This document discusses managing the revenue cycle in a healthcare practice. It explains that revenue cycle management involves determining patient insurance eligibility, coding claims properly, and streamlining billing and collections. The "old way" of billing involved seeing patients, filing insurance claims, and posting payments without verifying insurance upfront. This led to lost time and money. The "new way" involves obtaining complete patient information upfront, verifying insurance benefits, entering accurate patient data, proper coding, submitting claims electronically, posting payments, and following up on denials to improve the revenue cycle. It emphasizes the importance of assigning responsibilities and having standardized processes and trained staff to effectively manage the revenue cycle.
Revenue or yield management in hotels is a practice that has evolved significantly in its relatively short history. Adopted by hotels in the late 1980s, after the airline industry demonstrated great success using inventory, capacity and pricing to ‘manage’ revenue, revenue management has become one of the most integral and identifiable aspects of hotel operating strategy. Yet perhaps understandably, today’s brand of hotel revenue management differs significantly from that of two decades ago. Changes in the general approach to revenue management, pricing strategy, channel management, inventory allocation and the use of information as pertains to revenue management have redefined the field.
Vee Technologies provides a host of hybrid and versatile solutions for credentialing services. Our team expertly handles payer enrollment and contracting for our clients, turning an arduous task into a quick and easy process.
https://www.veetechnologies.com/industries/healthcare-payer/provider-network-data-management/credentialing.htm
What is revenue cycle management? How does it impact your practice’s ability to maintain profitability? What are the critical steps to take when managing your revenue cycle? This Quirk Healthcare Solutions Insights webinar will lead you through the important healthcare provider business practice of revenue cycle management. We’ll discuss the stages of RCM, development of a fee schedule, establishing financial policies, billing and collection cycles, and the practical application of revenue cycle management.
Dan Wellisch gave this presentation to the Chicago Technology For Vaue Based Healthcare Meetup at https://www.meetup.com/Chicago-Technology-For-Value-Based-Healthcare-Meetup/
Revenue cycle management (RCM) is the financial process, utilizing medical billing software, that healthcare facilities use to track patient care episodes from registration and appointment scheduling to the final payment of a balance.
Payment posting in RCM seems like an afterthought, something that happens after the “real” work of medical billing ends. After all, you’ve done the hard part and got the payments in the door. Payment Posting is the crucial step in the Revenue Cycle Management process.
Revenue or yield management in hotels is a practice that has evolved significantly in its relatively short history. Adopted by hotels in the late 1980s, after the airline industry demonstrated great success using inventory, capacity and pricing to ‘manage’ revenue, revenue management has become one of the most integral and identifiable aspects of hotel operating strategy. Yet perhaps understandably, today’s brand of hotel revenue management differs significantly from that of two decades ago. Changes in the general approach to revenue management, pricing strategy, channel management, inventory allocation and the use of information as pertains to revenue management have redefined the field.
Vee Technologies provides a host of hybrid and versatile solutions for credentialing services. Our team expertly handles payer enrollment and contracting for our clients, turning an arduous task into a quick and easy process.
https://www.veetechnologies.com/industries/healthcare-payer/provider-network-data-management/credentialing.htm
What is revenue cycle management? How does it impact your practice’s ability to maintain profitability? What are the critical steps to take when managing your revenue cycle? This Quirk Healthcare Solutions Insights webinar will lead you through the important healthcare provider business practice of revenue cycle management. We’ll discuss the stages of RCM, development of a fee schedule, establishing financial policies, billing and collection cycles, and the practical application of revenue cycle management.
Dan Wellisch gave this presentation to the Chicago Technology For Vaue Based Healthcare Meetup at https://www.meetup.com/Chicago-Technology-For-Value-Based-Healthcare-Meetup/
Revenue cycle management (RCM) is the financial process, utilizing medical billing software, that healthcare facilities use to track patient care episodes from registration and appointment scheduling to the final payment of a balance.
Payment posting in RCM seems like an afterthought, something that happens after the “real” work of medical billing ends. After all, you’ve done the hard part and got the payments in the door. Payment Posting is the crucial step in the Revenue Cycle Management process.
