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Medical billing services, medical billing companies, outsourcing medical billing, revenue cycle management, US healthcare industry, healthcare providers, accurate medical billing, healthcare services

4 Powerful Ways to Improve Medical Billing Services

Medical billing services are a vital player in the US healthcare industry. Without them, physicians would have to face dire consequences in the revenue cycle. However, when the focus is upon refining the quality of care, the healthcare providers demand the same quality criteria for medical billing companies as well.

Outsourcing medical billing is a way for dedicated billers to take control, but it also supports the whole revenue cycle management process. When we talk about taking the healthcare industry ahead, medical billing companies must equally go through the process of screening according to set standards. It will benefit physicians and patients alike.

Two physicians from Johns Hopkins University researched in this sector and concluded the following arguments.

Let’s find out!

Medical Billing Services Should Be Transparent

Medical claims should clearly state the codes to get an estimate of the total bill without difficulty. Not only physicians but also the patients can read the claims. They must have the facility to check if the rendered services are accurate and billed correctly.

Firstly, it empowers patients and then the doctors, making them independent financially. Secondly, it checks costs as they turn out to be accurate for patients, useful to both doctors and patients. Ultimately, it leads to increased transparency in the billing procedure.

Opt for Price Transparency 

Another suggestion by physicians is to make prices public for patients. Although some medical practices in the US offer this facility to patients, it is still not the norm everywhere. The vast majority haven’t made them public yet.

Allowing patients to view prices of diagnostic and surgical procedures is to offer them price transparency. Moreover, patients would know their out-of-pocket expenses beforehand, and physicians would know their bills.

To know more about quality medical billing services, this might be a good read:

What Steps Can be Helpful for Tracking and Maintaining Quality for Medical Billing Services?

Involve Patients in the Billing Process

In order to improve medical billing services, it was suggested to encourage patients to speak with the concerned person in case of any ambiguity in the bill.

With this facility, bills would often be correct, on time, and accuracy would increase while preventing errors resulting in reduced denials. Moreover, patients would get more involved in the billing process, and their input can be utilized to compile cleaner claims.

Don’t Burden Patients Unnecessarily

Looking into the payment system, patients have to pay higher than the insurance plan devises for them. This approach is actually unfair in terms of the transparent flow of money. Furthermore, medical billing services should consider complications that may occur while the patients receive care.

The idea is to offer value-driven healthcare services to the patient alongside an optimized healthcare expense.

The financial aspect is crucial for the healthcare industry. The focus has to be only on the quality of services, but also on optimization and transparency of prices. It is observed in a survey that a large population of patients thinks of delaying healthcare services due to concerns in medical bills.

Thus, CMS and other governing bodies have to empower patients in the billing process for better outcomes. Let’s do that right away.

MIPS 2020, MIPS Qualified Registries, MIPS consulting service, MIPS eligible clinicians, MIPS performance, final MIPS score, Electronic Healthcare records, Professional MIPS Reporting, MIPS Consultants, MIPS data submission, how to submit mips data, healthcare services

Why Your Medical Practice Needs a MIPS Qualified Registry?

The stressful time of the year for MIPS eligible clinicians has arrived.  We are going towards the end of the performance year MIPS 2020. It is the time when MIPS Qualified Registries help you check all boxes of reporting requirements.

They not only simplify the reporting process but also optimize your performance and help you stay ahead in the game with useful tools and strategies. Of course, the merits of submitting data via a MIPS Qualified Registry knows no bound.

Given below are some of the reasons why should your medical practice choose to consult a MIPS consulting service.

Merits of Consulting a Professional Qualified Registry

All-in-One MIPS Services

MIPS Qualified Registry submits data for all MIPS performance categories via an efficient and optimized system.

  • Quality
  • Promoting Interoperability (PI)
  • Improvement Activities (IA)

With a state-of-the-art infrastructure to manage data in one place, it is easier to estimate the final MIPS score. Moreover, the process goes smoothly, and reporting objectives are easily achieved. Moreover, professional companies also estimate the cost incurred in quality healthcare services. So, you can make better strategies to counter issues.

Specialty-Specific Quality Measures are Easy to Choose

Do you know that eligible clinicians were allowed to report only fifty measures via EHR (Electronic Healthcare records) in 2019? Whereas, with a MIPS Qualified Registry, there were 232 quality measures to choose from.

With professional help, clinicians can choose from a wide list of measures and report data for MIPS 2020 as per the specialty expertise. For Instance, at P3Care, we ensure each client reports data for higher points and not just for the sake of it.

