Use six workflow strategies to improve your bottom line.
Strategy No.5:
Track Denials
Don't underestimate the importance of following up on denials. They often can ve reversed on appeal; even if they cannot, they can help identify flaws in upfront processes that can be fixed to prevent further denials. Typically, there are filing deadlines associated with appeals, so you should run denial reports daily to support quick identifications and response.
Strategy No.6:
Provide Effective Cross Training
Although it is a time-intensive endeavor, cross training can bring more to your practice that just staff coverage during illnesses or vacations. When done well, cross training promotes better patient service and improves financial performance by broadening the knowledges base of every employee.
Thoroughness is the key to good cross-training program. Offering front-desk staff only a high-level view of back office operations, for instance, is not enough. Instead, solid cross training should reveal in detail how front-desk tasks affect the back-end, and vice versa. An effective program will also:
* Engage the most experienced individuals in the "teaching" roles
* Map out specific learning objectives for each staff member
* Occur frequently (ideally, twice per year, or more frequently in instances of high staff turnover)
* Allow staff members to experience both morning and afternoon shifts during training, with no
department having more than one person cross- training at a time.
These workflow strategies require commitment and buy-in from everyone in your practice - including providers, administrators, and staff. While not always easy to implement, these strategies can enhance evenue cycle management and improve efficiency, ultimately helping your practice realize measurable financial gains.
Showing posts with label healthcare. Show all posts
Showing posts with label healthcare. Show all posts
Thursday, November 3, 2011
Pursue Optimal Efficiency Strategies 3-4
Use six key workflow strategies to improve your bottom line.
Strategy No. 3:
Seek Prior Authorization
This is critical because failure to obtain proper authorization can have a drastic affect on practice income. Insurers will not pay for procedures if they correct prior authorization is not received, and most contracts restrict practices from billing the patient in these situations.
Although neccessary, keeping track of prior authorization policies is challenging. Each health plan has its own set of requirements, which can change frequently. Some Medicaid payers, for instance, request one "blanket" referral authorization before patients see certain specialists; the specialist is not required to obtain prior authorization for every procedure. Other plans are much more restrictive, approving prior authorization for specified procedures only when certain criteria and diagnoses are met.
Here are three actions you can take to help navigate the prior authorization process:
1. Designate someone to oversee all authorizations.
This allows a particular individual to become knowledgeable about each payer's unique
requirements. This person should track the authorization allowed and used for procedure codes
and visits, and be diligent about obtaining authorizations. By gaining a more thorough underst-
anding of payer policies, this person can better fight inappropriate authorizations denials.
2. Open the line of communication. Two-way communication between physicians and
authorization staff is essential. Providers should document completely and tell staff why a
patient is being seen, so staff can inform providers about the treatment options the patient's
payer will accept. Providers can them make treatment decisions based on all relevant knowledge.
3. Leverage technology. It can be helpful to develop a spreadsheet listing the guidelines for payer
authorizations, including which specific codes require authorization. The spreadsheet should
explain what justifies medical necessity for each procedure, according to each payer. Using
this tool, you can quickly decide when to submit an authorization request. Note: Some payers
publish their pre-authorization guidelines on their website, while others require you to call and
request these.
Strategy No.4:
Ensure Timely Charge Entry
Lagging charge entry can delay payment and hinder accounts receivable (A/R) negatively affecting your practice's bottom line. An important way to improve the timeliness of charge entry is to ensure coding staff has a solid understanding of ICD-9, ICD-10 (prior to October 2013), CPT, and HCPCS Level II codes, and modifiers. Hold meetings once or twice a month for coding staff to discuss coding- related issues and new developments to make sure everyone is up to speed on current requirements.
Educate physicians on importance of timely charge entry as well. Such education may involve explaining the consequences of delayed charge entry, and how those consequences affect physicians directly.
Once coded, claims may be run through claim scrubbers, clearinghouses applications, or other tools that verify accuracy. By ensuring a clean claim upfront, your practice can avoid costly delays and reimbursement headaches from denials down the road.
Strategy No. 3:
Seek Prior Authorization
This is critical because failure to obtain proper authorization can have a drastic affect on practice income. Insurers will not pay for procedures if they correct prior authorization is not received, and most contracts restrict practices from billing the patient in these situations.
