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outsourcing medical billing

Finding the Right Medical Billing Company in Georgia

Medical billing is a tedious and challenging job that needs special attention in order to ensure optimal competence. Although most doctors and hospital have an in house billing staff or get it done themselves, they are hardly qualified or trained to oversee the intricacies of billing efficiently. This is why it is important to invest in the services of a quality healthcare billing company.

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Basics of a Population Health Strategy

Broadly defined as the health outcome of specific groups of people, population health management is making significant strides due to the various integrated delivery systems which include hospital-based readmission prevention programs, patient-centered medical homes and accountable care organizations.

Increasingly being used to target high risk populations, the population health management approach exhibits a significant overlap with existing care management programs.

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Benefits of Population Health Management

Although one of the often used terms in the healthcare industry; population health management is also one of the least understood.  The industry uses the term to cover everything from big data analytics projects to basic team-based care initiatives.  However, in order to implement the Triple Aim, healthcare organizations and professionals need to know and understand population health management.

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Key differences between Population Health and Public Health

Population health and public health are amongst the most popular buzzwords in the healthcare delivery sector today.  Although both the terms appear to sound and mean the same, they are definitely two different concepts in both their meaning and application.

Population health and public health equally value the community’s well being.  The primary task for both is examining health trends and evaluating causes of health conditions in the community. 

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New England Journal of Medicine: 22% of Surprise Medical Bills occur in ER Visits

Have you ever experienced a situation when you have been made to pay a bill twice for the same product? This is exactly what is happening in the healthcare industry. According to a recent study published in the New England Journal of Medicine, surprise medical bills have been presented to 22% of ER visits or Emergency Room visits.

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apm vs mips

MACRA – APM vs. MIPS

The latest in a series of steps taken by the Centers for Medicare and Medicaid Services (CMS) to incentivize care quality over volume; MACRA was signed into law in 2015 and replaces the previous Medicare reimbursement schedule to a new pay-for-performance program that’s focused on quality and accountability. Starting January 1, 2017, all Medicare Part B providers will enter a new payment framework called the Quality Payment Program,

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10 Common HCC Coding Mistakes

In response to the demand for improving the capture of chronic illness diagnoses for reimbursements, the Center for Medicare and Medicaid Services (CMS) mandated the development of the Hierarchical Categorical Condition (HCC) code system and implemented it in the year 2004. The incorporation of the HCC codes has helped drive CMS payments to Medicare Advantage (MA) members.

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Risk Adjustment and HCC Documentation Basics

With healthcare reform and system changes underway, accurate medical documentation and coding is critical to the financial health of your practice and to the health of your patients. In 2004 Medicare implemented an HCC (Hierarchical Condition Categories) model to adjust capitation payments to private health care plans for the health expenditure risk of their enrollees. 

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Things You Need to Know about the MACRA Final Rule

Representing a departure from the volume based, fee-for-service model, MACRA replaces the SGR (sustainable growth rate) formula to control Medicare costs. Linking Medicare reimbursements to quality metrics with providers being rewarded for quality and value based care; MACRA repeals the set payment rates based on economic growth, which was the hallmark of SGR.

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