4 Reasons to Outsource Credentialing by a Medical Billing Company

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

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

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

What is Credentialing?

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

Why is Credentialing Important?

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

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

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

What are the Challenges that Occur During This Process?

Credentialing Takes Time

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

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

Peers Don’t Cooperate

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

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

No Access to the Latest Information

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

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

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

Inability to be Compliant with Value-Based Healthcare

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

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

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

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Providers’ Guide to Best Practices for Revenue Cycle Management

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

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

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How Independent Healthcare Providers Are Coping Up With Changes?

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

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

Reason for Reduced Rate of Independent Healthcare Practices

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

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

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

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

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

Impact of Low Reimbursement Rate

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

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

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

Reservations of Solo-Medical Practitioners

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

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

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

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

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

3 TRICKS BY MEDICAL BILLING SERVICES TO AVOID CLAIM DENIALS

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

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

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

How to Accelerate RCM?

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

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

How can medical billing services manage Denied Claims?

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

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

Verify Insurance Benefits

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

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

Verify If Healthcare Provider is among the Insurance Network

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

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

For Example,

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

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

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

Keep Track of Accounts Receivable

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

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

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

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

Follow this link to learn how a professional medical billing company looks like https://www.linkedin.com/company/p3-healthcare-solutions

PRIME PERFORMANCE WITH THE P3 TEAM!

At P3 Healthcare Solutions, our processes, people, and all-around performance stand alone in leading the business services industry. We focus on helping the patients and providers who form the backbone of the healthcare world, but more importantly, our team has the exact ability to save time, lives, and resources that never fall short in quantity or quality, even while customer service expectations continue rising.

Our innovative, efficient, and unique solutions range from risk analysis and audit to credentials, enrolling, and technical assistance. In short, P3 Healthcare Solutions has a track record of providing stand-out success that facilitates patients’ and providers’ experiences, making us one of the best billing services companies of the year.

Clutch, a B2B research and reviews agency, recently analyzed dozens of BPO companies, including our company, for service providers with the strongest market presence, industry experience, and client feedback around. We’re ecstatic to share that we took home a spot within the top 10 firms in our entire field, and knowing that our team has earned such well-deserved recognition means a lot to us.

They’re highly responsive, answering questions or concerns no matter the time or day. Healthcare is a complex field, but they understand it well and implement best practices,” raved one of our satisfied customers. “P3 Healthcare Solutions enables our providers to get paid faster, and they make billing consistent and reliable … They’re knowledgeable and understand our complex field well. They’ve managed to bridge a gap between running a medical practice and making medical care personnel for patients who are suffering.”

Beyond our billing services, the range of our capabilities has also turned heads due to our versatility, reputation, and strength of performance. The Manifest and Visual Objects, two of Clutch’s sister companies, have also featured us in similar industry-wide listings and company comparisons, particularly touting our HR services and digital prowess.

The Manifest, a business news website, included us in a list of the top 50 human resources firms anywhere, while portfolio curation platform Visual Objects now showcases our team, experience, and project management success on its website in a profile of our own.

We’re thankful for all of the support from these sources and from everybody who has been a part of our journey thus far, but we can’t wait to continue expanding and growing as we take on new challenges and clients to broaden our horizons and better our team. If you’re interested in hearing more about what P3 Healthcare Solutions can do for you and your business, please connect us. We’d love to see what we can do together!

2 NEW HEALTHCARE TECHNOLOGIES TO RULE IN 2019!

Healthcare Information and Management System Society –HIMSS each year showcase new ideas and technologies to support the healthcare industry. By viewing these technologies or adopting these methods, physicians can actually progress in MIPS in healthcare, medical billing and coding, and health IT sectors.

HIMSS19 conference offers hundreds of opportunities for clinicians with the latest tools and tactics to improve the quality of healthcare services. Moreover, the ideas and innovative methods presented in such forums give insight to strengthen revenue cycle management. In addition, MIPS in healthcare and other incentive payment programs can be facilitated in term of reducing cost-expenditure and efficient data storage system. All of these efforts contribute to the advanced healthcare system.

What was there in the box by the vendors in HIMSS19, which may move this industry in upcoming years? Let’s review.

  1. IoT-Enabled Platform

VivaLNK is a popular name in the health IT industry. It has developed a wearable sensor platform with Internet-of-Things that consists of a number of items such as,

  • Sensors
  • Internet of Health Things (Data cloud)
  • Computing technologies

What Does this System Do?

The function of this technology is to capture patient’s or human’s biometric data and input it to the edge computing technology or the cloud computing service for analysis.