Although neccessary, keeping track of prior authorization policies is challenging. Each health plan has its own set of requirements, which can change frequently. Some Medicaid payers, for instance, request one "blanket" referral authorization before patients see certain specialists; the specialist is not required to obtain prior authorization for every procedure. Other plans are much more restrictive, approving prior authorization for specified procedures only when certain criteria and diagnoses are met.
Here are three actions you can take to help navigate the prior authorization process:
1. Designate someone to oversee all authorizations.
This allows a particular individual to become knowledgeable about each payer's unique
requirements. This person should track the authorization allowed and used for procedure codes
and visits, and be diligent about obtaining authorizations. By gaining a more thorough underst-
anding of payer policies, this person can better fight inappropriate authorizations denials.
2. Open the line of communication. Two-way communication between physicians and
authorization staff is essential. Providers should document completely and tell staff why a
patient is being seen, so staff can inform providers about the treatment options the patient's
payer will accept. Providers can them make treatment decisions based on all relevant knowledge.
3. Leverage technology. It can be helpful to develop a spreadsheet listing the guidelines for payer
authorizations, including which specific codes require authorization. The spreadsheet should
explain what justifies medical necessity for each procedure, according to each payer. Using
this tool, you can quickly decide when to submit an authorization request. Note: Some payers
publish their pre-authorization guidelines on their website, while others require you to call and
request these.
Strategy No.4:
Ensure Timely Charge Entry
Lagging charge entry can delay payment and hinder accounts receivable (A/R) negatively affecting your practice's bottom line. An important way to improve the timeliness of charge entry is to ensure coding staff has a solid understanding of ICD-9, ICD-10 (prior to October 2013), CPT, and HCPCS Level II codes, and modifiers. Hold meetings once or twice a month for coding staff to discuss coding- related issues and new developments to make sure everyone is up to speed on current requirements.
Educate physicians on importance of timely charge entry as well. Such education may involve explaining the consequences of delayed charge entry, and how those consequences affect physicians directly.
Once coded, claims may be run through claim scrubbers, clearinghouses applications, or other tools that verify accuracy. By ensuring a clean claim upfront, your practice can avoid costly delays and reimbursement headaches from denials down the road.
Pursue Optimal Efficiency
Use six key workflow strategies to improve your bottom line.
Successful practices provide quality patient care while achieving good revenue cycle performance. They seek to be more efficent. From the front end of the office to the back, each employee finds ways to be more productive and ensure that the revenue stream is maintained.
In such practices, revenue cycle management is not haphazard, but involves specific workflow strategies that streamline processes, enhance productivity, and bolster patient satisfaction. Let's take a closer look at six specific workflow strategies to help your practice improve overall efficiency and, ultimately, strengthen your bottom line.
Strategy No 1:
Communicate Proactively with Patients
Share information proactively with patients about what they can expect from your practice - both clinically and financially - to help avoid misunderstandings, ehance patient satisfaction, and encourage repeat business. And, have an employee make courtesy calls prior to patients' visits to explain both payment policies and expectations and to help patients become aware of their out-of-pocket costs.
This call also provides the opportunity to address any potential payment problems early on, and avoid reimbursement issues on the back end. Informed patients improve morale because back-end staff spend less time chasing down payments and talking to patients who are dissatisfied because they did not fully understand their obligations to the practice.
Strategy No 2:
Verify Eligibility Upfront
To support proactive communication, revenue cycle staff must know a patient's insurance coverage, co-pay, and other financial details. Verifying this information prior to a patient's arrival at the practice allows staff to determine upfront whether a procedure is allowable through insurance; what the fee schedule is for the procedure; and the approxmate patient responsibility. This helps avoid unwelcome surprises, minimizing practice risk and preventing physicians from providing services for which they will not be paid.
Eligibility verification can be done manually or automatically. In a manual process, assigned staff members contact insurance providers via phone or website to verify patient benefits and eligibility. An automted process, which involves verification software, requires fewer staff resources and can lead to quicker eligibility verification. Either way, verification should be done prior to the patient visit.
Successful practices provide quality patient care while achieving good revenue cycle performance. They seek to be more efficent. From the front end of the office to the back, each employee finds ways to be more productive and ensure that the revenue stream is maintained.
