The healthcare insurance industry is in somewhat of a flux at the moment, which can cause problems for any practices that aren’t paying careful attention to what’s going on. For example, patients are being held more responsible for health insurance costs than insurance payers, which is evidenced by the rising co-payments and deductibles. This can be a problem for medical practices due to the fact that patients tend to pay much slower than insurance payers, which means that if they aren’t careful, their cash flow could decrease.   Preventing Cash Flow Problems Because patients are being forced to pay higher costs, it means that more of your cash flow is dependent on your patients than on insurance companies. According to the National Center for Health Statistics, 25% of families have an unpaid healthcare bill, 10% of families have medical bills they can’t pay at all and 20% are on a payment plan to pay off their bills over time. As you can imagine, this could affect your cash flo...

Consistent cash flow is essential to the health of any business. This holds true for medical practices, as well. Maintaining an adequate level of revenue while minimizing the number of claim denials can be a struggle. Unfortunately, claim disputes have a number of associated costs beyond the denied payment. Estimates show that the average medical practice could loose between $30,000 and $80,000 yearly in denied claims and the staffing expense associated with resolving them. Appealing denied claims can be a huge time drain on your staff. In some cases, the process is purposefully designed to discourage the provider. It is for this reason that some 50 to 65 percent of denied claims are never disputed. Bottom line and staffing costs can be exacerbated by deteriorating patient relations. When a patient is receiving bills months after service, they are likely to believe the medical practice is mishandling the billing. Ignore the issue and the same denials are likely to repeat. Staff trainin...

Patients today expect more from their physician experience than ever before. Communication and transparency are of utmost importance to many patients, but the more fundamental aspects of the relationship should not be ignored. Patients visit physicians in varying states of vulnerability. They are looking for someone to trust, especially when sharing personal details about their health, family and history. For physicians this means balancing the ever increasing demands of their work with the ability to form meaningful bonds with their patients. A strong physician/patient relationship makes for a positive patient experience and is essential to providing quality care. The more you can make patients feel at home, the more likely you are to earn their loyalty and referrals. There are a number of ways that medical practices can make patients feel welcome, trusting and nurtured.  Relationship Skills Positive, personal engagement with patients – by physicians as well as staff – is fundame...

Regulations that would require providers to also give good-faith estimates to health plans won’t take effect in 2022 as previously scheduled. A newly issued federal rule on surprise billing includes regulations designed to improve price transparency for self-pay patients starting in 2022. The interim final rule with comment period (IFC) requires providers to ask about a patient’s coverage status at the time a service is scheduled. If the patient does not have insurance, “a good-faith estimate” of expected charges for items and services must be provided — generally within three business days. The requirement also applies if the patient has insurance but does not intend to submit a claim. The rule states that the estimate must include “any items or services that are reasonably expected to be provided in conjunction with scheduled or requested items or services and such items or services reasonably expected to be so provided by another healthcare provider or healthcare facility” along wi...

Healthcare industry groups representing providers are upset with the latest surprise billing regulation detailing the independent dispute resolution process. The American Medical Association (AMA) is calling the latest in a series of surprise billing regulations “an undeserved gift to the insurance industry that will reduce [healthcare] options for patients.” The statement comes as the Biden-Harris Administration seeks to button up implementation of the No Surprises Act by the end of the year. The Act prohibits surprise medical billing in most situations by making it illegal for providers to bills patients more than the in-network cost-sharing amount for care. The latest regulation seeking to implement the ban on surprise billing detailed the independent despite resolution (IDR) process by which payers and providers will settle reimbursement rates for out-of-network care that would have resulted in a surprise bill for patients. The regulation released late last week included details,...

To prepare for potential FDA authorization, AMA has released new CPT codes for pediatric doses of the Pfizer COVID-19 vaccine. he American Medical Association (AMA) has issued new Current Procedural Terminology (CPT) codes for pediatric doses of the Pfizer COVID-19 vaccine. In September 2021, Pfizer and BioNTech shared the results of a Phase 2/3 clinical trial in which two doses of the vaccine elicited a strong immune response in children ages 5 to 11. Following the trial, the companies submitted the data to the Food and Drug Administration (FDA). Pfizer recently announced that they have submitted a formal request to the FDA for emergency use authorization of their COVID-19 vaccine in children ages 5 to 11. In August 2021, the FDA granted full approval of the Pfizer-BioNTech vaccine for individuals 16 and older. The AMA updated the COVID-19 vaccine CPT codes to ensure preparedness if the FDA approves Pfizer’s two-dose pediatric vaccine. The early publication may help healthcare pr...

Why the revenue cycle is vital to exceeding patient expectations and driving financial performance July 2, 2021 Joe Polaris, MBA As physician practices look for ways to build volume and engagement, it’s critical to thoughtfully consider it all from the point of view of patients and consumers. With the COVID-19 vaccine becoming more widely adopted, the US is slowly starting to emerge from the pandemic. While some things, like in-person gatherings, are starting to go back to pre-pandemic normal, there is still a long way to go when it comes to financial recovery. This may seem especially daunting for physician practices, with gross revenue losses estimated at $67,774 per physician in 2020 . Call Today: 614.706.5206