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Dismal patient collections? Make sure you aren’t making these 5 mistakes

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     Are you making these 5 common mistakes?

There can be nothing more discomforting than talking to patients about payment     responsibilities. Coverage cuts and high deductible healthcare plans make it imperative for healthcare organizations to focus on patient collections.

But do you feel queasy every time a patient collection issue crops up? Avoiding these 5  mistakes and training staff to steer clear of them, can boost your patient collections.

1. Giving the wrong signals!

Body-language matters. Smiling, while discussing about payments, can signal to your patients that you aren’t serious, or undermine the importance of paying the due amount. Frowning or speaking in a grave tone can put off patients. Maintain a neutral body language throughout. Familiarize yourself with contractual terms and coverage details before the discussion. Fumbling or giving the wrong information will further prolong the entire process.

2. Sending out overly complex patient statements…

You can bet your bottom dollar that most patients are not familiar with insurance terminology. So don’t send out a statement that can only be understood by a biller or insurance expert! Simple patient statements that don’t overwhelm patients work best. Don’t add aging buckets at the end of the statement. It can be an open invite for patients to procrastinate payment.

3. Let the patient speak!

Most medical offices make the mistake of dominating conversations with patients. Let the patient speak. More often than not the amount they agree to pay or the deadline they agree to clear bills will be much better than what medical practices expect! Encourage patients to come up with suggestions, payment options and payment schedules. This way, patients feel less browbeaten and more involved.

4. Not exploring newer methods for collecting payments…       

A lot many medical practices are implementing the “credit card on file” program. The details of the credit card are securely stored and the medical practice “swipes” the card to recover payments due, if and when required. Discover new, convenient and patient friendly payment options.

5. Missing out on upfront collections…

Failing to capture upfront collections complicates and delays the patient billing cycle. Ensure your front-desk staff, collect desk payments promptly. Call patients prior to an appointment to inform about their payment responsibility and what method of payment would suit them best. Have a swipe machine or request patients to pay online.

Provide a receipt, and if possible a note of thanks, upon receiving payment. This will induce patients to more promptly the next time around.

ACO Wars – Pioneer vs Shared Savings Programs

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ACO

Well, it is not a war in the strictest sense of the term, but it does denote the recent developments in the ACO or Accountable Care Organization scene where many Pioneer ACOs have been opting out of the program due to difficulties in meeting the targets and the high risks involved.  About 25% of the Pioneer registered Accountable Care Organizations are in the process of exiting the program and joining the lower-risk option, the Shared Savings Program.   CMS had this to say about the fallout :

 “We’re encouraged that these organizations want to continue in programs that promote better care at lower costs, we fully anticipated that as these programs get up and running, some organizations would shift between models.” 

Health Reforms & ACOs

 For those of you, who have been too busy to register what an ACO exactly is, it is a category of CMS program, which is part of the government health reform, which includes others like Patient Centered Medical Home, Medical Neighborhood, Health Home, etc.  The reforms themselves consist of three main components, which is a superset of any practice models.  They are :

a. Care Delivery Reforms.

b. Payment Reforms.

c.  Health and Healthcare Community Reform.

 ACO is a model which is, to quote a popular definition, “an organization, virtual or real that agrees to take on the responsibility for providing care for a particular population while achieving specified quality objectives and constraining costs.”

 As the above definition clearly points out, an ACO platform is expected to stimulate more integrated care for the patients, which would ultimately result in quality improvements and healthcare cost reduction.  Also, in these programs the ACO gets a share in the costs ultimately saved.

Pioneer vs Shared Savings Programs

 SSP and Pioneer were two landmark ACO programs created by CMS.  The latter has a slightly complex format, which takes into consideration organizations that already have some experience in providing coordinated care.

 The Main Differences between the two are:

 1.  SSP has two payments tracks and it is upto to the ACO to choose either the non-risk sharing one (which has less cost savings share) and the risk-sharing track (which has higher cost savings share but at the same time there are possibilities of losses upto even 60%).

 2.  The Pioneer utilizes a trending methodology that, all other things being equal, produces a slightly higher benchmark than the SSP for high-cost areas.

 3.  The SSP will need to cater to at least 5,000 Medicare fee-for-service beneficiaries, whereas the Pioneer needs to service 15,000.

 4.  The Pioneer program importantly includes a clause that 50% of Pioneer ACOs revenues should come from participating in “risk” contracts with other non-CMS  (private) payers.