In such practices, revenue cycle management is not haphazard, but involves specific workflow strategies that streamline processes, enhance productivity, and bolster patient satisfaction. Let's take a closer look at six specific workflow strategies to help your practice improve overall efficiency and, ultimately, strengthen your bottom line.
Strategy No 1:
Communicate Proactively with Patients
Share information proactively with patients about what they can expect from your practice - both clinically and financially - to help avoid misunderstandings, ehance patient satisfaction, and encourage repeat business. And, have an employee make courtesy calls prior to patients' visits to explain both payment policies and expectations and to help patients become aware of their out-of-pocket costs.
This call also provides the opportunity to address any potential payment problems early on, and avoid reimbursement issues on the back end. Informed patients improve morale because back-end staff spend less time chasing down payments and talking to patients who are dissatisfied because they did not fully understand their obligations to the practice.
Strategy No 2:
Verify Eligibility Upfront
To support proactive communication, revenue cycle staff must know a patient's insurance coverage, co-pay, and other financial details. Verifying this information prior to a patient's arrival at the practice allows staff to determine upfront whether a procedure is allowable through insurance; what the fee schedule is for the procedure; and the approxmate patient responsibility. This helps avoid unwelcome surprises, minimizing practice risk and preventing physicians from providing services for which they will not be paid.
Eligibility verification can be done manually or automatically. In a manual process, assigned staff members contact insurance providers via phone or website to verify patient benefits and eligibility. An automted process, which involves verification software, requires fewer staff resources and can lead to quicker eligibility verification. Either way, verification should be done prior to the patient visit.
Tuesday, November 1, 2011
New Online Application Fee Collection Process through PECOS
Medicare Learning Network (MLN) Matters Special Edition (SE) article 1130 changes Medicare's online application payment process and affects providers and suppliers. See MLN Matters SE1130 (www.cms.gov/MLNMattersArticles.Downloads/SE1130.pdf) for details.
Monday, October 24, 2011
Use Revised ABN by Jan.1 2012
Providers (including independent laboratories), physicians, practitioners, and suppliers now have until Jan. 1 2012 to begin using revised Advanced Beneficiary Notice of Noncoverage (ABN) Form CMS-R-131.
The orginal implementation date was Sept 1 2011 but the Centers for Medicare & Medicaid Services (CMS) extended the manditory use date to Nov. 1 2011 and then Jan. 1 2012 to give providers and suppliers more time to transistion to using the new form, and to use up stockpiles of old forms.
The revised form replaces the ABN-G (Form CMS-R-131G), ABN-L (Form CMS-R-131L), and NEMB(Form CMS-20007). The latest version of the ABN has a release date of March 2011 printed in the lower- left corner. All ABNs with a release date of March 2008 that are used on or after Jan.1 2012 will be considered invalid.
The ABN should be used in situations where Medicare payments is expected to be denied. Skilled nursing facilities (SNFs) should use the revised ABN form when services are expected to be denied under Medicare Part B only.
Download the revised ABN at www.cms.gov/BNI/02_ABN.asp, available now for immediate use.
The orginal implementation date was Sept 1 2011 but the Centers for Medicare & Medicaid Services (CMS) extended the manditory use date to Nov. 1 2011 and then Jan. 1 2012 to give providers and suppliers more time to transistion to using the new form, and to use up stockpiles of old forms.
The revised form replaces the ABN-G (Form CMS-R-131G), ABN-L (Form CMS-R-131L), and NEMB(Form CMS-20007). The latest version of the ABN has a release date of March 2011 printed in the lower- left corner. All ABNs with a release date of March 2008 that are used on or after Jan.1 2012 will be considered invalid.
The ABN should be used in situations where Medicare payments is expected to be denied. Skilled nursing facilities (SNFs) should use the revised ABN form when services are expected to be denied under Medicare Part B only.
Download the revised ABN at www.cms.gov/BNI/02_ABN.asp, available now for immediate use.
Tuesday, October 18, 2011
Why OutSource Medical Billing
Medical billing is one of the fastest-growing and most dynamic sectors of the health care industry. As a medical billing company, we serve as intermediaries between physicians or other health care providers and insurance companies, be they private or government-owned. Our process involves collecting fees from insurance companies in order to compensate doctors and healthcare providers for their services. We excel at providing one of the best services in the industry, helping our clients collect from the insurance companies faster than ever before.
