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The EMR Billing Specialists

Is your Medical Practice Ready to Face CQMs on 2014 ?

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The, final Clinical Quality Measures(CQM) for eligible professionals, is out. CQMs are hoped to bring about more structured and uniformed data on patient centered care. The update has caused ripples in the healthcare industry as it means another set of rules for physicians to comply with.

2014; A year most Healthcare Professionals wont look Forward to !

It is going to be hectic days ahead for the healthcare industry. From adopting a new coding system, to reporting on 9 of the 64 CQMS, there is a lot on the plate for physicians. Adopting a certified ehr that offers advantages in the generation of clinical quality measures, is tough enough!

Select a CQM that is Easier for your Practice to Report against…

This is a daunting task. But choosing an appropriate CQM based on the entire patient population, and collective patient information is half the battle won. It is easier to prioritize and streamline your approach after you’ve opted for clinical quality measures that are specific to your practice.

Clear Cut Roles…

It is essential that practice managers and physicians allocate their staff clearly defined roles. Physicians need to decide who collects data on forms, who enters information into the ehr, and who stays back after office to oversee the process. It is also important that a fixed time is set aside for entering data into the ehr. It would be ideal to key in information after a patient visit.

Every Detail Matters !

It could be the tax id number of your patient or national provider id, every, information determines, whether you are meeting CQMs regulations or not. Download the complete data element catalog. Assign a separate staff or team to document data elements in the ehr for every specific cqm requirement.

Select a CQM that is Easier for your Practice to Report Against…

This is a daunting task. But choosing an appropriate CQM based on the entire patient population, and collective patient information is half the battle won. It is easier to prioritize and streamline your approach after you’ve opted for clinical quality measures that are specific to your practice.

Hands on Approach…

If anything it is the time for medical providers to adopt a more hands on approach. Taking care of patients is unfortunately not the only priority of doctors anymore! Train your in-house staff on working with an ehr and meaningful use guidelines And of course, stay in the loop !

Is your Practice Safe Against Fraud and Abuse Penalties?

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You hear it everyday, practices being penalized, physicians being brought to book. But like cancer it is something that happens to somebody else, unless it hits you out of the blue.

Every physician strives to work in an ethical, profitable and secure practice. With Medicare coming down heavily on physicians with improper records, it is high time physicians took a closer look at what they’re billing for.

If it is not in your Records, it never Happened !

And that is why errorless medical documentation is absolutely necessary. The AMA and other regulatory bodies stress on the importance of having clear documentation for every claim submitted. More often than not physicians’ frantically search and put together documents to substantiate their claims, after a rejection slip from the insurer. It is good practice to have the necessary documents supporting your claim prior to filing it.

Small Errors can lead to Big Repercussions.

It is disheartening that most medical practitioners, who are penalized for fraud and abuse, are victims of minor errors. The most common mistake is upcoding. Not knowing how to assign E/M codes for subsequent visits or misuse of modifier – 25 are what most practices are guilty of.

Report Over-Payments inside of 2 months…

Just spotted a billing error? Report it and return the overpaid amount to Medicare and Medicaid funds. Practices who fail to return overpayments within sixty days will be penalized under the false claims act. Regular audits and close introspection of billing reports can help practices to notice and return overpayments, before it’s too late.

The Ball is in the Doctor’s Court !

Though being responsible for so many aspects of a medical practice can be burdensome it is also highly rewarding. Physicians need to juggle a lot many tasks. But the fact that the ball is always in the physicians court, and there is a chance to correct flaws is reason enough to smile.

Physicians need to be more proactive and involved in their billing cycle and the latest guidelines, are a remainder to stay in the loop !

Are Private Practices being given the Rough End of the Stick?

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Everybody who’s a name to reckon with in the healthcare industry is at the MGMA12 conference. One of the most pertinent topics discussed was the cookie cutter situation private practices are in. The healthcare landscape is changing and as we all know change can be expensive! It is going to take a lot of effort for small independent practices to stay afloat.

                       

 A Tough Call to Take !

According to recent studies physicians gravitate towards working for multispecialty hospitals, than take the risk of, branching out on their own. The possibilities, advantages, losses and responsibilities can be huge. But the future certainly isn’t bleak for the small practice owner.

The ACO HandShake .