 The Significance of events such as the above

Republicans have been ardently opposing the health reforms (which is really an attempt for universal healthcare).  The recent refusal by the National Football League to team up with the government to promote ObamaCare has been touted as some sort of vindication for their stance.  Also, the refusal of some states to adopt the Medicaid expansion plan and the setting up of online HIE, to realize the goal of “healthcare for all” , is seen as further supporting evidence.   And the above developments in the Pioneer ACO scene is construed by some health reform detractors as the “straw that will break the ACO camel’s back”.

 MedicalBillingStar :  A Voice of Sanity

 With a decade of hands-on experience in servicing over 500 clients when it comes to the RCM Cycle, MedicalBillingStar always endeavors to float above the cacophony of healthcare gossips and half-truths, to provide their medical billing and coding clients with information that is relevant, besides of course catering to their entire RCM workflow.   We are aware of the impact that ACO’s will have on payment models, the changes from which ultimately have to be incorporated into the RCM process.  Thus, we keep abreast of the latest happenings in the payment model scene.  Meanwhile you may call MedicalBillingStar at 877-272-1572 or visit our website at www.medicalbillingstar.com if you any questions about any of the above or the Medical Billing/Coding processes in general.

A Few Survival Strategies For Healthcare CFO’s To Handle 2014

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Time for healthcare CFO’s to step up their plate !

2014 is going to be a year of change. Federal mandates, financial constraints and heavy penalties for non –compliance is going to make 2014 a challenging, tumultuous year. It is time to up the game to ensure medical practices don’t crumble under pressure. And as always it is the man at the helm who needs to up the game!

Focusing on wellness programs can help you save on taxes !CFO

The PPACA requires all healthcare organizations to review the wellness plans of all full time employees. Choosing a wellness plan that is highly deductible can be a major tax saver. CFOs will have to examine the current coverage plans.

And freeze in on a wellness plan that works both for their employees and also saves on taxes. This could well be the major priority of healthcare CFOs in 2014.

Systems to record the quality of care…

The healthcare landscape is undergoing a period of transition. From volume based payments. To a model that is based on the quality of care and patient outcomes. It is essential that CFO’s implement systems and upgrades to report and measure clinical variations. Maintaining, longitudinal health records that are detailed and contain data across the care continuum, is important.

Will your clinical documentation cut it ?

Do you maintain pristine clinical documentation ? If yes you are lucky. If, like a majority of health care providers your answer is, no, then it’s time you upped the ante. Review your revenue cycle that coordinate with coders and physicians to ensure more accurate and updated clinical documentation.

Analyze every phase of the RCM to see where you can reduce costs. Have your billing team give a detailed report of key financial metrics.

Outsourcing can be a huge cost saver !

Reducing the number of full time employees can help you cut back on costs. But this is a move that has to be taken after weighing in the pros and cons. 

Here’s a quick presentation for CFO’s to handle the practice.

Don’t Fumble Your Way Through EHR Implementation !

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EHR Implementation ; How To Avoid The Tripwires…

Choosing an EHR is tough. A zillion glossy brochures, well-meaning colleagues and pushy sales persons only make the decision harder. The, fact that almost everybody who owns an ehr hates it with a passion makes the most determined of physicians, back-foot.

According to recent reports physicians are reverting to paper records. And some have started looking out for another EHR. A survey by American EHR partners found that user satisfaction levels dropped from 39% in 2010 to 27% in 2012. How do you ensure your EHR implementation process doesn’t turn out to be a harrowing experience ?ehr-implementation

Know What You Want…

Most physicians rush in to ehr implementation without clear direction or expectation. Analyse your workflow and see how the inclusion of an electronic health record impacts your practice operations. Do not fall for the “you can tweak it” line. Manipulating your ehr can prove to be counter-productive.

Customizing your system is fine as long as you don’t miss out on the features and automated comfort your ehr offers.

What Does Your Front Office Team Think ?

Yes, the mousy girl who sits in the reception needs to know whether the appointment scheduling and insurance eligibility feature, makes the cut. Your coders will have to decide if the coding and scrubbing options are easy to work with.

The end users are many and you have to choose an EHR that makes everyone happy. It will increase productivity and morale.

The Person Who Matters The Most !

Your patients are the lifeline of your medical practice. Ask your EHR vendor whether they offer a patient portal. Check if it is patient friendly and secure. Enquire about the level of training and support offered. Caring for your patients is after all the best investment, ever.

Stay The Course !

Adopting an EHR is like parenting. It does get on the nerves and makes you lose sleep. But being a quitter is not going to help. Vow to yourself no matter how tough it is you will not revert to paper. Scribbling down details is easy but not the best way to work. During the implementation stage itself, promise to yourself, you will stick to your EHR.

Should Patients Be Allowed To Access Their Physicians EHRs? Weighing The Pros And Cons

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Whose EHR Is It Anyway ? !