This technology will be a great addition in the healthcare industry and will support MIPS in healthcare and medical billing and coding services regarding data collection. It has the capacity to work wonders when deployed completely to its full potential. It will modernize proactive healthcare services and will predict flawed areas in a human body by analyzing symptoms and data.

The Purpose of This Technology

As with modern digital technology, the healthcare industry needs to change its curing methods. The focus should be on preventive healthcare procedures instead of treating a patient after a disease. Moreover, the complexity of diseases has doubled since the last years, making a challenging environment for physicians. The detection or seeing early symptoms of diseases has not remained easy.

This technology will help healthcare providers to identify diseases before they turn serious. Consequently, it will result in bringing positive impact in the value-based services that MIPS in healthcare promises.

The success of this system lies in the accuracy of the data. Machine learning and artificial intelligence will come from user-fed data. This task is daunting and may not work as precise as one may expect. Thus, sensors-equipped platforms will assist in this regard, providing medical-grade data directly from the patients and will be shared across the network via IoT.

This system is the next-level healthcare solution that benefits MIPS in healthcare and medical billing on larger grounds. According to physicians, healthcare service providers will be able to accelerate health IT efforts, especially for chronic diseases.

The system perfectly integrates health IT and value-based healthcare service for the patients’ betterment.

  1. The platform for Increased Patient Engagement

Another promising innovation at HIMSS19 was by TriFin Labs, named as Enlyt Patient Engagement Platform.

This system is designed to extend the application of the patient’s engagement via state-of-the-art technologies. It serves to save money and time while connecting physicians and patients in a reliable environment.

How Does It Work?

It a HIPAA-compliant and customizable platform to provide a one-to-one connection between patients and physicians.  It enhances customer-relationship management and has the potential to integrate with the electronic healthcare record (EHR) technology.

Its ability to provide customized operations allows clinicians to manage their systems as their requirements. Moreover, patients will be free to access their medical records whenever they want along with the other information i.e. a list of medication and treatments.

This system also holds opportunities for pharmacists to review past and present medicines at any time, ensuing value-based MIPS in healthcare.

Its other advanced features include a coordinated in-app connection that helps patients in remembering their appointments.  Thus, it makes perfect sense in terms of promoting interoperability and increasing healthcare workflow.

What do you think about these technologies? Do these seem like progressive steps to reduce healthcare cost? Share your thoughts with us at https://www.linkedin.com/company/p3-healthcare-solutions

 

4 QUALITIES OF MEDICAL BILLING SERVICES BENEFITING HEALTHCARE

What do you think is the main reason behind hiring or outsourcing a medical billing service? Follow https://www.linkedin.com/company/p3-healthcare-solutions/ to stay ahead in this field.

In the end, payments that you derive as a healthcare professional are the reason behind your survival, both socially and morally. If you are famous among your patients, it gives you satisfaction, but not for long if the revenue stream is unstable. The reimbursements are the lifeline of any practice, and hence, the role of a billing company becomes vital at this point.

Outsourcing medical billing improves the net collection rate as it gives a push to the reimbursements. It also speeds up the RCM process by not delaying the billing and coding of claims.

However, you should choose medical billing solutions cautiously, when you are in the right frame of mind. It means when you have nothing against them in any sense.  Read reviews, carry discussions, talk to co-workers, and the best way is to use Google for the best services nearby. Qualities below will keep you on the right track.

1. Top Medical Billing Services are Specialty-ready

Any company you’re looking to hire for your finances needs to be aware of your specialty. For instance, if you are a heart specialist, the HIPAA medical billing service company has to be familiar with the right billing codes and other standardized information.  Since there are constant changes in the system, it is not easy to keep up with it.

If they are a bunch of trained individuals who have experience with specialized healthcare practitioners in the past, it can be your best bet.

Some billing companies manage finances only for general practitioners such as physicians and physician assistants. Sometimes, it also goes to show their inexperience in medical billing.

Specialty medical billing services in the US are elaborate in their skills and work areas. They manage insurance companies by understanding the work process that goes in the acceptance or rejection of claims. The billers know their way around payers; understand them in a way better than the inexperienced billers.

It brings both the payer and the billing company closer to a point where they can produce better results. In addition, they also know how to avoid denials by creating insurance-friendly claims.

2. What Is Your Take On The Experience?

The answer to this question clears up any doubts about the ultimate selection. It is inadvisable to ask a newbie to handle your finances.

Your revenue cycle management is best suited in the hands of a veteran company with a multitude of satisfied clients. You need someone dependable who knows their way around the constantly changing healthcare system. It can only be someone with experience, the right attitude, and downright skills.

