One year ago, the United States marked a turning point for health care cost transparency with a new law aimed at helping Americans avoid unnecessary, unexpected medical debt. As of Jan. 1, 2022, health care providers and insurers are no longer allowed to sideswipe privately insured people with bills for out-of-network services. Experts say the bipartisan No Surprises Act was a rare victory for patients and the public against exploitative health care costs, but that challenges remain. In 2019, Republicans and Democrats in Congress worked together to craft legislation that ultimately became the No Surprises Act. The  law protects people  in group and individual health insurance plans from receiving unexpected bills from out-of-network providers who cared for them at in-network facilities – a system already in place for Medicaid and Medicare patients. An independent dispute resolution process now allows insurance companies and providers to figure out coverage and costs aft...

  New legislation, as well as changes in patient expectations, present a host of challenges and opportunities for getting paid for service this year. In a recent article in  Physician’s Practice , we discussed the challenges surrounding  getting paid for telehealth this year and beyond . This is an essential issue for independent practices, but it’s not the only one. New legislation, as well as changes in patient expectations, present a host of challenges and opportunities for getting paid for service this year. E/M Office and Outpatient Guidelines Changes For the first time in more than two decades, the AMA has revised the guidelines for office and outpatient visit evaluation and management (E/M) codes. It’s been a long time coming—effective this year, CMS has aligned E/M coding with the changes adopted by the AMA. For many providers, this means an increase in their revenue because they will finally be compensated for time spent in activities related to patient care that...

  Offering financial education helps patients understand what they owe, why, and when. Physicians can get paid by educating their patients about their medical bills and making it easy for patients to pay them. Some patients avoid going to their physicians at least partly out of fear of huge medical bills – or just not knowing how medical bills work. One poll found 50% of Americans avoid medical care due to cost, said Taya Gordon, MBA, CMPE, CMOM, and chief revenue cycle officer at H4 Technology LLC, a health care support company. When that happens, underlying health problems can grow worse, leading to emergency department visits that add to costs, said Gordon. She presented “Reduce Revenue Cycle Pain Points by Improving the Patient Financial Experience,” during the 2022 Medical Practice Excellence Leaders Conference of the Medical Group Management Association, and is coauthor of the association’s publication “Revenue Cycle Management: Don’t Get Lost in the Financial Maze.” Gordon c...

  It’s important to set realistic expectations about the billing process, which isn’t easy to integrate into regular workflows. Billing is one of the most critical parts of running a behavioral health practice. This is especially true for large practices, as maximizing efficiency at scale significantly affects their revenue cycle. It’s important to set realistic expectations about the mental health billing process, which isn’t easy to integrate into regular workflows. To take on practice billing, clinicians must devote time to learning and accommodating new processes. This includes creating clean claims and monitoring them after submission, correcting and resubmitting rejected claims, negotiating denials, collecting payments from patients, and reconciling bank statements. If any of these steps are skipped, clinicians risk losing some of the reimbursement that is due. Expecting too much too quickly can lead to disappointment and possibly burnout, neither of which are conducive to co...

  A new survey indicates that many physicians still plan to retire early after the COVID-19 pandemic despite growing economic concerns. By  Jacqueline LaPointe March 22, 2023  - Healthcare organizations need to prepare for a wave of physician retirements, according to a new  survey  from the physician, physician leader, and advanced practice provider recruitment firm Jackson Physician Search. The firm polled nearly 400 physicians and 60 healthcare administrators to understand their views on physician retirement and readiness. The survey showed that 62 percent of physicians have not changed their retirement plans because of the economy, including recent inflation, stock market volatility, and recession fears. Additionally, of the physicians delaying retirement because of the economy, most plan (27 percent) to postpone retirement by one to four years. COVID-19  is also still a factor when it comes to physician retirement. In a 2021 survey, more than half...