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How Can Misinterpreted ERA’s Affect Your Medical Practice?

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Do you understand what your insurer says ?

Being a part of a busy medical practice means there is no time to sit and analyse. Most medical practitioners hardly have enough time to communicate with insurers.Do you know that physicians are leaving most of their money on the table ? The major reason is not comprehending or following closely what the payer says.

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An, ERA consists details, of the final claim adjudication and payment information. Being able to read between the lines is one skill that physicians need to develop to ensure they don’t get underpaid.

There are a lot many times when a physician just doesn’t know why his claim didn’t translate into a check. Blame it on inconsistent and varied payer policies. Or complicated, state specific, medical billing regulations. But the fact remains that an enormous amount of claims are underpaid or unpaid and most physicians don’t even know what went wrong.

Do you deal with workers compensation and auto injury claims ?

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Agreed it can be tough. Trying to deal with workers compensation laws can be cumbersome. The last thing you need is receiving an ERA that you cannot make sense of. The AMA has come to the rescue of physicians.

AMA has launched a new tool to help physicians make sense of ERAs better. The AMA Claims Assistant Workflow tool can aid physicians in puzzling out payment adjustments. It can help medical care providers easily locate reason and remark codes. Tackling non-payments and denied claims is going to be a whole lot easy at the medical practice, from now on.

No longer left in the dark…

What happens inside the insurer’s office has always been a mystery for medical billers. Why it is certain claims get paid and some don’t ? Why was a claim that was perfectly acceptable last summer now been given the thumbs down? Luckily physicians who deal with workers compensation billing will have an answer to these questions and more.

The Claims Assistant Workflow tool will give providers information about how a claim was processed. And what the codes on the ERA mean.

A smart way to e bill !

The tool developed by AMA also guides physicians on receiving accurate payment. And also offers several template appeal letters to help physicians appeal denied claims. It is definitely a welcome relief for over-burdened physicians and billing companies.

11 Ways To Ensure You Join The List Of Successful EHR Implementation Stories !

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Get Off to a Good start !

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To start on shaky ground can sour your relationship with an EHR forever. Being hasty can prove to be disastrous. Imagine working with an EHR that does nothing to improvise your clinical workflow. Or, being stuck with templates that take hours on end to load ? Being careful during the EHR implementation process will lead to a healthy and beneficial experience with your EHR.

Don’t get swamped by sales talk and sagely advice. Grab a piece of paper and jot down what your expectations are. And make a promise to yourself that you will not make a compromise no matter what.

Here goes with the presentation on ways to implement an EHR with successful stories !

Don’t Fumble Your Way Through EHR Implementation !

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EHR Implementation ; How To Avoid The Tripwires…

Choosing an EHR is tough. A zillion glossy brochures, well-meaning colleagues and pushy sales persons only make the decision harder. The, fact that almost everybody who owns an ehr hates it with a passion makes the most determined of physicians, back-foot.

According to recent reports physicians are reverting to paper records. And some have started looking out for another EHR. A survey by American EHR partners found that user satisfaction levels dropped from 39% in 2010 to 27% in 2012. How do you ensure your EHR implementation process doesn’t turn out to be a harrowing experience ?ehr-implementation

Know What You Want…

Most physicians rush in to ehr implementation without clear direction or expectation. Analyse your workflow and see how the inclusion of an electronic health record impacts your practice operations. Do not fall for the “you can tweak it” line. Manipulating your ehr can prove to be counter-productive.

Customizing your system is fine as long as you don’t miss out on the features and automated comfort your ehr offers.

What Does Your Front Office Team Think ?

Yes, the mousy girl who sits in the reception needs to know whether the appointment scheduling and insurance eligibility feature, makes the cut. Your coders will have to decide if the coding and scrubbing options are easy to work with.

The end users are many and you have to choose an EHR that makes everyone happy. It will increase productivity and morale.

The Person Who Matters The Most !

Your patients are the lifeline of your medical practice. Ask your EHR vendor whether they offer a patient portal. Check if it is patient friendly and secure. Enquire about the level of training and support offered. Caring for your patients is after all the best investment, ever.

Stay The Course !

