Podiatry Practice Increase Revenue with Outsourced Billing Service

Podiatry billing like every other specialty billing faces its own set of challenges. Unskilled billing staff and inefficient billing practices can work havoc on the RCM process of your practice. Outsourcing the revenue cycle management of a podiatry practice to a medical billing expert can maximize claims payments and keep the practice compliant to governmental regulations. Professional medical billing services try to reach a level of efficiency when it comes to revenue cycle management of podiatry practices because of their exhaustive collection practices, incessant execution of billing tasks, and updated knowledge of prescribed documentation regulations. Here are the reasons why Podiatry Practice Increase Revenue with Outsourced Billing Service:

  • Better Understanding of Podiatry Billing Guidelines.

Centers for Medicare and Medicaid Services are very particular about the prescribed billing guidelines. The team of billing experts are well versed at podiatric procedures and related codes. This helps your podiatry practice to achieve your goal of flawless billing. Do check that the company you shortlist  has certified, professional, and experienced medical coders and billers that can keep your practice compliant with HIPAA and OIG, and in turn help you maximize payments, thus improving revenue streams. You can shortlist a company that already is dealing with podiatry practices, as this ensures that they know what they are doing.

  • Technological Aid

Podiatry medical billers and coders take help of automated technology to reach an overall efficiency of operations. They use customized templates of EHR that are specific to podiatry, as these ensure spec free use of codes native to podiatry procedures. This allows a practitioner to focus on the patient better without fretting about the billing front himself.  Billing teams also preauthorize all patient documents with the insurance providers and maintain records for them to avoid in discrepancies later.

  • Fighting Claims

Podiatry practices lose a significant portion of their annual revenue due to insurance underpayments and are often unable to estimate this loss of revenue correctly. An experienced billing partner checks all the payments received from insurers and matches them with bills filed. This brings to light underpayments, if any. The billing experts then respond to insurer’s queries about claims. They also make appeal for denied claims.  Such timely detection of underpayments also helps in timely claim filing and reimbursements. As rules and claim procedures surrounding Podiatry vary from insurer to insurer, it is a prudent step to seek the help of a podiatry medical billing company. Overtime, the expert would be able to identify the payers which usually write off your claims as underpaid or unpaid. This analysis helps the practice pay attention to the coding and documentation requirements of these insurers and chase collections regularly.

  • Dealing with The Patient

Every practice needs to realize that the overall exercises of bill collection from patients need to be improved. Outsourced Billing companies aid this by providing better customer service and putting in place an interactive interface. A more responsive approach to customer’s queries about billing and other medical practices helps in increasing the revenues in long term.

Services of expert billers in specialty Podiatry billing can help a practice overcome billing challenges easily.

 

Pros and Cons of Medicare for Independent Practices

These days, there’s no shortage of payers in the healthcare marketplace, and many physicians choose to contract with those that pay the highest rates. This strategy means that Medicare—a payer that often pays the lowest rates—falls to the bottom of the priority list, and many physicians simply choose not to participate.

In some ways, this makes sense—especially when a practice is already at optimal capacity. Why would a physician want to do the same amount work for less reimbursement? But is it the right approach when trying to expand the practice? We talked to Frank Cohen, director of analytics at Doctors Management, LLC in Spring Hill, Florida, to hear some pros and cons as it comes to Medicare’s impact on medical practices.

Pro – Faster Payments and Less Hassle with Medicare

“The truth is that Medicare doesn’t pay the best, but the hassle factor is the least, and it pays the fastest,” says Cohen. “Medicare is also totally transparent with its fee schedule, so you can plan ahead.”

Pro – Build Patient Volume

Accepting Medicare patients essentially allows physicians to grow their patient volume while establishing a predictable cashflow. “Practices can build volume on the front-end because there’s no shortage of Medicare patients out there,” he adds.

This is especially true for new practices. A recent study by the Kaiser Family Foundation found that younger physicians are more likely to accept new Medicare patients as they build their patient caseloads.

