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Why do independent practices fail when outsourcing RCM and billing to EHR companies?

January 18, 2023 by Ango Mark Leave a Comment

Outsourcing RCM and medical billing to EHR companies is a bad choice for independent practice.

Outsourcing RCM and medical billing
Independent practices are reliable sources when it comes to getting care immediately. PCP providers, ER rooms, and general medical practitioners, it is also common that other specialty providers like OBGYN, Podiatry, and mental health practitioners all have independent practices. But these independent practices have the responsibility of managing the complete practice with the collections they make. It is reasonable that they seek outsourcing options to cut costs and focus on core functions like patient care, improving patient access, and purchasing medical equipment to provide better patient engagement.

Why do independent practices choose EHR companies to outsource?

It is a well-known factor that there are plenty of RCM and billing services outsourcing companies. But why do independent practices choose EHR companies to outsource? The reason is simple. EHR companies mostly make their revenue from subscription fees. The reason why they have also included billing and RCM services packages from 2% collections as their fee is that they get reimbursed for a service that they don’t have core expertise on and get paid for it too.

Typically EHR companies target independent practices for this same reason, they get more revenue from these independent practices than they get subscription fees from selling their EHR software to hospitals and health systems. independent are already caught up with their daily clinical and patient care operations they hardly have time to concentrate on the billing and revenue cycle processes.

EHR company's medical billing and RCM services
We have encountered many of our independent practice clients who have similar problem scenarios. They first buy EHR and when the EHR company salesperson states that they provide billing and RCM services at 2% of collections per month, these independent practice managers and doctors seem this to be a good deal and go for it. 6 months down the line they return back to a proper RCM and billing services company like BillingParadise and request to undertake their entire revenue cycle operations because of the following drawbacks when outsourcing RCM services to an EHR company:

EHR companies only have technical and customer support for their products and hardly have experienced medical billers or coders.
Because the EHR companies do not have skilled billers or coders they outsource to third-party vendors that do not connect with the practice whatsoever in terms of improving the RCM operations.
Billers in EHR companies are only 1 or 2 years experienced newbies that do not understand the concepts of net collections, gross collections, profit margins, etc.
EHR companies do not work on claim rejections or denials. They assume all claims that pass the clearinghouse are deemed reimbursable.
They get reimbursed directly and pay the practice after deducting the 2% collections fees.
90% of EHR companies’ billing services are just data entry processes after that the RCM processes are incomplete.
1 out of every 3 claims that EHR companies code results in an error as they only want to send out claims rather than focus on quality.
EHR companies do not have a dedicated billing team specifically for your independent practice, they use whichever biller is available at the moment and use them as they have many independent practices that they handle at one go.
EHR companies only have access to a few report templates and use them often, unlike direct RCM outsourcing partners they do not dive deep into the practice’s complete RCM processes and performance.
They do not conduct daily, weekly or monthly reporting sessions to provide insights into the collections and financial growth of the practice.

Identifying a correct RCM services partner for an independent practice that provides a dedicated RCM manager, billing supervisor, and certified billing, and coding experts is the correct path to a well-performing independent practice. We advise independent practice managers and providers to first get a consult from BillingParadise’s RCM team and understand the revenue leakages and correct financial performance before continuing the EHR company’s RCM services as data and numbers do not lie and can provide deeper insights on how to grow your independent practice.

Talk to our RCM team through a virtual meeting or set up an onsite appointment where our experts can come visit your practice and provide analytical data in person.

23 RCM questions you should ask when reviewing a medical billing company

August 23, 2016 by Ango Mark Leave a Comment

So, you have considered taking on the challenges of finding the best medical billing company for your medical practice.

We should all by now know that the healthcare industry’s reimbursement laws aren’t going to stay put and be as they are. The changes they undergo are constant and continuous. They are always reforming, molding and reinforcing themselves as the system matures, necessitating the need for constant financial vigilance amongst medical practices.

Associating with billing professionals has been the go to option for most, especially those who haven’t got a billing department annexed to their healthcare’s business frontier. Meaning that most of the billing endeavors would be taken care of by an outsourced billing company, and the providers would be free to go ahead with what actually matters most to them – patient care.

Now, back to hunting for a fitting company that will do your bidding (billing), without you having to worry about all the cumbersome processes associated with it anymore.

When you chose a wrong billing company, something similar can happen to your practice

But, what’s more to it is that choosing a ‘good’ medical billing service almost always guaranties an increase in collection rates, and reduction in overall rejection or denial rates!

So, outsourcing the RCM can result in your business making more money. And, since you wouldn’t have to allocate working staffs to take care of these tasks (coding and billing), they wouldn’t be feeling overworked and could work more efficiently. Or you could save further by simply cutting down on your no. of working staffs.

Either way, you are on the track to saving more while making more.

Now to the big question…

How should you choose your billing service? As you will trust them with you business’s most important segment – the revenue cycle management.

The answer: By asking them a lot of questions! (Just like how you would, when interviewing an in-house billing faculty.)

And, to get you started with those question-sessions, here are 23 questions that you should consider asking to your would-be medical billing service provider.

We have split these questions under two categories ‘Pre’ and ‘Post’ subscription services/functionalities. Choose the ones best suited for your specific needs

1. Do they provide a summary of your current ‘Accounts Receivable’?

Keeping your monthly AR under 1.5 times the monthly charges is the ideal target.

Measuring Accounts Receivable (Days in AR):

Days in AR = Total AR ÷ Avg. daily charges

(Where: Avg. daily charges = total charges in last 6 mo ÷ no. of days in these 6 mo)

As the AR days increase, cash flow to your healthcare organization decreases, thus lowering your means to pay or hire better staffs and physicians. Also, it affects your group practice’s ability to invest in current gen tools and technology. So, higher your avg. AR days the more negative its impact on your ability to treat patients better.

AR is grouped under 5 classifications, which are 0-30 days, 31-60 days, 61-90 days, 91-120 days and over 120 days. You can compare your AR Benchmark with MGMA Data here.(Best viewed in Chrome browser)

Check if they can help you with you in getting your current A/R summary. The below table is a summary of a practice’s bad A/R.