As a medical billing company, our role is very significant in achieving efficiency for healthcare companies. Healthcare companies outsource their physician billing requirements for various reasons like reducing the facility costs and labour costs requeried. Outsourcing medical billing can increase the revenue of the healthcare facilities to a large extent. There is a high chance of encountering losses by managing the billing process on their own. For this main reason these companies go for outsourcing the physician billing services. As leaders in the industry we also strive to achieve maximum profits for our medical insurance billing clients.
Medical billing is a function that is crucial to any medical practice and hospital, big or small. More practices have run into trouble because they neglected financial part of their practice. It used to be normal for either the doctor to handle this himself or just hire someone to come into his office and take care of this either full time or part time. But things have changed drastically over the years and it is simply not practical for a doctor or any medical practitioner to take care of the medical billing and coding himself or hire someone who is not trained for this.
It also used to be very difficult and cumbersome in the days when the entire physician billing and claims filling and processing was done manually. It was slow and prone to a lot of errors. It was also very expensive. For a small practice or hospital with a few hundred or thousand patients, it became very difficult to maintain records. It was extremely difficult and slow to store, maintain and retrieve any information. There are many medical billing companies, but we are confident that we will remain as the industry leader, providing excellent services at a reasonable price. Here at T.E.A.M Medical Billing Services LLC we do just that.
We have a number of health care providers as our clients who rely on our medical billing service process rather than handling their billing on their own. We save physicians and their practices valuable time that they can instead devote to providing better care to their patients, and their expertise ensures that the procedure is carried out correctly. This makes the process easier on the insurance companies, and enables doctors to receive their payments in a more timely fashion. Additionally, our professional processes saves patients the trouble of dealing with doctors, insurance providers or even collections agencies. Often times a doctor will have to spend countless hours trying to make light of a rejected insurance claim, or trying to get ahead of aging account receivables. We provide an essencial solution to these doctors, allowing for increased ROI and better use of the physicians time.
Contact us today
T.E.A.M Medical Billing Services LLC
24 Blue Water Court
Wendell, NC 27591
1-800-881-0563
1-800-963-1686 http://teammedicalbilling.com
As a medical billing company, our role is very significant in achieving efficiency for healthcare companies. Healthcare companies outsource their physician billing requirements for various reasons like reducing the facility costs and labour costs requeried. Outsourcing medical billing can increase the revenue of the healthcare facilities to a large extent. There is a high chance of encountering losses by managing the billing process on their own. For this main reason these companies go for outsourcing the physician billing services. As leaders in the industry we also strive to achieve maximum profits for our medical insurance billing clients.
Medical billing is a function that is crucial to any medical practice and hospital, big or small. More practices have run into trouble because they neglected financial part of their practice. It used to be normal for either the doctor to handle this himself or just hire someone to come into his office and take care of this either full time or part time. But things have changed drastically over the years and it is simply not practical for a doctor or any medical practitioner to take care of the medical billing and coding himself or hire someone who is not trained for this.
It also used to be very difficult and cumbersome in the days when the entire physician billing and claims filling and processing was done manually. It was slow and prone to a lot of errors. It was also very expensive. For a small practice or hospital with a few hundred or thousand patients, it became very difficult to maintain records. It was extremely difficult and slow to store, maintain and retrieve any information. There are many medical billing companies, but we are confident that we will remain as the industry leader, providing excellent services at a reasonable price. Here at T.E.A.M Medical Billing Services LLC we do just that.
We have a number of health care providers as our clients who rely on our medical billing service process rather than handling their billing on their own. We save physicians and their practices valuable time that they can instead devote to providing better care to their patients, and their expertise ensures that the procedure is carried out correctly. This makes the process easier on the insurance companies, and enables doctors to receive their payments in a more timely fashion. Additionally, our professional processes saves patients the trouble of dealing with doctors, insurance providers or even collections agencies. Often times a doctor will have to spend countless hours trying to make light of a rejected insurance claim, or trying to get ahead of aging account receivables. We provide an essencial solution to these doctors, allowing for increased ROI and better use of the physicians time.
Contact us today
T.E.A.M Medical Billing Services LLC
24 Blue Water Court
Wendell, NC 27591
1-800-881-0563
1-800-963-1686 http://teammedicalbilling.com
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