A comprehensive view of how Medical Billing works. How to prepare medical claims, patient eligibility, example insurance cards, Medicare / Medicade, authorization of services, charge entry, fee schedules, claim submissions, posting ERAs / EOBs, rejected or denied claims (and their correction), secondary claims, cycle of a claim, revenue cycle, provider info needed on a claim, evaluation and management: coding and evaluations and basic components, etc,. By Medwave Medical Billing & Credentialing at http://medwave.io.
Watch this Webinar to find and plug leaks in your earned revenue and educate yourself on how to optimize the efficiency and profitability of your practice.
https://www.curemd.com/webinar/fixing-rcm-leaks.html
Take a proactive position to reduce claim costs and secure optimum benefits. This presentation will help you know the best practices for handling the complex liability claims.
This presentation covers the fundamentals of medical billing, coding, and reimbursement by explaining how all of these components work together. Emphasis is placed on the practical application of the latest industry knowledge and standards, with the goal of helping those who work with medical claims and claims data stay ahead of the game.
Sun Knowledge Revenue Cycle Management ServicesSun Knowledge
Sun Knowledge Revenue Cycle Management gives you a clear visibility of your finances through payment follow-up. Prosthetics and orthotics billing are handled diligently.
Start with a free practice analysis to increase your bottom line.
How doctors and hospital can get more of their money faster 2% rejection rate proven 98% recovery of all revenues.
www.medicalbillrecoverysolutions.com more info
A comprehensive view of how Medical Billing works. How to prepare medical claims, patient eligibility, example insurance cards, Medicare / Medicade, authorization of services, charge entry, fee schedules, claim submissions, posting ERAs / EOBs, rejected or denied claims (and their correction), secondary claims, cycle of a claim, revenue cycle, provider info needed on a claim, evaluation and management: coding and evaluations and basic components, etc,. By Medwave Medical Billing & Credentialing at http://medwave.io.
Watch this Webinar to find and plug leaks in your earned revenue and educate yourself on how to optimize the efficiency and profitability of your practice.
https://www.curemd.com/webinar/fixing-rcm-leaks.html
Take a proactive position to reduce claim costs and secure optimum benefits. This presentation will help you know the best practices for handling the complex liability claims.
This presentation covers the fundamentals of medical billing, coding, and reimbursement by explaining how all of these components work together. Emphasis is placed on the practical application of the latest industry knowledge and standards, with the goal of helping those who work with medical claims and claims data stay ahead of the game.
Sun Knowledge Revenue Cycle Management ServicesSun Knowledge
Sun Knowledge Revenue Cycle Management gives you a clear visibility of your finances through payment follow-up. Prosthetics and orthotics billing are handled diligently.
Start with a free practice analysis to increase your bottom line.
How doctors and hospital can get more of their money faster 2% rejection rate proven 98% recovery of all revenues.
www.medicalbillrecoverysolutions.com more info
Avi Cavale presentation at DevOpsDays India, September 2015
2014 was the year of Docker. The container-based world exploded on the scene with the promise to reinvent how you think about distributed applications. Continuous Integration/Continuous Delivery in support of DevOps is proving to be a successful early use case for a container-based architecture. Learn how Shippable has designed its Continuous Integration/Continuous Delivery system by fully leveraging containers and a microservices architecture, resulting in reduced Dev/Test cycle times and lower infrastructure costs.
Top 10 Medical Billing KPIs That Show Where Your Practice is Losing MoneyKareo
Kareo’s Billing Subject Matter Expert, Terri Joy, MBA, CPC, CGSC, COC, CPC-I, shares the 10 medical billing KPIs you need to know to prevent your practice from losing money.
Understanding Patients Eligibility, Copays, Co-Insurance, Past Due Balances 2...Conference Panel
To know more visit, https://conferencepanel.com/conference/understanding-patient-s-eligibility-copays-co-insurance-deductibles-and-past-due-balances-2023-changes
Insurance changes are upon us with January 1st right around the corner. Now is the time to review your internal processes and be sure your team is ready for the upcoming changes and prepare if not!
