medicare coverage of telemedicine was limited to rural areas where patients did not have care facilities like state-of-the-art hospitals and private clinics. Many Medicare Advantage plans also provide support for telemedicine. While the providers are busy treating the patients, telemedicine returns in the form of collections are good enough. Medical billing services play their part to full effect.

How Much Does It Cost?

Prices are variable. However, since the telemedicine initiative is being promoted, the prices are being waived off by many companies. It is to inspire them to use this outlet as their health companion.

It helps to check with your insurer or employer to see if it is part of your health plan. The plan may not offer specialty services like virtual therapy sessions or include only limited access.

For people without insurance, some telemedicine providers do give the option to pay out-of-pocket. The charges differ from provider to provider. Whichever company you choose, under the law of HIPAA, the texts of diagnosis and treatments are completely secure.

What Illnesses Can Be Sorted Out by Telehealth Services?

Some of the illnesses under telemedicine include sinus infections, seasonal flu, minor injuries, fevers, etc. Before you begin to doubt it, let me assure you that telemedicine saves you physical visits to the doctor’s office or pharmacy store.

Dermatologists can use it to treat moles and warts. Acne, pimples, blisters are additional examples for which they can offer their services. Moreover, therapists can be a source of calmness to patients suffering from anxiety, depression, and stress episodes during the pandemic.

Cyber consultation in case the patient has flu-like symptoms can be a relief. They have preprogrammed questions to gauge the health condition, and, immediately prescribe a remedy.

The Limits

With benefits come certain limitations.

A virtual doctor is unable to treat medical conditions in which the patient suffers from chest pains, fractures, or wounds in need of stitches. The virus test is also not available through this source.

Patients Need Time to Adapt

The association of gadgets such as your smartphone with healthcare has been there for a while but it is put to use with the spread of coronavirus nationwide. It will have lasting effects on the future of healthcare; patients who will get better will become its promoters.

If it doesn’t involve their regular doctor, they may be reluctant to try it all together. Additionally, awareness to make use of telemedicine in routine when the pandemic is over could send help where it is needed the most.

medical billing services, medical billing and coding, medical billing companies, healthcare services provider

How to Verify Healthcare Insurance via Medical Billing Services?

Undeniably, physicians need a stable revenue cycle. To achieve this complex goal, medical billing services work day and night to reimburse claims for them. It is their job and a way to give back. Eventually, efforts like these sum up to reflect better reimbursements and stability for a practice. If your practice’s focus is on developing a strategy for effective billing, the rest is easy.

Besides, it is crucial to verify the insurance eligibility of providers.

Medical billers have to find an answer to this question: Whether the patient’s health plan covers the treatment and the provider or not? Also, if the provider is out-of-network, it gives billing companies a chance to enroll them with the insurance company.

On the other hand, patients also have a responsibility to fulfill; they must keep their health plan updated. We are here to spread this sort of awareness, so they receive the healthcare they deserve.

The article discusses such a topic so the providers can get the most out of insurance companies maximizing their revenue. The RCM process is the backbone of practices!

Let’s not wait anymore and delve into how medical billing companies can verify insurance eligibility in 10 easy steps.

  1. Obtain Important Information from the Healthcare Provider

The process starts when the patient visits a medical practice. It is where the front-desk staff accurately records patient information. Such information includes:

  • Name of the patient
  • Date of birth
  • Social security number
  • Contact number
  • Information of insurance provider
  • Insurance ID & group number

Medical billing services have to find this information if healthcare providers don’t provide it, because, without it, it would be difficult to verify their insurance eligibility. Moreover, P3 Healthcare Solutions has a staff of billers and coders to expedite the process of verification.

  1. Ask for the Original Health Insurance Card from the Patients

Request the patient to provide the photo ID and make copies of the original health insurance card for the future.

  1. Contact the Respective Insurance Company

Make a call to the relevant insurance company or via electronic means, check if the insurance that patient claims, is valid.

  1. Research If the Insurance Benefits Remain Valid on the Date of Treatment

Verifying the patient’s health plan saves providers from unnecessary stress. In short, it is the additional job of medical billing services to verify and confirm a patient’s eligibility.