 This far and no further, is the approach physicians are taking when it comes to patient EHR access. Patient electronic access is an important objective of Meaningful Use. It can help physicians to deliver better quality of care.  And to bring everybody across the care continuum in one single, secure platform.

EHR-access

Data security risks is the key reason why the debate on patients access to EHR is still up in the air. Nothing can scare physicians more than a data breach. The average housewife in New Jersey may not be up to date on HIPAA regulations  And there is also the potential threat of patients misinterpreting their medical data.

A physicians understanding of a medical problem is not the same as that of a patients. It could cause unnecessary stress and anguish, and make patients vulnerable to self-medication dangers.

I Don’t Want My Patients In The Drivers Seat…

According to a recent survey conducted by Accenture, around 65% of doctors feel that patients should be given limited access. About 82% of physicians endorse the view that patients should be actively involved in their healthcare. Around 4% of doctors told they’d like to ban patients from having an online access to medical records.

Most physicians were of the opinion that other than demographics, patients shouldn’t be allowed to edit or update any other medical data.

The Way Around This Catch 22 situation !

  • Talk to your EHR vendor about including patient identity proofing and authentication features.
  • Standardize the information you want your patients to access.
  • Educate your patients about your EHR.
  • Work with a  biller who has experience in working with your EHR so patient billing is streamlined to a great extent
  • Follow a clear cut privacy policy and usage guidelines.

Make Sure Your EMR Doesn’t Make You Face Medical Billing Malpractice Charges

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EMR-Overbilling

Beware your EMR could land you in a tight spot !

There is a lot of dust raised about EMR’s again. According to recent reports an EMR can lead to inflated costs and fraudulent billing. Allegedly, physicians have added about 11 billion more to their fees, over the last decade alone. The Center for Public Integrity’s “Cracking the code” series, has found that the usage of EMR/EHR’s have resulted in widespread billing malpractices.

More to it than meets the eye…

Healthcare experts argue that this a strong marker of the negative impact, wishy-washy rules can cause. It can not only make physicians vulnerable to fraud and abuse charges, but also be potentially life threatening for patients. Mostashari, the National Coordinator for Health IT rues that “documenting care that didn’t occur, that’s not just fraud, it’s really dangerous medicine.”

It is being argued that the system is flawed. And it is high time the government sat up and took notice before it snowballs into a huge issue and causes irrevocable damage.

Has coding higher become par for the course ?

Upcoding is rampant. And emergency rooms in particular have been pulled up for assigning high level codes, despite the treatment not warranting it. Whistle-blowers  worried physicians and confused patients are making one collective demand. For, strong auditing tools, and transparent uncomplicated regulations.

The new CMS directive !

The centers for Medicare and Medicaid have issued a new directive to restrict billing malpractices. Federal authorities will be keeping a close eye on EMR users to curb this unhealthy trend.

Where the cracks appear…

Physicians are unusually busy people. Most doctors fume that EMR’s have reduced them to efficient machinery. Nobody likes to sit, and copy paste information. Or, working with straight out of a can, point and click templates. Long loading times and a maze of options can drive physicians round the bend. Impatience with the system, more than the willful intent to over-bill  might be the reason behind improper billing.

A quick guide to bill right !

  • Train your billing team to work closely with your EMR/EHR system.
  • Use an accredited medical billing software.
  • Conduct regular in-house financial audits.
  •  Ensure the same information isn’t entered again. Redundant data is the major cause of over-billing.
  • Educate your practice about CMS guidelines and updates.

Medical Practice Managers Needn’t Sulk ! Take It One Step At A Time.

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Medical Practice

What are your Plans this 2013 ?

Agreed ! It is probably too late in the year to make a resolution list, and berate yourself the whole year for not following it. But it is never too late for change. The year brings with it lots of changes to the way you work. From working towards Meaningful Use requirements to choosing those nine CQMS you want to qualify for !

Ten Steps you must take to Ensure you roll with the Punches !

1. Being the first one off the block does have its advantages! Whether it is testing ICD-10, or educating patients on your EHR do it now !

2. Choose clinical quality measurements keeping your patient population, practice workflow and specialty in mind.

3. Perform an audit. It needn’t be an extensive one that brings everything to a standstill. But make a vow that you conduct “mock audits” on important processes such as billing, regularly.

4. Try to reduce costs on every aspect of your medical practice’s food chain. From stationary supplies to revenue cycle management.

5. Focus on maintaining accurate clinical documentation. RAC audit might just be around the corner.

6. Hire a financial counselor or if it’s too expensive, train your front office staff on financial counseling to collect self pays. Remember it consists of a significant revenue opportunity.