  • The list of quality measures are fully researched and analyzed
  • The team segments measures that strictly relate to the practice
  • MIPS Consultants discuss the prospect of each measure and prepare data as per the CMS’s standards

Professional MIPS Reporting

MIPS Qualified Registries have the experience and clientele to report QPP MIPS appropriately. Their clientele ranges from clinics, hospitals, and medical billing companies, small and large groups. They know how to present data that translate efforts to CMS for maximum score and help stay away from penalty as per the requirement.

An Electronic Management System

Smart electronic management systems at MIPS Qualified Registries help eligible clinicians to plan, analyze, and discuss plans with the consultants. You can easily keep a check on the MIPS performance and suggest changes that you want.

Estimate Financial Estimations

If you are working on your own, you cannot estimate the financial implications of your MIPS data appropriately. However, with professional help, you can easily do the entire Math to avoid any surprise element in the end.

For penalty estimation, incentive calculation, and other estimations, P3Care is there for you.

MIPS Reporting Support 24/7

A professional MIPS Qualified Registry guides you at each start from the beginning to the end. Whether you have any questions or need assistance in solving any matter, the team is there at your service.

You can also seek our help for any MIPS related question, contact P3Care at https://www.p3care.com/ | 1-844-557-3227.

Timely MIPS Data Reporting

When MIPS Qualified Registries compile all data, they allow medical practices to review data to the fullest. Once you are satisfied, the process goes further. They ensure every performance data is in order and then submit data on time.

We know submitting data to CMS is complex. Therefore, a MIPS Qualified Registry is the perfect option to ease this process. If you have any concerns related to a smart reporting strategy, effective tools, and an efficient team, we are here to answer your queries.

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 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.

HIPAA medical billing, HIPAA medical billing and coding, healthcare services, healthcare system, outsource HIPAA medical compliance, Protected Health Information, PHI, billing companies, Medical Billing and Coding Companies, HIPAA violation, HIPAA compliance, HIPAA rules and regulations, HIPAA compliant medical billing, medical billing services, medical billing companies

HIPAA Medical Billing Is More Important Than You Think

If you belong to the healthcare industry in any capacity be it as a physician, nurse, surgeon, pharmacist, or health IT specialist, you would know the importance of privacy protection and confidentiality obligations.

HIPAA medical billing needs no introduction. The practice of HIPAA medical billing and coding has proved only to be fruitful for a progressive healthcare system in the USA.

Therefore, taking casual measures to ensure data protection and using ordinary software to store data is now just not enough.

Private Data is at Risk!

We say that healthcare services have progressed and we have gone automated, but so have data hackers.

Medical Billing and Coding Companies need to upgrade their systems and take standardized measures.

Lots of sensitive data is transferred from physicians to insurance companies to patients.

As billing companies are directly responsible for data handling, they are held accountable for any mishap.

Why HIPAA Compliance Is Important?

Because the expense for data breaches go far beyond fines and penalties.

No matter what the reason may be for healthcare organizations to outsource HIPAA medical compliance. We should keep in mind the following perspectives.

HIPAA Medical Billing Is Compulsory for Healthcare Organizations

According to the HIPAA Omnibus Final Rule, medical billing companies would be penalized for risking Protected Health Information (PHI). Any violations will not be entertained at any cost, and the company responsible for even minor negligence will have to bear heavy fines. Of course, it would also dent a company’s reputation leading to low revenue.

Data Security Threat Has Not Remained To Just Data Manipulation/Stealing

Not long ago, accidental exposure of sensitive data was considered a HIPAA violation. It means a situation in which you have to bear the financial loss.

However, the modern definition states that even unauthorized access to data is a threat to HIPAA compliance.

The following factors build the base for the damage of HIPAA violation.

  • The scope and type of healthcare data compromised
  • Characteristics of the party or person that accessed the data or violated the HIPAA rules
  • The measures, taken to avoid vulnerable areas to protect PHI

A medical billing company can only be successful by following the HIPAA rules and regulations. The best approach is to include clauses in the BAA – Business Associate Agreement.

Moreover, the Office of Civil Rights (OCR) also allows a bit of relaxation in HIPAA regulations to promote the trend of HIPAA compliance.

Things to Remember

To safeguard the interests of HIPAA compliant medical billing, it is important to not over-commit responsibilities to clients. The things, which, medical billing services are unable to commit can be strictly stated to the physicians.