Pro – Lower Denial Rates

Even though Medicare often pays less than commercial payers, Cohen says the denial rate is also often much lower, meaning physicians recoup much of what they bill without needing to waste precious time and administrative resources on appeals and resubmissions.

With private payers, reimbursement amounts may be higher, but denials occur much more frequently. “You’ve got to fight them to get your money. Sometimes it’s just not worth it,” he adds. This game of ‘bait and switch’ makes it difficult for practices to grow. The turnaround time for payments also tends to be longer with private payers, making cashflow problematic—particularly when a practice is trying to expand, he adds.

Con – Lower Reimbursement

Still, there are cons to participating with Medicare. Reimbursement amounts are one of the biggest cons with Medicare paying an average of 20% less than most private payers, says Cohen.

Another challenge is that physicians receive a financial penalty when they don’t satisfy requirements outlined in the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015, although participating physicians can also receive incentives. “You face the problem of being in a contract with a government agency that can come back and audit you at any time and take all of your money back,” says Cohen. “That’s a real problem.”

(To learn more about MACRA program requirements, see the Independent Practice Guide to the MACRA Quality Payment Program.)

Practices that have been in business for a while can perform a financial analysis to determine the average cost per relative value unit (RVU) before deciding whether to participate with Medicare, says Cohen. If the per-RVU costs are less than what Medicare pays per RVU (i.e., $30-$32), the practice profits every time a Medicare patient receives services. That profit might be nominal, but at least it’s money coming in the door, he adds.

And remember that accepting Medicare certainly isn’t the only way to grow a practice. Cohen says physicians should also explore other options, such as contracting with additional private payers or even transitioning to concierge medicine.

“It’s a business decision,” says Cohen. “You can only lose money for so long, and then you’re out of business.”

6 Tips to Get Paid by Medicare

Accepting Medicare is one of many ways in which physicians can expand their practices. That’s because even despite often having a lower fee schedule, Medicare tends to pay consistently and promptly, making it easier for practices to grow.

However, choosing to accept Medicare isn’t a ‘one and done’ decision. Instead, it requires a thoughtful approach to ensure that practices are paid appropriately, maintain adequate cash flow, and safeguard revenue so auditors don’t try to eventually recoup that money.

Frank Cohen, director of analytics at Doctors Management, LLC in Spring Hill, Florida, provides these six tips for practices that are new to Medicare:

1. Hire a nurse practitioner or physician assistant

The cost-to-revenue ratio is significantly lower when non-physician practitioners (NPP) treat Medicare patients, says Cohen. This means it’s ultimately more profitable when NPPs see these patients. This strategy also allows physicians to fill their schedules with patients whose insurance pays more per relative value unit. This allows the practice to accept and treat Medicare patients without having to drain all of the physician’s time and resources.

2. Be strategic when scheduling patients

For example, set aside a certain number of daily slots for patients with Medicare, Medicaid, and private insurance. Because Medicare often pays the lowest, consider setting strict limitations for the number of Medicare patients seen in a single day or week, says Cohen. Balancing the schedule in this way creates a cashflow equilibrium.

3. File clean claims every time

“Do it right on the front end so you’re not subject to an audit three years down the road,” says Cohen. “Clean claims are the secret to not only making—but keeping—money in this industry.”

Filing clean claims may require physicians to hire a certified medical coder. They’ll also need to budget for that individual’s ongoing continuing education. If the physician can’t afford a certified coder, then it’s best to outsource the coding function to a reputable company, says Cohen.

(Here’s a checklist to help you decide on your medical billing needs: Is Outsourcing Your Medical Billing the Right Choice?)

4. Establish a compliance plan—and follow it

The Office of Inspector General (OIG) provides guidance for individual and small group physician practices to help them conduct internal monitoring, implement practice standards, develop corrective action and more. Following a documented compliance plan helps physicians stay on track, and it mitigates risk for denials and recoupments, says Cohen.

