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GroupOne Health Source Blog

GroupOne Revenue Cycle Blog 

Insights to guide your practice.

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Verifying Patient Coverage in a Health Insurance Marketplace Plan

by Kaitlyn Houseman on December 31, 2013

The New Year and the new Health Insurance Marketplace, also known as Health Insurance Exchange, is here.  Over a million people will have a new insurance plan and in many cases their first insurance plan in years.  Some may have signed up a few months ago while others just a few days.  While some patients visiting your office will be aware of the need to carry their card with them, some won't and others may have not even received their card in the mail yet.  It is likely that your office will need to verify their coverage.

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Topics: Practice Management, Revenue Cycle Management, Affordable Care Act, Patient Engagement

24% Cut in Medicare Payments Averted For 3 Months

by Kaitlyn Houseman on December 27, 2013

CMS has released the following statement now that President Obama has signed into law the legislation necessary to prevent the SGR related cut from taking place on January 1, 2014.  According to this announcement, additional revisions may be made in the conversion factor.  It is not clear when those revisions will be announced but once they are we will be posting the updates to our website. 

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Topics: CMS, Revenue Cycle Management

[Infographic] Important Healthcare Deadlines to Remember

by Kaitlyn Houseman on December 19, 2013

Healthcare Deadlines Over the Next Few Years

Still trying to figure out the who, what, when and where of the upcoming healthcare deadlines? It can be hard to stay up-to-date with all of the changes with policies and payments. Check out the following timeline to plan for the changes over the next couple of years.

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Topics: EHR, CMS, ICD-10, Practice Management, Revenue Cycle Management, Affordable Care Act, Incentive Programs

2014 Medicare Physician Fee Schedule Final Rule Impact

by Keith Lage on December 4, 2013

Last Wednesday, while most of us were stuffing the turkey and preparing for a long weekend, the Centers for Medicare and Medicaid Services (CMS) finalized payment rates and policies for 2014 in the Physician Fee Schedule (PFS) Final Rule.  Care management outside of the routine office visit and policies to promote high quality care and efficiency in Medicare were a major focus in the proposal.  The final rule sets payment rates for physicians and non-physician practitioners paid under the Medicare Physician Fee Schedule for 2014 and addresses the policies included in the proposed rule issued in July. CMS projects that total payments under the fee schedule in 2014 will be approximately $87 billion.

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Topics: Revenue Cycle Management, CMS

CMS Phase 2 Denial Edits Will Begin January 6, 2014

by Kaitlyn Houseman on November 14, 2013

Several years ago, CMS mandated that payment for referral services would only be paid if the referring provider were properly enrolled in Medicare.  Due to industry pressure, the effective date for this policy was continually delayed to allow providers sufficient time to meet the enrollment criteria.  According to the following announcement, CMS intends to instruct their Contractors to turn on the ordering and referring edits on January 6, 2014.  

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Topics: Medical Business, Coding, Denial Management, Practice Management, Revenue Cycle Management, CMS

4 Major Risks with ICD-10

by Kaitlyn Houseman on November 13, 2013

According to CMS, 1 in 5 physician practices will see their Medicare denials double for up to 6 months after October 1, 2014, the deadline for ICD-10. Your practice does not have to be one of them. Get started early with planning for ICD-10.

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Topics: ICD-10, Medical Business, Coding, Practice Management, Revenue Cycle Management, CMS

The 5 Common Mistakes Made When Starting a Medical Practice

by Kaitlyn Houseman on November 8, 2013

1. Assuming it will be easy

You are excellent with medicine, and maybe a few other things. But no one can be good at everything.  Starting a medical practice entails much more than just seeing patients. Yes, there is a business side to starting a practice which is ultimately your business. There thousands of variables you haven’t even considered yet so do not be afraid to ask for help. 

Bringing in a practice start-up expert can save you time, money, and a few headaches.  Having the correct staff on board for your start-up can help you avoid some commin pitfalls that new practices can encounter so you have the best chance of building your new practice into a profitable, and long term solution for your specific situation.

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Topics: Revenue Cycle Management, Medical Business, Practice Management, Coding

Are You Preventing Denials?

by Kaitlyn Houseman on November 7, 2013

Increased demand for healthcare services as a result of an aging U.S. population should make for a successful and profitable medical practice.  However, improving a practice’s cash flow has become anything but easy in today’s changing reimbursement environment. 