There is a lot of controversy, diverse opinion and heated arguments about small practices collaborating with ACO’s. Some industry experts feel that is could sound the death knell for independent practices and can only benefit large scale “for profit insurers”. But the most widely agreed upon view is that ACO’s hold lots of promise and benefits in the long run.

The Trade-Offs .

It is important for independent medical practitioners to understand the medico-legal implications. Whether it is delivery mistakes or data leaks, the risks can almost outweigh the rewards, at least in the short term. Physicians will have to be completely clued into the minutest of details, before collaborating with an, accountable care organization.

As there is an increasing pressure on small practices to consolidate and build partnerships with the bigger players, it is more important than ever that physicians are aware of the financial aspects of a practice.

Leveraging Resources and Containing Costs…

Making the most of what is available is essential for independent practices to remain independent. Outsourcing tasks that can be outsourced such as medical billing can help in scaling down on costs. And free up in-house staff to attend to more pressing demands such as better patient communication.

Do EMR’s Lead to Higher Quality of Care ?

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Do EMR’s help in Better Medical Care ?

You are happy with your emr. It is easy to locate notes, enter and edit patient information and not wait for the trolley to come trundling along. But has it made your patients lives better ?

No matter how you slice it, you cannot get one single, convincing answer. As an increasing number of practices are joining the emr fray, this question and the answer to it, is more important than ever.

Comprehensive Progress notes, An Ancient Relic ?

Yes, documenting patient records has never been so easy. Or, so impersonal either. Straight out of a can templates have taken the place of long and informative patient progress notes. A physician going through the progress note in his emr is more likely to encounter highly edited and simplified information, which may not give him a clear picture of his patient’s progress.

Sigh, The Doctor is too busy…

A common complaint heard in the waiting room of doc’s offices is that patients are slowly becoming the least powerful factor in the equation. With cuts in reimbursement and constant changes in the healthcare landscape, it is a tough world to live in for physicians. And learning the ropes of a new system isn’t a walk in the park either. And in this entire din it is the voice of the patient that sadly goes unheard.

EMR’s do lead to Higher Quality of Care.

A recent study published in the The Journal of General Internal Medicine states that ehr use had led to significantly higher quality of care. It is one of the first extensive researches conducted on the usefulness of an emr in a clinical setting. And going by its results, despite its flaws electronic medical records billing services are here to stay. Physicians, who learn the ropes quickly enough and can work around the limitations of the system, can realize the endless possibilities it offers. Better patient care and easy access to records at all times, are just a few of them.

Is Adopting an EMR a Big Hurdle for Small Practices?

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Big changes in the healthcare landscape are affecting the way small medical practices function. By now all that dust about whether an emr can contribute directly towards more profits and better patient care has died down. Discussion forums are abuzz with practice managers seeking out everybody’s two cents on the best emrs around before taking the plunge.

The Biggest Check a Small Practice Owner is ever going to Sign !

Most small single physician practices make do with basic technological infrastructure to get by. Investing in a system that is pretty expensive and not being sure about the ROI is the biggest nightmare for physicians. And signing the check for the emr is the first of many expenses.

Training and Recruiting Staff…

Medical practices will have to implement a training program for staff to understand and work with electronic medical records. Most small facilities are understaffed and a new emr calls for recruiting more people to handle and manage the system. Needless to say, this means big bucks. But the question is, are costs the only factor that is making small practices, stand at the end of the queue?

My Eight Hours are Packed !

Small practices unlike their bigger counterparts do not have separate teams to handle different departments. Physicians juggle a lot many tasks and researching on a new emr means serious cutbacks on time. It could mean seeing fewer patients a day, which would adversely affect collections.  With hardly any time to breathe or fix up that faulty heater, it is going to be tough for physicians, to go shopping for an emr and come back with the best deal.

Can Having an Automated Appointment Scheduler help ?

Depends on how many patients you meet per day. If your receptionist can juggle your appointments with a smile, let her. There are a lot of physicians who realize that the features they were so excited about during the implementation stage are features they’re never going to use. It is lack of emr knowledge, expertise and the fear of making the wrong choice that is holding most doctors back.

Is, Trusting a Consultant a huge Leap of Faith ?

In a world where two out of three people you meet claims to be an expert consultant; it is certainly a risky proposition. And it could be expensive as well. Opt for certified consultants. Spend a whole day on the net reading up about emrs to show them they’re dealing with a tough customer. And finally request your physician billing EMR services company to help you analyze current operational expenses and profitability benchmarks, and how implementing an emr can help drive up profits.

