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Medical Billing Outsourcing, Medical Billing Services, Revenue Cycle Management, RCM

Apply These 5 Secret Techniques to Improve Revenue Cycle Management

Practices receive payments for rendered services after weeks, and sometimes it takes months for them to get paid. It is not a deal between patients and doctors, but there is a third player involved – payer (the one who pays). The word P3 stands for Patients, Providers, and Payers, the three main players and ‘Care’ join them in a meaningful way turning it into P3Care.

The healthcare system in the US is complex. Consequently, medical claims have to pass through insurance companies to convert into hard cash, in other words, collections.

Before getting paid in full, the provider spends effort in sending the remaining bills to the patients. It is critical to the life of practices to stay profitable and meet their monthly expenses. Medical billing services such as P3Care amplify the RCM process for doctors across the country.

  1. Bring medical billing services on board

Due to the disconnect between payments and physicians, going for medical billing outsourcing makes sense. A medical billing company becomes responsible for all their finances and the whole RCM process. Most physicians complain of the slow payment process from patients with High Deductible Health Plans (HDHPs).

To keep it simple and to the point, health IT firms like P3Care work on behalf of providers to get them what they deserve promptly. We believe an efficient billing company is central to the financial freedom of clinicians, for them to have a strong association with their patients, which is the most vital element in healthcare.

  1. Effective financial policymaking

For a patient, to get well is everything. However, before they get well, it is important to understand the cost of care. A financial policy means your practice receives payment before treating the patient. Except for a clinical emergency, if they are unable to pay, reschedule their appointments to another day. Lobbies and waiting areas should have this policy stated on their walls for public awareness. And, if you have a website or social media channels for that practice, pin it to the top of the page. Get the patients to sign it, so their acknowledgment comes in writing.

  1. Spread the word categorically

When someone calls for an appointment, inform them of your financial policy, i.e., collect payments before checking the patient. The automated message that goes out to different patients should include the recorded statement of your financial policy when new patients call in or sending out appointment reminders.

Keep the policy in the loop of communication whether it is at the front desk in the form of a hard copy, through email, or the messenger so there are no surprises.

  1. Calculate upfront costs before checking in

Some tools help practices calculate out-of-pocket costs for the care delivered. They collect data from payer contracts, physician and facility charges, and patient’s health information to calculate upfront costs accurately. We recommend the use of such tools for the sake of financial security. Build self-check-in kiosks in one corner of the waiting area to speed up the care process. They also have an option to accept payments.

Not only do such tools add to the patient experience because of their quick check-ins, but their application speeds up the payment process.

  1. Train front desk staff in insurance programs

When front desk staff is trained in applying for Medicaid and other patient assistance programs, it is an additional skill they can use to motivate the patients. Train staff in scenario-based scripts in which they are face-to-face with a real-time situation before it happens for copayments, cost-sharing charts, and outstanding balances.

Regardless of what the US healthcare seems like, the cost of care is inevitable. Whether we can afford it or not, physicians have the right to earn what they just delivered. P3 healthcare providers to be paid faster and to have a running revenue cycle management process. For that, we prepare claims according to ICD-10 and CPT coding guidelines by CMS and AMA, respectively as early as the patient leaves the doctor’s office.

How Does A Medical Billing Service Benefit the Physicians?

Most practitioners are well aware of the advantages of outsourcing a medical billing company. However, some of those merits are of continuous vitality and worth a discussion.

Medical billing services to physicians matters when they suffer at the hands of EHRs! American doctors need a break and nothing better than a medical billing specialist to take you out of the financial mess.

Essentially, they reduce costs, increase collections, keep up with the coding updates, ICD-10 guidelines and are on the lookout for new codes. We will go on with their advantages one by one to highlight their tangible usefulness.

Decreased Staff Cost

Medical billing firm gives power to physician practices in terms of the doctor/patient time, personal time, and finally, the staff finds relief from accounting burdens. They don’t have to be meticulous in their CPT codes or around the complete coding mechanism of claims for that matter. It is a designated duty of the medical billing service to assign charges against procedures performed.

