In recent years, specialty practices have shifted from reactive healthcare, toward more preventative medicine as a means to treat patients more effectively, and at lower costs. This trend is especially apparent in value-based care (VBC) and accountable care organizations (ACOs). The theory is sound: Why wait for patients to come to you with a serious problem when you can take proactive measures...
Healthcare providers have had to comply with the Health Insurance Portability and Accountability Act (HIPAA) since 1996; however, changes over the years in both the law and in healthcare’s operational environment have transformed what it really means to be HIPAA-compliant. For example, the initial, primary purpose of HIPAA was to ensure that health insurance coverage continued when an employee lost his or her job, according to Carnegie Mellon...
At a high level, three parties are involved in medical revenue cycle management (RCM):
Change can be scary – especially when it involves adjusting the workflows your practice has become so accustomed to in order to support a more patient-centric practice. But, high-deductible health plans and value-based care respectively inflate patient payment obligations and prioritize patient satisfaction rates.
For Specialty Practices, the road to revenue is oftentimes a drawn-out slog, due to the complexities of today’s difficult medical reimbursement cycle. Specialty practices can alleviate many of those challenges by better understanding some of the key risks tied to their revenue processes, and identifying new ways to manage them more effectively.
While payments from patients occupy an increasingly large share of specialty practice revenues these days, insurers still represent the most substantial source of their revenue. So while revenue cycle management (RCM) is the heart of a practice's financial performance, medical coding is the lifeblood.
Denied claims cost hospitals alone up to $262 billion annually and experts say the situation for independent practices is likely just as bad. Yet a recent study by MGMA suggests that more than 65 percent of denied claims are never followed up on. This means that many practices are accumulating entire cabinets full of unaddressed rejections and denials.
In theory, practice software solutions like practice managers (PM) and electronic health records (EHR) are supposed to provide whole-office perspective as centralized data repositories. The more data you have at your fingertips, the more insight you can achieve pertaining to the financial health...
The defining feature of effective billing and collections, or “revenue cycle management”, is the alignment of clinical and operational workflows to optimize every phase of the revenue cycle, from beginning to end. This has historically been easier said than done because of the many steps involved in ensuring timely payment and reimbursement, including...
Love them or hate them, high deductible healthcare plans (HDHP) show no signs of going away. According to the Kaiser Family Foundation, the number of workers subscribing to HDHPs has increased by 22 percent since 2009, with about half of all U.S. employees purchasing them today.
There might be something to love about value-based care (VBC). Studies have suggested that it can simultaneously cut back on healthcare costs while also boosting overall patient engagement and improving outcomes. By most measures, that's a win-win-win.
Nevertheless, the majority of practices are unprepared for a value-based reimbursement model, according to a Black Book study. In fact, nearly 70 percent of practices intend to seek the help of a third-party consultant...
Before there was electronic health record (EHR) systems, there was practice manager (PM) software. Medical practitioners deployed PM solutions to simplify the operational aspects of their practice, and for a long time, that’s what this software did.
In recent years, though, federal incentive programs spurred a tremendously higher adoption rate for EHRs. As a result, the capabilities of many practices’ EHRs have outpaced those of their PMs....
Financial viability is one thing, but specialty practices that efficiently utilize front-office resources can do more than just maintain financial health: they can thrive. But first, they need to overcome some of the core billing and collection challenges inhibiting cash flow in today's healthcare climate.
A proficient medical billing collection process can drastically reduce time between services offered and payment. Conversely, though, inefficiencies in the collection process can increase overhead as the front desk attempts to chase down delayed payments, retroactively encourage customers to cover the cost of rejected claims, or process reimbursements to patients as a result of over collecting.
Revenue cycle performance is arguably the most important indicator of a specialty practice's health. This has become apparent as more healthcare providers invest in new RCM resources. Case in point, the market for RCM solutions and services is projected to exceed $90 billion by 2022, up from $51 billion in 2017, according to Research and Markets.
A recent survey found that EHRs tailored to function in specialty settings continue to rank highest in specialty physician satisfaction. The study also found that EHRs that include robust coding tools, as well as tight integration with practice management solutions and billing and collections services will most likely continue to see the highest satisfaction rates in 2018.
The concept of Value-Based Healthcare (VBC) has only recently entered America’s larger awareness and, for patients, at least, it seems to be delivering improvements. According to research by Humana, total healthcare costs for patients on VBC plans are 15 percent lower than for patients on a fee-for-service (FFS) model. Furthermore, patients on VBC plans were more likely to have access to preventative care.
Every year, the American health care system loses $150 billion to missed appointments. According to Health Management Technology, this equates to approximately $200 in lost revenue per patient no-show.
There’s good news on the horizon for Medicare providers. Providers who qualify for Medicare Access and CHIP Reauthorization Act (MACRA) may have the opportunity to receive an incentive in the form of greater Medicare reimbursements if they are able to demonstrate high-quality care for patients.