In the long run it is the time and energy we invest before taking a decision that ultimately pays off !

Here is what you can do to Receive $44,000 !

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Getting ready for Stage Two ?

It is October. Time to get flu shots, hustle the kids to school for a new school year, and, yes concentrate on, mu! Qualifying for the stage two of meaningful use guidelines, is going to be tough for physicians. It is certainly no stroll in the park but it isn’t mission impossible either. The final regulations for meaningful use stage two emphasize on interoperability of data and more standardized data formats.

With 2014 drawing near it is time for the smart doc to plan ahead and gear up for the incentive !

Start with the lab…

Do you still run down the corridor to fetch x-rays ? A lab interface that can integrate with your existing emr or ehr can be helpful in qualifying for meaningful use. Lab data contains pertinent patient information and proper filing and documenting of patient records, is critical to attest for the mu incentive.

Several pac systems can integrate with ehrs and emrs. Pick one now and cast aside one major worry.

Are you Encrypting your Data ?

It is important that all personally identifiable health information is encrypted, when “not in use”. Ensure your vendors, staff and anybody who has access to your medical records, encrypts them.

Patient communication is going to be all important…

If you are a busy doctor who rushes through patient appointments, you’ll have to change the way you work. As expected meaningful use stage 2 raises the bar for patient engagement and communication. It is important that your patients are able to access their records and lab results. Asking your ehr vendor to set up a separate, password protected individual access, to patients can help in bettering patient communication.

A Mixed Bag !

The revised guidelines for stage 2 offer a mixed baggage for medical practitioners. It’s gone easy on several regulations that were proposed initially, such as reducing the number of patients, who have to be offered online access to medical information, from 10% to 5 %. But on the other hand has raised the bar for, ensuring patient communication and interoperability.

But it is widely believed to be, in the long run, not just a game changer but harbinger for a better and more secure healthcare environment.

Are you Receiving Billing Reports on Time?

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If your answer is no, here is why you should demand for one. Getting involved in the business side of medicine can be a nightmare, if you’re a busy doctor shuttling appointments. But going by the recent unhealthy trend of doctors being in the limelight for faulty billing, staying unaware of the financial state of your practice can be a costly mistake.

 On your Feet all day long but not Earning Enough…

Your appointment scheduling are choc-a-bloc and there is hardly enough time to breathe or do the laundry, but that just one indicator that you are running a successful practice. The other more important factor being how much you are earn at the end of the day. Entrusting the entire billing tasks to your in house biller or vendor can be prove to be a risky proposition in the long run.

All Fingers Point to the Physician !

It is unfair and crazy but every time there is a blooper it is the physician who is held at gunpoint. More often than not it is not planned embezzlement but simple oversights that can put your practice in the hot water.

Get that Financial Reporting System in Place !

The major hurdle for doctors and billers in setting up a reporting system is the lack of knowledge in implementing one. To start off create a dashboard of your key metrics. It can be revised, later on, to accommodate newer benchmarks and performance indicators set by you.

Here is what a Basic Checklist should consist of…

  • Ar reports that mention clearly the number of days in AR.
  • Insurance payment turnaround report.
  • A list of the contracted allowable for payment by insurers.
  • Monthly production and collection list.
  • The net collections of your practice.

Get it off the Ground, Today ! 

Demand for a financial report from your medical billing company or in-house biller to put your practice on the right track. It will help you analyze the financial performance of your practice, curb unhealthy trends, and finally know what your biller does !

Medicare Fraud one of the Biggest Exposes in Recent times

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The Biggest Expose in Recent times !

The healthcare industry is in the news once again. But this time, forentirely the wrong reasons. Medicare fraud has always been discussed about in hushed whispers. The lack of concrete evidence and mutual finger pointing ensured that allegations and counter allegations, soon faded into oblivion.

A 430 Million Dollar Scam.

We repeatedly hear of doctors being brought to book for billing errors. But more often than not it turns out to be miscommunication between the patient and doctor or not following revised guidelines. The recent expose that indicts over 90 physicians for submitting fraudulent bills and cheating medicare of four hundred and thirty dollars reveals a much darker story.

Higher Healthcare Costs… 

It is coordinated frauds like this that hike up the average patient’s bill, medico-legal experts allege. But the biggest fallout of this scam could be that physicians who make genuine mistakes with their bill could face more stringent action. Not to speak of the loss of faith and belief, of the public.

