Clinical, Financial and Administrative Insights For Physicians

If you find an overpayment, don’t expect to keep it. That’s because physicians must report and repay Medicare overpayments within 60 days of identifying them, according to a final rule that took effect March 14, 2016. This includes overpayments identified within six years of when the overpayment is received.

Do not forget the top 6 tips (given below) that will help physicians identify what could constitute an overpayment and how they should report overpayments as they discover them.

With a population of more than 321,000,000 people, it’s not surprising that patient identity mix-ups continue to plague the U.S. healthcare industry. The push for electronic health record (EHR) interoperability has only magnified the problem. Without a unique national patient identifier (NPI), the likelihood for errors and patient safety implications grows significantly as providers continue to engage in larger-scale health information exchange (HIE).

This article addresses four important questions about the NPI and what it could mean for EHR interoperability.

When used appropriately, modifier -25 can enhance revenue for a physician practice. That’s because reporting this modifier allows physicians to bypass an Outpatient Code Editor (OCE) edit to receive additional payment. However, physicians must understand the rules regarding this modifier—and the documentation required to support it. No physician wants to discover after the fact—during an audit—that he or she must pay the money back.

Here are some facts about modifier -25 that can help physician practices maintain compliance.

Many practices are struggling to do more with less revenue, due in part to changes in the Affordable Care Act, shifts in reimbursement models, and an increase in consumerism in the health care landscape. In fact, Forbes recently reported that the average provider (across all medical specialties) is seeing top line revenue drop by over $50,000 per year since the health reform law went into effect.

If you're looking at anemic revenue streams, there are steps you can take to revitalize your existing streams and explore new options to beef up your bottom line. Here are 10 steps any practice can adapt and use to bring more revenue through the door.

The explosive growth of Software as a Service (SaaS) technology has opened the door for even small and medium-sized practices to access a full-featured EMR systems without the major investment in infrastructure that accompanies any client-server based EMR (aka server-based EMR). This makes Cloud-based EMR (aka web-based EMR) very attractive for groups who want to implement a new system or upgrade to a more robust EMR. But each of these two types has its own strengths and weaknesses, so it's important to understand how each works with your practice and your ongoing needs. Here's what you should know before you reach a final decision. 

‘Denial’ and ‘rejection’ are two words that no physician wants to hear. Yet, the unfortunate reality is that many physician practices lose money every day to claims that fail to meet payer requirements, Yvonne Dailey, CPC, CPC-I, CPB told attendees at the 24^th annual HEALTHCON conference sponsored by the American Academy of Professional Coders. The conference, held in Orlando, Fla. last month, drew nearly 2,700 medical coding professionals.

During a presentation about denial management, Dailey spoke about how denials and rejections have only increased over time due to the increase in the number of carriers nationwide, each of which has its own nuances and rules for payment.