By Steve Selbst bio I am delighted to be able to share with you a key "secret to success" about payer contracting. Today's article is about getting in the "backdoor" with payers and complementing your payer network by building your patient/customer base. In my journey navigating tens of thousands of payer contracts' negotiations, it has become clear to me that there … [Read more...] about Finding the “backdoor” into payer networks
Billing & collections
How to improve your practice’s denial management system
With many payors now intensifying their efforts to deny or reduce claims, your medical office's denial management system is more critical than ever for protecting and increasing practice profitability, according to Beth Pysell, a certified professional coder (CPC) and healthcare consultant for Coding Strategies Inc. Pysell says an efficient denial management system can help … [Read more...] about How to improve your practice’s denial management system
6 key ingredients of a profitable medical practice
Medical office managers are often so focused on the day-to-day that it can be easy to lose sight of the big picture. That big picture is profitability—because, without it, the practice will not remain in business. Although profitability isn't rocket science—after all, only rocket science is rocket science—it does require attention to detail, or what Medical Office Manager … [Read more...] about 6 key ingredients of a profitable medical practice
Three key items to negotiate for successful payer contracts
By Steve Selbst bio The purpose of this article is to help you, as a provider, to focus on three key items to look for in payer contracts that will help you to get profitable contracts in place. The three key areas that we will examine are fee schedule amendments, lesser of billed charges vs. contracted rates, and claims' payments. 1. Fee Schedule Fee schedules … [Read more...] about Three key items to negotiate for successful payer contracts
You have less than one month to submit MIPS Year 2 (2018) Data for the Quality Payment Program
The Centers for Medicare & Medicaid Services (CMS) has officially opened the data submission period for Merit-based Incentive Payment System (MIPS) eligible clinicians who participated in Year 2 (2018) of the Quality Payment Program. Data can be submitted and updated any time until 8:00 p.m. ET on Tuesday, April 2, 2019. CMS Web Interface users need to report their … [Read more...] about You have less than one month to submit MIPS Year 2 (2018) Data for the Quality Payment Program
CY 2019 List of Medicare Telehealth Services
Why you need this tool: Has your practice recently implemented telehealth? If so, you might not know which CPT codes are available for reimbursement. How this tool helps you: This list, compiled by Nick Hernandez of ABISA LLC, will show you which CPT codes are currently (2019) available. How to use this tool: Refer to this list of codes when billing for telehealth services. … [Read more...] about CY 2019 List of Medicare Telehealth Services
4 best practices to help optimize your processes and increase your reimbursements
By Ranadene (Randi) K. Tapio, MBA, CMRS, CMC, Guest Contributor bio Revenue Cycle Management is multi-faceted. There may not be a right or wrong way as far as your process goes, but there are tips, tricks, and best practices that can optimize the process, and in turn, your reimbursements. After years of experience working with varying sized and specialty practices, … [Read more...] about 4 best practices to help optimize your processes and increase your reimbursements
5 proven levers for improving your medical practice
Virtually any medical practice can immediately improve its revenue, cash flow, profitability, and growth, along with streamlining its operations by embracing five levers for medical practice improvement. John W. McDaniel, founder and chairman of Peak Performance Physicians LLC of New Orleans, LA, says these five levers apply to any type of healthcare business, whether it is a … [Read more...] about 5 proven levers for improving your medical practice
Get personal to get patients to pay faster
Set the expectation of payment before the patient comes in. When the office calls to confirm an appointment, whether it's a live conversation or an automated message, say, "Your co-pay is due when you check in." In other words, "bring your wallet." Some offices go so far as to refuse people who don't have the co-pay at the time of the visit. However, such a strict policy … [Read more...] about Get personal to get patients to pay faster
How to determine the order of multiple insurance coverages
By Ranadene (Randi) K. Tapio, MBA, CMRS, CMC, Guest Contributor bio When patients have multiple insurance coverage, at times it can be difficult to determine which one is primary, secondary, and tertiary. Sometimes, the patients don't even know which order they go in! While there are always going to be exceptions, here are some basic guidelines to keep in mind: … [Read more...] about How to determine the order of multiple insurance coverages