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7 MACRA Preparation Tips

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.

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Revenue Cycle Analytics Improves Claims Submissions

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.

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HIMSS: One-third Clinicians still use manual Claims Denial Management

Claim submission and denial management are critical components to the revenue cycle of healthcare facilities.  As regulations are getting more stringent with the transition to value-based care, healthcare providers are facing an increase in claim denials.  It therefore comes as a surprise that nearly one-third of clinicians are still using manual processes to manage their claim denials. 

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MACRA – What Is It All About?

April 28, 2016 witnessed the release of the proposed rule that is intended to guide the implementation of MACRA (Medicare Access and CHIP Reauthorization Act of 2015) which aims to reward clinicians and physicians engaging in activities that support and drive positive patient outcomes.  MACRA, once implemented in totality, will change the way physicians taking care of Medicare patients are paid by CMS.

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3 Things You Need To Know About Medicare Audits

Healthcare facilities across the nation have or will have to face Medicare audits at some point.  Even those healthcare facilities that have done everything correctly and have never had to face an audit till date cannot be certain that it may not happen in the future.  An audit could be due to a single payment or a multitude of payments – in either case,

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Common Evaluation And Management (E/M) Services Coding Errors

One of the recurring problems facing healthcare facilities is incorrect coding of Evaluation and Management (E/M) Services.  The recent CERT (Comprehensive Error Testing) claim review analyzed by WPS Medicare reveals that within the fifteen or more services reviewed in that sample, three E/M CPT codes had been coded incorrectly in at least 44% of the total bills raised. 

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8 Tips On Medical Billing And Patient Collections

One of the biggest challenges faced by healthcare practices and crucial to their very survival is medical billing and collections.  A healthy revenue cycle is important to sustain the process of making patients healthy.  Unfortunately, physicians are trained to manage human health rather than revenue health and this is where the challenges arise. 

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8 Must-Knows for Balance Billing

Billing patients for outstanding balances after receiving the portion covered by the insurance company is known as balance billing.  This can happen if the insurance company gives less than the amount expected or if an episode of care is mistakenly believed to be in-network and hence expected to be covered by the insurance company.  Physicians who are not bound by the in-network rate agreements and are thus classified as out-of-network physicians,

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3 Steps To Creating Your Clinical Documentation Improvement Program

Improving clinical documentation leads to revenue gains and most healthcare facilities are now exploring this program.  The main reason for getting into this program is to improve your reimbursements and that will happen with improved documentation and coding.  However, it is important to set specific goals when putting together a Clinical Documentation Improvement (CDI) program for your facility.

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Benefits of Outsourcing Provider Credentialing And Enrollment Services

Healthcare facilities address the health needs of people and are supposed to treat the sick under all circumstances.  However, for any organization to remain viable and continue to provide services, it needs to be paid for the services provided – fully and in time.  In order to receive their just dues, organizations have to work with various payers,

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