Healthcare IT

Keep yourself updated on healthcare news regarding practices and medical software. The new regulations and trends in the health industry and all that you need to know.


Leave a comment

Can a practice successfully outsource medical billing before the ICD-10 deadline?

Less than 140 days are left for one of the biggest changes in US healthcare industry to take place. Yes, ICD-10 is hiding just around the corner, waiting to pounce upon us on October 1. About now, most physicians are finally convinced that they cannot run from ICD-10 anymore, and many medical practices have started taking appropriate steps in preparing for the new coding system. The only problem is that they don’t have enough time left! Credible sources such as Cecil Bohannon, consultant at CTG Health Solutions, have also come out to state that the ICD-10 implementation will not be delayed any further. Statements such as Cecil’s are growing by the week.

medical billing  company

Upgrading an existing medical billing system is one of the biggest hassles currently faced by numerous practices in the healthcare community. The software and training are going to cost both money and time, and practices rarely have enough of either as it is! Industry experts have advised small and medium practices to outsource their medical billing to third parties instead of going through the trouble of make the changes themselves. The question which remains now: Can a practice successfully outsource its medical billing before October 1?

Although some physicians have given up on the idea by now,  you must know that it’s still achievable. Physicians should first make a list of Medical Billing Services that have experience dealing with specialties similar. The selection process would take a couple of days because practices must be careful while choosing their vendor. The medical billing vendor you choose must have good online reviews and ratings. That’s because if current clients aren’t satisfied with their services, there’s little chance that you will be. It should also have a well trained team of coders and billing specialists who are up-to-date with the recent healthcare and coding regulations. Most of all, the vendor must increase the practice revenue by reducing the number of claim denials.
Once the practice has entered a contract with a suitable medical billing service, the next step is to formulate a plan for ICD-10. The plan must be divided in two phases; pre ICD-10 and post ICD-10. The practice and medical billing service must collectively decide on timelines for each step of the phase. These steps include patient data transfer, documentation training for physician and office staff, coding training for billers and pre-testing of ICD-10.

It is confirmed that medical practices will suffer from a direct revenue loss after ICD-10 for some time, which is why it is necessary for practices to make plans for post ICD-10 as well. The plan for post ICD-10 includes managing the financial budget as well as keeping a follow up plan for the ICD-10 workflow strategy. This way, any loopholes in documentation or billing process that are affecting practice revenue can be identified and improved.

Outsourcing medical billing is the best current alternative for physicians who own small practices and cannot afford in-house billing in such a short period. As mentioned earlier, ICD-10 is set to be implemented this year, so medical practices must starting looking for suitable vendors immediately to meet the deadline.


Leave a comment

No ICD-10 Penalty till 2017?

With the SGR repeal bill signed into law, the ICD-10 transition deadline of October 1 2015 is almost certain. However, an interesting recommendation surfaced last week during a hearing about HHS’ proposed 2016 budget.

Senator Bill Cassidy recommended that ICD-10 penalty be delayed for two years. This essentially means that CMS will continue accepting, processing and paying claims filed in ICD-9 even post October 1 for the next 2 years.

Secretary HHS Sylvia Burwell , countered by saying that many large payers and providers are ready and waiting for ICD-10 and that HHS is working to provide technical assistance and training to those organizations that are not at this point prepared.

For Further read Visit: http://blog.curemd.com/no-icd-10-penalty-till-2017/

Check out amazing infogrphic related to ICD-10

 


1 Comment

How can I safeguard my practice from Claim Denials?

Claim denials are the main reason behind the decreasing bottom line and low profit margins of many small, medium and large practices. Physicians put patients first in their practice, which is why providing quality care is their main priority. However it’s quite impossible for physicians to receive the ‘fair reimbursement’ for their services.
It is estimated that 20 to 30% of claims are denied by insurance companies on first submission. The main causes of these denials are errors made by the administrative and billing staff. Entry of incomplete or inaccurate information and failure to keep up with new billing regulations and insurance policies are the most common mistakes that lead to an increased claim denial rate. COO of RemitData, Brian Fugere, identified the five most common claim denials that affect practice revenue; duplicate claims, claims lacking information, eligibility expiration, claims uncovered by insurer and time limit expiration.
After identifying the problems, I got in touch with several renowned physicians and medical billers to find solutions for these problems. The three most effective techniques to reduce claim denials are

Claim Scrubber-CureMD

1. Making use of Claim Scrubber tools:

Claim scrubber is the latest technology being adopted by clearinghouse vendors for aiding billers in catching errors in claims prior to submission. Unlike Clean Claim Checks, A claim scrubber ensures that CPTs and ICDs are entered correctly in the claims. Other features of claim scrubbers include checking formats and validity of insurance policies, suggesting corrections for proper coding and providing quick results. Claim scrubber eliminates the need to manually check claims before their submission to insurance companies, and thus contribute in reducing denials by a large extent.

2. Keeping a Claim denial log

Claim denial logs can help billers in identifying claim error trends early, and react accordingly. These logs can be maintained both electronically or via paper. They should include important information like written documentation of insurance companies, date of submission and rejection, amount, reason of claim rejection or denial, and how effectively did the billing team of the practice handle the process. Physicians need to understand why their previous claims were denied so they can avoid such mistakes in the future.

