Survey reveals 5 opportunities to tackle denial prevention and management

  Organizations that devote greater resources to denial prevention see lower first-pass denial rates, a recent survey shows, but most steer more staff toward back-end denial management. When it comes to denial management, 31% of healthcare finance professionals say their organizations are most focused on denial prevention — but that’s not where they’re putting the majority of revenue cycle resources, according to a recent HFMA survey. The survey, sponsored by Waystar, a leading healthcare payments technology company, indicates nearly half of organizations (49.5%) allocate most of their denial-related resources toward back-end revenue cycle tasks like managing denials and submitting appeals. Just 17.3% devote more resources to front-end tasks focused on denial prevention. The difference between perception and resource-backed reality came as a surprise to revenue cycle experts, especially when compared with the decisions organizations are making around revenue cycle technology investment

Medical Billing Companies Spill About Outsourcing Operations

  A recent survey of medical billing companies shows a positive outlook on revenue cycle outsourcing, with many seeing payment collection as an opportunity. By  Jacqueline LaPointe February 22, 2023  - Nearly two-thirds of medical billing companies have a rising positive outlook about the current state of the revenue cycle outsourcing industry, according to a recent  survey  from Tebra. The practice growth technology company recently surveyed 277 medical billing company owners, leaders, and team members serving independent practices and clinics in the US. The majority of respondents belonged to companies that serve less than ten practices and clinics. Medical billers are optimistic about the future of the industry despite increased competition, healthcare consolidation, and other unfavorable macro forces. About 43 percent—up from 27 percent in 2018—reported outsourcing of medical billing as a significant opportunity to leverage technology to optimize services, reduce repetitive tasks,


  There’s No Such Thing as a Casual Interaction With Your Doctor Anymore Many calls and messages now count as a “visit” that you could be charged for. By  Zoya Qureshi The pandemic initiated a slew of transformations, and though many have not stuck, one indisputably has: Telehealth is booming in America. This golden age of electronic engagement has one massive benefit—doctors are more accessible than ever. Unfortunately, this virtue is also proving to be telehealth’s biggest problem. For patients, being able to reach their doctors by video visit, phone call, or email is incredibly convenient, but physicians have been overwhelmed by the constant communication. This cost is now being shifted back to the patients, and almost every interaction with a doctor, no matter how casual, counts as some form of “visit” now.

How this law reshaped medical billing, and what challenges remain for patients

  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 after a patient h

Getting Paid Today: Challenges and opportunities for independent practices

  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 were previous

MGMA 2022: Collect more revenue by making it easier for patients to pay

  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 chall

Achieving best-in-class billing for behavioral health practices

  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 compet