Posts

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:

10 Steps of Medical Billing Services for Effective Revenue Cycle Management

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.

News

CMS, medical billing company, medical billing services, healthcare services, healthcare solutions

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?

healthcare industry, medical billing services, CMS announced, outsourcing medical billing, healthcare system, medical billing experts, medical billing outsourcing companies, medical billing companies

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.