Given the current frequency of complex updates in the healthcare industry or Meaningful Use (MU) Stage 3 payment risks, it is sensible to find experienced medical billing services. In addition, they must provide 24/7 support and be at an arm’s length in case of developing situations.

Furthermore, if you need to talk to a person about a specific issue, the right technical person should always be reachable.

Ordinarily, with experienced companies, most bills see the light of approval rather than an outright denial.

3. Bear Advanced Software and Hardware Systems

Since an electronic health record (EHR) system has become a mandatory part of practices since 2017, you must be sound in practice management systems (PMS) and the use of EHR technology. It is clear that once both the systems corroborate with each other, the expenses drop and your practice prospers. It shows in the form of charged up reimbursements.

When three systems come together (PMS, EHRs and Patient billing systems) and form a solid alliance, there are fewer errors and the visit-to-billing cycle starts to roll.

Some medical billing services in the US have the latest machinery to keep an eye on the future and flexible enough to adapt to situations. Become one of those enterprises which use advanced computers and communication tools to meet the dynamic and ever-changing medical billing field.

4. Ready to Share Knowledge with Staff

The medical billing service companies not following the rules or adhering to the contractual agreements are not a good option. Despite the fact they are a professional team of billers, they must be ready and willing to bend a few rules just for your sake to make you feel well supported.

They should train the staff on the premises working for you. Moreover, the company has to be more than willing to educate someone in your staff that may help relieve the billing stress. Resultantly, when a situation builds up in real time, there will be someone to offer a potential solution.

4 STATISTICAL REPORTS TO ACCESS REVENUE CYCLE MANAGEMENT

Medical billing services in the USA improve the revenue cycle management process by using the latest billing techniques. According to Kaufman Hall study of CFOs from more than 350 hospitals in 2018, the priority of the physicians is to reduce the cost of care delivery.

A MIPS qualified registry collects data in this context along with the information about the quality of services. QPP 2018 has everything in favor of the physicians monetarily and patients in terms of their best treatment. Follow P3Care on LinkedIn – https://www.linkedin.com/company/p3-healthcare-solutions/ to stay updated with the US healthcare industry.

Key performance indicators (KPIs) give us an idea of how much money healthcare services invest in high-quality medical facilities for the patients.
In addition, we know about the profits they earn in return. Today, medical billers don’t use papers to manage patient’s information, but billing software and the electronic health records (EHRs) provide the necessary assistance.

Billing software along with handling information generates reports as per the required functionality. How a medical billing practice contributes to the progress of healthcare professionals and effectively maintains the revenue cycle management process depends on the software as well. It becomes easy for a MIPS qualified registry to collect the relevant data without redundancy.

Given below are some types of reports that will inform you about the progress of the revenue cycle management process.

1. High-Level KPI Report

This report helps in learning about the Current Procedural Terminology (CPT) in medical coding. It confirms that the medical coders use the most common and profitable codes in a medical claim.

This report estimates the following parameters:
• Total encounters
• Total collected payments
• Accounts receivables
• Number of procedures

The difficulties in these KPIs help in knowing the areas that need improvement. For example;

If in a month, cost consumption increases, profit for that month should also increase in the same ratio. You experience a reduction in the accounts receivables (ARs).

Generally, medical billing software conducts everyday tasks of medical billing and coding in an efficient manner. The software has an inbuilt template for CPT, and if there isn’t, you must create one to promote future accurate claim creation.

2. Per-Encounter Reimbursement Report

Another KPI is to compare the reimbursement rates with that of your competitors. The formula to calculate the rate is simple – It is per-encounter reimbursement which is the total payment divided by the total number of encounters in a specific time.
When we know the average reimbursement rate per patient, it improves the consistency of the revenue cycle management process.

3. Report To Keep a Track of Accounts Receivables (ARs)

Revenue cycle management becomes more efficient when we keep a track of accounts receivables for the physicians. Ordinarily, medical billing and coding agencies neglect accounts receivables which exceed 120 days.

However, professional medical billers know the periods for particular claims – 30 days, 60 days and so on to keep an eye on the amount due by the insurance companies. If payments cross the 120-days mark, medical billers find out the exact reason for the delay and join heads to figure out a solution.

When the AR is less than 10%, it represents an ideal situation. If it is more than 25%, drastic changes in the revenue cycle management or a medical billing audit may be the ultimate remedy.

4. Report for Checking the Ratio of Net Collection

By the net collection rate, we know the exact performance of the revenue cycle management system. It highlights whether we are collect payments as per the number of resources we utilize or otherwise. Medical billing practices aim for 95% of revenue collection to progress in the healthcare industry. If the ratio is lesser, there is a room for improvement in the RCM.

