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GroupOne Health Source Blog

GroupOne Revenue Cycle Blog 

Insights to guide your practice.

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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, PQRS, CMS

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

Lost in Translation: Reducing Errors in Medical Transcription

by Kaitlyn Houseman on October 6, 2015

The process of medical transcription is how the files representing patient histories, diagnoses and treatments are built. To perhaps oversimplify, healthcare practitioners dictate the particulars of their interaction with patients and medical transcriptionists may transcribe the oral dictation or edit reports that are generated by speech recognition software.

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Topics: Revenue Cycle Management, Practice Management

Collecting from Patients in a Difficult Economy

by Kaitlyn Houseman on October 2, 2015

Despite the fact that more Americans have health insurance, many still struggle to pay their medical bills due to the increasing number of high deductible health plans.  Collecting from self-pay patients can be also be costly for a medical practice since it typically takes more time and hassle. 

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

Protecting Against Credit Card Fraud at Your Practice

by Kathy Kuhn on October 1, 2015

One way healthcare providers increase medical billing collections is by allowing multiple payment options, including credit cards. But it's important that medical billing professionals understand credit card fraud and know how to prevent it. Credit card fraud costs credit card issuers millions of dollars each year, because consumers generally aren't responsible for fraudulent use of their cards.

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Topics: Practice Management, Self-Pay, Revenue Cycle Management

Post ICD-10: What to Expect After October 1st

by Keith Lage on September 30, 2015

Tomorrow ICD-10 will replace the current classification system, ICD-9. Whether you're ready or not, ICD-9 codes will no longer be accepted on claims. Claims with ICD-9 codes after October 1 will be denied without payment. While surveys indicating readiness for the ICD-10 transition vary, one thing is for sure: ICD-10 will dramatically impact medical billing and cash flow. 

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Topics: ICD-10, Coding, Revenue Cycle Management

Be Wary of the ICD-10 Grace Period

by Kaitlyn Houseman on September 28, 2015

With ICD-10 just 3 days away, healthcare providers and practices should be gearing up for the biggest change in healthcare to occur in decades. However, there seems to be a lot of debate and confusion surrounding the CMS announcement of a “grace period” with ICD-10. If you haven’t yet heard of the “grace period” it is intended to alleviate some of the concern surrounding the additional time physicians will need to spend on documenting with the new ICD-10 code set.

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Topics: Revenue Cycle Management, ICD-10, Coding

What Will ICD-10 Do To Your Cash Flow?

by Kaitlyn Houseman on September 26, 2015

The change from the ICD-9 coding standard to ICD-10 will affect healthcare provider cash flow from several different angles. In fact, you could do everything "right" in the lead-up to ICD-10 and still face problems with revenue cycle management. But knowing where and how ICD-10 will make an impact can help you prepare and do your best to minimize problems.

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Topics: Revenue Cycle Management, ICD-10

Will ICD-10 Cause the Extinction of Paper Superbills?

by Kaitlyn Houseman on August 26, 2015

Paper superbills have been as much a part of many medical practices as stethoscopes and blood pressure cuffs over the past few decades. And despite increasing prevalence of electronic health records (EHRs), more than half of physician practices today still use paper superbills. That's because they're flexible and powerful and do their job well.

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Topics: Revenue Cycle Management, ICD-10

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