Other question you could be asking on that line…

Do they have an organized system in order to keep track of and follow through with your pending AR?
Would they be providing you with periodic analysis of AR, and assisting you with recommendations based off of it, so that your hospital’s overall financial performance can be boosted?

2. Do they offer ‘Denial Management’ on your existing claims?

A HIMSS Analytics’ survey found; “44% of the participating hospital executives indicated that they use revenue cycle management vendor solution to manage denials, while 31% use manual process and 18% use homegrown tools, but surprisingly, 7% are unsure about their denial practices.”

Should the billing company be pursuing after your ‘denied’ claims or would it be better for the group practice to take responsibility?

Whatever maybe your choice; a proven fact is, a dedicated medical billing company is more capable/efficient at managing payer denials than a medical practice.

Do they have dedicated platforms to do that!

Checkout if they utilize any denial management platform? If yes, then you may want to opt for a quick demo before proceeding.
Also, do they incorporate a team dedicated for denial management? If yes, go for a con-call and throw in few of your existing concerns.

3. Can they keep track of and make analysis of your ‘Rejected Claims’?

A research notes; “about 20 to 30 percent of the claims that are raised get rejected on a regular basis.”

Another report suggests; “of these (rejected) claims, almost 80 percent are left unprocessed.”

Considering these reports where true, you are seeing an avg. of tens of thousands of dollars lost due to rejections every year.

Can a healthcare organization afford to face such loses?

From sloppy documentation to issues such as up-coding/under-coding, there are numerous reasons why your claim could get rejected.

Check if you can get insights into unreviewed rejection reports like a one below:

And, you need a team of expert billers to handle all these rejections at a moment’s notice. An established billing company can afford that.

4. Can they offer a ‘Code Analysis’ based on your existing medical practice’s history?

Claim rejections, denials and low reimbursements are the primary causes of revenue undercuts in any healthcare organization.

So, reports such as ‘top used codes’, ‘top paying codes’ and ‘most denied codes’ go a long way in keeping you updated on revenue flow. A company that can work out these details and also provide you with alternate solutions (codes) that could save you from a lot of trouble and some money will prove to be a resourceful billing partner.

Are they up-to-date with the industry’s latest tweaks & amendments?

On an added note; a billing company that ensures continual training & orientation of its staffs on the latest resource/updates in the industry, will give your organization an edge in revenue handling.

Let’s take a look at the analysis of the Top CPTs of a medical practice.

5. How good are they at ‘Contract Analysis’?

Coverage plans can change from state to state…

At some states they could offer extended coverage (including even comprehensive healthcare issues), yet at other states they may only cover the program’s set ‘minimum requirements’ laid down by the federal governments.

So, a billing company that can demonstrate in-depth expertise on those contract’s pros & cons, can significantly influence your healthcare’s revenue flow in a positive way!

6. Can the billing company add value to your business with their ‘Fee Scheduling’ knowledge?

Medicare fee schedules are updated once every year, and when they do so, they bring a load of changes to your reimbursement values. So, it is mandatory of your chosen billing company to know the ‘widths’ and ‘depths’ of these Medicare updates. Check out medicare physician fee schedule for CPT codes in your city

An example:

Let’s say a doctor from California sees 1000 patients in a month, of those 1000 there are 500 patients who are billed under a single code, which is ‘CPT code: 99241’.

Let’s say Medicare pays $150 per claim for that code…

Hence, the total reimbursement you should receive will be 500 * $150 = $75,000.

Now, let’s consider that Medicare has revised the fee schedule for this code to $100 instead of its previous $150. Then, during your next billing you would be left with a negative difference of a whopping $25,000 as reimbursement.

…which shouldn’t come as a surprise to you if you are prepared for it!

That’s why you need a billing company that’s aware of these changes, and is capable of passing on to you the warnings – on time and effectively.

Now; these six questions should get you through the pre-subscription short-listing process of your ‘medical billing company’ hunt. Further, the remaining questions will help you filter down your choices, based on their services/offers and your organization’s specific needs.

7. Do they have ‘Certified’ coders taking care of your coding needs?

About 80% of rejected claims are the results of wrong coding!

Under-level coding and general coding can leave constrains on your revenue flow, so, ensuring if the billing service providers will handle your coding processes with certified coders should be on the top of your need-to-do list.

Coding to the highest level of specificity will help you get the most for your services. So, that’s what the billing company must be proficient at.

8. Do they utilize ‘Specialty Specific Coders’?

While any experienced billing company can boost your productivity to a certain degree, a professional with expertise in your ‘specific specialty’ can do even greater good for your organization.

And a billing company with a collection of ‘specialty specific coders’ can potentially shift your revenue graph north almost instantaneously!

9. Do they offer ‘EMR Specific Billers?

Why EMR specific billers? Because, they can fit right in with any EMR the doctor is currently using.

Most common issue that the doctors face when having an in-house billing team is that they aren’t tech-savvy enough to handle claim operations through the EHR/EMR chosen by the doctors. And doctors aren’t trained to handle the revenue processes, but, only in treating the patients. This often leaves a void at the business aspect of a medical practice.

So, when a medical billing company offers EMR specific teams, you can rest-assured that your claim submission processes will see a massive boost. As an added bonus, these experts will be able to better navigate across the EMR software allowing them to effectively export revenue kpi performance reports.

End of the day, it is important for every medical practice to keep track and analyze their past week’s/month’s revenue performance, isn’t it?

Here’s how a sample for to help you question an eClinicalWorks RCM company on it’s workflow

10. Will they offer ‘Patient Eligibility Verification’ services?

Medical practices being aware of patient eligibility saves a lot of hassles when it comes to patient tracking & payments further down the line.

As missing out on eligibility verification prior to patient visit can leave you revenue-vulnerable it becomes a mandatory process, but, one that takes a lot of effort and dedicated resources to handle. So, when a billing company can offer it for you, it’s an advantage you wouldn’t want to miss.

Advantage of patient eligibility verification…

Allows you to be aware of the patient’s payment responsibility ‘estimates’ ahead of the treatment
Also, patients can be intimated of these estimates beforehand, helping them be prepared or keep their options open as they make the visit

Thus, you are more likely preventing most of patient payment issues, (especially the ones due to patients being unaware or incorrect about their insurance coverage).