Adopting an EHR is like parenting. It does get on the nerves and makes you lose sleep. But being a quitter is not going to help. Vow to yourself no matter how tough it is you will not revert to paper. Scribbling down details is easy but not the best way to work. During the implementation stage itself, promise to yourself, you will stick to your EHR.

Increased Reimbursement For Primary Care Physicians, A Closer Look !

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A welcome respite for primary care physicians !

Everybody knows that primary care physicians are struggling to stay in business. A mandate by the Affordable Care act has announced that Medicaid rates for certain primary care procedures will be paid on par with Medicare rates.

 To receive additional reimbursement physicians will have to fill out, a, state specific Medicaid self-attestation form.

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Who are covered ?

Family practices, pediatricians and general internal medicine physicians are eligible for increased reimbursement. So are several other sub-specialties and physicians who perform high levels of primary care services. The major criteria are that, physicians should be board certified and have a billing history that indicates that about 60% of their billing is for primary care codes.

The rate increase will be in effect till the end of 2014. Physicians, who’ve registered through MITS and are approved by the Office of Medical Assistance, can see more digits in their pay check from April 2013.

The code to more dollars !

Primary care physicians will be reimbursed in accordance to HCPCS codes related to primary care. Evaluation and management codes from 99201 through 99499 are eligible, as are certain vaccine administration codes.

The rough and tumble of practicing primary care…

Primary care physicians are working under heavy financial pressure. The sequestration cuts of 2013 have taken a heavy toll on medical practices. The sustainable growth rate formula has quickly turned in to a nightmare for physicians.

 Reimbursement cuts, operational pressures and complicated regulations scared the daylights out of physicians.

Quite arguably it was primary care practices that were the hardest hit. Primary care centers were soon shutting their doors as it became increasingly difficult to practice. Primary care practitioners were finding it almost unfeasible to take care of their elderly Medicare patients.

At a time when it was needed the most !

The increase in reimbursement has come at a time when physicians need it the most. The increased Medicaid reimbursement means physicians are offered a reprieve after all the financial pressures they’ve gone to.

Want a few tips to increase the revenue of primary care practices ?

Want To Save $ 23,000 ? Switching To E-Billing Will Improve Your Practice’s Financial Health

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Still Stuck With Paper ?

What is your carbon footprint ? If you are still sending out paper claims, you are felling more trees. Agreed, this is an argument that is as old as fossils. Apart from saving trees there are a lot more advantages to using e bills ! It helps to track claims easily and lessens the amount of time your insurer takes to sign your check.

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Save More Dollars !

According to the American Medical Association submitting claims electronically can save a practice 55% of its claims submission costs. The AMA further states that physicians stand to gain above 23,000 dollars a year by switching to electronic claims.

Electronic billing also reduces the TAT of insurers. The overall efficiency and cost effectiveness of the process is just what overworked medical practitioners need. Paper claims are time consuming to generate, transmit, and maintain a record of. Electronic bills are quite simply put, the smarter way to bill !

Joining The e-club !

According to a recent survey of America’s health insurance plans the usage of billing electronically has doubled. From a measly 44% in 2002 to 94% in 2012 there’s been an exponential increase in providers who are switching to e billing.

Almost 79% of claims are now automatically adjudicated without manual support. Physicians are finding e billing helpful as it helps their staff to focus on patient engagement.

A Huge Relief For Billers…

What is the biggest headache of a medical biller ? No. It is not getting claims paid. The bigger headache is finding out which claim is in what stage of processing. An average medical office sends out dozens of claims per day. Keeping tabs on each one of them can trip up the most determined of medical billers.

ERA’s and EFT’s help medical billers to hasten the pace of the billing process. And make it easier for them to maintain a clear cut billing record.

Ask Your Insurer To Move On From The Stone Ages !

It is time for insurance companies to stop working with paper claims. Physicians need to put their foot down and ask insurers to accept electronic claims! Concerted and continuous effort across the continuum will ensure that the healthcare industry functions a lot more smoothly and efficiently. And yes, save a billion trees in the process !

Is Your Medical Practice Ready To Attest For Meaningful use?

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Are You Ready To Attest For Meaningful Use ?

If you are an EP, receiving the MU incentive check is going to top your list of priorities. It is time for physicians to pull up their socks and start working towards meeting the eligibility criteria for MU 2. Before getting down to the brass tacks it is important that you phase out the attestation process.