Here’s a List of Things Medical Billing Should Perform

  • Perform thorough risk assessment
  • Design and implement a full-proof security plan
  • Secure Privacy policy
  • Dedicate trained resources for operations

The accuracy of billing procedure is the second priority; the first remains the infrastructure that supports the cause of HIPAA compliance. Thus, meeting security parameters and confidentiality clause is the only way forward for medical billing companies.

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

Forget In-House Medical Billing, Hire Medical Billing Company!

Hiring a medical billing company is a great decision. After all, physicians hand over all of the precious data to another company, and their reimbursements are based upon the performance of the medical billing service.

Particularly, this decision is very hard for small medical practices. They don’t have extravagant budgets to spend on medical billing. Efficient revenue cycle management remains their main objective. Moreover, their operations revolve around doing more with less.

Doing medical billing and taking care of patients simultaneously don’t do good for physicians. They often fall short in their efforts and don’t get reimbursements on time, making their survival even more difficult in the complex U.S healthcare system.

However, consulting a professional medical billing company as P3 Healthcare Solutions helps in saving lots of bucks while managing medical claims with accuracy and precision.

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

Why Medical Practices Hire Medical Billing Companies?

If you’re confused while making the right decision for your practice, have a look into the following advantages. It may make up your mind in favor of hiring a medical billing service provider.

The Medical Billing Process Becomes Streamlined

A medical billing service makes sure that physicians get notified of all the accounts receivable (AR) and the received payments from both ends, that are, from patients and insurance companies.

Medical practices don’t have to dedicate resources, who spend hours keeping track of payment posting for each patient. Hence, when they hire a medical billing company, they get a complete report at the end of a specified time and can plan revenue strategies for the future.

Medical Billing Company has an Integrated Practice Management System

With the advancement in the healthcare sector and the focus on value-driven medical services, the medical billing system has also become advanced. Now, insurance companies don’t receive papers, but they receive claims electronically via practice management software. In addition to the introduction of electronic healthcare records (EHRs) in the healthcare system, data collection has become secure but complex.

The integration of practice management with electronic healthcare records is important. Otherwise, you won’t be able to create and submit medical claims in an organized manner.

Now, do you think that it is possible for medical organizations to have a fully integrated system? No. It requires separate dedicated staff to handle all of the systems, which means more cost expenditure. However, medical billing services have experienced team of medical billers and coders on hand with an integrated practice management system.

Accurate Medical Claim Submission

The Healthcare industry undergoes several changes each year. The changes may be regulatory or by the federal or state government. Nevertheless, keeping up with the industry norms and changes is indeed a tiresome task, which only a medical billing service can do efficiently.

Professional services have time and resources to make sure that medical claims are created with up-to-date knowledge and in accordance with the rules and regulations. Thus, by hiring medical billing services, physicians’ time is saved.

Increased Return over Investment (ROI)

Medical billing services submit medical claims according to the guidelines of the insurance companies. They have the time, resources, and expertise to process medical claims professionally. They don’t only submit claims but keep track of the claims with the denial management system and follow-up services.

Healthcare organizations that want to improve their medical billing reporting method should definitely hire medical billing services. After all, physician’s work is to take care of the patients rather than scratching their heads over medical codes and bills.

Thus, the best option left for physicians is to consult a medical billing company and improve their revenue cycle management.

3 Types Of Payment Models, Physicians Probably Don’t Know!

Value-based healthcare services have not only changed the patients’ healthcare standards but also the physicians’ payment model. Value-based reimbursement models encourage clinicians to adopt methods that make healthcare easy and efficient. Programs like MIPS & MACRA and more depict a value-based care system and allow physicians to achieve rewards and bonuses. The purpose is value-based reimbursement models are too.

  • Straighten up physicians’ revenue cycle management
  • Make patients empower the healthcare system where they choose their desired service

We have heard many of the benefits and the need for value-based healthcare models, but the proper information about the available models is not very common. Let’s review that.

What are the Available Value-Based Care Models?

There are a few types of value-based payment models with a variety of risks attached and the benefits.

1. Accountable Care Organizations (ACO)

It is a system of hospitals, clinicians, and other healthcare providers to provide organized and high-quality services to Medicare beneficiaries. It was started to help patients receive up-to-the-mark services at the most appropriate time. It means that in case of emergencies or other scenarios, patients don’t have to wait to get to the relevant doctor.

This organization ensures that patient only bears expenses for those services that are absolutely necessary to treat an illness. Redundant medical services are reduced by eliminating medical errors that occur while diagnosis or treatment.

