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GroupOne Health Source Practice Management Blog

      

The GroupOne Health Source Blog

 Answers and Insights Every Healthcare Professional Needs.

 

Most Commonly Unexpected Denied Procedures

by Kaitlyn Houseman on December 23, 2015

Claim denials are an unpleasant fact of life, and too many of them can dramatically impact your practice's cash flow. Not only do coders have to cope with murky and complicated rules for coding and documentation but at the same time they have the threat of an audit hanging over them, and it's not easy.
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Topics: Revenue Cycle Management, Coding, Denial Management

Improving Your Revenue Cycle Management in 2016

by Kaitlyn Houseman on December 22, 2015

A new year on the calendar offers something of the "look and feel" of a clean slate, but any medical practice manager will tell you that things aren't going to get simpler or easier in 2016. The entire revenue cycle management process is undergoing a period of rapid change due to the Affordable Care Act, the rise of value-based reimbursement, and the proliferation of high-deductible healthcare plans.
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Topics: Revenue Cycle Management, Practice Management

10 Quick Tips for Successful Provider Credentialing

by Kaitlyn Houseman on December 16, 2015

Whether you are adding a new doctor or opening your own practice, you need to start the credentialing process in advance to avoid potential problems. If you ignore the significance of the credentialing process you will experience delayed cash flow, difficult scheduling because of patient restrictions, and repeated phone calls to and from payers.

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Topics: Revenue Cycle Management, Credentialing

Increasing Patient Pay: 5 Questions You Must Ask

by Kaitlyn Houseman on December 14, 2015

Medical billing can be the "elephant in the room" when it comes to dealing with patients. Tricky as it can be, however, it's important to maintain lines of communication with patients, particularly since more patients are paying a larger portion of their medical bills despite more people having insurance.

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Topics: Revenue Cycle Management, Patient Engagement, Self-Pay

3 Ways to Avoid Patient Complaints About Medical Bills

by Kaitlyn Houseman on December 12, 2015

Has your practice seen an increase in patient phone calls surrounding billing complaints? Mistakes on medical bills are not uncommon. In fact, over 80% of medical bills contain errors, whether from erroneous charges, double billings or, in some cases, abusive charging practices. Your practice can avoid these mistakes by following a few simple guidelines.

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Topics: Revenue Cycle Management, Patient Engagement

Why Your ICD-10 Transition Might Not Be Long Term Success

by Keith Lage on December 9, 2015

Many health organizations have checked ICD-10 off as a complete success since its go-live date of October 1st brought little disruption to practice productivity and cash flow. But is it too early to declare with certainty that the ICD-10 transition was indeed successful?
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Topics: Revenue Cycle Management, ICD-10

How to Revamp Your Revenue Cycle Without Destroying Your Practice

by Kaitlyn Houseman on December 8, 2015

Do you know how your revenue cycle is performing? If I asked you today to run some reports that measure the effectiveness of your revenue cycle, could you do it? A surprising number of doctors and practice managers have trouble answering those questions. Often, practices tick along as usual until a noticeable change in cash flow occurs, and then the staff scrambles to discover the source of the problem.
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Topics: Revenue Cycle Management, Practice Management

5 Surprising Ways Physicians Can Prevent Revenue Loss

by Nicole Laucks on December 3, 2015

Decreasing reimbursement and rising costs aren’t the only factors causing financial problems for medical practices. In most practices, inefficiency can cause significant amount of revenue loss. You might even be surprised at the subtle ways revenue could be leaking from your practice. 

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Topics: Revenue Cycle Management, Practice Management

Have 15 Minutes? Run These 5 Reports to Assess Your Revenue Cycle

by Adrienne Schrimpf on December 1, 2015

Are you (or your practice manager) regularly measuring key performance indicators (KPIs) that indicate the health of your revenue cycle management? If not, you should be. When you select and measure KPIs and monitor those measurements for trends, you can more easily see where improvements are necessary and will be of most benefit.

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Topics: Revenue Cycle Management

Preventing Revenue Cycle Disruptions When Acquiring a Practice

by Kaitlyn Houseman on November 24, 2015


In recent years, hospital systems have been buying up physician practices, expanding their networks and preparing for managed health approaches to reimbursement. With meeting cost and outcome goals as the long term objective, hospitals are coping now with the inevitable shocks to the revenue cycle that result from these acquisitions.

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Topics: Revenue Cycle Management, Medical Business, Practice Management

Why Finding a Qualified Medical Coder is Difficult

by Kaitlyn Houseman on November 22, 2015

Whether in a hospital, a physician practice, or a skilled nursing facility, medical coders are the essential connection between the clinicians who care for patients and the insurance companies that reimburse physicians under patient policies. The job of the medical coder is to inform insurers about patient diagnoses and treatments in a format that allows them to calculate reimbursements for medical services.