  1. Check for Insurance Benefits

By contacting the insurance company, medical billing services verify the benefits that a patient can avail and the copayment that they have to pay.

If there are charges that insurance doesn’t cover, make sure to inform the patient before the treatment, so that, they recognize their financial responsibility before time.

  1. Ensure You Are Included in the Patient’s Insurance Network

If the healthcare provider is not included in the patient’s insurance network, the insurance company may not reimburse completely to the doctor.

  1. Know About Deductibles

A deductible is an amount that the patient pays before the insurance company pays for them. There is a different amount for each insurance plan that a patient has to pay. In fact, medical billing companies need to ensure if the patient has paid the respective dues or not.

  1. Verify Copayments

Collect copayments from the patient, give them a slip, and share with them the treatment details. In this way, patients get to know their insurance benefits too.

  1. Be Efficient with Customer Support Services

Ordinarily, healthcare providers are busy people. It is not advisable for them to treat and charge patients at the same time. Therefore, medical billing services come to their rescue to deal with their payment matters. Besides, the front desk staff assists the patients for clarity in this regard.

  1. Verify If the Patient Has a Secondary Insurance

Often patients have secondary insurance. Only a certain amount of charges is covered by the primary plan. It is advisable to verify secondary insurance information too as described above.

Medical Billing Services for Small Practices

‘Medical billing near me’ is often the search phrase providers search in Google for the nearest billing services. However, it is not a matter of distance but experience. Whether you are a small practice or a big one, one cannot deny the value of experience. Moreover, if the company maintains quality staff; online and offline reputation; and, high first-time claims acceptance rates, practices are bound to flourish within no time.

As a matter of fact, they help physicians to join the insurance network and demonstrate efficiency. It is necessary to kickoff their revenue cycle.

Successful medical billing companies ensure practices that best suit the healthcare service provider and elevate his revenue cycle. Insurance verification serves the same purpose. If the insurance verification process is completed beforehand the treatment, patients know about their financial responsibilities, and the rate of accounts receivable (AR) is reduced.

What do you think of the whole insurance verification process?

In What Ways Medical Practices Can Take Risks to Increase Revenue

Everybody agrees that healthcare professionals, no matter in what capacity they serve, require every bit of applause. Working in hospitals is indeed a hectic job, and clinicians work tirelessly from day tonight.

When it became difficult for physicians to meet up with ever-changing scenarios, medical billing companies came to their rescue.

Now, insurance companies have strict rules and regulations, and physicians get reimbursements only when they meet the standards. Also, with the already complex U.S healthcare system and value-based incentive programs as MIPS, physicians tend to put greater efforts for their survival. It also put pressure on the medical billing services, as they could not afford to perform below average.

Besides, the focus on value-driven healthcare services has increased. Patients’ engagement level and integrated healthcare infrastructure have also gained more importance than before. Thus, medical practices ought to implement strategies that benefit them in the long run.

According to a survey report of Healthcare Financial Management Association (HFMA), more than 7 medical facilities in a group of 10, aim to take risk via

  • New commercial payers
  • Medicare advantages
  • Medicare contracts

One thing is interesting to note that many healthcare leaders support the idea of a revolutionary healthcare system that benefits both, patients and physicians.

Provider-Sponsored Healthcare Plans (PSHP) is gaining much attention even from medical billing companies as patients get insurance plan owned by a hospital or physician. 25% of the medical practices are already going to be part of the PSHP system, and 19% of hospitals want to launch their own healthcare insurance plan in the upcoming years.

Alongside this, Medicare and private payers are also increasing their range of insurance benefits.

What do Benefits Will Physicians get?

If medical practices take chances to go for new payment models, both payers and physicians will be equally benefitted. Physicians will be able to implement accurate value-based practices while being closely in touch with the payers. The communication gap will be reduced, and the medical billing companies will reduce the rate of denied medical claims.

The Use of Healthcare Technology

Use of Healthcare technology

By taking bold steps to increase reimbursements and efficiently run revenue cycle management, physicians will be able to use the latest healthcare technology successfully.