But, we must all agree that insurance information is often confusing and is likely to change often. So, keeping patients aware of their coverage plans will allow them to make payment on time, which most patients want to.

Compare the billing companies insurance eligibility verification process with this sample report

11. Are they having separate teams for handling claims, rejections and denials?

Reimbursement models are continuously evolving, and medical billing companies can provide you with the most expert solution to tackling current claims, rejections and denials scenarios. However, what you should be looking for is how well they are equipped for meeting future needs as well.

Choosing a billing company that has individual teams to handle different sects of revenue cycle can ensure that they are well equipped to tackle the evolving trends quickly and efficiently.

12. How transparent are their reports?

To begin, let’s question yourself; was your previous medical billing company producing revenue reports that you were able to review on a regular basis?

Where you able to retrieve ‘specific’ details from these reports?
Where you sure of the accuracy of those produced reports?
Where you able to compare the sent reports with the industry’s standard benchmarks?

Well, these are all part of the components that affect your company’s financial growth; and only a billing company that can offer these reports ‘transparently’ can allow you to achieve maximum financial growth.

Note: Now that the mobile applications are ruling the technology world, does your biller offer opportunities to produce reports through mobile apps?

13. Is the medical billing company offering any dedicated revenue reporting app/platform for the organizations to keep track of their revenue whenever needed?

Today’s environment demands vast knowledge and expertise in handling reimbursements. Certain companies may counsel different technologies to meet both regulatory requirements as well as your specific needs.

From practice management tools, billing system to different IT solutions, however, certain billing companies offer dedicated platforms and revenue reporting applications. These companies should be able to better integrate your revenue setup such that the collection process is more effective.

14. Can they offer benchmarking services to track your doctors’ productivity levels with other doctors in the area?

Conducting benchmarking on regular basis will help track the progress of physicians in your group practice. Assessing and comparing performance metrics will allow you to test your standing on the industry’s standards.

Why benchmarking is important?

Because, it is one of the best ways for finding problem areas and opportunities

15. Do they offer patient billing services?

Who follows up when a patient doesn’t pay his/her bill?

A medical billing company that can correspond with your patients, who don’t pay their bills on time and/or handle your organization’s similar billing concerns, can become a valuable asset to the business.

As, outsourcing to such companies will help optimize your revenue collection practices significantly!

Check out their collection techniques. How do they follow up with? A sample procedure:

16. Are they engaging ‘Insurance Specific Calling Teams’?

How import is it to have dedicated calling teams for different payers?

Primary reason for opting for insurance specific calling teams is that with experience they know what the fine prints say. They know what the reasons behind different denials and rejections would be. And they know how to answer in the language of (how to handle) the particular insurance company.

And since over 30% of most practice’s revenue comes through AR, a payer specialized service will be more efficient at collecting than a general biller.

17. Is the billing company ‘HIPAA Compliant’?

Handing over your patient’s medical information to other third-party organizations is a huge responsibility as you become liable for legal issues.

So, ensuring the billing service provider is HIPAA (Health Insurance Accountability and Portability Act) compliant is a must. Privacy, security and confidentiality of the protected health information (PHI) must be practiced rigorously.

News like the ones below should alert you on doing a rigorous check:

18. Are their teams well-versed at mapping codes from ICD9 to ICD10?

Like already discussed a number of times, since the healthcare billing regulations are changing rapidly, it is vital to ensure that the billing company you are opting for is playing an active role when it comes to healthcare revenue cycle management.

You should look up for information on how the company is staying updated with these changes and how effective their ICD10 coding service is.

Now this is what I mean when I said well-versed in mapping:

19. Will they be providing ‘RVU Analysis’ specific to your healthcare organization?

RVU analysis allows you to determine the performance of your individual physicians based on their contribution to the organization.

Since it is consistent across the nation and is vetted by specialty societies; they are much more appropriate for benchmarking when compared to other values. (Example: Charges are arbitrary, costs are often unknown and encounters don’t show the intensity.)

A professional billing company offering this service can automate the evaluation process for you.

And, here’s what you need for RVU Analysis and how it comes up:

20. Do they offer ‘Contract Negotiation’ services to maximize your revenue?

Improper contract negotiations have known to hold down 10-30 percent of a business’s revenue; however, an expert in the field can help negotiate aggressively and yet maintain a formidable balance with the payers.

The process of contract evaluation and negotiating is complex, and frankly most of the staffs in a healthcare organization wouldn’t have the time or expertise to handle it.

From auditing Explanation of Benefits (EOB) to scheduling renegotiation reminders and verifying termination deadlines, there are a lot of painful steps involved with contract negotiation.

A fine way to tackle it would be to let the billing company handle this process entirely. Outsourcing it can potentially increase your revenue, and save you a lot of time while at it.

21. Would they assist the medical practice in ‘Credentialing’ with a specific insurance company?

After long hours of documentation, regular follow ups and lots of ‘on hold’ minutes, you can finally expect to get credentialed (in-network) with the insurance panel you want to be a part of.

Or you could have someone else help with all the meticulous procedures and simply get on with getting your credentialed… Ok’ed!

22. Do they schedule weekly/monthly governance meeting?

A major benefit of hiring medical billing services is that they will be having better business insight when compared to the provider’s team. This should allow them to provide valuable feedback on how your organization is performing and how it can be improved.

Would you rather prefer a one-page statement each month?

But, a billing service provider who organizes weekly or at the least a monthly governance meeting should allow you to handle billing issues better by giving you valuable feedback on the business part of your medical practice.

Doctors and the billing company can have a discussion to come to the next step of action and improvements required.

23. Are they having teams who can manage ‘Patient Support’ and ‘Patient Portal’ to assist you with patient management?

Offering alternate ways for patients to keep in touch with your healthcare adds value to your organization. They will appreciate communicating with the providers, being able to keep updated in-between visits and the convenience in general.