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Being Up To Speed On Data Transmission…

Data transmission is a tricky word. It means you need to share data without making compromises on data privacy. To, begin with exchange a clinical document with one of your peers who use a, different EHR. Send out “trial” documents to test the waters. Check whether you are able to transmit clinical data securely.

Shop for a HIE and team up with one, to be able to transmit medical data easily across the care continuum.

Time To Stop Fighting Over Turf  !

Physicians have always felt a little queasy about letting patients access their EHR. A secure patient portal that allows patients to view and download medical information is important to meet the patient engagement criteria.

It is essential that stringent authorization methods are followed to prevent data misuse. And that, patients, are sufficiently educated about data security.

Dial Your Vendor’s Number…

You’ve pulled out all stops to make sure your practice meets MU standards. But is it is of little or no use, if your vendor doesn’t match your pace. Check with your vendor whether your EHR is compliant with the Meaningful Use 2 guidelines. Communicate with your EHR vendor and emphasize that a specific timeline needs to be adhered to.

With data interoperability being one of the key considerations, to attest for MU, it is important that you join forces with your EHR vendor, to reach the finishing line on time.

Have you spoken to your business associates ?

It is important that your business associates are an integral part of your MU attestation efforts. Whip up a plan with your business associates to optimize your workflow and streamline your everyday work processes.

2 hours a day !

Spending as little as two hours a day to work towards achieving MU can put you on the fast track to receiving your check. The key is to coordinate. Make sure that everybody who is involved with your medical practice is on the same boat. And to, make the most important person in the equation, your patients, to get more actively involved.

Should Patients Be Allowed To Access Their Physicians EHRs? Weighing The Pros And Cons

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Whose EHR Is It Anyway ? !

 This far and no further, is the approach physicians are taking when it comes to patient EHR access. Patient electronic access is an important objective of Meaningful Use. It can help physicians to deliver better quality of care.  And to bring everybody across the care continuum in one single, secure platform.

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Data security risks is the key reason why the debate on patients access to EHR is still up in the air. Nothing can scare physicians more than a data breach. The average housewife in New Jersey may not be up to date on HIPAA regulations  And there is also the potential threat of patients misinterpreting their medical data.

A physicians understanding of a medical problem is not the same as that of a patients. It could cause unnecessary stress and anguish, and make patients vulnerable to self-medication dangers.

I Don’t Want My Patients In The Drivers Seat…

According to a recent survey conducted by Accenture, around 65% of doctors feel that patients should be given limited access. About 82% of physicians endorse the view that patients should be actively involved in their healthcare. Around 4% of doctors told they’d like to ban patients from having an online access to medical records.

Most physicians were of the opinion that other than demographics, patients shouldn’t be allowed to edit or update any other medical data.

The Way Around This Catch 22 situation !

  • Talk to your EHR vendor about including patient identity proofing and authentication features.
  • Standardize the information you want your patients to access.
  • Educate your patients about your EHR.
  • Work with a  biller who has experience in working with your EHR so patient billing is streamlined to a great extent
  • Follow a clear cut privacy policy and usage guidelines.

Will Doctors Fade Into Oblivion? The Survival Guide For Newyork Physicians !

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Can I Meet A Physician ?

The answer would most probably be “no” in a few years time. It is going to get increasingly hard to find a physician in New York. The State University of New York center (SUNY) has predicted that there will be severe physician shortage in New York by 2030. The study further reveals that the average age of physicians in New York is alarmingly high.

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I Have An Insurance Number, But Not Medical Care…

The huge physician deficit can leave millions of newly insured patients, under Obama-care  have insurance numbers. But it is no guarantee they will get to meet a doctor. The physician workforce is slowly dwindling and finding a doctor can be the biggest challenge, in the years to come.

The problem is steadily getting worse and it is not just the healthcare law that is to be blamed. Proprietary and complicated EHRs and ambiguous reimbursement models are driving physicians out of the business.

84% Docs Feel The Profession Is In Decline !

And nearly 60% wouldn’t recommend medicine as a career choice. About 75% of physicians feel they are being overworked. These are just a few worrying markers of the disillusioning climate the healthcare industry is in.