Every healthcare practice must verify coverage before services, especially in the new year. If needed, we can implement new protocols within your office to be more proactive about patient copays, co-insurance, deductibles, and even patient past-due balances.
Our speaker will give real-world examples of processes successfully implemented at busy practices across the country! Common errors, top training tips, and a detailed checklist for eligibility verification will be covered in depth.
Be sure to attend this MUST SEE webinar, it will bring your practice revenue improvement tools for the upcoming 2023 year!
Billing Basics for Mental Health Professionals (1 CE Credit)Procentive
Practicing psychologist Richard Sethre, Psy.D., L.P. and Marjie Brinkman, Director of BillCare, combine real world experience and industry knowledge for an informative and practical presentation outlining key billing concepts and issues. They will help you understand how claims are created by billing services, how claims are processed by insurance companies, and how you should respond when there are problems like denials or other payment issues.
Unless you stay current on billing issues and love doing it, this webinar will help you… a busy professional who provides great care but also knows that getting paid for it is pretty important.
Watch the presentation & get continuing education credits here. https://procentive.com/billing-basics/
Overview of Medical Pay Solutions Revenue Maximizer system allowing medical practices to end the BILLING NIGHTMARE and collect more revenue easier, faster - very patient-centric!
Medical Billing Monitor LLC is one of the leading medical billing companies, based out of Los Angeles, California, started by a team of dedicated experienced experts in the medical billing industry, to provide quality medical billing services to medical practices and medical billing companies in the United States. The experts in our team started in the early 2000’s, and have grown to be one of the global leaders in the Industry.
We provide end-to-end medical billing services that help our clients in reducing the expenses and increasing the reimbursements. Our medical billing services include revenue cycle management, accounts receivable management, medical coding, outsourcing, indexing, medical records, insurance eligibility verification, and physician credentialing and data conversion. Moreover being HIPAA compliant medical billing company, we achieve accuracy, eliminating flaws and we have greater process control as well as efficiency.
Process Improvement: A Consultant's View of your Healthcare Revenue Cycle | A...Meduit
Get a look at how well your revenue cycle processes are functioning and learn how to identify the initiatives your healthcare facility can take to reduce days in A/R and boost revenue! Download the live event recording here: https://lab.meduitrcm.com/process-improvement-innovationlab-webinar/
MDBillables & Practice Management Services: Medical billing and servicesMiguel Rodriguez
MDBillables & Practice Management is a full medical practice management firm dedicated to assisting medical and dental practices in achieving greater efficiency while reducing costs. MDBillables provides a transparent outsource billing services; free access to our leading medical software MedOffice, and 9 additional services ranging from: Transparent Billing; to EMR; Credentialing; Revenue Cycle consulting services; Business Intelligence and Analytics; EFT; Transcriptions; Document Management and MD Audit Shield which provides protection so you are always up to date with new or changing regulations from Hippa, Medicare and Medicaid.
Technology: Increase Revenue, Decrease Workload An AOA WebinarHealth iPASS
The growing chorus of patients with high deductible plans places a greater burden on medical providers to implement patient revenue cycle solutions that optimize net collection rates. Patients are now the largest payers in healthcare. Patient payment technology solutions have the unique ability to promote healthcare price transparency by educating and empowering healthcare consumerism with insurance eligibility information, cost-of-care estimates, co-pay and deductible amounts, and estimates of what balance may be owed post insurance claim adjudication. Learn more about how and why implementing a patient payment collection technology solution empowers, engages, educates, and delights patients through a convenient and intuitive patient check-in kiosk. Plus, learn more about the new “vitals” to track patient revenue cycle management to improve patient net collection rates in this webinar slide deck.
Explore our infographic on 'Essential Metrics for Palliative Care Management' which highlights key performance indicators crucial for enhancing the quality and efficiency of palliative care services.
