Your credentialing process needs to start well in advance if you are planning to start your own practice or bring in new doctors to your existing practice. It is important to understand how credentialing can make a significant difference to the pace of your cash flows and how smooth your practice runs. Ignoring the credentialing process will result in delayed cash flows,
Revenue cycle management throws up tons of data for tracking. However, not everything requires regular tracking and measuring. While it is important to look at all the data derived from the system periodically, it is very important to track and measure some key metrics regularly. Measuring the key metrics against the industry standard is a good way to determine where your processes require improvement.
A worldwide trend in healthcare reforms and new organizational arrangements, integrated care (also known as comprehensive care, transmural care, co-ordinated care or seamless care) focuses on more integrated and co-ordinated forms of care provision. According to the WHO, “Integrated care is a concept bringing together inputs, delivery, management and organization of services related to diagnosis,
Physicians educate and train themselves to practice medicine and impart health care to the populace. However, a large part of their daily lives is spent tending to administrative tasks – something that they would rather not be doing given half a chance. With the constantly evolving medical regulatory and payment space, it is very difficult for physicians to escape from the requirements of administrative tasks.
Identifying keywords from about 35,000 Google+ reviews of physicians that were most commonly associated with the rating levels given, a marketing and public relations firm for specialty medical practices, conducted a study of patient complaints regarding physician offices. Published in the Journal of Medical Practice Management, the study reveals that the majority of patient complaints are about customer service at the physician’s office.
Healthcare practices typically outsource their billing for two reasons – lack of resources and/or lack of time. While outsourcing your billing has many advantages, there are certain factors that need to be checked before hiring a billing company. Remember that most outsourcing contracts generally last for two to three years and it would be detrimental to your practice if you choose a billing company that exhibits most of the following:
- The billing company has no existing clients with the same specialty as yours.
Replacing the much-maligned sustainable growth rate formula and in an effort to increase quality while bringing down costs, the Congress last year passed the Medicare Access and CHIP Reauthorization Act (MACRA). While MACRA rules are still being finalized, it will essentially transform the way Medicare reimburses healthcare providers for services. The main purpose of this overhaul to the payment system is to improve the quality of healthcare that is provided to patients.
After ICD-10 went live on October 1, 2015; CMS (Centers for Medicare and Medicaid Services) allowed a one year grace period for ICD-10 flexibility, to overcome the strong opposition from the AMA (American Medical Association) to ICD-10 implementation. For the one year period, even though a more specific code existed, CMS allowed healthcare providers to submit claims with a valid code from the ICD-10 three character category,
Healthcare revenue cycle management has undergone a radical and drastic change in the last decade. From days when most patients had $20 or so as co-payments and insurance companies paid claims in full, to today, when the physician first needs to consider medical necessity before ordering a lab test – things have certainly become more complex and challenging.
Starting August 1, 2016, the penalties under the False Claims Act (FCA) along with the Anti-Kickback Act, The Program Fraud Civil Remedies Act and a host of other Acts have nearly doubled to a minimum of $ 10,781 and a maximum of $ 21,563. A result of the interim final rule issued by the Department of Justice,