Hospitals will manage to spend efficiently upon the technological infrastructure to increase engagement between physicians, patients, and payers. Surprisingly, many physicians are ready to spend money on new technology avenues.

What are the hurdles that might come?

Even in 2019, there is not much demand for drastic risks in the healthcare industry. Although, many physicians like the idea to try something new. Still, they are comfortable with the Fee-for-Service (FFS) payment model.

What Should Physicians Do?

You can always take risks whenever you want.  On the contrary, you can also benefit yourself from the existing payment model and generate revenue by focusing on the betterment of the following parameters.

  • Engagement rate
  • Standardized clinical procedures
  • Cost-effectiveness

If you’re struggling in managing accounts receivable (AR), taking risks may seem like an appropriate option, but the transition process is also tiring. You can’t expect to achieve everything within a little time. The best approach is to keep improving healthcare strategies gradually and consult a professional medical billing company that creates medical claims with up-to-date knowledge. Like, P3 Healthcare Solutions- A professional medical billing company in Ontario, CA that has years of experience in the billing field and helps in generating revenue for its clients.

What are your thoughts? Let us know if you’re willing to take risks regarding revenue generation?

https://www.linkedin.com/company/p3-healthcare-solutions

4 Definitive Methods To Skyrocket Your Medical Practice

When we talk about regaining health, it is time to stay in that thought for a little longer and think about those who cure us – the healthcare professionals. We can’t leave them too far, behind when we know health is only a matter of time. Falling ill to a disease awaits us at the other end of the road we know as life.

Since medical professionals are the healers, the motivators, the role models, the mentors in some cases, and without them, the US healthcare system will come to a halt, we will find ways to uplift their practice.

If anyone deserves a reward, it is them. The system depends on them to survive and move forward. Whatever the case may be, when we get sick, we go straight to the hospital. If we decide to stay at home and do nothing about the situation at hand, we only make things worse.

It’s time to give something back to them which may benefit them in some way.

Revenue Cycle Management (RCM) is like the central nervous system of medical practice. If it flows flawlessly, it enables steady revenue and things are good. We will touch upon medical billing services, accounts receivables (AR Management), follow-up on the pending claims, patients engagement,  promoting interoperability (PI) and HIPAA compliance. All of these factors contribute to the success of the medical practice.

1. Outsource Medical Billing Services

It may come more as a reminder to you. By relieving the in-house staff of the medical billing process, providers are able to improve the cash flow. It allows them to care for visiting patients and listen to their problems attentively.

The nurses and clinical professionals are not there to figure out the next accounting glitch or remember thousands of medical codes. It is the job of the medical billing and coding professionals to do that for the practice.

P3Care is one of those positive startups which only recently came to the scene and made it big. To reach the top in only a few years pays heed to their hard work and willingness to excel.

To find and hold on to the right medical billing solutions is probably the best way to increase overall collections. When someone authentic comes on board, physicians are able to see the overlooked pile of accounts receivables and ample delay in claim submissions.

The first-time clearinghouse acceptance rate suddenly goes up in the mid-90s. No matter what you do, denials are still going to happen but what matters is the time you take to work the appeals and resubmit the claims.

2. Demonstrate HIPAA Compliance

It is necessary for medical professionals to show HIPAA compliance. Every individual or organization that interacts with Protected Health Information (PHI) is bound by law to implement measures for its safety, physically and virtually.

You must be aware of the minimum requirements of HIPAA as a covered entity and a business associate because they will keep you safe from penalties. When there are no extra fines, the practice becomes an automatic success with a smooth flow of revenue.

OCR penalties are happening and relate to the nature of HIPAA violations. Therefore, get rid of the non-compliance issues as early as possible to save your medical practice from a big financial & reputational loss. Patients are aware of their rights and if there is a breach in their electronic health records, they may just never see you again.

As a doctor and a hospital, HIPAA compliance brings in reputational advantages along with the trust of the patients.

