Prevention of readmission denials improves case mix index (CMI), reimbursement, and quality metrics. As a consultant, I am like the FBI – if you invite me in, I will likely take your case. This often leads to varied and challenging projects. Often, I am engaged to assess opportunity in provider documentation, clinical documentation integrity (CDI) competence, or a focused condition, like sepsis or postprocedural respiratory failure. Recently, I did a project for which I was evaluating 30-day readmissions to see if I felt something done or an action not taken on the index admission had resulte ..read more

Providers draw more on-time and uncut payer reimbursements and patient payments by automating these operations with a quality practice management system Via using a quality total practice management system, your company can evade putting as much attempts into accomplishing quality work and rather find effectiveness, accuracy, and peace of mind. An integrated billing and scheduling solution can build on your practice’s fundamental and patient satisfaction while modernizing billing and scheduling operations. Advantages of a standard total practice management system: Upgraded Workflow over Entir ..read more

Physicians with paid medical malpractice claims are more likely to have at least 1 more claim in the next five years, compared to physicians with none. A new study found “a single prior paid claim was associated with substantial, long-lived, higher future claim risk, independent of whether a physician was practicing in a high- or low-risk specialty, or whether a state publicly disclosed paid claims.” That held true among 881,876 licensed medical doctors across the United States from 2006 to 2016, according to the investigation, “Association of Past and Future Paid Medical Malpractice Claims ..read more

Using this technology to create the discharge summary is that the output is only as good as the input. A physician advisor once had a terribly unfortunate incident in which a pregnant patient died. This initiated a mandatory investigation by the Ohio Department of Health (ODH). This was one of those imperfect storms in which the request for records arrived after hours and was not seen by the Health Information Management (HIM) department in a timely fashion, and the rotating resident was not aware that the discharge summary was their responsibility. There was a critical inconsistency in the r ..read more

Inflation and pressing household expenses are forcing some people to postpone health needs, an emerging trend that has health experts worried that conditions may only worsen. Megan Swanson has warily watched the erosion of her family’s savings as inflation chips away at a reserve for emergencies. She often postpones any regular doctor’s appointments, including her yearly dermatology appointment, even though annual skin checks are typically recommended for residents of sunny Florida, where she lives in Naples with her husband and their three children. “Each month we are seeing our costs go up ..read more

A new report analyses the state of outsourced medical billing and uncovers areas of opportunity. KEY TAKEAWAYS Sixty five percent of respondents say they have a positive outlook on the industry, while 9% have a negative outlook. Automation is key for billing companies to grow and attract providers, who want to outsource billing to save on costs and improve efficiency. Nearly two-thirds (65%) of medical billing companies have a positive outlook on the outsourced billing industry, according to a report. In its 2023 State of the U.S. Medical Billing Industry Report, 277 medical billing compani ..read more

KEY TAKEAWAYS Denials rose to 11% of all claims last year, up nearly 8% from 2021. Revenue cycle leaders should place their focus on clinical validation denials to help ease the overall denials burden. A key defensive strategy for preventing denials is provider education. Revenue cycle leaders need to understand that clinical validation denials are also happening outside of the claims process and after payment. Denials management has become a major area of concentration for revenue cycle leaders. In fact, denials rose to 11% of all claims last year, up nearly 8% from 2021. That 11% rate tran ..read more

Medical claims denials are on the rise and continue to be a costly problem for health systems. Unfortunately, the vast majority of providers focus their resources on reactive responses, working to appeal denials and recover payments after denials have already occurred. In a Becker’s Healthcare podcast an expert, discussed the problem of rising denials, why a proactive approach based on data is more effective and best practices for writing appeal letters. Four key takeaways were: Claims denials are a significant and growing problem for health systems. Eighty nine percent of health systems saw ..read more

While these activities oftentimes become challenging, they should help in facilitating reimbursement. This month, we’ll dive into the next steps needed for medical practices to take after being credentialed to maximize the chances of receiving reimbursement. The next critical steps after getting credentialed are (1) to conduct eligibility checks for patient visits and (2) get preauthorization for procedures. Why These Steps Are Important One scenario where an eligibility check becomes useful is when a patient has an inactive or termed insurance. An eligibly check would help the front desk to ..read more

The medical billing process is a complex system that requires various steps to ensure accuracy and efficiency. Medical billing services work hard to make sure that medical bills are processed quickly and accurately, allowing for timely payments from insurance companies. Patient Registration The medical billing process begins with patient registration, where the patient’s demographic information like name, age, address, contact information, and medical insurance information is collected. This helps medical billing services to have quick access to patient records and simplify the medical billin ..read more