Ever since the RAC audit has been introduced, there is an element of fear amongst healthcare facilities with regards to the RAC program. Fuelled by rumors and myths, most of these fears have been proved to be baseless with the CMS (Centers for Medicare and Medicaid Services) addressing these fears through conferences, write-ups and articles.
The increase in audits has made them more of a rule than an exception. Each year, approximately 9% of physicians undergo a RAC audit. According to projections, within the next eleven years, every eligible physician will face a RAC audit. Insurance companies and government agencies are using the audit to recover improper claims payments as the rising cost of healthcare is impacting their bottom lines like never before.
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,
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.
All healthcare facilities – irrespective of whether they are a business enterprise or a charitable institution – have to be financially viable in order to continue to provide services. Clinical documentation improvement (CDI) programs have evolved from being an informal part of the process to becoming the backbone of the facilities financial viability.
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.
Times are tough – reimbursements are declining and expenses increasing. Keeping your practice viable in this environment requires being able to identify areas in your medical practice which are bleeding money and working out a strategy to stem the bleed. While each practice will require a different strategy to boost its bottom line, here are some tips that all medical practices can follow.
“Money makes the world go round” – and it can make you go round in circles too, if you make financial mistakes. This is one part of our existence, where even age and experience are no guarantee for not making mistakes. Having said that, youth and inexperience create more chances for making financial blunders than the old and wise.
The addition of ancillary services to your existing medical practice can help maximize profitability and serve your patients better. Patients prefer to have the convenience of getting medications at the medical clinic/office and having laboratory or diagnostic services done by the physician’s setup itself, rather than having to go to different places across town. Physicians providing patients with these added services are likely to see an increase in both revenues and patients.
Managing your healthcare revenue cycle is never easy. Revenue leaks can create havoc with your organizations financial viability. The root cause of revenue leaks are generally internal, with someone in the system or the system itself, not performing correctly or efficiently. According to Marc Lion, CEO of Lion & Company CPAs, the average medical practice has a 10 to 15 percent profit leak.