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Topics: Revenue Cycle Management, Coding

Top Questions About Healthcare Revenue Cycle Management

by Kaitlyn Houseman on November 18, 2015

As with any business, healthcare providers must deal with the nuts and bolts of getting paid so that the business can continue to function and serve people. But in healthcare, revenue cycle management is complicated by a number of factors, including strict regulations, an ever-evolving payer mix, and consumers who are dealing with shouldering more of the cost of their care themselves.

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Topics: Revenue Cycle Management

The Importance of Preauthorization

by Kaitlyn Houseman on November 16, 2015

In the medical billing world, preauthorization, prior authorization, precertification, and notification are terms that may be used interchangeably to mean that for certain situations and procedures, providers have to contact insurers in advance and obtain a certification number in order to be reimbursed properly (or at all) for services. Insurance verification and insurance authorization services play a vital role in revenue cycle management. In fact, most claim denials happen when a patient is ineligible for services billed by the provider.

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Topics: Revenue Cycle Management

15 Things to Know About the 2016 Medicare Physician Fee Schedule

by Kaitlyn Houseman on November 12, 2015

On Friday, the Obama administration issued its final rule for the 2016 Medicare Physician Fee Schedule that includes several health IT provisions.  The fee schedule – the first since repeal of the Sustainable Growth Rate (SGR) formula and enactment of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) – includes changes to payment policies, modifications to misvalued codes, and updates to quality performance metrics under the PQRS, the Medicare Shared Savings Program, and Physician Compare, among others. (Internal Medicine News, 10/31)
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Topics: Revenue Cycle Management, Medical Business, CMS, PQRS

Bipartisan Budget Act of 2015 Signed Into Law

by Keith Lage on November 10, 2015

On Monday, November 2, President Obama signed into law the Bipartisan Budget Act of 2015. Among its provisions, the two-year budget deal sets 2016 Medicare Part B premium rates, changes Medicaid rebate policy, repeals the ACA auto-enrollment requirement, and provides for a new Medicare payment policy for new outpatient providers.

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Topics: Revenue Cycle Management, Medical Business, CMS, Incentive Programs

Revenue Cycle Management: Outsourcing on the Increase

by Kaitlyn Houseman on November 8, 2015

Revenue cycle management is not something that most medical professionals understand, but it is a concept that is very near and dear to the bottom line of each medical practice. These days, medical practice management is being split up into two segments: managing the daily operations of the office and managing the way the practice does business. These are two separate functions and they both require full-time attention, which is why RCM outsourcing is on the rise.

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Topics: Revenue Cycle Management

Can Billing Software Help Minimize Denials?

by Keith Lage on November 6, 2015

Medical providers make most of their revenue by successfully processing claims, and claims mistakes affect the bottom line. Fortunately, many claims are preventable and recoverable. Successfully preventing billing mistakes and appealing a denied or rejected claim often has to do with the quality of the medical billing software a practice uses. 

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Topics: Revenue Cycle Management, Denial Management

5 Spooky ICD-10 Codes as Costumes

by Kaitlyn Houseman on October 30, 2015

With Halloween just around the corner, you surely have seen the various blog posts with Halloween ICD-10 codes. Since ICD-10 go live was this year, we decided to take it to another level. We thought we'd pair a few spooky codes with a costume. On the off chance you still haven't decided what you'll dress up as this year, feel free to snatch up one from this list of the top 5 ICD-10 codes with costumes.

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Topics: Revenue Cycle Management, ICD-10

4 Major Insurance Payers Share Policies on Reimbursing ICD-10 Claims

by Kaitlyn Houseman on October 19, 2015

While the Centers for Medicare and Medicaid Services announced a year's grace period this summer when it comes to claims coded with ICD-10, not all large commercial payers are following suit.

According to the CMS announcement, during the 12 months immediately following the October 1, 2015, date, “Medicare review contractors will not deny physician or other practitioner claims billed under the Part B physician fee schedule through either automated medical review or complex medical record review based solely on the specificity of the ICD-10 diagnosis code as long as the physician/practitioner used a valid code from the right family.”

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Topics: Revenue Cycle Management, ICD-10

Payment Disputes: What Are Your Next Steps?

by Keith Lage on October 10, 2015

Payment disputes are a fact of life for most medical practices. With the increasing number of high deductible health plans, Americans are struggling over medical debt and putting more of their take-home pay into medical costs than ever. A survey by NerdWallet found out that Americans pay three times more for third party collection of medical debt than for credit card and bank debt combined. In 2014, around 20% of American adults were contacted by debt collection agencies because of medical bills.

Even when Americans expect sizable medical bills, they're often surprised by just how sizable they are. The NerdWallet survey found that 63% of Americans say they've received medical bills that were higher than they expected. From 2010 to 2013, American median household income fell by $2,300, yet healthcare expenses during that time increased by $1,814, and out-of-pocket healthcare spending is expected to experience annual growth of double the GDP growth for the next several years. It's no wonder billing disputes between medical practices and patients are so common. Here's what you can do to prevent and cope successfully with billing disputes.

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Topics: Revenue Cycle Management