This visual guide breaks down important metrics across four categories: Patient-Centered Metrics, Care Efficiency Metrics, Quality of Life Metrics, and Staff Metrics. Each section is designed to help healthcare professionals monitor and improve care delivery for patients facing serious illnesses. Understand how to implement these metrics in your palliative care practices for better outcomes and higher satisfaction levels.
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
Deep Leg Vein Thrombosis (DVT): Meaning, Causes, Symptoms, Treatment, and Mor...The Lifesciences Magazine
Deep Leg Vein Thrombosis occurs when a blood clot forms in one or more of the deep veins in the legs. These clots can impede blood flow, leading to severe complications.
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
As we watch Dr. Greene's continued efforts and research in Arizona, it's clear that stem cell therapy holds a promising key to unlocking new doors in the treatment of kidney disease. With each study and trial, we step closer to a world where kidney disease is no longer a life sentence but a treatable condition, thanks to pioneers like Dr. David Greene.
ICH Guidelines for Pharmacovigilance.pdfNEHA GUPTA
The "ICH Guidelines for Pharmacovigilance" PDF provides a comprehensive overview of the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) guidelines related to pharmacovigilance. These guidelines aim to ensure that drugs are safe and effective for patients by monitoring and assessing adverse effects, ensuring proper reporting systems, and improving risk management practices. The document is essential for professionals in the pharmaceutical industry, regulatory authorities, and healthcare providers, offering detailed procedures and standards for pharmacovigilance activities to enhance drug safety and protect public health.
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
2. Revenue Cycle Management (RCM)
• Revenue cycle management (RCM) is the process of managing claims,
payment and revenue generation. RCM encompasses everything from
determining patient insurance eligibility and collecting co-pays to
properly coding claims. A well-designed RCM system is able to
communicate with the EHR and accounting systems to streamline the
billing and collection cycles.
3. Managing the Revenue Cycle
• The Old Way
See
Patient
File
Insurance
Claim
Post
Payment
Bill
Patient
Collect
Payment
4. Managing the Revenue Cycle
• What’s wrong with the old way?
• No Insurance verification
• Nothing collected upfront
• Depending on insurance to cover the payment
• Hassle of billing and making collection efforts from patients
BOTTOM LINE
TIME AND MONEY LOST FOR THE PRACTICE!!!
5. Managing the Revenue Cycle
• The New Way
Obtain
complete
demographic
and insurance
information
from patient
Insurance
Verification
Patient
Demographic
Entry
Coding
Claims
Submission
Payment
Posting
A/R Follow-up
& Denial
Management
6. 1 of 7
Obtain
complete
demographic
and insurance
information
from patient
• Who is responsible?
• Front Desk
• Information must be collected
at the time of making the
appointment
• Before the patient arrives in
the office
7. 2 of 7
Insurance
Verification
• Who is responsible?
• Insurance Coordinator
• Determine eligibility
• Verify benefits
• Copay, coinsurance and deductibles met
• Referrals
8. 2 of 7
Insurance
Verification
• Who is responsible?
• Insurance Coordinator
• How much is the patient portion?
• Ask about authorizations for certain
procedures.
• Have a standardized verification form.
9. 3 of 7
Patient
Demographic
Entry
• Who is responsible?
• Front Desk
• Enter accurate demographics
• Current insurance
• Current address and phone number
• Scan in and update all changes
10. 3 of 7
Patient
Communication
• Who is responsible?
• Insurance Coordinator
• Communicate to the patient what they
owe upfront
• Have the allowables from patient’s
insurance available
• Collect, Collect, Collect
11. • Patient is the second largest payer in most offices
• 20% – 35% of revenue is patient’s responsibility
• Huge deal for practice’s bottom line
• Difference between a thriving and a sinking practice
12. 4 of 7
Coding
• Who is responsible?
• Coding Staff
• Know coding guidelines
• Know payer guidelines
• Accurate coding
• Sending clean claims
13. 4 of 7
ICD-10
Coding
• Who is responsible?
• Coding Staff
• Dual coding before implementation date
• Learn on the job
• Measure productivity
• Always train and educate staff
14. 5 of 7
Claims
Submission
• Who is responsible?