5. Work with your practice management vendor

Because Medicare’s National Coverage Determinations, Local Coverage Determinations, and National Correct Coding Initiative edits are completely transparent, physicians are most successful when they work with their practice management vendors to ensure that this information is loaded on the front end. This enables practices to validate claims prior to submission. Many systems also offer coding checks that validate procedural codes and modifiers.

It’s difficult to implement this same type of checks and balances with private payers, says Cohen. “The problem with private payers is that there’s still a lot of black box editing that goes on,” he says, adding that he recently had to look 22 pages deep into a payer’s website to find its payment policy.

6. Hire an external auditor annually

Under these self-disclosure and payback policies, the government and private payers are expecting physicians to hire an external auditor, says Cohen. External auditors can easily identify billing and compliance risk that could be potentially catastrophic when left unaddressed, he adds.

Choosing to accept Medicare can help physicians grow their practices, but only when implementing a strategic approach to stay profitable. This includes careful consideration of staffing, scheduling, billing and auditing.

Top 10 Reasons to Train for a Medical Billing and Coding Career

Medical billing and coding can be a demanding career. To succeed, you must be precise, you must be able to meet deadlines, and you must have enough medical knowledge to accurately identify a wide array of conditions, procedures and outcomes. Becoming a medical insurance biller and coder requires special training and you must regularly update your knowledge for as long as you practice your profession. Your performance can not only determine if a patient receives the proper course of treatment, but it can also expedite or delay payments that can total in the tens of thousands of dollars.

It’s a lot to think about.

But as demanding as medical billing and coding is, there are many compelling reasons to pursue it as your career. Here are 10 of them:

1. There’s a demand for trained professionals. Health care is one of America’s healthiest industries (no pun intended), accounting for 17.9 percent of our Gross Domestic Product (GDP)…and growing. As for medical billing and coding professionals in particular, the U.S. Department of Labor expects jobs openings to increase 21 percent between 2010 and 2020, a rate it describes as “faster than average.”

2. The field is secure. With America’s population aging, the demand for medical services and support personnel is only going to increase. Even if the U.S. went to a Canadian-style single-payer health care system, there would still be a need for specialists to handle the biggest thing the private and public sectors have in common: paperwork.

3. You can train quickly. Yes, you need specialized training, but if you have a high school diploma or its equivalent, you can usually earn your medical billing and coding diploma in one year or less.

4. It’s a health care position with no patient contact. An a medical billing and coding specialist, you can enjoy all the benefits of working in the health care industry without having to expose yourself to germs, bodily fluids or the other “ick” factors often associated with actual patient contact.

5. You will work in a professional environment. You will likely work in a physician’s office, clinic, hospital or similar environment alongside highly educated professionals. Or you may work for an insurance company in an organized corporate atmosphere.

6. You may be able to work from home. Like medical transcription, medical billing and coding is a specialty that can also be performed from the convenience and comfort of your own home. A medical billing career is a great career for young parents or others who’d prefer to avoid the hassle and expense associated with daily commuting.

7. You may be able to work part-time. Many medical billing and coding specialists work only half days, or on evenings and weekends. Again, if you’re looking for flexibility, medical billing and coding can be a great choice.

8. Pay is competitive. Compensation will naturally depend on where you live, local market conditions, whether you work full- or part-time, and your level of experience. Nationally, the average starting rate is about $10.70 per hour, but it can be as high as $12.12 per hour in states like California and New York.

9. There’s room for growth. With time and experience, your income can more than double. Nationally, top-tier medical billing and coding specialists average more than $56,000 per year, and more than $58,000 in higher-wage states.

10. Your skill set is transportable. Are you a displaced worker or changing careers? The skills you acquire in medical insurance biller and coder can allow you to transition smoothly to other industries that rely on detailed documentation, such as insurance, banking and home lending.