Doctors Across New York ; The Much Needed Relief For Physicians !

The DANY program offers physicians based in New York the life support they need. It offers physician practice support, physician loan repayment and help for facilities that recruit new doctors. The application process has also been streamlined to help practices based in NY meet the financial pressures they’re under.

Large health plans are also working in tandem with local medical practices and community health centers to bring in more primary care doctors.

Joining Forces…

Nurse practitioners can fill in the void by offering primary care to patients. Physicians and NPs instead of being at loggerheads, can work together to provide better care for patients across the state. As the shortage worsens team based care will act as the most effective solution.

Outsourcing documentation and billing needs will also offer harried Newyork physicians a brief respite in an otherwise blistering healthcare climate !

The Face-Off Between Doctors And Nurse Practitioners!

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Working, without someone looking over our shoulder, is a secret wish of all of us. And that has led to one of the most heated debates in the healthcare industry. Coming, close on the heels, of the battle between, CRNAs, and, anesthesiologists. It is now physicians and nurse practitioners who are at loggerheads.

Endangering patients…

Physicians fear that working without their supervision can put patients at risk. And lead to fragmented, patchy patient data. Providing longitudinal care and unifying diverse factors across the care continuum is an ongoing challenge. Nurse practitioners functioning independently can lead to increased confusion, is the chief complaint of docs.

It is a known fact that recent regulations and compliance thresholds have put physicians under a lot of stress. To have nurse practitioners challenge their role in the medical fraternity. And compete for patients, is the last thing physicians need.

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End the monopoly !

Do we know how to bill for services ? Yes.

 Do we know how to take care of patients in need of primary care ? Yes.

Do we need a physician to tell us what to do ? No.

This is the war cry of America’s nurse practitioners. They feel practicing under the supervision of physicians is unnecessary and restrictive. Despite being highly qualified and experienced, nurse practitioners feel they are being given a rough deal.

Not a turf war for money !

The request by NP’s to reduce physician interference can surprisingly prove to be beneficial. Obama care is going to result in a sudden influx of thousands of patients. As United States battles severe primary care physician shortage. Qualified nurse practitioners and a newer model of working might just be the right solution.

Once the dust settles down…

It is being hoped that once the storm settles down it will bring a lasting and mutually agreeable solution. The need of the hour is clear cut billing regulations. Reformed, payer policies, that don’t leave room for doubt. And, nurse practitioners and physicians, who work together towards a sustainable solution.

As a nurse practitioner there is enough on your plate already ! Here is the presentation on “Reimbursements guide for nurse practitioners to survive the storms in 2013 !”

Ten Tips For Surgery Centers To Pump In More Greens!

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There you go ! Another rejected claim. Well, running a surgery center billing practice can be demanding, expensive, and on a bad week, thankless! With, surgery centers constantly battling with payers, and, patients who have no idea what their financial liabilities, are. It can be an uphill climb on a snowy day, to get paid !

Here is how you can fight those financial demons and come out at the other end a winner ! And also ensure your clinical documentation is never short of perfect !

10 ways to increase the revenue of your surgery center…

  1. Encourage your surgeons on-board to have a financial stake in your surgery center to avoid losing out on case load.
  2. Create a better atmosphere to work by upgrading to better systems and work processes to attract and retain a strong physician base.
  3. Collect copay’s and deductibles at the front-desk and have multiple payment options.
  4. Compare your staff members’ cost per case with your competitors, and how reimbursement varies across different specialties. Analyze and set benchmarks.
  5. Follow a rigorous claims follow up process and fight denied claims as soon as they reach your table, to increase the revenue and valuation of your center.
  6. Physician documentation plays an important role. Surgeons should dictate clearly, name the procedure. And ensure details and events are sequenced in the operative note.
  7. Don’t put off renegotiating with your insurer. If you put off renegotiating year after year there are little chances of your insurer ever giving you a reimbursement hike !
  8. Collect and verify patient information during the pre-registration stage to avoid fall outs.
  9. Call your patients prior to their appointment and inform them about their financial liabilities.
  10. Have a quick sheet that includes pertinent questions, such as, how many surgeries were performed, the number of co-surgeons etc for physicians to fill out after a surgery.