Steering Clear of the Muck.

Physicians will have to ensure that every claim sent out is thoroughly scrubbed and “clean”. A scam of this magnitude is certainly going to put everybody else in the scanner. And as skeletons keep tumbling out of the closet, the dust is not going to settle down anytime soon. Medical practices will have to be fully aware of, and pay close attention to the billing process.

The Man in the Mirror…

Like the cult song, nothing much is going to change if the man in the mirror refuses to change. No healthcare reform, billing audit or screaming headline is going to bring about a better and safer healthcare environment, unless physicians take it upon themselves to ensure their medical practice bills the right way ! Or call up their physician billing company to ensure that they’re following all billing regulations.

Dont let 55,000 more Codes Faze you !

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Is 10.1.2014 a Date set in Stone ?

Much to the consternation of physicians, according to the department of health and human services, it most certainly is. After frequent postponements, much hullabaloo and divided opinions, a date has been finally announced to make the transition.

Though the granularity in codes can lead to more clarity and a more structured coding system, most codes physicians fume, are never going to be used.

An Expensive Change !

Change comes with its own baggage. Now healthcare providers will have to make major changes to the infrastructure and workflow of their practice, to accommodate the revised coding system. One of the biggest roadblocks is to train staff and set up a testing schedule, amidst busy workdays. The slew of recent changes in healthcare informatics and billing regulations is going to leave physicians with little time to catch their breath.

What Defines ICD 10 ready ?

This is a question that stares at the face of every healthcare provider today. Most find working with codes that are not going to be of any purpose or use till 2014 a drain of time and human resources. But, the time to start gearing up for the change is, now !

Small Steps can make Huge Strides.

Small steps can shorten the path to adapting to an entirely new coding system. One easy way for medical practices, to stay ahead of the curve is to have a database of ICD10 codes that they’re most likely to use. This will get the “55,000 more codes” scare out of the way.

Assess the Impact of ICD 10 .

Performing a realistic and comprehensive assessment of the impact that ICD10 is going to have on your practice is essential. Draw a bucket-list of the aspects of your workflow that are going to undergo major change during the transition, and start a testing plan on them. Educate staff members or if you work with a vendor request for a detailed plan of action to deal with the onslaught of codes.

Being quick and informed can beat those deadline blues, and make your practice truly ICD-10  ready ! Whether you are planning on creating a training program for your team or ask your ICD-10 medical coding services company to set up an implementation plan, do it today !

Important Decision Making Factors to choose a Medical Billing Company

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Tick all your Boxes before Making that Call !

To trust someone with your medical practice’s future is not an easy choice. But a choice that medical practitioners and practice managers are forced to make. Due to evolving guidelines and the need to be on top of them, physicians all across the country pin their hopes on medical billing companies Not spending enough time on checking the facts can dash hopes and lead to bitter arguments.

A quick checklist of what you need to keep in mind before making that call.

Know what your Bill is !

You don’t want to receive a fat bill whether you get paid or not. Option for a billing company that charges a percentage of your collections. Ensure that the percentage is fixed. This will drive your biller to collect more and also save you from spending dollars when you aren’t earning any.

Truth is in the Details…

A lot many physicians just ask for the names of a few clients and projects, the firm’s handled before, and leave it at that. It is always advisable to shoot a mail or make a call to existing clients to cross verify facts. Like they say, the proof is in the pudding.

24×7 is not Enough !

A 24×7 firm that never sleeps looks good on paper. But the focus should be on what difference that can make to your practice? Whether it will help in quickening your workflow or not ? Ask for a detailed, blow by blow account, of their work process.

Be in the know…

It helps to always be at the driver’s seat. Somebody else to work on your claims and make that long calls to insurers is wonderful. But that doesn’t mean you loosen your tie and take the backseat. It is the physician who is held responsible for billing errors. Ask for regular work reports and fix up the cracks instead of falling through them.

Scout for Someone who understands your EMR !

Most healthcare providers use an eclinicalworks emr billing services or ehr system and have gone the electronic way. Whether you use an emr or planning to make the transition, ensure that your biller understands the workings of it. This will help in cutting down mundane tasks such as pasting records.

Go beyond what the brochures claim, and invest a little time on choosing a concern that is the best suited to your needs.