Likewise, providing patient portals for better overall patient management is a welcome accessibility not just to the patients but the physicians themselves. From setting up appointments, to asking and answering clear and pointed questions (where email volumes would be problematic), these portals are very effective.

But, they also mean setting-up dedicated additional resources both technology-wise and staff-wise. This could add on to an all already complex revenue management.

Then, there are some billing companies who offer these service as well; with dedicated teams to handle them expertly.

40% of patients have no idea of patient portal benefits
49% said their doctors have portals
11% said their doctors don’t offer portals

This is the first roadblock to using a portal. So if your billing partner can help you in creating a plan to make your portal usage a success, it would be an icing on the cake.

And Remember:

What must be considered is that as the no. of rendered services increase, so does the cost/fees. The healthcare practice must engage a proper balance by considering their in-house proficiency and the billing company’s expertise to work out a cost effective, performance-centric solution.

And, keep in mind, that you get what you pay for. Lower costs aren’t always the better option, and a lower fee of smaller bottom line doesn’t always save money!

Are Your Front Desk Collections Helping or Hurting Your Practice?

July 20, 2016 by Ango Mark Leave a Comment

It is possible, depending on the practice size, you could be missing out on up to $100,000.00 dollars each month with little effort. Is this startling news to you? Have you done an analysis of what you should be collecting for co-pays? Have you compared this to the actual collections?

Co-pays

Co-pays are an integral part of the managed care program. You get a capitation check each month for the members you have in your practice. You are then expected to collect that co-pay for each member as they use your services.

YES, I said “EXPECTED.” These co-pays are contractual obligations made by the patient when they signed up for their care. The managed care program is expecting you to be collecting this fee every time they are seen for a covered service. They base their fee reimbursement and your capitated check, in part, on those monies.

In many practices I have analysed, the front desk does not even broach this particular subject. Why? Usually, because there has been no expectation of this collection explained to them. This is a subject that must be explained and taught upon hiring and periodically reviewed both through observation and formal educational activities later in employment.

Educating patients is mandatory

The specific amount of patient education that must be built into this. Many patients do not know or understand what a co-pay is. Gentle explanations with reference to their insurance cards for guidance can usually clear this up. Explaining the importance of payment AT THE TIME OF SERVICE is the one concept that MUST be emphasised. This is many times exactly how the contract is written.

Think about this fact: It cost you approximately $8.45 to send and collect on monies owed. The more notices, the higher this figure goes. When co-pays are $5 or $10 you are losing a lot of money. When co-pays are higher, there is still a financial loss that could have easily been avoided.

This article will help you achieve your financial goals by pointing out the tried and tested methods that successful group practices follow.

Stressing contract law is not the way to go, but mixing this information in with other things the patient can do to utilize their insurance to the best of their ability is a good first step. Writing reports and analyzing the biggest managed care programs your office works for is the beginning of the process. Medical Billing Services can help with running and analyzing these reports.

Nowadays these companies are capable of working with several popular EMRs, such as eClincalWorks™, NextGen™, ADP Advancedmd™, Greenway™, Care 360™, Allscripts™, AmazingCharts™, Epic™, and several more. Once you know who the payers are, putting together patient literature can easily be accomplished with your insurance representative from that plan. They may even have information ready to go in flyers for you.

At MedicalBillingStar We can go a step further and assist with the training of your personnel and write scripts that are effective, professional, and consistent across the board with each employee in the office. We are here to help!!! Collecting money legally due to you is why we are here! Give us a call to see where we can assist today. MedicalBillingStar can bridge that gap between the payers and doctors office collections team.

8 Hospitals bankruptcy facts, know to avoid!

August 13, 2015 by Ango Mark Leave a Comment

“We shouldn’t feel sorry for ourselves. A lot of us say, oh my God, how could this be happening. Look at all the unpredictable things happening all the time.These are happening in every industry.”Michael Dowling, CEO of Great Neck

This June didn’t work well for some healthcare systems. Many hospitals struggling financially for years were forced to announce their failure. What could have made these hospitals suffer major revenue losses and file for bankruptcy protection? Let us check the most recent ones who had to face such setbacks and challenges and what you can learn from them.

5 facts I bet you don’t know about Kona Community Hospital!

The hospital announced that it would be eliminating 34 positions and shutting down its 18-bed skilled nursing service according to KHON
According to officials, a contingency plan to file a $6 billion budget shortfall which came partly by increased costs of collective bargaining and retiree health benefits resulted in planned cuts and closures.The costs were paid by the state in the past.
KCH had to face reductions also due to the Hawaii Health Systems Corporation(HHSC) corporate-wide reduction in force and services which was targeted to address a $50 million projected deficit for the entire HHSC system for the FY 2016.
Employees who lost their positions due to layoffs will be placed in a budgeted vacant position.
The 18-bed skilled nursing unit could be reopened in the future if required.
What made Victory voluntarily file under Chapter 11 of the U.S. Bankruptcy Code?

On June 12,2015,the Texas based Victory Healthcare which manages six for profit medical and surgical centers, filed for Chapter 11 of the U.S. Bankruptcy code. Nobilis, a Houston based health system agreed to take over Victory Medical Centre in Plano, Texas for which Victory has reached the court to accelerate the sale. Victory stated it has “many interested buyers for its centers”.

Victory Medical Centre Beaumont and Victory Medical Centre Houston-East are the two centers not included in the filing. These centers don’t need the court process because they have buyers in place.

“We had built an extremely high quality, state-of-the-art group of community-centric medical centers and hospitals,” said Robert N Helms,Jr.,Chairman and CEO and Manager of Victory. “Unfortunately, as out-of-network providers, we came under attack by large insurance carriers. Even though we were able

to execute in-network agreements with three large insurers, the extreme slowness and lack of payment from the carriers constrained liquidity significantly.”

To overcome these challenges, Victory had to cut down on expenses, reduce services but they did not close their emergency rooms.Mr. Helms said, “Unfortunately, now we have no other choice except to sell our facilities with the intent of remunerating secured and unsecured creditors alike.”

Some information about the filing:

Parkview Adventist files for bankruptcy, eyes for merger!

