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The EMR Billing Specialists

Negotiation Tips to help Physicians land Better Deals

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Stung by the Recent Reimbursement Cuts ?

It is a tough economic climate. Physicians feel they’ve been backed into a corner by tough regulations and, yes, dreaded reimbursement cuts. The business side of medicine has always been scorned upon. But, now focusing on it matters more than ever.

 Negotiate tough…

Doctors have traditionally shied away from negotiation rates with payers. Drowning under paperwork and making long phone calls, are enough to scare the most persistent of physicians. But to get paid and to survive, it is important that practices negotiate tough. The effort you put in today is going to determine the tomorrow of your practice.

Getting the Facts on Paper !

Most medical practitioners make the mistake of sending out proposal letters that do not include key facts. Including a brief introduction to your practice, patient population and expectation is important.Sit with your team and come up with an exhaustive spreadsheet that illustrates your growth curve. Nobody loves facts and figures more than insurers.

What Color does your Insurer like ?

Luckily that is just one of the few things you don’t have to know. But for successful payer negotiation, knowing your insurer is important. What are the cpt codes that are more likely to be reconsidered? What are the documents your insurer might require? Every, information, is key to shorten the turnaround and back and forth phone calls.

It isn’t Mission Accomplished !

You’ve struck the deal. Time, to, celebrate and hope for better collections. But it is also important you have the details of your negotiation summarized. It will help you to inform your billing team about the changes. To, inform your patients about the revised rates. And yes it comes in handy when working on your next set of contracts.

As with all else it is a constant work in progress !

Focus on Patients to Run a more Profitable Practice

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Are your Patients Happy?

What do CQMs, recent Medicare updates and the health center down the road have in common ? An increased focus on the quality of patient care and better patient communication ! There’s been a lot of dust raised in recent times about physicians who rush through appointments.

             Being Sidelined and Neglected…

Patients repeatedly complained in local tabloids and social networking sites about long waits and unfriendly staff. Physicians groaned about the constant need to stay on top of evolving guidelines and frequent updates. It is never easy for anyone during a period of transition.

Towards a Patient Centered Practice…

A Medicare program announced recently is going to push physicians to make that follow-up call ! Doctors will be paid for following up on their services after a patient discharges. Phone calls and other forms of communication and management activities will be reimbursed by Medicare.

A Carrot and Stick Approach…

A value based payment modifier is also in the offing. It could either penalize or reward healthcare professionals based on the quality of their patient care. These updates and changes again emphasize on practices becoming more patient centered. The pressure on physicians to report more meaningful and patient centric services is escalating.

Attainable of Course !

Is it possible for medical providers to reach the benchmarks set for them ?

The upside is that ehr and emr are set to pave the way for better clinical documentation. There are more softwares and tools to track down and store information.

But the flipside is that practices need to hire additional workforce to handle data management tasks to help physicians concentrate on patient care. Working with a third party biller or data management firm can help practices contain costs. And give physicians the time and space they need to focus on what matters, patient care.

Efficient Error Reporting Systems lead to Healthier Practices

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 Be the one to take a call !

To error is human, but, to report it took super human efforts, until recently. A recent study by the Perelman school of medicine at the University of Pennsylvania, confirms that reporting errors leads to a safer medical practice.

As frontline healthcare workers, physicians fear, losing credibility or possible intimidation. And, are dubbed as, “reluctant partners” when it comes to reporting medical errors. This finding is hoped to open the doors for more open communication within a medical practice.

I’d Rather tell My Friend !

Error reporting systems in most healthcare facilities frustrate and limit physicians. Most hospitals do not have a structured reporting system, for physicians to report errors. Though all healthcare facilities have a reporting system in place, they are hardly what doctors hope for.

Not just a Fancy Asset…

The reason why most reporting systems fail is that they’re, like that vase of pansies in the reception, just a fancy asset in most practices. They don’t guarantee privacy and reporting anonymously is not an option at all. This lack of privacy can in effect harm patients and the security of patient data.

Speaking up !

As the awareness about the need for efficient reporting systems increases, it is high time that hospitals set up a system that their staff are, comfortable with. Building baseline data on errors can lead to higher efficiency and healthier patients.

Every physician setting up a new practice should, apart from concentrating on low cost insurance credentialing services , recruiting and payrolls, also set up an efficient reporting system !

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 !