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Topics: Revenue Cycle Management, Denial Management

EHR Incentive Programs: Important Payment Adjustment Information

by Kaitlyn Houseman on November 1, 2013

Medicare EPs participating in the EHR Incentive Program may be subject to payment adjustments beginning on January 1, 2015. 

CMS will determine the payment adjustment based on meaningful use data submitted prior to the 2015 calendar year. EPs must demonstrate meaningful use prior to 2015 to avoid payment adjustments. Determine how your EHR Incentive Program participation start year will affect the 2015 payment adjustments:

If you began in 2011 or 2012
If you first demonstrated meaningful use in 2011 or 2012, you must demonstrate meaningful use for a full year in 2013 to avoid the payment adjustment in 2015. 

If you began in 2013
If you first demonstrate meaningful use in 2013, you must demonstrate meaningful use for a 90-day reporting period in 2013 to avoid the payment adjustment in 2015. 

If you plan to begin in 2014
If you first demonstrate meaningful use in 2014, you must demonstrate meaningful use for a 90-day reporting period in 2014 to avoid the payment adjustment in 2015. This reporting period must occur in the first 9 months of calendar year 2014, and EPs must attest to meaningful use no later than October 1, 2014, to avoid the payment adjustment. 

Avoiding Payment Adjustments in the Future
You must continue to demonstrate meaningful use every year to avoid payment adjustments in subsequent years.

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Topics: CMS, Affordable Care Act, Revenue Cycle Management, Incentive Programs

Anderson Reveals “Scary” Truth About ICD-10 Test Results

by Kaitlyn Houseman on October 16, 2013

The North Carolina Healthcare Information and Communications Alliance executive director Holt Anderson revealed a ‘scary’ finding after some end-to-end ICD-10 testing.  Anderson made the announcement of their findings during the MGMA 2013 annual conference last week.

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Topics: ICD-10, Medical Business, Revenue Cycle Management, Coding, Practice Management

Effect of Government Shutdown on Medicare

by Kaitlyn Houseman on October 1, 2013

The federal Fiscal Year runs from October 1 through September 30th.  This means that Fiscal Year 2014 begins today on Tuesday, October 1.  In order for the government to operate, the Congress must pass and the President must sign appropriations bills that release the money necessary to fund the operation of the federal government. 

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Topics: CMS, Medical Business, Practice Management, Revenue Cycle Management

Is Your EHR Your Certified Professional Coder (CPC)?

by Kaitlyn Houseman on September 26, 2013

The key to successful Electronic Health Record (EHR) adoption is not only selecting the right system, but ensuring you have the right people involved in the process. Many EHR’s pledge the reduction of coding staff because the EHR will allow you to swiftly document, accurately code your progress notes, and auto generate your coding. Sounds easy enough, right? What you might want to consider when listening to the sales demonstration is who is giving the demonstration. As a software vendor, do they have the experience of medical coders and reimbursement staff that have lived the tricks of the trade? Do they understand that sometimes submitting a clean claim requires more than automated claim creation and filing?

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Topics: EHR, Medical Business, Coding, Practice Management, Revenue Cycle Management

EHR Satisfaction and Profitability Study Results

by Kaitlyn Houseman on September 21, 2013

EHRs with Integrated Billing Solutions Key to EHR Satisfaction and Improved Practice Profitability Reveals Black Book RCM study

In this segmented survey of healthcare financial leaders, over 8,000 respective CFOs, CIOs, administrators and support staff of US hospitals and physician practices contributed their perceptions to Black Book™ between April 2013 and August 2013.

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Topics: EHR, Practice Management, Revenue Cycle Management, Incentive Programs

Now Available: New EHR Interactive Timeline

by Kaitlyn Houseman on September 17, 2013

Plan Ahead: Review Upcoming eHealth Milestones Using New eHealth Interactive Timeline

CMS posted a new interactive timeline that highlights key 2013 and 2014 milestones for its eHealth programs. The timeline helps you identify key program dates and corresponding required actions, as well as resources to help you complete each milestone.

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Topics: CMS, PQRS, Revenue Cycle Management, Incentive Programs

How to Evaluate Revenue Cycle Management Companies

by Arun Murali on September 3, 2013

Are you thinking about outsourcing your revenue cycle management (RCM) services to a third party vendor? Welcome to the party!  Increasing pressures on physician groups to lower operating costs is forcing them to look at outsourcing options.  Well, outsourcing is nothing new and companies on-shore and off are saturating the market with thousands of options - one of which could be right for you.  

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Topics: Revenue Cycle Management

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