The Brunswick, Maine based medical centre on June 16,2015 filed for Chapter 11 bankruptcy, reported by WCHS6.Randee Reynolds,Parkview President said, “This is not a shock to anyone that’s been here at Parkview. You can only go so far.”

According to officials, the healthcare system, after struggling financially for years, closed its inpatient care and emergency department.Mid Coast Health Services will be getting these 2 services on merger and it will also employ its 180 FTEs.

Brief information about the case filed:

3 lesser known facts about Palomar Health!

In a 5-2 vote by Hospital directors on June 24, the Escondido, C.A. based Palomar Health Downtown Campus is set to close and shift its existing patient care to sister facilities in 90 days.

This downtown campus which has 850 people working, houses labor and delivery department, inpatient rehabilitation, behavioral health care, a reserve emergency care and few outpatient surgical services. The Poway based Palomar Medical Center and Pomerado Hospital will be taking over those services.
Following the patients to the new Poway facilities will be the clinical workers such as nurses and technicians, while those losing their jobs will be support workers. The Palomar’s CEO estimates that between 60 & 75 FTEs and an added 180 to 220 “per diem” part-time workers have to give up their jobs.
As reported by The San Diego Union-Tribune, due to $20 million operational losses a year and requirement of more than $162 million maintenance costs, the healthcare executives at Palomar recommended closing the downtown medical centre.

What forced Kindred Hospital to target layoffs?

Following the end of Kindred’s lease in Natick by MetroWest Medical Center, the hospital in Boston is aiming layoffs as reported by the Boston Business Journal.

On June 26,2015 the 60 person Kindred hospital, which is part of a larger organization of transitional care and other types of hospitals, closed formally soon after its master the Metrowest put an end to the lease

“We explored several options to move Natick to another location, but determined it was not feasible,” said Amber Hester, Chief Executive Officer at Kindred Healthcare. “We are confident that we will continue to serve the community through our other Kindred hospitals in Boston, Stoughton, and Peabody and our additional lines of service.”

“Almost half of the workers at Natick got jobs at other Kindred centers in M.A.”, Ms, Hester told the, Boston Journal .And her healthcare organization continues to work with employees on finding appropriate jobs.

Kindred is well known for reducing admission rates by 8.4% from 2008-2011.

Why Partners Health decided to cut jobs, closures?

1.In the reestablishment of the NSMC wing of Partners healthcare, all the inpatient services located at Community Hospital will be consolidated at the Salem Campus over the next three years

2.The North Shore Medical Center will rebuild the emergency department, provide,additional 58 beds and 50 new beds for behavioral health.

3.The hospital executives said this plan will target 100 jobs.And they believe to achieve the job cuts through attrition rather than layoffs, according the reports.

4.There’s no date set by the officials for closing the Lynn campus hospital.But the emergency department will be there for over 3 years, and a medical practice with the strength of 16 physicians will stay there.

5.Local residents have opposed the decision to close the hospital as they don’t want to see critical medical services shut down. However officials at NSMC believe that this approach would improve patient care at the more advanced and wide ranging Salem campus.

6.The Union hospital was finding it tough to attract patients and thus couldn’t afford to employ specialty care, particularly doctors who specialize in different cardiology types.

7.Due to Medicare and Medicaid insufficient reimbursements both Lynn and Salem lost more than $20 million last year according to Robert G. Norton, president of North Shore Medical Center. Of the patients visiting the Centers, Medicare and Medicaid patients are about 60%.

8.The losses by NSMC over the years were subsidized by Massachusetts General, Brigham and Women’s, the organizations successful wings.

9.One major reason of the medical centers’ plan to close came from,Partners putting their decision on pause, to acquire Hallmark Health Systems.The expected cost savings with the consolidation is to be $18million per year.

Why did Jameson end its Maternity services?

On July 23,2015 New Castle,P.A. based Jamison Hospital announced that it will no longer be providing maternity services with effect from September 1st.

One of the reasons is the uncertainty of the merger of Jamison hospital located in New Castle into the UPMC network. In February the merger was given a formal nod. The officials were expecting the much needed regulatory approvals from Pennsylvania Attorney General, which didn’t happen.

The childbirth services were maintained appreciably well only by two obstetricians for over nine months. It forced the hospital to close its childbirth services when one of the two obstetrician decide to shift her practice to another hospital.

If any OB services arrive after September 1st to the emergency room, the team at Jameson will assess,provide emergency care and transfer appropriately.

The additional staff of childbirth center will be offered to bid on positions available in other wings of the organization.

Michigan’s only independent hospital files for bankruptcy!

In their chapter 11 petition filed last month in Detroit, the Pontiac based Doctors Hospital pointed debts between $10 million and $50 million

The doctors hospital was unable to bear the financial losses it received between 2009 to 2013.The physician-owned hospital listed a loss of $11.9 million on net patient revenue of $63.8 million, the latest financial data available, according to the report.

The hospital tried to cut expenses all these years by shutting down its emergency department in October 2013 and targeting 40 layoffs out of the hospital’s 200 employees.But the hospital couldn’t do more to prevent losses and is now under pressure from its investors.

An example of how a petition form looks like:

Pro Tips:

What forced these healthcare organizations to file bankruptcy, target layoffs and service closures?

Attack by large insurance carrier on out-of-network providers
Struggle to attract patients,
Low Medicare & Medicaid reimbursements rate
Uncertainty or failure of a merger.
Shortage of specialists such as an obstetrician or cardiologist
Consecutive revenue loss and pressure from investors.

There could be more reasons to force the executives to close a service, file for bankruptcy and target layoffs. When it comes to cutting operational costs, get your employees to identify cost saving opportunities and reward the ones who come with best ideas.

The slow payment process of payers creates a massive revenue backlog. The payers have to implement strategies to improve their payment process.

4 tips from organizations which experienced value of growth from mergers:

Combine a growth strategy of acquisition and new development.
Analyzing acquisitions for all the pieces of coordinated care will help you determine the results.
To form a single system culture compare centralized system leadership with site-based local leadership.
To fit the organization’s mission, vision and values learn how to identify physician partners and potential hospitals

Healthcare organizations have to take a chance to invest in the expansion of a specialty line. Though the investment is more it will provide valuable care and boost the revenue of the center. Organisations who rely on two or three specialists will be forced towards service closure.