Healthcare providers volunteer in this program to get shared savings if the ACO fulfills the standardized healthcare criteria with reduced expenditure.

Risk Factor Involved in ACO

It is not like ACO volunteers always end up adding a bonus to their revenue cycle, but the financial risk is also involved. When able to meet the requirement, physicians have a jackpot, but on the other side, they also have to bear shared losses if any.

For shared loss, healthcare providers have to pay Medicare as compensation for not delivering value-based care to patients.

This value-based reimbursement model is not just about value-based medical procedures but also supports volume-based services. However, the evaluation is based on quality, safety, and experience.

2. Bundled Payment for Rendered Services

This payment model pays physicians not for each service but as a whole series of services. Clinicians receive collective reimbursement for treating a medical condition, including all the charges for physicians and the types of rendered procedures.

For Instance,

If a patient undergoes a surgical procedure, CMS (The Centers for Medicare and Medicaid Services) sets a collective payment for surgeons, an anesthesiologist. It then pays a total amount rather than paying separately to each clinician.

Risks Attached with Bundled Payment Model

A certain level of risk is also involved with this type of payment model same as the ACO. Physicians get to full their pockets when they collectively reduce the incurred cost. Otherwise, they get will have to bear the loss.

Thus, this practice requires standardized procedures so that, all stakeholders get the rightful reimbursements.

3. Patient-Centered Medical Homes (PCMH)

It represents the healthcare payment model in which a primary care physician coordinates the patients’ healthcare. This payment model manages and handles all the needs of the patient in a centralized setting.

It’s certification highlights that the physicians are capable of providing healthcare in a patient-centered setting with team-based methods. Moreover, it also ensures consistent care quality for patients.

Patients are allowed to develop a one-to-one relationship with their physicians, and it governs the medical and environmental factors.

This payment system has shown great potential in reducing the unnecessary cost expenditure. According to a Maryland – based PCMH, via the efficient practice of this reimbursement model, they were able to save up to $98 million and enhance their quality standards by 10%.

Alternative payment methods other than the fee-per-service are not very popular practices. However, physicians are unable to meet their financial requirements. Thus, they are devising ways to incorporate new technologies into their system to speed up the workflow.

Like our LinkedIn page for more information. https://www.linkedin.com/company/p3-healthcare-solutions

The Popular FAQs About MIPS – Explained!

Providing value-based healthcare services to patients and having a penalty-less spot in MIPS 2018 requires great effort. However, if strategize properly, physicians can get incentives and bonuses from this program.

Knowing the MIPS program better and accordingly report MIPS quality measures to increase your chances of payment rate from CMS. Therefore, it is always the best to resolve any misconception that might disturb later.

Given below are some of the important FAQs about MIPS that might answer your MIPS queries.

Is saving from penalties in MIPS is not enough?

2018 was the second operational year of MIPS and the minimum threshold for penalties was 15%. This bar is expected to rise in the coming years with strict reporting criteria.

70 MIPS points are the threshold set to get incentives. However, when achieved score higher than that, physicians can qualify for the bonus pool of $500 million. Physicians’ score is displayed on website www.medicare.gov/physiciancompare. The high scorer physicians get an extreme reputation and well-renowned authorities like Medicare, AARP, and CMS endorse them as a brand in the healthcare industry.

Thus, targeting incentives rather than just aiming for a penalty-less spot can open success gateways.

If physicians are still eligible for MIPS, when not using EHR technology?

If you don’t use the 2014 version of EHR technology, physicians may not be able to earn points for Advancing Care Information (ACI), now known as Promoting Interoperability (PI). For maximizing your score, physicians can earn from MIPS quality measures of Quality and Improvement Activities (IA).

Does reporting data for more than 90 days increase the chances of getting a higher MIPS score?

Physicians can choose to report clinical data for 90 days or more for up to 12 months. However, your result is solely based on the performance you showed throughout the performance year.

Thus, choose a report for the period that best suits your requirements and helps to increase the score.

What is the best practice, reporting as a group or an individual clinician?

Both practices benefit clinicians in their own manner so before deciding the best approach, consider the following points.

  • While reporting data to CMS in a group, all physicians will have the same payment rate. However, as an individual clinician, you’ll get your own payment rate. You have to decide which practice will benefit from more revenue generation.
  • Moreover, if any physician has a low-volume threshold, he will not be considered as an individual but as a member of the group.
  • In a multi-specialty group, some providers may find measures that are suitable for their practice, and conversely, they may not be suitable for others’ practice. In such cases, you have to choose measures that suit the single specialty of medical practice.