3. Make the Practice Interoperable – Meaningful Use (MU) of EHRs

Meaningful use of EHR

The EHR incentive programs now turn into Promoting Interoperability (PI) programs. The name says it all for them. CMS changed its name to promote interoperability – The health information exchange (HIE) between providers and hospitals regardless of the variety of EHR systems.

PI becomes the new meaningful use of EHRs. All of this facilitates and spreads the data across networks so that it is available to the healthcare professionals on demand. If you use a CEHRT and you are on the list of providers signing the Trusted Exchange Framework and Common Agreement (TEFCA), it will take you a step ahead of others and the Department of Health and Human Services (HHS) may consider you as a compliant healthcare services provider.

It adds to your reputation and status as a medical practitioner. Patients vote in favor of those providers who follow the principles and regulations in order to improve the quality of care.

4. Focus on Increasing Patients’ Engagement

Another factor contributes greatly to efficient revenue cycle management and that is patients’ engagement. “Empowered Patients” is the motto of the modern healthcare system. Technology does not only make everyday life easy. It also supports the idea of easy accessibility and affordability of value-based healthcare to everyone.

If a medical practice incorporates technology to makes things convenient, there is nothing better than that.

For this:

  • Implement tech-integrated practical solutions to reduce the administrative burden
  • Make a user-friendly website to book online appointments
  • Offer friendly reminders to patients beforehand appointments

These small steps need a little investment in the start, but the outcomes are worth a try for increased revenue and a prominent reputation among competitors.

Final Thoughts

The above-mentioned techniques can push your practice to a new level that favors you and your patients. In addition, if you take these three steps, the federal authorities will be on your side. They will mention your name as someone showing compliance with the law on their social channels, web portals, and newsletters.

The methods are unique to what people usually expect to read under this topic. They bring in more patients as the ‘trust’ in the institution motivates them to do so. Apply them and become a successful value-based clinician.

Follow P3Care on LinkedIn – https://www.linkedin.com/company/p3-healthcare-solutions/ to stay updated with the US healthcare industry.

Introduction To The Physician Compare Initiative

Launched as a part of the Affordable Care Act (ACA) or the Obamacare Act of 2010, the physician compare initiative started out as a simple online searchable database of healthcare professionals eligible under Medicare.  Since its launch in 2011, the Physician Compare website has been regularly updated by the CMS’ Medicare department to enhance the information that helps patients make informed healthcare decisions.

The second purpose of the Physician Compare Initiative is to incentivize clinicians and clinician groups to improve their performance. MIPS 2017 performance information on the portal is in line with both the purposes. Patients can select Medicare physicians with higher ratings while clinicians receive payment adjustments based on their performances.

MIPS quality measures, Consumer Assessment for Healthcare Provider and Systems (CAHPS), Qualified Clinical Data Registry (QCDR) measures convert into scores and ratings for individuals and clinician groups. MIPS thrives in the present and before it enters into the year 2020, CMS has a proposal ready for the MIPS 2020 program.

Changes to Physician Compare Website

Presently, the Physician Compare website shows necessary physician and group association information like physician name, practice name, location, phone numbers, specialties, gender, medical certifications, affiliations, and languages spoken. However, so far the website is just that, it gives the necessary information. The website does say whether or not a physician participated in the outdated Physician Quality Reporting System (PQRS) program and the most recent information on the site is related to MIPS 2017. Doctors supporting the Million Hearts initiative by the Department of Health and Human Services (HHS) are also identified.

Portal for Patients and Clinicians

The physician compare initiative stands firm on grounds to improve the quality of care and reduce healthcare expenses. CMS has made it clear on numerous occasions that the Quality Payment Program is here to stay and works for the betterment of US healthcare. After 2017, we are going to have a MIPS 2018 showdown of scores and star ratings, and it is going to add a rich flavor to this program.

The portal displays provider scores in performance categories, i.e., Quality, Cost, Promoting Interoperability, and Improvement Activities. The data will be available in downloadable file format free for use by online directories and health information websites like Yelp, ZocDoc, Healthgrades, and Vitals, etc.