For hospitals that face consistent revenue loss, the best choice would be outsourcing the revenue cycle management to a service with proven expertise.

What actions are you going to take to assure you don’t get listed as one of these hospitals?

How telemedicine can be a cash cow for your hospital?

August 26, 2014 by Ango Mark Leave a Comment

Is telemedicine an answer to the healthcare financial future?

The transition of payment from a service based model to a value based mode can make telemedicine to become a fix for a healthcare’s financial issues. Telemedicine has the possibility for transforming outcomes for certain patients such as the ones with chronic illness.

Telemedicine can also help in Sepsis, the top issue of the healthcare services!

Sepsis the top issue for any healthcare services can cause about 6% worst outcomes in every hour of delay in treatment. Randy Moore president of Mercy Virtual says “Turnkey telesepsis can speed up the recognitions and treatment, enabling his hospital to decrease mortality by 50% and cut costs per case by over $8000. So if the outcomes are not worse for the patients, the money saved revamps the operating margin.

What if telemedicine matures? Where are the future aspects?

As telemedicine may go through the roof, it can become the top cost saving platform for all hospitals. Smaller healthcare systems that don’t have the capital to make telemedicine feasible may join hands with bigger healthcare entities. The quality of care will improve and the cost can be cut by sharing treatment of specialists. Providing healthcare services outside institution can lead to increased revenue, such as telestroke treatment for non hospital systems.

Telemedicine could get US. companies $6 billion of savings annually!

The study done by Tower Watson’s 2014 healthcare changes on U.S. employers with 1000 employees shows the below report:

37% of the employers who responded to the survey said they can offer telemedicine services by 2015.

34% of the respondents they consider to offer services by 2016/2017.

22% of the respondents currently offer telemedicine consultations.

The overall report suggests that the percentage of employers offering telemedicine services is expected to grow from 22% to 37% which represents a 68% increase. Thus in order to generate the big figure of $6 billion employers with their partners will have to replace the face-to-face doctor interaction by telemedicine services.

Three question which still haunts every individual in healthcare services:

How to change the patient and physician mindset?

Will a healthcare plan show its willingness to integrate and reimburse this service and if yes then what do you think?

How many healthcare services you know or will adopt a virtual centre for telemedicine?

Generate more revenue and increase your medical practice’s footprints

August 11, 2014 by Ango Mark Leave a Comment

Position your medical practice as a market leader!

Great! Physicians have finally realized that they will have to move beyond the traditional approach towards practicing medicine and become savvy businessmen as well. All that murmurs and complaints have died down. The writing is on the wall, it is smart physicians who can also be mean businessmen who can survive.

And physicians are not half as pathetic as businessmen as most people would like to believe. The tremendous efforts medical practices take to position themselves as leaders in their specialty or niche is proof enough that physicians are savvy businessmen in their own right.

What are the best ways to increase the authority and reach of your medical practice?

There are several ways you can ensure your medical practice is a step ahead of the competition. And most importantly, to end every day on a happy note, despite mounting financial pressure… So what is the secret behind insanely successful medical practices? Apart from best of class medical care there is a lot more healthcare professionals need to do to have a firm footing in the industry.

This may sound clichéd and you’d have come across this a million times but these tips to increase and expand your authority and client-base also explain how to break a complex process into small, bite-sized pieces!

These are the areas you need to be focusing on…

There are no two ways about it- increase patient engagement

1. A strong social media presence

2. Cleverly designed marketing strategies

Here is how to increase patient engagement!

Providing undivided attention to patients during a visit is one of the best ways to engage patients. Automate tasks by using apps to record encounters, outsource or automate tasks such as transcription and documentation of medical records. Most EHRs come with full featured patient portals and walking your patients through it will increase patient engagement.

Dissemination of information is vital. Providing electronic access to medical records to patients will help drive up patient engagement and also make them more involved in their healthcare.

A clinic based in Cleveland allows patients to input their health information into the clinics patient portal. It doesn’t take a genius to figure out that it is a great move by the clinic. It reduces patient information errors, increases engagement with their health and saves up precious staff time!

Time to go social!

Having a strong social media presence is vital to stay on top of the game. Hire experts or step up the effort and time you spend on social media. One sure fire strategy to grab eyeballs is to add pictures and videos to your Facebook page or Tweets. Share information about latest healthcare updates, drugs, equipment or experiments specific to your specialty and organize regular surveys and polls.

It is the quickest and easiest way to position yourself as a leader in your niche. Be responsive. Mention names and Twitter handles to show that you are paying personal attention and be prompt with replies, always!
Have a marketing plan…

Medical practices hardly spend time in marketing efforts. It sounds almost gross to physicians. But to gain a strong toehold in a fiercely competitive industry, getting on the marketing bandwagon certainly helps. Distribute pamphlets or drop flyers at your neighbourhood supermarket during the flu season, school physicals etc… Have a toll-free helpline for patients to reach you at all times. Have a strong recall system and scheduling plan.

Conduct regular market assessment studies to know where you stand and what could be the best way to leverage your strengths. Maintain an implementation, process and results log to track the implementation and end result of your marketing efforts. Spruce up your website and contribute to healthcare journals, magazines and e-zines.

Post your contributions and that of the physicians who work with you in your website and notice board. It will build credibility.
Nothing beats freebies!

Here is the secret sauce. Provide free screenings, health camps, blood checks, BMI checks and blood pressure screenings every few months. This will get the word around and help in “brand” recall.

Organize health awareness seminars and summer camps for kids. Being known as the friendly doctor down the lane is probably the best marketing tactic, afterall!

Patient Eligibility Verification! Different voices across the spectrum

August 4, 2014 by Erika Regulsky Leave a Comment

How important is patient eligibility verification?

Are patients aware of co-pays or what if the doctor asks his team to adjust the co-pays while billing?

What if they are not aware of deductibles?