Is there any exclusion for MIPS?

YES! Physicians are only excluded from the participation of MIPS when,

Medicare allowable is less than $30,000 or less than 100 Medicare patients in 12 months

The healthcare service provider is already a participant of Medicare Advanced APM

Hospital-based healthcare providers are exempted from ACI (MU) category. For them, 25% weight of this category is reassigned to Quality category making its worth to 85% in the final MIPS scorecard

What happens when a physician moves to another medical practice in the payment year?

MIPS score moves with the physician. Even, if you have moved to a new working place, your score will be based on the data reported in the last year, no matter what the medical practice is.

When you work in two different medical practices in the same year, your payment rate under the new TIN (Tax Identification Number) will base on the higher score among both.

What factors should be in mind while selecting MIPS Quality Measures?

MIPS Quality measure and MIPS registry

Choosing the right MIPS measures, according to your practice is a difficult task so research properly about the following points.

There are 250 quality measures and 5 MIPS submission methods and some quality measures are only available for specific reporting methods, so how will you collect data and report to CMS?

Never report for a measure that has less than 20 eligible cases or no benchmark will receive 3 points.

Each reporting method has its own benchmark; thus, determine score by using the correct benchmark. For Example,

The same measure may have less benchmark when reported via a qualified registry as compared to EHR technology.

The above-mentioned points are the most frequently asked questions (FAQs). This article is all about clarifying those misconceptions, which may confuse physicians and block their way of success.

For detailed information about MIPS and its reporting services, visit our LinkedIn page https://www.linkedin.com/company/p3-healthcare-solutions

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.

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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

tPA drug, COVID-19, anti-clotting drug, COVID-19 Treatment, Health IT Industry, healthcare services, COVID-19 pandemic

There Might be a Breakthrough for COVID-19 Respiratory Failure Cure

COVID-19 has struck everything. From people to the economy, everything is suffering, and the death toll is increasing day by day. While some countries have managed to restrict the risk like China, some are still struggling.

The symptoms of this infection are cough, flu, fever, and fatal respiratory issues. Although, this virus is serious but not every COVID positive person ends up in the hospital, generally, the intense or worse cases require hospitalization. As a result of acute respiratory distress syndrome (ARDS), which is a severe lung injury, these patients seek serious medical assistance.

A concrete cure for ARDS is still not found. Physicians treat the bearer of this disease with mechanical ventilation and supportive care.

What Health IT Industry is doing for COVID-19 Treatment?

A team of physician-scientists is conducting research and testing out the anti-clotting drug for serious COVID infectees with ARDS. After several tests and trials, the scientists have concluded that a drug called tPA has the potential to reduce the death rate among ARDS infectees.

Researchers say that this drug can be life-changing. It can reduce recovery time and with a faster recovery time of patients, there can be more ventilators available.

A Little History

The US Food and Drug Administration in 1996 approved tPA to be used for patients experiencing a heart attack, stroke, and pulmonary embolism.

Therefore, for two decades, researchers have found anti-clotting drugs useful against ADRS diseases.

FDA really didn’t give thumbs up to this method. However, for ARDS induced COVID patients, this drug might work.

How An Anti-Clotting Drug is Expected to Help COVID?

There is major clotting around IV lines in many COVID patients. Researchers are hopeful that tPA drug can show fruitful results in severe patients or at least tell if the assumption is true.

This clinical trial committee is now enrolling patients.

Later on, they will record biomarkers, such as, the medical conditions of each patient to identify under which conditions tPA gives the most advantage. The drug is already approved on a large scale to treat heart patients and people with strokes as an off-label medicine.

The COVID Effect on American Hospitalization Capability

This pandemic is not over. We don’t have any effective treatment for it at the moment, and the number of COVID-19 infected persons is only going to rise.

When the lockdown will lift up, chances are the pandemic situation will get worse. According to a study, many more Americans are expected to use ventilation services in the upcoming months. Looking into statistics, America has currently 200,000 ventilators.

With collective efforts, hopefully, we’ll be able to generate an effective strategy to deal and restrict COVID -19.

Before the pressure of pandemic saturates our healthcare services, it is important to consider the existing therapies and procedures that may help us to accommodate the surge of patients in the future. These procedures/therapies must be widely available so that they serve the purpose of easily accessible healthcare to COVID.