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

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.

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. 

Top Pediatric EMR, EHR 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.

Optimize EHR for MACRA - What Does it Mean?

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.

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. 

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.