Here are a few opinions of those in the healthcare industry

Judi Birch a Risk Assessment Specialist, Certified Professional Coder from Pennsylvania says “ There are certain times that it is more important to verify eligibility. New patients, patients who have not been seen recently and at the beginning of each calendar year come to mind. My experience has been to always verify eligibility on Medicaid insurance since there can be changes at any time. Patients should be, and usually are, aware of co-payments. There are always those who act like they are unaware. A provider is technically breaching his contract with the insurance company when Co-pays are waived. When I have explained this to providers, they love it because they can “blame the insurance” when refusing to waive it. It has been a long time since I have seen a provider not expect payment of co-pay at time of service. Many make the patient reschedule, especially if they have a habit of showing up without payment. Deductibles-An excellent reason to verify eligibility! A good billing team will be willing to educate their customers about their individual plans. This takes a little extra time, but pays off with patients taking on responsibility because they have a better understanding of their policy.”

Michelle Uhl a professional in Revenue cycle management/CPC from Maryland says “Co-pays must be collected they cannot by law be written off same goes for deductibles. That breaks the physician to insurance and patient to insurance contract.”

Mary Strange a professional in Medical Practice & A/R Management from Kentucky says “Always, always verify eligibility is my motto. The more informed patients are about their benefits and financial responsibilities prior to services being rendered can decrease the patient’s concern about financial issues and allow the physician and the patient to focus on the care being provided. As a secondary benefit (because the care of the patient is the most important thing), it allows the practice to increase revenues and decrease A/R days by increased collections of deductibles, copays and co-insurance ahead of the services being performed and decreasing denials of claims after billing. Patients do appreciate being included in this process and it allows them to get well without the added worry of how to pay their bills if they know what to expect and if financial arrangements are made in advance of their services.”

Inay Hernandez a Billing Specialist at Citrus Health Network, Inc from Florida says.”Checking patient eligibility is crucial. You should do it while you are scheduling an appointment, this way you are letting the patient know about deductibles and/or co-pays. When billing, if possible, check eligibility to avoid future denials for invalid member id#, DOB, policy termed, etc. Always pay special attention to TPLs (if billing Medicaid, Medicaid HMOs or MMAs)”

Nikki Carlson a professional in Revenue Cycle/Practice Management, Medical Billing/Coding, Training & Development, Electronic Health Records from North Carolina says “Eligibility verification is very important. Revenue gets lost in a variety of ways, but front desk personnel not collecting the correct co-pay amount is a big one. For instance, a very large hospital/physician office system here in the Raleigh-Durham area has consistently asked me for my “$15 co-pay” (what it says on the card) when in reality my co-pay is $25. This indicates to me they are just looking at the card and not verifying benefits. Another scenario is with United Healthcare (and I’m sure other payers as well)…where they list a certain co-pay on the card, but it is not the “real” co-pay. UHC has a “premium provider” plan and if a patient sees the premium provider, they pay the co-pay amount listed in the card, however, if they see a non-premium provider (and that is way more common than the former), they pay a higher co-pay that is not seen on the card. The only providers who know about this little secret are generally the premium providers (and again, there aren’t many, at least not in my network/area), and the providers who check eligibility, and are aware of these co-pay rate fluctuations based on provider status with UHC.”

Daniel Figueroa a CBCS, CICS, CPAT, CPB, CPC professional from Florida says “ Inspirational and Motivational Speaker, Trainer, Mentor, Support Manager, Leader, Medical Billing & Coding Professional: Checking eligibility is one of the most important roles in the medical practice, if not done correctly it will cause a domino effect in reimbursement, and attempting to collect monies owed and or additional information is time consuming. Its important to do it right in the beginning, Remember people change jobs often or lose their job due to financial situation in the company, so always ask if they are still insured with their current insurance carrier. Collect any co-pays and or co-insurance due to the practice so the patient does not have a running balance when they come to the office again. Always verify if its an injury or illness, so you can bill the proper insurance carrier; example workers comp/auto/liability etc.”

Mary Stark an Administrative Assistant Customer Service at Casey’s Cookies from Florida says “Patient eligibility is very important. If the patient’s benefits have expired, you can contact them to make the patient aware. Some patients are aware of co-pays while others have to have them explained. The doctor & his team could adjust the co-pays while billing but many insurance companies have banned waiving write offs because of lawsuits, jail etc .The deductible is an amount that gets paid throughout the year.”

Jennifer Bevak a Student at Ultimate Medical Academy from Pennsylvania says “Checking patient information at the beginning of the registration is very important. This is where you explain to the patient that they have co-pay, and to see if their medicare deductible has been met. This also gives the patient a chance to ask any questions about their insurance they do not understand and you can explain to them, they also have the chance to ask questions about the practice. This is very important to make sure you gather all the information from the patient so that you can check eligibility because if there is a problem, you can let the patient know and then all the concerns can be taken care of right then and there.”

Doreen Boivi an owner at Chiro Practice, Inc from Portland says “ Simply said and to repeat – It is important to verify eligibility. New patients, patients who have not been seen recently and at the beginning of each calendar year. My experience has been to always verify eligibility. This will plug up a huge hole in revenue for over the counter collections.”

Maureen Landry a Patient Account Representative III at Novant Health from North Carolina says “Verifying benefits is very important. And it needs to be done before Every visit. People change jobs all the time and just because they came in last month with say “Cigna”, does not mean they have Cigna today. My motto is to verify eligibility/benefits Every time they come in for services. Not doing that can make or break a practice. Oh ya, writing off co-pays is a breech of contract and it is illegal. Whoever does that, better hope they are not audited. 🙁 Remember, Medicare is planning on paying for services for the next 10 years by auditing and taking back all monies that should not have been paid. How long before the other insurance companies do the same????”

Virginia Vickie Rocha Ortega who works at Medical Billing Healthcare from California says “Very very important to the claim billing process Timeliness. Clean claim submission. Prompt payment process keeps from billing incorrect ins companies that could hold claims rejects from piling a backlog in laisun paid.”

Monica Sanchez, an MBA, RHIA, CCS, ICD-10 Senior Consultant at MonuMed Revenue Solutions from Texas says “The belief that verifying eligibility is not important can have negative impact on your cash flow. Patients put the responsibility on the doctor offices to ask for the appropriate payment upfront. Let’s face it; many patients are not benefits-literate. They just accept what the front office tells them. So, if the receptionist says they own $20, they pay. If she says they owe $0, even better. One thing patients will fight is when they get a bill for a payment that was never even attempted to collect due to the negligence of the office staff at the time services were rendered.”