• Billing Staff
• Visual scanning
• Scrubbing
• Setting up system to prompt incorrect entries
• Explosion codes
• Modifiers
15. 6 of 7
Payment
Posting
• Who is responsible?
• Coding and/or billing staff
• Electronic Remittance (ERAs)
• Electronic Funds Transfer (EFT)
• Post from paper EOBs
• Send secondary & tertiary claims
• Automate
16. 7 of 7
A/R Follow-up &
Denial
Management
• Who is responsible?
• Billing Staff
• Working Denials
• Clearinghouse
• Catch errors before payer denials
• EOB denials
• Fix easy errors right away
17. 7 of 7
A/R Follow-up &
Denial
Management
• Choose one day a week to work denials
• Register on insurance websites for faster claim
status updates.
• Use your clearinghouse, Availity, Navinet for
multiple insurances
• Call insurance companies and document all
conversations in the claim window
18. 7 of 7
A/R Follow-up &
Denial
Management
• Look at unpaid claims every two weeks
• File appeal if needed
• Know Medicare and payer guidelines for
filing appeals
19. 7 of 7
A/R Follow-up &
Denial
Management
Patient Collections: Do’s and Don'ts
*** Collect Upfront***
• Payment Plan (Do’s)
• Down payment
• Schedule of payments
• Definitive end date
• Payment Plan (DON’Ts)
• Don’t offer unlimited time
• Don’t take just any amount
• Don’t let patients talk to physician about payment
20. 7 of 7
A/R Follow-up &
Denial
Management
Patient Collections
• Collect balance when making appointment
• Collect when patient comes in
• Online payment options
• Send statement
• Limit the amount of statements sent
• Have a plan for patients who cannot pay
• Send to collections
• Bad debt write-off
• Dismissal from practice (review the consequences)
21. Managing the Revenue Cycle
It takes a village!!
• Office policies and procedures manual
• Standardized forms and scripts
• Everyone needs to be on the same page!
• Cross Training
• Divides the burden
• Cost-effective
• Everyone in the office should have the same philosophy
• Empowers the employees
You should have a list of allowable from at least top 5 payers and have the exact amount ready for the patient.
If your practice routinely does certain procedures, it is a good idea to get preauths for those services.
Accuracy is more important than speed. Many offices make mistakes entering the information which can lead in claim denials and loss of revenue. Share the nickname scenario.
Download CCI edit file (keep current). Beware of modifier use.
ICD-10 is 10 days away and most practices should be ready to go on October 1st. If not, there is still time to come up with a crosswalk and train staff on free and low cost webinars offered by clearinghouses and AAPC and AHIMA.
The system was not setup to send secondary claims. These are the things you need to look for.
Some insurance companies do not send paper EOBs, instead just send a check. Make sure you register on the website so you can match the check number and amount to proper claims and post.
Do not be afraid to file appeals. If your claim is correct and you should be paid for the service, you must fight to get paid. Write-off should be the last resort after exhausting the appeals process.
It is not a payment plan without money down, When you finance a car, you have to put a deposit and the balance is distributed into a set amount of time. A medical practice’s payment plan should work exactly the same way.
Check with your PM system about online payment options. IF you have a website, setup PayPal so patients can pay securely online so you are not responsible to keep credit cards on file. Setup patient on a recurring basis.
Paientpay.net – integrates with your PM system as a financial institution and automatic statement emails are generated instead of printing and mailing statements.
We generally recommend that practices check with their malpractice carrier regarding their recommended language and process. We also generally recommend the following: You will need a formal policy regarding patient dismissal, the patient needs to be informed in writing, the letter should clearly state the patient is dismissed from the practice as of a specific date, the letter should be sent via regular mail and certified mail with return receipt. A common practice is to allow the patient 30 days to find alternative care, while in the meantime providing acute care services only with full payment required at the time of service. To facilitate transfer of care to another physician the letter should include contact information for a physician referral service or local hospital and include a medical records release form. Again, however, it is important to check with your malpractice carrier as they may have some specific process to recommend.