Reputation Impact of Physician Compare

What this means is that all those clinicians that have been reporting a minimal amount of data to avoid an MIPS penalty need to rethink their strategy. MIPS score is not only about receiving an incentive payment anymore. The doctor’s reputation is at stake here, not just dollars. Furthermore, individual physician star ratings will follow them if they change their organization. The MIPS score may directly impact their future career opportunities, clinician recruitment, potential mergers or acquisitions, insurance contracts and more.

Eligibility Criteria for Appearance on the Website

A physician or a provider group needs to have ratified Medicare PECOS information available. Furthermore, the clinicians should have submitted at least one value-based claim within the last 12 months. Groups must have at least two clinicians reallocating their benefits to the group as a whole.

What Sources of Data Will CMS Use?

Healthcare Technology and  CMS

CMS has been using multiple sources to update its website; these sources will be expanded in the future. The information displayed on the site may be derived from self-submitted data via claims, qualified clinical data registry, qualified registries, consumer assessment of healthcare providers and systems (CAHPS) and the provider enrollment, chain, and ownership system (PECOS). CMS also coordinates with national certifying boards to confirm board certifications. CMS determines which quality measures are statistically reliable enough to be displayed on the website.

Star Ratings for Easy Comparison

Beginning this year, performance on quality measures will be depicted by a one-to-five star rating system. Each star represents a 20 percent performance score on MIPS (i.e. 1 Star = 20%, 2 Stars = 40%, 3 Stars = 60%, 4 Stars = 80%, 5 Stars = 100%). These ratings are relative, that is, they depend on the performance of other eligible practitioners and groups under the program.

30-Day Preview for Checking Information & Correction

CMS has announced that it will provide a 30-day preview to the clinicians for review and correction before the measures and ratings are finally made public on the Physician Compare website. The physicians will be made aware through the MLN Connects weekly newsletter and various other platforms. If you discover any errors or omissions in the information, you can contact CMS for correction. You may need to submit proofs supporting your claim for your correction. Also, there is no formal appeals process thus ensuring correction within the 30 days preview period is highly critical. If you discover any errors during the preview period, you can report it to CMS via the contact information provided on the website.

How Can P3 Healthcare Solutions help?

Be patient, for instance, if you have switched a group practice or a hospital, or you upgraded your certifications, you need to update the information through PECOS. Corrections made in PECOS could take up to 4 months to be reflected in the website. Furthermore, healthcare providers will only learn about their MIPS score for the performance year 2018 by late 2019. That means when they learn about bad performance, the year after the bad performance will also almost be over. Thus they can start focusing on improvement only in the next year. It means that not only the incentive payments will continue to get hurt, the reputation impact will also continue until at least the end of 2020.

P3 Healthcare Solutions is a MIPS Registry for the second consecutive year in 2018. Our advanced analytical tools help you track your performance throughout the year and can give an estimated MIPS score to ensure that you are satisfied with your score before you submit your reports to CMS.

It is very vital to get an expert opinion about how to balance the costs associated with getting a high MIPS score and the potential negative impacts of a low MIPS score.  For any more questions related to this, or for instructions on how to get started call one of our MIPS medical billing service experts today at 1-844-557-3227 (1-844-55-P3CARE) or email at info@www.p3care.com.

OVERVIEW AND TIPS FOR PROVIDER CREDENTIALING PROCESS

Provider credentialing is critical for authenticating expertise, experience, willingness, and interest in providing medical care. If you are not able to follow the provider credentialing process, it can result in delay or worse, denial of the provider payment.

Provider Credentialing Process

It is not one of the formalities that you have to complete or a form that you need to fill. It is an ongoing process that involves a lot of complexities. Therefore, you need to closely follow all the requirements. There are many steps that you need to follow in order to qualify for credentialing. Also, it is essential for your business that you practice without any hindrances.

Besides the simplistic definition, it also involves submitting a lot of documents and forms to various third parties for verifying your practice. You do not need to follow the entire process each year. However, you must provide annual updates.

Some Tips to Keep in Mind When Credentialing

Here are some tips that you need to consider when going for provider credentialing.