Jeaninee Gomersall an EHR Activation Specialist at University Hospitals of Cleveland from Ohio says “Eligibility should always be checked prior to an appointment. Co pays are often found in ID cards as well. Staff should be trained how to read eligibility responses and then ask for the appropriate co-pay at the time of service. Co pays are due up front. Shouldn’t have to spend any more money to collect them.”

Phyllis Cupil a medical Records and Health Information Technology Professional from Illinois says”Medical biller/medical office specialists are required to let patients know about co pays before being seen by the doctor. write offs are allowed, but im not sure about how it works or how many annually.”
Erika Regulsky a NextGen EHR consultant from Florida says “The healthcare landscape is constantly shifting and patient payment responsibilities have increased. A thorough insurance verification process is half the battle won. The cost of resubmitting claims is very expensive so it is essential that medical practices pay a lot more attention to their patient insurance verification process.”

These are the comments from healthcare professionals . Do you agree that a skilled and knowledgeable team can help you in reducing patient eligibility verification mistakes?

Nextgen becomes more interoperable now!

June 13, 2014 by Ango Mark Leave a Comment

Surescripts announces that it can now share medical information between varied technology platforms:

The healthcare industry is becoming more interconnected. There is nation-wide demand and awareness for more interoperable systems. Surescripts a national clinical network that connects pharmacies, insurers,
physicians and integrated delivery networks (IDNs) announced that it is now capable of securely sharing healthcare information between varied technology platforms. It is certainly a huge step ahead for the medical care industry…

For more information, here’s what NextGen Healthcare release says..

Are you worried about HIPAA audits? Tips to come out unscathed!

June 3, 2014 by Ango Mark Leave a Comment

Don’t let a HIPAA audit catch your practice off-guard!

HIPAA audits are painful and unwelcome. But failing an audit can be a disastrous and a huge blow to the reputation of medical practices. Despite guidelines being formulated every other day, there is, very little coordinated effort being taken by healthcare organizations to meet them. Failure to prepare is preparing to fail.

Put these ten tips into action to prevent your medical practice from penalized by auditors. It is a team effort so rope in employees and make a cohesive effort, to stay HIPAA compliant. There are lot of plates spinning and deadlines to meet. So it is important you chalk up a plan and tick things off a checklist to stay on track and move towards complete HIPAA compliance.

Run a thorough end to end risk analysis check across the entire organization. Check your documentation management and informational security policies.

Devise clear cut policies such as passwords for accessing information and that all images such as scans are securely encrypted.

Invest in workforce training. Conduct regular workshops for all your employees on operating procedures and security protocols.

Monitor closely if all the newly implemented procedures are working in the first place. Check and re-check the progress of each strategy created to meet HIPAA guidelines.

Keep clinical documentation updated and maintain a report of your security procedures and documentation. This will help when auditors ask for evidentiary documents.

Create a contingency plan. In a landscape that is constantly shifting things may not play out the way you plan. Having a plan B is important too.

Revised HIPAA guidelines place emphasis on business associates and subcontractors being HIPAA compliant. Discuss with your business associates about the security measures they have to follow and keep tabs on the physical and informational security they provide.

The economic liability of data leaks has increased to over two million dollars which is $400,000 dollars more than in 2010. So pull up your socks and start working towards HIPAA compliance, now.

Laptops and paper based records are the major reasons of data breaches. Almost 202 cases of data breaches due to stolen or lost laptops have been recorded according to a 2014 survey. Prohibit employees from bringing laptops or digital storage devices to office.

If you work with a business associate and need to share medical information insist that your partner has a secure VPN connection to transmit and receive medical data.

5 ways hospitals can reduce their physician shortage rate!

April 4, 2014 by Ango Mark Leave a Comment

Is your hospital facing a shortage of physicians?

The country has been hit by massive physician shortages. Bureaucratic pressures, financial constraints and the sheer pressure of offering medical care while trying to deal with complex electronic systems, have forced physicians to retire early. Recent studies suggest that the shortage will only become more acute over the years.

Retaining physicians and providing a healthy environment to work in has quickly become the biggest worry and challenge of hospital CEOs. Physicians quitting their jobs and leave can lead to dissatisfied and confused patients.

5 ways to improve physician retention…

The magic of a shared vision!

There is nothing that works like teamwork! Explain about your hospital’s goals, aspirations and vision for the future. Let new recruits know beforehand the patient population they are most likely to handle and the volume of work per day. Being transparent can invoke trust and make physicians feel a part of a team and not well-oiled machinery.

Provide administrative support…

The deluge of admin work every single day can catch most physicians, off-guard. Delegate staff to junior staff, hire scribes or outsource tasks such as billing and transcription. This can, not just unburden physicians but also cut down on administrative expenses.

Perks matter!

To make physicians stay longer offer perks that most competitors don’t. Profit-sharing options, paid holidays, fitness and entertainment space, allowances, lesser working hours and a positive work atmosphere and culture, can stop physicians from looking for other employment opportunities.

Is there space for professional development?

Every healthcare professional likes to grow, to fledge. An environment that stifles their growth and wears them out means they are going to quit sooner rather than later. Include professional development activities such as conducting regular workshops, seminars, group discussions etc… This will not only ensures your employees are actively involved, but also, more aware of current healthcare regulations. A working environment that is conducive to growth can make physicians stay back longer at your hospitals. It is not just perks and incentives, but the fact that they can navigate tricky learning curves with your organization that will help them stay put!

Offer EMR training!

The major reason for befuddled and disgruntled physicians is complex EMR systems. Hire EMR consultants and experts to train new physicians. Manuals and discussion forums can only be of so much help. Hiring someone to offer remote or on-site EMR guidance to new recruits will prevent them from feeling lost and increase productivity at the practice.

Join The webinar

Lisa Maciejewski-WestCMC, CMOM, CMIS, MCS-P