Charge value is an important parameter and it is the contractual adjustment of the total billed amount. By knowing this value, billers can calculate the total collected amount and give an estimate of the profit.

Conclusion

We can’t measure the performance of practice unless the billing system works on specific lines of improvement. Ineffective billing directly reflects in your revenue at the end of the day.

Revenue, in general, experiences turbulence with little or no increase in it. The statistical reports mentioned in this article breathe life into the process of revenue generation from the start to finish.

P3Care holds a respectable status in the medical billing and coding field. Call us for a free RCM consultation 1-844-557-3227.

3 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, promoting interoperability (PI) and HIPAA compliance. All of these factors contribute to the success of 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

The EHR incentive programs now turn into Promoting Interoperability (PI) programs. The name says it all for them. CMS changed their 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.

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.

4 TIPS FOR ACCOUNTS RECEIVABLE MANAGEMENT IN MEDICAL BILLING

According to statistics, out of pockets, the cost of patients has increased by 230% in the previous years. It means that the patient’s healthcare has become expensive in recent years and it will continue to cost more in the coming times. MIPS 2018 is an important advancement in this context as physicians focus more on providing value-based services to the patients.

Medical billing and coding team creates accurate claims and synchronize with the physician’s clinical function to reap the rightful payments.

However, Group One Healthsource states that around 40% of the healthcare service providers are unable to collect $31,713 per year from their patients. The reasons for this failed collection amount are the errors in the documentation of medical procedures and lack of precise and up-to-date information.

Moreover, the incentive models based on value-based health services such as the quality payment program 2018 and the Medicaid meaningful use are transforming medical billing services. Healthcare providers lose around $125 billion to poor billing practices. Thus, the healthcare industry is only going to progress when medical billing and coding services aid the providers to get a hold of their accounts receivables.

Given below are tips to improve the billing and coding process and maximize accounts receivable (AR) management.

1. Focus on Error-Free Medical Claim Submissions

Late payments and claim denials usually occur due to medical billing and coding errors. The insurance companies accept only those claims that are according to their claim filing standards. The strict policies don’t have room for even minor errors.

It is important to review each claim precisely before submitting it to the insurance companies. In the case of a claim denial, you must have a professional denial management system in place. Insurance payers’ representatives can help rectify each problem efficiently.

2. Make the Payment Procedure Transparent

Another approach to minimize accounts receivables is by making the payment procedure transparent. When the healthcare providers notify patients of any outstanding medical expenses prior to the treatment, it becomes easier to collect the payments. Consequently, there are fewer accounts receivables in the pipeline.

Billing companies inform physicians about the payments approved by the insurance companies and payers like Medicare and Medicaid. To maintain transparency in the medical billing system, professional medical billers verify the eligibility of the patient before submitting the medical claim. It reduces the problems in the later on.

Accounts receivables (ARs) lessen when you collect copayments earlier into the revenue cycle management (RCM) process. It reduces the unnecessary paperwork later.

Medical billing outsourcing companies perform at crunch times, as their performance is crucial to keep functioning for the respective physician.

3. Make Use of the Latest Medical Billing Tactics

Medical billing standards have changed over the years. Hence, the billing staff requires constant training and knowledge to improve their skills. It results in improved medical billing tactics for better reimbursements and reporting MIPS 2018 Quality measures to score high in MIPS.

The latest trends demand investment, but they benefit in the end. By staying up-to-date with the latest tactics, we not only reduce errors in medical claims but improve accounts receivable management as well.

4. Audit Medical Billing Process

When we audit a medical billing and coding system, it helps us identify the problem areas which are creating the mountain of accounts receivables. For instance, a claim may have errors when there are frequent changes to the patient’s information. Such mistakes lead to outright denial. The audit catches these errors in light of the day-to-day activities and streamlines the billing process.

The areas with glitches once fixed make it easy for the medical billers and coders to submit the medical claim. Thus, an improved medical billing system maximizes accounts receivable (AR) management.

Conclusion

The above-mentioned tips reduce the number of resubmissions of claims to the insurance companies. The time duration for payment collection shortens. In addition, physicians get to receive revenue in a timely manner.

P3Care’s medical billing services provide professional medical billing solutions to healthcare professionals and increase their revenue considerably via the latest billing methods.

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.

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 from 2016. Doctors supporting the Million Hearts initiative by the Department of Health and Human Services (HHS) are also identified.

However, is this about to change?

CMS has declared that it will soon make available the MIPS score of all eligible providers on its website. Provider scores in each of the performance category, i.e., Quality, Cost, Promoting Interoperability, and Improvement Activities will be posted on the site based on 2017 performance scores. 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 a 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?

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.