Do Not Wait

You can mostly complete the process in three months’ time and take up to five months to complete the entire process. You can no more expedite and shorten the process but abide by the regulations and others’ timelines. The timelines of the payers may vary, so do not wait for initiating the application process.

Be Careful With Requirements

Most of the applicants lack critical data for processing the complete application. Here is what a Credentialing Manager has to say about the state of applicants’ affairs.

“85 percent of applications are missing critical information that is required for processing.” Missing, outdated, or incomplete information is most common in the following four areas:

  • Work history and current work status (include the physician’s effective date with your practice);
  • Malpractice insurance;
  • Hospital privileges and covering colleagues; and
  • Attestations.”

Furthermore, he also points to the fact that applicants can avoid delays by taking care of these small mistakes. Therefore, the applicants must try to get it right the first time.

Shopping infographics. Process chart, step diagram, template. Creative concept for infographics, presentation, project. Can be used for topics like shopping, marketing, research.

Stay Updated on CAQH

CAQH (Council for Affordable Quality Healthcare) has been running its program for the last 18 years. Most of the providers are already following this program. Therefore, the new as well as established physicians, who are adopting this program, have a lot of ease in credentialing and re-credentialing.

Give a Provider’s Start Date

Many healthcare providers remain reluctant when it comes to asking new physicians to submit requisite credentialing paperwork. The health service providers may think of short-term benefits. Therefore, they need to focus on complying with the requirements to avoid any delays or worse, denial of the payments. Furthermore, it is also better for new physicians since they can grow their practice a lot faster.

State Regulations Are Important

The reciprocity and other regulations differ from one state to another. If a physician is credentialed in one state, their credentialing can be updated in another state. However, if a physician moves from one practice to another, they do not require any update to the entire credentialing process. If a physician moves from one state to another and they are not sure about the details, they need to get in touch with their respective Medical Group Management Association. This information will help the physician use the state’s standards to your benefit.

Success Factors to Take Into Account

CAQH Universal Provider has the most comprehensive data source. It is also accepted across the United States as the most detailed credentialing database. By filling their form you will be able to find all the necessary details that you require. However, if you feel tempted to leave some of these fields blank, you are only increasing your chances of rejection. If you fail to realize that, it would be months before you are able to know about the rejection. Once you get the bad news, you would have to provide updates in a very short time. Therefore, it is better to complete the requirements of all the requisites. Do not rely on your memory for estimating dates or other vital clinical data to fill.

Be Careful About the Form Filling Process

Many still believe that it is OK to bill under some other physician’s name when you are waiting for the credentialing process to complete. If you tend to fall for this suggestion, you are subjecting yourself to potentially big legal problems. A lot of the contracts explicitly forbid the physicians to file under someone else’s name. Health providers must also keep a check on the total denials so that they can follow a careful course of action accordingly.

As credentialing and enrollment agents, P3 requires a copy of your National Provider Databank File and requests for credit report information. It is critical to the process of credentialing to run thorough criminal background checks in addition to the procedure of primary source verification. Despite discrepancies, P3 Healthcare Solutions, Ontario, CA assembles a comprehensive case to help you settle down in your new workplace.

News

Medicare Payment Increased for 3 Healthcare Providers Says CMS

CMS (The Centers for Medicare and Medicaid Services) decides to upgrade the Medicare payment adjustments for three types of physicians namely:

  • Hospices
  • Skilled nursing facilities
  • Inpatient psychiatric facilities

This step is great in order to reward the healthcare professionals in the respective facilities for their up-scaled services, especially during the pandemic.

How it will impact the Hospices?

Right from the year 2021, hospice payment rates will be raised by the market basket percentage of 2.4%. In numbers, this percentage is around $540 million.

Where CMS has shown support in the payment rate, they also demand quality reporting services. Hospices failed to meet the performance threshold will have to face a 2% decline in the annual payment market basket.

The system also has a statutory aggregate cap that puts a limit to payments made to the hospices.

The final cap amount for FY 2021 is $30,683.93 updated by 2.4% as per 2020.