According to Barbara L. McAneny, MD, the American providers spend almost 20% of their medical revenue to ensure the accuracy of billing. They usually hire staff who is responsible for the collection of the authentic medical history of patients, entering specific codes and making claims.

If the doctors go with medical billing outsourcing, it will hugely reduce the costs and expenditures which they have to spend on their staff. The point is to choose cost-effective solutions and most companies are willing to provide just that!

Enhanced Transparency

One more thing is to look for a service with a clear and consistent reporting mechanism. Revenue reports at the end of the week or month can either be satisfying or a red sign for the future. In other words, the process of transparency becomes prominent in case you hire a credible medical billing service.

It is a good deal to find software assistance, EMR training and guidance to increase your practice’s revenue under one roof. If you find a service with extra capabilities, which is rare, don’t let this chance slip away.

Transparency further materializes into the design of an accurate claim. To track the charges for each procedure and medication is difficult and demands focus. In the case of claim denials, providers have the right to ask for reasons and evidence in support of the argument. A good practice is to state the reporting requirements on the agreement forms.

Technology Commitment

A medical billing service company brings technology commitments with them. Purchasing the latest software for complex billing tasks costs are part of the investment. For a business that wishes to make a difference depends on generous spending. Quality is what matters to them. Therefore, a company with intricate design, infrastructure, and knowledgeable health IT consultants must be better at billing.

The software and latest technology tools are necessary for creating accurate claims and enhancing the revenue cycle management (RCM) process. Moreover, the experts also incorporate tools to improve patient reminders, online bill payments, and access patient portals in an elaborate revenue cycle system. The experts can make use of technology to generate expected results.

Increased Efficiency of the Work

There is an overall improvement in the ability to work for practitioners with outsourced medical billing services in comparison to those with an in-house billing team. The doctors who are running their independent clinics have administrative duties to fulfill. It is insane to burden them with additional workloads. It is as if we don’t want them to concentrate on patient care.

Ordinarily, the doctors with a medical billing service have more time for their patients and serve them with greater focus and care. Outsourcing enhances the efficiency of the practitioner.

Accurate Billing and Coding

It is the primary responsibility of expert medical billers and coders to code accurately. To be able to submit precise insurance claims to the insurance company is an actual art. Because, if there are errors, it is going to come back from the clearinghouse!

The insurance companies have a set time limit for practitioners to collect reimbursements. The billers ensure to collect claims on time. It helps in increasing revenue per year and the medical practice moves forward day after day.

For accurate medical billing claims, please follow us on LinkedIn –

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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

Highlighted Aspects Of Medicare Usage Of EHR Technology For Hospitals!

The healthcare industry emphasizes on value-based medical services to patients with the correct use of technology and innovation. The purpose is to empower physicians’ RCM and patients with the right to choose quality care services. MIPS is a great addition in this context. It allows physicians to take small steps towards a better healthcare system. However, along with MIPS, the Medicare EHR incentive program also shares the responsibility with the same approach.

Since many hospitals don’t use EHR technology until now. However, the healthcare industry will only progress forward in a secure environment when using the latest technologies. For encouraging physicians and boosting their RCM, The American Recovery and Reinvestment Act of 2009 (ARRA) initiated a program under Medicare. It was to facilitate eligible physicians to use the Certified Electronic Health Record (CEHR) technology meaningfully.

CMS named this program as Medicare Promoting Interoperability (PI) since last year. MIPS also contains this category featuring the benefits of this program, ensuring advancement in healthcare services with the appropriate use of EHRs. This measure appreciates interoperability efforts and applauses for allowing reasonable access of patients to information.

What if Clinicians don’t meet the Promoting Interoperability (PI) criteria!

Healthcare organizations that don’t illustrate the correct depiction of PI will not get payment adjustment for the respective year.
Healthcare, which participates in both incentive programs i.e; Medicare and Medicaid EHR programs can subject to payment adjustments only when it demonstrates the true value in its reporting.