3. Consider outsourcing billing

Errors on the biller’s part are responsible for more than half of all claim denials and rejections. The best alternative is to either assign each of your billers to one or two individual health plans, because of the difference of policies and reimbursement contracts among insurance companies. This can help the billers gain expertise in the plans they are assigned to. For small and medium practices, an even better alternative is to Outsource Medical Billing to a third party vendor. The reasons: they are up-to-date with billing regulations, healthcare policies, and upcoming major changes in the healthcare system like ICD-10.
After implementing these techniques at your practice, you will observe a significant reduction in the claim denials at your practice. Do let us know if the strategies made a difference to the billing revenues at your practice in the comments section below.


Leave a comment

Back to 90 days: The big Meaningful Use announcement

The Announcement:

Healthcare providers across the country breathed a collective sigh of relief when The Centers for Medicare & Medicaid Services (CMS) announced its plan to implement a new rule which would shorten the 2015 Meaningful Use reporting period from 365 to just 90 days.

The federal agency’s Chief Medical Officer (CMO) Patrick Conway, M.D. made this announcement via a blog post on January 29.

“The new rule, expected this spring, would be intended to be responsive to provider concerns about software implementation, information exchange readiness, and other related concerns in 2015,” he said, adding that “It would also be intended to propose changes reflective of developments in the industry and progress toward program goals achieved since the program began in 2011.”

Meaningful-Use  CureMD

The list of proposals being considered by CMS:

  • Realigning hospital EHR reporting periods to the calendar year. Consequently, eligible hospitals will have much-needed time to conveniently amalgamate the 2014-Edition software with their workflows. They would also be assisted in adapting to other quality programs which have similar requirements.
  • Adjust other MU specifics so that they are aligned with the long-term goals of the program, and to decrease the complexity and reporting burden faced by providers.
  • Shortening the 365-day reporting period for EHRs in 2015 would aide in accommodating these changes.

The distinction:

However, it is pertinent to mention that the forthcoming proposed rule for MU Stage 3 is unrelated to this announcement; and will go on as planned. The proposal for Stage 3 will be applicable for the Meaningful Use of EHRs from 2017 onwards.

The history:

Many stakeholders in the health care industry had united in opposition of the 365-day MU reporting period for 2015.  The pressure groups were able to persuade several members of the Congress to push for legislation to reduce the reporting period to 90 days.

In response to the final rule published by CMS and the Office of National Coordinator for Health IT (ONC) last August, Congresswoman Renee Elmers drafted the Flex-IT bill in the September of 2014.

The aim of this legislation was for providers to continue 90-day EHR reporting for receiving Meaningful Use incentive payments. However, the last legislative session came to an end before anything significant could materialize.

The bill was re-introduced on January 12, 2015, and College of Healthcare Information Management Executives (CHIME), the American Hospital Association, the American Medical Association, and other large healthcare groups supported its reintroduction.

The reasons:

Pressure to reduce the reporting period had been piling on the CMS for quite some time. More and more care providers and stakeholders were uniting to see this done, stating that the requirements were too stringent to be met.

As mentioned above, this pushed for the matter to be debated in Congress. Additionally, when the stats for Meaningful Use of EHRs came out, the adoption rates for Stage 2 were significantly lower than those of Stage 1.

My views are that the CMS must have already been under immense pressure, and looking to amend the rule, when Congresswoman Elemers reintroduced the bill in Congress. This seems to be the icing on the cake, and could have prompted CMS to finally make the crucial decision.


1 Comment

Oncology specific EHR improves patient care

Electronic Health Records (EHRs) have been designed to drive more productivity at practices, while improving healthcare of patients. For a specialty practice, it is recommended that they adopt an EHR which is specific to their practice needs and workflow. Same goes for Oncology.

Oncologists have the option to adopt an Oncology EHR that can be purchased from the market after some careful research. Some vendors offer Oncology specific modules that can be integrated into a general EHR to make it practice specific. Others offer EHRs that have been specifically designed and developed for Oncologists from the scratch.

Oncology patients require complex treatments that stretch over a long period of time, resulting in extensive data recording and management. Generic EHRs do not offer Oncology specific modules to assist physicians to identify symptoms, apply procedures and treatment of the patients.

Some useful features

A suitable EHR for Oncologists should offer features that are integral to patients’ diagnosis and treatment, such as:

  • Calculation and administration of drug dosage during chemotherapy
  • Specific charts and diagrams to assist physician in diagnosis
  • Manage and follow-up clinical trials
  • Oncology specific provider note templates
  • Comprehensive library
  • Integrated charge capture for billing
  • E-Prescribing

How Oncologists benefit?

Specialty EHR acts as a support system for Oncologists that enables them to create most detailed medical record that result in timely and accurate diagnosis and treatment of patients. Oncologists can remain updated with patients’ conditions and modify medication and cancer treatment accordingly.

Specialty EHRs support Oncologists gives complete access to patients’ past and current medical records and library that prompts a timely calculation of the patient’s stage of cancer, as mentioned in the American Joint Committee of Cancer’s staging criteria (AJCC).

Some of the other benefits include the interoperability functionality that is extremely helpful to Oncologists. Most of the cancer patients have more than one physicians providing them treatment simultaneously. This is necessary for each physician to be aware of the medication and treatment provided to the patient, so that there is no clash that may be fatal for the patient.