How it will impact the Skilled Nursing Facilities?

The aggregate payments to skilled nursing facilities are going to increase by 2.2%, in 2021, which is $750 million.

These facilities are upgraded by the routine technical rate-setting updates in payments. The final rule also applies a 5% cap on the wage index, which is lower than in 2020. Hearing the concerns of the stakeholders, CMS also tweaked the ICD 10 code maps, which will be in effect from 2021.

The updated mapping address the care based patient characteristics under  Medicare Patient-Driven Payment Model.

However, the payments for skilled nursing facilities depend on the performance of a single claims-based, all-cause, all-condition hospital readmission measure.

How it will impact the Inpatient Psychiatric Facilities?

Inpatient psychiatric facilities will observe an increase in their payment rate by 2.2%, estimated to be $95 million in 2021.

Office of Management and Budget statistical area delineations will be revised to better estimate the cost born by the healthcare professional.

With this update, the following physicians will be able to practice within the scope determined by the state law.

Advanced practice providers including:

  • Physician assistants
  • Nurse practitioners
  • Psychologists
  • Clinical nurse specialists

They also have to record the progress of their patient along with the medical record.

Further efforts would be required to dissolve the inconsistencies that don’t align with the latest final rules changes and to loosen the regulatory conditions.

We hope CMS brings more innovations to reduce administrative burden and improve payment rates for all physicians.

For more updates, visit our page – https://www.p3care.com/blog

Medical billing services, healthcare system, healthcare practitioners, medical billing companies, healthcare professionals, Medicare and Medicaid Services

CMS Prioritizes Surveys Post Pandemic for the safety of patients

Every business came to a halt with the COVID-19 pandemic. Now, everything is settling back to normalcy, and CMS is getting back to business with its full strength.

They have officially asked state survey agencies to get on with the normal operations.

According to the CMS (The Centers for Medicare and Medicaid Services) memo, they will be inspecting and regulating quality and safety measures for patients of their authorized healthcare professionals, medical billing services, and other care suppliers. They are to resume their enforcement activities and other surveys in order to get an idea of their performance having patients being the priority.

How Is It Going to Work?

The last few months were hectic for the CMS. They were conducting surveys about the virus control and response in particular, virtually from all nursing homes in America.

However, now non-emergency onsite revisit surveys will be conducted. Compliant surveys and annual certification surveys will now be more focused upon, as soon the right resources are accessible to the team. The on-hold enforcement cases will also see the light of day and be resolved.

CMS also says that they will continue with the desk review policy to ensure that survey parties comply with the federal rules for an onsite survey.

Even during the catastrophic pandemic situation, CMS only focused on patients’ satisfaction.

“They have imposed more than $15 million in civil money penalties (CMPs) to more than 3,400 nursing homes during the public health emergency for non-compliance with infection control requirements and the failure to report coronavirus disease 2019 (COVID-19) data.” (Source: CMS)

Protect the Residents of Nursing Homes

The penalties were an extension to Trump’s vision of safeguarding the residents of nursing homes during the pandemic. However, CMS ensures some comfort as via relaxing the strict quality measures requirements based on the critical situation in any particular state.

Provider Surveys in Progress for a Stable Healthcare System

Given below is the list of types of surveys that would be in the top priority.

The idea is to give healthcare professionals and medical practices the ease to estimate their survey turn and plan accordingly.

The FY 2020 Mission & Priority Document highlighted how survey agencies should resume back to normal work.

  1. Initial surveys of new providers
  2. Special Purpose Renal Dialysis Facilities (SPRDFs)
  3. Past-due recertification surveys without a statutorily required survey interval
  4. Unfinished complaint surveys triaged as non-immediate Jeopardy level or higher
  5. Revisit surveys for past non-compliance that do not otherwise qualify for a desk review
  6. Past-due recertification surveys with a statutorily required survey interval (home health agencies and hospices must be surveyed every 36 months)

(Source: AAPC)

As medical billing companies and healthcare practitioners, we should be ready for audits and surveys, which will also help us to see where we stand in a progressive healthcare system.