Clinical, Financial and Administrative Insights For Physicians

Suzanne Prasad

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Choosing the Best Healthcare Clearinghouse for your Medical Practice

Posted by Suzanne Prasad

Medical Billing Clearinghouse

Criteria for Selecting a Great Medical Billing 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 medical billing clearinghouse has increased significantly and encompasses entire revenue cycle stretching from insurance verification, claims submission, remittance and all the way to appeals and settlement.

1. What is a Clearinghouse?

2. Why functions does a good Clearinghouse perform?

3. What is the Clearinghouse Process?

4. What are the benefits of using a great Clearinghouse?

5. Best Practices for choosing a Clearinghouse

6. Which are the top medical billing Clearinghouses?

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Transitioning from Fee for Service to Value-Based Reimbursement

Posted by Suzanne Prasad

Value Based Care vs. 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.

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Switching Your EHR? How to Overcome EHR Replacement Challenges?

Posted by Suzanne Prasad

Thinking About Switching Your EHR System?

Why, When and How to Successfully Replace Your EHR?

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. 

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7 Top Pediatrics EMR Features

Posted by Suzanne Prasad

Best Pediatrics EMR Features

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.

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6 Questions You Must Ask Your EHR Vendor to Optimize your EHR for MACRA

Posted by Suzanne Prasad

Optimize EHR for MACRA - What Does it Mean?

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.

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Best Medical Billing Software - 10 Top Questions To Ask Before Choosing One

Posted by Suzanne Prasad

Best Medical Billing 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. 

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Top 3 EHR Compliance Risks - How to avoid Auditor Scrutiny?

Posted by Suzanne Prasad

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 88th 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.

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Medicare Overpayments: 6 Tips to Comply with CMS’ New Rule

Posted by Suzanne Prasad

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.

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EHR Interoperability & National Patient Identifier - Are they Related? If so, how?

Posted by Suzanne Prasad

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.

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(Updated) Primer on Modifier -25? Use it but don't abuse it.

Posted by Suzanne Prasad

Modifier 25

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.

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