If these benefits sound good to you, then medical billing and coding is a field you should explore further. With the right training, you could be out of school and ready to go to work by this time next year. So what are you waiting for?

[1] Source: http://data.worldbank.org/indicator/SH.XPD.TOTL.ZS

[2] Source: http://www.onetonline.org/link/summary/29-2071.00

[3] Source: http://ije.oxfordjournals.org/content/31/4/776.full

[4] Source: http://www.careerinfonet.org/occ_rep.asp?optstatus=011000000&soccode=292071&id=1&nodeid=2&stfips=36&search=Go

How do physicians choose an outsourced medical billing provider?

The best way to choose a medical billing service is to understanding the needs of your practice. After that check the accuracy and the amount of time they take for claims filing and the collection percentage.

Accuracy, timeliness and collection percentage.

Accuracy – How accurate are the claims that are going out. Do they go to the right insurance company? Do they contain all of the information necessary for payment? Do the payments go to the right lock box or bank account? Who is responsible for errors? What kinds of reports are available? Often known as slicing and dicing, what kind of accurate reporting can the vendor supply that can help the practice with productivity, planning, forecasting, etc.

Timeliness – How quickly does the information provided by the practice get turned around? What is the process for handling claims denied for timely filing? This is usually a negotiation to determine who is at fault when this happens. Making sure these terms are fair to the client as well as the vendor is key here. How soon are reports available for the practice? (Daily, weekly, hourly) How quick is the response to questions, issues, requests. How available is the vendor?

Collection percentage – Who does claim follow up? Who works denials? Percentage of clean claims that go out? How much is collected on the billed dollar? How much work does the practice do to resolve the AR and how much is taken care of by the billing company?

These are common concerns when shopping for a billing company.

What is MACRA and MIPS?

What is MACRA?

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MACRA is the Medicare Access and CHIP Re-Authorization Act. MACRA replaces the current Medicare reimbursement schedule with a new pay-for-performance program that’s focused on quality, value, and accountability. The Centers for Medicare and Medicaid Services (CMS) stated that MACRA enacts a new payment framework that rewards health care providers for giving better care instead of more service.

President Obama signed into law the Medicare Access and CHIP Re-Authorization Act (MACRA) on April 16, 2015. It passed with a 392 to 37 vote in the House of Representatives, and a 92 to 8 vote in the Senate. That bipartisanship indicates the legislative support for MACRA and the significance of the bill in U.S. healthcare reform.

MACRA combines parts of the Physician Quality Reporting System (PQRS), Value-based Payment Modifier (VBM), and the Medicare Electronic Health Record (EHR) incentive program into one single program called the Merit-based Incentive Payment System, or “MIPS”.

 

What is MIPS?
MIPS is the name of a new program that will determine Medicare payment adjustments and is an acronym for the Merit-Based Incentive Payment System. Using a composite performance score, eligible professionals (EPs) may receive a payment bonus, a payment penalty, or no payment adjustment.

The Composite Performance Score is based on four performance categories:

  • Quality
  • Resource use
  • Clinical practice improvement activities
  • Meaningful use of certified electronic health records (EHR) technology

Performance for MIPS will start on January 1, 2017 and will annually measure eligible providers in four performance categories to derive a “MIPS score” (0 to 100). The MIPS score can significantly impact a provider’s Medicare reimbursement in each payment year from -9% to +27% by 2022. The four performance categories are weighted:

50% for quality (PQRS/VBM)
25% for Meaningful Use
15% for clinical practice improvement
10% for resource use

The points provided for each category will shift over time to place an increasing focus on more resource use.

 

What should I be doing now to get ready?

The best way to get ready for MACRA and MIPS is to satisfy Meaningful Use Stage 2 requirements and continue to work on achieving PQRS requirements. CMS has stated that providers already attesting to Meaningful Use and PQRS will likely have no net new requirements. mips-macra-next

The MIPS proposed rule is expected in the summer of 2016 and the final rule is expected in November. The final rule will determine how points are earned within each component.