Reporting Criteria for EHR Incentive Program

Prior to 2018, physicians demonstrated EHR use via either CMS Medicare EHR Incentive Programs Attestation System or the state’s attestation system. Now, QNet System confirms the EHR meaningful use and payment adjustments are calculated via a formula specified by the CMS.

What Expectations Should clinicians have for payment adjustments for 2019?

Eligible healthcare organizations, which are not meaningful EHR users, get payment adjustment as a reduction to the applicable percentage proportional to the Inpatient Prospective Program System (IPPS). Thus, it reduces the IPPS standardized amount of healthcare centers.

What are the hardship exceptions?

MIPS and the EHR meaningful uses

Eligible hospitals can avoid negative payment adjustments through hardship exceptions on day-to-day scenarios. Sometimes, CMS itself determines that eligible healthcare falls in an exceptional case.

To apply as an exception, clinicians or hospitals can get information on the official CMS website.

https://www.cms.gov/Regulations-and- Guidance/Legislation/EHRIncentivePrograms/PaymentAdj_Hardship.html

Given below are the categories for hardship exception cases.

1. New Eligible Healthcare Organizations

Healthcare organizations having new CMS Certification Numbers (CCNs) and insufficient time to submit data can get relaxation for 1 year.

2. Infrastructure Liabilities

Eligible hospitals having no Internet access in their operating area or with insufficient resources to meet the threshold of EHR meaningful use.

3. Unexpected Circumstances

In the case of natural disasters or unforeseen conditions.

4. Vendor Related Issues

Hospitals can apply for this category when they encounter EHR vendor issues to obtain a certification or due to related delays.

What will physicians get in return for their efforts?

  • The foremost purpose is to avoid negative Medicare payment adjustment, and thus revenue cycle management becomes efficient, supporting all the financial matters.
  • The healthcare system improves, and the transparency travels across the board from a higher level to a lower level.

Thus, EHR technology is not just about technology incorporation but a way to fill gaps between patient and physician. Moreover, the advancement in its context helps in successfully submitting clinical data for MIPS as well. Consequently, the healthcare industry flourishes.

Consult the official CMS website for further information https://www.cms.gov EHRIncentivePrograms

Or, visit our LinkedIn page

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

Key Points:

  • EHR incentive program
  • The result when not submit data for this program
  • Payment adjustment criteria
  • Hardship exceptional cases
  • Advantages

P3care’s Medical Billing Services For Emergency Physicians

P3Care’s medical billing services are precise when it comes to physician-specialists and accurate when we talk about accounts receivable management. Hence, strength on both the fronts make us one of the most recognized medical billing company in Ontario, California.

CMS recognizes P3 Healthcare Solutions as a MIPS Qualified Registry for the 3rd time in 2019. To see the list of qualified registries for 2019, check out the following link – https://b0wms2ojuok4bi2s1zhfjksf-wpengine.netdna-ssl.com/wp-content/uploads/2019-Qualified-Registry-Posting_Final_v1.0.xlsx. When you tap the “P” tab in this excel sheet, P3 Healthcare Solutions appears at the top.

Outsourcing medical billing is a tough decision to make but an important one. There are several factors that influence the decision-making process such as putting your finances at risk, in the hands of a company that is physically unreachable.

A medical billing service expedites the process of filing a claim with the insurance company for timely reimbursements. When you receive the payment in your bank, it completes the revenue cycle for that claim. Revenue cycle management is a highly professional way of providing organized transactional insights. Moreover, the first-time claim acceptance rate matters a lot, and P3Care does perform reasonably well when it comes to first-time acceptance of claims.

What is an ASC? P3Care Stands by Your Side in Critical Times

ASC stands for Ambulatory Surgery Center. P3Care’s philosophy and the visionary statement speaks of the deep relationship it has with the healthcare professionals dealing with emergencies. Emergencies can be traumatic and stressful.