7. Have a clinical discussion with your pharmacist to reduce drug costs.

8. Analyze your AR reports, revenue cycle management reports and look for ways to optimize your workflow and exploit revenue opportunities.

9. Be active on social networking sites. That could be the easiest way to engage with your patients.

10. Instead of setting an ambitious annual goal, set small, practical and immensely achievable monthly goals to increase collections !

Why Physicians are in Verge of a Meltdown ?

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You didn’t really need statistics to know this. For the last few years, physicians have been complaining about having to juggle a million tasks. But the toll it takes on the mental health of physicians is clearly illustrated in a study conducted recently.

According to a finding published in the Archives of internal medicine, an alarming 45.8%, of physicians surveyed suffered from, at least one symptom of a burnout.

Bitter Pills…

Facing a rejected claim again, trying to stay in compliance, chasing deadlines, there are dozens of bitter pills physicians have to swallow everyday. The high level of stress associated with practicing medicine, is not just unhealthy but can lead to doctors becoming endangered species in the near future.

Can I Meet the Doctor ?

This is the first question that most patients ask. And there are chances that they’d be meeting a nurse practitioner or physician assistant, instead. Due to severe shortage of physicians, NPs and PAs are backfilling, to provide patient care.

Not all Grey and Bleak !

Training and hiring staff to shoulder a bit of the responsibilities physicians handle can be a huge relief for doctors. Healthcare providers should work in an environment that facilitates teamwork and shared responsibility, to stop stress from chipping away at their efficiency and morale.

Taking Time off to Catch up on Basketball…

Having a cup of green tea, going for strolls and taking a holiday now and then are important. But to make major decisions such as hiring third party associates or physician assistants, it is important that physicians take time off to reflect. And build a strategy that can help them step over stumbling blocks instead of pretending they don’t exist.

Efficient Error Reporting Systems lead to Healthier Practices

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 Be the one to take a call !

To error is human, but, to report it took super human efforts, until recently. A recent study by the Perelman school of medicine at the University of Pennsylvania, confirms that reporting errors leads to a safer medical practice.

As frontline healthcare workers, physicians fear, losing credibility or possible intimidation. And, are dubbed as, “reluctant partners” when it comes to reporting medical errors. This finding is hoped to open the doors for more open communication within a medical practice.

I’d Rather tell My Friend !

Error reporting systems in most healthcare facilities frustrate and limit physicians. Most hospitals do not have a structured reporting system, for physicians to report errors. Though all healthcare facilities have a reporting system in place, they are hardly what doctors hope for.

Not just a Fancy Asset…

The reason why most reporting systems fail is that they’re, like that vase of pansies in the reception, just a fancy asset in most practices. They don’t guarantee privacy and reporting anonymously is not an option at all. This lack of privacy can in effect harm patients and the security of patient data.

Speaking up !

As the awareness about the need for efficient reporting systems increases, it is high time that hospitals set up a system that their staff are, comfortable with. Building baseline data on errors can lead to higher efficiency and healthier patients.

Every physician setting up a new practice should, apart from concentrating on low cost insurance credentialing services , recruiting and payrolls, also set up an efficient reporting system !

Are Private Practices being given the Rough End of the Stick?

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Everybody who’s a name to reckon with in the healthcare industry is at the MGMA12 conference. One of the most pertinent topics discussed was the cookie cutter situation private practices are in. The healthcare landscape is changing and as we all know change can be expensive! It is going to take a lot of effort for small independent practices to stay afloat.

                       

 A Tough Call to Take !

According to recent studies physicians gravitate towards working for multispecialty hospitals, than take the risk of, branching out on their own. The possibilities, advantages, losses and responsibilities can be huge. But the future certainly isn’t bleak for the small practice owner.

The ACO HandShake .

There is a lot of controversy, diverse opinion and heated arguments about small practices collaborating with ACO’s. Some industry experts feel that is could sound the death knell for independent practices and can only benefit large scale “for profit insurers”. But the most widely agreed upon view is that ACO’s hold lots of promise and benefits in the long run.

The Trade-Offs .

It is important for independent medical practitioners to understand the medico-legal implications. Whether it is delivery mistakes or data leaks, the risks can almost outweigh the rewards, at least in the short term. Physicians will have to be completely clued into the minutest of details, before collaborating with an, accountable care organization.

As there is an increasing pressure on small practices to consolidate and build partnerships with the bigger players, it is more important than ever that physicians are aware of the financial aspects of a practice.

Leveraging Resources and Containing Costs…

Making the most of what is available is essential for independent practices to remain independent. Outsourcing tasks that can be outsourced such as medical billing can help in scaling down on costs. And free up in-house staff to attend to more pressing demands such as better patient communication.