Healthcare Clearinghouse

The profitability of physician practices is being squeezed by declining payer reimbursement rates and increasing operating costs. There is also a growing trend towards enhanced patient responsibility both for self-pay and insured patients. This has a direct impact on physician practices which now run a risk of increasing patient account receivable (A/R) balances.

Proactive revenue cycle management processes are key to ensure full and timely reimbursement from payers and minimizing the financial risk due to patient A/R exposure. Even though clearinghouses had a limited function earlier, the scope of functionality delivered by a good clearinghouse has increased significantly and encompasses entire revenue cycle stretching from insurance verification, claims submission, remittance and all the way to appeals and settlement.

Benefits of EHR Software

The word is out -- ambulatory practices continue to reap the benefits of adopting integrated EHR platforms. According to the National Coordinator for Health Information Technology, EHR adoption in the medical practice has doubled since 2008. For the remaining practices failing to seek the benefits of EMR, declining reimbursement tied to MACRA will encourage most of these providers to eventually adopt the technology. One bit of good news for the solo or small practice is that Medicare adoption incentives still exist for the office-based physician practice. But perhaps the best news for physicians reluctant to switch is that there are documented benefits in EHR adoption for both patients and providers.

This article summarizes the top EHR benefits experienced by an ambulatory practice for their patients and practice when deploying the technology.

Medical Billing Audits

There is no doubt that the transition to ICD-10 forced a lot of healthcare organizations to take a long hard look at their claim processing practices. While that transition is in the past, the importance of medical billing audits isn’t.

Every practice should have a strong understanding not only of the nature of billing audits but also what kinds best fit their individual needs. If you don’t you have a strong grasp on the billing practices, weaknesses, and opportunities for growth in your practice, it might be time for a refresher.

Value Based Care vis-a-vis Fee For Service

The transition from fee-for-service to value-based reimbursement represents a paradigm shift for the entire healthcare industry but

also promises specific opportunities and challenges for individual providers. If you’re considering transitioning to a value-based

reimbursement model, it is important to learn as much as possible about the two systems, the changes ahead of you, as well as your strategic options.

Switching EMR Systems?

Although the EHR adoption rate has more than doubled over the past decade, significantly bolstered by passage of the HITECH Act in 2009, satisfaction with EHR systems is definitely trending downward. A study published last year by the U.S. National Library of Medicine showed that a shocking 67% of physician respondents were dissatisfied with their EHR and 31% were actively considering switching EMR systems because of their dissatisfaction. Over 30% considered dissatisfaction with their EMR a primary contributor to physician burnout. 

That's a lot of unhappiness—and a lot of practices potentially switching EHR vendors this year.

If you're in that situation yourself, there's much to consider before actually making a change, both  in terms of challenges and opportunities for enhanced productivity and overall practice performance. 

Pediatrics EMR

According to the Agency for Healthcare Research and Quality (AHRQ), EMR implementation among pediatric practices lags behind other specialties, with 31% of pediatricians using a basic pediatric EMR and only 14% using a fully functional pediatric EMR solution. This is despite the American Academy of Pediatrics suggestion that EHRs may increase patient safety and standards of care.

What is MACRA?

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) marks an entirely new era in physician reimbursement—one characterized by quality, cost containment, and population health management. MACRA essentially shifts Medicare payments from fee-for-service to pay-for-performance that rewards participation in risk-bearing payment models.

To participate in MACRA, physicians must choose one of the following two tracks:

1. Advanced Alternative Payment Models (APM)
2. Merit-Based Incentive Payment System (MIPS)

The choice that physicians make today will affect their payment beginning in 2019. Physicians participating in MIPS will see a sliding-scale bonus or penalty ranging from 4% in 2019 to 9% in 2022. The bonus or penalty derived from 2017 data is based on a composite score that includes these components: Quality measures (60%), advancing care information (25%), and clinical improvement activities (15%). Physicians participating in APMs will see a bonus of 5% of Part B professional services payments between 2019 and 2024.

Practice Management Software

Choosing the right medical billing software for your practice is one of the most important decisions you'll make when it comes to managing your cash flow. After all, billing is at the heart of your revenue cycle—when it's going well, the results show in your bottom line. 

But selecting the right medical billing software is a challenge; there are easily hundreds of options available. If you're trying to choose the right-fit software for your practice, here are 10 tips to help you decide. 

EHRs provide physicians with many benefits; however, there are also compliance risks inherent in the technology. Physicians must be aware of these risks and take steps to address them, said Sandy Giangreco, RHIT, CCS, CCS-P, RCC, CPC, COC, CPC-I, COBGC, coding compliance audit senior manager at CHAN Healthcare, and Kim Huey, MJ, CHC, CPC, CCS-P, PCS, CPCO, independent coding and reimbursement consultant.

Giangreco and Huey both spoke during the 88^th annual American Health Information Management Association’s (AHIMA) convention held October 16-19, 2016 in Baltimore, MD.

This article addresses several compliance vulnerabilities that Giangreco and Huey discussed and provides tips on how to mitigate risk.