P3Care sympathizes with doctors who are part of the emergency setup. Furthermore, it wants the doctors to feel the support round the clock. Doctors volunteering to treat those in bad shape deserve all the praise and appreciation. Going the distance for healthcare professionals who save lives by treating patients at the right time is one of P3Care’s core principles. We do everything we can to lend a helping hand to providers and Eligible Professionals.

The ASC billing goes on a different pattern as compared to the normal billing. P3Care realizes the demands of insurance companies, therefore, preparing correct claims according to those demands is one of our specialties.

Anti-Traumatic Medical Billing Services

P3 Healthcare Solutions takes pride in handling the billing for surgical practices and ASCs. The trauma or emergency doctors require an anti-traumatic billing solution. That means they are looking for reliable and trustworthy medical billing services. The accuracy of those claims leads the way to their acceptance resulting in smooth cash flow for our clients.  If you sign up for P3Care medical billing services, you will be updated, as part of our workflow, with timely reports, evaluations, and reimbursements. Call us for a quote at 1-844-557-3227.

P3Care delivers for the ASCs and Surgeons

At the ASC, both critical and diagnostic procedures are performed. There may be instant surgeries at hand and lives can be at risk. Whatever the situation may be, your billing partner needs to be proactively involved. There is no chance for errors in ASCs, and similarly, P3Care creates error-free claims to get those reimbursements quickly.

You should meet certain requirements for better ASC billing outcomes. P3Care files the bills using CMS-1500 forms.

Nonetheless, for ASC’s better performance, the patients and the providers must agree to a few terms and conditions. Once those conditions are met, insurance companies reimburse the full amount. There can be deductions on account of missing CPT or medical codes. P3Care makes sure everything is in place.

ASC Procedures

Ambulatory Surgery Centers can have all the specialized workings under one roof. They can be an independent entity or part of a larger hospital.

The procedures or operations performed in an ASC can include:

  • Colonoscopy
  • Surgical Dressings
  • To get a cast.

Final Verdict

P3Care takes the lead in medical billing services for Ambulatory Surgery Centers or surgical claim approvals. Our medical billing & coding staff caters to the department of pain management, orthopedics, gastrointestinal, ENT, urology, and general surgery.

Request Your 2016 PQRS Feedback Report

If you haven’t so already, now is the time to request your PQRS feedback report for 2016, and see if you can apply for an informal review performed by P3Care.

Did you know a Medicare penalty is put in place for those who do not apply for an informal review, which will take effect in 2018! The absolute deadline to request your feedback report is December 1st, 2017. The feedback report will illustrate your 2016 PQRS reporting results and indicate if you are subjected to a positive, neutral, or negative payment adjustment for 2018. Based on the 2016 quality reporting results, you will also receive information on how individual and group providers have performed on quality and cost measures through the Annual Quality and Resource and Use Reports (QRURs). The objective of the PQRS feedback report is to ensure you have the necessary information for a positive outcome on future Quality Payment Programs (MIPS). The feedback report also consists of comprehensive information regarding the overall quality of healthcare provided to Medicare patients and cost performance. You are also given the opportunity to have your results reviewed if you believe there has been a miscalculation in the value modifier adjustment; you must make this request by December 1st, 2017.

Apply Today!

Don’t worry if you’re subjected to a negative payment adjustment for 2016; it’s never too late to get back on the right track with P3Care! The primary reason to replace the previous PQRS, and introduce the new and more effective MIPS was so providers can submit data by picking a pace that is best suited for their practice and focus on providing quality care at the same time. There is still enough time to take part in this year’s QPP and avoid a negative payment adjustment for 2019. P3Care is dedicated to improve your quality reporting and help you take full advantage of the remaining MIPS year. Our consultants will assist you every step of the way, and make sure you submit at least one quality measure for 2017 to help avoid further negative payment adjustments. The deadline is fast approaching, contact P3Care today for assistance in requesting your 2016 PQRS feedback report and to avoid a Medicare penalty.

909-245-8350 (P3 Client Service).